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1

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

PubMed

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

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

2011-01-01

2

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

PubMed

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

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

2011-01-01

3

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

PubMed Central

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 by age (± 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test. Results Univariate analysis demonstrated that the CPHP group had significantly greater BMI (29.8 ± 5.4 kg/m2 vs. 27.5 ± 4.9 kg/m2; P < 0.01), a more pronated foot posture (FPI score 2.4 ± 3.3 vs. 1.1 ± 2.3; P < 0.01) and greater ankle dorsiflexion ROM (45.1 ± 7.1° vs. 40.5 ± 6.6°; P < 0.01) than the control group. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. Multivariate logistic regression revealed that those with CPHP were more likely to be obese (BMI ? 30 kg/m2) (OR 2.9, 95% CI 1.4 – 6.1, P < 0.01) and to have a pronated foot posture (FPI ? 4) (OR 3.7, 95% CI 1.6 – 8.7, P < 0.01). Conclusion Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress may not play a role in CPHP.

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

2007-01-01

4

Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis.  

PubMed

We describe the design of a new cost-effective, comfortable orthotic designed to treat heel pain associated with plantar fasciitis. The heel pad is fabricated from a 4 degrees Sorbothane medial wedge with a customized insertion of low-density Plastazote. The orthotic is medium-density Plastazote reinforced with cork in the medial longitudinal arch. One pair of orthotics takes less than 1 hour to make. Pilot data were collected retrospectively to evaluate the efficacy of the orthotic for reducing pain. Ten clients at a hand and foot orthotic clinic with a mean age of 71+/-9.1 years and with unilateral or bilateral heel pain associated with plantar fasciitis were provided with customized heel pads and soft, molded orthotics at their initial visit. Pain levels were recorded with verbal and Likert-type scales. After 5 weeks of heel pad and orthotic use, all patients showed a reduction in pain, with the overall reduction being highly significant (Pheel pads and soft molded orthotics are an effective first-line treatment for the heel pain and loss of function associated with plantar fasciitis. PMID:14586928

Seligman, Deborah A; Dawson, Deirdre R

2003-10-01

5

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

Microsoft Academic Search

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

Matthew P Cotchett; Karl B Landorf; Shannon E Munteanu; Anita Raspovic

2011-01-01

6

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

NASA Astrophysics Data System (ADS)

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

Cong, Yan; Lee, Winson; Zhang, Ming

2011-12-01

7

The effects of off-the-shelf in-shoe heel inserts on forefoot plantar pressure.  

PubMed

Off-the-shelf heel inserts are used widely without adequate scientific information regarding their effects upon the forefoot. The aim of this study was to assess whether the use of in-shoe heel inserts affects the plantar pressure distribution under the forefoot. Thirty-five asymptomatic volunteers consented to participate. Six brands of off-the-shelf heel inserts were tested. Subjects walked along a 10 m walkway with no inserts and then with each pair of inserts, in a randomised order. The Pedar system was used to record in-shoe plantar pressure data. The results confirmed that heel inserts increased pressure under the metatarsal heads and altered the biomechanics of the foot even in asymptomatic subjects. The findings suggested that heel inserts should be used with caution especially in people predisposed to foot problems. The classification of these inserts as an over-the-counter product may need to be reviewed. PMID:18434158

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

2008-11-01

8

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

PubMed Central

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

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

2014-01-01

9

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

2010-01-01

10

Percutaneous drilling for chronic heel pain  

Microsoft Academic Search

The authors report a retrospective study involving 25 feet in 21 patients who underwent percutaneous drilling for chronic heel pain. Patients with increased activity of the heel were considered for surgical treatment if there was increased uptake on the delayed bone scans. The average follow-up was 21 months (range, 6 to 30 months). All patients were treated in day surgery

Stefano Santini; Arturo Rebeccato; Roberto Schiavon; Livio Nogarin

2003-01-01

11

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

PubMed

A comparative study of endoscopic plantar fasciotomy versus traditional type heel spur surgery has been performed involving 76 patients and 92 procedures. Sixty-six of those procedures consisted of endoscopic fasciotomy, whereas 26 involved traditional type surgery. Those patients in which the endoscopic fasciotomy was performed had significantly less postoperative pain, returned to regular activities 4 weeks earlier, and had fewer complications postoperatively than those patients involving traditional heel spur surgery. An overview of the surgical technique involving endoscopic fasciotomies is presented, as well as factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity. PMID:8130790

Kinley, S; Frascone, S; Calderone, D; Wertheimer, S J; Squire, M A; Wiseman, F A

1993-01-01

12

Plantar Fasciitis  

MedlinePLUS

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

13

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.

2011-01-01

14

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis  

PubMed Central

Background Planter fasciitis is a common cause of heel pain in adults. Many treatment options exist. Most of patients resolve with conservative management. Approximately 10% of patients develop persistent and often disabling symptoms. Patients and methods This prospective study includes 37 patients with an established diagnosis of chronic plantar fasciitis, aiming to compare two different techniques of treatment. First group includes 17 patients with a mean age of 42 years treated by endoscopic plantar fasciotomy (EPF); the mean follow-up was 11 months. Second group includes 20 patients with a mean age of 45 years treated by extracorporeal shock Wave Therapy (ESWT); the mean follow-up was 7.6 months. Results In the first group (EPF), using the visual analog scale the average post-operative pain was improved from 9.1 to 1.6. Post-operatively, 58.8% had no limitation of functional activities, 35.3% had minimal limitation of activities and 5.9% had moderate limitation of activities. Concerning patient satisfaction, 82.3% of patients were completely satisfied, 11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied. For the second group (ESWT), using the visual analog scale the average post-operative pain was improved from 9 to 2.1. Post-operatively, 50% had no functional limitation of activities, 35% had minimal limitation of activities, 10% had moderate limitation of activities, and 5% had severe limitation of activities. Concerning patient satisfaction, 75% of patients were completely satisfied and 25% were satisfied with reservation or unsatisfied. Conclusion Because of better results with endoscopic release versus the benefits of no complications, no immobilization, and early resumption of full activities with ESWT, we conclude that ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF.

Ragab, Ehab Mohamed

2009-01-01

15

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

PubMed Central

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

Hake, Daniel H.

2000-01-01

16

Plantar fasciitis  

MedlinePLUS

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

17

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

PubMed Central

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

2013-01-01

18

How I Manage Heel Spur Syndrome.  

ERIC Educational Resources Information Center

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

Seder, Joseph I.

1987-01-01

19

Plantar fascia: imaging diagnosis and guided treatment.  

PubMed

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

McNally, Eugene G; Shetty, Shilpa

2010-09-01

20

Heel pain  

MedlinePLUS

Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... awkwardly on the heel Conditions related to heel pain include: Achilles tendinitis, inflammation of the large tendon ...

21

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

Microsoft Academic Search

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

Andrew M McMillan; Karl B Landorf; Mark F Gilheany; Adam R Bird; Adam D Morrow; Hylton B Menz

2010-01-01

22

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

2013-01-01

23

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.

1989-01-01

24

Lung cancer presenting as heel pain: A case report  

PubMed Central

Bone metastasis as the first symptom of lung cancer is common, particularly in the axial skeleton. The calcaneus is an unusual site of metastatic involvement. Chronic plantar heel pain (CPHP) is one of the most common complaints of the foot requiring medical treatment. The most typical symptom of CPHP is pain under the medial heel during weight-bearing, and this symptom is therefore generally initially diagnosed as CPHP by clinicians. The current case study reports a female patient never-smoker with non-small cell lung cancer accompanied by calcaneal metastasis presenting as heel pain. The patient was initially diagnosed with CPHP without any imaging examinations. As there was no relief from the heel pain six months later, a foot X-ray was performed, which revealed a lesion of the calcaneus. The analysis of a biopsy obtained from the lesion resulted in a diagnosis of adenocarcinoma. The present case indicates that patients suspected to have CPHP should be conventionally examined with radiography of the foot during the initial diagnosis. Similarly, if a patient with lung cancer has symptoms such as CPHP, distant metastasis should be accounted for; despite their rarity, clinicians should maintain a high level of suspicion, since accurate diagnosis and timely treatment is important in management and outcome.

DAI, HAO; QIANG, MINFEI; CHEN, YANXI; ZHAI, WEITAO; ZHANG, KUN

2014-01-01

25

Narcissistic rage: The Achilles' heel of the patient with chronic physical illness  

PubMed Central

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

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

2009-01-01

26

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

2010-01-01

27

Changes in the activation and function of the ankle plantar flexor muscles due to gait retraining in chronic stroke survivors  

PubMed Central

Background A common goal of persons post-stroke is to regain community ambulation. The plantar flexor muscles play an important role in propulsion generation and swing initiation as previous musculoskeletal simulations have shown. The purpose of this study was to demonstrate that simulation results quantifying changes in plantar flexor activation and function in individuals post-stroke were consistent with (1) the purpose of an intervention designed to enhance plantar flexor function and (2) expected muscle function during gait based on previous literature. Methods Three-dimensional, forward dynamic simulations were created to determine the changes in model activation and function of the paretic ankle plantar flexor muscles for eight patients post-stroke after a 12-weeks FastFES gait retraining program. Results An median increase of 0.07 (Range [?0.01,0.22]) was seen in simulated activation averaged across all plantar flexors during the double support phase of gait from pre- to post-intervention. A concurrent increase in walking speed and plantar flexor induced forward center of mass acceleration by the plantar flexors was seen post-intervention for seven of the eight subject simulations. Additionally, post-training, the plantar flexors had an simulated increase in contribution to knee flexion acceleration during double support. Conclusions For the first time, muscle-actuated musculoskeletal models were used to simulate the effect of a gait retraining intervention on post-stroke muscle model predicted activation and function. The simulations showed a new pattern of simulated activation for the plantar flexor muscles after training, suggesting that the subjects activated these muscles with more appropriate timing following the intervention. Functionally, simulations calculated that the plantar flexors provided greater contribution to knee flexion acceleration after training, which is important for increasing swing phase knee flexion and foot clearance.

2013-01-01

28

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.

2010-01-01

29

Imaging the shear modulus of the heel fat pads  

Microsoft Academic Search

Background. Steady state, dynamicMR elastography provides quantitative images of the shear modulus of tissues in vivo. MR elastography was evaluated for its ability to characterize the mechanical properties of the weight bearing plantar soft tissues in vivo. Methods. MR elastography was used to image the heel fat pad and surrounding soft tissues when the subject applied a low pres- sure

John B. Weaver; Marvin Doyley; Yvonne Cheung; Francis Kennedy; Ernest L. Madsen; Elijah E. W. Van Houten; Keith Paulsen

2005-01-01

30

Heel pain and HIV-associated lipodystrophy: a report of two cases  

PubMed Central

Plantar fasciitis is diagnosed based on a pathognomonic clinical presentation and physical examination including plantar heel pain with the initial few steps after a period of inactivity. People living with HIV/AIDS, who are taking anti-retroviral medications, often have an associated redistribution of body fat (lipodystrophy). Lipoatrophy of the extremities may involve the heel fat-pad in this population and result in the signs and symptoms of plantar fasciitis. Two cases of plantar heel pain in HIV-associated lipodystrophy are presented to discuss the possible clinical association between the two conditions. Although conservative therapies have limited evidence, they are commonly used and have been seen, clinically, to result in a resolution of symptoms. In the presented cases, the individuals benefited from soft tissue therapy, modalities, activity modification and education on proper footwear. Clinicians should be aware that the association between these two conditions may be a significant cause of morbidity in a population of patients with HIV.

Stupar, Maja; Tibbles, Anthony

2008-01-01

31

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

SciTech Connect

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

Niewald, Marcus, E-mail: marcus.niewald@uks.eu [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany)] [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany); Seegenschmiedt, M. Heinrich [Radiotherapy Center, Hamburg (Germany)] [Radiotherapy Center, Hamburg (Germany); Micke, Oliver [Franziskus Hospital, Bielefeld (Germany)] [Franziskus Hospital, Bielefeld (Germany); Graeber, Stefan [Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar (Germany)] [Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar (Germany); Muecke, Ralf [Lippe Hospital, Lemgo (Germany)] [Lippe Hospital, Lemgo (Germany); Schaefer, Vera; Scheid, Christine; Fleckenstein, Jochen; Licht, Norbert; Ruebe, Christian [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany)] [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany)

2012-11-15

32

Measurement of functional heel pad behaviour in-shoe during gait using orthotic embedded ultrasonography.  

PubMed

The ability to measure the functional behaviour of the plantar heel pad is clinically relevant in dystrophic or pathological heel conditions and may help to inform the design and development of interventions that attempt to restore normal function. In this study we present a novel technique which utilises orthotic heel inserts with an embedded ultrasound (US) transducer to allow the functional, dynamic behaviour of the heel pad to be measured in-shoe during gait. The aim of this study was to demonstrate feasibility of the technique, determine the reproducibility of measurements, and to compare the effects of two orthotic inserts: (i) a flat orthotic heel raise and (ii) a contoured heel cup insert on the behaviour of the heel pad during gait. Dynamic compression of the heel pads of 16 healthy participants was recorded during treadmill walking and combined with plantar pressure measurements to allow stiffness and energy disappation ratio (EDR) to be estimated. Inter-session reliability of the US measurements was found to be excellent (ICC2,1=0.94-0.95), as was inter-rater reliability (ICC2,1=0.89). Use of the heel cup insert significantly reduced the maximum compression of the heel pad (p<0.0001) as well as the overall stiffness of the pad (p<0.001). There was no change in EDR (p=0.949). In-shoe embedded US is a reliable method to establish person-specific functional geometry of plantar soft tissues. Use of a contoured heel cup reduces the compression of the mid portion of the heel pad. PMID:23962596

Telfer, Scott; Woodburn, James; Turner, Deborah E

2014-01-01

33

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

NASA Astrophysics Data System (ADS)

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

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

2012-02-01

34

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

PubMed

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

2009-12-01

35

Partial calcanectomy for the treatment of recalcitrant heel ulcerations.  

PubMed

Pressure ulcers of the heel are a major and growing health-care problem. Although prevention and aggressive local wound care and pressure reduction remain the gold standard for treatment of most heel ulcers, recalcitrant wounds may require surgical intervention. Limb salvage when dealing with heel ulcers remains a challenge. Nine feet (eight patients) that underwent partial calcanectomy for chronic nonhealing heel ulcers were evaluated retrospectively. Complete healing occurred in seven of nine feet. Patients who were ambulatory before surgery remained ambulatory after healing. PMID:16037547

Randall, David B; Phillips, John; Ianiro, Goffredo

2005-01-01

36

Heel Injuries and Disorders  

MedlinePLUS

Heel problems are common and can be painful. Often, they result from too much stress on your heel bone and the tissues that surround it. That stress can ... Being overweight These can lead to tendinitis, bursitis, and fasciitis, which are all types of inflammation of ...

37

Pediatric heel pain.  

PubMed

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

2013-10-01

38

Plantar Wart (Verruca Plantaris)  

MedlinePLUS

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

39

Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?  

PubMed Central

Background Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. Methods Weightbearing lateral foot radiographs of 216 people (140 women and 76 men) aged 62 to 94 years (mean age 75.9, SD 6.6) were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored. Results Of the 216 participants, 119 (55%) had at least one plantar calcaneal spur and 103 (48%) had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5). Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0), report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8) and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4). No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture. Conclusion Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.

Menz, Hylton B; Zammit, Gerard V; Landorf, Karl B; Munteanu, Shannon E

2008-01-01

40

Diagnosis of hyperostosis of the medial calcaneal tubercle similar to a heel spur.  

PubMed

Calcaneal osteochondromas are rare conditions. To our knowledge, we present the first report of a calcaneal osteochondroma in an adolescent patient that was surprisingly similar to a heel spur, and, in addition, symptoms due to compression of the medial plantar nerve were present. PMID:23536504

Altan, Egemen; Senaran, Hakan; Can, Nuray; Aydin, Bahattin Kerem; Erkocak, Omer Faruk

2013-01-01

41

Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality  

PubMed Central

Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

Thapa, Deepak; Ahuja, Vanita

2014-01-01

42

Plantar fascia (image)  

MedlinePLUS

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

43

Plantar fibromatosis: an isolated disease.  

PubMed

Plantar fibromatosis is a relatively uncommon benign disease characterized by bilateral nodular thickening of the plantar fascia similar in appearance to the disease which occurs in the palm of the hand. Descriptions of plantar fibromatosis in the literature were usually included as a part of a syndrome described as ectopic diseases of Dupuytren. Isolated case reports have described Dupuytren-like contractures of the plantar fascia but often suggested a relationship with palmar lesions. We have recently treated four patients with isolated plantar fibromatosis without other stigmata of Dupuytren's disease. These patients were treated by removal of all the involved plantar fascia with a wide margin of normal-appearing fascia. PMID:2911628

Haedicke, G J; Sturim, H S

1989-02-01

44

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.

2011-01-01

45

Heel Pain in the Athlete  

PubMed Central

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

Hunt, Kenneth John; Anderson, Robert B.

2009-01-01

46

Plantar Fascia Ruptures in Athletes  

Microsoft Academic Search

Objective: To educate sports medicine practitioners as to length of time for an athlete to return to activity after sustaining a rupture of the plantar fascia.Methods: Athletic patients sustaining plantar fascia ruptures and subsequent treatment were reviewed. Diagnosis was based on clinical findings, although radiographic studies were done. Patients were treated for 2 to 3 weeks with a below-knee or

Amol Saxena; Brian Fullem

2004-01-01

47

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

PubMed Central

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

Moghtaderi, Alireza; Khosrawi, Saeid; Dehghan, Farnaz

2014-01-01

48

The effects of running cadence manipulation on plantar loading in healthy runners.  

PubMed

Our purpose was to evaluate effects of cadence manipulation on plantar loading during running. Participants (n=38) ran on a treadmill at their preferred speed in 3 conditions: preferred, 5% increased, and 5% decreased while measured using in-shoe sensors. Data (contact time [CT], peak force [PF], force time integral [FTI], pressure time integral [PTI] and peak pressure [PP]) were recorded for 30 right footfalls. Multivariate analysis was performed to detect differences in loading between cadences in the total foot and 4 plantar regions. Differences in plantar loading occurred between cadence conditions. Total foot CT and PF were lower with a faster cadence, but no total foot PP differences were observed. Faster cadence reduced CT, pressure and force variables in both the heel and metatarsal regions. Increasing cadence did not elevate metatarsal loads; rather, total foot and all regions were reduced when healthy runners increased their cadence. If a 5% increase in cadence from preferred were maintained over each mile run the impulse at the heel would be reduced by an estimated 565 body weights*s (BW*s) and the metatarsals 140-170?BW*s per mile run despite the increased steps taken. Increasing cadence may benefit overuse injuries associated with elevated plantar loading. PMID:24595812

Wellenkotter, J; Kernozek, T W; Meardon, S; Suchomel, T

2014-08-01

49

Morphological characteristics of the human skin over posterior aspect of heel in the context of pressure ulcer development.  

PubMed

The posterior aspect of heel is known as a particularly vulnerable site for pressure ulcer development, however, it is not well understood why this is so. This study was undertaken to identify the morphological characteristics of the skin over posterior aspect of heel in the context of pressure ulcer development. Human skin tissues were obtained from four different sites of the body of 4 aged subjects postmortem: posterior aspect of heel, plantar aspect of heel, sacrum and centre of gluteus maximus. The skin samples were processed for the examination using light microscopy and scanning electron microscopy. The posterior aspect of heel was characterized by a thicker epidermis, denser distribution and larger diameter of capillaries in the papillary layer, 3-dimensional architecture of collagen fibre meshwork in the reticular layer and elliptic adipose tissues situated perpendicularly to the skin surface being surrounded by thick collagen and elastic fibre septa compared to the sacrum. Given our observations in the papillary layer of the posterior aspect of heel, we assume that the tissue of this area may be less tolerant to ischaemia since the tissue has high metabolic demand to provide oxygen and nutrients to the epidermis which protects underlying tissue from external force. In addition, elliptic configuration of adipose tissues in the posterior aspect of heel situated perpendicularly to the skin surface may result in deep lesion if the forces applied exceed the tolerable level since the forces will be concentrated within the elliptic compartments. PMID:23561224

Arao, Hiromi; Shimada, Tatsuo; Hagisawa, Satsue; Ferguson-Pell, Martin

2013-05-01

50

Acute effect of heel-drop exercise with varying ranges of motion on the gastrocnemius aponeurosis-tendon's mechanical properties.  

PubMed

The objectives of this study was to investigate the acute effects of various magnitudes of tendon strain on the mechanical properties of the human medial gastrocnemius (MG) in vivo during controlled heel-drop exercises. Seven male and seven female volunteers performed two different exercises executed one month apart: one was a heel-drop exercise on a block (HDB), and the other was a heel-drop exercise on level floor (HDL). In each regimen, the subjects completed a session of 150 heel-drop exercises (15 repetitions×10 sets; with a 30 s rest following each set). Before and immediately after the heel-drop exercise, the ankle plantar flexor torque and elongation of the MG were measured using a combined measurement system of dynamometry and ultrasonography and then the MG tendon strain and stiffness were evaluated in each subject. The tendon stiffness measured prior to the exercises was not significantly different between the two groups 23.7±10.6N/mm and 24.1±10.0N/mm for the HDB and HDL, respectively (p>.05). During the heel-drop exercise, it was found that the tendon strain during the heel-drop exercise on a block (8.4±3.7%) was significantly higher than the strain measured on the level floor (5.4±3.8%) (p<.05). In addition, the tendon stiffness following the heel-drop exercise on a block (32.3±12.2N/mm) was significantly greater than the tendon stiffness measured following the heel-drop exercise on the level floor (25.4±11.4N/mm) (p<.05). The results of this study suggest that tendon stiffness immediately following a heel-drop exercise depends on the magnitude of tendon strain. PMID:24717405

Jeong, Siwoo; Lee, Dae-Yeon; Choi, Dong-Sung; Lee, Hae-Dong

2014-06-01

51

Painful Os Peroneum Syndrome Presenting as Lateral Plantar Foot Pain  

PubMed Central

Lateral plantar foot pain can be caused by various entities, and the painful os peroneum syndrome should be considered in the differential diagnosis. Recent developments in musculoskeletal ultrasonography are very useful for initial diagnosis. We discuss a 69-year-old female who experienced lateral plantar foot pain for over one month. Through physical examination, radiography, ultrasound and magnetic resonance imaging, she was diagnosed with the painful os peroneum syndrome with a chronic fatigue fracture of multipartite os peroneum and peroneus longus tenosynovitis, for which she underwent surgery. We herein report this rare condition and reviewed the relevant literature.

Oh, Seon Jeong; Kim, Young Hoon; Kim, Sun Ki

2012-01-01

52

Proportional EMG control of ankle plantar flexion in a powered transtibial prosthesis.  

PubMed

The human calf muscle generates 80% of the mechanical work to walk throughout stance-phase, powered plantar flexion. Powered plantar flexion is not only important for walking energetics, but also to minimize the impact on the leading leg at heel-strike. For unilateral transtibial amputees, it has recently been shown that knee load on the leading, intact limb decreases as powered plantar flexion in the trailing prosthetic ankle increases. Not surprisingly, excessive loads on the leading, intact knee are believed to be causative of knee osteoarthritis, a leading secondary impairment in lower-extremity amputees. In this study, we hypothesize that a transtibial amputee can learn how to control a powered ankle-foot prosthesis using a volitional electromyographic (EMG) control to directly modulate ankle powered plantar flexion. We here present preliminary data, and find that an amputee participant is able to modulate toe-off angle, net ankle work and peak power across a broad range of walking speeds by volitionally modulating calf EMG activity. The modulation of these key gait parameters is shown to be comparable to the dynamical response of the same powered prosthesis controlled intrinsically (No EMG), suggesting that transtibial amputees can achieve an adequate level of powered plantar flexion controllability using direct volitional EMG control. PMID:24187210

Wang, Jing; Kannape, Oliver A; Herr, Hugh M

2013-06-01

53

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

PubMed Central

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

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

2011-01-01

54

On muscle, tendon and high heels.  

PubMed

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

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

2010-08-01

55

Plantar soft tissue thickness during ground contact in walking  

NASA Technical Reports Server (NTRS)

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

Cavanagh, P. R.

1999-01-01

56

Making heel pricks less painful  

Microsoft Academic Search

A mechanical lancet, the Autolet, was compared with a manual heel prick in 36 newborn infants undergoing routine blood sampling for the Guthrie test and hypothyroid screening. Each method was equally effective in obtaining satisfactory blood samples but the Autolet was considerably less painful.

V A Harpin; N Rutter

1983-01-01

57

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.

2002-01-01

58

Gait analysis of the hemophilic ankle with silicone heel cushion.  

PubMed

Shock absorption becomes very important in damaged joints with destroyed cartilage and progressive muscular imbalance as occurs in hemarthropathy. The effects of silicone heel cushioning on the ankle motion of hemophilic patients in different stages of hemarthropathy of the ankle joints was measured using an ultrasound motion analysis system. It is concluded that silicone heel cushioning has no influence on ankles in the late stage of hemarthropathy. Silicone heel cushioning will lead to uncontrolled changes of the ankle joint in the early hemarthropathic ankle, involving the tibiotalar and the subtalar joints. The angular velocity of the ankle is increased producing higher acceleration at the ankle joint. The higher angle acceleration is related to higher joint loading uncontrolled by the muscles. The resulting uncoordinated motion can cause ligamentous overloading, strains, and a higher probability of joint bleeding. Therefore, silicone heel cushioning or other shock absorbing devices that return the energy immediately to the foot are not useful for prevention and treatment of chronic hemophilic synovitis and may cause additional deterioration of the joint. PMID:9345210

Seuser, A; Wallny, T; Klein, H; Ribbans, W J; Schumpe, G; Brackmann, H H

1997-10-01

59

MRI of the plantar structures of the foot after falanga torture  

Microsoft Academic Search

.   Falanga is an ancient form of punishment or torture but is still commonly reported by our refugees. The late result of caning\\u000a the heel and ball of the foot is a chronic painful condition with few clinical signs. The aim of the present study was to\\u000a assess, by MRI, possible morphologic characteristics of the heel and ball of the

A. Savnik; K. Amris; H. Røgind; K. Prip; B. Danneskiold-Samsøe; F. Bojsen-Møller; E. M. Bartels; H. Bliddal; J. Boesen; N. Egund

2000-01-01

60

[Differences in Plantar Loading between Orthosis with and without Lateral Wedge in Healthy Subjects].  

PubMed

Background: Insoles and foot orthotics change the distribution of the plantar pressure. No information exists concerning the effects of plantar pressure distribution and lateral wedge orthoses. The purpose of this study was to determine the effect of the lateral wedge on the plantar pressure distribution. Methods: The GP Mobil Data system was used to evaluate the data mentioned above, using a 6?mm lateral wedge orthotic worn by 50 healthy volunteers (100 feet). Patient age was 18 to 61 years. The first measurement was performed with, the second without a 6?mm lateral wedge. 50 volunteers walked a standardised distance of 10?m and the results with and without the wedge were compared. For evaluation, the foot was divided in 6 different anatomic regions. Statistical analysis was performed with the t2 test using graph pad prism. Results: The preliminary results revealed that the maximum peak pressure and intermediate pressure, contact time and force time integral decreased significantly at the medial middle- and forefoot plus the heel and increased significantly at the lateral middle- and forefoot using the lateral wedge. The maximum peak pressure under the great toe decreased by 22?% using a wedge, under the MTP I joint by 19?%, under the MTP II-III joints by 8?% and under the heel by 7?%. By contrast, maximum peak pressure increased under the area of MTP IV-V (+?11.3?%) and under the lateral metatarsus (+?15?%) when wearing a wedge. Conclusion: This study reveals the effects of a lateral wedge orthosis on the plantar pressure distribution of the foot. These relationships and the changing pattern may serve as a useful guide for the clinician. A full medical screen of the foot should be undertaken before laterally wedged foot orthotic devices are prescribed. PMID:24960093

Trieb, K; Zachhuber, D; Hofstätter, S

2014-06-01

61

Heel-rise test in the assessment of individuals with peripheral arterial occlusive disease  

PubMed Central

Introduction The Heel-Rise Test (HRT) is a clinical instrument relevant to vascular rehabilitation that has been proposed to assess the function of the triceps surae muscle. To use HRT in the assessment of individuals with peripheral arterial occlusive disease (PAOD), its ability to detect differences in the functional performance of patients with PAOD must be verified. Aim To verify whether the test is sensitive in differentiating between individuals with PAOD with distinct functional capacities. Materials and methods A transversal study in which individuals with PAOD were assessed using the HRT, the Walking Impairment Questionnaire (WIQ), and the Shuttle Walk Test. The following variables were analyzed: number of plantar flexions performed in the HRT (time in seconds) and velocity (plantar flexions per second) when performing plantar flexions up to the point of volunteer fatigue, maximum distance walked in the Shuttle Walk Test, and scores obtained in each WIQ domain. Results Twenty-five individuals (14 male) were included in the study, with a mean age of 63.36 ± 9.83 years. The variables number of plantar flexions and time to perform the HRT were sensitive enough to differentiate between distinct functional capacities in individuals with PAOD (P = 0.003 and P = 0.009, respectively). However, this result was not found for the variable of velocity in the HRT. The number of plantar flexions in the HRT was sensitive enough to differentiate individuals of extreme classes on the WIQ domain, stairs (P = 0.008). Conclusion The HRT can be applied in clinical practice as a valid assessment of the distinct function capacities of individuals with PAOD.

Monteiro, Debora Pantuso; Britto, Raquel Rodrigues; Lages, Ana Clara Ribeiro; Basilio, Marluce Lopes; de Oliveira Pires, Monize Cristine; Carvalho, Maria Luiza Vieira; Procopio, Ricardo Jayme; Pereira, Danielle Aparecida Gomes

2013-01-01

62

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.

2010-01-01

63

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

2007-01-01

64

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

65

The impact of increasing body mass on peak and mean plantar pressure in asymptomatic adult subjects during walking  

PubMed Central

Introduction The implication of high peak plantar pressure on foot pathology in individuals both with and without diabetes has been recognized. The aim of this study was to investigate and clarify the relationship between increasing body mass and peak and mean plantar pressure in an asymptomatic adult population during walking. Methods Thirty adults without any relevant medical history, structural foot deformities or foot posture assessed as highly pronated or supinated, and within a normal body mass index range were included in the study. An experimental, same subjects, repeated measures design was used. Peak and mean plantar pressure were evaluated with the F-Scan in-shoe plantar pressure measurement system under four different loading conditions (0, 5, 10, and 15 kg) simulated with a weighted vest. Pressure data were gathered from three stances utilizing the mid-gait protocol. Results There were statistically significant increases in peak pressure between the 10 and 15 kg load conditions compared to the control (0 kg) within the heel and second to fifth metatarsal regions. The first metatarsal and hallux regions only displayed statistically significant increases in peak pressure between 15 kg and the control (0 kg). The midfoot and lesser digits regions did not display any statistically significant differences in peak pressure between any load conditions compared to the control (0 kg). The second to fifth metatarsal region displayed statistically significant increases in mean pressure in the 5, 10 and 15 kg groups compared to the control (0 kg). A statistically significant increase in peak pressure between the 15 kg and control (0 kg) group was evident in all other regions. Conclusion The relationship between increasing body mass and peak and mean plantar pressure was dependent upon the plantar region. This study provides more detail outlining the response of peak and mean pressure to different loading conditions than previously reported in the literature. Further research including measurement of temporal parameters is warranted.

Arnold, John B.; Causby, Ryan; Pod, Grad Dip; Jones, Sara

2010-01-01

66

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

PubMed

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

2012-07-01

67

Shock absorbency of factors in the shoe/heel interaction--with special focus on role of the heel pad.  

PubMed

The heel pad acts as a shock absorber in walking and in heel-strike running. In some patients, a reduction of its shock-absorbing capacity has been connected to the development of overuse injuries. In this article, the shock absorption of the heel pad as well as external shock absorbers are studied. Individual variation and the effect of trauma and confinement on the heel pad were specifically investigated. Drop tests, imitating heel impacts, were performed on a force plate. The test specimens were cadaver heel pads (n = 10); the shoe sole component consisted of ethyl vinyl acetate (EVA) foam and Sorbothane inserts. The shock absorption was significantly greater in the heel pad than in the external shock absorbers. The mean heel pad shock absorption was 1.1 times for EVA foam and 2.1 times for Sorbothane. The shock absorption varied by as much as 100% between heel pads. Trauma caused a decrease in the heel pad shock absorbency (24%), whereas heel pad confinement increased the shock absorbency (49% in traumatized heel pads and 29.5% in nontraumatized heel pads). These findings provide a biomechanical rationale for the clinical observations of a correlation between heel pad shock absorbency loss and heel strike-dependent overuse injuries. To increase shock absorbency, confinement of the heel pad should be attempted in vivo. PMID:2744671

Jørgensen, U; Bojsen-Møller, F

1989-06-01

68

Knee–heel length measurement in healthy preterm infants  

Microsoft Academic Search

AIMTo examine the reproducibility of crown–heel length measurement; the precision and reproducibility of knee–heel length measurement; and the association between the two in healthy preterm infants.METHODSPaired crown–heel and knee–heel lengths were measured on 172 occasions by three observers in 43 preterm infants between 205 and 458 days of postconceptional age.RESULTSCrown–heel length (CHL) measurement was highly reproducible, with a coefficient of

Ian J Griffin; Naomi M Pang; Jeffery Perring; Richard J Cooke

1999-01-01

69

Plantar angiomyxolipoma in a child  

PubMed Central

Angiomyxolipoma, a lipoma variant with myxoid areas and vascular proliferation was originally described in 1996 and till date has only 12 cases in published literature. Only two cases have been reported in children involving buccal mucosa and knee, respectively. The authors report a case of angiomyxolipoma, on the plantar surface of the left foot, in a 4-year-old male child who presented to our institution in Abha city (Kingdom of Saudi Arabia). The significant differential diagnosis of this neoplasm from other similar lipomatous tumours occurring in adult and paediatric population is discussed. The importance of recognising these tumours lies in their recognition as separate entity and the present case may add to the knowledge, clinical behaviour and prognosis of these less reported lipomatous neoplasms.

Shraim, Mubarak Al; Hasan, Mahboob; Hawan, Ali; Radad, Khaled; Eid, Refaat

2011-01-01

70

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

PubMed Central

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

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

2011-01-01

71

Infracalcaneal heel pain in the athlete.  

PubMed

Heel-spur syndrome is a condition encountered on a daily basis by those practitioners who primarily treat athletes. The authors discuss anatomy, the clinical examination, radiographic evaluation, exercise, and alternative medicines. PMID:9257037

Agostinelli, J; Ross, J A

1997-07-01

72

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

2013-01-01

73

Dressing plantar wounds with foam dressings, is it too much pressure?  

PubMed Central

Diabetes and its associated complications have become a major concern locally, nationally and internationally. One such complication is lower extremity amputation, commonly preceded by chronic ulceration. The cause of this tissue breakdown is multi-faceted, but includes an increase in pressure, particularly plantar pressure. As such, the choice of dressing to be applied to a plantar wound should ideally not increase this pressure further. A commonly used and possibly more bulky dressing is the foam dressing. This pilot study investigates the plantar pressures associated with three common foam dressings (Allevyn®, Lyofoam® and Mepilex®) compared with a control dressing (Melolin®). Twelve healthy males and 19 females [SD] age 36.6 [10.4] were measured using the F-scan plantar pressure measurement system. Substantial variations in individual pressure changes occurred across the foot. No significant differences were identified, once a Bonferroni correction was applied. In healthy adults, it could be concluded that foam dressings do not have any effect on the plantar pressures of the foot. However, the need remains for a robust trial on a pathological population.

Scott Causby, Ryan; Pod, M; Jones, Sara

2011-01-01

74

Changes of bioelectrical activity in cervical paraspinal muscle during gait in low and high heel shoes.  

PubMed

High heel footwear may be destructive for the spine because of an increased erector spinae muscle bioelectrical activity and increased ground reaction forces affecting lower limbs and the spine. The aim of this study was to evaluate the changes of bioelectrical activity in cervical paraspinal muscle during gait in low and in high heel shoes in different age groups. In 31 women aged 20-25 years and in 15 women aged 45-55 years without neck pain, the bioelectrical activity of the cervical paraspinal muscle was assessed during gait on flat surface with natural speed in three conditions: without shoes, in low (4 cm) and in high (10 cm) heel shoes. Higher bioelectrical activity cervical paraspinal muscle was noted during gait in high heel shoes in comparison to gait without shoes. The changes were more pronounced in the group of subjects aged 45-55 years. The prolonged wearing of shoes with stiletto type heels by individuals without neck pain is not safe for their spine and may lead to chronic paraspinal muscle fatigue. PMID:21500761

Mika, Anna; Oleksy, ?ukasz; Miko?ajczyk, Edyta; Marchewka, Anna; Mika, Piotr

2011-01-01

75

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.

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

2010-01-01

76

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

PubMed

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

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

2013-09-01

77

PLANTAR WARTS TREATED WITH TOPICAL ADAPALENE  

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

2011-01-01

78

Plantar Foot Surface Temperatures with Use of Insoles  

PubMed Central

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

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

2004-01-01

79

The Effect of Backpack Load on Muscle Activities of the Trunk and Lower Extremities and Plantar Foot Pressure in Flatfoot  

PubMed Central

[Purpose] The purpose of this study was to investigate the changes in muscle activation of the trunk and lower extremities and plantar foot pressure due to backpack loads of 0, 10, 15, and 20% of body weight during level walking in individuals with flatfoot. [Methods] Fourteen young flatfoot subjects and 12 normal foot subjects participated in this study. In each session, the subjects were assigned to carry a backpack load, and there were four level walking modes: (1) unloaded walking (0%), (2) 10% body weight (BW) load, (3) 15% BW load, and (4) 20% BW load. Trunk and lower extremity muscle activities were recorded by surface EMG, and contact area and plantar foot pressure were determined using a RS scan system. [Results] The erector spinae, vastus medialis, tibialis anterior and gastrocnemius muscle activities, but not the rectus femoris and rectus abdominis muscle activities of flatfoot subjects significantly and progressively increased as load increased in flatfoot subjects. Contact area and pressure of the lateral and medial heel zones were significantly increased too. [Conclusion] Based on this data, the weight of a backpack could influence muscle activation and plantar foot pressure in flatfoot.

Son, Hohee

2013-01-01

80

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

PubMed

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

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

1993-01-01

81

Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis  

PubMed Central

The plantar aponeurosis (PA), in spanning the whole length of the plantar aspect of the foot, is clearly identified as one of the key structures that is likely to affect compliance and stability of the longitudinal arch. A recent study performed in our laboratory showed that tension/elongation in the PA can be predicted from the kinematics of the segments to which the PA is attached. In the present investigation, stereophotogrammetry and inverse kinematics were employed to shed light on the mechanics of the longitudinal arch and its main passive stabilizer, the PA, in relation to walking speed. When compared with a neutral unloaded position, the medial longitudinal arch underwent greater collapse during the weight-acceptance phase of stance at higher walking speed (0.1°±1.9° in slow walking; 0.9°±2.6° in fast walking; P = 0.0368). During late stance the arch was higher (3.4°±3.1° in slow walking; 2.8°±2.7° in fast walking; P = 0.0227) and the metatarsophalangeal joints more dorsiflexed (e.g. at the first metatarsophalangeal joint, 52°±5° in slow walking; 64°±4° in fast walking; P < 0.001) during fast walking. Early-stance tension in the PA increased with speed, whereas maximum tension during late stance did not seem to be significantly affected by walking speed. Although, on the one hand, these results give evidence for the existence of a pre-heel-strike, speed-dependent, arch-stiffening mechanism, on the other hand they suggest that augmentation of arch height in late stance is enhanced by higher forces exerted by the intrinsic muscles on the plantar aspect of the foot when walking at faster speeds.

Caravaggi, Paolo; Pataky, Todd; Gunther, Michael; Savage, Russell; Crompton, Robin

2010-01-01

82

Neglected isolated plantar dislocation of middle cuneiform : a case report  

PubMed Central

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

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

2007-01-01

83

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

PubMed Central

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.

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

2013-01-01

84

Neuromuscular performance of paretic versus non-paretic plantar flexors after stroke  

Microsoft Academic Search

The objective of this study was to compare the neuromuscular function of the paretic and non-paretic plantar flexors (i.e.\\u000a soleus, gastrocnemius medialis, lateralis) in chronic stroke patients. It was hypothesized that the contractile rate of force\\u000a development (RFD) and neural activation, assessed by electromyogram (EMG) and V-waves normalized to the M-wave, and voluntary\\u000a activation (twitch interpolation) would be reduced during

Marius Steiro Fimland; Per Marius R. Moen; Tessa Hill; Tor Ivar Gjellesvik; Tom Tørhaug; Jan Helgerud; Jan Hoff

85

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

PubMed

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

2013-07-01

86

Black heel a minor hazard of sport.  

PubMed

"Black heel" (calcaneal petechiae) is a traumatic lesion affecting the back or posterolateral aspect of the heel. It is seen almost exclusively in adolescentes or young adults engaged in active sports, notably basketball, but also football, lacrosse, tennis, and so forth. The lesion is disposed horizontally at the upper dege of the calcaneal fat-pad and consists of grouped punctate hemorrhages, the nature of which is revealed by repeated paring of the lesion. The nature of the pigment is shown by specialized stains. "Black heel" is probably more common than is realized. It is likely to be cuased by a shearing or pinching stress from abrupt contact of th foot with a floor or hard ground. As it si usually symptomless, it may be disregarded or only observed by chance. However, it has been confused clinically with a melaonoa, and as it is such a trivial self-healing process, it is important that it be recognized for what it is. PMID:891256

Wilkinson, D S

1977-09-01

87

[Plantar pruritus after trip to Vietnam].  

PubMed

A 33 year old man is evaluated for a pruriginous plantar eruption on the right foot. Three weeks ago he walked across a river barefoot in the south of Vietnam. In the clinical examination of the foot a red, serpiginuous dermatitis was seen. Patient history and clinical picture were typical for a larva migrans. After starting a treatment with albendazol the patient felt well and the lesions disappeared. PMID:17966826

Tanneberger, O; Fehr, J; Nuesch, R

2007-10-01

88

Effectiveness of insoles on plantar pressure redistribution.  

PubMed

For this study, we compared the effectiveness of different design insoles for redistributing pressure during walking for diabetic patients and for normal control subjects. Comparisons of dynamic plantar foot pressure patterns were made with different support, including shoe-only, flat insole, and three contoured insoles. We custom-molded the three contoured insoles by casting the plantar surface of the foot under the conditions of non-weight-bearing, semi-weight-bearing, and full-weight-bearing. With the F-Scan in-shoe system, the interfacial pressure distribution during walking with different plantar supports was measured at 50 Hz for 10 s. The use of insoles could significantly reduce local peak pressure and pressure-time integral and increase the contact area. Contoured insoles were significantly better than flat insoles with regard to the insole functions in reducing local peak pressures. The insole with the semi-weight-bearing foot shape can offer the greatest peak pressure reduction compared to other insole designs, especially for patients with peak pressure located at the second to third metatarsal heads. PMID:15685465

Tsung, Bonnie Yuk San; Zhang, Ming; Mak, Arthur Fuk Tat; Wong, Margaret Wan Nar

2004-01-01

89

The effects of high heeled shoes on female gait: a review.  

PubMed

Walking is the most common form of human locomotion. From a motor control perspective, human bipedalism makes the task of walking extremely complex. For parts of the step cycle, there is only one foot on the ground, so both balance and propulsion are required in order for the movement to proceed smoothly. One condition known to compound the difficulty of walking is the use of high heeled shoes, which alter the natural position of the foot-ankle complex, and thereby produce a chain reaction of (mostly negative) effects that travels up the lower limb at least as far as the spine. This review summarises recent studies that have examined acute and chronic effects of high heels on balance and locomotion in young, otherwise healthy women. Controversial issues, common study limitations and directions for future research are also addressed in detail. PMID:24508305

Cronin, Neil J

2014-04-01

90

Influence of Inflammatory Polyarthritis on Quantitative Heel Ultrasound Measurements  

PubMed Central

Background There are few data concerning the impact of inflammatory polyarthritis (IP) on quantitative heel ultrasound (QUS) measurements. The aims of this analysis were i) to determine the influence of IP on QUS measurements at the heel and, ii) among those with IP to determine the influence of disease related factors on these measurements. Methods Men and women aged 16?years and over with recent onset IP were recruited to the Norfolk Arthritis Register (NOAR). Individuals with an onset of joint symptoms between 1989 and 1999 were included in this analysis. At the baseline visit subjects underwent a standardised interview and clinical examination with blood taken for rheumatoid factor. A population-based prospective study of chronic disease (EPIC-Norfolk) independently recruited men and women aged 40 to 79?years from the same geographic area between 1993 and 1997. At a follow up assessment between 1998 and 2000 subjects in EPIC-Norfolk were invited to have quantitative ultrasound measurements of the heel (CUBA-Clinical) performed. We compared speed of sound (SOS) and broadband ultrasound attenuation (BUA), in those subjects recruited to NOAR who had ultrasound measurements performed (as part of EPIC-Norfolk) subsequent to the onset of joint symptoms with a group of age and sex matched non-IP controls who had participated in EPIC-Norfolk. Fixed effect linear regression was used to explore the influence of IP on the heel ultrasound parameters (SOS and BUA) so the association could be quantified as the mean difference in BUA and SOS between cases and controls. In those with IP, linear regression was used to examine the association between these parameters and disease related factors. Results 139 men and women with IP and 278 controls (mean age 63.2?years) were studied. Among those with IP, mean BUA was 76.3?dB/MHz and SOS 1621.8?m/s. SOS was lower among those with IP than the controls (difference?=??10.0; 95% confidence interval (CI) –17.4, -2.6) though BUA was similar (difference?=??1.2; 95% CI ?4.5, +2.1). The difference in SOS persisted after adjusting for body mass index and steroid use. Among those with IP, disease activity as determined by the number of swollen joints at baseline, was associated with a lower SOS. In addition SOS was lower in the subgroup that satisfied the 1987 ACR criteria. By contrast, disease duration, steroid use and HAQ score were not associated with either BUA or SOS. Conclusions In this general population derived cohort of individuals with inflammatory polyarthritis there is evidence from ultrasound of a potentially adverse effect on the skeleton. The effect appears more marked in those with active disease.

2012-01-01

91

Waste Tank Heel Chemical Cleaning Summary  

SciTech Connect

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

Barnes, M.J.

2003-12-02

92

Change in the Mechanical Energy of the Body Center of Mass in Hemiplegic Gait after Continuous Use of a Plantar Flexion Resistive Ankle-foot Orthosis  

PubMed Central

[Purpose] The aim of this study was to investigate the changes in mechanical energy due to continuous use of a plantar flexion resistive ankle-foot orthosis (AFO) of subjects with chronic hemiplegia. [Subjects and Methods] The subjects were 5 hemiplegic patients using AFOs without a plantar flexion resistive function in their daily lives. We analyzed the gait of the subjects using a 3D motion capture system under three conditions: patients’ use of their own AFOs; after being fitted with a plantar flexion resistive AFO; and after continuous use of the device. The gait efficiency was determined by calculating the mutual exchange of kinetic and potential energy of the center of mass. [Results] An increased exchange rate of the kinetic and potential energy was found for all subjects. A larger increase of energy exchange was shown on the non-paralyzed side, and after continuous use of the plantar flexion resistive AFO. [Conclusion] We found that continuous use of a plantar flexion resistive AFO increased the rate of mutual exchange between kinetic energy and potential energy. The change in the rate was closely related to the role of the non-paretic side, showing that the subjects needed a certain amount of time to adapt to the plantar flexion resistive AFO.

Haruna, Hirokazu; Sugihara, Shunichi; Kon, Keisuke; Miyasaka, Tomoya; Hayakawa, Yasuyuki; Nosaka, Toshiya; Kimura, Kazuyuki

2013-01-01

93

Structural analysis of the Heel Jet secondary catch mechanism.  

National Technical Information Service (NTIS)

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

B. L. Coverdell

1995-01-01

94

Diagnostic accuracy of heel pad palpation – A phantom study  

Microsoft Academic Search

Falanga torture involves repetitive blunt trauma to the soles of the feet and typically leaves few detectable changes. Reduced elasticity in the heel pads has been reported as characteristic sequelae and palpatory testing of heel pad elasticity is therefore part of medicolegal assessment of alleged torture victims.The goal was to test the accuracy of two experienced investigators in determining whether

Søren T. Torp-Pedersen; Sara Matteoli; Jens E. Wilhjelm; Kirstine Amris; Jakob I. Bech; Robin Christensen; Bente Danneskiold-Samsøe

2008-01-01

95

Performance of insole in reducing plantar pressure on diabetic patients in the early stages of the disease.  

PubMed

It has been well documented that subjects with peripheral neuropathy resulting from diabetes mellitus are at high risk of developing foot ulceration. Decreased sensation, in combination with high underfoot pressures, have been identified as prime etiology factors in the cause of plantar naturopathic ulceration [1]. This study presents the effect of four orthotic treatment techniques in reducing metatarsal head, heel and toes pressure during walking. A pressure measurement study was carried out on a diabetic patients group wearing four insoles, including the insole designed by the computer model proposed in this project. The aim of this study was to evaluate the effect on plantar pressure in diverse insoles prescribed and manufactured with various techniques on a random group of patients with diabetes mellitus in the early stages of the disease. Four types of insoles were designed and manufactured by methods available in the market; the computer model proposed on this project was used in order to design and manufacture the insole. The results show that every patient requires an individual assessment and often a personalized insole. PMID:21095715

Zequera, Martha L; Solomonidis, Stephan

2010-01-01

96

Angiokeratoma presenting as plantar verruca: a case study.  

PubMed

One of the more frequent pathologic conditions that podiatric physicians are confronted with is plantar verrucae. Plantar verrucae have been studied extensively in terms of morphological features and incidence in the population at large and in patients with human immunodeficiency virus infection. Solitary angiokeratomas can be morphologically similar to plantar verrucae, presenting as hyperkeratotic pedunculated lesions. We present a unique case study of a 40-year-old man with human immunodeficiency virus with a painful solitary angiokeratoma masquerading as plantar verrucae. The lesion demonstrated clinical signs consistent with those highlighted in the literature for verrucae, namely, showing as red and black lacunae, punctuated hyperkeratotic epidermis. We propose that solitary angiokeratomas should be an important part of a podiatric physician's differential diagnosis in the lower extremity owing to the similarity of morphological features with plantar verrucae. PMID:21084538

Dunnihoo, Mark E; Kitterman, Ryan T; Tran, David

2010-01-01

97

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

PubMed Central

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

2014-01-01

98

Severe plantar hyperhidrosis: an effective surgical solution.  

PubMed

Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database. Plantar sweating was graded as cured, improved, or unchanged. ELS (using 5-mm titanium clips) was performed in 154 patients, 68.2 per cent at the third lumbar vertebrae and 31.8 per cent at the fourth lumbar vertebrae. Follow-up averaged 15 months and ranged up to 4.7 years. Anhidrosis was achieved in 97.4 per cent of patients with the remainder reporting major reduction in symptoms. All patients were discharged home within 24 hours of surgery, requiring only oral analgesics, if any. There were two surgical complications (lymphatic leak and misidentification of genitofemoral nerve for sympathetic nerve). Six early patients required conversion to an open surgical procedure. Partial recurrence, usually mild, occurred in 4.5 per cent with 2.6 per cent requiring revision surgery. Severe plantar hyperhidrosis can be safely and effectively treated by endoscopic lumbar sympathectomy using the clamping method. It can be accomplished on an outpatient basis with low morbidity, complete resolution of symptoms, and a significant improvement in quality of life. PMID:23896256

Reisfeld, Rafael; Pasternack, Glenn A; Daniels, Parviz D; Basseri, Eraj; Nishi, Gregg K; Berliner, Karen I

2013-08-01

99

Gait pattern generation with knee stretch motion for biped robot using toe and heel joints  

Microsoft Academic Search

This paper presents a new alternative methodology to generate gait pattern with a knee stretched motion for biped robot utilizing toe and heel joints. During walking sequence, human heels act as passive joints that create some support area which enhances the stability of human walking. This research tries to replace human-heel like mechanism with a heel joint in the biped

Nandha Handharu; Jungwon Yoon; Gabsoon Kim

2008-01-01

100

Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial  

PubMed Central

Background If conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporarily pain reduction, but no healing. Blood platelets initiate the natural healing rate. GPS® gives an eightfold concentrate platelets of patients own blood. Injection of these platelets in the attachment of the fascia to the os calcis might induce a healing rate. Methods and design A randomized controlled multi centre trial will be performed. The study population consists of 120 patients of 18 years and older. Patients with chronic plantar fasciitis will be allocated randomly to have a steroid injection or an autologous platelet concentrate injections. Data will be collected before the procedure, 4,8,12,26 weeks and 1 year after the procedure. The main outcome measures of this study are pain and function measured with questionnaires. Conclusion Recent literature show positive effects for the treatment of tendinosis with autologous platelet injections. The forthcoming trial will compare treatment for chronic plantar fasciitis with a steroid injection versus an autologous platelet injection. Our results will be published as soon as they become available. Trial Registration Trial registration number: http://www.clinicaltrials.gov NCT00758641.

2010-01-01

101

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

PubMed

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

2013-01-01

102

Hookah Smoking Popular Among Well-Heeled Teens  

MedlinePLUS

... sharing features on this page, please enable JavaScript. Hookah Smoking Popular Among Well-Heeled Teens: Survey Survey ... school seniors now say they have smoked a hookah pipe, a new survey shows. A form of ...

103

Don't Ignore Your Kid's Heel Pain  

MedlinePLUS

... Text Size Print Bookmark Don’t Ignore Your Kid’s Heel Pain Address Pain Early, Avoid Long Recovery ... and ankle surgeon. The good news is that kids are good healers and treatment may be simple ...

104

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

1981-01-01

105

Vitamin A Acid in the Topic Treatment of Plantar Warts  

Microsoft Academic Search

An ointment with 2% vitamin A acid was applied under occlusion to 50 patients with plantar warts. Only 17 could be considered as cured after 2–10 weeks of treatment.Copyright © 1975 S. Karger AG, Basel

J. de Bersaques

1975-01-01

106

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

2011-01-01

107

A comparison of shoe insole materials in plantar pressure relief  

Microsoft Academic Search

A clinical study was performed to evaluate the effectiveness of seven shoe insole materials and their ability to relieve areas of high plantar pressure. The following materials were tested: Latex foam, PlastazoteR, DynafoamR, Ortho felt, PPT R, SpencoR, and MoloR. Twenty-six patients with areas of high plantar pressure were tested using each of these materials. The Harris and Beath footprinting

C. LEBER; P. M. EVANSKI

1986-01-01

108

Reduced plantar sensation causes a cautious walking pattern  

Microsoft Academic Search

The aim of this study was to investigate the influence of reduced plantar sensation on gait patterns during walking in 20 healthy subjects (25.9±1.2 years, 61.6±11.5kg, 178±9.5cm) with no history of sensory disorders. Force plate measurements, electromyography (EMG) measurements and a three-dimensional movement analysis were performed simultaneously during barefoot walking before and after reduction of plantar sensation using an ice

Eric Eils; Susann Behrens; Oliver Mers; Lothar Thorwesten; Klaus Völker; Dieter Rosenbaum

2004-01-01

109

[Plantar zygodactylous triradii in a population comparison].  

PubMed

The plantar prints of 125 male Japanese were examined with regard to the frequencies of zygodactylous triradii and their expression types. Comparing the results with those of 500 males Viennese the two samples proved to be significantly different. The differences amount to such an extent that even by enlarging the Japanese sample no fundamental changes in the relations between the two populations might be expected. In Japanese the medium expression occurs in very low frequencies and the strong one not at all, while Europeans show those traits in about 60%. Comparing the pattern types characteristic for zygodactylous triradii, the Japanese revealed almost no proximal loops in the second and almost no whorls in the third interdigital area whereas Viennese showed high frequencies of both types. The findings of a sample of Angolan Bantus as well as those of a German one differ from the Japanese in the same way as the Viennese. It was observed that the line connecting the distal ends of the 2nd, 3rd, 4th and 5th toes is formed rather transversally in Japanese, while it is declining towards the 5th toe in Europeans and in Bantus. It requires further studies to prove if there exists a relation between this anatomical trait and the occurrence of zygodactylous triradii. PMID:485102

Aue-Hauser, G; Brehme, H; Wytek, R

1979-06-01

110

Effect of viscoelastic properties of plantar soft tissues on plantar pressures at the first metatarsal head in diabetics with peripheral neuropathy.  

PubMed

Diabetic foot ulcers are one of the most serious complications associated with diabetes mellitus. Current research studies have demonstrated that biomechanical alterations of the diabetic foot contribute to the development of foot ulcers. However, the changes of soft tissue biomechanical properties associated with diabetes and its influences on the development of diabetic foot ulcers have not been investigated. The purpose of this study was to investigate the effect of diabetes on the biomechanical properties of plantar soft tissues and the relationship between biomechanical properties and plantar pressure distributions. We used the ultrasound indentation tests to measure force-deformation relationships of plantar soft tissues and calculate the effective Young's modulus and quasi-linear viscoelastic parameters to quantify biomechanical properties of plantar soft tissues. We also measured plantar pressures to calculate peak plantar pressure and plantar pressure gradient. Our results showed that diabetics had a significantly greater effective Young's modulus and initial modulus of quasi-linear viscoelasticity compared to non-diabetics. The plantar pressure gradient and biomechanical properties were significantly correlated. Our findings indicate that diabetes is linked to an increase in viscoelasticity of plantar soft tissues that may contribute to a higher peak plantar pressure and plantar pressure gradient in the diabetic foot. PMID:23248175

Jan, Yih-Kuen; Lung, Chi-Wen; Cuaderes, Elena; Rong, Daqian; Boyce, Kari

2013-01-01

111

Aspects of treatment for posterior heel pain in young athletes  

PubMed Central

Posterior heel pain occurs in young athletes involved in running and jumping. Due to the pain, the child often limits his/her physical activity level, with a possible negative effect on health and well-being. Although numerous research studies have examined the cause and treatment of heel and Achilles tendon pain in adults, there are no randomized clinical trials on treatment in children and adolescents. Therefore, there is limited evidence for how to treat young athletes with this type of complaint. The purpose of this review was to analyze critically and summarize the literature in regards to the cause and treatment of posterior heel pain in young athletes. The various diagnoses and clinical presentations relating to posterior heel and Achilles tendon pain are discussed. The theory and mechanism behind various recommended treatment strategies are also reviewed in the context of use in the young athlete. In summary, it is important to perform a thorough evaluation of each young athlete with heel pain to determine the appropriate diagnosis and to treat the deficits found and allow for a gradual progression to training. However, the recommendations at this time are based on clinical experience and a few retrospective studies, so further well designed prospective studies with validated outcome measures are urgently needed for the young athlete.

Elengard, Thomas; Karlsson, Jon; Silbernagel, Karin Gravare

2010-01-01

112

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

2012-01-01

113

Is heel prick as safe as we think?  

PubMed Central

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.

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

2011-01-01

114

Site-specific differences in the association between plantar tactile perception and mobility function in older adults  

PubMed Central

Introduction: Impaired somatosensation is common in older adults and contributes to age-related loss of mobility function. However, little is known about whether somatosensation at different sites on the plantar surface of the foot are differentially related to mobility function. Such a finding may have important implications for clinical care of older adults and other at-risk populations, such as for optimizing interventions (e.g., footwear for augmenting somatosensory feedback) and for improving the efficiency of clinical assessment. Materials and Methods: Tactile perception was evaluated with a 10 g monofilament at four sites on the plantar surface of each foot: great toe (GT), first metatarsal head (MT1), heel (H) and fifth metatarsal head (MT5). Mobility function was assessed with the Berg Balance Scale and walking speed. Results: Sixty-one older adults participated. Tactile perception was significantly positively associated with Berg Balance Score (adjusted r = 0.30 ? 0.75; p = 0.03 ? < 0.001), with the strongest association found at the site of the MT1. Only at this site was tactile perception found to be significantly associated with usual walking speed (adjusted r = 0.51; p < 0.001) and maximal walking speed (adjusted r = 0.38, p = 0.004). Clinically mild somatosensory impairment at MT1, but not at other sites, was found to yield substantial deficits in both Berg Balance Score and walking speed. Discussion: The present findings indicate that tactile perception at MT1 is more closely linked to mobility function than is tactile perception at GT, MT5 or H. These findings warrant further research to examine whether interventions (e.g., textured insoles) and assessments that preferentially or exclusively focus on the site of MT1 may be more effective for optimizing clinical care.

Cruz-Almeida, Yenisel; Black, Mieniecia L.; Christou, Evangelos A.; Clark, David J.

2014-01-01

115

Site-specific differences in the association between plantar tactile perception and mobility function in older adults.  

PubMed

Introduction: Impaired somatosensation is common in older adults and contributes to age-related loss of mobility function. However, little is known about whether somatosensation at different sites on the plantar surface of the foot are differentially related to mobility function. Such a finding may have important implications for clinical care of older adults and other at-risk populations, such as for optimizing interventions (e.g., footwear for augmenting somatosensory feedback) and for improving the efficiency of clinical assessment. Materials and Methods: Tactile perception was evaluated with a 10 g monofilament at four sites on the plantar surface of each foot: great toe (GT), first metatarsal head (MT1), heel (H) and fifth metatarsal head (MT5). Mobility function was assessed with the Berg Balance Scale and walking speed. Results: Sixty-one older adults participated. Tactile perception was significantly positively associated with Berg Balance Score (adjusted r = 0.30 - 0.75; p = 0.03 - < 0.001), with the strongest association found at the site of the MT1. Only at this site was tactile perception found to be significantly associated with usual walking speed (adjusted r = 0.51; p < 0.001) and maximal walking speed (adjusted r = 0.38, p = 0.004). Clinically mild somatosensory impairment at MT1, but not at other sites, was found to yield substantial deficits in both Berg Balance Score and walking speed. Discussion: The present findings indicate that tactile perception at MT1 is more closely linked to mobility function than is tactile perception at GT, MT5 or H. These findings warrant further research to examine whether interventions (e.g., textured insoles) and assessments that preferentially or exclusively focus on the site of MT1 may be more effective for optimizing clinical care. PMID:24782765

Cruz-Almeida, Yenisel; Black, Mieniecia L; Christou, Evangelos A; Clark, David J

2014-01-01

116

Minimal invasive percutaneous bipolar radiofrequency for plantar fasciotomy: a retrospective study.  

PubMed

The purpose of this study was to present the results of a relatively new, minimally invasive surgical technique for the treatment of chronic plantar fasciitis in 14 patients, 2 of whom underwent the treatment bilaterally one foot at time on separate occasions. This was a retrospective, multicenter, nonrandomized study. All of the patients had failed conservative therapy and had symptoms for at least 6 months. The mean follow-up duration was 15.25 months (range, 6-33 months). The postoperative mean American Orthopaedic Foot & Ankle Society hindfoot score was 82.06 (range, 56-100). None of the patients developed complex regional pain syndrome, and all but 2 (14.29% of patients, 12.5% of feet) of the patients were able to return to regular shoe gear by 2-4 weeks postoperative, and only 1 (7.14% of patients, 6.25% of feet) patient was considered a treatment failure. Based on our experience with minimally invasive percutaneous bipolar radiofrequency plantar fasciotomy, we believe the technique to be a relatively easy intervention that is effective and requires less healing time in comparison with traditional open surgical procedures. PMID:21513869

Hormozi, Jones; Lee, Suzette; Hong, Daniel K

2011-01-01

117

The effects of rocker sole and SACH heel on kinematics in gait  

Microsoft Academic Search

The rocker sole and solid-ankle cushion-heel (SACH) heels are the most commonly prescribed external shoe modification. Only a limited number of scientific evidence exists to support these interventions in clinical practice. The objective of this study was to determine the effects of rocker soles and SACH heels on kinematics during gait. In this study, we investigated the gait parameters during

Wen-Lan Wu; Dieter Rosenbaum; Fong-Chin Su

2004-01-01

118

Biomechanical simulation of high-heeled shoe donning and walking.  

PubMed

Footwear serves to protect the foot in various activities, to enhance athletic performance in sports and in many cases to fulfill aesthetic and cultural needs of urban society. Most women like wearing high-heeled shoes (HHS) for the benefit of sensuous attractiveness, while foot problems are often associated. Computational modeling based on finite element (FE) analysis is a useful tool for deep understanding of foot and footwear biomechanics and incorporating footwear with foot in the model is the prerequisite. In this study, a three-dimensional FE model of coupled foot-ankle-shoe complex and preceding gait simulation were established. Interfacial contact simulation was employed to complete the donning process of foot and shoe upper contact. Three major stance phases namely heel strike, midstance and push off were simulated to investigate the biomechanical response of high-heeled shod walking. It was found that the contact pressure at all metatarsophalangeal (MTP) joints intensified and reached their maximum at push off phase during locomotion, meanwhile the first MTP had the largest magnitude. The first and fifth MTP joints had larger movements in transverse plane among all MTP joints, indicating that these two joints bended more significantly by toe box restraint during locomotion. The dorsal contact pressure at the first toe increased by four times from heel strike to push off. The established HHS donning and walking simulation in this study proved the versatility and promising potential of computational approach for realistic biomechanical evaluation and optimization of footwear design in a virtual environment. PMID:23855974

Yu, Jia; Cheung, Jason Tak-Man; Wong, Duo Wai-Chi; Cong, Yan; Zhang, Ming

2013-08-01

119

Diabetic heel ulcer in the Sudan: determinants of outcome.  

PubMed

Heel ulceration, on average, costs 1.5 times more than metatarsal ulceration. The aim of this study was to analyze the determinant factors of healing in diabetic patients with heel ulcers and the late outcomes at Jabir Abu Eliz Diabetic Centre Khartoum, Khartoum, Sudan. Data were collected prospectively for 96 of 100 diabetic patients presenting with heel ulcers at the Jabir Abu Eliz Diabetic Centre Khartoum from May 2003 to January 2005. Late outcome was assessed 3 years later (February 2008). Heeling was achieved in one half of the patients (n = 48). In the remaining 48 patients, 22 ended with major lower extremity amputation and 22 were still receiving wound care. A total of 8 patients died, 4 in each group, the healed and unhealed. The most significant determinants of healing using a logistic multivariate regression model, 95% confidence intervals, and odds ratios included a shorter duration of diabetes (p < .009), adequate lower limb perfusion (p < .043), and a superficial foot ulcer (p < .012). Three years later, of the 88 patients who could be traced, 78 were alive and 59 had healed ulcers (7 had died of unrelated causes and 3 of diabetic-related complications), and no additional lower extremity amputation was recorded. Mortality in the series was 18 patients, of whom 14 had undergone a previous lower extremity amputation. Superficial heel ulcers in diabetic patients with a short history of diabetes and with good limb circulation are more likely to heal within an average duration of 25 weeks. At 3 years of follow-up, 75% showed a favorable outcome for ulcer healing, and 22 patients underwent lower extremity amputation (25%), of whom 14 were dead within 3 years. PMID:22078157

Bakheit, Haseeb E; Mohamed, Mohamed F; Mahadi, Seif ElDin I; Widatalla, Abu Bakr H; Shawer, Mohamed A; Khamis, Amar H; Ahmed, Mohamed E

2012-01-01

120

The role of plantar cutaneous sensation in unperturbed stance  

Microsoft Academic Search

Considerable evidence shows that sensation from the feet and ankles is important for standing balance control. It remains unclear, however, to what extent specific foot and ankle sensory systems are involved. This study focused on the role of plantar cutaneous sensation in quasi-static balance control. Iontophoretic delivery of anesthesia was used to reduce the sensitivity of the forefoot soles. In

Peter F. Meyer; Lars I. E. Oddsson; Carlo J. De Luca

2004-01-01

121

Recalcitrant plantar warts during azathioprine therapy for Crohn's disease  

PubMed Central

Dermatological complications of long-term immunosuppressive therapy in inflammatory bowel disease (IBD) are rarely reported. We present the case of a 29-year-old man with worsening of plantar warts while on azathioprine therapy for Crohn’s disease. This case underlines the need to perform thorough skin examination of IBD patients before and during immunosuppressive therapy.

Timmer, Margriet R.; van Ooteghem, Nancy A.M.

2013-01-01

122

Equivocal plantar responses: a clinical and electromyographic study  

Microsoft Academic Search

Thirty patients in whom others found equivocal plantar reflexes were studied clinically and electromyographically (EMG-og flexor hallucis brevis, extensor hallucis longus, and tibialis anterior), during mechanical stimulation of the sole. Bias of recording or interpretation of EMG was excluded. The study was repeated after one week; the EMG outcome was reproducible in 26 patients (87%). Of these 26, a pathological

J Van Giju

1976-01-01

123

Skin-to-Skin Contact Analgesia for Preterm Infant Heel Stick.  

PubMed Central

Objectives The purpose of the study was to compare a heel stick conducted during skin-to-skin contact with the mother to a heel stick in an incubator in reducing premature infant physiologic and behavioral pain responses. Study Design 24 premature infants in a University-based NICU were recruited and randomized to two sequences: Sequence A group received three hours of skin-to-skin contact with a heel stick in skin-to-skin followed by three hours in an incubator with a heel stick in the incubator. Sequence B group had incubator care and heel stick before skin contact care and heel stick. 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. Results Heart rate and crying responses to pain were significantly reduced during the skin-to-skin contact and skin contact heel stick as compared to incubator care and incubator heel stick. Three infants did not cry at all during the skin contact heel stick. Infants slept more during skin-to-skin contact than in the incubator. Conclusion Skin-to-skin positioning before and during a heel stick is a simple and inexpensive intervention to ameliorate pain in medically stable premature infants.

Ludington-Hoe, Susan M.; Hosseini, Robert B.

2005-01-01

124

Plantar Foot Pressures After the Augmented Low Dye Taping Technique  

PubMed Central

Context: Taping and orthoses are frequently applied to control excessive foot pronation to treat or prevent musculoskeletal pain and injury of the lower limb. The mechanism(s) by which these devices bring about their clinical effects are at best speculative and require systematic evaluation. Objective: To determine the initial effect of the augmented low Dye taping technique (ALD) on plantar foot pressures during walking and jogging. Design: Within-subjects, repeated-measures randomized control trial. Setting: Gait research laboratory. Patients or Other Participants: Fifteen women and 7 men with an average age of 28.0 ± 7.4 years who were asymptomatic. Intervention(s): Participants walked and jogged along a 12-m walkway before and after the application of ALD. The untaped side served as the control. Main Outcome Measure(s): Peak and mean maximum plantar pressure data were calculated for the medial and lateral areas of the rear and midfoot and the medial, central, and lateral forefoot areas. Thus, a 3-factor model was tested: condition (ALD, control) × time (preapplication, postapplication) × area (medial and lateral rearfoot and midfoot and medial, central, and lateral forefoot). Results: Significant 3-way interactions were present for both peak and mean maximum plantar pressure during walking (F 6,126 = 9.55, P = .006 and F 6,126 = 11.36, P = .003, respectively) and jogging (F 6,126 = 5.76, P = .026 and F 6,126 = 4.56, P = .045, respectively) tasks. The ALD predominantly increased plantar pressures in the lateral midfoot during walking and jogging. In addition, tape reduced mean maximum pressure at the medial forefoot and at the medial rearfoot during walking. Conclusions: The ALD, which has previously been shown to reduce excessive pronation, produced significant increases in lateral midfoot plantar pressures, thereby providing additional information to be considered when the mechanism(s) of action of such a treatment are modeled.

Vicenzino, Bill; McPoil, Thomas; Buckland, Susan

2007-01-01

125

Analysis of plantar loading parameters pre and post surgical intervention for hallux vargus.  

PubMed

INTRODUCTION:: The purpose of the study was to compare range of motion (ROM) and plantar loading parameters pre and post surgical intervention for hallux valgus (HV). Fifteen female patients volunteered for the study, providing 27 feet with a diagnosis of moderate or severe HV deformity (greater than 26 degrees HV angle). All participants were screened by the same orthopaedic surgeon to ensure that no other foot deformities or neuromuscular diseases were present that would alter lower extremity biomechanics. Prior to surgery, each patient filled out a five-part questionnaire on previous medical history, description and location of symptoms, perceived pain and current functional status. Radiographs were taken from the dorsoplantar and oblique aspects with the patient weight bearing. HV and intermeditarsal angle (IM) were measured from the radiographs. Seated talocrural and first metatarsophalangeal (MP) joint active and passive (ROM) were measured with a hand-held goniometer as described by Norkin and White (1985). Plantar loading patterns were assessed using barefoot for the involved limb using the two step method as described by Meyers-Rice et al. (1992). Data was collected using a capacitive pressure measurement platform (EMED SD Pedography Analyzer, Novel GmbH, Munich) and stored for further analysis. The pressure platform consisted of a 32 x 62 sensor matrix with a resolution of 2 sensor/cm(2). The sampling rate of the platform was fixed at 70 Hz and auto triggered upon first contact. Five acceptable trials were collected for each subject. All of the following were conducted again eight weeks after a Chevron-Aikin Osteotomy surgical correction for HV. Each step was analysed by dividing the foot into seven plantar regions: heel (HL), midfoot (MF), medial forefoot (MFF), central forefoot (CFF), lateral forefoot (LFF), medial toe (MT) and lateral toe (LT). The following variables for each region were generated via the Novel-win software: peak force (%BW), peak pressure (Kpa), length of contact (ms), pressure time integral (Kpa(*)s), force time integral (%BW(*)s), instant of peak pressure (ms) and instant of peak force (ms). A repeated measures multivariate analysis of variance was used to detect differences in each loading and ROM measure before and after surgery. Post surgically, patients indicated that they had less pain and a higher rating of functional status (p<0.05). Differences were found in active dorsiflexion, active plantar flexion, and passive plantar flexion of the MP joint (p<0.05). No differences were found in talocrural ROM or MP neutral position. Radiographic measures indicated that HV and IM angles were changed following surgery (p<0.05). The average correction for HV angle was 14.0 degrees and 4.6 degrees for IM angle. No differences in loading were found for the HL, MF, MFF regions post surgically. Force time integrals increased from 15.7 BW(*)s to 18.8 BW(*)s post surgically in the CFF region (p<0.05). The LFF region exhibited a greater peak force (22.12 %BW vs. 27.12 %BW), force time integral (7.14 %BW(*)s vs. 9.04 %BW(*)s), pressure time integral (9.24 N/cm2(*)s vs. 12.10 N/cm2(*)s), instant to peak force (520.73 ms vs. 592.03 ms) and instant to peak pressure (548.40 ms vs. 607.97 ms) post surgically (p<0.05). Peak force and peak pressure decreased from 15.11 %BW to 6.92 %BW and 423.24 Kpa to 158.00 Kpa, respectively post surgically (p<0.05). Force time integrals decreased from 3.90 %BW(*)s to 1.72 %BW(*)s and pressure time integrals decreased from 10.41 Kpa(*)s to 4.40 Kpa(*)s post surgically (p<0.05). Contact time in the LT region increased from 627.57 ms to 575.33 ms post surgically (p<0.05). All pain scale and functional status measures improved eight weeks post surgically. Dorsiflexion ROM for the MP joint were decreased post surgically but were still adequate for gait (Hetherington et al., 1990). Loading variables indicated that, post surgically, the foot was loaded more laterally with less load on the hallux. Further research is needed to assess if the lateral loading

Kernozek, TW; Roehrs, TD; McGarvey, S

1997-04-01

126

Heel and toe driving on fuel cell vehicle  

DOEpatents

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

Choi, Tayoung; Chen, Dongmei

2012-12-11

127

Nordic walking practice might improve plantar pressure distribution.  

PubMed

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

2011-12-01

128

The accuracy of an automasking algorithm in plantar pressure measurements.  

PubMed

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. PMID:22294959

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

2011-02-01

129

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.

2010-01-01

130

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

PubMed

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

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

1995-09-01

131

A comparison of two pressure-relieving devices on the prevention of heel pressure ulcers.  

PubMed

The effectiveness of hospital pillows versus a commercial heel elevation device (the Foot Waffle [EHOB incorporated]) in preventing heel pressure ulcers was examined using an experimental balanced factorial design with repeated measures on 52 patients (ages 27 to 90) in randomized groups. Heel interface pressures were taken with patients in supine and right lateral tilt positions. Logistic regression demonstrated a statistically significant difference between interface pressures on left and right heels (p = .004) and a trend toward significance between the pillow and Foot Waffle (p = .069). The Generalized Estimating Equations (GEE) method revealed the Foot Waffle was four times more likely not to suspend the heel off the bed than the pillow, and the left heel was four-and-a-half times more likely to have higher interface pressures than the right. There was no significant difference between groups in incidence of lower-extremity pressure ulcers, but patients using the Foot Waffle developed pressure ulcers significantly sooner (10 days versus 13 days for the pillow). Heels require additional protection beyond the use of specially beds and mattress overlays. In order to provide continuous heel suspension, clinicians must consider proper fit, turning schedules, patient position, patient activity, and presence of additional equipment when selecting heel protection products. This study illustrates how difficult it is to control for all these factors when doing clinical research. Note: This study was done with a Foot Waffle model that has since been redesigned. No research is available on the new model. PMID:9204803

Tymec, A C; Pieper, B; Vollman, K

1997-01-01

132

The Effect of Target Strain Error on Plantar Tissue Stress  

PubMed Central

Background Accurate quantification of soft tissue properties, specifically the stress-relaxation behavior of viscoelastic tissues such as plantar tissue, requires precise testing under physiologically relevant loading. However, limitations of testing equipment often result in target strain errors that can contribute to large stress errors and confound comparative results to an unknown extent. Previous investigations have modeled this artifact but they have been unable to obtain empirical data to validate their models. Moreover, there are no studies that address this issue for plantar tissue. The purpose of this research was to directly measure the difference in peak force for a series of small target strain errors within the range of our typical stress-relaxation experiments for subcutaneous plantar soft tissue. Method of Approach Five plantar tissue specimens were tested to seven incremental target strain error levels of ?0.9%, ?0.6%, ?0.3%, 0.0%, 0.3%, 0.6%, and 0.9%, so as to undershoot and overshoot the target displacement in 0.3% increments. The imposed strain errors were accurately attained using a special compensation feature of our materials testing software that can drive the actuator to within 0% (1 to 2?m) of the target level for cyclic tests. Since stress-relaxation tests are not cyclic, we emulated the ramp portion of our stress relaxation tests with 5Hz triangle waves. Results The average total stress variation for all specimens was 25±5%, with the highest and lowest stresses corresponding to the largest and smallest strain errors of 0.9% and ?0.9% respectively. A strain overshoot of 0.3%, the target strain error observed in our typical stress relaxation experiments, corresponded to an average stress overshoot of 3±1%. Conclusions Plantar tissue in compression is sensitive to small target strain errors that can result in stress errors that are several fold larger. The extent to which overshoot may affect the peak stress will likely differ in magnitude for other soft tissues and loading modes.

Pai, Shruti; Ledoux, William R.

2012-01-01

133

Docetaxel-associated palmar-plantar erythrodysesthesia: a case report and review of the literature.  

PubMed

Docetaxel-associated palmar-plantar erythrodysesthesia is rarely reported in literature, particularly when used in the treatment of sarcomas. Here, we report a case of docetaxel-related palmar-plantar erythrodysesthesia in a 28-year-old male with recurrent Ewing sarcoma. Although palmar-plantar erythrodysesthesia has been seen in the literature for 30 years, there has still been little progress in understanding and appropriately addressing this adverse effect. This case report and literature review illustrates an infrequently documented adverse skin reaction and discusses the etiology, presentation, and available treatment options for palmar-plantar erythrodysesthesia. PMID:23478198

Harris, Christy S; Wang, Dorothy; Carulli, Alison

2014-02-01

134

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

2010-01-01

135

Distribution and correlates of plantar hyperkeratotic lesions in older people  

PubMed Central

Background Plantar hyperkeratotic lesions are common in older people and are associated with pain, mobility impairment and functional limitations. However, little has been documented in relation to the frequency or distribution of these lesions. The aim of this study was to document the occurrence of plantar hyperkeratotic lesions and the patterns in which they occur in a random sample of older people. Methods A medical history questionnaire was administered to a random sample of 301 people living independently in the community (117 men, 184 women) aged between 70 and 95 years (mean 77.2, SD 4.9), who also underwent a clinical assessment of foot problems, including the documentation of plantar lesion locations, toe deformities and the presence and severity of hallux valgus. Results Of the 301 participants, 180 (60%) had at least one plantar hyperkeratotic lesion. Those with plantar lesions were more likely to be female (?2 = 18.75, p < 0.01; OR = 2.86), have moderate to severe hallux valgus (?2 = 6.15, p < 0.02; OR = 2.95), a larger dorsiflexion range of motion at the ankle (39.4 ± 9.3 vs 36.3 ± 8.4°; t = 2.68, df = 286, p < 0.01), and spent more time on their feet at home (5.1 ± 1.0 vs 4.8 ± 1.3 hours, t = -2.46, df = 299, p = 0.01). No associations were found between the presence of plantar lesions and body mass index, obesity, foot posture, dominant foot or forefoot pain. A total of 53 different lesions patterns were observed, with the most common lesion pattern being "roll-off" hyperkeratosis on the medial aspect of the 1st metatarsophalangeal joint (MPJ), accounting for 12% of all lesion patterns. "Roll-off" lesions under the 1st MPJ and interphalangeal joint were significantly associated with moderate to severe hallux valgus (p < 0.05), whereas lesions under the central MPJs were significantly associated with deformity of the corresponding lesser toe (p < 0.05). Factor analysis indicated that 62% of lesion patterns could be grouped under three broad categories, relating to medial, central and lateral locations. Conclusion Plantar hyperkeratotic lesions affect 60% of older people and are associated with female gender, hallux valgus, toe deformity, increased ankle flexibility and time spent on feet, but are not associated with obesity, limb dominance, forefoot pain or foot posture. Although there are a wide range of lesion distribution patterns, most can be classified into medial, central or lateral groups. Further research is required to determine whether these patterns are related to the dynamic function of the foot or other factors such as foot pathology or morphology.

Spink, Martin J; Menz, Hylton B; Lord, Stephen R

2009-01-01

136

Diagnosis and management of chronic compartment syndrome  

Microsoft Academic Search

Background. This article describes the diagnosis and management of chronic compartment syndrome and functional popliteal entrapment syndrome, unusual causes for claudication in young adults. Methods. A total of 276 patients (<50 years old) with isolated muscle cramping, swelling, and plantar paresthesia were routinely evaluated with compartment pressures (normal < 15 mm Hg), stress plethysmography, and selectively evaluated with pulse volume

William D Turnipseed

2002-01-01

137

Prediction of plantar shear stress distribution by artificial intelligence methods.  

PubMed

Shear forces under the human foot are thought to be responsible for various foot pathologies such as diabetic plantar ulcers and athletic blisters. Frictional shear forces might also play a role in the metatarsalgia observed among hallux valgus (HaV) and rheumatoid arthritis (RA) patients. Due to the absence of commercial devices capable of measuring shear stress distribution, a number of linear models were developed. All of these have met with limited success. This study used nonlinear methods, specifically neural network and fuzzy logic schemes, to predict the distribution of plantar shear forces based on vertical loading parameters. In total, 73 subjects were recruited; 17 had diabetic neuropathy, 14 had HaV, 9 had RA, 11 had frequent foot blisters, and 22 were healthy. A feed-forward neural network (NN) and adaptive neurofuzzy inference system (NFIS) were built. These systems were then applied to a custom-built platform, which collected plantar pressure and shear stress data as subjects walked over the device. The inputs to both models were peak pressure, peak pressure-time integral, and time to peak pressure, and the output was peak resultant shear. Root-mean-square error (RMSE) values were calculated to test the models' accuracy. RMSE/actual shear ratio varied between 0.27 and 0.40 for NN predictions. Similarly, NFIS estimations resulted in a 0.28-0.37 ratio for local peak values in all subject groups. On the other hand, error percentages for global peak shear values were found to be in the range 11.4-44.1. These results indicate that there is no direct relationship between pressure and shear magnitudes. Future research should aim to decrease error levels by introducing shear stress dependent variables into the models. PMID:19725696

Yavuz, Metin; Ocak, Hasan; Hetherington, Vincent J; Davis, Brian L

2009-09-01

138

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

ERIC Educational Resources Information Center

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

Liu, Yuanlong; Wang, Yong Tai

2004-01-01

139

The influence of lateral heel flare of running shoes on pronation and impact forces.  

PubMed

The purpose of this investigation was to study the influence of the flare at the lateral side of the heel of running shoes on: initial and total pronation; impact forces in heel-toe running; and to explain the results with a mechanical model. The experimental part of the study was performed by using 14 male runners. Their running movement (4 m/s) was quantified by using a force platform and high-speed film (100 frames X s-1). Three shoes were used, identical except in their lateral heel flare, one shoe with a conventional flare of 16 degrees, a second shoe with no flare, and a third shoe with a rounded heel (negative flare). The experimental results indicate that (for the used set of shoes); increasing heel flare increases the amount of initial pronation; changes in heel flare do not affect the magnitude of the total pronation; and changes in heel flare do not alter the magnitude of the impact force peaks. Since shoes with rounded lateral heels do reduce initial pronation, it is speculated that this construction could be used to prevent anterior medial compartment syndrome at the tibia of runners. It was concluded that more research is needed to specify whether the reported result is representative for various shoe types or is shoe specific. PMID:3600244

Nigg, B M; Morlock, M

1987-06-01

140

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

2007-01-01

141

The Effect of 3 MHz Ultrasound on the Treatment of Plantar Warts  

Microsoft Academic Search

Background and purpose. Verrucae, or warts, are common, contagious epidermal tumors that plague many individuals. They are caused by the human papillomavirus (HPV) that often enters the skin through small cuts and abrasions. Our research focused on warts found on the sole of the foot, known as plantar warts. Most plantar warts are benign, but can be rather painful since

Wendy Neglay; Gina Paine

2001-01-01

142

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

2009-01-01

143

Improvement of plantar tactile sensitivity by stochastic resonance for prevention of falling  

Microsoft Academic Search

For a senior person, the fall is danger with the risk of the injuries such as bone fractures. Plantar tactile sensibility is one of the senses contributing to stability of gait. In this study, we develop a device improving plantar tactile sensitivity by stochastic resonance to improve stability of gait of elderly person. For development of the device, we tested

Satoshi Kudoh; Ming Ding; Hirohsi Takemura; Hiroshi Mizoguchi

2011-01-01

144

Injury Reduction Effectiveness of Assigning Running Shoes Based on Plantar Shape in Marine Corps Basic Training  

Microsoft Academic Search

Background: Shoe manufacturers market motion control, stability, and cushioned shoes for plantar shapes defined as low, normal, and high, respectively. This assignment procedure is presumed to reduce injuries by compensating for differences in running mechanics.Hypothesis: Assigning running shoes based on plantar shape will not reduce injury risk in Marine Corps basic training.Study Design: Randomized controlled clinical trial; Level of evidence,

Joseph J. Knapik; Daniel W. Trone; David I. Swedler; Adriana Villasenor; Steve H. Bullock; Emily Schmied; Timothy Bockelman; Peggy Han; Bruce H. Jones

2010-01-01

145

RELIABILITIES OF PLANTAR PRESSURE MEASURES: SYMMETRY INDICES DURING RUNNING AT TWO DIFFERENT VELOCITIES  

Microsoft Academic Search

Reliabilities (REL) of 4 plantar pressure parameters (PPP) and 4 symmetry indices (SI) were assessed during the support phase of treadmill running at 8 and 14 km*hr -1 . Bilateral plantar pressure was recorded for 11 female and 9 male students with Pedar insoles during 4 right and 4 left foot contacts at each velocity. The RELs of 4 PPP

David Ben-Sira; Moshe Ayalon

146

Resistance exercise prevents plantar flexor deconditioning during bed rest  

NASA Technical Reports Server (NTRS)

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

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

1997-01-01

147

Symptomatic plantar fibroma with a unique sonographic appearance.  

PubMed

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

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

2012-02-01

148

Analysis of Changes in Muscle Length of Lower Limbs during High-heeled Walking Based on the Musculoskeletal Model  

Microsoft Academic Search

In this paper, we analyzed changes in muscle length of lower limbs during high-heel walking based on the musculoskeletal model. Twenty young healthy women participated in this study. For each subject, the 3D motion analysis was performed for four different cases; walking with flat shoe, 3 cm high-heel, 6 cm high-heel, and 9 cm high-heel. Then the musculoskeletal model, with

Jongsang Son; Hueseok Choi; Youngho Kim

2008-01-01

149

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

PubMed

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

2013-01-01

150

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

PubMed

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

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

2011-05-01

151

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

PubMed

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

Ko, Dong Yeol; Lee, Han Suk

2013-10-01

152

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

PubMed

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

1989-11-01

153

Quantitative heel ultrasound variables in powerlifters and controls  

PubMed Central

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

Jawed, S; Horton, B; Masud, T

2001-01-01

154

Free medial plantar artery flap for the reconstruction of great toe pulp.  

PubMed

The great toe is an important body structure both functionally and cosmetically. The defect over the great toe is very challenging to treat. Our patient was a 9-year-old boy, presenting with posttraumatic loss of partial right great toe pulp. The mode of injury was the toe getting caught in the cycle wheel and sustaining amputation of the plantar aspect of the great toe. The great toe with exposed bone was reconstructed with a free medial plantar artery flap, harvested from the same limb. To our best knowledge, this was the first reported case of free medial plantar artery flap used for the reconstruction of great toe defects. PMID:24472390

Jyoshid, R B; Vardhan, Harsha; Anto, Francis

2014-06-01

155

Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial  

PubMed Central

Objective To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts. Design A multicentre, open, two arm randomised controlled trial. Setting University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland. Participants 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. Interventions Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks. Main outcome measures Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment. Results There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI –8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients’ preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference –3.15% (–16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar warts at 12 weeks (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). Conclusions Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts. Trial registration Current Controlled Trials ISRCTN18994246, National Research Register N0484189151.

2011-01-01

156

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

NASA Technical Reports Server (NTRS)

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

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

2007-01-01

157

A New Distal Arthrogryposis Syndrome Characterized by Plantar Flexion Contractures  

PubMed Central

The distal arthrogryposis (DA) syndromes are a distinct group of disorders characterized by contractures of two or more different body areas. More than a decade ago, we revised the classification of DAs and distinguished several new syndromes. This revision has facilitated the identification of five genes (i.e., TNNI2, TNNT3, MYH3, MYH8, and TPM2) that encode components of the contractile apparatus of fast-twitch myofibers and cause DA syndromes. We now report the phenotypic features of a novel DA disorder characterized primarily by plantar flexion contractures in a large five-generation Utah family. Contractures of hips, elbows, wrists, and fingers were much milder though they varied in severity among affected individuals. All affected individuals had normal neurological examinations; electromyography and creatinine kinase levels were normal on selected individuals. We have tentatively labeled this condition distal arthrogryposis type 10 (DA10).

Stevenson, D.A.; Swoboda, K.J.; Sanders, R.K.; Bamshad, M.

2011-01-01

158

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.

2010-01-01

159

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

PubMed Central

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

Stainsby, G. D.

1997-01-01

160

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

PubMed

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

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

2012-01-01

161

Traumatic Lateral Plantar Artery Pseudoaneurysm and the Use of Time-Resolved MR Angiography  

PubMed Central

Vascular injury resulting in pseudoaneurysm formation in the plantar aspect of the foot is an uncommon injury after trauma. Such injuries are more often reported in the lateral plantar artery rather than the medial plantar artery, most likely because of its more superficial location. Traditional modalities in diagnosis have included ultrasound and digital subtraction angiography. We present a case of traumatic pseudoaneurysm of the lateral plantar artery following a foot laceration. Diagnosis was made by the use of high-resolution, time-resolved contrast-enhanced 3D magnetic resonance angiography, also referred to as “TRICKS” (time-resolved imaging of contrast kinetics). This technique provided high spatial resolution for the arterial anatomy as well as temporal resolution which allowed better delineation of the hemodynamic characteristics of the pseudoaneurysm. Electronic supplementary material The online version of this article (doi:10.1007/s11420-010-9170-3) contains supplementary material, which is available to authorized users.

Chang, Anthony; Foo, Li Foong

2010-01-01

162

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

2000-01-01

163

Bilateral deficit in plantar flexion: relation to knee joint position, muscle activation, and reflex excitability  

Microsoft Academic Search

Six male subjects made maximal isometric plantar flexions unilaterally (UL) and bilaterally (BL), with the knee joint angle\\u000a positioned at 90° and 0° (full extension) and the ankle joint kept at 90°. Plantar flexion torque and electromyogram (EMG)\\u000a of the lateral gastrocnemius (LG) and the soleus (Sol) muscles were recorded. There was a deficit in torque in BL compared\\u000a to

Yasuo Kawakami; Digby G. Sale; J. Duncan MacDougall; John S. Moroz

1998-01-01

164

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

PubMed Central

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

Schaefer, Sabine; Lindenberger, Ulman

2013-01-01

165

[The design of plantar pressure distribution monitoring system and preliminary clinical application].  

PubMed

Plantar pressure distribution can reflect the force of several key points on foot while standing and walking. A comprehensive understanding of the plantar pressure distribution makes great sense in the following aspects: the understanding of the normal foot biomechanics and function, clinical diagnosis, measurement of disease extent, postoperative efficacy evaluation, and rehabilitation research. A simple plantar pressure measurement device was designed in this study. This paper uses FlexiForce flexible sensor to pickup plantar pressure signal and USB A/D board to do data acquisition. The data are transferred into a laptop and processed by a VB-based software which can display, remember and replay the data. We chose patients with hallux valgus and normal people to measure the pressure distribution and make contrast analysis of plantar pressure with this device. It can be concluded that people with hallux valgus have higher pressure on the second metatarsophalangeal joint and the distribution move outward. The plantar pressure of patients postoperative could be greatly improved compared to the preoperative. The function of this device has been confirmed. PMID:25039156

Zhu, Xianfeng; Zhao, Zilei; Xu, Donghao; Xu, Dongming

2014-04-01

166

Short term alteration of balance control after a reduction of plantar mechanoreceptor sensation through cooling.  

PubMed

Proprioceptive inputs from the plantar sole contribute to balance control during normal quiet standing. This study investigated the cooling of plantar sole mechanoreceptors through ice immersion and its effects on balance control and lower leg muscle activity. Ten healthy males participated in this study. Plantar sole sensitivity was tested using the two point discriminatory test and the Von Frey monofilaments test. Plantar sole cooling was achieved through foot immersion in ice water. Balance control was measured using a force platform with seven trials (30s) performed before and after ice water foot immersion. Lower limb balance control muscle activity was measured with electromyography. Ice cooling reduced the plantar sole sensitivity of the foot. A short term alteration in balance control was observed with only the first trial showing significantly greater speed and RMS of the velocity of the centre of pressure in the cooling condition when compared to control trials before cooling. Muscular activity increased following the first trial. The adaptation observed after the short term alteration of balance control, could result from sensory reweighting processes. It is suggested that the muscular activity increase is evidence of sensory reweighting and contributes to the regulation of balance control when the plantar sole sensation is partially inhibited. PMID:23305721

Billot, Maxime; Handrigan, Grant A; Simoneau, Martin; Corbeil, Philippe; Teasdale, Normand

2013-02-22

167

Myxochondroid metaplasia of the plantar foot: a distinctive pseudoneoplastic lesion resembling nuchal fibrocartilaginous pseudotumor and the equine digital cushion.  

PubMed

Cartilaginous tumors of soft tissue are uncommon, with benign chondromas of soft parts greatly outnumbering rare soft-tissue chondrosarcomas. Over the past several years, we have seen in consultation a distinctive, benign-appearing chondroid soft-tissue lesion of the plantar foot that differs in a number of respects from chondroma of soft parts. Herein we report our experience with this distinctive lesion. A retrospective review of all cases from the foot in our soft-tissue consultation and institutional surgical pathology archives identified 9 similar cases, most often previously coded as 'fibroconnective tissue with chondroid metaplasia'. Six cases were submitted in consultation due to concern for a neoplastic process, in particular chondroma of soft parts or fibro-osseous pseudotumor of the digits. The patients were 4 young males (age range 8-16 years, mean 11.5 years) and 5 older patients, including 4 women and 1 man (age range 34-78 years, mean 56.4 years). All cases occurred in the subcutaneous plantar soft tissues of the feet, including four cases confined to the toes, and presented as non-specific, variably painful masses. Radiographic studies, available in six cases, did not show any evidence of bone involvement. Histologically, the lesions were characterized by a partially circumscribed, variably cellular proliferation of bland fibroblastic cells in a fibromyxoid background in areas showing distinct stromal basophilia and a chondroid appearance. Small foci of true cartilaginous metaplasia with lacuna formation were occasionally seen. Cartilaginous differentiation was confirmed in three cases with immunohistochemistry for S100 and ERG proteins. Intralesional cystic change was common, as were a variety of other reactive-appearing changes in the surrounding connective tissue. Characteristic morphological features of chondroma of soft parts and/or fibro-osseous pseudotumor of the digits were absent. Clinical follow-up (7 patients, 2-115 months, median 38 months) showed all patients to be without recurrent disease. We have identified a morphologically distinctive lesion of the foot that appears to represent a reactive, metaplastic process, presumably secondary to chronic mechanical stress. The morphological features of myxochondroid metaplasia of the plantar foot are reminiscent of those of nuchal fibrocartilaginous pseudotumor and the equine digital cushion, further suggesting a reactive/reparative etiology. Awareness of the unique features of this lesion should allow its ready distinction from other neoplastic and pseudoneoplastic (osteo) cartilaginous lesions of the feet. PMID:23765248

Shon, Wonwoo; Folpe, Andrew L

2013-12-01

168

Determinants of premature infant pain responses to heel sticks.  

PubMed

The exposure of premature infants to stressors, such as pain intended to ensure their survival, may instead alter their brain development and contribute to several learning and behavioral difficulties observed in later childhood. The objective of this descriptive, cross-sectional study was to compare the pain responses of 72 preterm infants to a heel stick procedure taking into consideration a variety of factors, including the use of opioids and sedatives. The pain scores assessed on the Preterm Infant Pain Profile (PIPP) scale were highest for the lowest gestational age (GA) group. Multiple linear regression analysis with the four predictor variables noted to be correlated with the PIPP scores (GA, type of needle, severity of illness, and behavioral state) indicated a significant overall relationship (F [5/66] = 5.62, p < 0.01) and accounted for 44% of the variance. All but severity of illness did not add significantly to the variance. Gender, postnatal age, amount, opioids, and sedatives used were not correlated to the PIPP scores. It was concluded that sick premature infants and those who have been exposed to a variety of painful procedures may not manifest behavioral or physiological signs of pain, but may be the most to benefit from precise pain assessment and prudent management. PMID:20687304

Badr, Lina Kurdahi; Abdallah, Bahia; Hawari, Mirvat; Sidani, Saadieh; Kassar, May; Nakad, Pascale; Breidi, Julianna

2010-01-01

169

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

SciTech Connect

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

Yu, Yongjian [X-ray Products, Varian Medical Systems Inc., Liverpool, New York 13088 (United States)] [X-ray Products, Varian Medical Systems Inc., Liverpool, New York 13088 (United States); Wang, Jue [Department of Mathematics, Union College, Schenectady, New York 12308 (United States)] [Department of Mathematics, Union College, Schenectady, New York 12308 (United States)

2013-08-15

170

Lower leg muscle strengthening does not redistribute plantar load in diabetic polyneuropathy: a randomised controlled trial  

PubMed Central

Background Higher plantar pressures play an important role in the development of plantar foot ulceration in diabetic polyneuropathy and earlier studies suggest that higher pressures under the forefoot may be related to a decrease in lower leg muscle strength. Therefore, in this randomised controlled trial we evaluated whether lower-extremity strength training can reduce plantar pressures in diabetic polyneuropathy. Methods This study was embedded in an unblinded randomised controlled trial. Participants had diabetes and polyneuropathy and were randomly assigned to the intervention group (n?=?48) receiving strength training during 24 weeks, or the control group (n?=?46) receiving no intervention. Plantar pressures were measured in both groups at 0, 12, 24 and 52 weeks. A random intercept model was applied to evaluate the effects of the intervention on peak pressures and pressure–time-integrals, displacement of center-of-pressure and the forefoot to rearfoot pressure–time-integral-ratio. Results Plantar pressure patterns were not affected by the strength training. In both the intervention and control groups the peak pressure and the pressure–time-integral under the forefoot increased by 55.7 kPa (95% CI: 14.7, 96.8) and 2.0 kPa.s (95% CI: 0.9, 3.2) over 52 weeks, respectively. Both groups experienced a high number of drop-outs, mainly due to deterioration of health status and lower-extremity disabilities. Conclusions Plantar pressures under the forefoot increase progressively over time in people with diabetic polyneuropathy, but in this study were not affected by strength training. Future intervention studies should take this increase of plantar pressure into account and alternative interventions should be developed to reduce the progressive lower extremity problems in these patients. Trial registration This study was embedded in a clinical trial with trial number NCT00759265.

2013-01-01

171

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

2011-01-01

172

An Achilles' Heel in an Amyloidogenic Protein and Its Repair  

PubMed Central

Insulin fibrillation provides a model for a broad class of amyloidogenic diseases. Conformational distortion of the native monomer leads to aggregation-coupled misfolding. Whereas ?-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 13C NMR chemical shifts and rapid 15N-detected 1H-2H amide-proton exchange were observed in one of the three classical ?-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 13C NMR studies suggest that the A-chain segment participates in a fibril-specific ?-sheet. Accordingly, we investigated whether helicogenic substitutions in the A1–A8 segment might delay fibrillation. Simultaneous substitution of three ?-branched residues (IleA2 ? Leu, ValA3 ? Leu, and ThrA8 ? His) yielded an analog with reduced thermodynamic stability but marked resistance to fibrillation. Whereas amide-proton exchange in the A1–A8 segment remained rapid, 13C? chemical shifts exhibited a more helical pattern. This analog is essentially without activity, however, as IleA2 and ValA3 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 13C? 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.

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.

2010-01-01

173

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

PubMed

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

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

2014-02-01

174

Increased forefoot loading is associated with an increased plantar flexion moment.  

PubMed

The aim of this study was to identify the cascade of effects leading from alterations in force generation around the ankle joint to increased plantar pressures under the forefoot. Gait analysis including plantar pressure measurement was performed at an individually preferred and a standardized, imposed gait velocity in diabetic subjects with polyneuropathy (n=94), without polyneuropathy (n=39) and healthy elderly (n=19). The plantar flexion moment at 40% of the stance phase was negatively correlated with the displacement rate of center of pressure (r=-.749, p<.001 at the imposed, and r=-.693, p<.001 at the preferred gait velocity). Displacement rate of center of pressure was strongly correlated with forefoot loading (r=-.837, p<.001 at the imposed, and r=-.731, p<.001 at the preferred gait velocity). People with a relatively high plantar flexion moment at 40% of the stance phase, have a faster forward transfer of center of pressure and consequently higher loading of the forefoot. This indicates that interventions aimed at increasing the control of the roll-off of the foot may contribute to a better plantar pressure distribution. PMID:23958476

Melai, Tom; Schaper, Nicolaas C; Ijzerman, T Herman; de Lange, Ton L H; Willems, Paul J B; Meijer, Kenneth; Lieverse, Aloysius G; Savelberg, Hans H C M

2013-08-01

175

Plantar flexion seems more reliable than dorsiflexion with Labat's sciatic nerve block: a prospective, randomized comparison.  

PubMed

Labat's classic approach to the sciatic nerve has not been able to show which motor response of the foot provides a more frequent rate of complete sensory and motor block. In this prospective, randomized, double-blind study, we compared plantar flexion with dorsiflexion with regard to onset time and efficacy of sciatic nerve block using the classic posterior approach. A total of 80 patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block after evoked plantar flexion (n=40) or dorsiflexion (n=40). Twenty milliliters of 0.75% ropivacaine was injected after the motor response was elicited at <0.5 mA. Success rate was defined as complete sensory and motor block in all sciatic nerve distributions associated with a pain-free surgery. Time required for onset of sensory and motor block of the foot was recorded. Success was more frequent after elicited plantar flexion (87.5%) than dorsiflexion (55%; P <0.05). Onset of complete sensory and motor block of the foot was faster after elicited plantar flexion (10 +/- 10 min and 13 +/- 10 min, respectively) compared with dorsiflexion (20 +/- 11 min and 24 +/- 12 min; P <0.05). We conclude that plantar flexion of the foot predicts a shorter onset time and a more frequent success rate than dorsiflexion with Labat's classic posterior sciatic nerve block. PMID:15616086

Taboada, Manuel; Atanassoff, Peter G; Rodríguez, Jaime; Cortés, Joaquín; Del Rio, Sabela; Lagunilla, Juan; Gude, Francisco; Alvarez, Julián

2005-01-01

176

Steadiness in plantar flexor muscles and its relation to postural sway in young and elderly adults.  

PubMed

To investigate the functional significance of force fluctuations during voluntary contraction with a select muscle group, we examined the association between force fluctuations during voluntary contraction with plantar flexor muscles and postural sway during quiet standing in 20 young and 20 elderly adults. Young and elderly subjects maintained a quiet standing position on a force platform. They also performed a force-matching task with unilateral isometric plantar flexion. A positive correlation was found in young and elderly adults between the coefficient of variation (CV) of center of pressure during quiet standing and the CV of force during plantar flexion only at contraction intensities of < or =5% maximum voluntary contraction that corresponded to muscle activity during quiet standing. The electromyogram power in the medial gastrocnemius was greater in the elderly than in young adults by approximately 10 Hz during quiet standing and at low contraction intensities during plantar flexion. Fluctuations in motor output during low-intensity plantar flexion were associated with postural sway during quiet standing in both young and elderly adults. PMID:20544908

Kouzaki, Motoki; Shinohara, Minoru

2010-07-01

177

Hallux valgus and plantar pressure loading: the Framingham foot study  

PubMed Central

Background Hallux valgus (HV), a common structural foot deformity, can cause foot pain and lead to limited mobility. The purpose of this study was to evaluate differences in plantar pressure and force during gait by HV status in a large population-based cohort of men and women. Methods A trained examiner performed a validated physical examination on participants’ feet and recorded the presence of hallux valgus and other specific foot disorders. Each foot was classified into one of four mutually exclusive groups based on the foot examination. Foot groups were: (i) HV only, (ii) HV and at least one additional foot disorder (FD), (iii) no HV but at least one other FD, and (iv) neither HV nor FD (referent). Biomechanical data for both feet were collected using Tekscan Matscan. Foot posture during quiet standing, using modified arch index (MAI), and foot function during gait, using center of pressure excursion index (CPEI), were calculated per foot. Further, walking scans were masked into eight sub-regions using Novel Automask, and peak pressure and maximum force exerted in each region were calculated. Results There were 3205 participants, contributing 6393 feet with complete foot exam data and valid biomechanical measurements. Participants with HV had lower hallucal loading and higher forces at lesser toes as well as higher MAI and lower CPEI values compared to the referent. Participants with HV and other FDs were also noted to have aberrant rearfoot forces and pressures. Conclusions These results suggest that HV alters foot loading patterns and pressure profiles. Future work should investigate how these changes affect the risk of other foot and lower extremity ailments.

2013-01-01

178

Syndactyly correction using a venous flap with the plantar cutaneous venous arch.  

PubMed

A combination of skin grafts and local flaps is widely used in the reconstruction of syndactyly of the toes. Covering the skin defect without skin grafts on the unilateral side of the toe is preferred, and for this purpose, a rotated flap from the plantar area is typically used. However, the flap can become ischemic or congested in some cases. To avoid this, we elevated a plantar flap with the plantar cutaneous venous arch using a triangular venous flap and covered the lateral side of the web in 7 cases of syndactyly. The dorsal flap was used to create the new web, and the opposite lateral side was reconstructed using a skin graft. The flap circulation was stable, the pedicle of the flap was narrow, and the flap relocation was simple. No flap in any patient showed any evidence of congestion or ischemia. Follow-up demonstrated that the new web was patent in all cases, with no evidence of contraction. PMID:24841825

Sakamoto, Natsuki; Matsumura, Hajime; Komiya, Takako; Imai, Ryutaro; Niyaz, Ahmatjan; Watanabe, Katsueki

2014-06-01

179

Anterior cruciate ligament rupture secondary to a 'heel hook': a dangerous martial arts technique.  

PubMed

The 'heel hook' is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a 'heel hook'. PMID:19629437

Baker, Joseph F; Devitt, Brian M; Moran, Ray

2010-01-01

180

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

PubMed

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

2009-01-01

181

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

PubMed Central

Changes in the plantar soft tissue shear properties may contribute to ulceration in diabetic patients, however, little is known about these shear parameters. This study examines the elastic and viscoelastic shear behavior of both diabetic and non-diabetic plantar tissue. Previously compression tested plantar tissue specimens (n = 54) at six relevant plantar locations (hallux, first, third, and fifth metatarsal heads, lateral midfoot, and calcaneus) from four cadaveric diabetic feet and five non-diabetic feet were utilized. Per in vivo data (i.e., combined deformation patterns of compression followed by shear), an initial static compressive strain (36–38%) was applied to the tissue followed by target shear strains of 50% and 85% of initial thickness. Triangle waves were used to quantify elastic parameters at both strain levels and a stress relaxation test (0.25s ramp and 300s hold) was used to quantify the viscoelastic parameters at the upper strain level. Several differences were found between test groups including a 52–62% increase in peak shear stress, a 63% increase in toe shear modulus, a 47% increase in final shear modulus, and a 67% increase in middle slope magnitude (sharper drop in relaxation) in the diabetic tissue. Beyond a 54% greater peak compressive stress in the third metatarsal compared to the lateral midfoot, there were no differences in shear properties between plantar locations. Notably, this study demonstrates that plantar soft tissue with diabetes is stiffer than healthy tissue, thereby compromising its ability to dissipate shear stresses borne by the foot that may increase ulceration risk.

Pai, Shruti; Ledoux, William R.

2011-01-01

182

The age-dependent deterioration in light touch sensation on the plantar aspect of the foot in a rural community in India: implications when screening for sensory impairment.  

PubMed

Regular testing for impaired sensation is important in the management of diseases that can cause progressive nerve damage, such as leprosy. It has been shown that light touch sensibility decreases with age in the hands of healthy individuals, but little research has been undertaken to assess possible changes in the feet in developing countries. This information is needed to allow an appropriate level of sensation to be chosen when screening for nerve damage in the foot. To clarify this, a cross-sectional study on male adults was carried out in the rural town of Salur, Andhra Pradesh, India. A range of Semmes-Weinstein monofilaments were employed at 12 locations on the foot to determine sensation to light touch stimuli in individuals from each decade of adult life. It was found that in this population, sensibility threshold in the foot increases with age and this was noted in both soft and callous skin. This shows the increase was due to neurological factors, not merely due to an increase in callous deposition with advancing age. In the majority of individuals in their fifties and sixties, the callous skin at the forefoot and heel was unable to detect the 5.07 monofilament (equivalent to 8-12 g), previously recommended as a method to screen for plantar neuropathy. All areas of all feet were able to detect the 5.46 filament (approximately 30 g). The size of this study (54 individuals) prevents the determination of definitive normal ranges for each decade of life in this population. However, it does demonstrate the degree to which sensation deteriorates with age and could be used as an approximate guide when interpreting the results of sensory testing in similar rural areas of the developing world. PMID:10920612

Mitchell, P D; Mitchell, T N

2000-06-01

183

Treatment for simple plantar verrucae: monochloroacetic acid and 10% formaldehyde versus 10% formaldehyde alone.  

PubMed

Verrucae are small, benign, highly vascular epithelial neoplasms that occur singly or in a multiple presentation. Plantar verrucae are usually caused by infection with human papillomavirus types 1, 2, and 4. A clinical trial was conducted to assess the safety and efficacy of monochloroacetic acid and 10% formaldehyde versus 10% formaldehyde alone in the treatment of simple plantar verrucae. Of 57 patients enrolled in the study, 26 were in the monochloroacetic acid and 10% formaldehyde group and 31 were in the 10% formaldehyde alone group. The overall cure rate for this population was 61.4%. There was no statistically significant difference in the cure rate between treatment groups. PMID:16415283

Jennings, Maureen B; Ricketti, James; Guadara, John; Nach, Wendy; Goodwin, Susan

2006-01-01

184

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

PubMed

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

2005-01-01

185

Rothmund-Thomson syndrome. The first case with plantar keratoderma and the second with coeliac disease.  

PubMed

We report two unusual patients with Rothmund-Thomson syndrome (RTS), a rare genodermatosis. The first patient is a 5-year-old girl with congenital poikiloderma, photosensitivity, plantar punctate keratoderma, stunted growth and severe mental retardation. Plantar keratoderma associated with RTS has been reported only once. The second patient is a 21-year-old female presenting with rounded "moon" face, trunk obesity, coeliac disease, short stature and mild mental retardation. This is the first case of RTS associated with coeliac disease. PMID:16998609

Popadi?, S; Nikoli?, M; Gaji?-Velji?, M; Bonaci-Nikoli?, B

2006-06-01

186

Heel pressure ulcers in orthopedic patients: a prospective study of incidence and risk factors in an acute care hospital.  

PubMed

Heel pressure ulcers (PU) are a major concern in orthopedic patients. A prospective 6-month study was conducted in an acute care hospital in Canada to determine the incidence of heel PU in an orthopedic population, evaluate the effect of patient and care variables on heel PU incidence, and describe the natural history/sequelae of Stage I heel PU. One hundred and fifty (150) patients (average age 70.6 years) admitted for elective orthopedic surgery or treatment of a fractured hip participated in the study. A direct heel skin assessment was performed following admission and before discharge. Patients with a Stage I ulcer were assessed or contacted 1 week following discharge. The incidence of heel PU in this population was 13.3% CI (range 8% to 19%). Incidence was 16% in the hip fracture and 13% in the elective surgery group. PU incidence in the hip fracture group was significantly lower (P = 0.016) for patients receiving heel pressure relief measures (pillows, rolled sheets). In the elective surgery group, PU incidence rates were higher for patients with respiratory disease, lower hemoglobin, low pulse rate, and altered mental status (P <0.05). When both patient groups were combined, only the presence or absence of respiratory disease significantly affected PU incidence. Length of stay was an average of 3 days longer in all groups with a heel PU but the difference was not statistically significant. One week following discharge, 13 of the 17 (76%) Stage I heel PU had resolved, one remained unchanged, and two were assessed as deep tissue injury (11%) and one as Stage II. These incidence rates are similar to those reported in other countries and confirm that efforts to reduce heel PU incidence rates are needed. PMID:20200445

Campbell, Karen E; Woodbury, M Gail; Houghton, Pamela E

2010-02-01

187

SOLID PHASE CHARACTERIZATION OF HEEL SAMPLES FROM TANK 241-C-110  

Microsoft Academic Search

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

PAGE JS; COOKE GA; PESTOVICH JA; HUBER HJ

2011-01-01

188

Hypoglycemia:The Achilles Heel of the Treatment of Children With Type 1 Diabetes  

Microsoft Academic Search

Hypoglycemia is the Achilles heel of the treatment of all indi- viduals with diabetes, and children and adolescents in partic- ular. In the Diabetes Control and Complications Trial (DCCT), the relative risk of severe hypoglycemia due to intensive diabetes management was similar in adolescent and adult subjects; however, rates of severe hypoglycemia were almost doubled in adolescents compared to adults.

Danièle Pacaud

189

Failure Mechanism and Solution Study of IC Wire Bond Heel Crack on Leadframe  

Microsoft Academic Search

Many discussion and activity were focusing on the 1st bond (ball bond) on fine pitch for IC wire bonding in the past few years. However, the industry has been getting more and more challenges on the 2nd bond (stitch bond) to seek the robust interconnect solutions. The weak bond and heel crack are two major issues in terms of the

Meijiang Song; Jinzhong Yao; Yongsheng Lu

2008-01-01

190

Development of a Solid-State Microhydraulic Energy Harvesting Mechanism for Heel Strike Power Harvesting.  

National Technical Information Service (NTIS)

A Microhydraulic Transducer (MHT) device was developed with the goal of extracting energy from heel strike motion. The required power output is approximately 1W, with an associated power density of approximately 0.1-1W/kg. The MHT relies on the incorporat...

J. L. Steyn N. W. Hagood

2003-01-01

191

The heel strike transient during walking in subjects with patellofemoral pain syndrome  

Microsoft Academic Search

ObjectivesThe foot impact during the initial ground contact has been suggested to be related to pain and injury to joints. This study investigated the peak heel strike transient vertical force; its timing and the rearfoot angle relative to the tibia in the frontal plane at this time in 11 females with patellofemoral pain syndrome (PFPS) compared to 14 healthy controls.

Pazit Levinger; Wendy L Gilleard

2005-01-01

192

Tank Farm WM-182 and WM 183 Heel Slurry Samples PSD Results  

SciTech Connect

Particle size distribution (PSD) analysis of INTEC Tank Farm WM-182 and WM-183 heel slurry samples were performed using a modified Horiba LA-300 PSD analyzer at the RAL facility. There were two types of testing performed: typical PSD analysis, and setting rate testing. Although the heel slurry samples were obtained from two separate vessels, the particle size distribution results were quite similar. The slurry solids were from approximately a minimum particle size of 0.5 mm to a maximum of 230 mm-with about 90% of the material between 2-to-133 mm, and the cumulative 50% value at approximately 20 mm. This testing also revealed that high frequency sonication with an ultrasonic element may break-up larger particles in the WM-182 and WM-183 tank from heel slurries. This finding represents useful information regarding ultimate tank heel waste processing. Settling rate testing results were also fairly consistent with material from both vessels in that it appears that most of the mass of solids settle to an agglomerated, yet easily redispersed layer at the bottom. A dispersed and suspended material remained in the "clear" layer above the settled layer after about one-half an hour of settling time. This material had a statistical mode of approximately 5 mm and a maximum particle size of 30 mm.

Batcheller, Thomas Aquinas

2000-09-01

193

Tank Farm WM-182 and WM-183 Heel Slurry Samples PSD Results  

SciTech Connect

Particle size distribution (PSD) analysis of INTEC Tank Farm WM-182 and WM-183 heel slurry samples were performed using a modified Horiba LA-300 PSD analyzer at the RAL facility. There were two types of testing performed: typical PSD analysis, and setting rate testing. Although the heel slurry samples were obtained from two separate vessels, the particle size distribution results were quite similar. The slurry solids were from approximately a minimum particle size of 0.5 mm to a maximum of 230 mm with about 90% of the material between 2-to-133 mm, and the cumulative 50% value at approximately 20 mm. This testing also revealed that high frequency sonication with an ultrasonic element may break-up larger particles in the WM-182 and WM-183 tank from heel slurries. This finding represents useful information regarding ultimate tank heel waste processing. Settling rate testing results were also fairly consistent with material from both vessels in that it appears that most of the mass of solids settle to an agglomerated, yet easily redispersed layer at the bottom. A dispersed and suspended material remained in the ''clear'' layer above the settled layer after about one-half an hour of settling time. This material had a statistical mode of approximately 5 mm and a maximum particle size of 30 mm.

Batcheller, T.A.; Huestis, G.M.

2000-08-31

194

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

2006-01-01

195

Voluntary activation of the ankle plantar flexors following whole-body vibration.  

PubMed

This study investigated the effect of whole-body vibration (WBV) on the voluntary activation of the ankle plantar flexors. Twelve healthy young adults were randomly exposed to two treatments on separate occasions. The first (non-WBV) involved stretching of the plantar flexors at end range of dorsiflexion for five 1-min bouts. The second involved the same stretch with WBV (26 Hz) for five 1-min bouts. Attempted maximal voluntary contractions (AMVCs) of the plantar flexors were performed on an isokinetic dynamometer (30 degrees s(-1)) before and after each treatment. A twitch interpolation technique was used to investigate voluntary activation. Post-treatment data were normalised against pre-treatment data. Subjects were classified as maximally (n = 6) or sub-maximally (n = 6) activated using the pre-treatment twitch interpolation data. The effects of WBV were assessed by repeated measure (RM) MANOVA. After WBV, the group of subjects classified as sub-maximally activated increased peak voluntary torque and rate of voluntary torque production (P < 0.05), whereas angular displacement to peak torque reduced (P < 0.05); i.e. peak torque was produced at a longer muscle length. No significant non-WBV treatment effects were found for this group. No significant WBV effects were found for the group of subjects classified as maximally activated. This study found that the response to WBV was dependent on the level of voluntary activation of the ankle plantar flexors during a set of AMVCs. PMID:19946699

Pellegrini, Michael J; Lythgo, Noel D; Morgan, David L; Galea, Mary P

2010-03-01

196

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

Microsoft Academic Search

Shock absorption and stability during landings is provided by both, gymnast ability and mat properties. The aims of this study were to determine the influence of different mat constructions on their energy absorption and stability capabilities, and to analyse how these properties affect gymnast's plantar pressures as well as subjective mat perception during landing. Six mats were tested using a

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

2010-01-01

197

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

ERIC Educational Resources Information Center

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

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

2014-01-01

198

Second Toe Plantar Free Flap for Volar Tissue Defects of the Fingers  

PubMed Central

Background The reconstruction of volar surface defects is difficult because of the special histologic nature of the tissue involved. The plantar surface is the most homologous in shape and function and could be considered the most ideal of reconstructive options in select cases of volar surface defects. In this paper, we evaluate a single institutional case series of volar tissue defects managed with second toe plantar free flaps. Methods A single-institution retrospective review was performed on 12 cases of reconstruction using a second toe plantar free flap. The mean age was 33 years (range, 9 to 54 years) with a male-to-female ratio of 5-to-1. The predominant mechanism was crush injury (8 cases) followed by amputations (3 cases) and a single case of burn injury. Half of the indications (6 cases) were for soft-tissue defects with the other half for scar contracture. Results All of the flaps survived through the follow-up period. Sensory recovery was related to the time interval between injury and reconstruction-with delayed operations portending worse outcomes. There were no postoperative complications in this series. Conclusions Flexion contracture is the key functional deficit of volar tissue defects. The second toe plantar free flap is the singular flap whose histology most closely matches those of the original volar tissue. In our experience, this flap is the superior reconstructive option within the specific indications dictated by the defect size and location.

Cho, Yong Jin; Kim, Jin Soo; Lee, Dong Chul; Yang, Jae Won

2013-01-01

199

Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain  

Microsoft Academic Search

Objective. The purpose of this investigation was to quantify the longitudinal arch support properties of several types of foot orthosis.Design. An in vitro method that simulated ‘static stance” was used to determine arch support capabilities, with plantar aponeurosis strain implemented as the performance measure.Background. A longitudinal arch support mechanism of an orthosis resists depression of the foot's arches by transferring

GF Kogler; SE Solomonidis; JP Paul

1996-01-01

200

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

PubMed

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

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

2014-01-01

201

Anatomía de la inervación del Hallux: nervio cutáneo dorsal interno y plantar interno  

Microsoft Academic Search

This is a detailed anatomical study of the inervation of hallux in its dorsal and medial aspect of plantar medial nerve and cutaneous dorsal medial nervel of hallux, in a series of cases, in fresh cadavers, in the period from February to April 2004. A total of 20 feet was analyzed. The crosses the extensor hallucis longus tendon towards medial

Kinsthmena Andrea; Ardila Buitrago; Enrique Manuel Vergara Amador; Residente de Ortopedia

2005-01-01

202

Medium thickness plantar skin graft for the management of digital and palmar flexion contractures  

Microsoft Academic Search

The fundamental principle of reconstruction is to replace the lost tissue with similar tissue. Because of the unique similarities in characteristics, plantar skin is an excellent donor area for skin grafting for the palmar aspect of the digits and hand. It provides an ideal color and texture match and long durability with an inconspicuous donor site. However, the use of

A. R Bunyan; Bhagwat S Mathur

2000-01-01

203

Utility of heel dual-energy X-ray absorptiometry in diagnosing osteoporosis.  

PubMed

Although peripheral dual-energy X-ray absorptiometry measurements have been found to predict fractures in population studies of white subjects, little is known about their utility in other races and in patients with greater risk of fracture. In a cross-sectional study of 874 women referred for bone mineral density (BMD) testing, we examined the utility of heel BMD in African-American (AA) compared with Caucasian (CA) women and in women using glucocorticoids. The ability of heel T-score to predict central osteoporosis was similar in AA and CA women (odds ratio [OR] per 1 unit decrease in T-score of 2.79 [95% confidence interval {CI} 2.16-3.60] and 3.15 [95% CI 2.53-3.92], respectively). The association between heel T-score and prevalent vertebral fractures was also similar in the 2 groups (OR 1.46 [95% CI 1.15-1.85] in AA and 1.42 [95% CI 1.16-1.74] in CA). In women using glucocorticoids heel T-score was better than central T-score in predicting vertebral fractures (OR 1.38 [95% CI 1.03-1.85] and 1.22 [95% CI 0.86-1.73], respectively). We conclude that in a multiracial referral population heel BMD predicts central osteoporosis and prevalent vertebral fractures equally well in AA as in CA women and may be better than central BMD in assessing fragility in glucocorticoid users. PMID:24144894

Chou, Sharon H; Hwang, Jessica; Ma, Siu-Ling; Vokes, Tamara

2014-01-01

204

Effect of medial arch-heel support in inserts on reducing ankle eversion: a biomechanics study  

PubMed Central

Background Excessive pronation (or eversion) at ankle joint in heel-toe running correlated with lower extremity overuse injuries. Orthotics and inserts are often prescribed to limit the pronation range to tackle the problem. Previous studies revealed that the effect is product-specific. This study investigated the effect of medial arch-heel support in inserts on reducing ankle eversion in standing, walking and running. Methods Thirteen pronators and 13 normal subjects participated in standing, walking and running trials in each of the following conditions: (1) barefoot, and shod condition with insert with (2) no, (3) low, (4) medium, and (5) high medial arch-heel support. Motions were captured and processed by an eight-camera motion capture system. Maximum ankle eversion was calculated by incorporating the raw coordinates of 15 anatomical positions to a self-compiled Matlab program with kinematics equations. Analysis of variance with repeated measures with post-hoc Tukey pairwise comparisons was performed on the data among the five walking conditions and the five running conditions separately. Results Results showed that the inserts with medial arch-heel support were effective in dynamics trials but not static trials. In walking, they successfully reduced the maximum eversion by 2.1 degrees in normal subjects and by 2.5–3.0 degrees in pronators. In running, the insert with low medial arch support significantly reduced maximum eversion angle by 3.6 and 3.1 degrees in normal subjects and pronators respectively. Conclusion Medial arch-heel support in inserts is effective in reducing ankle eversion in walking and running, but not in standing. In walking, there is a trend to bring the over-pronated feet of the pronators back to the normal eversion range. In running, it shows an effect to restore normal eversion range in 84% of the pronators.

Fong, Daniel TP; Lam, Mak-Ham; Lao, Miko LM; Chan, Chad WN; Yung, Patrick SH; Fung, Kwai-Yau; Lui, Pauline PY; Chan, Kai-Ming

2008-01-01

205

The mechanical properties of the human heel pad: a paradox resolved.  

PubMed

In vivo and in vitro mechanical testing of the human heel pad gave apparently different properties for this structure: the in vivo stiffness is about six times lower, whereas the percentage of energy dissipation is about three times higher (up to 95% loss). It was postulated that this divergence must be ascribed to the lower leg being involved in in vivo heel pad testing. This hypothesis is presently evaluated by applying the two experimental procedures formerly used in the in vivo (an instrumented pendulum) and in vitro (an Instron servo-hydraulic testing machine) investigations on the same isolated heel pad samples. Instron load-deformation cycles mimicking pendulum impacts (i.e. 'first loop-half cycles') are first evaluated and then compared to real pendulum impacts. When performed properly, the pendulum test procedure reveals the same mechanics for isolated heel pads as the Instron does. The load-deformation loops are basically identical. Thus similar non-linear stiffnesses (about 900 kN m-1 at body weight) and comparable amounts of energy dissipation (46.5-65.5%) are found with both types of test, still being largely different from the former in vivo results (150 kN m-1 and 95%, respectively). Therefore, the present findings support the hypothesis that the presence of the entire lower leg in in vivo tests indeed influences the outcome of the measurements. It must be concluded that the previously published in vivo data, if interpreted for the heel pad alone, implied not only an incorrectly low resilience but also a value far too low for stiffness. PMID:8522543

Aerts, P; Ker, R F; De Clercq, D; Ilsley, D W; Alexander, R M

1995-11-01

206

Platelet-rich plasma: a ‘feeling' and ‘hope' ailing athletes  

Microsoft Academic Search

IntroductionA number of orthopaedic and sports conditions remain a major therapeutic challenge to orthopaedic surgeons even in this day and age of technological advance. Some of these difficult conditions include plantar fasciitis (chronic pain in the sole of the foot), tennis elbow (chronic pain in the elbow), ligament and muscle injuries (around the knee and other joints) and tendo-achelles (heel)

Vijay D Shetty

2010-01-01

207

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

2012-01-01

208

Effect of calcaneal osteotomy and plantar fasciotomy on arch configuration in a flatfoot model.  

PubMed

Seven fresh-frozen cadaver specimens had a calcaneal osteotomy performed obliquely through the posterior portion of the calcaneus. Angular relationships between the first metatarsal and talus were recorded with the use of a motion-analysis system in the transverse, sagittal, and coronal planes. The specimen was mounted in a testing machine and loaded via an intramedullary rod to 150, 350, and 550 N. A flatfoot model was created, and repeat measurements were obtained. The calcaneal osteotomy was then displaced 1 cm medially, and repeat measurements were made at each of the three load levels. The calcaneal osteotomy was then returned to its original position, the plantar fascia was divided, and the new angular measurements were obtained. The calcaneal osteotomy was again displaced 1 cm, and repeat angular measurements were obtained. A mild consistent flatfoot deformity was created in all three axes before the plantar fascia was cut. A statistically significant increase in deformity was noted after cutting the plantar fascia. A correction of the flatfoot deformity in all three planes occurred with the medial displacement of the calcaneal osteotomy, which was greater at the lower load levels. We noted that a medial displacement calcaneal osteotomy partially corrected a flatfoot deformity in all three planes. The correction occurred with or without an intact plantar fascia and, therefore, is independent of the structure. We also noted an increased deformity after dividing the plantar fascia. This study provides some biomechanical insight as to the corrective effect of a medial displacement calcaneal osteotomy in correcting a flatfoot deformity. PMID:9677080

Thordarson, D B; Hedman, T; Lundquist, D; Reisch, R

1998-06-01

209

Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients  

Microsoft Academic Search

Twelve chronic hemiparetic outpatients with pronounced lower limb extensor spasticity were injected with 400 units of botulinum toxin A, EMG guided into the soleus, tibialis posterior, and both heads of the gastrocnemius muscles. Botulinum toxin A caused a definite reduction of plantar flexor spasticity, in 10 patients two weeks after the injection, as assessed by the Ashworth scale. Four of

S Hesse; D Lücke; M Malezic; C Bertelt; H Friedrich; M Gregoric; K H Mauritz

1994-01-01

210

Assessment of Effective Ankle Joint Positioning in Strength Training for Intrinsic Foot Flexor Muscles: A Comparison of Intrinsic Foot Flexor Muscle Activity in a Position Intermediate to Plantar and Dorsiflexion with that in Maximum Plantar Flexion Using Needle Electromyography  

PubMed Central

[Purpose] The effectiveness of intrinsic foot flexor strength training performed in the plantar flexion position was examined using needle electromyography. [Subjects] The subjects of this study were 18 healthy men. [Methods] We used needle electromyography to measure the muscle activities of the flexor hallucis brevis (FHB), and the flexor digitorum brevis (FDB) in maximum plantar and an intermediate position. [Results] Significant increases in muscle activities were observed for both FHB and FDB, and the rates of increase from the intermediate position to the plantar flexion position were 43% for FHB and 46% for FDB. [Conclusion] This study demonstrated that it is possible to evaluate intrinsic foot flexors, in addition to the numerous reports on treatment methods focusing on extrinsic foot flexors. Furthermore, the results suggest that toe flexion exercises performed during plantar flexion of the ankle joint are an effective method for intrinsic foot flexor strength training.

Hashimoto, Takayuki; Sakuraba, Keishoku

2014-01-01

211

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

SciTech Connect

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

Fellinger, A.

2010-02-16

212

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

PubMed

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

Wicart, Philippe; Seringe, Raphael

2006-01-01

213

An exploration of emergency department presentations related to high heel footwear in Victoria, Australia, 2006-2010  

PubMed Central

Background Many women are warned against the dangers of wearing high heel footwear however there is limited empirical evidence demonstrating an association between wearing high heel with injury. Gait laboratory testing has found a higher heel height placed the foot in a position that increases the risk of ankle sprain. Women have also been surveyed about wearing high heels and approximately half of those reported inconvenience and pain after wearing a high heel shoe. This study aims to explore emergency department presentations of injuries and the estimated costs that have been directly attributed to wearing high heeled footwear within Victoria, Australia during 2006–2010. Methods The Victorian Emergency Minimum Dataset (VEMD) was searched for all injuries attributed to wearing high heel footwear presenting to emergency departments in Victoria Australia, between the years of 2006–2010. The VEMD produced a report detailing sex, age at presentation, month of presentation, time of day of presentation, day of presentation, location that injury occurred and type of injury for presentation. Monash Health in Victoria Australia, provided emergency department estimates for injury types to calculate an estimated cost of an acute injury related to wearing high heel footwear. Results There were 240 injuries presenting to Victorian emergency departments directly attributed to wearing high heeled footwear. The majority of people injured were women (n?=?236) and all were less than 55 years of age. More injuries presented on a Sunday (n?=?83) and more in the 8 am-12 pm time bracket (n?=?64). There were also more injuries presenting in the months of November, December and January (n?=?80). The most commonly injured body part was the ankle (n?=?123). The emergency department estimate of the cost of these injuries over this time-frame was almost $72,000 (mean of $316.72 per presentation). Conclusions People who wear high heel footwear on weekends appear to be at higher risk for injury that leads to emergency department presentation. However, there was not a large cost associated with emergency department presentations attributable to wearing high heel footwear over a 5 year period.

2014-01-01

214

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

PubMed

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

Shahla, Ahmad

2009-07-01

215

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

PubMed

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

2014-02-01

216

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

2008-01-01

217

Feasibility of quantitative ultrasound measurement of the heel bone in people with intellectual disabilities  

Microsoft Academic Search

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 status that can be used outside the hospital.

S. Mergler; B. Löbker; H. M. Evenhuis; C. Penning

2010-01-01

218

Chronic spinal infusion of loperamide alleviates postsurgical pain in rats.  

PubMed

Plantar incision in rat generates spontaneous pain behaviour. The opioid drug, morphine used to treat postsurgical pain produces tolerance after long-term administration. Loperamide, a potent mu-opioid agonist, has documented analgesic action in various pain conditions. However, loperamide analgesia and associated tolerance following continuous spinal administration in postsurgical pain has not been reported. Chronic spinal infusion of drugs was achieved using intrathecal catheters connected to osmotic minipump. Coinciding with the onset of spinal infusion of loperamide or morphine, rats were subjected to plantar incision. Pain-related behaviour was assessed by Hargreaves apparatus (thermal hyperalgesia) and von Frey filaments (mechanical allodynia). Morphine and loperamide (0.5, 1 and 2 microL/h) induced analgesia was observed until 7th day post-plantar incision in Sprague-Dawley rats. Morphine and loperamide produced dose-dependent analgesia. Loperamide, in the highest dose, produced analgesia till 7th day. However, the highest dose of morphine produced inhibition of thermal hyperalgesia till 5th day and mechanical allodynia only till 3rd day post-plantar incision. Morphine and loperamide produced analgesia in postsurgical pain, which may be mediated through different mechanisms. Longer duration of analgesia with loperamide could probably be due sustained blockade of calcium channels. PMID:24772934

Kumar, Rakesh; Reeta, K H; Ray, Subrata Basu

2014-04-01

219

[A new type of plantar-pressure distribution measuring system and its application].  

PubMed

It has been shown from medical researches that many diseases are major causes of foot morbidity, which are deeply related to the abnormality of the plantar pressure distribution. In this respect, we made a new type of conductive rubber sensor and designed a dynamic contact pressure measuring system of plantar-pressure distribution with 251 testing points successfully. It includes the multipoint conductive rubber sensor, the interface circuit and the computer data collecting and progressing system. The measuring system can give the intuitional and full-scale image results with the full-court, real time testing. Also in this paper are introduced the design of the system, the testing results, and its applications in primary medical studies. PMID:15762134

Jin, Guanchang; Zhang, Jun; Zhang, Jianzhong; Sun, Chao

2005-02-01

220

The distributed plantar vertical force of neutrally aligned and pes planus feet.  

PubMed

The distributed vertical ground reaction forces were determined for a normative population and contrasted with data from subjects with flat feet. Nineteen asymptomatic subjects, 11 with a neutrally aligned foot type (normal arch) and 8 with a pes planus foot type (low arch), were studied as they walked barefoot across a pressure plate. The pressure plate data were converted to force values at seven locations (subhallucal, five submetatarsal and subcalcaneal) on the plantar aspect of the foot. The distributed loading pattern of the plantar soft tissue throughout the stance phase of gait was determined. Pes planus feet had significantly more force at the subhallucal area with no difference seen under the other areas. These data are indicative of aberrant first ray mechanics in pes planus feet. PMID:11809575

Ledoux, William R; Hillstrom, Howard J

2002-02-01

221

Comparison of the Plantar Pressure Distributions at Different Degrees of Tilting: A Preliminary Report  

PubMed Central

[Purpose] The purpose of this study was to investigate the amount of plantar pressures on the lower limb during tilt table standing and to indicate the ideal degree of tilting for partial weight bearing. [Subjects and Methods] Fifteen healthy subjects between the ages of 20 and 30 were recruited as volunteers for this study. All the measurements were taken while standing on a tilt table according to different inclination angles. [Results] The plantar pressures for 60° tilt table standing were lower by 7–9% of total body weight than the pressures during tilt table standing at 90°, and the pressures for 30° tilt table standing were lower by 18–20% of total body weight than the pressures for tilt table standing at 90°. [Conclusion] Standing training on a 60° tilt table might be equivalent to 80% of full weight bearing training, and tilt table standing training at 30° might be equivalent to 60% of full weight bearing training.

Son, Sung-Min; Lee, Jun-Ho; Cha, Yong-Jun

2014-01-01

222

Plantar verrucae in patients with human immunodeficiency virus. Clinical presentation and treatment response.  

PubMed

Several previous studies have yielded data showing that plantar and other cutaneous verrucae follow a more aggressive course in patients infected with human immunodeficiency virus (HIV) than in uninfected individuals. A pilot study was undertaken to identify trends in a sample population that would support this characterization of plantar verrucae in HIV+ patients and to determine whether there are differences in treatment response between HIV+ and HIV- patients. The results show that the HIV+ patients in the study presented with a significantly greater number and total area of lesions than did the HIV- patients. Furthermore, the HIV+ patients experienced a greater frequency of recurrence of their lesions following treatment with surgical curettage. These findings should provide the foundation for other extensive, multicenter studies to further characterize the treatment response of these lesions in HIV+ patients and to develop effective guidelines for their management. PMID:11266482

Whitaker, J M; Gaggero, G L; Loveland, L; Segura, L; Barbosa, P

2001-02-01

223

Design and Reliability of a Novel Heel Rise Test Measuring Device for Plantarflexion Endurance  

PubMed Central

Background. Plantarflexion results from the combined action of the soleus and gastrocnemius muscles in the calf. The heel rise test is commonly used to test calf muscle endurance, function, and performance by a wide variety of professionals; however, no uniform description of the test is available. This paper aims to document the construction and reliability of a novel heel rise test device and measurement protocol that is suitable for the needs of most individuals. Methods. This device was constructed from compact and lightweight materials and is fully adjustable, enabling the testing of a wide variety of individuals. It is easy to assemble and disassemble, ensuring that it is portable for use in different settings. Findings. We tested reliability on 40 participants, finding excellent interrater reliability (ICC2,1 0.97, 95% CI: 0.94 to 0.98). Limits of agreement were less than two repetitions in 90% of cases and the Bland-Altman plot showed no bias. Interpretation. We have designed a novel, standardized, simple, and reliable device and measurement protocol for the heel rise test which can be used by researchers and clinicians in a variety of settings.

Sman, Amy D.; Hiller, Claire E.; Ocsing, Aldrin; Refshauge, Kathryn M.

2014-01-01

224

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

PubMed Central

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 "Hospital with no pain". Practices such as skin to skin contact, or breastfeeding, in healthy newborn, may represent an alternative to the use of analgesic drugs. The aim of our work is to evaluate the analgesic effect of breastfeeding during heel puncture in full term healthy newborn. Methods We studied 200 healthy full term newborns (100 cases and 100 controls), proposing the puncture to mothers during breastfeeding, and explaining to them all the advantages of this practice. Pain assessment was evaluated by DAN scale (Douleur Aigue Nouveau ne scale). Results The difference in score of pain according to the DAN scale was significant in the two groups of patients (p = 0.000); the medium score was 5.15 for controls and 2.65 for cases (newborns sampled during breastfeeding). Conclusion Our results confirmed the evidence of analgesic effect of breastfeeding during heel puncture. This procedure could easily be adopted routinely in maternity wards.

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

2008-01-01

225

Anatomy of the foot venous pump: physiology and influence on chronic venous disease.  

PubMed

The aim of this paper is to demonstrate the location of the venous foot pump using an anatomical study. Four hundred cadaveric feet were injected with green neoprene latex followed by a dissection. A coloured segmentation of the venous system was achieved. The Lejars' concept of the venous sole of the foot is incorrect: the true blood venous reservoir of the foot is located deeply in the plantar veins, between the plantar muscles. The medial and mostly lateral plantar veins converge into the plexus shaped calcaneal crossroad, where the blood is ejected upwards into the two posterior tibial veins. In addition, the several medial perforators of the foot directly connect the deep system (medial plantar veins) to the superficial venous system (medial marginal vein). This forms a true 'medial functional unit' which is unique in the limb given its directional flow is from deep to superficial. In conclusion, the plantar veins play an important role in the physiology of the venous return since a venous reservoir of 25 mL of blood is mobilized upwards with each step during walking. Therefore, the impairment of the foot pump by a static foot disorder should be considered as an important risk factor for chronic venous disease, and should be evaluated and corrected in any patient with venous insufficiency. PMID:22847928

Uhl, J-F; Gillot, C

2012-08-01

226

Anatomy and Biomechanical Properties of the Plantar Aponeurosis: A Cadaveric Study  

PubMed Central

Objectives To explore the anatomy of the plantar aponeurosis (PA) and its biomechanical effects on the first metatarsophalangeal (MTP) joint and foot arch. Methods Anatomic parameters (length, width and thickness of each central PA bundle and the main body of the central part) were measured in 8 cadaveric specimens. The ratios of the length and width of each bundle to the length and width of the central part were used to describe these bundles. Six cadaveric specimens were used to measure the range of motion of the first MTP joint before and after releasing the first bundle of the PA. Another 6 specimens were used to evaluate simulated static weight-bearing. Changes in foot arch height and plantar pressure were measured before and after dividing the first bundle. Results The average width and thickness of the origin of the central part at the calcaneal tubercle were 15.45 mm and 2.79 mm respectively. The ratio of the length of each bundle to the length of the central part was (from medial to lateral) 0.29, 0.30, 0.28, 0.25, and 0.27, respectively. Similarly, the ratio of the widths was 0.26, 0.25, 0.23, 0.19 and 0.17. The thickness of each bundle at the bifurcation of the PA into bundles was (from medial to lateral) 1.26 mm, 1.04 mm, 0.91 mm, 0.84 mm and 0.72 mm. The average dorsiflexion of the first MTP joint increased 10.16° after the first bundle was divided. Marked acute changes in the foot arch height and the plantar pressure were not observed after division. Conclusions The first PA bundle was not the longest, widest, or the thickest bundle. Releasing the first bundle increased the range of motion of the first MTP joint, but did not acutely change foot arch height or plantar pressure during static load testing.

Chen, Da-wei; Li, Bing; Aubeeluck, Ashwin; Yang, Yun-feng; Huang, Yi-gang; Zhou, Jia-qian; Yu, Guang-rong

2014-01-01

227

Isolated Limb Infusion as a Novel Treatment for Extensive Plantar Warts  

Microsoft Academic Search

Background: We describe the previously unreported use of isolated limb infusion (ILI) to treat extensive, bilateral plantar warts in a 54-year-old female. The warts had covered the weight-bearing surfaces of both feet for 10 years and had failed to respond to all previous treatments. Methods: A standard ILI technique was used to infuse melphalan and actinomycin D to the left

Daniel James Wilks; Alan Howard Skyrme Peach

2009-01-01

228

Case study: Epidermoid cyst following percutaneous Topaz coblation for plantar fasciitis.  

PubMed

An epidermoid cyst is formed when there is proliferation of epidermal cells within an area of the dermis. They may be formed by the traumatic implantation of epidermal cells within the dermis as well as many other mechanisms. We present a case of epidermoid cyst formation following Topaz coblation for plantar fasciitis; a complication we believe is yet to be reported in the literature. PMID:22265448

Ferguson, Kim; Thomson, Allan George; Moir, John Stuart

2012-03-01

229

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

PubMed Central

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.

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

2009-01-01

230

Dilated cardiomyopathy and sudden death in a teenager with palmar-plantar keratosis (occult Carvajal syndrome)  

Microsoft Academic Search

A 16-year-old female who was diagnosed with palmar-plantar keratosis and Papillon-Lefevre syndrome in life died following a period of stress\\/affray. Autopsy examination revealed evidence of minor trauma and a grossly abnormal heart. The heart was sent fresh and intact to a cardiac pathologist for examination. This revealed a dilated cardiomyopathy with left ventricular fibrosis, without fatty infiltration of the right

A. J. O. Kolar; C. M. Milroy; P. F. Day; S. K. Suvarna

2008-01-01

231

[Realization of a compact mobile phone based wireless plantar pressure monitoring system and application].  

PubMed

An improved compact mobile phone based wireless plantar pressure monitoring system and software are proposed based on former progress, which can collect pressure data by sensors and circuit board, transmit data through Bluetooth wirelessly, and display and calculate the data on the mobile terminal. Conceptual experiments carried out demonstrate the feasibility and accuracy of the new system The system is expected to be widely used in the future owing to its portability, ease of use, and cost-effectiveness PMID:22916468

Liu, Lin; Liu, Jing

2012-05-01

232

Effects of eccentric training on mechanical properties of the plantar flexor muscle-tendon complex.  

PubMed

Eccentric training is a mechanical loading classically used in clinical environment to rehabilitate patients with tendinopathies. In this context, eccentric training is supposed to alter tendon mechanical properties but interaction with the other components of the muscle-tendon complex remains unclear. The aim of this study was to determine the specific effects of 14 wk of eccentric training on muscle and tendon mechanical properties assessed in active and passive conditions in vivo. Twenty-four subjects were randomly divided into a trained group (n = 11) and a control group (n = 13). Stiffness of the active and passive parts of the series elastic component of plantar flexors were determined using a fast stretch during submaximal isometric contraction, Achilles tendon stiffness and dissipative properties were assessed during isometric plantar flexion, and passive stiffness of gastrocnemii muscles and Achilles tendon were determined using ultrasonography while ankle joint was passively moved. A significant decrease in the active part of the series elastic component stiffness was found (P < 0.05). In contrast, a significant increase in Achilles tendon stiffness determined under passive conditions was observed (P < 0.05). No significant change in triceps surae muscles and Achilles tendon geometrical parameters was shown (P > 0.05). Specific changes in muscle and tendon involved in plantar flexion are mainly due to changes in intrinsic mechanical properties of muscle and tendon tissues. Specific assessment of both Achilles tendon and plantar flexor muscles allowed a better understanding of the functional behavior of the muscle-tendon complex and its adaptation to eccentric training. PMID:23239873

Fouré, Alexandre; Nordez, Antoine; Cornu, Christophe

2013-03-01

233

Effects of experimentally induced plantar insensitivity on forces and pressures under the foot during normal walking  

Microsoft Academic Search

Pressures under the foot during level walking were measured in 15 healthy young adults (8 females, 7 males, mean age 25.7, S.D. 5.3) before and after immersing the feet in ice-cold water (2°C) for 30min to evaluate the role of plantar insensitivity on gait patterns. Following ice water immersion, there was a significant decrease in walking speed. Maximum forces and

Amanda J. Taylor; Hylton B. Menz; Anne-Maree Keenan

2004-01-01

234

Effects of total contact insoles on the plantar stress redistribution: a finite element analysis  

Microsoft Academic Search

Objective. To investigate the effects of total contact insoles on the plantar stress redistribution using three-dimensional finite element analysis.Design. The efficacies of stress reduction and redistribution of two total contact insoles with different material combinations were compared with those of a regular flat insole used as a baseline condition.Background. Many specially designed total contact insoles are currently used to reduce

Weng-Pin Chen; Chia-Wei Ju; Fuk-Tan Tang

2003-01-01

235

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

2011-01-01

236

Recalibration of somesthetic plantar information in the control of undisturbed upright stance maintenance.  

PubMed

To assess the effects of changes in somesthetic plantar information on upright quiet stance, a rotary plantar massage was applied under the feet of healthy subjects for ten minutes. The controlling variable, the centre of pressure (CP) displacements, were recorded, before and after massage, through a force platform and decomposed into two elementary motions: the vertical projection of the centre of gravity (CG(v)) and the difference between the latter and the CP (CP-CG(v)) along medio-lateral ML and antero-posterior AP directions. These motions were processed through frequency analysis and modelled as fractional Brownian motion. For CP-CG(v) motions, the frequency analysis shows that massage under the plantar soles induces a decrease of the amplitudes along the ML direction suggesting reduced overall muscular activity (abductor-adductor muscles of the hip according to Winter et al.). A general trend is that the CG(v) amplitudes are also diminished after massage especially in the ML direction, indicating a better distribution of the body weight on the two supports. On the other hand, the effects tend to vanish after about 8 minutes. Conversely, when the massage was given under the toes, no particular effect on any elementary motion was observed, suggesting that the plantar mechanoreceptors under the toes necessitate stronger stimulation to respond significantly and/or that the greater sensitivity obtained was not used by the CNS. Overall, this data emphasises the fact that a recalibration of somesthetic cues may occur when enhanced afferent information is fed to the postural system. PMID:15657978

Bernard-Demanze, L; Burdet, C; Berger, L; Rougier, P

2004-12-01

237

Randomized trial - oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy  

PubMed Central

OBJECTIVE: Hyperhidrosis is a common disease, and thoracoscopic sympathectomy improves its symptoms in up to 95% of cases. Unfortunately, after surgery, plantar hyperhidrosis may remain in 50% of patients, and compensatory sweating may be observed in 70%. This clinical scenario remains a challenge. Our objective was to evaluate the effectiveness of oxybutynin in the treatment of persistent plantar hyperhidrosis and compensatory sweating and its effects on quality of life in women after thoracoscopic sympathectomy. METHOD: We conducted a prospective, randomized study to compare the effects of oxybutynin at 10 mg daily and placebo in women with persistent plantar hyperhidrosis. The assessment was performed using a quality-of-life questionnaire for hyperhidrosis and sweating measurement with a device for quantifying transepidermal water loss. Clinicaltrials.gov: NCT01328015. RESULTS: Sixteen patients were included in each group (placebo and oxybutynin). There were no significant differences between the groups prior to treatment. After oxybutynin treatment, there was a decrease in symptoms and clinical improvement based on the quality-of-life questionnaire (before treatment, 40.4 vs. after treatment, 17.5; p?=?0.001). The placebo group showed modest improvement (p?=?0.09). The outcomes of the transepidermal water loss measurements in the placebo group showed no differences (p?=?0.95), whereas the oxybutynin group revealed a significant decrease (p?=?0.001). The most common side effect was dry mouth (100% in the oxybutynin group vs. 43.8% in the placebo group; p?=?0.001). CONCLUSION: Oxybutynin was effective in the treatment of persistent plantar hyperhidrosis, resulting in a better quality of life in women who had undergone thoracoscopic sympathectomy.

da Silva Costa, Altair; Leao, Luiz Eduardo Villaca; Succi, Jose Ernesto; Perfeito, Joao Alessio Juliano; Filho, Adauto Castelo; Rymkiewicz, Erika; Filho, Marco Aurelio Marchetti

2014-01-01

238

Effectiveness of scalpel debridement for painful plantar calluses in older people: a randomized trial  

PubMed Central

Background Plantar calluses are a common cause of foot pain, which can have a detrimental impact on the mobility and independence of older people. Scalpel debridement is often the first treatment used for this condition. Our aim was to evaluate the effectiveness of scalpel debridement of painful plantar calluses in older people. Methods This study was a parallel-group, participant- and assessor-blinded randomized trial. Eighty participants aged 65 years and older with painful forefoot plantar calluses were recruited. Participants were randomly allocated to one of two groups: either real or sham scalpel debridement. Participants were followed for six weeks after their initial intervention appointment. The primary outcomes measured were the difference between groups in pain (measured on a 100-mm visual analogue scale) immediately post-intervention, and at one, three and six weeks post-intervention. Results Both the real debridement and sham debridement groups experienced a reduction in pain when compared with baseline. Small, systematic between-group differences in pain scores were found at each time point (between 2 and 7 mm favoring real scalpel debridement); however, none of these were statistically significant and none reached a level that could be considered clinically worthwhile. Scalpel debridement caused no adverse events. Conclusions The benefits of real scalpel debridement for reducing pain associated with forefoot plantar calluses in older people are small and not statistically significant compared with sham scalpel debridement. When used alone, scalpel debridement has a limited effect in the short term, although it is relatively inexpensive and causes few complications. However, these findings do not preclude the possibility of cumulative benefits over a longer time period or additive effects when combined with other interventions. Trial registration Australian Clinical Trials Registry (ACTRN012606000176561).

2013-01-01

239

Plantar loading during cutting while wearing a rigid carbon fiber insert.  

PubMed

Context Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. Objective: To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Design: ?Crossover study. Setting: Laboratory. Patients or Other Participants: A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Main Outcome Measure(s): ?Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (? = .05). Results: During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Conclusions: Although a rigid carbon graphite footplate altered some aspects of the plantar-pressure profile during cutting in uninjured participants, it was ineffective in reducing plantar loading beneath the fifth metatarsal. PMID:24955620

Queen, Robin M; Abbey, Alicia N; Verma, Ravi; Butler, Robert J; Nunley, James A

2014-06-01

240

Comparison of Radial Shockwaves and Conventional Physiotherapy for Treating Plantar Fasciitis  

PubMed Central

OBJECTIVE: To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis. MATERIALS AND METHODS: Thirty-two patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 was composed of 16 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 was composed of 16 patients who underwent three applications of radial shockwaves (once a week) and received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 47.3 ± 10.3 years (range 25–68); 81% were female, 87% were overweight, 56% had bilateral impairment, and 75% used analgesics regularly. RESULTS: Both treatments were effective for pain reduction and for improving the functional abilities of patients with plantar fasciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment. CONCLUSION: Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment.

Greve, Julia Maria D'Andrea; Grecco, Marcus Vinicius; Santos-Silva, Paulo Roberto

2009-01-01

241

Effects of the lapidus arthrodesis and chevron bunionectomy on plantar forefoot pressures.  

PubMed

Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p < .001). However, Lapidus group exhibited an increase in the mean fifth metatarsal head plantar pressure (p = .008) and pressure under the fifth metatarsal as a percentage of the total forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy. PMID:24958073

King, Christy M; Hamilton, Graham A; Ford, Lawrence A

2014-01-01

242

Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials  

PubMed Central

A narrative literature review of RCTs only, was conducted to ascertain which conservative treatments provide the best results for plantar fasciitis patients. Stretching, prefabricated and custom-made orthotics and night splints have all been scrutinized in numerous studies with mixed results. Chiropractic manipulative therapy has been examined in one study, with favorable results. Therapeutic ultrasound and low intensity laser therapy have been examined in one study apiece with unsatisfactory results. Based on the trials reviewed a trial of therapy beginning with low-cost, patient-centered treatments is recommended, particularly stretching, over-the-counter orthotics, and patient education. Several (but not all) of the reviewed articles indicated that custom-made orthoses are more beneficial for plantar fasciitis than over-the-counter orthotics. In the event these treatments do not provide satisfactory results, use of night splints should be considered. Based on this review, there is no support for the use of magnetic insoles for plantar fasciitis. Most of the studies were found to have at least one methodological flaw, including inadequate sample sizes, high drop-out rates, comparing multiple interventions to multiple interventions (thus making it difficult to determine the effect of each individual intervention) and lack of long-term follow-up. Outcome measure use between studies was inconsistent.

Stuber, Kent; Kristmanson, Kevyn

2006-01-01

243

Relationship between lumbar changes and modifications in the plantar arch in women with low back pain  

PubMed Central

OBJECTIVE : Evaluate the probable relationship among plantar arch, lumbar curvature, and low back pain. METHODS : Fifteen healthy women were assessed taking in account personal data and anthropometric measurements, photopodoscopic evaluation of the plantar arch, and biophotogrammetric postural analysis of the patient (both using the SAPO software), as well as evaluation of lumbar pain using a Visual Analog Scale (VAS). The average age of the participants was 30.45 (±6.25) years. RESULTS : Of the feet evaluated, there were six individuals with flat feet, five with high arch, and four with normal feet. All reported algic syndrome in the lumbar spine, with the highest VAS values for the volunteers with high arch. Correlation was observed between the plantar arch and the angle of the lumbar spine (r = -0.71, p = 0.004) Conclusion: High arch was correlated with more intense algic syndrome, while there was moderate positive correlation between flat foot and increased lumbar curvature, and between high arch and lumbar correction. Level of Evidence IV. Case Series.

Borges, Claudia dos Santos; Fernandes, Luciane Fernanda Rodrigues Martinho; Bertoncello, Dernival

2013-01-01

244

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

2013-01-01

245

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

2013-01-01

246

Colonic ischemia: the Achilles heel of ruptured aortic aneurysm repair.  

PubMed

Colonic ischemia is an often fatal complication of abdominal aortic aneurysm (AAA) repair. In elective AAA repair, patency of the inferior mesenteric artery (IMA) has been shown to be an important contributing factor. The purpose of this study was to determine which clinical and operative factors are important in the development of colonic ischemia in ruptured AAA repair. A retrospective review of all patients treated for ruptured AAA over a 7-year period was performed. Of 101 patients who were treated for ruptured AAA, 71 (70 per cent) survived for longer than 24 hours postoperatively, and these patients are the basis for this study. Colonic ischemia, primarily left sided, was a common perioperative complication (n = 24; 35 per cent) requiring colectomy in 11 patients (44 per cent). It carried a 44 per cent mortality compared to 20 per cent in patients without this complication (P = 0.07). Colonic ischemia occurred more frequently in patients with preoperative shock (P = 0.01) and a greater intraoperative blood loss (P = 0.003), but showed no correlation with patient age, co-morbid medical conditions, laboratory values, time to operation, or treatment of the IMA. Most patients with postoperative bowel ischemia were found to have chronic IMA occlusion, including 8 of the 11 patients requiring colectomy. Revascularization would not be feasible in this group. Revascularization of patent IMAs had little effect on outcome. Of the 17 patent IMAs, 9 were reimplanted and 5 (55 per cent) developed bowel ischemia, two of which required colectomy. Eight were ligated and 3 (38 per cent) developed bowel ischemia, one requiring colectomy. The presence of preoperative shock is the most important factor predicting the development of colonic ischemia following ruptured AAA. The incidence of ischemia is not altered by the presence of a patent IMA or with attempts at IMA revascularization. Colonic ischemia remains a significant source of morbidity and mortality in these patients. PMID:8651551

Piotrowski, J J; Ripepi, A J; Yuhas, J P; Alexander, J J; Brandt, C P

1996-07-01

247

Discrepant NOXA (PMAIP1) transcript and NOXA protein levels: a potential Achilles' heel in mantle cell lymphoma  

PubMed Central

Mantle cell lymphoma (MCL) is an aggressive lymphoid neoplasm with transient response to conventional chemotherapy. We here investigated the role of the Bcl-2 homology domain 3-only protein NOXA for life–death decision in MCL. Surprisingly, NOXA (PMAIP1) mRNA and NOXA protein levels were extremely discrepant in MCL cells: NOXA mRNA was found to be highly expressed whereas NOXA protein levels were low. Chronic active B-cell receptor signaling and to a minor degree cyclin D1 overexpression contributed to high NOXA mRNA expression levels in MCL cells. The phoshatidyl-inositol-3 kinase/AKT/mammalian target of rapamycin pathway was identified as the major downstream signaling pathway involved in the maintenance of NOXA gene expression. Interestingly, MCL cells adapt to this constitutive pro-apoptotic signal by extensive ubiquitination and rapid proteasomal degradation of NOXA protein (T½?15–30?min). In addition to the proteasome inhibitor Bortezomib, we identified the neddylation inhibitor MLN4924 and the fatty acid synthase inhibitor Orlistat as potent inducers of NOXA protein expression leading to apoptosis in MCL. All inhibitors targeted NOXA protein turnover. In contrast to Bortezomib, MLN4924 and Orlistat interfered with the ubiquitination process of NOXA protein thereby offering new strategies to kill Bortezomib-resistant MCL cells. Our data, therefore, highlight a critical role of NOXA in the balance between life and death in MCL. The discrepancy between NOXA transcript and protein levels is essential for sensitivity of MCL to ubiquitin-proteasome system inhibitors and could therefore provide a druggable Achilles' heel of MCL cells.

Dengler, M A; Weilbacher, A; Gutekunst, M; Staiger, A M; Vohringer, M C; Horn, H; Ott, G; Aulitzky, W E; van der Kuip, H

2014-01-01

248

Discrepant NOXA (PMAIP1) transcript and NOXA protein levels: a potential Achilles' heel in mantle cell lymphoma.  

PubMed

Mantle cell lymphoma (MCL) is an aggressive lymphoid neoplasm with transient response to conventional chemotherapy. We here investigated the role of the Bcl-2 homology domain 3-only protein NOXA for life-death decision in MCL. Surprisingly, NOXA (PMAIP1) mRNA and NOXA protein levels were extremely discrepant in MCL cells: NOXA mRNA was found to be highly expressed whereas NOXA protein levels were low. Chronic active B-cell receptor signaling and to a minor degree cyclin D1 overexpression contributed to high NOXA mRNA expression levels in MCL cells. The phoshatidyl-inositol-3 kinase/AKT/mammalian target of rapamycin pathway was identified as the major downstream signaling pathway involved in the maintenance of NOXA gene expression. Interestingly, MCL cells adapt to this constitutive pro-apoptotic signal by extensive ubiquitination and rapid proteasomal degradation of NOXA protein (T½?15-30?min). In addition to the proteasome inhibitor Bortezomib, we identified the neddylation inhibitor MLN4924 and the fatty acid synthase inhibitor Orlistat as potent inducers of NOXA protein expression leading to apoptosis in MCL. All inhibitors targeted NOXA protein turnover. In contrast to Bortezomib, MLN4924 and Orlistat interfered with the ubiquitination process of NOXA protein thereby offering new strategies to kill Bortezomib-resistant MCL cells. Our data, therefore, highlight a critical role of NOXA in the balance between life and death in MCL. The discrepancy between NOXA transcript and protein levels is essential for sensitivity of MCL to ubiquitin-proteasome system inhibitors and could therefore provide a druggable Achilles' heel of MCL cells. PMID:24457957

Dengler, M A; Weilbacher, A; Gutekunst, M; Staiger, A M; Vöhringer, M C; Horn, H; Ott, G; Aulitzky, W E; van der Kuip, H

2014-01-01

249

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

SciTech Connect

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

Sams, T.L.; Kirch, N.W.; Reynolds, J.H. [Washington River protection Solutions, Richland, WA 99352 (United States)] [Washington River protection Solutions, Richland, WA 99352 (United States)

2013-07-01

250

Effect of shoe heel height on vastus medialis and vastus lateralis electromyographic activity during sit to stand  

PubMed Central

Background It has been proposed that high-heeled shoes may contribute to the development and progression of knee pain. However, surprisingly little research has been carried out on how shoe heel height affects muscle activity around the knee joint. The purpose of this study was to investigate the effect of differing heel height on the electromyographic (EMG) activity in vastus medialis (VM) and vastus lateralis (VL) during a sit to stand activity. This was an exploratory study to inform future research. Methods A repeated measures design was used. Twenty five healthy females carried out a standardised sit to stand activity under 4 conditions; barefoot, and with heel wedges of 1, 3, and 5 cm in height. EMG activity was recorded from VM and VL during the activity. Data were analysed using 1 × 4 repeated measures ANOVA. Results Average rectified EMG activity differed with heel height in both VM (F2.2, 51.7 = 5.24, p < 0.01), and VL (F3, 72 = 5.32, p < 0.01). However the VM: VL EMG ratio was not significantly different between conditions (F3, 72 = 0.61, p = 0.609). Conclusion We found that as heel height increased, there was an increase in EMG activity in both VM and VL, but no change in the relative EMG intensity of VM and VL as measured by the VM: VL ratio. This showed that no VM: VL imbalance was elicited. This study provides information that will inform future research on how heel height affects muscle activity around the knee joint.

Edwards, Lindsay; Dixon, John; Kent, Jillian R; Hodgson, David; Whittaker, Vicki J

2008-01-01

251

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

PubMed

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

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

2005-12-01

252

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

PubMed

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

2013-01-01

253

SLUDGE HEEL REMOVAL BY ALUMINUM DISSOLUTION AT SAVANNAH RIVER SITE 12390  

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.

2012-01-12

254

Ergonomic procedure for heel sticks and shots in Kangaroo Care (skin-to-skin) position.  

PubMed

Kangaroo Care (KC) has been recommended as a pain-reducing strategy in neonates; however, KC has not been widely used to minimize procedural pain caused in part by nurses'/phlebotomists' discomfort when positioning themselves and the infant for blood drawing and injections. Therefore, an ergonomically designed setup incorporating the use of KC was introduced into clinical practice to facilitate blood draws and injections. The step-by-step procedure used for heel sticks and injections is presented in this manuscript. After implementing the ergonomic step-by-step protocol, complaints of discomfort by nurses and phlebotomists ceased, and an additional benefit was that infant pain responses were significantly reduced. PMID:23985473

Cong, Xiaomei; Ludington-Hoe, Susan; Vazquez, Victoria; Zhang, Di; Zaffetti, Sharon

2013-01-01

255

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

PubMed

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

2013-09-01

256

Biochemical response to chronic shortening in unloaded soleus muscles  

NASA Technical Reports Server (NTRS)

One leg of tail-casted suspended rats was immobilized in a plantar-flexed position to test whether chronic shortening of posterior leg muscles affected the metabolic response to unloading. The immobilized plantaris and gastrocnemius muscles of these animals showed approximately 20 percent loss of muscle mass in contrast to simply a slower growth rate with unloading. Loss of mass of the soleus muscle during suspension was not accentuated by chronic shortening. Although protein degradation in the isolated soleus muscle of the plantar-flexed limb was slightly faster than in the contralateral free limb, this difference was offset by faster synthesis of the myofibrillar protein fraction of the chronically shortened muscle. Total adenine nucleotides were 17 percent lower (P less than 0.005) in the chronically shortened soleus muscle following incubation. Glutamate, glutamine, and alanine metabolism showed little response to chronic shortening. These results suggest that, in the soleus muscle, chronic shortening did not alter significantly the metabolic responses to unloading and reduced activity.

Jaspers, S. R.; Fagan, J. M.; Tischler, M. E.

1985-01-01

257

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

PubMed

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

2009-01-01

258

Quantitative comparison of plantar foot shapes under different weight-bearing conditions.  

PubMed

Knowledge of the plantar foot shape alteration under weight bearing can offer implications for the design and construction of a comfortable and functional foot support. The purpose of this study was to quantify the change in three-dimensional foot shape under different weight-bearing conditions. The plantar foot shapes of 16 normal feet were collected by an impression casting method under three weight-bearing conditions: non-weight bearing, semi-weight bearing, and full-weight bearing. An optical digitizing system was used to capture the three-dimensional plantar surface shape of the foot cast. Measurements and comparisons from the digitized shapes were conducted for the whole foot and regions of the foot. The data showed that increased weight bearing significantly increased the contact area, foot length, foot width, and rearfoot width, while it decreased average height, arch height, and arch angle. Compared with the non-weight-bearing foot shape, the semi-weight-bearing condition would produce increases in the contact area of 35.1% +/- 21.6 %, foot length of 2.7% +/- 1.2%, foot width of 2.9% +/- 2.4%, and rearfoot width of 5.9% +/- 4.8%, and decreases in the arch height of 15.4% +/- 7.8% and arch angle of 21.7% +/- 17.2%. The full-weight-bearing condition would produce increases in the contact area of 60.4% +/- 33.2%, foot length of 3.4% +/- 1.3%, foot width of 6.0% +/- 2.1%, and rearfoot width of 8.7% +/- 4.9%, and decreases in the arch height of 20.0% +/- 9.2% and arch angle of 41.2% +/- 16.2%. The findings may be useful for considering the change of foot shape in the selection of shoe size and shoe or insole design. PMID:15077664

Tsung, Bonnie Yuk San; Zhang, Ming; Fan, Yu Bo; Boone, David Alan

2003-01-01

259

Fusimotor neurone responses to medial plantar nerve stimulation in the decerebrate cat.  

PubMed Central

1. The effect of single shock electrical stimulation, up to 20 x threshold (T), of the medial plantar nerve on the discharges of single medial gastrocnemius static and dynamic gamma-efferents has been investigated in the decerebrate cat. 2. The neurones were classified as static (15) or dynamic (8) indirectly on the basis of their locomotor and/or resting discharge characteristics. 3. All gamma-efferents were affected by stimulation of the medial plantar nerve. Dynamic units showed net inhibition while facilitation dominated the responses of static neurones. 4. The responses of dynamic units consisted of powerful short latency (15 +/- 1.2 ms, mean +/- S.D.) spinal inhibition followed by weaker facilitation that was difficult to characterize due to concomitant rephasing of neuronal discharge. 5. Static neurones showed two patterns of response. Some units (7 of 15) were facilitated at medium latency (39.9 +/- 12.2 ms) while the remainder showed mixed effects in which short latency (18 +/- 3.6 ms) spinal inhibition was followed by stronger facilitation (latency, 38.1 +/- 5.3 ms). 6. Fusimotor facilitation and inhibition were generally present at 2T. The inhibition of dynamic and static gamma-efferents, and the facilitation of the latter type, increased with stimulus intensity. Thus low and high threshold afferents contributed to the effects without changing their qualitative nature. 7. We conclude that low threshold cutaneous mechanoreceptors in the plantar surface of the foot are capable of influencing the discharges of medial gastrocnemius static and dynamic gamma-efferents. Further, the cutaneous responses of fusimotor neurones appear to vary according to both the source of the afferent input and the type of unit involved. 8. The results are discussed in relation to the control and function of fusimotor neurones and the possible existence of subdivisions within the static system.

Murphy, P R; Martin, H A

1995-01-01

260

Plantar aponeurosis and internal architecture of the ball of the foot.  

PubMed Central

On the basis of its internal structure, the ball of the foot can be divided into three transverse areas, each with a different mechanical function: (1) an area proximal to the heads of the metatarsals in which the retinacula cutis are developed into a series of transverse bands, and in which the deep fibres of the plantar aponeurosis form ten sagittal septa connected to the deep transverse metatarsal ligament and through this the proximal phalanges of the toes, (2) an area below the heads of the metatarsals in which vertical fibres from the joint capsules and the sides of the fibrous flexor sheaths form a cushion below each metatarsal head, and in which fat bodies cover the digital nerves and vessels in their passage between the cushions, and (3) a distal area which comprises the interdigital web. The superficial fibres of the plantar aponeurosis are inserted into the skin of this distal area, and deep to them the plantar interdigital ligament forms a series of transverse lamellae connected to the proximal phalanges by a mooring ligament which arches from one fibrous flexor sheath to the next. When the metatarsophalangeal joints are extended, the fibres of the three areas are tensed and the skin is anchored firmly to the skeleton. The direction of the fibres in the distal and proximal area promotes the transfer of forces exerted on the skin during push-off and braking respectively, while the intermediate area is adapted to bear the weight of the body. A concentration of Pacinian corpuscles is found along the digital nerves in the weight-bearing area below the transverse metatarsal ligament. The nerves for the second, and especially for the third, interstice are close to or in contact with the sharp proximal edges of the sagittal septa. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5

Bojsen-Moller, F; Flagstad, K E

1976-01-01

261

Plantar thermography is useful in the early diagnosis of diabetic neuropathy  

PubMed Central

OBJECTIVES: This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease. METHODS: Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n?=?37), pre-diabetics (n?=?13) and type 2 diabetics (n?=?29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination. RESULTS: Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group. CONCLUSION: In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.

Balbinot, Luciane Fachin; Canani, Luis Henrique; Robinson, Caroline Cabral; Achaval, Matilde; Zaro, Milton Antonio

2012-01-01

262

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

PubMed

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

2006-05-01

263

Acquired unilateral pes planus in a child caused by a ruptured plantar calcaneonavicular (spring) ligament.  

PubMed

A traumatic cause for acquired pes planus in children is uncommon and it is not often considered as a primary diagnosis. We describe a patient, who ruptured her plantar calcaneonavicular (spring) ligament and presented late with an acquired unilateral flat foot similar to a tibialis posterior rupture. Corrective surgery in the form of calcaneal osteotomy with iliac graft lengthening and medial advancement of tibialis posterior achieved excellent results with patient remaining asymptomatic and returning to routine activities. In the presence of an acute traumatic onset of unilateral pes planus, spring ligament and tibialis posterior tendon rupture should be considered in the differential diagnosis. PMID:19373112

Shuen, Vivien; Prem, Hari

2009-05-01

264

Larger plantar flexion torque variability implies less stable balance in the young: an association affected by knee position.  

PubMed

The present study examined the association between plantar flexion torque variability during isolated isometric contractions and during quiet bipedal standing. For plantar flexion torque measurements in quiet stance (QS), subjects stood still over a force plate. The mean plantar flexion torque level exerted by each subject in QS (divided by 2 to give the torque due to a single leg) served as the target torque level for right leg force-matching tasks in extended knee (KE) and flexed knee (KF) conditions. Muscle activation levels (EMG amplitudes) of the triceps surae and mean, standard deviation and coefficient of variation of plantar flexion torque were computed from signals acquired during periods with and without visual feedback. No significant correlations were found between EMG amplitudes and torque variability, regardless of the condition and muscle being analyzed. A significant correlation was found between torque variability in QS and KE, whereas no significant correlation was found between torque variability in QS and KF, regardless of vision availability. Therefore, torque variability measured in a controlled extended knee plantar flexion contraction is a predictor of torque variability in the anterior-posterior direction when the subjects are in quiet standing. In other words, larger plantar flexion torque variability in KE (but not in KF) implies less stable balance. The mechanisms underlying the findings above are probably associated with the similar proprioceptive feedback from the triceps surae in QS and KE and poorer proprioceptive feedback from the triceps surae in KF due to the slackening of the gastrocnemii. An additional putative mechanism includes the different torque contributions of each component of the triceps surae in the two knee angles. From a clinical and research standpoint, it would be advantageous to be able to estimate changes in balance ability by means of simple measurements of torque variability in a force matching task. PMID:24060221

Mello, Emanuele Moraes; Magalhães, Fernando Henrique; Kohn, André Fabio

2013-12-01

265

The influence of heel height on lower extremity kinematics and leg muscle activity during gait in young and middle-aged women.  

PubMed

The aim of this study was to evaluate the changes in electromyographic (EMG) activity of the lower limb muscles, and hip, knee and ankle kinematics during gait while wearing low- (4-cm) and high-heeled (10-cm) shoes in 31 young and 15 middle-aged adult women. We observed an increase in knee flexion and decrease in ankle eversion associated with elevated heel heights suggesting that compensatory mechanisms attenuating ground reaction forces may be compromised during gait with higher-heeled shoes. Additionally, we observed increased muscle activity during high-heeled gait that may exacerbate muscle fatigue. Collectively, these findings suggest that permanent wearing of heeled footwear could contribute to muscle overuse and repetitive strain injuries. PMID:22300729

Mika, Anna; Oleksy, ?ukasz; Mika, Piotr; Marchewka, Anna; Clark, Brian C

2012-04-01

266

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.

2012-01-01

267

Acute Effects of Two Massage Techniques on Ankle Joint Flexibility and Power of the Plantar Flexors  

PubMed Central

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 participants were randomly subjected to three conditions (control and two massages) before performing two power tests. Prior to the intervention, subjects completed ankle joint flexibility assessments. The conditions were; (1) control, where subjects lay prone and had a therapist’s hands resting, (2) vigorous petrissage, and (3) tapotement applied at a rate of 4Hz; all on the triceps surae. Following completion of the intervention, subjects immediately completed a post- ankle joint flexibility test, followed by a drop-jump and concentric calf raise. The power measures were; concentric peak force, rate of force development, and drop-jump height / contact time. The data showed a significant increase (p < 0.05) in ankle joint angle on the right leg and a corresponding tendency on the left. No significant change was seen with the power measures. Results suggest that massage can increase plantar flexors’ flexibility without a change in power and thus may be an alternative to static stretching during an athletic warm-up. Key pointsThree minutes of petrissage and tapotement forms of massage increased ankle flexibility.Massage did not adversely affect jump power measures.Massage may be an effective alternative to static stretching as a component of a pre-event warm-up.

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

2007-01-01

268

Reconstruction of Lisfranc joint dislocations secondary to Charcot neuroarthropathy using a plantar plate.  

PubMed

Lisfranc joint dislocation secondary to Charcot arthropathy is a debilitating condition that often leads to ulceration and infection. After conservative treatment, such as bracing and appropriate shoe wear fail, the only option might be amputation. However, we have seen good clinical outcomes from applying a plate to the plantar (tension) side of the medial midfoot. In our retrospective study, 24 consecutive patients (25 feet) from April 1999 through July 2004 underwent Charcot reconstruction for Lisfranc dislocation. Clinical and radiographic follow-up examinations were performed every 3 weeks during the postoperative course. Union was achieved in 24 (96%) of the 25 feet. The average time to ambulation was 11.68 (range 7 to 20) weeks for the 24 patients. The average follow-up period was 38.0 (range 17 to 64) months. The union and interval to ambulation rates showed that a plate applied to the plantar aspect of the medial midfoot provides a strong, sturdy construct for arthrodesis and ambulation. PMID:23621976

Garchar, Dave; DiDomenico, Lawrence A; Klaue, Kaj

2013-01-01

269

Analysis of the plantar pressure distribution in children with foot deformities.  

PubMed

This paper describes the method of measuring and assessing the pressure distribution under typical feet and the feet of patients with deformities such as: planovalgus, clubfoot, and pes planus using a pedobarograph. Foot pressure distribution was measured during static and walking at individual normal walking speed. Time-series pressure measurements for all sensors were grouped into five anatomical areas of human foot. In typical subjects, the heel was the first part of the foot receiving the loading of the body. Then it moved to the toe through the midfoot and the metatarsal area. The highest mean pressure in typical subjects was found under the heel and the metatarsal heads. The lowest pressure distribution was under the cuboid bone. In the planovalgus subjects, a higher pressure distribution was found under cuboid bone compared to typical one. In the pes cavus subjects, the pressure distribution was lower under all parts of foot. In the clubfoot subjects, the pressure distribution, the contact area of each mask, and the time of foot contact area in left and right foot are respectively different. PMID:20653322

Pauk, Jolanta; Daunoraviciene, Kristina; Ihnatouski, Mikhai?; Griskevicius, Julius; Raso, James V

2010-01-01

270

Results of Characterization and Retrieval Testing on Tank 241-C-109 Heel Solids  

SciTech Connect

Eight samples of heel solids from tank 241-C-109 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, one-half to two-thirds of the solids were off-white to tan solids that, visually, were fairly evenly graded in size from coarse silt (30-60 μm) to medium pebbles (8-16 mm). The remaining solids were mostly strongly cemented aggregates ranging from coarse pebbles (16-32 mm) to fine cobbles (6-15 cm) in size. Solid phase characterization and chemical analysis indicated that the air-dry heel solids contained ≈58 wt% gibbsite [Al(OH){sub 3}] and ≈37 wt% natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}?19H{sub 2}O]. The strongly cemented aggregates were mostly fine-grained gibbsite cemented with additional gibbsite. Dissolution testing was performed on two test samples. One set of tests was performed on large pieces of aggregate solids removed from the heel solids samples. The other set of dissolution tests was performed on a composite sample prepared from well-drained, air-dry heel solids that were crushed to pass a ?-in. sieve. The bulk density of the composite sample was 2.04 g/mL. The dissolution tests included water dissolution followed by caustic dissolution testing. In each step of the three-step water dissolution tests, a volume of water approximately equal to 3 times the initial volume of the test solids was added. In each step, the test samples were gently but thoroughly mixed for approximately 2 days at an average ambient temperature of 25 ?C. The caustic dissolution tests began with the addition of sufficient 49.6 wt% NaOH to the water dissolution residues to provide ≈3.1 moles of OH for each mole of Al estimated to have been present in the starting composite sample and ≈2.6 moles of OH for each mole of Al potentially present in the starting aggregate sample. Metathesis of gibbsite to sodium aluminate was then allowed to proceed over 10 days of gentle mixing of the test samples at temperatures ranging from 26-30 ?C. The metathesized sodium aluminate was then dissolved by addition of volumes of water approximately equal to 1.3 times the volumes of caustic added to the test slurries. Aluminate dissolution was allowed to proceed for 2 days at ambient temperatures of ≈29 ?C. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.0 wt% of the tank 241-C-109 crushed heel solids composite test sample. The 20 wt% of solids remaining after the dissolution tests were 85-88 wt% gibbsite. If the density of the residual solids was approximately equal to that of gibbsite, they represented ≈17 vol% of the initial crushed solids composite test sample. In the water dissolution tests, addition of a volume of water ≈6.9 times the initial volume of the crushed solids composite was sufficient to dissolve and recover essentially all of the natrophosphate present. The ratio of the weight of water required to dissolve the natrophosphate solids to the estimated weight of natrophosphate present was 8.51. The Environmental Simulation Program (OLI Systems, Inc., Morris Plains, New Jersey) predicts that an 8.36 w/w ratio would be required to dissolve the estimated weight of natrophosphate present in the absence of other components of the heel solids. Only minor amounts of Al-bearing solids were removed from the composite solids in the water dissolution tests. The caustic metathesis/aluminate dissolution test sequence, executed at temperatures ranging from 27-30 ?C, dissolved and recovered ≈69 wt% of the gibbsite estimated to have been present in the initial crushed heel solids composite. This level of gibbsite recovery is consistent with that measured in previous scoping tests on the dissolution of gibbsite in strong caustic solutions. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.3 wt% of the tank 241-C-109 aggregate solids test sample. The residual solids were 92-95 wt% gibbsite. Only a minor portion (≈4.

Callaway, William S.

2013-09-26

271

Oral Baclofen Increases Maximal Voluntary Neuromuscular Activation of Ankle Plantar Flexors in Children With Spasticity Due to Cerebral Palsy  

Microsoft Academic Search

Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. We tested voluntary

Johan van Doornik; Sahana Kukke; Kevin McGill; Jessica Rose; Sara Sherman-Levine; Terence D. Sanger

2008-01-01

272

Calcaneal fractures cause a lateral load shift in Chopart joint contact stress and plantar pressure pattern in vitro  

Microsoft Academic Search

In order to evaluate the effects of the anatomical changes after calcaneal fractures on joint loading characteristics we investigated the effects of simulated calcaneal fractures on intra-articular loading in the Chopart joint and on plantar pressure patterns in vitro. Five fresh-frozen lower leg specimens were axially loaded with 500 N in three positions: neutral, 10° plantarflexion and 10° dorsiflexion. The

Dieter Rosenbaum; Gerhard Bauer; Peter Augat; Lutz Claes

1996-01-01

273

Isokinetic profile of dorsiflexors and plantar flexors of the ankle--a comparative study of ?lite versus untrained subjects.  

PubMed Central

A comparative study was made of the isokinetic characteristics of the ankle (plantar-flexion and dorsiflexion) in young men. Six cyclists, seven gymnasts, 10 soccer players and 25 non-athletic young men were tested on the Cybex II+ dynamometer. Peak torque, torque acceleration energy (TAE), total work and average power were measured. Cyclists had slightly higher (5%) mean plantar flexion than the others, but this was not significant. The situation was reversed for dorsiflexion. Moreover, the average dorsiflexion per unit of plantar flexion was significantly higher in the gymnasts than it was in the cyclists for both torque and work. This suggests that at a specific level of plantar flexion, the gymnasts had stronger dorsiflexion compared with the cyclists and that in sports involving jumping and running, increased attention should be given to strengthening the antagonist muscle groups (dorsiflexors) in order to achieve greater agonist-to-antagonist muscle balance thus preventing injury. The non-athletic subjects had substantially lower endurance capability in both flexors as measured by the endurance ratio. This implies that identifiable specialization in particular muscles results from training or participating in specialized sports.

So, C H; Siu, T O; Chan, K M; Chin, M K; Li, C T

1994-01-01

274

Activation of spinal phosphatidylinositol 3-kinase/protein kinase B mediates pain behavior induced by plantar incision in mice.  

PubMed

The etiology of postoperative pain may be different from antigen-induced inflammatory pain and neuropathic pain. However, central neural plasticity plays a key role in incision pain. It is also known that phosphatidylinositol 3-kinase (PI3K) and protein kinase B/Akt (PKB/Akt) are widely expressed in laminae I-IV of the spinal horn and play a critical role in spinal central sensitization. In the present study, we explored the role of PI3K and Akt in incision pain behaviors. Plantar incision induced a time-dependent activation of spinal PI3K-p110? and Akt, while activated Akt and PI3K-p110? were localized in spinal neurons or microglias, but not in astrocytes. Pre-treatment with PI3K inhibitors, wortmannin or LY294002 prevented the activation of Akt brought on by plantar incision in a dose-dependent manner. In addition, inhibition of spinal PI3K signaling pathway prevented pain behaviors (dose-dependent) and spinal Fos protein expression caused by plantar incision. These data demonstrated that PI3K signaling mediated pain behaviors caused by plantar incision in mice. PMID:24594219

Xu, Bing; Guan, Xue-Hai; Yu, Jun-Xiong; Lv, Jing; Zhang, Hong-Xing; Fu, Qiao-Chu; Xiang, Hong-Bing; Bu, Hui-Lian; Shi, Dai; Shu, Bin; Qin, Li-Sheng; Manyande, Anne; Tian, Yu-Ke

2014-05-01

275

Compressive damage to the deep branch of the lateral plantar nerve associated with lameness caused by proximal suspensory desmitis  

Microsoft Academic Search

OBJECTIVE: To describe pathologic changes in the deep branch of the lateral plantar nerve (DBLPN) of horses determined to be lame because of proximal suspensory desmitis (PSD), and to report the outcome after treatment by excision of a segment of the horses' DBLPN. STUDY DESIGN: Retrospective case series. ANIMALS: Adult horses (n=16). METHODS: Horses determined to be lame on one

Ferenc Toth; James Schumacher; MICHAEL SCHRAMME; Troy Holder; H. STEVE ADAIR; ROBERT L. DONNELL

2008-01-01

276

A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes  

PubMed Central

Background Hallux valgus deformity is a common musculoskeletal foot disorder with a prevalence of 3.5% in adolescents to 35.7% in adults aged over 65 years. Radiographic measurements of hallux valgus angles (HVA) are considered to be the most reproducible and accurate assessment of HVA. However, in European countries, many podiatrists do not have direct access to radiographic facilities. Therefore, alternative measurements are desired. Such measurements are computerised plantar pressure measurement and clinical goniometry. The purpose of this study was to establish the agreement of these techniques and radiographic assessments. Methods HVA was determined in one hundred and eighty six participants suffering from diabetes. Radiographic measurements of HVA were performed with standardised static weight bearing dorsoplantar foot radiographs. The clinical goniometry for HVA was measured with a universal goniometer. Computerised plantar pressure measurement for HVA was executed with the EMED SF-4® pressure platform and Novel-Ortho-Geometry software. The intra-class correlation coefficients (ICC) and levels of agreement were analysed using Bland & Altman plots. Results Comparison of radiographic measurements to clinical goniometry for HVA showed an intraclass correlation coefficient (ICC) of 0.81 (95% confidence interval, 0.76 to 0.86; p<0.001). Radiographic measurement versus computerised plantar pressure measurement showed an ICC of 0.59 (95% confidence interval, 0.49 to 0.68; p<0.001). In addition, clinical goniometry versus computerised plantar pressure measurement showed an ICC of 0.77 (95% confidence interval, 0.70 to 0.82; p<0.001). The systematic difference of the computerised plantar pressure measurement compared with radiographic measurement and clinical goniometry was 7.0 degrees (SD 6.8) and 5.2 degrees (SD 5.0), respectively. The systemic difference of radiographic measurements compared with clinical goniometry was 1.8 degrees (SD 5.0). Conclusions The agreement of computerised plantar pressure measurement and clinical goniometry for HVA compared to radiographic measurement of HVA is unsatisfactory. Radiographic measurements of HVA and clinical goniometry for HVA yield better agreement compared to radiographic measurements and computerised plantar pressure measurement. The traditional radiographic measurement techniques are strongly recommended for the assessment of HVA.

2014-01-01

277

The fungal Achilles' heel: targeting Hsp90 to cripple fungal pathogens.  

PubMed

There is a pressing need for new therapeutic strategies for life-threatening fungal infections. Targeting the molecular chaperone Hsp90 has emerged as a promising approach to cripple fungal pathogens, thereby enhancing antifungal efficacy, impairing the evolution of drug resistance, and rendering resistant pathogens responsive to treatment. Hsp90 inhibitors in clinical development for cancer may be repurposed for some therapeutic applications, though others require fungal selective Hsp90 inhibitors or alternative strategies to inhibit the chaperone machinery. Novel targets include upstream regulators of Hsp90 function and downstream effectors, such as co-chaperones, lysine deacetylases, kinases, and phosphatases. As a hub of cellular circuitry governing stress responses, drug resistance, morphogenesis, and virulence, Hsp90 serves as a fungal Achilles' heel, with broad therapeutic potential. PMID:23588026

Cowen, Leah E

2013-08-01

278

Foam slipper in place of the walking heel for lower limb plaster of Paris casts.  

PubMed

Avoidable delays in the application of weight-bearing lower limb plaster of Paris casts on our patients caused by shortages of the standard walking heels (rockers) made us try the common and always--available foam slippers in their place. Their use in the treatment of 450 patients is reported here. The slippers performed all the usual functions of the rockers well and there were no complications due to their use. The patients felt very steady and comfortable on them and particularly appreciated the cushioning effect of their soft soles and the fact that they could use the other slipper on the uninjured leg comfortably. On the basis of the excellent results obtained in this study and in view of their cheapness and ready availability, the author recommends a wider use of slippers in place of the conventional rockers. PMID:2226230

Iwegbu, C G

1990-07-01

279

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

2007-01-01

280

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.

2011-01-01

281

Analysis of the physical and functional parameters of older adults with chronic venous disease.  

PubMed

The chronic venous disease (CVD) results from a situation of venous hypertension which occurs when there is a dysfunction of the calf pump musculature. Such alteration contributes to the worsening of the disease and may generate physical and functional limitations among older adults, carriers of CVD. In the present study, we aimed to compare the performance of the plantar flexor, the range of motion (ROM) of the ankle, gait speed and functional capacity among older adults with and without CVD. This is a cross-sectional study, with a convenience sample of 30 older adults with CVD and 30 without the disease. Gait speed was assessed by the GAITrite system, version 3.9; the dorsiflexion (DF) and plantar flexion (PF) ROMs, by goniometry, and the function of the plantar flexors by the isokinetic dynamometry. Functional capacity was evaluated by Katz and Lawton scales and by the assessment of the activities of social nature. The CVD group presented lesser ROM of DF and PF, peak torque and power of plantar flexors, gait speed and social restriction when compared to the control group (p<0.05). We concluded that older adults with CVD present important limitations of ROM and strength, mobility and social restriction confirming findings of previous studies. Such results might guide professionals in their approaches both for determining the relevance of parameters to be assessed and of their therapeutic approaches. PMID:22682424

de Moura, Regina Márcia Faria; Gomes, Henrique de Alencar; da Silva, Silvia Lanziotti Azevedo; Britto, Raquel Rodrigues; Dias, Rosângela Correa

2012-01-01

282

Dermatophyte infections in hereditary palmo-plantar keratoderma. Frequency and therapy.  

PubMed

The frequency of dermatophyte infections in hereditary palmo-plantar keratoderma ( HPPK ) of the Unna - Thost variety was investigated in 280 patients admitted to the Department of Dermatology, Central Hospital, Boden , during 1977-1981, and was found to be 35.0%. The distribution of fungi did not differ from that found for the total number of dermatophytes. An almost complete therapeutical resistance was found especially in Trichophyton rubrum infections, when patients were treated with micronized griseofulvin and topical econazole cream. Treatment of dermatophyte infections in HPPK with 50% propylene glycol in distilled water gave poor results but when 1% econazole nitrate was added negative cultures were found in 86.4% of the patients treated for 3 weeks. PMID:6233189

Gamborg Nielsen, P

1984-01-01

283

Dilated cardiomyopathy and sudden death in a teenager with palmar-plantar keratosis (occult Carvajal syndrome).  

PubMed

A 16-year-old female who was diagnosed with palmar-plantar keratosis and Papillon-Lefevre syndrome in life died following a period of stress/affray. Autopsy examination revealed evidence of minor trauma and a grossly abnormal heart. The heart was sent fresh and intact to a cardiac pathologist for examination. This revealed a dilated cardiomyopathy with left ventricular fibrosis, without fatty infiltration of the right ventricle. The features were in keeping with Carvajal syndrome, a variant of Naxos disease. This rare cardiac pathology and the interaction between stress (physiological, psychological and traumatic) and natural disease are discussed. The role of prompt referral for cardiac pathology assessment and association with the genodermatoses is also considered. PMID:18313016

Kolar, A J O; Milroy, C M; Day, P F; Suvarna, S K

2008-04-01

284

Supermicrosurgical free sensate intercostal artery perforator flap based on the lateral cutaneous branch for plantar reconstruction.  

PubMed

The use of an intercostal artery perforator (ICAP) flap has recently become popular in reconstructive surgery. We have developed a novel free sensate ICAP flap based on the lateral cutaneous branch (LCB) and applied it to a case with a plantar defect. To the best of our knowledge, this case is the first to describe a free sensate ICAP flap based on the LCB. This method has several advantages: (1) a sensate flap is possible because the LCB neurovascular bundle is consistently available; (2) the long neurovascular pedicle can be harvested in the supine position without the risk of pneumothorax; (3) the donor-site morbidity is low; and (4) conversion or combination with a superficial circumflex iliac artery perforator (SCIP) or a superficial inferior epigastric artery (SIEA) flap is readily possible. We believe that this method represents a new option for soft-tissue reconstruction. PMID:24491457

Iida, Takuya; Narushima, Mitsunaga; Hara, Hisako; Yamamoto, Takumi; Yoshimatsu, Hidehiko; Morizaki, Yutaka; Uehara, Kosuke; Koshima, Isao

2014-07-01

285

Effect of teeth clenching on isometric and isokinetic strength of ankle plantar flexion.  

PubMed

To investigate the effect of voluntary teeth clenching on the isometric and isokinetic exercises of the lower limbs, the association of muscle strength (peak torque, PT) and muscle activities (integrated electromyographic activity per unit of time, iEMG/s) of the three muscles of the triceps surae with teeth clenching during isometric and isokinetic plantar flexion were simultaneously measured for 12 healthy male volunteers using a Cybex 6000 Extremity Testing and Rehabilitation System and a surface EMG analyzing system. The statistical analysis demonstrated that for the isometric exercise, PT and each iEMG/s significantly increased in association with teeth clenching, and a positive correlation existed between the biting force and each variable. In contrast, no association was found with teeth clenching for the isokinetic exercise. In this study, therefore, it was found that the effect of teeth clenching differed between the isometric and isokinetic exercises. PMID:12160243

Sasaki, Y; Ueno, T; Taniguchi, H; Ohyama, T

1998-03-01

286

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?

2012-01-01

287

Autoperipheral blood mononuclear cell transplantation improved giant ulcers due to chronic arteriosclerosis obliterans  

Microsoft Academic Search

We report the case of a 74-year-old man with Fontaine stage IV chronic arteriosclerosis obliterans who had been suffering\\u000a from inveterate giant skin ulcers on the dorsum and heel of the right foot. As conventional medical treatments had not improved\\u000a these ulcers and surgical treatment was considered unfeasible, amputation of the right lower limb below the knee appeared\\u000a to represent

Shinobu Sugihara; Yasutaka Yamamoto; Koichi Matsubara; Katsunori Ishida; Takashi Matsuura; Fumihiro Ando; Go Igawa; Genta Narazaki; Junichiro Miake; Fumihito Tajima; Ryutaro Nishio; Bin Nakayama; Osamu Igawa; Chiaki Shigemasa; Ichiro Hisatome

2006-01-01

288

Plantar Pressure in Diabetic Peripheral Neuropathy Patients with Active Foot Ulceration, Previous Ulceration and No History of Ulceration: A Meta-Analysis of Observational Studies  

PubMed Central

Aims Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Methods Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Results Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290–0.811, p<0.001; and 0.762, 95% CI 0.303–1.221, p?=?0.001, respectively). Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181– 0.753, p?=?0.001). Statistical heterogeneity between studies was moderate. Conclusions Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings.

Fernando, Malindu Eranga; Crowther, Robert George; Pappas, Elise; Lazzarini, Peter Anthony; Cunningham, Margaret; Sangla, Kunwarjit Singh; Buttner, Petra; Golledge, Jonathan

2014-01-01

289

REMOVING SLUDGE HEELS FROM SAVANNAH RIVER SITE WASTE TANKS BY OXALIC ACID DISSOLUTION  

SciTech Connect

The Savannah River Site (SRS) will remove sludge as part of waste tank closure operations. Typically the bulk sludge is removed by mixing it with supernate to produce a slurry, and transporting the slurry to a downstream tank for processing. Experience shows that a residual heel may remain in the tank that cannot be removed by this conventional technique. In the past, SRS used oxalic acid solutions to disperse or dissolve the sludge heel to complete the waste removal. To better understand the actual conditions of oxalic acid cleaning of waste from carbon steel tanks, the authors developed and conducted an experimental program to determine its effectiveness in dissolving sludge, the hydrogen generation rate, the generation rate of other gases, the carbon steel corrosion rate, the impact of mixing on chemical cleaning, the impact of temperature, and the types of precipitates formed during the neutralization process. The test samples included actual SRS sludge and simulated SRS sludge. The authors performed the simulated waste tests at 25, 50, and 75 C by adding 8 wt % oxalic acid to the sludge over seven days. They conducted the actual waste tests at 50 and 75 C by adding 8 wt % oxalic acid to the sludge as a single batch. Following the testing, SRS conducted chemical cleaning with oxalic acid in two waste tanks. In Tank 5F, the oxalic acid (8 wt %) addition occurred over seven days, followed by inhibited water to ensure the tank contained enough liquid to operate the mixer pumps. The tank temperature during oxalic acid addition and dissolution was approximately 45 C. The authors analyzed samples from the chemical cleaning process and compared it with test data. The conclusions from the work are: (1) Oxalic acid addition proved effective in dissolving sludge heels in the simulant demonstration, the actual waste demonstration, and in SRS Tank 5F. (2) The oxalic acid dissolved {approx} 100% of the uranium, {approx} 100% of the iron, and {approx} 40% of the manganese during a single contact in the simulant demonstration. (The iron dissolution may be high due to corrosion of carbon steel coupons.) (3) The oxalic acid dissolved {approx} 80% of the uranium, {approx} 70% of the iron, {approx} 50% of the manganese, and {approx} 90% of the aluminum in the actual waste demonstration for a single contact. (4) The oxalic acid dissolved {approx} 100% of the uranium, {approx} 15% of the iron, {approx} 40% of the manganese, and {approx} 80% of the aluminum in Tank 5F during the first contact cycle. Except for the iron, these results agree well with the demonstrations. The data suggest that a much larger fraction of the iron in the sludge dissolved, but it re-precipitated with the oxalate added to Tank 5F. (5) The demonstrations produced large volumes (i.e., 2-14 gallons of gas/gallon of oxalic acid) of gas (primarily carbon dioxide) by the reaction of oxalic acid with sludge and carbon steel. (6) The reaction of oxalic acid with carbon steel produced hydrogen in the simulant and actual waste demonstrations. The volume produced varied from 0.00002-0.00100 ft{sup 3} hydrogen/ft{sup 2} carbon steel. The hydrogen production proved higher in unmixed tanks than in mixed tanks.

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

2009-03-01

290

Mixing of process heels, process solutions, and recycle streams: Results of the small-scale radioactive tests  

SciTech Connect

Various recycle streams will be combined with the low-activity waste (LAW) or the high-level waste (HLW) feed solutions during the processing of the Hanford tank wastes by BNFL, Inc. In addition, the LAW and HLW feed solutions will also be mixed with heels present in the processing equipment. This report describes the results of a test conducted by Battelle to assess the effects of mixing specific process streams. Observations were made regarding adverse reactions (mainly precipitation) and effects on the Tc oxidation state (as indicated by K{sub d} measurements with SuperLig{reg_sign} 639). The work was conducted according to test plan BNFL-TP-29953-023, Rev. 0, Small Scale Mixing of Process Heels, Solutions, and Recycle Streams. The test went according to plan, with only minor deviations from the test plan. The deviations from the test plan are discussed in the experimental section.

GJ Lumetta; JP Bramson; OT Farmer III; LR Greenwood; FV Hoopes; MA Mann; MJ Steele; RT Steele; RG Swoboda; MW Urie

2000-05-17

291

Maximum toe flexor muscle strength and quantitative analysis of human plantar intrinsic and extrinsic muscles by a magnetic resonance imaging technique  

PubMed Central

Background The aims of this study were to investigate the relationships between the maximum isometric toe flexor muscle strength (TFS) and cross-sectional area (CSA) of the plantar intrinsic and extrinsic muscles and to identify the major determinant of maximum TFS among CSA of the plantar intrinsic and extrinsic muscles. Methods Twenty six young healthy participants (14 men, 12 women; age, 20.4?±?1.6 years) volunteered for the study. TFS was measured by a specific designed dynamometer, and CSA of plantar intrinsic and extrinsic muscles were measured using magnetic resonance imaging (MRI). To measure TFS, seated participants optimally gripped the bar with their toes and exerted maximum force on the dynamometer. For each participant, the highest force produced among three trials was used for further analysis. To measure CSA, serial T1-weighted images were acquired. Results TFS was significantly correlated with CSA of the plantar intrinsic and extrinsic muscles. Stepwise multiple linear regression analyses identified that the major determinant of TFS was CSA of medial parts of plantar intrinsic muscles (flexor hallucis brevis, flexor digitorum brevis, quadratus plantae, lumbricals and abductor hallucis). There was no significant difference between men and women in TFS/CSA. Conclusions CSA of the plantar intrinsic and extrinsic muscles is one of important factors for determining the maximum TFS in humans.

2014-01-01

292

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.

2012-01-01

293

Preliminary considerations on the application of toe-to-heel steam flooding (THSF): Injection well–producer well configurations  

Microsoft Academic Search

This work examines the operational parameters that may influence the performance of toe-to-heel steamflooding in a laboratory-scale simulation model built on the basis of the fluid and rock samples from a fractured, low-permeable, carbonate heavy oil reservoir in Southwestern Iran, called KEM (Kuh-e-Mond). Using vertical (V) or horizontal (H) injectors (I) and producers (P), the effects of different well configurations

S. Mobeen Fatemi; Benyamin Yadali Jamaloei

2011-01-01

294

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

1996-01-01

295

Kinaesthetic ipsilateral and crossed extensor plantar response: A new way to elicit upgoing toe sign (Babinski response)?  

PubMed Central

We describe a phenomenon of “kinaesthetic extensor plantar response” in advanced pyramidal dysfunction, an interesting observation noted in a patient with dorsal myelopathy. A 44-year-old woman presented with one-year history of gradually progressive weakness and stiffness of both lower limbs along with urge incontinence of urine. Examination showed spontaneous elicitation of extensor plantar response while assessing the tone by rolling method as well as on noxious stimulation of the thigh. Magnetic resonance imaging (MRI) of the dorsal spine and digital subtraction angiography showed the presence of spinal dural arteriovenous fistula causing myelopathy. This case exemplifies the fact that in advanced pyramidal dysfunction, not only the receptive field of Babinski reflex may extend to the leg or thigh, but may also integrate with other modalities of stimulation, such as the rolling movement. The possible underlying pathophysiology of such a phenomenon is discussed.

Kuruvilla, Abraham; Wattamwar, Pandurang R.

2011-01-01

296

Dynamic plantar pressure measurement for the normal subject: Free-mapping model for the analysis of pediatric foot deformities.  

PubMed

In measuring plantar pressures during gait, prior methods have divided the foot into five regions and neglected forefoot alignment as it is involved in intoeing and outtoeing. The authors' proposed free-mapping method divides the foot into nine regions and incorporates a pedobarograph foot progression angle. The purpose of the study was to provide normal pressure parameter data during stance phase using a free-mapping model. Sixty-six normal children, ages 6 to 16 years, were recruited and walked along the 5-m walkway at self-selected speeds. The mean and standard deviation for the plantar contact area, contact time, peak pressure, maximal mean pressure, pressure-time integral, force-time integral, instant of peak pressure, and instant of maximum force in nine foot regions are reported. These normative data will provide a basis with which assessment of foot deformities involved in clubfoot, pes planus, and cavus foot will be more accurately defined. PMID:15614070

Liu, Xue C; Thometz, John G; Tassone, Channing; Barker, Brady; Lyon, Roger

2005-01-01

297

Pedal bone density, strength, orientation, and plantar loads preceding incipient metatarsal fracture after Charcot neuroarthropathy: 2 case reports  

PubMed Central

Study Design Case reports Background Charcot neuroarthropathy (CN) is a progressive, non-infective, inflammatory destruction of bones and joints leading to foot deformities and plantar ulceration. Though individuals with CN typically have low areal bone mineral density (aBMD), little is known regarding changes in volumetric bone mineral density (vBMD), bone geometry, joint mal-alignment, and biomechanical loads preceding fracture. Case Description Two females, aged 45 and 54 years at the onset of an acute non-fracture CN event, received regular physical therapy with wound care and total contact casting. Both enrolled in a larger research study that included plantar pressure assessment and quantitative computed tomography (QCT) at enrollment and 3, 6, and 12 months later. The women sustained mid-diaphyseal fifth metatarsal fracture 10–11 months after enrollment. QCT image analysis techniques were used to measure vBMD; bone geometric indices reflecting strength in compression, bending, and cortical buckling; and 3-dimensional bone-to-bone orientation angles reflecting foot deformity. Outcomes Fifth metatarsal mid-diaphyseal vBMD decreased during off-loading treatment from 0 to 3 months, then increased to above baseline levels by 6 months. All geometric strength indices improved from baseline through 6 months. Plantar loading in the lateral midfoot increased preceding fracture, concomitant with alterations in bone orientation angles which suggest progressive development of metatarsus adductus and equinovarus foot deformity. Discussion Fractures may occur when bone strength decreases or when biomechanical loading increases. Incipient fracture was preceded by increased loading in the lateral midfoot, but not by reductions in vBMD or geometric strength indices, suggesting that loading played a greater role in fracture. Moreover, the progression of foot deformities may be causally linked to the increased plantar loading. Level of evidence Therapy, level 4

Gutekunst, David J.; Sinacore, David R.

2014-01-01

298

Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study.  

PubMed

Plantar warts are common viral infection that are usually challenging in treatment. Conventional treatment methods are usually invasive, have low efficacy, and need long recovery periods. In this study, we compared pulsed dye laser (PDL) and neodymium yttrium aluminum garnet (Nd:YAG) lasers in the treatment of recalcitrant plantar warts. The study included 46 patients with multiple plantar warts. In each patient, lesions were divided into two groups: one treated with Nd:YAG (spot size, 7 mm; energy, 100 J/cm(2); and pulse duration, 20 ms) and the other with PDL (spot size, 7 mm; energy, 8 J/cm(2); and pulse duration, 0.5 ms). Laser sessions were applied every 2 weeks with maximum of six sessions. The study included 63 % males and 37 % females with a mean age of 29.6?±?7.34 years. The cure rate was 73.9 % with PDL with no significant difference (p?=?0.87) from Nd:YAG (78.3 %). The number of sessions required was more in PDL (mean, 5.05?±?0.2) compared with Nd:YAG (mean, 4.65?±?0.5) but without significant difference. Complications were significantly higher with Nd:YAG (43.5 %) compared with PDL (8.7 %). Hematoma was the most common complication recorded by Nd:YAG (28.3 %), and it was significantly higher (p?=?0.002) than PDL (2.2 %). Relapse was recorded in 8.7 % with Nd:YAG compared with 13 % in PDL with no significant difference (p?=?0.74). Our results suggested that PDL and Nd:YAG lasers are effective in the treatment of resistant plantar warts. PDL is safer and less painful but needs more sessions, while Nd:YAG is more painful and shows more complications. PMID:24218179

El-Mohamady, Abd El-Shakor; Mearag, Ibrahim; El-Khalawany, Mohamed; Elshahed, Ahmed; Shokeir, Hisham; Mahmoud, Anas

2014-05-01

299

Nerve conduction and ATP concentrations in sciatic-tibial and medial plantar nerves of hens given phenyl saligenin phosphate.  

PubMed

To assess the relationship of nerve conduction and adenosine triphosphate (ATP) status in organophosphorus-induced delayed neuropathy (OPIDN), we evaluated both in adult hen peripheral nerves following exposure to a single 2.5 mg/kg dose of phenyl saligenin phosphate (PSP). ATP concentrations were determined at days 2, 4, 7, and 14 post-dosing, from five segments (n = 5 per group) representing the entire length of the sciatic-tibial and medial plantar nerve. Initial effects of PSP dosing were seen in the most distal segment at day 2, when a transient ATP concentration increase (388 +/- 79 pmol/ml/mg versus control value of 215 +/- 23, P < 0.05) was noted. Subsequently, ATP concentration in this distal segment returned to normal. In the most proximal nerve segment, ATP concentrations were decreased on day 7, and further decreased on day 14 post-dosing (P < 0.05). Changes in ATP concentration and nerve conduction velocity begin at post-dosing day 2, and were found prior to development of clinical neuropathy and axonopathic lesions. These results suggest that alterations in sciatic-tibial and medial plantar nerve conduction associated with sciatic-tibial and medial plantar nerve ATP concentration are early events in the development of OPIDN. PMID:11307855

Massicotte, C; Barber, D S; Jortner, B S; Ehrich, M

2001-02-01

300

Immunoediting and Antigen Loss: Overcoming the Achilles Heel of Immunotherapy with Antigen Non-Specific Therapies  

PubMed Central

Cancer immunotherapy has emerged as a mainstream therapy option in the battle against cancer. Pre-clinical data demonstrates the ability of immunotherapy to harness the immune system to fight disseminated malignancy. Clinical translation has failed to recapitulate the promising results of pre-clinical studies although there have been some successes. In this review we explore some of the short-comings of cancer immunotherapy that have limited successful clinical translation. We will give special consideration to what we consider the most formidable hurdle to successful cancer immunotherapy: tumor-induced immune suppression and immune escape. We will discuss the need for antigen-specific immune responses for successful immunotherapy but also consider the need for antigen specificity as an Achilles heel of immunotherapy given tumor heterogeneity, immune editing, and antigen loss. Finally, we will discuss how combinatorial strategies may overcome some of the pitfalls of antigen specificity and highlight recent studies from our lab which suggest that the induction of antigen non-specific immune responses may also produce robust anti-tumor effects and bypass the need for antigen specificity.

Monjazeb, Arta Monir; Zamora, Anthony E.; Grossenbacher, Steven K.; Mirsoian, Annie; Sckisel, Gail D.; Murphy, William J.

2013-01-01

301

EM-21 ALTERNATIVE ENHANCED CHEMICAL CLEANING PROGRAM FOR SLUDGE HEEL REMOVAL  

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.

2009-12-18

302

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

PubMed

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

2013-01-01

303

EM-31 ALTERNATIVE AND ENHANCED CHEMICAL CLEANING PROGRAM FOR SLUDGE HEEL REMOVAL - 11220  

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.

2010-12-10

304

Use of an orthotic device in the treatment of posterior heel pain.  

PubMed

Research Funded by the Lexington Clinic Foundation for Research and Education. Posterior heel pain (PHP) presents a difficult clinical challenge. The causes of PHP include Haglund syndrome (pump bump deformity), Achilles tendinitis, and Sever's disease (retrocalcaneal bursitis, traction apophysitis). The purposes of this study were to 1) describe a new orthotic device used in the treatment of PHP and 2) evaluate the effectiveness of this device. The orthotic device consisted of a neoprene sleeve holding 1/4 inch PPT foam rubber horseshoe (Sports Supports, Inc., Dallas, TX). The horseshoe was placed directly over the injury to protect and relieve pressure or was inverted and used as a counterforce brace to reduce the tensile stress to the Achilles tendon. Eight patients (6 children, 2 adults) were evaluated at the time of application and after 1 month of use. Three criteria were considered: 1) subjective pain scale, 2) active goniometric measurements, and 3) toe raise test. The statistical analysis indicated a significant improvement in pain during activity from initial to follow-up and in pain after activity from initial to follow-up. All patients demonstrated improved strength and flexibility. It was concluded that this device may be an effective adjunct to the treatment of PHP. J Orthop Sports Phys Ther 1990;11(9):410-413. PMID:18787273

Wooten, B; Uhl, T L; Chandler, J

1990-01-01

305

Effect of the vibration board on the strength of ankle dorsal and plantar flexor muscles: a preliminary randomized controlled study.  

PubMed

Aim of this preliminary work is to study the effects of the vibration board on the strength of dorsal and plantar flexor muscles of the ankle through a randomized and controlled observation. Sixteen sedentary right-handed females, ranged from 20 to 30 years of age, were selected; they were not affected by previous ankle sprains and were divided into two randomized groups. The study group followed a vibration board training in the orthostatic position with a 60 degrees flexion of the knee in order to direct its mechanical impulses to the inferior limbs. Each patient of the study group performed daily, for 2 weeks, 10 repetitions that lasted 1 minute each (25 hertz of frequency). The control group followed a training protocol including 10 daily sessions for 2 weeks. Each session included 3 series of 10 repetitions of flexi-extension of the foot versus an opposite resistance of an elastic band, 60 centimetres long, that was stretched till 100 cm. Both groups were tested before and after these training programmes by Biodex isokinetic dynamometer in order to quantify the strength of the plantar and dorsal flexor muscles of the dominant ankle. Peak torque, power and total work of the dorsal and plantar flexor muscles were assessed. A power test at an angular velocity of 60 degrees/sec for five repetitions and a resistance test at an angular velocity of 180 degrees/sec. for 20 repetitions were performed. After the final isokinetic test, the results were submitted to a statistic evaluation (T test of Student) in order to analyze any possible significant differences (p < 0.05) among the initial and final values before and after the treatment. The results of the study group compared to the control group showed a significant increase in the power of the dorsal flexor muscles at an angular velocity of 60 degrees/sec and in the peak torque, power and total work of the plantar flexor muscles at an angular velocity of 60 degrees/sec and 180 degrees/sec. We conclude that the use of the vibration board causes a continuous proprioceptive stimulation which increases neuromuscular receptivity determining a prevailing reinforcement of the plantar flexor muscles of the ankle. PMID:16856702

Costantino, Cosimo; Pogliacomi, Francesco; Soncini, Giovanni

2006-04-01

306

Prevalence of osteochondral fragments, osteochondrosis dissecans and palmar/plantar osteochondral fragments in Hanoverian Warmblood horses.  

PubMed

In this study, the prevalences of osteochondral fragments in the distal (DUI) and proximal interphalangeal joints (PIJ) as well as in the fetlock, hock and stifle joints, of palmar/plantar osteochondral fragments in the fetlock joints (POFs) and of osteochondrosis dissecans (OCD) in fetlock, hock and stifle joints were estimated in a large sample of Hanoverian Warmblood horses. For this purpose, radiographic findings of 9478 Hanoverian Warmblood horses collected from 2005 to 2011 were analyzed. Overall 31.9% of the horses showed one or more osteochondral fragments in at least one joint. The fetlocks were predominantly affected with a prevalence of 19.7%, followed by the hocks with 8.2% and the stifles with 2.7%. For OCD, an overall prevalence of 14.3% was determined. In fetlock joints, 5.4% of the horses had OCD, in the hock joints 6.9% and in the stifle joints 2.6%, with bilateral occurrence in 25.8% of the hock, 24.9% of the stifle and 12.6% of the fetlock joints. POFs were observed in 6.8% of the horses. With a prevalence of 6.3%, the hindlimbs were significantly more frequently affected than the forelimbs with 0.6%. Of the horses with POFs, 16.5% were also affected with OCD. The high prevalences for osteochondral fragments determined in this study show their great importance with regard to economics and animal welfare. PMID:23758039

Hilla, Dorothea; Distl, Ottmar

2013-01-01

307

In vivo fascicle behavior of synergistic muscles in concentric and eccentric plantar flexions in humans.  

PubMed

Ultrasonography was used to directly measure in vivo fascicle behavior of the medial gastrocnemius (MG) and soleus (SOL) muscles while the subjects (n=6 men) performed maximal voluntary concentric and eccentric plantar flexions at 60, 120, 180 and 240 deg/s. Fascicle shortening and lengthening velocities of MG, obtained from fascicle length changes over time, were significantly higher than those of SOL at +/-120, +/-180 and +240 deg/s, possibly reflecting physiological and mechanical differences between these muscles. On the other hand, the effective fascicle shortening and lengthening velocities, defined as the velocities in the longitudinal direction of muscle belly, were not significantly different between MG and SOL. This could be due to difference in fascicle architecture and/or the existence of mechanical linkages between these muscles. Moreover, when the contribution of tendinous tissues to muscle-tendon complex length change was determined from fascicle length, pennation angle, moment arm and joint angle, it accounted for approximately 50% in both concentric and eccentric trials, but showed considerable intra-subject variations. This result quantifiably demonstrates the importance of tendinous tissues in isokinetically controlled joint movements. PMID:17071107

Chino, Kentaro; Oda, Toshiaki; Kurihara, Toshiyuki; Nagayoshi, Toshihiko; Yoshikawa, Kohki; Kanehisa, Hiroaki; Fukunaga, Tetsuo; Fukashiro, Senshi; Kawakami, Yasuo

2008-02-01

308

The extent of small fibre sensory neuropathy in diabetics with plantar foot ulceration.  

PubMed Central

Thresholds for cutaneous warming and cooling stimuli were measured in 20 diabetics with neuropathic foot ulcers. All patients had a profound disturbance of sensory perception in the ulcerated foot with complete loss of perception of warming; thresholds for vibration and cooling were highly abnormal in all but two patients. Measurements of thermal threshold were made on both feet in 10 patients: warming was lost bilaterally in all, and cooling was bilaterally absent in six. There was no clear pattern of sensory loss in those diabetics with unilateral foot ulceration to suggest that sensory impairment was the determining factor for the development of a plantar ulcer. Measurements of thermal thresholds were made at additional sites in 13 patients and although the most marked abnormalities of sensation were always found in the feet, in some severe neuropaths, abnormal thresholds on the hand and even the face were demonstrated. Thresholds for warming were invariably more abnormal than thresholds for cooling. The diabetics with neuropathic ulceration in this study all had severe generalised peripheral nerve disease involving large myelinated as well as both small myelinated and unmyelinated sensory fibres. The quantitative evidence on the distribution of sensory loss for thermal sensations supports the hypothesis that the neuropathic process affecting the small myelinated and unmyelinated fibres is length dependent. Images

Ali, Z; Carroll, M; Robertson, K P; Fowler, C J

1989-01-01

309

Quantitative Estimation of Temperature Variations in Plantar Angiosomes: A Study Case for Diabetic Foot  

PubMed Central

Thermography is a useful tool since it provides information that may help in the diagnostic of several diseases in a noninvasive and fast way. Particularly, thermography has been applied in the study of the diabetic foot. However, most of these studies report only qualitative information making it difficult to measure significant parameters such as temperature variations. These variations are important in the analysis of the diabetic foot since they could bring knowledge, for instance, regarding ulceration risks. The early detection of ulceration risks is considered an important research topic in the medicine field, as its objective is to avoid major complications that might lead to a limb amputation. The absence of symptoms in the early phase of the ulceration is conceived as the main disadvantage to provide an opportune diagnostic in subjects with neuropathy. Since the relation between temperature and ulceration risks is well established in the literature, a methodology that obtains quantitative temperature differences in the plantar area of the diabetic foot to detect ulceration risks is proposed in this work. Such methodology is based on the angiosome concept and image processing.

Peregrina-Barreto, H.; Morales-Hernandez, L. A.; Rangel-Magdaleno, J. J.; Avina-Cervantes, J. G.; Ramirez-Cortes, J. M.; Morales-Caporal, R.

2014-01-01

310

Evaluation of potential variables contributing to the development and duration of plantar lesions in a population of aquarium-maintained African penguins (Spheniscus demersus).  

PubMed

Bumblefoot (pododermatitis), often described as the most significant environmental disease of captive penguins, is commonly due to excessive pressure or trauma on the plantar surface of the avian foot, resulting in inflammation or necrosis and causing severe swelling, abrasions, or cracks in the skin. Although not formally evaluated in penguins, contributing factors for bumblefoot are thought to be similar to those initiating the condition in raptors and poultry. These factors include substrate, body weight, and lack of exercise. The primary purpose of this retrospective study was to evaluate variables potentially contributing to the development and duration of plantar lesions in aquarium-maintained African penguins (Spheniscus demersus), including sex, weight, age, season, exhibit activity, and territory substrate. Results indicate that males develop significantly more plantar lesions than females. Penguins weighing between 3.51 and 4.0 kg develop plantar lesions significantly more often than penguins weighing between 2.5 and 3.5 kg, and because male African penguins ordinarily weigh significantly more than females, weight is likely a contributing factor in the development of lesions in males compared with females. Significantly more plantar lesions were observed in penguins standing for greater than 50% of their time on exhibit than swimming. Penguins occupying smooth concrete territories developed more plantar lesions compared with penguins occupying grate territories. Recommendations for minimizing bumblefoot in African penguins include training penguins for monthly foot examinations for early detection of plantar lesions predisposing for the disease, encouraging swimming activity, and replacing smooth surfaces on exhibit with surfaces providing variable degrees of pressure and texture on the feet. PMID:21557300

Erlacher-Reid, Claire; Dunn, J Lawrence; Camp, Tracy; Macha, Laurie; Mazzaro, Lisa; Tuttle, Allison D

2012-01-01

311

Influence of Lifestyle Factors on Quantitative Heel Ultrasound Measurements in Middle-Aged and Elderly Men.  

PubMed

We examined the distribution of quantitative heel ultrasound (QUS) parameters in population samples of European men and looked at the influence of lifestyle factors on the occurrence of these parameters. Men aged between 40 and 79 years were recruited from eight European centers and invited to attend for an interviewer-assisted questionnaire, assessment of physical performance, and quantitative ultrasound (QUS) of the calcaneus (Hologic; Sahara). The relationships between QUS parameters and lifestyle variables were assessed using linear regression with adjustments for age, center, and weight. Three thousand two hundred fifty-eight men, mean age 60.0 years, were included in the analysis. A higher PASE score (upper vs. lower tertile) was associated with a higher BUA (? coefficient = 2.44 dB/Mhz), SOS (? = 6.83 m/s), and QUI (? = 3.87). Compared to those who were inactive, those who walked or cycled more than an hour per day had a higher BUA (? = 3.71 dB/Mhz), SOS (? = 6.97 m/s), and QUI (? = 4.50). A longer time to walk 50 ft was linked with a lower BUA (? = -0.62 dB/Mhz), SOS (? = -1.06 m/s), and QUI (? = -0.69). Smoking was associated with a reduction in BUA, SOS, and QUI. There was a U-shaped association with frequency of alcohol consumption. Modification of lifestyle, including increasing physical activity and stopping smoking, may help optimize bone strength and reduce the risk of fracture in middle-aged and elderly European men. PMID:20084503

Pye, Stephen R; Devakumar, Vinodh; Boonen, Steven; Borghs, Herman; Vanderschueren, Dirk; Adams, Judith E; Ward, Kate A; Bartfai, Gyorgy; Casanueva, Felipe F; Finn, Joseph D; Forti, Gianni; Giwercman, Aleksander; Han, Thang S; Huhtaniemi, Ilpo T; Kula, Krzysztof; Lean, Michael E J; Pendleton, Neil; Punab, Margus; Silman, Alan J; Wu, Frederick C W; O'Neill, Terence W

2010-03-01

312

Influence of lifestyle factors on quantitative heel ultrasound measurements in middle-aged and elderly men.  

PubMed

We examined the distribution of quantitative heel ultrasound (QUS) parameters in population samples of European men and looked at the influence of lifestyle factors on the occurrence of these parameters. Men aged between 40 and 79 years were recruited from eight European centers and invited to attend for an interviewer-assisted questionnaire, assessment of physical performance, and quantitative ultrasound (QUS) of the calcaneus (Hologic; Sahara). The relationships between QUS parameters and lifestyle variables were assessed using linear regression with adjustments for age, center, and weight. Three thousand two hundred fifty-eight men, mean age 60.0 years, were included in the analysis. A higher PASE score (upper vs. lower tertile) was associated with a higher BUA (beta coefficient = 2.44 dB/ Mhz), SOS (beta = 6.83 m/s), and QUI (beta = 3.87). Compared to those who were inactive, those who walked or cycled more than an hour per day had a higher BUA (beta = 3.71 dB/Mhz), SOS (beta = 6.97 m/s), and QUI (beta = 4.50). A longer time to walk 50 ft was linked with a lower BUA (beta = -0.62 dB/ Mhz), SOS (beta = -1.06 m/s), and QUI (beta = -0.69). Smoking was associated with a reduction in BUA, SOS, and QUI. There was a U-shaped association with frequency of alcohol consumption. Modification of lifestyle, including increasing physical activity and stopping smoking, may help optimize bone strength and reduce the risk of fracture in middle-aged and elderly European men. PMID:20205346

Pye, Stephen R; Devakumar, Vinodh; Boonen, Steven; Borghs, Herman; Vanderschueren, Dirk; Adams, Judith E; Ward, Kate A; Bartfai, Gyorgy; Casanueva, Felipe F; Finn, Joseph D; Forti, Gianni; Giwercman, Aleksander; Han, Thang S; Huhtaniemi, Ilpo T; Kula, Krzysztof; Lean, Michael E J; Pendleton, Neil; Punab, Margus; Silman, Alan J; Wu, Frederick C W; O'Neill, Terence W

2010-03-01

313

Influence of lifestyle factors on quantitative heel ultrasound measurements in middle-aged and elderly men  

PubMed Central

We examined the distribution of quantitative heel ultrasound (QUS) parameters in population samples of European men, and looked at the influence of lifestyle factors on the occurrence of these parameters. Men aged between 40 and 79 years were recruited from eight European centres and invited to attend for an interviewer-assisted questionnaire, assessment of physical performance and quantitative ultrasound (QUS) of the calcaneus (Hologic - SAHARA). The relationships between QUS parameters and lifestyle variables were assessed using linear regression with adjustments for age, centre and weight. 3,258 men, mean age 60.0 years were included in the analysis. A higher PASE score (upper vs lower tertile) was associated with higher BUA (? coefficient = 2.44 dB/Mhz), SOS (? coefficient = 6.83 m/s) and QUI (? coefficient = 3.87). Compared to those who were inactive, those who walked or cycled more than an hour per day had a higher BUA (? coeff =3.71 dB/Mhz), SOS (? coeff = 6.97 m/s) and QUI (? coeff = 4.50). A longer time to walk 50 feet was linked with lower BUA (? coeff = ?0.62 dB/Mhz), SOS (? coeff = ?1.06 m/s) and QUI (? coeff = ?0.69). Smoking was associated with a reduction in BUA, SOS and QUI. There was a U shaped association with frequency of alcohol consumption. Modification of lifestyle, including increasing physical activity and stopping smoking may help optimise bone strength and reduce the risk of fracture in middle aged and elderly European men.

Pye, Stephen R; Devakumar, Vinodh; Boonen, Steven; Borghs, Herman; Vanderschueren, Dirk; Adams, Judith E; Ward, Kate A; Bartfai, Gyorgy; Casanueva, Felipe F; Finn, Joseph D; Forti, Gianni; Giwercman, Aleksander; Han, Thang S; Huhtaniemi, Ilpo T; Kula, Krzysztof; Lean, Michael EJ; Pendleton, Neil; Punab, Margus; Silman, Alan J; Wu, Frederick CW; O'Neill, Terence W

2014-01-01

314

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.

2012-01-01

315

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

PubMed

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

2012-10-01

316

Influence of pressure-relief insoles developed for loaded gait (backpackers and obese people) on plantar pressure distribution and ground reaction forces.  

PubMed

The aims of this study were to test the effects of two pressure relief insoles developed for backpackers and obese people on the ground reaction forces (GRF) and plantar pressure peaks during gait; and to compare the GRF and plantar pressures among normal-weight, backpackers, and obese participants. Based on GRF, plantar pressures, and finite element analysis two insoles were manufactured: flat cork-based insole with (i) corkgel in the rearfoot and forefoot (SLS1) and with (ii) poron foam in the great toe and lateral forefoot (SLS2). Gait data were recorded from 21 normal-weight/backpackers and 10 obese participants. The SLS1 did not influence the GRF, but it relieved the pressure peaks for both backpackers and obese participants. In SLS2 the load acceptance GRF peak was lower; however, it did not reduce the plantar pressure peaks. The GRF and plantar pressure gait pattern were different among the normal-weight, backpackers and obese participants. PMID:24468683

Peduzzi de Castro, Marcelo; Abreu, Sofia; Pinto, Viviana; Santos, Rubim; Machado, Leandro; Vaz, Mario; Vilas-Boas, João Paulo

2014-07-01

317

Spinal plasticity in stroke patients after botulinum neurotoxin A injection in ankle plantar flexors.  

PubMed

The effect of botulinum neurotoxin A (BoNT-A) in stroke patients' upper limbs has been attributed to its peripheral action only. However, BoNT-A depressed recurrent inhibition of lumbar motoneurons, likely due to its retrograde transportation along motor axons affecting synapses to Renshaw cells. Because Renshaw cells control group Ia interneurons mediating reciprocal inhibition between antagonists, we tested whether this inhibition, particularly affected after stroke, could recover after BoNT-A. The effect of posterior tibial nerve (PTN) stimulation on tibialis anterior (TA) electromyogram (EMG) was investigated in 13 stroke patients during treadmill walking before and 1 month after BoNT-A injection in ankle plantar flexors. Before BoNT-A, PTN stimuli enhanced TA EMG all during the swing phase. After BoNT-A, the PTN-induced reciprocal facilitation in TA motoneurons was depressed at the beginning of swing and reversed into inhibition in midswing, but at the end of swing, the reciprocal facilitation was enhanced. This suggests that BoNT-A induced spinal plasticity leading to the recovery of reciprocal inhibition likely due to the withdrawal of inhibitory control from Renshaw cells directly blocked by the toxin. At the end of swing, the enhanced reciprocal facilitation might be due to BoNT-induced modification of peripheral afferent inputs. Therefore, both central and peripheral actions of BoNT-A can modify muscle synergies during walking: (1) limiting ankle muscle co-contraction in the transition phase from stance to swing, to assist dorsiflexion, and (2) favoring it from swing to stance, which blocks the ankle joint and thus assists the balance during the single support phase on the paretic limb. PMID:24400171

Aymard, Claire; Giboin, Louis-Solal; Lackmy-Vallée, Alexandra; Marchand-Pauvert, Véronique

2013-11-01

318

Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients  

PubMed Central

Objective To assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients. Methods Fifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted walking on the treadmill with the same body support in random order. The contact area, contact pressure, trajectory length of center of pressure (COP), temporal data on both limbs and asymmetric index of both limbs were obtained during both walking conditions, using the F-Scan in-shoe pressure measurement system. Results The contact area of midfoot and total foot on the affected side were significantly increased in robotic-assisted walking as compared to unassisted walking (p<0.01). The contact pressure of midfoot and total foot on affected limbs were also significantly increased in robotic-assisted walking (p<0.05). The anteroposterior and mediolateral trajectory length of COP were not significantly different between the two walking conditions, but their trajectory variability of COP was significantly improved (p<0.05). The asymmetric index of area, stance time, and swing time during robotic-assisted walking were statistically improved as compared with unassisted walking (p<0.05). Conclusion The robotic-assisted walking may be helpful in improving the gait stability and symmetry, but not the physiologic ankle rocker function.

Yang, Jin Kyu; Ahn, Na El; Kim, Dae Hyun

2014-01-01

319

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

2007-01-01

320

The adaptation of the foot to heavy loads: plantar foot pressures study.  

PubMed

INTRODUCTION:: The foot serves as the main shock absorber during various activities as walking running and jumping. There are static and dynamic mechanisms which play a role in the adaptation of the foot to weight bearing walking with weights. The function of the foot while weight bearing was studied mainly under static conditions. We designed an experiment to explore dynamically the adaptation of the foot to weight bearing walking with weights. METHODS:: Ten healthy subjects participated the study. They walked barefoot over an EMED force plate which based on multiple pressure capacitance sensors. Each subject walked three times. The first walk was without any weight, the second walk with weight of 20 kg in backpack and the third walk with weight of 40 kg. Contact area, peak pressures, peak forces and duration of contact time were measured in seven areas of interest of the foot-heel, midfoot, lateral, central and medial forefoot, lateral toes and hallux. RESULTS:: The pressure time integral and force time integral increased in most areas of the foot except for the midfoot in the 20 kg walk. The largest increase was at the central and medial forefoot. Adding additional 20 kg to the load did not increased the loads on the midfoot but increased further the loads mainly at the central and medial forefoot. CONCLUSIONS:: The human foot adapts itself under loading condition by maintaining the medial longitudinal arch. Increasing the loading further activates compensatory mechanisms which maintain the longitudinal arch and shifts the the loads to the central and medial forefoot. PMID:11415706

Nyska, M; Linge, K; McCabe, C; Klenerman, L

1997-04-01

321

Endoscopic Transthoracic Limited Sympathotomy for Palmar-Plantar Hyperhidrosis: Outcomes and Complications During a 10-Year Period  

PubMed Central

OBJECTIVE: To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade. PATIENTS AND METHODS: We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications. RESULTS: Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%). CONCLUSION: In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.

Atkinson, John L. D.; Fode-Thomas, Nicolee C.; Fealey, Robert D.; Eisenach, John H.; Goerss, Stephan J.

2011-01-01

322

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

PubMed

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

2013-12-01

323

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.

2013-01-01

324

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

2012-01-01

325

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

PubMed

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

2013-01-01

326

Plantar melanoma that mimics melanocytic nevi: a report of 4 cases with lymph node metastases and with review of positive and negative controls.  

PubMed

We report 4 cases of melanoma localized on the sole with some striking histological similarities to the compound nevi. One case showed inguinal lymph node metastases after a diagnosis of compound nevus made 5 years earlier. The other 3 cases were sent to us in consultation as suspected plantar lesions; a diagnosis of melanoma mimicking compound nevus was proposed: the sentinel lymph node technique was accordingly performed and resulted positive. These 4 index cases were compared with 26 cases of ordinary plantar melanoma and with 117 cases of benign compound plantar nevi. Histologically, the similarity of areas of these 4 cases of plantar melanoma to compound plantar nevi (namely Miescher, Clark, or acral lentiginous nevus) is so close that it may prove misleading in the diagnostic pathway. In such cases, an erroneous diagnosis of benign lesion may be made. The correct diagnosis of melanoma can, however, be done by combining the clinical and pathological findings. In fact, this deceptive form of melanoma mimicking a compound nevus is characterized by patients' advanced age (>45 years), large lateral diameters (>10 mm), and significant depth of the lesion (>1 mm). In our 4 cases, such features were combined with one or more of the following histological clues: lentiginous (ie, continuous) proliferation of enlarged and hyperchromatic melanocytes aligned in single units at the dermoepidermal junction; extensive eccrine duct melanocytic infiltration; dermal melanocytes with slight nuclear enlargement, nuclear membrane thickening and folding, and conspicuous central nucleoli; and cellular pleomorphism of the epidermal and dermal component. Moreover, mitotic figures were an inconstant but decisive indication of malignancy. In conclusion, a small group of plantar melanoma has striking similarities with compound nevi. Only the correlation of clinical data (old age of the patient and large size of the lesion) with subtle architectural and cytological alterations (depth of the lesion, lentiginous melanocytic epidermal and eccrine proliferation, and cellular alteration and mitoses) allows a correct diagnosis. PMID:19318796

Massi, Guido; Vellone, Valerio Gaetano; Pagliarello, Calogero; Fabrizi, Giuseppe

2009-04-01

327

Mechanical analysis of the landing phase in heel-toe running.  

PubMed

Results of mechanical analyses of running may be helpful in the search for the etiology of running injuries. In this study a mechanical analysis was made of the landing phase of three trained heel-toe runners, running at their preferred speed and style. The body was modeled as a system of seven linked rigid segments, and the positions of markers defining these segments were monitored using 200 Hz video analysis. Information about the ground reaction force vector was collected using a force plate. Segment kinematics were combined with ground reaction force data for calculation of the net intersegmental forces and moments. The vertical component of the ground reaction force vector Fz was found to reach a first peak approximately 25 ms after touch-down. This peak occurs because, in the support leg, the vertical acceleration of the knee joint is not reduced relative to that of the ankle joint by rotation of the lower leg, so that the support leg segments collide with the floor. Rotation of the support upper leg, however, reduces the vertical acceleration of the hip joint relative to that of the knee joint, and thereby plays an important role in limiting the vertical forces during the first 40 ms. Between 40 and 100 ms after touch-down, the vertical forces are mainly limited by rotation of the support lower leg. At the instant that Fz reaches its first peak, net moments about ankle, knee and hip joints of the support leg are virtually zero. The net moment about the knee joint changed from -100 Nm (flexion) at touch-down to +200 Nm (extension) 50 ms after touch-down. These changes are too rapid to be explained by variations in the muscle activation levels and were ascribed to spring-like behavior of pre-activated knee flexor and knee extensor muscles. These results imply that the runners investigated had no opportunity to control the rotations of body segments during the first part of the contact phase, other than by selecting a certain geometry of the body and muscular (co-)activation levels prior to touch-down. PMID:1564058

Bobbert, M F; Yeadon, M R; Nigg, B M

1992-03-01

328

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

PubMed

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

2009-12-01

329

Barefoot-pedestrian tribometry: in vivo method of measurement of available friction between the human heel and the walkway.  

PubMed

We have developed an in vivo tribometer for characterizing the friction of a human heel against a planar test surface. The pedestrian steps down on an angled test surface and an observer determines if the person's heel slips. In the simplest variation, the subject simply steps down onto the test surface. The second variation has the standing subject's lower leg constrained to a vertically running carriage, forcing the pedestrian's leg to descend vertically. The third variation has the subject sitting, with an operator raising and lowering the carriage to which the leg is attached. The test surface was fixed at a given angle, a set of repeated tests was run, and the number of tests and slips were recorded. The test-surface angle was incremented through a range that varied from no slips to all slips. We analyzed the data using logistic regression. We found that the unconstrained test subject's logistic-regression curves varied greatly from subject to subject. The standing, constrained subjects were significantly closer to each other, but at the expense of a much higher spread of the angular range. The seated, constrained test subject's results were both extremely close and had extremely low angular spread. PMID:18270450

Besser, Marcus; Marpet, Mark; Medoff, Howard

2008-01-01

330

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

PubMed

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

2009-04-01

331

Effects of the playing surface on plantar pressures and potential injuries in tennis  

PubMed Central

Objectives To examine the influence of different playing surfaces on in?shoe loading patterns during tennis?specific movements. Methods Ten experienced male players performed two types of tennis?specific displacements (serve and volley (SV) and baseline play (BA)) on two different playing surfaces; eg, clay vs Greenset. Maximum and mean force and pressure, contact time, contact area and relative load were recorded by an insole with 99 sensors (X?Pedar system) divided into 9 areas. Results Regarding the whole foot, mean (SD) force (SV: 615 (91) vs 724 (151)?N; ?12.4%, p<0.05 and BA: 614 (73) vs 717 (133)?N; ?11.6%, p<0.05) was lower on clay than on Greenset, whereas contact time was longer (SV: 299 (113) vs 270 (148)?ms; +16.5%, NS and BA: 354 (72) vs 272 (60)?ms; +30.3%, p<0.001). Greenset induced higher loading in the hallux (SV: +15.3%, p<0.05 and BA: +11.4%, not significant) and lesser toes areas (SV: +12.6%, p<0.05 and BA: +18.0%, p<0.01). In contrast, the relative load on the medial (SV: +27.4%, p<0.05 and BA: +16.1%, p?=?0.06) and lateral midfoot (SV: +23.3%, p<0.05 and BA: +28.3%, p<0.01) was higher on clay. Conclusions This study demonstrates that playing surface affects plantar loading in tennis: Greenset induced higher loading in the hallux (SV: +15.3%, p<0.05 and BA: +11.4%, NS) and lesser toes areas (SV: +12.6%, p<0.05 and BA: +18.0%, p<0.01) but lower relative load on the medial (SV: ?27.4%, p<0.05 and BA: ?16.1%, p?=?0.06) and lateral midfoot (SV: ?23.3%, p<0.05 and BA: ?28.3%, p<0.01) than clay.

Girard, O; Eicher, F; Fourchet, F; Micallef, J P; Millet, G P

2007-01-01

332

Chronic wounds.  

PubMed

Chronic wounds are a challenge to treat for the clinician. We present a current overview of intrinsic and extrinsic factors in the development chronic nonhealing wounds. Solutions to some of these difficult problems are presented. PMID:15814118

Izadi, Kouros; Ganchi, Parham

2005-04-01

333

Citral: A monoterpene with prophylactic and therapeutic anti-nociceptive effects in experimental models of acute and chronic pain.  

PubMed

Citral (3,7-dimethyl-2,6-octadienal) is an open-chain monoterpenoid present in the essential oils of several medicinal plants. The aim of this work was to evaluate the effects of orally administered citral in experimental models of acute and chronic nociception, inflammation, and gastric ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs). Oral treatment with citral significantly inhibited the neurogenic and inflammatory pain responses induced by intra-plantar injection of formalin. Citral also had prophylactic and therapeutic anti-nociceptive effects against mechanical hyperalgesia in plantar incision surgery, chronic regional pain syndrome, and partial ligation of sciatic nerve models, without producing any significant motor dysfunction. In addition, citral markedly attenuated the pain response induced by intra-plantar injection of glutamate and phorbol 12-myristate 13-acetate (PMA, a protein kinase C activator), as well as by intrathecal (i.t.) injection of ionotropic and metabotropic glutamate receptor agonists (N-methyl-d-aspartic acid [NMDA] and 1-amino-1,3-dicarboxycyclopentane [trans-ACPD], respectively), substance P, and cytokine tumour necrosis factor-?. However, citral potentiated behaviours indicative of pain caused by i.t., but not intra-plantar, injection of a transient receptor potential vanilloid receptor type 1 (TRPV1) agonist. Finally, the anti-nociceptive action of citral was found to involve significant activation of the 5-HT2A serotonin receptor. The effect of citral was accompanied by a gastro-protective effect against NSAID-induced ulcers. Together, these results show the potential of citral as a new drug for the treatment of pain. PMID:24792822

Nishijima, Catarine M; Ganev, Ellen G; Mazzardo-Martins, Leidiane; Martins, Daniel F; Rocha, Lúcia R M; Santos, Adair R S; Hiruma-Lima, Clelia A

2014-08-01

334

Discriminative Ability of Heel Quantitative Ultrasound in Postmenopausal Women With Prevalent Low-Trauma Fractures: Application of Optimal Threshold Cutoff Values Using CART Models  

Microsoft Academic Search

Quantitative ultrasound (QUS) of the heel has been proposed as a screening tool to evaluate the bone status and risk of osteoporotic fragility fractures. The aim of this study was to define threshold values of QUS that would maximize the predictive ability of this technique to discriminate subjects with fragility fractures. A cross-sectional analysis was made of a cohort of

María del Carmen Navarro; Pedro Saavedra; María Jesús Gómez-de-Tejada; Mercedes Suárez; Diego Hernández; Manuel Sosa

2011-01-01

335

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.

2013-01-01

336

The influence of the heel effect in cone-beam computed tomography: artifacts in standard and novel geometries and their correction  

NASA Astrophysics Data System (ADS)

For decades, the heel effect has been known to cause an angular dependence of the emitted spectrum of an x-ray tube. In radiography, artifacts were observed and attributed to the heel effect. However, no problems due to the heel effect were discerned in multi-slice computed tomography (MSCT) so far. With flat-detector CT (FDCT), involving larger cone angles and different system geometries, the heel effect might cause new artifacts. These artifacts were analyzed in this paper for system geometries different from the ones widely used nowadays. Simulations and measurements were performed. Simulations included symmetric as well as asymmetric detector layouts and different x-ray tube orientations with respect to the detector plane. The measurements were performed on a micro-CT system in an asymmetric detector layout. Furthermore, an analytical correction scheme is proposed to overcome heel effect artifacts. It was shown that the type of artifact greatly depends on the orientation of the x-ray tube and also on the type of detector alignment (i.e. symmetric or different types of asymmetric alignment). Certain combinations exhibited almost no significant artifact while others greatly influenced the quality of the reconstructed images. The proposed correction scheme showed good results that were further improved when also applying a scatter correction. When designing CT systems, care should be taken when placing the tube and the detector. Orientation of the x-ray tube like in most MSCT systems seems advisable in asymmetric detector layouts. However, a different type of tube orientation can be overcome with suitable correction schemes.

Braun, H.; Kyriakou, Y.; Kachelrieß, M.; Kalender, W. A.

2010-10-01

337

Multiple inguinal and pelvic lymph node metastases of malignant melanoma of the heel identified by common iliac lymphadenopathy.  

PubMed

It is extremely rare that swelling of pelvic lymph nodes is found when inguinal lymph nodes contain only a microscopic amount of disease without enlargement. A 69-year-old woman with malignant melanoma of the heel was treated with a wide, local excision. About four years after the initial operation, a left common iliac node was enlarged although all lymph nodes in the obturator, external iliac and inguinal regions were not enlarged. Rapid pathological examination of the resected swollen lymph nodes revealed involvement of malignant melanoma, and left pelvic and groin dissection was undertaken. Histologically, multiple lymph node metastases were found in the common iliac, obturator, external iliac and inguinal regions. This case indicates that sentinel lymph node biopsy may be worth considering even for stage IA malignant melanoma of the lower extremity. PMID:22984908

Nakamura, Yoshiyuki; Nakamura, Yasuhiro; Fujisawa, Yasuhiro; Obara, Saeko; Furuta, Junichi; Kawachi, Yasuhiro; Otsuka, Fujio

2012-09-01

338

Effectiveness of a heel cup with an arch support insole on the standing balance of the elderly  

PubMed Central

Background The use of insoles may enhance postural stability and prevent falls. The aim of this study was to design a new insole and to explore the effectiveness of the insole on the standing balance of the healthy elderly. Methods The study was conducted at a community hospital. Patients older than 65 years at an outpatient clinic without abnormal gait patterns, lower limb deformities, or foot pain were enrolled. The participants were assigned to good- and poor-stability groups on the basis of the stability index (SI), using the Biodex® Balance System. A heel cup with an arch support insole was provided. Participants wore the insole for 8 weeks for a minimum of 4 hours/day. A static balance test for SI was performed at the initial meeting and 8 weeks after the assigned insoles were worn for each participant. Results Five participants (10.0%) of 50 total did not finish the study. There were 25 patients in the good-stability group and 20 in the poor-stability group. The SI, before and after intervention, was significantly different for all 45 participants (3.244±0.688 versus 3.064±0.671; P<0.001). The differences in SI before and after the intervention both in the good-stability group (2.764±0.546 versus 2.592±0.538) and the poor-stability group (3.845±0.188 versus 3.655±0.128) were statistically significant (P<0.001). No statistically significant difference on changes of SI were seen between the two groups. Conclusion The results suggest a heel cup with arch support insole is effective in enhancing the standing balance of the elderly. This may be of benefit in preventing falls.

Chen, Tzu-Hsuan; Chou, Li-Wei; Tsai, Mei-Wun; Lo, Ming-Jor; Kao, Mu-Jung

2014-01-01

339

The M?ori foot exhibits differences in plantar loading and midfoot morphology to the Caucasian foot.  

PubMed

The question being addressed in the current study was whether the diabetic M?ori foot was more or less prone to ulceration than the diabetic New Zealand Caucasian (NZC) foot. Harris mat and pedobarographic analyses were employed to assess static and dynamic foot morphology and plantar loading in 40 M?ori and NZC diabetic and non-diabetic participants. Significantly higher peak pressures were exhibited by the diabetic M?ori participants compared to their NZC peers at the central forefoot. Significantly higher static and dynamic arch index values and significantly higher sub-arch angle values were exhibited by the non-diabetic M?ori participants compared to their NZC peers. The latter findings suggest that healthy M?ori may have a predisposition towards having a flatter foot than healthy NZC, which may have footwear design implications. PMID:22364845

Gurney, J K; Kuch, C; Rosenbaum, D; Kersting, U G

2012-05-01

340

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

PubMed

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

2013-01-01

341

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

PubMed

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

2013-01-01

342

Contribution of central vs. peripheral factors to the force loss induced by passive stretch of the human plantar flexors.  

PubMed

The purpose of the present research was to identify the contribution of central vs. peripheral factors to the force loss after passive muscle stretching. Thirteen men randomly performed both a 5-min constant-torque stretch of the plantar flexors on an isokinetic dynamometer and a resting condition on 2 separate days. The triceps surae electromyogram (EMG) was recorded simultaneously with plantar flexor isometric torque. Measures of central drive, including the EMG amplitude normalized to the muscle compound action potential amplitude (EMG/M), percent voluntary activation and first volitional wave amplitude, and measures of peripheral function, including the twitch peak torque, 20-to-80-Hz tetanic torque ratio and torque during 20-Hz stimulation preceded by a doublet, were taken before and immediately and 15 min after each condition. Peak torque (-15.7%), EMG/M (-8.2%), and both twitch (-9.4%) and 20-Hz peak torques (-11.5%) were reduced immediately after stretch but recovered by 15 min. There were strong correlations between the torque loss and the reductions in central drive parameters (r = 0.65-0.93). Torque recovery was also strongly correlated with the recovery in EMG/M and percent voluntary activation (r = 0.77-0.81). The moderate decreases in measures of peripheral function were not related to the torque loss or recovery. These results suggest that 1) central factors were strongly related to the torque reduction immediately after stretch and during torque recovery; and 2) the muscle's contractile capacity was moderately reduced, although these changes were not associated with the torque reduction, and changes in excitation-contraction coupling efficiency were not observed. PMID:23661620

Trajano, Gabriel S; Seitz, Laurent; Nosaka, Kasunori; Blazevich, Anthony J

2013-07-15

343

The Relationships between Foot Arch Volumes and Dynamic Plantar Pressure during Midstance of Walking in Preschool Children  

PubMed Central

Objectives The purpose of this study was to examine the correlation between the foot arch volume measured from static positions and the plantar pressure distribution during walking. Methods A total of 27 children, two to six years of age, were included in this study. Measurements of static foot posture were obtained, including navicular height and foot arch volume in sitting and standing positions. Plantar pressure, force and contact areas under ten different regions of the foot were obtained during walking. Results The foot arch index was correlated (r?=?0.32) with the pressure difference under the midfoot during the foot flat phase. The navicular heights and foot arch volumes in sitting and standing positions were correlated with the mean forces and pressures under the first (r?=??0.296??0.355) and second metatarsals (r?=??0.335??0.504) and midfoot (r?=??0.331??0.496) during the stance phase of walking. The contact areas under the foot were correlated with the foot arch parameters, except for the area under the midfoot. Conclusions The foot arch index measured in a static position could be a functional index to predict the dynamic foot functions when walking. The foot arch is a factor which will influence the pressure distribution under the foot. Children with a lower foot arch demonstrated higher mean pressure and force under the medial forefoot and midfoot, and lower contact areas under the foot, except for the midfoot region. Therefore, children with flatfoot may shift their body weight to a more medial foot position when walking, and could be at a higher risk of soft tissue injury in this area.

Chang, Hsun-Wen; Chieh, Hsiao-Feng; Lin, Chien-Ju; Su, Fong-Chin; Tsai, Ming-June

2014-01-01

344

Genetic determinants of heel bone properties: genome-wide association meta-analysis and replication in the GEFOS/GENOMOS consortium.  

PubMed

Quantitative ultrasound of the heel captures heel bone properties that independently predict fracture risk and, with bone mineral density (BMD) assessed by X-ray (DXA), may be convenient alternatives for evaluating osteoporosis and fracture risk. We performed a meta-analysis of genome-wide association (GWA) studies to assess the genetic determinants of heel broadband ultrasound attenuation (BUA; n = 14 260), velocity of sound (VOS; n = 15 514) and BMD (n = 4566) in 13 discovery cohorts. Independent replication involved seven cohorts with GWA data (in silico n = 11 452) and new genotyping in 15 cohorts (de novo n = 24 902). In combined random effects, meta-analysis of the discovery and replication cohorts, nine single nucleotide polymorphisms (SNPs) had genome-wide significant (P < 5 × 10(-8)) associations with heel bone properties. Alongside SNPs within or near previously identified osteoporosis susceptibility genes including ESR1 (6q25.1: rs4869739, rs3020331, rs2982552), SPTBN1 (2p16.2: rs11898505), RSPO3 (6q22.33: rs7741021), WNT16 (7q31.31: rs2908007), DKK1 (10q21.1: rs7902708) and GPATCH1 (19q13.11: rs10416265), we identified a new locus on chromosome 11q14.2 (rs597319 close to TMEM135, a gene recently linked to osteoblastogenesis and longevity) significantly associated with both BUA and VOS (P < 8.23 × 10(-14)). In meta-analyses involving 25 cohorts with up to 14 985 fracture cases, six of 10 SNPs associated with heel bone properties at P < 5 × 10(-6) also had the expected direction of association with any fracture (P < 0.05), including three SNPs with P < 0.005: 6q22.33 (rs7741021), 7q31.31 (rs2908007) and 10q21.1 (rs7902708). In conclusion, this GWA study reveals the effect of several genes common to central DXA-derived BMD and heel ultrasound/DXA measures and points to a new genetic locus with potential implications for better understanding of osteoporosis pathophysiology. PMID:24430505

Moayyeri, Alireza; Hsu, Yi-Hsiang; Karasik, David; Estrada, Karol; Xiao, Su-Mei; Nielson, Carrie; Srikanth, Priya; Giroux, Sylvie; Wilson, Scott G; Zheng, Hou-Feng; Smith, Albert V; Pye, Stephen R; Leo, Paul J; Teumer, Alexander; Hwang, Joo-Yeon; Ohlsson, Claes; McGuigan, Fiona; Minster, Ryan L; Hayward, Caroline; Olmos, José M; Lyytikäinen, Leo-Pekka; Lewis, Joshua R; Swart, Karin M A; Masi, Laura; Oldmeadow, Chris; Holliday, Elizabeth G; Cheng, Sulin; van Schoor, Natasja M; Harvey, Nicholas C; Kruk, Marcin; Del Greco M, Fabiola; Igl, Wilmar; Trummer, Olivia; Grigoriou, Efi; Luben, Robert; Liu, Ching-Ti; Zhou, Yanhua; Oei, Ling; Medina-Gomez, Carolina; Zmuda, Joseph; Tranah, Greg; Brown, Suzanne J; Williams, Frances M; Soranzo, Nicole; Jakobsdottir, Johanna; Siggeirsdottir, Kristin; Holliday, Kate L; Hannemann, Anke; Go, Min Jin; Garcia, Melissa; Polasek, Ozren; Laaksonen, Marika; Zhu, Kun; Enneman, Anke W; McEvoy, Mark; Peel, Roseanne; Sham, Pak Chung; Jaworski, Maciej; Johansson, Asa; Hicks, Andrew A; Pludowski, Pawel; Scott, Rodney; Dhonukshe-Rutten, Rosalie A M; van der Velde, Nathalie; Kähönen, Mika; Viikari, Jorma S; Sievänen, Harri; Raitakari, Olli T; González-Macías, Jesús; Hernández, Jose L; Mellström, Dan; Ljunggren, Osten; Cho, Yoon Shin; Völker, Uwe; Nauck, Matthias; Homuth, Georg; Völzke, Henry; Haring, Robin; Brown, Matthew A; McCloskey, Eugene; Nicholson, Geoffrey C; Eastell, Richard; Eisman, John A; Jones, Graeme; Reid, Ian R; Dennison, Elaine M; Wark, John; Boonen, Steven; Vanderschueren, Dirk; Wu, Frederick C W; Aspelund, Thor; Richards, J Brent; Bauer, Doug; Hofman, Albert; Khaw, Kay-Tee; Dedoussis, George; Obermayer-Pietsch, Barbara; Gyllensten, Ulf; Pramstaller, Peter P; Lorenc, Roman S; Cooper, Cyrus; Kung, Annie Wai Chee; Lips, Paul; Alen, Markku; Attia, John; Brandi, Maria Luisa; de Groot, Lisette C P G M; Lehtimäki, Terho; Riancho, José A; Campbell, Harry; Liu, Yongmei; Harris, Tamara B; Akesson, Kristina; Karlsson, Magnus; Lee, Jong-Young; Wallaschofski, Henri; Duncan, Emma L; O'Neill, Terence W; Gudnason, Vilmundur; Spector, Timothy D; Rousseau, François; Orwoll, Eric; Cummings, Steven R; Wareham, Nick J; Rivadeneira, Fernando; Uitterlinden, Andre G; Prince, Richard L; Kiel, Douglas P; Reeve, Jonathan; Kaptoge, Stephen K

2014-06-01

345

Reduction of peak plantar pressure in people with diabetes-related peripheral neuropathy: an evaluation of the DH Pressure Relief Shoe(TM)  

PubMed Central

Background Offloading plantar pressure is a key strategy for the prevention or healing of neuropathic plantar ulcers in diabetes. Non-removable walking casts, such as total contact casts, are currently considered the gold-standard for offloading this type of wound. However, alternative methods for offloading that are more cost effective and easier to use are continually being sought. The aim of this study was to evaluate the capacity of the DH Pressure Relief Shoe™ to offload high pressure areas under the neuropathic foot in diabetes. Methods A within-subjects, repeated measures design was used. Sixteen participants with diabetic peripheral neuropathy were recruited and three footwear conditions were evaluated in a randomised order: a canvas shoe (the control), the participants’ own standard shoe, and the DH Pressure Relief Shoe™. The primary outcome was peak plantar pressure, measured using the pedar-X® mobile in-shoe system between the three conditions. Results Data analysis was conducted on 14 out of the 16 participants because two participants could not complete data collection. The mean peak pressure values in kPa (±SD) for each condition were: control shoe 315.9 (±140.7), participants’ standard shoe 273.0 (±127.1) and DH Pressure Relief Shoe™ 155.4 (±89.9). There was a statistically significant difference in peak plantar pressure between the DH Pressure Relief Shoe™ compared to both the control shoe (p?=?0.002) and participants’ standard shoe (p?=?0.001). The DH Pressure Relief Shoe™ decreased plantar pressures by 51% compared to the control shoe and by 43% compared to participants’ standard shoe. Importantly, for a couple of study participants, the DH Pressure Relief Shoe™ appeared unsuitable for day-to-day wearing. Conclusions The DH Pressure Relief Shoe™ reduced plantar pressures more than the other two shoe conditions. The DH Pressure Relief Shoe™ may be a useful alternative to current offloading modalities used in clinical management of diabetic foot ulceration. However, clinical trials are needed to test their effectiveness for ulcer healing and to ensure they are useable and safe for patients in everyday activities.

2012-01-01

346

Autologous growth factor injections in chronic tendinopathy.  

PubMed

Reference: de Vos RJ, van Veldhoven PLJ, Moen MH, Weir A, Tol JL. Autologous growth factor injections in chronic tendinopathy: a systematic review. Br Med Bull. 2010;95:63-77. Clinical Question: The authors of this systematic review evaluated the literature to critically consider the effects of growth factors delivered through autologous whole-blood and platelet-rich-plasma (PRP) injections in managing wrist-flexor and -extensor tendinopathies, plantar fasciopathy, and patellar tendinopathy. The primary question was, according to the published literature, is there sufficient evidence to support the use of growth factors delivered through autologous whole-blood and PRP injections for chronic tendinopathy? Data Sources: The authors performed a comprehensive, systematic literature search in October 2009 using PubMed, MEDLINE, EMBASE, CINAHL, and the Cochrane library without time limits. The following key words were used in different combinations: tendinopathy, tendinosis, tendinitis, tendons, tennis elbow, plantar fasciitis, platelet rich plasma, platelet transfusion, and autologous blood or injection. The search was limited to human studies in English. All bibliographies from the initial literature search were also viewed to identify additional relevant studies. Study Selection: Studies were eligible based on the following criteria: (1) Articles were suitable (inclusion criteria) if the participants had been clinically diagnosed as having chronic tendinopathy; (2) the design had to be a prospective clinical study, randomized controlled trial, nonrandomized clinical trial, or prospective case series; (3) a well-described intervention in the form of a growth factor injection with either PRP or autologous whole blood was used; and (4) the outcome was reported in terms of pain or function (or both). Data Extraction: All titles and abstracts were assessed by 2 researchers, and all relevant articles were obtained. Two researchers independently read the full text of each article to determine if it met the inclusion criteria. If opinions differed on suitability, a third reviewer was consulted to reach consensus. The data extracted included number of participants, study design, inclusion criteria, intervention, control group, primary outcome measures (pain using a visual analog or ordinal scale or function), time of follow-up, and outcomes for intervention and control group (percentage improvement) using a standardized data-extraction form. Function was evaluated in 9 of the 11 studies using (1) the Nirschl scale (elbow function) or the modified Mayo score for wrist flexors and extensors, (2) the Victorian Institute of Sports Assessment-Patella score, a validated outcome measure for patellar tendinopathy, or the Tegner score for patellar tendinopathy, and (3) the rearfoot score from the American Orthopaedic Foot and Ankle Scale for plantar fasciopathy. The Physiotherapy Evidence Database (PEDro) scale contains 11 items; items 2-11 receive 1 point each for a yes response. Reliability is sufficient (0.68) for the PEDro scale to be used to assess physiotherapy trials. A score of 6 or higher on the PEDro scale is considered a high-quality study; below 6 is considered a low-quality study. The PEDro score results determined the quality of the randomized controlled trial (RCT), nonrandomized clinical trial, or prospective case series (?6 or <6). A qualitative analysis was used with 5 levels of evidence (strong, moderate, limited, conflicting, or no evidence) to determine recommendations for the use of the intervention. The number of high-quality or low-quality RCT or nonrandomized clinical trial studies with consistent or inconsistent results determined the level of evidence (1-5). Main Results: Using the specific search criteria, the authors identified 418 potential sources. After screening of the title or abstract (or both), they excluded 405 sources, which left 13 studies. After viewing the full text, they excluded 2 additional sources (a case report and a study in which the outcome measure was remission of symptoms and not pain o

Sandrey, Michelle A

2014-06-01

347

[Chronic catatonias].  

PubMed

The present article is intended to review the clinical profile of chronic catatonias as described by the Wernicke-Kleist-Leonhard's school of psychiatry: chronic psychoses characterized by a motor profile symptomatology that differs from that present in acute catatonia. PMID:21218202

Derito, María N C; Monchablon Espinoza, Alberto

2010-01-01

348

Effect of Continuing or Stopping Smoking during Pregnancy on Infant Birth Weight, Crown-Heel Length, Head Circumference, Ponderal Index, and Brain:Body Weight Ratio  

Microsoft Academic Search

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,

Anna A. Lindley; Stan Becker; Ronald H. Gray; Allen A. Herman

349

Powered ankle exoskeletons reveal the metabolic cost of plantar flexor mechanical work during walking with longer steps at constant step frequency  

Microsoft Academic Search

SUMMARY We examined the metabolic cost of plantar flexor muscle-tendon mechanical work during human walking. Nine healthy subjects walked at constant step frequency on a motorized treadmill at speeds corresponding to 80% (1.00 m s -1 ), 100% (1.25 m s -1 ), 120% (1.50 ms -1 ) and 140% (1.75 m s -1 ) of their preferred step length

Gregory S. Sawicki; Daniel P. Ferris

2009-01-01

350

Individual variation of human plantar stratum corneum lipids, determined by automated multiple development of high-performance thin-layer chromatography plates  

Microsoft Academic Search

The stratum corneum lipids are unique in composition and have been used frequently as a model system of the skin's lipid barrier. Automated multiple development (AMD) of high-performance thin-layer chromatography plates in combination with a 25-step gradient, based on methanol, diethyl ether and n-hexane separated the six major human plantar stratum corneum lipids. Post-chromatographic staining of these lipids with a

Sebastian Zellmer; Jürgen Lasch

1997-01-01

351

Influence of ankle plantar flexor muscle architecture and strength on gait in boys with haemophilia in comparison to typically developing children.  

PubMed

Altered gait patterns, muscle weakness and atrophy have been reported in young boys with severe haemophilia when compared to unaffected peers. The aim of this study was to determine whether lateral gastrocnemius muscle size and architecture influenced biomechanical walking patterns of boys with haemophilia and if these relationships differed from age-matched typically developing boys. Biomechanical function of the knee and ankle during level walking, lateral gastrocnemius anatomical cross-sectional area, thickness, width, fascicle length and pennation angle and ankle plantar flexor muscle strength were recorded in 19 typically developing boys aged 7-12 years and 19 age-matched haemophilic boys with a history of ankle joint bleeding. Associations between gait, strength and architecture were compared using correlations of peak gait values. Haemophilic boys walked with significantly larger (P < 0.05) ankle dorsi flexion angles and knee flexion moments. The ankle plantar flexor muscles of haemophilic boys were significantly weaker and smaller when compared to typically developing peers. In the typically developing boys there was no apparent association between muscle architecture, strength and walking patterns. In haemophilic boys maximum muscle strength and ACSA normalized torque of the ankle plantar flexors together with the muscle width, thickness, fascicle length and angulation (P < 0.05) were associated with motion at the ankle and peak moments at the knee joint. Muscle strength deficits of the ankle plantar flexors and changes in muscle size and architecture may underpin the key biomechanical alterations in walking patterns of haemophilic boys with a history of ankle joint bleeding. PMID:24261822

Stephensen, D; Drechsler, W I; Scott, O M

2014-05-01

352

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 [controlled-trials.com] and National Research Register N0484189151.

2012-01-01

353

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.

2010-01-01

354

Genome-Wide Linkage Scan for Quantitative Trait Loci Underlying Normal Variation in Heel Bone Ultrasound Measures  

PubMed Central

Quantitative ultrasound (QUS) traits are correlated with bone mineral density (BMD), but predict risk for future fracture independent of BMD. Only a few studies, however, have sought to identify specific genes influencing calcaneal QUS measures. The aim of this study was to conduct a genome-wide linkage scan to identify quantitative trait loci (QTL) influencing normal variation in QUS traits. QUS measures were collected from a total of 719 individuals (336 males and 383 females) from the Fels Longitudinal Study who have been genotyped and have at least one set of QUS measurements. Participants ranged in age from 18.0 to 96.6 years and were distributed across 110 nuclear and extended families. Using the Sahara ® bone sonometer, broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI) were collected from the right heel. Variance components based linkage analysis was performed on the three traits using 400 polymorphic short tandem repeat (STR) markers spaced approximately 10 cM apart across the autosomes to identify QTL influencing the QUS traits. Age, sex, and other significant covariates were simultaneously adjusted. Heritability estimates (h2) for the QUS traits ranged from 0.42 to 0.57. Significant evidence for a QTL influencing BUA was found on chromosome 11p15 near marker D11S902 (LOD = 3.11). Our results provide additional evidence for a QTL on chromosome 11p that harbors a potential candidate gene(s) related to BUA and bone metabolism.

Lee, M.; Choh, A.C.; Williams, K.D.; Schroeder, V.; Dyer, T.D.; Blangero, J.; Cole, S.A.; Chumlea, WM.C.; Duren, D.L.; Sherwood, R.J.; Siervogel, R.M.; Towne, B.; Czerwinski, S.A.

2012-01-01

355

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

PubMed

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

2012-05-01

356

A Chronic fatigue syndrome model demonstrates mechanical allodynia and muscular hyperalgesia via spinal microglial activation.  

PubMed

Patients with chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) display multiple symptoms, such as chronic widespread pain, fatigue, sleep disturbance, and cognitive dysfunction. Abnormal pain sensation may be the most serious of these symptoms; however, its pathophysiology remains unknown. To provide insights into the molecular basis underlying abnormal pain in CFS and FMS, we used a multiple continuous stress (CS) model in rats, which were housed in a cage with a low level of water (1.5 cm in depth). The von Frey and Randall-Seritto tests were used to evaluate pain levels. Results showed that mechanical allodynia at plantar skin and mechanical hyperalgesia at the anterior tibialis (i.e., muscle pain) were induced by CS loading. Moreover, no signs of inflammation and injury incidents were observed in both the plantar skin and leg muscles. However, microglial accumulation and activation were observed in L4-L6 dorsal horn of CS rats. Quantification analysis revealed a higher accumulation of microglia in the medial part of Layers I-IV of the dorsal horn. To evaluate an implication of microglia in pain, minocycline was intrathecally administrated (via an osmotic pump). Minocycline significantly attenuated CS-induced mechanical hyperalgesia and allodynia. These results indicated that activated microglia were involved in the development of abnormal pain in CS animals, suggesting that the pain observed in CFS and FMS patients may be partly caused by a mechanism in which microglial activation is involved. GLIA 2014;62:1407-1417. PMID:24852223

Yasui, Masaya; Yoshimura, Takashi; Takeuchi, So; Tokizane, Kyohei; Tsuda, Makoto; Inoue, Kazuhide; Kiyama, Hiroshi

2014-09-01

357

Functional joint analysis of the foot in juvenile chronic arthritis.  

PubMed

In juvenile chronic arthritis, foot joints become affected relatively frequently. Depending on the pattern of joint involvement, different deviations or deformities can develop. The most important malpositions are pes valgoplanus, pes cavus, heelfoot (pseudocavus), hallux flexus resp. rigidus, hallux valgus, forefoot adduction and claw or hammer toes. Combinations of several deviations occur frequently. Foot involvement influences the gait pattern. Usually the heel strike phase is shortened. The loading and push-off phases are disturbed according to the pattern of joint involvement and the resulting malpositions. A muscular imbalance develops which is mainly characterized by a hypertense tibialis anterior muscle and atrophy of the triceps sursae. Successful treatment requires adequate drug therapy as well as functionally oriented individual physiotherapy supported by foot adapted insoles and partial relief from weight-bearing. PMID:7955636

Truckenbrodt, H; Häfner, R; von Altenbockum, C

1994-01-01

358

Chronic Pericarditis  

MedlinePLUS

... 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 ...

359

[Chronic migraine].  

PubMed

The classification of the International Headache Society (IHS) generally differentiates episodic from chronic headache. Chronic migraine is defined as headache on 15 and more days a month over more than 3 months and headache on 8 days or more fulfils the criteria for migraine or were triptan/ergot-responsive when thought to be migrainous in early stages of the attack. The prevalence of chronic migraine is estimated at 2-4?%. The quality of life is highly compromised in this condition and comorbidities are much more frequent compared to episodic migraine. Data from prospective randomized studies are scarce as most patients with chronic migraine were excluded from previous trials and only few studies were conducted for this condition. The efficacy for prophylactic treatment compared with placebo is proven for topiramate and onabotulinum toxin A. PMID:24337617

Diener, H C; Holle, D; Müller, D; Nägel, S; Rabe, K

2013-12-01

360

Chronic Diarrhea  

MedlinePLUS

... Challenges and Resources Hygiene-related Diseases Athlete's Foot (tinea pedis) Body Lice Chronic Diarrhea Dental Caries Head Lice Hot Tub Rash Lymphatic Filariasis Pinworms Pubic Lice ("Crabs") Ringworm (Tinea) Swimmer's Ear (otitis externa) Scabies Trachoma Information for ...

361

Ear infection - chronic  

MedlinePLUS

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, ...

362

Chronic pancreatitis  

PubMed Central

Introduction Chronic pancreatitis affects 3–9 people in 100,000; 70% of cases are alcohol-induced. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of lifestyle interventions in people with chronic pancreatitis? What are the effects of dietary supplements in people with chronic pancreatitis? What are the effects of drug interventions in people with chronic pancreatitis? What are the effects of nerve blocks for pain relief in people with chronic pancreatitis? What are the effects of different invasive treatments for specific complications of chronic pancreatitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (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 27 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: avoiding alcohol consumption, biliary decompression, calcium supplements, ductal decompression (endoscopic or surgical), low-fat diet, nerve blocks, opioid analgesics, pancreatic enzyme supplements, pseudocyst decompression (endoscopic or surgical), resection using distal pancreatectomy, resection using pancreaticoduodenectomy (Kausch–Whipple or pylorus-preserving), and vitamin/antioxidant supplements.

2011-01-01

363

Chronic pancreatitis  

PubMed Central

Introduction Chronic pancreatitis affects 3–9 people in 100,000; 70% of cases are alcohol-induced. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of lifestyle interventions in people with chronic pancreatitis? What are the effects of dietary supplements in people with chronic pancreatitis? What are the effects of drug interventions in people with chronic pancreatitis? What are the effects of nerve blocks for pain relief in people with chronic pancreatitis? What are the effects of different invasive treatments for specific complications of chronic pancreatitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2008 (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 23 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: avoiding alcohol consumption, biliary decompression, calcium supplements, ductal decompression (endoscopic or surgical), low-fat diet, nerve blocks, opioid analgesics, pancreatic enzyme supplements, pseudocyst decompression (endoscopic or surgical), resection using distal pancreatectomy, resection using pancreaticoduodenectomy (Kausch–Whipple or pylorus-preserving), and vitamin/antioxidant supplements.

2008-01-01

364

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

PubMed

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

2013-09-01

365

Optimal pennation angle of the primary ankle plantar and dorsiflexors: variations with sex, contraction intensity, and limb.  

PubMed

Ultrasonography was used to measure the pennation angle of the human tibialis anterior (TA), lateral gastrocnemius (LG), medial gastrocnemius (MG), and soleus (Sol). The right and left legs of 8 male and 8 female subjects were tested at rest and during maximum voluntary contraction (MVC). Joint angles were chosen to control muscle tendon lengths so that the muscles were near their optimal length within the length-tension relationship. No differences in pennation angle were detected between the right and left legs. Another consistent finding was that the pennation angle at MVC was significantly greater than at rest for all muscles tested. Optimal pennation angles for the TA, MG, and Sol were significantly greater for the men than for the women. Optimal pennation angles for the TA, LG, MG, and Sol for the male subjects were 14.3 degrees, 23.7 degrees, 34.6 degrees, and 40.1 degrees respectively, whereas values of 12.1 degrees, 16.3 degrees, 27.3 degrees, and 26.3 degrees were recorded for the female subjects. The results of this study suggest the following: (1) similar values for pennation angle can be used for the right and left TA, LG, MG, and Sol; (2) pennation angle is significantly greater at MVC than at rest for all muscles tested; and (3) sex-specific values for optimal pennation angle should be used when modeling the force-generating potential of the primary muscles responsible for ankle plantar and dorsiflexion. PMID:17293622

Manal, Kurt; Roberts, Dustyn P; Buchanan, Thomas S

2006-11-01

366

Can pennation angles be predicted from EMGs for the primary ankle plantar and dorsiflexors during isometric contractions?  

PubMed

Ultrasonography was used to measure pennation angle and electromyography (EMG) to record muscle activity of the human tibialis anterior (TA), lateral gastrocnemius (LG), medial gastrocnemius (MG), and soleus (SOL) muscles during graded isometric ankle plantar and dorsiflexion contractions done on a Biodex dynamometer. Data from 8 male and 8 female subjects were collected in increments of approximately 25% of maximum voluntary contraction (MVC) ranging from rest to MVC. A significant positive linear relationship (p<0.05) between normalized EMG and pennation angle for all muscles was observed when subject specific pennation angles at rest and MVC were included in the analysis. These were included to account for gender differences and inter-subject variability in pennation angle. The coefficient of determination, R(2), ranged between 0.76 for the TA and 0.87 for the SOL. The EMG-pennation angle relationships have ramifications for use in EMG-driven models of muscle force. The regression equations can be used to characterize fiber pennation angle more accurately and to determine how it changes with contraction intensity, thus providing improved estimates of muscle force when using musculoskeletal models. PMID:18579147

Manal, Kurt; Roberts, Dustyn P; Buchanan, Thomas S

2008-08-01

367

The extraction and partial purification of the deoxycholate-soluble matrix protein from human plantar horny layer.  

PubMed

The electron-dense, amorphous matrix protein in human horny cells was extracted with deoxycholate. The deoxycholate-soluble material was partially purified by differential centrifugation and molecular sieve chromatography. Approximately 44% of the total protein was extracted into the 270,000 g supernatant fraction. Macroaggregates with histochemical characteristics indentical with those in situ keratohyalin granules were formed upon dialysing the 270,000 g supernatant fraction against redistilled water. Antibody was raised to the purified material of the initial peak from the Sepharose 6B column. The resulting antiserum yielded a single precipitin line when tested against the immunizing antigen. Electrophoresis in the presence of sodium dodecylsulfate showed this antigenic material to be heterogeneous. It was immunologically homogeneous when this antigenic material was examined by immuno-electrophoresis. Since the antibody was localized on the keratohyalin granules of human planter skin by indirect immunofluorescence, the partially purified, deoxycholate-soluble material from human plantar horny layers is considered to originate from keratohyalin granules. Amino acid analysis revealed a high content of glycine, glutamic acid and aspartic acid, and a low content of histidine and leucine. PMID:55033

Tezuka, T

1975-01-01

368

Acute Effects of 5 Min of Plantar Flexor Static Stretching on Balance and Gait in the Elderly  

PubMed Central

[Purpose] The purpose of this study was to examine the acute effects of five minutes of plantar flexor static stretching (PSS) on the balance and gait of the elderly. [Subjects and Methods] Twenty-five subjects aged 65?years and above performed 5?min of PSS in the form of wedge board standing. The sway length of each subject’s center of mass was measured to examine the subject’s static balance. It was measured by one minute of quiet standing with the eyes closed. Functional reach tests (FRTs), timed up and go tests (TUGs), and 10-meter walk tests (10MWTs) were performed to examine dynamic balance and gait before and after PSS. [Results] The outcome showed significant increases in sway distances (6.55 ± 5.03?cm) after stretching. However, in the FRTs, TUGs, and 10MWTs, the reach distance and time did not show any significant changes. [Conclusion] These results suggest that the elderly subjects temporarily experienced difficulties in maintaining balance immediately after the PSS but that their dynamic balance and gait were not adversely affected after a short period of time. Therefore, to prevent falls and perform exercises in a safe way, it is recommended to allow patients to rest after performing PSS.

Han, Min-Jung; Yuk, Goon-Chang; Gak, Hwangbo; Suh, Soon-Rim; Kim, Seong-Gil

2014-01-01

369

Increased peripherin in sympathetic axons innervating plantar metatarsal arteries in STZ-induced type I diabetic rats  

PubMed Central

A common characteristic of axonopathy is the abnormal accumulation of cytoskeletal proteins. We recently reported that streptozotocin (STZ)-induced type 1 diabetes produced a change in the morphology of sympathetic nerve fibers supplying rat plantar metatarsal arteries (PMAs). Here we investigated whether these morphological changes are associated with axonal accumulation of the type III intermediate filament peripherin and the microtubule protein ?-tubulin III, as both are implicated in axonal remodeling. PMAs from hyperglycemic STZ-treated rats receiving a low dose of insulin (STZ-LI) were compared with those from normoglycemic STZ-treated rats receiving a high dose of insulin (STZ-HI) and vehicle-treated controls. Western blotting revealed an increase in protein expression level for peripherin in PMAs from STZ-LI rats but no change in that for ?-tubulin III. In addition, there was an increase in the number of peripherin immunoreactive nerve fibers in the perivascular nerve plexus of PMAs from STZ-LI rats. Co-labeling for peripherin and neuropeptide Y (a marker for sympathetic axons) revealed that peripherin immunoreactivity increased in sympathetic axons. None of these changes were detected in PMAs from STZ-HI rats, indicating that increased peripherin in sympathetic axons of STZ-LI rats is likely due to hyperglycemia and provides a marker of diabetes-induced nerve damage.

Johansen, Niloufer J.; Frugier, Tony; Hunne, Billie; Brock, James A.

2014-01-01

370

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

2013-01-01

371

Effect of a rocker non-heeled shoe on EMG and ground reaction forces during gait without previous training.  

PubMed

Unstable shoes have been designed to promote "natural instability" and during walking they should simulate barefoot gait, enhancing muscle activity and, thus, attributing an advantage over regular tennis shoes. Recent studies showed that, after special training on the appropriate walking pattern, the use of the Masai Barefoot Technology (MBT) shoe increases muscle activation during walking. Our study presents a comparison of muscle activity as well as horizontal and vertical forces during gait with the MBT, a standard tennis shoe and barefoot walking of healthy individuals without previous training. These variables were compared in 25 female subjects and gait conditions were compared using ANOVA repeated measures (effect size:0.25). Walking with the MBT shoe in this non-instructed condition produced higher vertical forces (first vertical peak and weight acceptance rate) than walking with a standard shoe or walking barefoot, which suggests an increase in the loads received by the musculoskeletal system, especially at heel strike. Walking with the MBT shoe did not increase muscle activity when compared to walking with the standard shoe. The barefoot condition was more effective than the MBT shoe at enhancing muscle activation. Therefore, in healthy individuals, no advantage was found in using the MBT over a standard tennis shoe without a special training period. Further studies using the MBT without any instruction over a longer period are needed to evaluate if the higher loads observed in the present study would return to their baseline values after a period of adaptation, and if the muscle activity would increase over time. PMID:22424760

Sacco, Isabel C N; Sartor, Cristina D; Cacciari, Licia P; Onodera, Andrea N; Dinato, Roberto C; Pantaleão, Elcio; Matias, Alessandra B; Cezário, Fernanda G; Tonicelli, Lucas M G; Martins, Maria Cecília S; Yokota, Mariane; Marques, Paulo Eduardo C; Costa, Paulo Henrique C

2012-06-01

372

[Chronic cough].  

PubMed

In non-smokers without intake of an ACE-inhibitor, the three most common causes of chronic cough are eosinophilic airways disease (asthma or eosinophilic bronchitis), Upper-airway-cough-syndrome (UACS) and Gastro-esophageal-reflux desease (GERD). In smokers, chronic bronchitis and COPD are common causes as well. In patients with a normal chest X-ray and lack of information on a less frequent cause in history and physical examination, it is recommended therefore to routinely look for these diseases and/or to treat them empirically. PMID:24025176

Schafroth Török, Salome

2013-09-18

373

Chronic Migraine  

MedlinePLUS

... only medication approved by the FDA specifically for chronic migraine. Patients starting new preventive therapy should keep in mind that it may take one to two months for full treatment effects to take place. ShareThis Give the gift of pain relief Your donation goes to work immediately, helping ...

374

Age-related greater Achilles tendon compliance is not associated with larger plantar flexor muscle fascicle strains in senior women.  

PubMed

The aim of the present study was to test the hypothesis that the age-associated decrease of tendon stiffness would necessitate greater muscle fascicle strains to produce similar levels of force during isometric contraction. Greater fascicle strains could force sarcomeres to operate in less advantageous regions of their force-length and force-velocity relationships, thus impairing the capacity to generate strong and explosive contractions. To test this hypothesis, sagittal-plane dynamic velocity-encoded phase-contrast magnetic resonance images of the gastrocnemius medialis (GM) muscle and Achilles tendon (AT) were acquired in six young (YW; 26.1 ± 2.3 yr) and six senior (SW; 76.7 ± 8.3 yr) women during submaximal isometric contraction (35% maximum voluntary isometric contraction) of the plantar flexor muscles. Multiple GM fascicle lengths were continuously determined by automatically tracking regions of interest coinciding with the end points of muscle fascicles evenly distributed along the muscle's proximo-distal length. AT stiffness and Young's modulus were measured as the slopes of the tendon's force-elongation and stress-strain curves, respectively. Despite significantly lower AT stiffness at older age (YW: 120.2 ± 52.3 N/mm vs. SW: 53.9 ± 44.4 N/mm, P = 0.040), contraction-induced changes in GM fascicle lengths were similar in both age groups at equal levels of absolute muscular force (4-5% fascicle shortening in both groups), and even significantly larger in YW (YW: 11-12% vs. SW: 6-8% fascicle shortening) at equal percentage of maximum voluntary contraction. These results suggest that factors other than AT stiffness, such as age-associated changes in muscle composition or fascicle slack, might serve as compensatory adaptations, limiting the degree of fascicle strains upon contraction. PMID:24505104

Csapo, R; Malis, V; Hodgson, J; Sinha, S

2014-04-01

375

Adherence to Wearing Prescription Custom-Made Footwear in Patients With Diabetes at High Risk for Plantar Foot Ulceration  

PubMed Central

OBJECTIVE Prescription custom-made footwear can only be effective in preventing diabetic foot ulcers if worn by the patient. Particularly, the high prevalence of recurrent foot ulcers focuses the attention on adherence, for which objective data are nonexisting. We objectively assessed adherence in patients with high risk of ulcer recurrence and evaluated what determines adherence. RESEARCH DESIGN AND METHODS In 107 patients with diabetes, neuropathy, a recently healed plantar foot ulcer, and custom-made footwear, footwear use was measured during 7 consecutive days using a shoe-worn, temperature-based monitor. Daily step count was measured simultaneously using an ankle-worn activity monitor. Patients logged time away from home. Adherence was calculated as the percentage of steps that prescription footwear was worn. Determinants of adherence were evaluated in multivariate linear regression analysis. RESULTS Mean ± SD adherence was 71 ± 25%. Adherence at home was 61 ± 32%, over 3,959 ± 2,594 steps, and away from home 87 ± 26%, over 2,604 ± 2,507 steps. In 35 patients with low adherence (<60%), adherence at home was 28 ± 24%. Lower BMI, more severe foot deformity, and more appealing footwear were significantly associated with higher adherence. CONCLUSIONS The results show that adherence to wearing custom-made footwear is insufficient, particularly at home where patients exhibit their largest walking activity. This low adherence is a major threat for reulceration. These objective findings provide directions for improvement in adherence, which could include prescribing specific off-loading footwear for indoors, and they set a reference for future comparative research on footwear adherence in diabetes.

Waaijman, Roelof; Keukenkamp, Renske; de Haart, Mirjam; Polomski, Wojtek P.; Nollet, Frans; Bus, Sicco A.

2013-01-01

376

Inflammatory hyperalgesia induced by zymosan in the plantar tissue of the rat: effect of kinin receptor antagonists.  

PubMed

The Randall-Selitto paradigm (maximal tolerated pressure externally applied by a mechanical device) was used to develop a rat model of localized inflammatory hyperalgesia in order to compare the analgesic effects of bradykinin (BK) B1 and B2 receptor antagonists and of a non-steroidal anti-inflammatory drug (NSAID). Intra-plantar injection of zymosan (12.5 mg per paw) induced a considerable inflammation as evidenced from gross and histological evaluation and a mechanical hyperalgesia at 6 h. The contra-lateral paw of zymosan-treated animals or saline vehicle-injected paws did not exhibit a decreased pressure tolerance, relative to pre-injection measurements. Since the B1 receptor may be induced under inflammatory situations, we examined the amount of corresponding mRNA using quantitative RT-PCR. We found a significant increase of B1 receptor mRNA in the zymosan--but not the saline-injected paw at 6 h. Drugs were given subcutaneously 2 h before the 6 h readings to test their analgesic potential. The kinin B1 receptor antagonists [Leu8]des-Arg9-BK (3-30 nmol/kg) and R-715 (100 nmol/kg), the B2 receptor antagonists Hoe 140 (15 nmol/kg) and LF 16.0687 (3 and 10 mg/kg), as well as the NSAID diclofenac sodium (1 and 3 mg/kg) significantly reversed zymosan-induced hyperalgesia. We conclude that zymosan-induced hyperalgesia is a model suitable for the rapid evaluation of analgesic drugs with a peripheral site of action interfering either with kinin receptors or with prostanoid formation. In this regard, results of the present study confirm that blocking kinin B1 receptors is a novel approach for treatment of inflammatory pain. PMID:10647872

Bélichard, P; Landry, M; Faye, P; Bachvarov, D R; Bouthillier, J; Pruneau, D; Marceau, F

2000-02-01

377

Neuromuscular adjustments of the knee extensors and plantar flexors following match-play tennis in the heat  

PubMed Central

Objectives This study tested the hypothesis that impairments in lower limb maximal strength and voluntary activation (VA) are exacerbated following match-play tennis in hot compared with cool conditions. Methods Torque and VA were evaluated during brief (5?s) and sustained (20?s) maximal voluntary isometric contractions of the knee extensors (KE) and plantar flexors (PF) in 12 male tennis players before (pre) and after (post, 24?h and 48?h) ?115?min of play in hot (?37°C) and cool (?22°C) conditions. Results Rectal temperature was higher following play in hot than in cool (?39.2 vs ?38.5°C; p<0.05). Torque production decreased from prematch to postmatch during the brief and sustained contractions in hot (KE: ?22%; PF: ?13%) and cool (KE: ?9%, PF: ?7%) (p<0.05). KE strength losses in hot were greater than in cool (p<0.05) and persisted for 24?h (p<0.05). Postmatch brief and sustained KE VA was lower in hot than in cool (p<0.05), in which VA was maintained. PF VA was maintained throughout the protocol. Peak twitch torque and maximum rates of torque development and relaxation in the KE and PF were equally reduced postmatch relative to prematch in hot and cool conditions (p<0.05), and were restored near baseline within 24?h. Conclusions Neuromuscular system integrity of the lower limbs is compromised immediately following match-play tennis in hot and cool conditions due to the development of peripheral fatigue. The larger and persistent KE strength losses observed under heat stress are associated with greater levels of central fatigue especially during sustained contractions.

Periard, Julien D; Girard, Olivier; Racinais, Sebastien

2014-01-01

378

Influence of musculo-tendinous stiffness of the plantar ankle flexor muscles upon maximal power output on a cycle ergometre.  

PubMed

The importance of maximal voluntary torque (T (MVC)), maximal rate of torque development (MRTD) and musculo-tendinous stiffness of the triceps surae for maximal power output on a cycle ergometre (Pmax) was studied in 21 healthy subjects by studying the relationships between maximal cycling power related to body mass (Pmax BM(-1)) with T (MVC), MRTD and different indices of musculo-tendinous stiffness of the ankle flexor. Pmax BM(-1) was calculated from the data of an all-out force-velocity test on a Monark cycle ergometre. T (MVC) and MRTD were measured on a specific ankle ergometre. Musculo-tendinous stiffness was estimated by means of quick releases at 20, 40, 60 and 80% T (MVC) on the same ankle ergometre. Pmax BM(-1) was significantly and positively correlated with MRTD related to body mass but the positive correlation between Pmax BM(-1) and T (MVC) did not reach the significance level (0.05). Pmax BM(-1) was significantly and positively correlated with the estimation of stiffness at 40% T (MVC) (S(0.4)), but not with stiffness at 20, 60 and 80% T (MVC). The results of the present study suggest that maximal power output during cycling is significantly correlated with the level of musculo-tendinous stiffness which corresponds to torque range around peak torque at optimal pedal rate. However, the low coefficient of determination (r2 = 0.203) between Pmax BM(-1) and S (0.4) BM(-1) suggested that Pmax BM(-1) largely depended on other factors than the musculo-tendinous stiffness of the only plantar flexors. PMID:22354446

Driss, Tarak; Lambertz, Daniel; Rouis, Majdi; Vandewalle, Henry

2012-11-01

379

Proximally based sural adipose-cutaneous/scar flap in elimination of ulcerous scar soft-tissue defect over the achilles tendon and posterior heel region: a new approach.  

PubMed

Scar ulcers that spread over the Achilles tendon and posterior heel disturb patients by causing pain, impeding hygiene, and creating difficulty in finding appropriate shoe wear. As this region undergoes pressure, effective reconstruction is based on the flap use. The most popular flaps currently used are distally based sural fasciocutaneous flap, calcaneal artery skin flap, and free flaps. These flaps, however, are insensate, can create soft-tissue excess, and cause donor site morbidity. Ulcerous soft-tissue defects over Achilles tendon and posterior heel after burns, frost, and trauma were studied and reconstructed in 16 patients, using proximally based sural adipose-cutaneous flap, the anatomy of which was studied on lower extremities of 27 cadavers. Ulcerous soft-tissue defect consists of two parts: ulcer and surrounding pathologic scars that should be excised in one block. Resulting soft-tissue defects with exposed tendon and calcaneal bone varied from 6 to 20 cm in length and 6 cm in width. For such wound resurfacing a flap was developed that was sensate, thin, large, and having steady blood circulation. The flap was harvested from the lower third of the leg and lateral foot, consisting of skin and subcutaneous fat layer (without fascia), including the sural nerve and lesser vein. The blood supply was ensured through peroneal and anterior tibial artery perforators, which formed a vascular net in the flap. In 14 of 16 cases excellent and stable functional and good cosmetic results with acceptable donor site morbidity were achieved. In two patients the distal flap loss took place because of arteriitis obliterans (one case) and because of the cross-cutting of the sural nerve and vessels during previous surgeries (another case). Proximally based sural adipose-cutaneous/scar flap is the only flap that satisfies all requirements for Achilles tendon and posterior heel region resurfacing. The author believes that this technique, based on this flap use, is anatomically justified, clinically profitable, and should be considered as the first choice operation. PMID:24043244

Grishkevich, Viktor M

2014-01-01

380

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.

2012-01-01

381

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

2001-01-01

382

Chronic pain - resources  

MedlinePLUS

Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association - www.theacpa.org National Fibromyalgia and Chronic Pain Association - www.fmcpaware.org ...

383

Chronic Fatigue Syndrome  

MedlinePLUS

... said she had chronic fatigue syndrome. What Is Chronic Fatigue Syndrome? Chronic fatigue syndrome (CFS) is a complicated disease ... connection between this and CFS. Continue Who Gets CFS? Chronic fatigue syndrome can affect people of all ...

384

Chronic constipation.  

PubMed

The lack of information about management of chronic constipation in children amidst general physicians has necessitated this review. A literature search in PubMed was conducted with regard to epidemiology, clinical features, investigation and management of chronic constipation in children. English language studies published over the last 20 y were considered and relevant information was extracted. Constipation is a common problem among children; the commonest cause is functional (95 %). An elaborate history and thorough physical examination are only essential things required to make a diagnosis of functional constipation. Management consists of disimpaction, followed by maintenance therapy with oral laxative, dietary modification and toilet training. A regular follow-up with slow tapering of laxative is the must for effective treatment. Early withdrawal of laxative is the commonest cause of recurrence. PMID:23943571

Agarwal, Jaya

2013-12-01

385

Chronic urticaria.  

PubMed Central

Urticaria affects 15% to 20% of the population once or more during a lifetime. Chronic urticaria is a frequent recurrent eruption over a period greater than 6 weeks; the cause remains a mystery in more than 75% of cases. Urticaria and angioedema may be produced by immunologic or nonimmunologic means. Urticarial vasculitis, contact urticaria, mastocytosis, physical urticarias, dermatographism, cholinergic urticaria, localized heat urticaria, cold urticaria, aquagenic urticaria, and vibratory angioedema all require specific evaluation and treatment. Chronic idiopathic urticaria is usually controlled by antihistamines; depending on the circadian rhythm of the eruption, sedative or nonsedative antihistamines are prescribed. Some patients will require a combination of H1 and H2 antagonists, or even parenteral corticosteroids.

Burrall, B. A.; Halpern, G. M.; Huntley, A. C.

1990-01-01

386

Chronic diarrhea  

Microsoft Academic Search

Opinion statement  Chronic diarrhea can be due to any of several hundred conditions. When investigation fails to uncover a specific cause that\\u000a can be treated successfully, nonspecific therapy is implemented. This includes dietary alterations if specific aggravating\\u000a foods can be identified, enteral or parenteral nutrition if nutritional status is compromised, and use of oral rehydration\\u000a solutions if diarrhea produces volume depletion.

Lawrence R. Schiller

2005-01-01

387

Chronic cough.  

PubMed

Chronic cough is often viewed as a difficult clinical problem. It can be physically and psychologically debilitating, occasionally leading to serious complications. Although there are many etiologies, an organized approach including focused history and physical examination, directed testing in select cases, and treatment trials lead to accurate, safe, and cost-effective diagnoses in most patients. Additional symptomatic treatment is frequently beneficial. Occasionally, diagnostic dilemmas, treatment failures, or more serious causative disorders necessitate referral for further testing and management. PMID:24490448

Rai, S P

2013-05-01

388

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

389

Plantar rotational flap technique for panmetatarsal head resection and transmetatarsal amputation: a revision approach for second metatarsal head transfer ulcers in patients with previous partial first ray amputation.  

PubMed

Transfer ulcers beneath the second metatarsal head are common after diabetes-related partial first ray amputation. Subsequent osteomyelitis of the second ray can further complicate this difficult situation. We present 2 cases depicting our plantar rotational flap technique for revision surgery involving conversion to either panmetatarsal head resection or transmetatarsal amputation (TMA). These cases are presented to demonstrate our indications, procedure selection criteria, flap technique, operative pearls, and staging protocol. The goals of this surgical approach are to excise and close the plantar ulcer beneath the second metatarsal head, remove any infected bone, allow staged surgery if needed, remove all remaining metatarsal heads to decrease the likelihood of repeat transfer ulcers, preserve the toes when practical, avoid excessive shortening of the foot, avoid multiple longitudinal dorsal incisions, and create a functional and cosmetically appealing foot. The flap is equally suited for either panmetatarsal head resection or TMA. The decision to pursue panmetatarsal head resection versus TMA largely depends on the condition of the remaining toes. Involvement of osteomyelitis in the base of the second proximal phalanx, the soft tissue viability of the remaining toes, the presence of a preoperative digital deformity, and the likelihood that saving the lesser toes will be beneficial from a cosmetic or footwear standpoint are factors we consider when deciding between panmetatarsal head resection and TMA.