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Plantar heel pain.  


Plantar heel pain is a common complaint encountered by orthopedic surgeons, internists, and family practitioners. Although it is most often caused by plantar fasciitis, this is a diagnosis of exclusion. Other mechanical, rheumatologic, and neurologic causes must be considered first. The history and physical examination are typically all that is needed to make the proper diagnosis, but diagnostic adjuncts are available to assist the clinician. When plantar fasciitis is diagnosed, conservative modalities must be tried first. Corticosteroid injections and extracorporeal shock-wave therapy may also be used. After 6 months of failed conservative treatments, surgical intervention should be considered. PMID:24559879

Rosenbaum, Andrew J; DiPreta, John A; Misener, David



Plantar and medial heel pain: diagnosis and management.  


Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution. PMID:24860133

Lareau, Craig R; Sawyer, Gregory A; Wang, Joanne H; DiGiovanni, Christopher W



Clinical Characteristics of the Causes of Plantar Heel Pain  

PubMed Central

Objective The objectives of this study were to investigate the causes of plantar heel pain and find differences in the clinical features of plantar fasciitis (PF) and fat pad atrophy (FPA), which are common causes of plantar heel pain, for use in differential diagnosis. Method This retrospective study analyzed the medical records of 250 patients with plantar heel pain at the Foot Clinic of Rehabilitation Medicine at Bundang Jesaeng General Hospital from January to September, 2008. Results The subjects used in this study were 114 men and 136 women patients with a mean age of 43.8 years and mean heel pain duration of 13.3 months. Causes of plantar heel pain were PF (53.2%), FPA (14.8%), pes cavus (10.4%), PF with FPA (9.2%), pes planus (4.8%), plantar fibromatosis (4.4%), plantar fascia rupture (1.6%), neuropathy (0.8%), and small shoe syndrome (0.8%). PF and FPA were most frequently diagnosed. First-step pain in the morning, and tenderness on medial calcaneal tuberosity correlated with PF. FPA mainly involved bilateral pain, pain at night, and pain that was aggravated by standing. Heel cord tightness was the most common biomechanical abnormality of the foot. Heel spur was frequently seen in X-rays of patients with PF. Conclusion Plantar heel pain can be provoked by PF, FPA, and other causes. Patients with PF or FPA typically show different characteristics in clinical features. Plantar heel pain requires differential diagnosis for appropriate treatment. PMID:22506166

Yi, Tae Im; Seo, In Seok; Huh, Won Seok; Yoon, Tae Hee; Kim, Bo Ra



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


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



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



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. PMID:22995253

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



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

PubMed Central

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

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



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


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

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



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

PubMed Central

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 associated with plantar heel pain. Methods We searched specific electronic databases (MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus and AMI) in April 2010 to identify randomised and non-randomised trials. We included trials where participants diagnosed with plantar heel pain were treated with dry needling and/or injections (local anaesthetics, steroids, Botulinum toxin A and saline) alone or in combination with acupuncture. Outcome measures that focussed on pain and function were extracted from the data. Trials were assessed for quality using the Quality Index tool. Results Three quasi-experimental trials matched the inclusion criteria: two trials found a reduction in pain for the use of trigger point dry needling when combined with acupuncture and the third found a reduction in pain using 1% lidocaine injections when combined with physical therapy. However, the methodological quality of the three trials was poor, with Quality Index scores ranging form 7 to 12 out of a possible score of 27. A meta-analysis was not conducted because substantial heterogeneity was present between trials. Conclusions There is limited evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain. However, the poor quality and heterogeneous nature of the included studies precludes definitive conclusions being made. Importantly, this review highlights the need for future trials to use rigorous randomised controlled methodology with measures such as blinding to reduce bias. We also recommend that such trials adhere to the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) to ensure transparency. PMID:20807448



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


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

Zhang, Xianyi; Li, Bo



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

PubMed Central

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

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



Plantar fasciitis  

PubMed Central

INTRODUCTION In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition. METHODS A literature search was performed using PubMed and MEDLINE®. The following keywords were used, singly or in combination: ‘plantar fasciitis’, ‘plantar heel pain’, ‘heel spur’. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. FINDINGS Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques. PMID:23131221

Cutts, S; Obi, N; Pasapula, C; Chan, W



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

PubMed Central

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



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 NCT01865734 PMID:24299257



Platelet-rich plasma and plantar fasciitis.  


Plantar fasciitis is the most common cause of heel pain and can prove difficult to treat in its most chronic and severe forms. Advanced cases of plantar fasciitis are often associated with ankle stiffness, heel spurs, and other conditions and can lead to extensive physical disability and financial loss. Most available traditional treatments, including orthoses, nonsteroidal anti-inflammatory drugs, and steroid injections have a paucity of supportive clinical evidence. More invasive treatments, ranging from corticosteroid and botulinum-A toxin injections to shockwave therapy and plantar fasciotomy, have demonstrated varying clinical success in severe cases but carry the potential for serious complication and permanent disability. Platelet-rich plasma has recently been demonstrated to be helpful in managing chronic severe tendinopathies when other techniques have failed. This review examines the pathophysiology, diagnostic options, nonoperative treatment modalities, and surgical options currently used for plantar fasciitis. It also focuses on the clinical rationale and available evidence for using autologous platelet-rich plasma to treat severe refractory chronic plantar fasciitis. PMID:24212370

Monto, Raymond R



Diagnosis of heel pain.  


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

Tu, Priscilla; Bytomski, Jeffrey R



Plantar fascia: imaging diagnosis and guided treatment.  


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



Heel pain  


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


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



Correlation between the outcome of extracorporeal shockwave therapy and pretreatment MRI findings for chronic plantar fasciitis.  


Background. The purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) findings before extracorporeal shockwave therapy (ESWT) and the treatment outcome of ESWT. Methods. This study examined 50 feet with chronic plantar fasciitis. The scores before ESWT and after a six-month follow-up were investigated using the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale and the Visual Analog Scale (VAS). MRI before ESWT was used for image evaluation. MRI revealed thickening of the plantar fascia (PF), and an investigation was conducted regarding the findings of a high-signal-intensity area (HSIA) inside the PF, edema near the PF, and bone marrow edema (BME) of the calcaneus. Results. The average JSSF score and VAS score improved significantly at follow-up. In total, 44 feet were noted in the improved group. MRI revealed that the average amounts of PF thickening did not significantly differ between the improved group and the non-improved group. HSIA, edema near the PF, and BME were observed in 36, 41, and 11 feet in the improved group, respectively; and 2, 4, and 2 feet in the non-improved group, respectively. Conclusions. An HSIA in the PF predicted symptom improvement more easily than other MRI findings. Level of Evidence: IV. PMID:25401230

Maki, Masahiro; Ikoma, Kazuya; Imai, Kan; Kido, Masamitsu; Hara, Yusuke; Arai, Yuji; Fujiwara, Hiroyoshi; Kubo, Toshikazu



Medial calcaneal nerve entrapment as a cause for chronic heel pain.  


Clinicians often have difficulty correctly identifying the etiology of heel pain. The purpose of the case report was to demonstrate differential diagnosis and possible interventions for heel pain. The article describes the diagnosis and management of a 36-year-old female patient with an 8-year history of heel pain. After all mechanical etiologies were ruled out, it was determined that her heel pain was the result of entrapment of the medical calcaneal branch of the tibial nerve. Correct diagnosis led to an intervention that resulted in complete symptom relief. The case presents an example for how careful differential diagnosis of heel pain is essential for achieving the desired intervention outcomes. PMID:18574754

Diers, David J



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

PubMed Central

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

Sudo?-Szopi?ska, Iwona; Zaniewicz-Kaniewska, Katarzyna; Kwiatkowska, Brygida



Imaging study of the painful heel syndrome  

SciTech Connect

A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45 degrees medial oblique radiographs of both feet. Of the 52 painful heels 31 (59.6%) showed increased uptake of tracer at the calcaneum. Patients with scans showing increased uptake tended to have more severe heel pain and responded more frequently to a local hydrocortisone injection. On plain x-ray, 39 of 52 painful heels (75%) and 24 of the 38 opposite nonpainful heels (63%) showed plantar spurs, compared with five of 63 (7.9%) heels in 59 age- and sex-matched controls. No evidence of stress fractures was seen.

Williams, P.L.; Smibert, J.G.; Cox, R.; Mitchell, R.; Klenerman, L.



Analysis of release of the first branch of the lateral plantar nerve.  


The authors conducted a retrospective study of the release of the first branch of the lateral plantar nerve in the treatment of chronic heel pain unrelieved by conservative treatment modalities. A total of 17 patients (18 feet) were evaluated following external neurolysis for heel pain caused by entrapment of the first branch of the lateral plantar nerve. The average postoperative follow-up time was 32.8 months, with a range of 10 to 72 months. Every patient deemed the surgery successful. At the time of follow-up examination, nine feet were asymptomatic and nine feet experienced mild pain after extended activity. There was one postoperative complication, medial calcaneal nerve entrapment; it was successfully treated with neurectomy. PMID:10881458

Goecker, R M; Banks, A S



Heel Pain  


... Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may ... Excessive Pronation: Heel pain sometimes results from excessive ...


Percutaneous bipolar radiofrequency microdebridement for recalcitrant proximal plantar fasciosis.  


Success rates for traditional methods of surgical intervention for chronic plantar fasciosis are low, and associated with high rates of complications and long recovery times. The purpose of this prospective case series was to assess the effectiveness of percutaneous bipolar radiofrequency microfasciotomy for the treatment of recalcitrant proximal plantar fasciosis in 21 patients. The mean preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 22.10 ± 12.96 (out of a possible 68 points) and the mean postoperative AOFAS hindfoot score was 59.57 ± 13.23 points, and this difference was statistically significant (P < .0001). A total of 7 (33.33%) patients experienced satisfactory pain relief within 1 to 4 weeks and 10 (47.62%) did so within 1 to 4 months, whereas 2 (9.52%) patients required longer than 4 months, and 2 (9.52%) others never attained satisfactory relief of symptoms. Fourteen (66.67%) patients subjectively rated their outcome as excellent, 4 (19.05%) as good, 1 (4.76%) as fair, and 2 (9.52%) as poor. One (4.76%) patient experienced iatrogenic flexor hallucis longus tendonitis. The results of this clinical investigation indicate that bipolar radiofrequency microdebridement plantar fasciotomy safely alleviates recalcitrant heel pain. The technique is minimally invasive and simple to perform, and it spares the overall integrity of the plantar fascia without being associated with undue complications. PMID:21354000

Sorensen, Matthew D; Hyer, Christopher F; Philbin, Terrence M



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

PubMed Central

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

Miller, Larry E.; Latt, Daniel L.



Acroangiodermatitis (pseudo-Kaposi sarcoma): a rarely-recognized condition. A case on the plantar aspect of the foot associated with chronic venous insufficiency.  


Acroangiodermatitis, often known as pseudo-Kaposi sarcoma, is an uncommon angioproliferative entity related to chronic venous insufficiency, arteriovenous fistulae, paralysed limbs, amputation stumps, vascular syndromes and conditions associated with thrombosis. It presents most frequently as purple macules, papules or plaques in the dorsal aspects of the feet, especially the toes, and the malleoli. We report a case of acroangiodermatitis in the plantar aspect of the foot, misdiagnosed for two years, in which haematoxylin-eosin hystopathological stain and immunolabeling with CD34 histochemistry examination were decisive for diagnosis. Patient had chronic venous insufficiency. The lesion responded well to the treatment with a combination of leg elevation and compression. PMID:22068760

Pimentel, Maria Inęs Fernandes; Cuzzi, Tullia; Azeredo-Coutinho, Rilza Beatriz Gayoso de; Vasconcellos, Érica de Camargo Ferreira E; Benzi, Tatiana Silva Costa Gregory; Carvalho, Lívia Martins Veloso de



Comparison of Plantar Loads During Running on Different Overground Surfaces  

Microsoft Academic Search

The objective of this study is to compare plantar loads during running on different overground surfaces. Fifteen heel-to-toe runners participated in the study. Plantar load data were collected and analyzed using an insole sensor system during running on concrete, synthetic rubber, and grass surfaces at a running speed of 3.8 m\\/s. Compared with running on concrete surface, running on natural

Lin Wang; Youlian Hong; Jing-Xian Li; Ji-He Zhou



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: [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)



Lateral plantar neuropathy.  


We report 8 cases of lateral plantar neuropathy (LPN). All had sensory impairment over the territory of the lateral plantar nerve. Near-nerve needle sensory nerve conduction study (NCS) of the plantar nerves showed abnormality confined to the lateral plantar nerve, confirming LPN. The most common cause for LPN was trauma and the most common site of injury was at the passage of the lateral plantar nerve through the abductor tunnel at the instep of the foot. PMID:10454719

Oh, S J; Kwon, K H; Hah, J S; Kim, D E; Demirci, M



The effects of fatigue on plantar pressure distribution in walking.  


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

Bisiaux, M; Moretto, P



Bursitis of the heel  


... heel is swelling of the fluid-filled sac (bursa) at the back of the heel bone under ... A bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas around ...


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

ERIC Educational Resources Information Center

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

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



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


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

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



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

SciTech Connect

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

Hermann, Robert Michael, E-mail: [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Meyer, Andreas [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Gemeinschaftspraxis für Strahlentherapie Hildesheim/Goslar (Germany); Becker, Alexandra [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Schneider, Michael [Orthopaedic Centre for Musculoskeletal Research, University of Würzburg (Germany); Reible, Michael; Carl, Ulrich Martin [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Christiansen, Hans [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Nitsche, Mirko [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel (Germany)



Heel pain and phonophoresis.  


A review of 25 cases of heel pain treated conservatively with phonophoresis, using the anti-inflammatory gel containing a combination of flufenamic acid, salicylic acid and mucopolysaccharide polysulphate is being reported here. The purpose of the study was to assess the effectiveness of a noninvasive procedure called phonophoresis in treating hell pain. It involved usage of ultrasound waves to deliver anti-inflammatory drugs to the painful site. The heel pain subsided in all the cases and did not recur for a period of one year till last reviewed indicating the definite role of phonophoresis in heel pain. PMID:21121387

Deshpande, Milind M; Patil, C B



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. PMID:24963184

Thapa, Deepak; Ahuja, Vanita



Chiropractic management of pediatric plantar fasciitis: a case report  

PubMed Central

Objective The purpose of this report is to present the case of a 10-year-old football player with bilateral plantar fasciitis who improved with a multimodal conservative approach using chiropractic treatment. Clinical Features The patient presented with bilateral plantar heel pain at the origin of the plantar fascia with a duration of 3 weeks. Intervention and Outcome Treatment was provided for 6 visits over a 6-week period. Chiropractic care consisted of manipulative therapy, soft tissue therapy, and home rehabilitation exercises. The soft tissue technique (Graston Technique) was performed to the origin of the plantar fascia and the triceps surae bilaterally. High-velocity, low-amplitude manipulation was applied to the restricted ankle mortise joint. After 6 treatments, the patient reported resolution of foot pain bilaterally and improvements in activities of daily livings. Three months later, the patient reported no further complications and the absence of pain. Conclusion This patient with bilateral plantar fasciitis improved after a course of a multimodal treatment approach using chiropractic manipulation and soft tissue therapy in addition to exercise and stretching therapies. PMID:22942843

Daniels, Clinton J.; Morrell, Adam P.



Effect of heel height on in-shoe localized triaxial stresses.  


Abnormal and excessive plantar pressure and shear are potential risk factors for high-heeled related foot problems, such as forefoot pain, hallux valgus deformity and calluses. Plantar shear stresses could be of particular importance with an inclined supporting surface of high-heeled shoe. This study aimed to investigate the contact pressures and shear stresses simultaneously between plantar foot and high-heeled shoe over five major weightbearing regions: hallux, heel, first, second and fourth metatarsal heads, using in-shoe triaxial force transducers. During both standing and walking, peak pressure and shear stress shifted from the lateral to the medial forefoot as the heel height increased from 30 to 70mm. Heel height elevation had a greater influence on peak shear than peak pressure. The increase in peak shear was up to 119% during walking, which was about five times that of peak pressure. With increasing heel height, peak posterolateral shear over the hallux at midstance increased, whereas peak pressure at push-off decreased. The increased posterolateral shear could be a contributing factor to hallux deformity. It was found that there were differences in the location and time of occurrence between in-shoe peak pressure and peak shear. In addition, there were significant differences in time of occurrence for the double-peak loading pattern between the resultant horizontal ground reaction force peaks and in-shoe localized peak shears. The abnormal and drastic increase of in-shoe shear stresses might be a critical risk factor for shoe-related foot disorders. In-shoe triaxial stresses should therefore be considered to help in designing proper footwear. PMID:21705002

Cong, Yan; Cheung, Jason Tak-Man; Leung, Aaron K L; Zhang, Ming



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

PubMed Central

The aim of this study was to examine the effect of changes in speed and incline slope on plantar pressure distribution of the foot during treadmill jogging. Plantar pressure parameters were measured with the Pedar-X system in twenty healthy girls (mean age of 20.7 years, mean height of 1.60m, and a mean weight of 53.35kg). Because variations in walking speed or slope can significantly change the magnitude of plantar pressure, comparisons of plantar pressure distribution between the two independent protocols during treadmill jogging were considered in this study. First, the subjects ran at the same speed of 2 m·s-1 with different incline slopes of 0%, 5%, 10%, and 15%. Second, they ran on the same slope of 0% with different speeds of 1.5 m·s-1, 2.0 m·s-1, and 2.5 m·s-1. The peak pressure of the eight plantar surface areas, apart from the medial forefoot and the hallux, significantly increased (p < 0.05) with an increase of 33% of peak pressure from 1.5 m·s-1 to 2.5 m·s-1 (speed) at heel region. In contrast, the peak pressures at the heel, medial fore-foot, toe and hallux decreased significantly (p < 0. 05) with increasing incline slope. At the heel, peak pressure reduced by 27% from 0% to 15% incline, however, pressure at the lateral midfoot region increased as following. Different speeds and incline slopes during jogging were associated with changes in plantar pressures. By systematic investigation of foot kinematics and plantar pressure during jogging with varying incline slope and speed, the results of this study provided further insight into foot biomechanics during jogging. Key points The study aimed to compare the plantar pressure distribution of the foot between different incline and speed during treadmill jogging by using plantar insole measurement system. With the increase of speed, apart from the hallux and medical forefoot, the peak pressure of all regions was raised significantly. As the slope increased, there was reduced peak pressure of the heel, medial forefoot, and hallux and toes. PMID:24149400

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



Neurilemmoma of the first branch of the lateral plantar nerve causing tarsal tunnel syndrome.  


In this article, the authors report a case of tarsal tunnel syndrome caused by neurilemmoma of the first branch of the lateral plantar nerve, with symptom resolved after excision. A 42-year-old man presented with left medial heel pain radiating to the lateral sole for 6 months. On examination, there was positive Tinel sign over the medial heel with pain radiating to the lateral sole. Ultrasonography and magnetic resonance imaging confirmed the presence of a 1-cm neurogenic tumor inside the tarsal tunnel. Intraoperatively, a 1-cm neurilemmoma was found at the first branch of the lateral plantar nerve inside the tarsal tunnel. The lesion was excised completely with preservation of its fascicle. The symptom resolved completely after the operation. PMID:20400427

Kwok, Ka Bon; Lui, Tun Hing; Lo, Wing Nin



Predictors of Barefoot Plantar Pressure during Walking in Patients with Diabetes, Peripheral Neuropathy and a History of Ulceration  

PubMed Central

Objective Elevated dynamic plantar foot pressures significantly increase the risk of foot ulceration in diabetes mellitus. The aim was to determine which factors predict plantar pressures in a population of diabetic patients who are at high-risk of foot ulceration. Methods Patients with diabetes, peripheral neuropathy and a history of ulceration were eligible for inclusion in this cross sectional study. Demographic data, foot structure and function, and disease-related factors were recorded and used as potential predictor variables in the analyses. Barefoot peak pressures during walking were calculated for the heel, midfoot, forefoot, lesser toes, and hallux regions. Potential predictors were investigated using multivariate linear regression analyses. 167 participants with mean age of 63 years contributed 329 feet to the analyses. Results The regression models were able to predict between 6% (heel) and 41% (midfoot) of the variation in peak plantar pressures. The largest contributing factor in the heel model was glycosylated haemoglobin concentration, in the midfoot Charcot deformity, in the forefoot prominent metatarsal heads, in the lesser toes hammer toe deformity and in the hallux previous ulceration. Variables with local effects (e.g. foot deformity) were stronger predictors of plantar pressure than global features (e.g. body mass, age, gender, or diabetes duration). Conclusion The presence of local deformity was the largest contributing factor to barefoot dynamic plantar pressure in high-risk diabetic patients and should therefore be adequately managed to reduce plantar pressure and ulcer risk. However, a significant amount of variance is unexplained by the models, which advocates the quantitative measurement of plantar pressures in the clinical risk assessment of the patient. PMID:25647421

Barn, Ruth; Waaijman, Roelof; Nollet, Frans; Woodburn, James; Bus, Sicco A.



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. PMID:24800188

Moghtaderi, Alireza; Khosrawi, Saeid; Dehghan, Farnaz



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



Ultrasound- versus Palpation-Guided Injection of Corticosteroid for Plantar Fasciitis: A Meta-Analysis  

PubMed Central

Background It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis. Methods Databases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Results Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI. Conclusion Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research. PMID:24658102

Yu, Aixi; Qi, Baiwen



Treatment of Plantar Hyperhidrosis with Dermojet Injections of Botulinum Toxin  

Microsoft Academic Search

Focal axillary, palmar or plantar hyperhidrosis is a chronic, distressing and sometimes disabling disorder that often responds poorly to conventional therapies. Surgical procedures are performed in severely affected patients. Intra- or subcutaneous injections of botulinum toxin are a novel, effective and safe alternative therapeutic modality in the management of focal hyperhidrosis [1–6]. Its benefits may last as long as 14

J. Vadoud-Seyedi; T. Simonart; M. Heenen



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. PMID:22169152

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



Plantar pressures in the tennis serve.  


In-shoe loading patterns were examined in each foot (back and front) separately during two types of tennis serve [first (or flat) and second (or twist) serve] and two service stance styles [foot-up (back foot is moved forward next to front foot for push-off) and foot-back (feet remain at the same relative level)]. Ten competitive tennis players completed five trials for each type of serve and service stance style in random order. Plantar pressure distribution was recorded using Pedar insoles divided into nine areas for analysis. Mean and peak pressures (+15.2%, P < 0.01 and +12.8%, P < 0.05) as well as maximal forces (+20.2%, P < 0.01) were higher under the lateral forefoot of the front foot in first than in second serves, while mean forces were higher (+17.2%, P < 0.05) under the lesser toes. Relative load was higher on the lateral forefoot (+20.4%, P < 0.05) but lower (-32.5%, P < 0.05) on the medial heel of the front foot with foot-up compared with foot-back stance. Using a foot-up stance, loading of the back foot was higher (+31.8%, P < 0.01) under the lateral mid-foot but lower (-29.9%, P < 0.01) under the medial forefoot. The type of serve and the stance style adopted have a significant effect on foot loading. Such findings might help improve mechanical efficiency of the serve. PMID:20496222

Girard, Olivier; Eicher, Frank; Micallef, Jean-Paul; Millet, Grégoire



Effect of variable body mass on plantar foot pressure and off-loading device efficacy.  


An increasing body of evidence has implicated obesity as having a negative effect on the development, treatment, and outcome of lower extremity pathologic entities, including diabetic foot disease. The objective of the present study was to increase the body of knowledge with respect to the effects of obesity on foot function. Specifically, we attempted to (1) describe the relationship between an increasing body mass index (BMI) on plantar foot pressures during gait, and (2) evaluate the efficacy of commonly prescribed off-loading devices with an increasing BMI. A repeated measures design was used to compare the peak plantar foot pressures under multiple test conditions, with the volunteers acting as their own controls. The primary outcome measure was the mean peak plantar pressure in the heel, midfoot, forefoot, and first metatarsal, and the 2 variables were modification of patient weight (from "normal" BMI to "overweight," "obese," and "morbidly obese") and footwear (from an athletic sneaker to a surgical shoe, controlled ankle motion walker, and total contact cast). Statistically significant increases in the peak plantar pressures were observed with increasing volunteer BMI weight class, regardless of the off-loading device used. The present investigation has provided unique and specific data with respect to the changes that occur in the peak plantar pressures with variable BMIs across different anatomic levels and with commonly used off-loading devices. From our results, we have concluded that although the plantar pressures increase with increasing weight, it appears that at least some reduction in pressure can be achieved with an off-loading device, most effectively with the total contact cast, regardless of the patient's BMI. PMID:24735742

Pirozzi, Kelly; McGuire, James; Meyr, Andrew J



Comparison of ultrasound-, palpation, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis  

Microsoft Academic Search

Background  The aim of the study was to compare the efficacies of steroid injections guided by scintigraphy, ultrasonography, and palpation\\u000a in plantar fasciitis.\\u000a \\u000a \\u000a \\u000a Methods  A total of 35 heels of 27 patients were randomly assigned to three steroid injection groups: palpation-guided (pg), ultrasound-guided\\u000a (ug), and scintigraphy-guided (sg). Patients were evaluated for pain intensity before the injections and at the last follow-up\\u000a of

Istemi Yucel; Burhan Yazici; Erdem Degirmenci; Besir Erdogmus; Semih Dogan



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


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

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



Plantar vein thrombosis and pulmonary embolism.  


Plantar vein thrombosis is an unusual and under-diagnosed condition that affects the plantar deep venous system. Current ultrasound investigation protocols for deep venous thrombosis neglect this entity. To our knowledge, there are only seven reports in the literature of 20 patients with plantar vein thrombosis detected with sonography without an associated pulmonary embolism. We present a case report of a patient with a plantar vein thrombosis associated with pulmonary embolism. Patients who present with pain and/or swelling of the foot should undergo ultrasound examination and careful evaluation for respiratory symptoms. PMID:24429378

Barros, Mvl; Nascimento, Is; Barros, Tls; Labropoulos, N



Heel ulcer and blood flow: the importance of the angiosome concept.  


A young female diabetic patient is reported, who presented with a double foot lesion. She presented with a first metatarsal head exposure concomitant with a heel wet gangrene. Magnetic resonance demonstrated osteomyelitis of the rear portion of the calcaneus. Transmetatarsal amputation was performed and a wide debridement was required to remove all gangrenous tissue from the heel wound. The pedal artery was palpable; the posterior tibial pulse was present, but weak.Transcutaneous oximetry (TcPO2) at the dorsum of the foot was TcPO2 = 56 mmHg despite significant oedema. Nevertheless, TcPO2 on the perilesional area of the heel ulcer (TcPO2 = 24mmHg) was suggestive for critical chronic ischemia. At angiographic examination, anterior tibial and peroneal arteries were patent, but the posterior tibial artery that showed severe stenosis then percutaneous angioplasty (PTA) was performed. Just the day after PTA, values of TcPO2 at the perilesional area of the heel ulcer increased to 41 mmHg. Heel osteomyelitis was subsequently treated by partial calcanectomy. The patient was discharged after a 21-day hospital stay. In the treatment of heel ulcers, it is clinically useful to use the angiosomic concept. The majority of the blood supply to the heel is provided by the posterior tibial artery, and only to a small extent by the posterior branch of peroneal artery. If the decrease in blood flow to this region is not detected, and direct flow based on the angiosome concept is not obtained, the healing of a heel ulcer may be delayed or impaired. PMID:24043681

Faglia, Ezio; Clerici, Giacomo; Caminiti, Maurizio; Vincenzo, Curci; Cetta, Francesco



Neurotized distally based sural flap for heel reconstruction.  


The use of local flaps for the reconstruction of leg has lost their popularity with the more often performed flaps on the basis of perforators and microsurgical technique. Like the head and neck reconstruction, in the lower extremity there are limited units of tissue to base the flaps because of the lack of vascularity and arc of mobilization. The distally based sural flap represents an ideal flap for the reconstruction of heel, and with the inclusion of the sural nerve, we can neurotize the flap to give the stability of a weight-bearing area and provide the necessary sensibility to avoid ulcerations of the reconstructed heel. We present a case of a 32-year-old woman with a traumatic loss of the tissue covering the heel, with a diagnosis of a pseudoepithelial hyperplasia treated in previous occasions with skin grafts that led to chronic ulcerations. A distally based sural flap was planned for a definitive coverage, planning a perineural neurorrhaphy, to the intermediate dorsal cutaneous branch of the superficial peroneal nerve to give sensibility to the flap. PMID:23757153

Mendieta, Mauricio J; Roblero, Carlos; Vega, Juan C



Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.  


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

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



Abnormalities of plantar pressure distribution in early, intermediate, and late stages of diabetic neuropathy.  


Inconsistent findings with regard to plantar pressure while walking in the diabetic population may be due to the heterogeneity of the studied groups resulting from the classification/grouping criteria adopted. The clinical diagnosis and classification of diabetes have inherent uncertainties that compromise the definition of its onset and the differentiation of its severity stages. A fuzzy system could improve the precision of the diagnosis and classification of diabetic neuropathy because it takes those uncertainties into account and combines different assessment methods. Here, we investigated how plantar pressure abnormalities evolve throughout different severity stages of diabetic polyneuropathy (absent, n=38; mild, n=20; moderate, n=47; severe, n=24). Pressure distribution was analysed over five areas while patients walked barefoot. Patients with mild neuropathy displayed an increase in pressure-time integral at the forefoot and a lower peak pressure at the heel. The peak and pressure-time integral under the forefoot and heel were aggravated in later stages of the disease (moderate and severe) compared with early stages of the disease (absent and mild). In the severe group, lower pressures at the lateral forefoot and hallux were observed, which could be related to symptoms that develop with the aggravation of neuropathy: atrophy of the intrinsic foot muscles, reduction of distal muscle activity, and joint stiffness. Although there were clear alterations over the forefoot and in a number of plantar areas with higher pressures within each severity stage, they did not follow the aggravation evolution of neuropathy classified by the fuzzy model. Based on these results, therapeutic interventions should begin in the early stages of this disease to prevent further consequences of the disease. PMID:25086801

Sacco, Isabel C N; Hamamoto, Adriana N; Tonicelli, Lucas M G; Watari, Ricky; Ortega, Neli R S; Sartor, Cristina D



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


It is known that cutaneous reflexes in human hand muscles show strong location-specificity dependent on the digit stimulated. We hypothesized that in lower leg muscles the cutaneous reflex following tactile sensation of the plantar surface of the foot is also organized in a location-specific manner. The purpose of the present study was to test this hypothesis. Middle latency reflexes (approximately 70-110 ms, MLR) following non-noxious electrical stimulation to different locations on the plantar foot were recorded from 16 neurologically intact volunteers (15 males, 1 female). Electrical stimulation was given to the fore-medial (f-M), fore-lateral (f-L) and heel (HL) regions of the plantar surface of the right foot while the subjects performed isometric dorsiflexion (tibialis anterior, TA), plantarflexion (soleus, Sol and medial gastrocnemius, MG), eversion (peroneus longus, PL) and knee extension (vastus lateralis, VL) while sitting and standing. In the Sol and MG, an excitatory response was observed following HL stimulation, which was switched to an inhibitory response following f-M or f-L stimulation (P < 0.001). A reciprocal pattern in contrast to Sol was observed in the TA. In the PL, MLR exhibited significant excitation following both f-L and HL stimulation, which, however, was switched to an inhibitory response following f-M stimulation (P < 0.001). Moderate inhibition of the MLR was seen in the VL for all stimulated positions. Systematic stimulation along the lateral side of the plantar foot demonstrated that the reflex reversal occurred around the middle of the plantar foot in the Sol and TA. In all muscles tested, the slope of the regression line between the magnitude of the MLR and background electromyographic activity significantly decreased during standing compared with sitting except for the PL following f-L simulation. These results suggest that reflex effects from cutaneous nerves in the plantar foot onto the motoneurons innervating the lower leg muscles are organized in a highly topographic manner in humans. The organization of these reflexes may play an important role in the alteration of limb loading and/or ground contact in response to tactile sensation of the plantar foot while sitting and standing. PMID:16847613

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



Histomorphological Evaluation of Diabetic and Non-Diabetic Plantar Soft Tissue  

PubMed Central

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

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



Gaenslen's split-heel incision for calcaneal osteomyelitis—Case report  

Microsoft Academic Search

BackgroundThe purpose of the report was to present a 45-year-old lady who had a chronic osteomyelitis right calcaneum with a large non-healing ulcer and discharging sinus, treated by split-heel incision of Gaenslen.

J. Terrence Jose Jerome; Simon Thomas



An innovative ultrasound foot scanner system for measuring the change in biomechanical properties of plantar tissue from sitting to standing.  


The present study investigated the reliability of an innovative ultrasound foot scanner system in assessing the thickness and stiffness of plantar soft tissue and the comparison of stiffness and thickness in sitting and standing. Fifteen young healthy individuals were examined. The target sites on the foot sole for investigation included the heel pad, the fifth metatarsal head, the second metatarsal head, the first metatarsal head, and the pulp of the hallux. The test (day 1) and retest (day 2) were performed 1 week apart at the exact time with humidity and temperature of the assessment room under control. The thickness and stiffness of the plantar soft tissue obtained in sitting and standing positions on day 1 were used for comparison. The results showed significant test-retest reliability [intraclass correlation coefficient(3,2)>0.90, P<0.001] at all five sites in both sitting and standing positions. When changing from sitting to standing, the plantar soft tissue became significantly thinner (with decrease ranging from 10 to 14% at various sites) and stiffer (with increase ranging from 123 to 164% at various sites, all P<0.05). The present innovative system is a reliable device for the measurement of the thickness and stiffness of plantar soft tissue in either the sitting or the standing position. The change in positions from sitting to standing resulted in a significant thinning and stiffening of plantar soft tissues. This system could be a potential clinical device to monitor the biomechanical properties of plantar tissue in the elderly or in patients with diseases such as diabetes to estimate the risk of developing foot ulcer or other foot complications. PMID:25426574

Ng, Thomas Ka-Wai; Zheng, Yong-Ping; Kwan, Rachel Lai-Chu; Cheing, Gladys Lai-Ying



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


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

Jřrgensen, U; Bojsen-Mřller, F



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


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

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



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. PMID:23738240

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



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. PMID:22396822

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



Foot Plantar Pressure Measurement System: A Review  

PubMed Central

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

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



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. PMID:23644849

Wolosker, Nelson; Ishy, Augusto; Yazbek, Guilherme; de Campos, José Ribas Milanez; Kauffman, Paulo; Puech-Leăo, Pedro; Jatene, Fábio Biscegli



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

PubMed Central

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




Diabetic Heel Ulcer in the Sudan: Determinants of Outcome  

Microsoft Academic Search

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

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


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


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



Improved method for determining tank heel volumes  

SciTech Connect

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

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



Plantar melanoma: Results of treatment in three population groups  

Microsoft Academic Search

Background: The frequency of plantar melanoma varies widely in different population groups. The plantar surface is an infrequent site in white persons but is common in the black population. The effect of ethnicity on melanoma of the plantar surface has not previously been well defined. The aim of this study was to analyze the results of a standard protocol of

Don A. Hudson; Jake E. J. Krige; Helen Stubbings



Transarterial Coil Embolization of a Symptomatic Posttraumatic Plantar Pseudoaneurysm  

PubMed Central

Posttraumatic pseudoaneurysms of the lateral plantar artery are rare. We report the case of a 31-year-old woman with a painful pseudoaneurysm of the lateral plantar artery resulting from a deep plantar cut injury. The pseudoaneurysm was successfully treated by performing a transarterial “frontdoor-backdoor” coil embolization technique, which is a minimally invasive alternative to conventional ligature of the artery.

Beyer, Lukas Philipp; Wohlgemuth, Walter A.; Müller-Wille, René



Classification and mass production technique for three-quarter shoe insoles using non-weight-bearing plantar shapes.  


We have developed a technique for the mass production and classification of three-quarter shoe insoles via a 3D anthropometric measurement of full-size non-weight-bearing plantar shapes. The plantar shapes of fifty 40-60-year-old adults from Taiwan were categorized and, in conjunction with commercially available flat or leisure shoe models, three-quarter shoe-insole models were generated using a CAD system. Applying a rapid prototype system, these models were then used to provide the parameters for manufacturing the shoe insoles. The insoles developed in this study have been classified into S, M and L types that offer user-friendly options for foot-care providers. We concluded that these insoles can mate tightly with the foot arch and disperse the pressure in the heel and forefoot over the foot arch. Thus, practically, the pressure difference over the plantar region can be minimised, and the user can experience comfort when wearing flat or leisure shoes. PMID:18620334

Sun, Shuh-Ping; Chou, Yi-Jiun; Sue, Chun-Chia



[The use of papain in plantar ulcers].  


This work has as a goal to contribute to decrease the inability in leprosy and continuous recurrence of plantar ulcers, through the use of a treatment method using papaine and actions of health education. This work has been done in a health centre with patients that presented plantar ulcers and agreed to participate in the proposed treatment. Analysing and comparing the obtained data before and after treatment, a greater adhesion of patients to this treatment, a quicker healing in relation to other methods used before and a greater interaction with the patient has been observed. PMID:9220838

Otuka, E S; Pedrazzani, E S; Pioto, M P




Microsoft Academic Search

A b s t r a c t: Psoriasis is a common, chronic, genetically determined, T-cell- mediated inflammatory dermatosis. The aim of this study is to determine the frequency of delayed-type hypersensitivity to contact allergens in palmo-plantar psoriasis and their importance in provoking and\\/or perpetuating the same. Materials and methods: 101 patients with different clinical forms of psoriasis were included

Nina Caca-Biljanovska; Marija V'lckova-Laskoska; Margareta Balabanova-Stefanov; Vesna Grivceva-Panovska


The Use of Dry Needling and Myofascial Meridians in a Case of Plantar Fasciitis  

PubMed Central

Objective The purpose of this case report is to describe the use of dry needling based on myofascial meridians for management of plantar fasciitis. Clinical features A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity. Intervention and outcome Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient’s pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient. Conclusion Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis. PMID:24711784

Behnam, Akhbari; Mahyar, Salavati; Ezzati, Kamran; Rad, Shahrzad Mohammadi



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. PMID:23468936

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



Plantar trophic ulcers in patients with leprosy  

Microsoft Academic Search

Summary Thirty patients with leprosy were studied to correlate the presence and the site of ulcers with the neurological status of the plantar surface of the foot, the range of motion of the ankle and the pattern of ground pressure beneath the foot as obtained by a Footprint apparatus. A highly significant association was found between the presence of an

S. Sabato; Z. Yosipovitch; A. Simkin; J. Sheskin



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

PubMed Central

Several studies have already reported that specific foot/ankle muscle reinforcement strategies induced strength and joint position sense performance enhancement. Nevertheless the effects of such protocols on sprint performance and plantar loading distribution have not been addressed yet. The objective of the study is to investigate the influence of a 5-wk foot/ankle strength training program on plantar loading characteristics during sprinting in adolescent males. Sixteen adolescent male athletes of a national training academy were randomly assigned to either a combined foot/ankle electromyostimulation and resistance training (FAST) or a control (C) group. FAST consisted of foot medial arch and extrinsic ankle muscles reinforcement exercises, whereas C maintained their usual training routine. Before and after training, in-shoe loading patterns were measured during 30-m running sprints using pressure sensitive insoles (right foot) and divided into nine regions for analysis. Although sprint times remained unchanged in both groups from pre- to post- training (3.90 ± 0.32 vs. 3.98 ± 0.46 s in FAST and 3.83 ± 0.42 vs. 3.81 ± 0.44 s in C), changes in force and pressure appeared from heel to forefoot between FAST and C. In FAST, mean pressure and force increased in the lateral heel area from pre- to post- training (67.1 ± 44.1 vs. 82.9 ± 28.6 kPa [p = 0.06]; 25.5 ± 17.8 vs. 34.1 ± 14.3 N [p = 0.05]) and did not change in the medial forefoot (151.0 ± 23.2 vs. 146.1 ± 30.0 kPa; 142.1 ± 29.4 vs. 136.0 ± 33.8; NS). Mean area increased in FAST under the lateral heel from pre- to post- (4.5 ± 1.3 vs. 5.7 ± 1.6 cm2 [p < 0.05]) and remained unchanged in C (5.5 ± 2.8 vs. 5.0 ± 3.0 cm2). FAST program induced significant promising lateral and unwanted posterior transfer of the plantar loads without affecting significantly sprinting performance. Key points We have evaluated the effects of a foot/ankle strength training program on sprint performance and on related plantar loading characteristics in teenage athletes, and this have not been examined previously. Our results showed no significant pre- to post- changes in sprint performance. This study revealed initially a lateral transfer and secondly a posterior transfer of the plantar loads after the foot/ankle strength training program. PMID:24149874

Fourchet, François; Kuitunen, Sami; Girard, Olivier; Beard, Adam J.; Millet, Grégoire P.



Plantar pressure distribution in older people with osteoarthritis of the first metatarsophalangeal joint (hallux limitus/rigidus).  


The purpose of this study was to evaluate differences in dynamic plantar pressure distribution between older people with and without radiographically confirmed osteoarthritis (OA) of the first metatarsophalangeal joint (first MPJ) of the foot. Dynamic plantar pressure recordings using the TekScan MatScan system were obtained during barefoot level walking in 40 older participants; 20 with radiographically confirmed OA of the first MPJ displaying less than 55 degrees of passive dorsiflexion, and 20 with no evidence of OA in the first MPJ displaying greater than 55 degrees of passive dorsiflexion. Group comparisons between the variables maximum force and peak pressure were made for seven different regions underneath the right foot (heel, midfoot, first MPJ, second MPJ, third to fifth MPJs, hallux, and lesser toes). Compared to the control group, participants with OA of the first MPJ exhibited 34% greater maximum force (7.9 +/- 2.5 vs. 5.9 +/- 1.7 kg, p = 0.005) and 23% higher peak pressure (1.6 +/- 0.3 vs. 1.3 +/- 0.3 kg/cm(2), p = 0.001) under the hallux. Similar results were also found under the lesser toes with 43% greater maximum force (5.0 +/- 1.9 vs. 3.5 +/- 1.4 kg; p = 0.006) and 29% higher peak pressure (0.9 +/- 0.2 vs. 0.7 +/- 0.2 kg/cm(2), p = 0.018). No significant differences were found to exist between groups for any other plantar region. These findings indicate that OA of the first MPJ is associated with significant changes in load-bearing function of the foot, which may contribute to the development of secondary pathological changes associated with the condition, such as plantar callus formation and hyperextension of the hallux interphalangeal joint. PMID:18634037

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



Plantar melanoma: a case-control study in Paraguay  

Microsoft Academic Search

In Paraguay, the plantar surface of the foot is the most common site for malignant melanoma, as it is in several other populations\\u000a worldwide, most notably in those of African descent. Here, we report the results of the first case-control study of plantar\\u000a melanoma, carried out in Paraguay. Sixty incident, histologically confirmed cases of plantar melanoma and 256 hospital controls

P. A. Rolón; E. Kramárová; H. I. Rolón; M. Khlat; D. M. Parkin



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

PubMed Central

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

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



Blunt dissection for the treatment of plantar verrucae.  


The treatment of plantar verrucae has always been a challenging and perplexing problem to physicians. Due to the inherent nature of verrucae, response to various forms of treatment has been extremely unpredictable. It is believed that hyperhidrosis and abnormal pressure to the plantar aspects of the feet are contributing factors predisposing one to developing verrucae. This article describes a painless and effective approach to the treatment of plantar verruca through the use of blunt dissection. Following anesthesia obtained with a posterior tibial nerve block, the plantar verruca can be successfully dissected with an 80 percent cure rate. PMID:2209078

Baruch, K



Plantar fasciitis (fasciosis) treatment outcome study: plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement.  


Ultrasound, well recognized as an effective diagnostic tool, reveals a thickening of the plantar fascia in patients with plantar fasciitis/fasciosis disease. The authors hypothesized that ultrasound would also reveal a decrease in the plantar fascia thickness for patients undergoing treatment for the disease, a hypothesis that, heretofore, had been only tested on a limited number of subjects. They conducted a more statistically significant study that found that clinical treatment with injection and biomechanical correction does indeed diminish plantar fascia thickness as shown on ultrasound. The study also revealed that patients experience the most heightened plantar fascia tenderness toward the end of the day, and improvement in their symptomatic complaints were associated with a reduction in plantar fascia thickness. As a result, the authors conclude that office-based ultrasound can help diagnose and confirm plantar fasciitis/fasciosis through the measurement of the plantar fascia thickness. Because of the advantages of ultrasound--that it is non-invasive with greater patient acceptance, cost effective and radiation-free--the imaging tool should be considered and implemented early in the diagnosis and treatment of plantar fasciitis/fasciosis. PMID:21398108

Fabrikant, Jerry M; Park, Tae Soon



Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis.  


We report the case of a 72-year-old woman suffering with severe plantar fasciitis who received a therapeutic corticosteroid injection. Two-and-a-half years after the injection she developed a small calcified lump under the skin which subsequently caused ulceration and infection. She went on to develop a diabetic foot infection requiring an extended course of intravenous antibiotics. PMID:23955985

Fox, Thomas Peter; Oliver, Govind; Wek, Caesar; Hester, Thomas



In-shoe plantar tri-axial stress profiles during maximum-effort cutting maneuvers.  


Soft tissue injuries, such as anterior cruciate ligament rupture, ankle sprain and foot skin problems, frequently occur during cutting maneuvers. These injuries are often regarded as associated with abnormal joint torque and interfacial friction caused by excessive external and in-shoe shear forces. This study simultaneously investigated the dynamic in-shoe localized plantar pressure and shear stress during lateral shuffling and 45° sidestep cutting maneuvers. Tri-axial force transducers were affixed at the first and second metatarsal heads, lateral forefoot, and heel regions in the midsole of a basketball shoe. Seventeen basketball players executed both cutting maneuvers with maximum efforts. Lateral shuffling cutting had a larger mediolateral braking force than 45° sidestep cutting. This large braking force was concentrated at the first metatarsal head, as indicated by its maximum medial shear stress (312.2 ± 157.0 kPa). During propulsion phase, peak shear stress occurred at the second metatarsal head (271.3 ± 124.3 kPa). Compared with lateral shuffling cutting, 45° sidestep cutting produced larger peak propulsion shear stress (463.0 ± 272.6 kPa) but smaller peak braking shear stress (184.8 ± 181.7 kPa), of which both were found at the first metatarsal head. During both cutting maneuvers, maximum medial and posterior shear stress occurred at the first metatarsal head, whereas maximum pressure occurred at the second metatarsal head. The first and second metatarsal heads sustained relatively high pressure and shear stress and were expected to be susceptible to plantar tissue discomfort or injury. Due to different stress distribution, distinct pressure and shear cushioning mechanisms in basketball footwear might be considered over different foot regions. PMID:25468303

Cong, Yan; Lam, Wing Kai; Cheung, Jason Tak-Man; Zhang, Ming



Froude number fractions to increase walking pattern dynamic similarities: application to plantar pressure study in healthy subjects.  


The purpose of this study was to determine if using similar walking velocities obtained from fractions of the Froude number (N(Fr)) and leg length can lead to kinematic and kinetic similarities and lower variability. Fifteen male subjects walked on a treadmill at 0.83 (VS(1)) and 1.16ms(-1) (VS(2)) and then at two similar velocities (V(Sim27) and V(Sim37)) determined from two fractions of the N(Fr) (0.27 and 0.37) so that the average group velocity remained unchanged in both conditions (VS(1)=V (Sim27)andVS(2)=V (Sim37)). N(Fr) can theoretically be used to determine walking velocities proportional to leg lengths and to establish dynamic similarities between subjects. This study represents the first attempt at using this approach to examine plantar pressure. The ankle and knee joint angles were studied in the sagittal plane and the plantar pressure distribution was assessed with an in-shoe measurement device. The similarity ratios were computed from anthropometric parameters and plantar pressure peaks. Dynamically similar conditions caused a 25% reduction in leg joint angles variation and a 10% significant decrease in dimensionless pressure peak variability on average of five footprint locations. It also lead to heel and under-midfoot pressure peaks proportional to body mass and to an increase in the number of under-forefoot plantar pressure peaks proportional to body mass and/or leg length. The use of walking velocities derived from N(Fr) allows kinematic and plantar pressure similarities between subjects to be observed and leads to a lower inter-subject variability. In-shoe pressure measurements have proven to be valuable for the understanding of lower extremity function. Set walking velocities used for clinical assessment mask the effects of body size and individual gait mechanics. The anthropometric scaling of walking velocities (fraction of N(Fr)) should improve identification of unique walking strategies and pathological foot functions. PMID:16434196

Moretto, P; Bisiaux, M; Lafortune, M A



The effects of fatigue on plantar pressure distribution in walking  

Microsoft Academic Search

The purpose of this study was to assess plantar pressure deviations due to fatigue. Plantar pressure was assessed using a portable system while eleven healthy subjects performed three walking tests, one before, one immediately after and another 30-min after intensive running. Pressure peak, intra-subject coefficient of variation and relative impulse were recorded. Significant decrease in pressure peak and the relative

M. Bisiaux; P. Moretto



The role of hamstring tightness in plantar fasciitis.  


The purpose of this prospective cohort study was to determine if hamstring tightness was an increased risk in plantar fasciitis. It was thought that there is an increased risk of plantar fasciitis when hamstring tightness is present. A total of 105 patients (68 women, 37 men) were included in the study, 79 of whom were diagnosed with plantar fasciitis. Body mass index (BMI) was calculated and the presence of plantar fasciitis, equinus, and calcaneal spurs were assessed. The popliteal angle was measured using standard diagnostic techniques. Without controlling for covariates, BMI, the presence of a calcaneal spur, tightness in the gastrocnemius, gastrocnemius-soleus, and hamstring all had statistically significant association with plantar fasciitis. After controlling for covariates, patients with hamstring tightness were about 8.7 times as likely to experience plantar fasciitis (P < .0001). Patients with BMI >35 were approximately 2.4 times as likely to experience plantar fasciitis compared with those with BMI <35 (P = .04). This study demonstrates that hamstring tightness plays a significant role in the presence of plantar fasciitis and should be addressed along with equinus and obesity when providing treatment to patients with this diagnosis. PMID:21368068

Labovitz, Jonathan M; Yu, Jenny; Kim, Chul



Iontophoresis for palmar and plantar hyperhidrosis.  


Iontophoresis is a safe, efficacious, and cost-effective primary treatment of palmar and plantar hyperhidrosis. Decades of clinical experience and research show significant reduction in palmoplantar excessive sweating with minimal side effects. To get the best results from iontophoresis, health care professionals need to provide education on the mechanism of action and benefits, evidence of its use, and creation of a future patient-specific plan of care for continued treatments at home or in the physician's office. Iontophoresis may be combined with other hyperhidrosis treatments, such as topical antiperspirants and botulinum toxin injections. PMID:25152342

Pariser, David M; Ballard, Angela



Nerve conduction study of the medial and lateral plantar nerves.  


The medial and lateral plantar nerves may be evaluated through the recordings of the compound sensory nerve action potentials (CSNAP), compound mixed nerve action potentials (CMNAP) and compound muscular action potentials (CMAP). As some of these potentials are not easily and always obtainable in normal individuals, our purpose was to verify the consistency of these potentials for the study of these nerves. Fifty-one normal adult volunteers were examined. The CSNAP, CMNAP and CMAP, related to the medial and lateral plantar nerves were evaluated bilaterally. CSNAP were not obtained in 7.8% and in 17.6% from the medial and lateral plantar nerves respectively. CMNAP from the lateral plantar nerve were not obtained in 15.6%. CMNAP from the medial plantar nerves and CMAPs from the abductor hallucis and abductor digiti quinti were obtained for all nerves tested. Our results, therefore, suggest that these last 3 parameters are the ones more reliable for clinical application. PMID:10812535

Antunes, A C; Nobrega, J A; Manzano, G M



Temperature as a predictive tool for plantar triaxial loading.  


Diabetic foot ulcers are caused by moderate repetitive plantar stresses in the presence of peripheral neuropathy. In severe cases, the development of these foot ulcers can lead to lower extremity amputations. Plantar pressure measurements have been considered a capable predictor of ulceration sites in the past, but some investigations have pointed out inconsistencies when solely relying on this method. The other component of ground reaction forces/stresses, shear, has been understudied due to a lack of adequate equipment. Recent articles reported the potential clinical significance of shear in diabetic ulcer etiology. With the lack of adequate tools, plantar temperature has been used as an alternative method for determining plantar triaxial loading and/or shear. However, this method has not been previously validated. The purpose of this study was to analyze the potential association between exercise-induced plantar temperature increase and plantar stresses. Thirteen healthy individuals walked on a treadmill for 10 minutes at 3.2km/h. Pre and post-exercise temperature profiles were obtained with a thermal camera. Plantar triaxial stresses were quantified with a custom-built stress plate. A statistically significant correlation was observed between peak shear stress (PSS) and temperature increase (r=0.78), but not between peak resultant stress (PRS) and temperature increase (r=0.46). Plantar temperature increase could predict the location of PSS and PRS in 23% and 39% of the subjects, respectively. Only a moderate linear relationship was established between triaxial plantar stresses and walking-induced temperature increase. Future research will investigate the value of nonlinear models in predicting plantar loading through foot temperature. PMID:25446272

Yavuz, Metin; Brem, Ryan W; Davis, Brian L; Patel, Jalpa; Osbourne, Abe; Matassini, Megan R; Wood, David A; Nwokolo, Irene O



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. PMID:24642291



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

NASA Astrophysics Data System (ADS)

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

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



Severe plantar hyperhidrosis: an effective surgical solution.  


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



Plantar tendons of the foot: MR imaging and US.  


Tendon disorders along the plantar aspect of the foot may lead to significant symptoms but are often clinically misdiagnosed. Familiarity with the normal anatomy of the plantar tendons and its appearance at magnetic resonance (MR) imaging and ultrasonography (US) is essential for recognizing plantar tendon disorders. At MR imaging, the course of the plantar tendons is optimally visualized with dedicated imaging of the midfoot and forefoot. This imaging should include short-axis images obtained perpendicular to the long axis of the metatarsal shafts, which allows true cross-sectional evaluation of the plantar tendons. Normal plantar tendons appear as low-signal-intensity structures with all MR sequences. At US, accurate evaluation of the tendons requires that the ultrasound beam be perpendicular to the tendon. The normal tendon appears as a compact linear band of echogenic tissue that contains a fine, mixed hypoechoic and hyperechoic internal fibrillar pattern. Tendon injuries can be grouped into six major categories: tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, and instability (subluxation or dislocation) and can be well assessed with both MR imaging and US. The radiologist plays an important role in the diagnosis of plantar tendon disorders, and recognizing their imaging appearances at MR imaging and US is essential. PMID:24224599

Donovan, Andrea; Rosenberg, Zehava Sadka; Bencardino, Jenny T; Velez, Zoraida Restrepo; Blonder, David B; Ciavarra, Gina A; Adler, Ronald Steven



Distally based sural fasciomyocutaneous flap: anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel.  


The reconstruction of the distal third leg and weight-bearing heel, especially when complicated with infection and/or dead space, remains a challenge in reconstructive surgery. The distally based sural neurofasciomyocutaneous flap has been proved a valuable tool in repair of the soft tissue defects of those areas. In this report, we present the results of the anatomical study on vascular communication between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle and a modified technique in clinical applications for reconstruction of the soft tissue defects in the distal lower leg and heel. Six lower limbs of fresh cadavers were injected with red gelatin and dissected. A constant vascular connection with average four musculo-fasciocutaneous perforators with diameter 0.2-0.5 mm was identified in the overlapping area between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle. Based on these findings, a modified distally based sural neurofasciomyocutaneous flap including the distal gastrocnemius muscle component was designed and used for repairs of the soft tissue defects in the distal lower limb and plantar heel pad in six patients. The blood supplies of flaps comprised either the peroneal perforator and adipofascial pedicle or the peroneal perforator only. The average size of the fasciocutaneous flap was 51 cm(2), and the muscle component 17.7 cm(2). All flaps survived uneventfully. Our results suggest that this technical modification could provide wider range for applications of the distally based sural neurofasciomyocutaneous flap in repair of the soft tissue defects of the lower extremity and heel. PMID:19031395

Chang, Shi-Min; Zhang, Kai; Li, Hai-Feng; Huang, Yi-Gang; Zhou, Jia-Qian; Yuan, Feng; Yu, Guang-Rong



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 PMID:7272653

Maclellan, G. E.; Vyvyan, Barbara



Fiber optic plantar pressure/shear sensor  

NASA Astrophysics Data System (ADS)

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

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



Foot Modeling and Smart Plantar Pressure Reconstruction from Three Sensors  

PubMed Central

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

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



Dielectric Elastomer Generators for Foot Plantar Pressure Based Energy Scavenging  

E-print Network

Dielectric Elastomer Generators for Foot Plantar Pressure Based Energy Scavenging Vishwa Goudar Abstract-- Parasitic energy scavenging from human-generated vibrations with piezoelectric materials has cycles, we contrast the energy scavenged from shoe strikes by DEGs that are virtually embedded

Potkonjak, Miodrag


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

PubMed Central

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

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



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


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

Han, Dongwook



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

PubMed Central

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

Han, Dongwook



The biomechanical efficacy of dressings in preventing heel ulcers.  


The heels are the most common site for facility-acquired pressure ulcers (PUs), and are also the most susceptible location for deep tissue injuries. The use of multilayer prophylactic dressings to prevent heel PUs is a relatively new prevention concept, generally aimed at minimizing the risk for heel ulcers (HUs) through mechanical cushioning and reduction of friction at the dressing-support interface. We used 9 finite element model variants of the posterior heel in order to evaluate the biomechanical performance of a multilayer dressing in prevention of HUs during supine lying. We compared volumetric exposures of the loaded soft tissues to effective and maximal shear strains, as well as peak stresses in the Achilles tendon, without any dressing and with a single-layer or a multilayer dressing (Mepilex(®) Border Heel-type), on supports with different stiffnesses. The use of the multilayer dressing consistently and considerably reduced soft tissue exposures to elevated strains at the posterior heel, on all of the tested support surfaces and when loaded with either pure compression or combined compression and shear. The aforementioned multilayer design showed (i) clear benefit over a single-layer dressing in terms of dissipating tissue strains, by promoting internal shear in the dressing which diverts loads from tissues; (ii) a protective effect that was consistent on supports with different stiffnesses. Recent randomized controlled trials confirmed the efficacy of the simulated multilayer dressing, and so, taken together with this modeling work, the use of a prophylactic multilayer dressing indicates a great promise in taking this route for prevention. PMID:25639600

Levy, Ayelet; Frank, Mor Ben-Or; Gefen, Amit



Proportional EMG Control of Ankle Plantar Flexion in a Powered Transtibial Prosthesis  

E-print Network

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 ...

Wang, Jing



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. PMID:24782765

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



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

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...



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

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...



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

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...



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

Code of Federal Regulations, 2014 CFR

...2014-10-01 2014-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...



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

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...



Plantar Loading Reflects Ulceration Risks of Diabetic Foot with Toe Deformation  

PubMed Central

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

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



A case of recalcitrant plantar warts associated with statin use.  


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

Wernham, Aaron G; Velangi, Shireen S



A Case of Recalcitrant Plantar Warts Associated with Statin Use  

PubMed Central

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

Wernham, Aaron G.; Velangi, Shireen S.



Treatment of pachyonychia congenita with plantar injections of botulinum toxin.  


Pachyonychia congenita (PC) is a rare genodermatosis which may be associated with painful, focal hyperkeratosis on the soles. Plantar sweating at high ambient temperatures increases the blistering of the callosities. We report three patients with PC who had great problems in walking, especially during summer time. They were treated with intracutaneous plantar injections of botulinum toxin type A (Dysport, 100 U mL(-1); Ipsen, Slough, U.K.) after prior intravenous regional anaesthesia of the foot with a low tourniquet and 25 mL prilocaine (5 mg mL(-1)). Within a week all three patients experienced dryness and a remarkable relief of pain from plantar pressure sites. The effect duration was 6 weeks to 6 months. Repeated injections over a 2-year period confirmed the good results, with no side-effects or tachyphylaxis noted. PMID:16536826

Swartling, C; Vahlquist, A



Don't Ignore Your Kid's Heel Pain  


... if it is done quickly. “Put in a little time to address the problem early because if you wait, you might be in a cast or boot later for a long time,” Dr. Collins says. Kids undergoing growth spurts are especially susceptible to heel pain starting at age 8 until around age 13 for girls and ...


Nuclear mitochondrial DNA: an Achilles' heel of molecular systematics, phylogenetics,  

E-print Network

Nuclear mitochondrial DNA: an Achilles' heel of molecular systematics, phylogenetics. In studies of animal species, most researchers prefer to use mitochondrial DNA (mtDNA) because of certain-transcribed DNA regions which were trans- ferred from the mitochondrial to nuclear genome (numts), (Lopez et al


Heel Lifts and the Stance Phase of Gait in Subjects With Limited Ankle Dorsiflexion  

PubMed Central

Context: Heel lifts are often prescribed as part of the treatment program for patients with overuse injuries associated with limited ankle dorsiflexion. However, little is known about how joint kinematics and temporal variables are affected by heel lifts. Objective: To determine the effects of heel lifts on selected lower extremity kinematic and temporal variables during the stance phase of gait in subjects with limited ankle dorsiflexion. Design: Two-way, fully repeated-measures design. The 2 factors were side (right or left) and walking condition (shoes alone, 6-mm heel lifts in shoes, 9-mm heel lifts in shoes). Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-six volunteers (21 females, 5 males) with no more than 5° of ankle joint dorsiflexion. Intervention(s): Subjects were tested in shoes alone and in shoes with 6-mm and 9-mm heel lifts. Main Outcome Measure(s): We used the Qualisys Motion Analysis System to measure ankle dorsiflexion excursion, maximal knee extension, and time to heel off during the stance phase of gait under the 3 walking conditions. Results: On the right side, ankle dorsiflexion excursion increased significantly with the 6-mm and 9-mm heel lifts compared with shoes alone ( P < .05). On the left side, ankle dorsiflexion increased significantly with the 9-mm heels lifts over shoes alone and with the 9-mm heel lifts compared with the 6-mm heel lifts ( P < .05). Time to heel off increased significantly for walking with the 9-mm heel lifts compared with shoes alone ( P < .05). No differences were noted for maximal knee extension ( P > .05). Conclusions: Clinicians may consider prescribing heel lifts for patients with limited dorsiflexion range of motion if increasing ankle dorsiflexion excursion and time to heel off during the stance phase of gait may be beneficial. PMID:16791300

Johanson, Marie A; Cooksey, Alanna; Hillier, Caroline; Kobbeman, Heather; Stambaugh, Amy



Pedal and plantar loop angioplasty: technique and results.  


Endovascular and subintimal approaches fails in obtaining a below-the-knee recanalization in 10-40% of cases, even in high-volume and expertise centers. The presence of long calcified occlusions, characterized by a complex anatomy, often necessitate the use of alternative techniques in order to obtain a direct blood flow to the foot arteries. Recanalization using pedal and plantar loop angioplasty could improve outcomes in the presence of a communication between the dorsal and plantar arch of the foot, if conventional techniques are not effective. PMID:24941239

Gandini, R; Del Giudice, C; Simonetti, G



Quantitative scintigraphy in diagnosis and management of plantar fasciitis (Calcaneal periostitis): concise communication  

SciTech Connect

We have found that Tc-99m methylene diphosphonate imaging of the heel is of diagnostic value in the painful heel syndrome, permitting positive identification of the site of inflammation in cases where radiography is unhelpful. With this technique, tracer uptake in the heel is susceptible to quantification, allowing a serial and objective assessment of response to therapy.

Sewell, J.R.; Black, C.M.; Chapman, A.H.; Statham, J.; Hughes, G.R.V.; Lavender, J.P.



Plantar Vein Thrombosis—Evaluation by Ultrasound and Clinical Outcome  

Microsoft Academic Search

Objective: This study was designed to describe the characteristics and clinical outcome of patients diagnosed with plantar vein thrombosis. Methods: Patients presenting with sudden pain and\\/or swelling of the foot were evaluated by duplex scanning of the affected leg. All the main foot veins were imaged with high resolution multi-linear array transducers. The location and extent of thrombosis was recorded

Marcio Vinicius Lins Barros; Nicos Labropoulos



Nordic Walking Practice Might Improve Plantar Pressure Distribution  

ERIC Educational Resources Information Center

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

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



Heel and toe driving on fuel cell vehicle  


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



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


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

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



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


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



Plantar pitted keratolysis: a study from non-risk groups  

PubMed Central

Pitted keratolysis is an acquired, superficial bacterial infection of the skin which is characterized by typical malodor and pits in the hyperkeratotic areas of the soles. It is more common in barefooted people in tropical areas, or those who have to wear occlusive shoes, such as soldiers, sailors and athletes. In this study, we evaluated 41 patients who had been diagnosed with plantar pitted keratolysis. The patients were of high socioeconomic status, were office-workers, and most had a university degree. Malodor and plantar hyperhydrosis were the most frequently reported symptoms. The weight-bearing metatarsal parts of the feet were those most affected. Almost half the women in the study gave a history of regular pedicure and foot care in a spa salon. Mean treatment duration was 19 days. All patients were informed about the etiology of the disease, predisposing factors and preventive methods. Recurrences were observed in only 17% of patients during the one year follow-up period. This study emphasizes that even malodorous feet among non-risk city dwellers may be a sign of plantar pitted keratolysis. A study of the real incidence of the disease in a large population-based series is needed. PMID:25386314

Kaptanoglu, Asli Feride; Yuksel, Ozlem; Ozyurt, Selcuk



Sural--lateral plantar nerve communications in Japanese macaque.  


It is generally accepted that the sural nerve in humans contains exclusively sensory and autonomic fibers. Recently, however, a few clinical reports have suggested that the human sural nerve contains motor fibers. On the other hand, it is known that motor fibers are present in the sural nerve of rats and dogs, and that the fibers reach intrinsic muscles of the foot via a communicating branch to the lateral plantar nerve. The author investigated the communicating branch between the sural and lateral plantar nerves in Japanese macaques, and examined both nerves by the fiber analysis method, removing the perineurium under a stereoscopic microscope. The communicating branch was found in all examined macaques. Nerve fibers which derived from the sural nerve via the branch reached the abductor digiti quinti, the flexor digiti quinti brevis, the contrahentes digitorum, the adductor hallucis, the interosseous and the lumbrical muscles. Furthermore, these fibers supplied the lateral part of the skin of the sole and the metatarsophalangeal joints. These findings in the Japanese macaques suggest that we may encounter the communicating branch between the sural and lateral plantar nerves in other primates including humans as in rats and dogs. PMID:10659577

Sekiya, S



A knowledge-based modeling for plantar pressure image reconstruction.  


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

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



Neonatal pain response to heel stick vs venepuncture for routine blood sampling  

Microsoft Academic Search

Neonatal pain response and adverse effects and maternal anxiety were assessed in 27 infants who were randomly allocated to venepuncture or heel stick. Pain was assessed by nurses using the Neonatal Infant Pain Scale (NIPS) and a three point scale for the mothers. NIPS scores were higher in the heel stick group compared with the venepuncture group. Maternal anxiety was

Vibhuti S Shah; Anna Taddio; Sian Bennett; Brian D Speidel



Extracorporeal Shockwave for Chronic Patellar Tendinopathy  

Microsoft Academic Search

Background: Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies.Hypothesis: Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy.Study Design: Randomized controlled clinical trial; Level of evidence, 2.Methods: This study consisted of 27 patients (30 knees) in

Ching-Jen Wang; Jih-Yang Ko; Yi-Sheng Chan; Lin-Hsiu Weng; Shan-Lin Hsu



Does osteoporosis classification using heel BMD agree across manufacturers?  


The lack of standardization in bone mineral density (BMD) measurements is known. Several studies have been carried out to cross-calibrate the axial dual X-ray absorptiometry (DXA) devices. Recently, a number of peripheral DXA (pDXA) densitometers have been introduced. In this study we evaluated the agreement between two heel DXA devices on BMD and T-scores. A total of 99 females aged 21-78 years (ca. 16 per decade) had their non-dominant heel BMD measured using the PIXI (Lunar Inc.) and the Apollo (Norland Medical) pDXA scanners. The mean BMD values were 0.492 and 0.607 g/cm(2) and the mean T-scores using manufacturers' specified reference data were -0.07 and -0.25 for the PIXI and Apollo, respectively. Both the BMD and T-score intermachine relationships were highly correlated but showed significant nonidentity slopes and non-zero offsets. The diagnostic comparison on T-scores resulted in 86% agreement between the instruments (weighted kappa score of 0.550). Normalizing the reference peaks and SDs using this study's young adult population BMD results removed the systematic T-score disagreement. We found that PIXI and Apollo are highly correlated. Differences in BMD values are mainly due to different region of interest (ROI) definitions and additional T-score disagreement reflects the difference in normative databases. PMID:12181618

Grigorian, M; Shepherd, J A; Cheng, X G; Njeh, C F; Toschke, J O; Genant, H K



Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings  

PubMed Central

Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US. PMID:25229032

Park, Jong-Wan; Yoon, Kyungjae; Chun, Kwang-Soo; Lee, Joon-Youn; Park, Hee-Jin; Lee, So-Yeon



Influence of the calcaneus shape on the risk of posterior heel ulcer using 3D patient-specific biomechanical modeling  

E-print Network

1 Influence of the calcaneus shape on the risk of posterior heel ulcer using 3D patient: Biomechanical model for heel ulcer prevention *Corresponding author: Yohan Payan Equipe GMCAO - Laboratoire TIMC in Annals of Biomedical Engineering #12;2 Abstract Most posterior heel ulcers are the consequence

Payan, Yohan


Neuroscience Letters 421 (2007) 173177 Inter-individual variability in sensory weighting of a plantar  

E-print Network

of a plantar pressure-based, tongue-placed tactile biofeedback for controlling posture Nicolas Vuillerme the sensory weighting of a plantar pressure-based, tongue-placed tactile biofeedback for controlling posture asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback

Payan, Yohan


RESEARCH ARTICLE How a plantar pressure-based, tongue-placed tactile biofeedback  

E-print Network

RESEARCH ARTICLE How a plantar pressure-based, tongue-placed tactile biofeedback modifies postural the effects of a plantar pressure-based, tongue- placed tactile biofeedback on postural control mechanisms with their eyes closed in two conditions of No-biofeedback and Biofeed- back. Centre of foot pressure (Co

Payan, Yohan


Brief report Integration of plantar soft tissue stiness measurements in routine  

E-print Network

for the diabetic plantar tissue compared with that of normal. For the diabetic patients, local stiness in proximityBrief report Integration of plantar soft tissue stiness measurements in routine MRI of the diabetic in the diabetic foot is associated with development of ulcers at the highest-pressure sites. MRI is used

Gefen, Amit


Anatomical study of the communicating branches between the medial and lateral plantar nerves.  


The plantar areas of the foot have specific biomechanical characteristics and play a distinct role in balance and standing. For the forefoot surgeon, knowledge of the variations in the anatomy of communicating branches is important for plantar reconstruction, local injection therapy and an excision of interdigital neuroma. The anatomy of the communicating branches of the plantar nerves between the fourth and third common plantar digital nerves in the foot were studied in 50 adult men cadaveric feet. A communicating branch was present between the third and fourth intermetatarsal spaces nerves in all eight left feet and in six right feet (overall, 28%), and absent in 36 (72%). A communicating branch was found in 14 ft. Ten of the 14 communications were from the lateral to the medial plantar nerve. The length of the communicating branch ranged from 8 to 56 mm (average 16.4 mm) and its diameter was 0.2-0.6 times of the fourth common plantar digital nerve. The angle of the communicating branch with the common plantar digital nerve from which it originated was less than 30 degrees in 11 ft, 30-59 degrees in 27 ft, 60-80 degrees in 8 ft, and more than 80 degrees in 4 ft. Classification of the branch is based on the branching pattern of the communicating branch and explains variations in plantar sensory innervations. We think that the perpendicular coursing communicating branch is at higher risk to be severed during surgery. PMID:16308663

Govsa, Figen; Bilge, Okan; Ozer, Mehmet Asim



Ankle dorsi-and plantar-flexion torques measured by dynamometry in healthy subjects  

E-print Network

Ankle dorsi- and plantar-flexion torques measured by dynamometry in healthy subjects from 5 to 80:// #12;RESEARCH ARTICLE Open Access Ankle dorsi- and plantar-flexion torques measured Ledoux, Valérie Doppler, Christine Payan and Jean-Yves Hogrel* Abstract Background: Ankle strength


Contributions of the individual ankle plantar flexors to support, forward progression and swing initiation during walking  

Microsoft Academic Search

Walking is a motor task requiring coordination of many muscles. Previous biomechanical studies, based primarily on analyses of the net ankle moment during stance, have concluded different functional roles for the plantar flexors. We hypothesize that some of the disparities in interpretation arise because of the effects of the uniarticular and biarticular muscles that comprise the plantar flexor group have

R. R. Neptune; S. A. Kautz; F. E. Zajac



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.



Plantar fasciitis: a retrospective analysis of 267 cases  

Microsoft Academic Search

Objectives: To gain a better understanding of the anthropometric, biomechanical and treatment statistics for a diversified population affected with plantar fasciitis. Design: A retrospective case review. Setting: The Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, Canada. Subjects: Referral patients seen by attending physicians from 1998–2000. Age 43·1 years (±3·81), weight 72·2kg (±14·7), height 1·61m (±0·9), BMI 24·7kg\\/m2

Jack E. Taunton; Michael B. Ryan; Douglas B. Clement; Donald C. McKenzie; D. Robert Lloyd-Smith



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

PubMed Central

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

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



Functional Analysis of the Gibbon Foot During Terrestrial Bipedal Walking: Plantar Pressure Distributions and  

E-print Network

described roll-off patterns of gib- bons, based on general observations, video images, force plates, and EMG and human bipedalism. We found that gibbons are midfoot/ heel plantigrade, and lack the typical heel to triangular in shape, with high peak values compared to humans. The braking com- ponent is shorter than

D'Août, Kristiaan


Radiation levels on empty cylinders containing heel material  

SciTech Connect

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

Shockley, C.W. [Martin Marietta Energy Systems, Inc., Paducah, KY (United States)



Backwards in High Heels: Getting Women Elected, 1842-1990  

NSDL National Science Digital Library

Incorporated as the capital of the Republic of Texas in 1839, Austin didnâ??t elect its first female council woman until the middle of the 20th century. The first female legislators didnâ??t find their way into office until the 1970s, and it wasnâ??t until 1990 that Texas elected a female governor. This exhibit by Austinâ??s Public Library tells the story of women in the cityâ??s politics through photographs, essays, and old newspaper clippings. Categories include Womenâ??s Work, Political Pioneers, and A Foot in the Door, among many others. Of particular interest, the biography of Ann Richards, the former governor of Texas, contextualizes her famous quote: â??Ginger Rogers did everything that Fred Astaire did. She just did it backwards and in high heels.â?ť



Medial ankle and heel: ultrasound evaluation and sonographic appearances of conditions causing symptoms.  


The complex anatomy of the medial ankle and hindfoot can make clinical assessment of medial ankle and heel pain challenging. Ultrasound is an accessible, relatively inexpensive modality, and modern high-resolution probes allow eloquent demonstration of the main structures that are implicated as potential causes of medial ankle pain. In this work we review highlights the clinically relevant anatomy and normal sonographic appearances of structures around the medial ankle and heel and discuss key techniques to allow optimal ultrasound assessment. The conditions that cause medial-sided ankle and heel symptoms are discussed with their characteristic sonographic appearances. PMID:21414548

Kotnis, Nikhil; Harish, Srinivasan; Popowich, Terry



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.



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). PMID:17103435

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



Liquid Silicone to Mitigate Plantar Pedal Pressure: A Literature Review  

PubMed Central

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

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



Liquid silicone to mitigate plantar pedal pressure: a literature review.  


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

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



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

Microsoft Academic Search

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

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



Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia  

PubMed Central

We describe the case of a 32-year-old woman who developed bilateral heel numbness after obstetric epidural analgesia. We diagnosed her with bilateral neuropathy of the medial calcaneal nerve, most likely due to longstanding pressure on both heels. Risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy. Padded footrests decrease pressure and can possibly prevent this neuropathy. PMID:25802500

Kamphuis, Vivian P.; Zegers, Marie P.A.; Koppen, Hille



Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing  

Microsoft Academic Search

Objective: The objective of this study was to determine the effectiveness of treatment of nonhealing heel ulcers and gangrene and to define those variables that are associated with success.Methods: A multi-institutional review was undertaken at four university or university-affiliated hospitals of all patients with wounds of the heel and arterial insufficiency, which was defined as absent pedal pulses and a

Gerald S Treiman; Gustavo S. C Oderich; Amir Ashrafi; Peter A Schneider



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


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

Schaefer, Sabine; Lindenberger, Ulman



Classification of metatarsophalangeal joint plantar plate injuries: history and physical examination variables.  


Although metatarsophalangeal (MTP) plantar plate tears are common, they are still often missed. The purpose of this study is to find the best clinical variables to define and grade the plantar plate injuries. Sixty-eight patients (100 MTP joints) were graded arthroscopically and divided into five groups (0 to IV) according to the anatomical classification. Their medical records were reviewed to establish correlations of clinical findings with the anatomical lesions. The positive correlations found were acute pain, widening of the interdigital space, loss of ground touch, positivity of the MTP joint drawer test, reduction of the toe purchase, and toe supination. The drawer test is the most reliable and accurate tool to classify and grade the plantar plate lesion, followed by ground touch and rotational deformities. It is possible to improve the accuracy of diagnosis of plantar plate tears by means of the combination of both clinical history and physical examination data. PMID:25785472

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



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

Microsoft Academic Search

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

Yusuf Ziya Tatli; Sameer Kapasi



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


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



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


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

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



Evaluation of plantar flexion contracture contribution during the gait of children with Duchenne muscular dystrophy.  


Because of extensor weakness, children with Duchenne muscular dystrophy (DMD) maintain internal flexion moments at the joints of the lower extremities when they walk. We believe that at the ankle, the plantar flexion moments caused by contractures may contribute significantly to the production of the net ankle flexion moment during the gait in these children. The goal of the present study is to quantify ankle plantar flexion passive moments that may be associated with the presence of flexion contractures and to estimate their contribution to the net moment during the gait of children with DMD. Kinematic and kinetic parameters were collected during gait of eleven subjects with DMD. Ankle plantar flexion passive moments were also measured experimentally during the same session. Fourteen control children participated in the study in order to have normal reference values. The presence of ankle plantar flexion contractures in children with DMD was reflected by a rigidity coefficient obtained at a common moment of -7 Nm that was higher for these children (0.75 Nm/degrees vs. 0.48 Nm/degrees; p<0.05). The relative passive moment contribution to the net plantar flexion moments was higher for the children with DMD at the end of the lengthening phase of the plantar flexors (25% vs. 18%; p<0.05). We believe that the passive moments can compensate for the presence of progressive muscle weakness in the children with DMD and help these children with gait. PMID:17977021

Gaudreault, Nathaly; Gravel, Denis; Nadeau, Sylvie



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)



Post-traumatic pseudoaneurysm of the medial plantar artery combined with tarsal tunnel syndrome: two case reports.  


Pseudoaneurysms in the foot are more often reported in the lateral plantar artery than the medial plantar artery, most likely because of its more superficial location. There are no reports of pseudoaneurysm of the medial plantar artery after trauma. We present two cases of pseudoaneurysm of the medial plantar artery after blunt foot trauma and foot laceration. This pseudoaneurysm compressed a posterior tibial nerve, resulting in tarsal tunnel syndrome. The patients were treated successfully using transcatheter embolization without the need for surgical intervention. The tarsal tunnel syndrome also subsided. Here, the authors report these cases and provide a review of literature. PMID:23242453

Park, Sang-Eun; Kim, Ji-Chang; Ji, Jong-Hun; Kim, Young-Yul; Lee, Hwan-Hee; Jeong, Jae-Jung



An investigation into plantar pressure measurement protocols for footwear research.  


Many researchers investigate how footwear design affects plantar pressure (PP) and ask participants to walk in unfamiliar footwear as part of their studies. However, there are no clear guidelines for the required period of time or number of steps a healthy participant requires to acclimatise to unfamiliar footwear. Nor are there clear guidelines for how many steps should be collected to produce data that is representative of gait in each particular shoe being tested. There were therefore two aims to this study: (1) to investigate the number of steps required to produce an average step that is representative of normal gait; (2) to investigate the number of steps required for a participant to acclimatise to a range of footwear types. PP data were collected in 20 healthy participants whilst they walked for 400 m in a range of footwear. The results showed that the number of steps required for both acclimatisation and to ensure data quality are dependent on shoe type and the foot region being investigated. It is recommended that 30 steps from one foot are collected during data collection and an acclimatisation period of at least 166 steps is given for each shoe condition. The former recommendation is not met by most studies in the literature. PMID:25161007

Melvin, J M A; Preece, S; Nester, C J; Howard, D



Tap water iontophoresis in palmo-plantar hyperhidrosis.  


Plain tap water iontophoresis as a method of treatment of idiopathic palmo-plantar hyperhidrosis was evaluated. In the present study, different strengths of current were used for varying periods of time and the treatment was given 6 days a week, until the patients became euhidrotic. Whereas previous workers have used the two electrodes in separate pans, we, in one study, placed them in the same pan of tap water, so that electrolysis occurred at the electrodes on which palms or soles were resting, the current passing through the medium. It was observed that, irrespective of the method used, euhidrosis of palms or soles were achieved. The time and the amount of current required to produce euhidrosis were significantly greater with the single pan technique (average 14-1 sittings in Group I) as compared to the separate pan method (average 7-09 sittings in group II) (t = 3-41, P less than 0.01). The euhidrosis persisted for between 6 and 8 months (average 6-26 months). In our study 90% of the patients treated developed anhidrosis on both the anode and cathode treated palms or soles. In 10% of the subjects, the effect was, however, greater on the anodal side. PMID:843454

Shrivastava, S N; Singh, G



Effect of Different Forefoot and Heel Support Surfaces on the Activities of the RF and HAM Muscles during the Sit-to-stand Task while Wearing High-heel Shoes  

PubMed Central

[Purpose] The purpose of this study was to show the effect of different forefoot and heel support surfaces on the activities of the rectus femoris and medial hamstring muscles during the sit-to-stand task while wearing high-heel shoes. [Subjects] Fifteen female subjects were recruited. [Methods] The muscle activities of the rectus femoris and hamstring muscles were recorded using an MP150 system during the sit-to-stand task while wearing various high-heeled shoes. [Results] The activities of the rectus femoris and medial hamstring muscles significantly decreased when subjects wore condition 1 shoes compared with when they wore condition 2, 3 or 4 high-heeled shoes. The activities of the rectus femoris and medial hamstring muscles significantly decreased when subjects wore condition 2 high-heeled shoes compared with condition 3 or 4 high-heeled shoes. [Conclusion] The results can be interpreted as indicating that the size of the forefoot supporting surface can influence the lower extremity muscles of women wearing high-heeled shoes more than the size of the heel supporting surface. PMID:25364105

Yoo, Won-gyu



Correction for sensor creep in the evaluation of long-term plantar pressure data.  


Plantar pressure measurements are frequently applied in the biomechanical assessment of lower extremity injury risk. Different conditions such as footwear, orthopedic insoles or movement tasks are usually compared by separate trials of the individual conditions. However, injury risk may be related to fatigue from long-term exercise and no actual measurements of plantar pressure during fatigue treatment have been published. A simple method is presented for determining sensor creep over a 3 h walking trial carrying a heavy load (49% of bodyweight). Plantar pressure measurements were conducted using Pedar insoles with capacitative sensors. Repeated standing trials were conducted and the total force underneath both feet measured under the assumption that this value should remain constant over time. The percentage fluctuation from the first such static measurement can be used to correct measured parameters of interest for the influence of sensor creep. The pressure sensor values increased by up to 17% after 3 h and the method presented permitted the correction of measured plantar pressure parameters to account for this sensor creep behaviour. Such correction appears necessary for correct interpretation of the fatigue effects on plantar loading. Creep correction as described here should be performed individually and separately in each long-term trial. PMID:14614934

Arndt, A



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

PubMed Central

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

Jung, Jaemin; Lee, Sang-yeol



Combining bone resorption markers and heel quantitative ultrasound to discriminate between fracture cases and controls  

Microsoft Academic Search

Summary  This nested case-control analysis of a Swiss ambulatory cohort of elderly women assessed the discriminatory power of urinary\\u000a markers of bone resorption and heel quantitative ultrasound for non-vertebral fractures. The tests all discriminated between\\u000a cases and controls, but combining the two strategies yielded no additional relevant information.\\u000a \\u000a \\u000a \\u000a Introduction  Data are limited regarding the combination of bone resorption markers and heel quantitative

D. Nanchen; J. Cornuz; C. Ruffieux; W. Riesen; P. Burckhardt; M. A. Krieg



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. PMID:24138804




E-print Network

HOW A PLANTAR PRESSURE-BASED, TONGUE-PLACED TACTILE BIOFEEDBACK MODIFIES POSTURAL CONTROL of the present study was to determine the effects of a plantar pressure- based, tongue-placed tactile biofeedback to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback

Paris-Sud XI, Université de


Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study  

Microsoft Academic Search

BACKGROUND: Metatarsalgia is related to repetitive high-pressure loading under the metatarsal head (MH) that causes pain. The high pressure under the MH can be reduced by adequately applying metatarsal pads (MPs). Plantar pressure measurements may provide a method to objectively evaluate pressure loading under the MH. However, it is still unclear if the decrease in plantar pressure under the MH

Jiunn-Horng Kang; Min-Der Chen; Shih-Ching Chen; Wei-Li Hsi



Ground Reaction Force Patterns in Stroke Patients with Various Degrees of Motor Recovery Determined by Plantar Dynamic Analysis  

Microsoft Academic Search

Background: To study ground reaction force (GRF) patterns in stroke patients with various degrees of motor recovery, using plantar dynamic analysis. Methods: Forty-three people with hemiplegic stroke and 20 healthy subjects were enrolled in the study. Motor impairment (motor recovery and muscle tone) and plantar dynamic data (GRF patterns, peak pressure, and walking speeds) were analyzed. GRF patterns were categorized

Chung-Yao Chen; Paul Wei-Hsien Hong; Chia-Ling Chen; Shih Wei Chou; Ching-Yi Wu; Pao-Tsai Cheng; Fuk-Tan Tang; Hsieh-Ching Chen


Medial plantar and dorsal sural nerve conduction studies increase the sensitivity in the detection of neuropathy in diabetic patients  

Microsoft Academic Search

ObjectiveClinical utility of nerve conduction studies (NCS) of the medial plantar and dorsal sural nerves in the early detection of polyneuropathy have already been shown separately. However, at present, there is no data about the combined assessment of these two nerves in distal sensory neuropathy. In the present study, we aimed to evaluate the medial plantar and dorsal sural NCS

Kayihan Uluc; Baris Isak; Deniz Borucu; Cagri Mesut Temucin; Yilmaz Cetinkaya; Pinar Kahraman Koytak; Tulin Tanridag; Onder Us



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


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 (0.25 s ramp and 300 s 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. PMID:22079385

Pai, Shruti; Ledoux, William R



The communicating branch of the lateral plantar nerve: a descriptive anatomic study.  


Since the communicating branch of the lateral plantar nerve has been implicated as a factor in the etiology of Morton's neuroma, a painful perineurofibrosis of a common plantar digital nerve, this project was designed to investigate the anatomy of this communicating branch. Both feet of 40 embalmed human cadavers were dissected to show the frequency of occurrence and anatomical variation of the communicating branch. The communicating branch was present in 66.2% of the feet we studied with no large gender-based differences. Branches occurred bilaterally in 52.5% of cadavers, while 27.5% had branches unilaterally. The occurrence of this branch does not correlate well with the likelihood of development of Morton's neuroma. Differences in diameter of the communicating branch ranged from less than 0.5 mm to as large as the common plantar digital nerves themselves, about 2 mm. The presence or absence of the communicating branch made no qualitative difference in the diameters of the common plantar digital nerves. There were 60.4% of the communicating branches in this study that had a typically-described orientation, arising more proximally in the foot from the fourth common plantar digital nerve, while 39.6% of the branches had a reversed orientation, arising more proximally from the third common plantar digital nerve. These reversed branches had a more oblique orientation when compared to the classic branches. Other anatomical variations were noted, including accessory branches that attached to deeper structures in the foot. These data form a basis for further research into the etiology of Morton's neuroma and improved surgical techniques for correcting this condition. PMID:8793217

Frank, P W; Bakkum, B W; Darby, S A



Static Versus Dynamic Musculoskeletal Ultrasound for Detection of Plantar Plate Pathology.  


Musculoskeletal ultrasound (US) is a common modality used to examine plantar plate pathology. Comparison of the diagnostic accuracy of static versus dynamic ultrasound has not been previously published. The objective of this study was to prospectively compare the value of using preoperative static and dynamic ultrasound findings to diagnose plantar plate pathology using intraoperative inspection as the standard of reference. Patients attending a single foot and ankle specialty clinic from August 2012 to June 2013 with clinically suspected plantar plate pathology that was unresponsive to conservative care served as the study population. Static and dynamic ultrasound exams were performed by a single experienced rater and compared to intraoperative findings. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were determined for static and dynamic ultrasound exams. Thirty-six patients (45 lesser metatarsophalangeal joints) were included in this analysis. Of the 36 patients, 29 were females and 7 were males with average age of 57.9 ± 7.8 years (range, 38-73). There were 38 plantar plate tears (84.4%) noted on intraoperative examination. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the static US exam were 80.0%, 81.6%, 71.4%, 93.9%, and 41.7%, respectively. The same values for the dynamic US exam were 88.9%, 100%, 28.6%, 88.3%, and 100%, respectively. Static and dynamic ultrasound techniques are each highly sensitive methods for assessing plantar plate pathology. However, the sensitivity and accuracy of the exam is best when dynamic assessment of the plantar plate is employed. Caution should be used when relying solely on static images to diagnose subtle injuries in this area of the foot. PMID:25027985

Feuerstein, Catherine A; Weil, Lowell; Weil, Lowell Scott; Klein, Erin E; Fleischer, Adam; Argerakis, Nicholas G



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


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

Wang, Hao; Han, Meng; Liu, Jing



Palmar-plantar keratoderma of Unna Thost associated with atopic dermatitis: an underrecognized entity?  


We report six cases of palmar-plantar keratoderma of Unna Thost (PPKUT) associated with atopic dermatitis. All had typical features of PPKUT with diffuse, yellowish thickening on the palms and soles with a well-defined erythematous rim of demarcation on the sides associated with palmar-plantar hyperhidrosis. The changes were obvious since birth or arose during early life, and were persistent. We believe that the association between the two disorders is not coincidental but an underrecognized entity that may shed light on the underlying pathogenesis of these two conditions. PMID:12787265

Loh, Teck-Hiong; Yosipovitch, Gil; Tay, Yong-Kwang



The medial and inferior calcaneal nerves: an anatomic study.  


The existence of chronic heel pain induced by the compression of nerves prompted us to conduct an anatomic study of the innervation of the heel. Fifteen cadaver feet were dissected to investigate the origin, course and branches of the medial calcaneal nerve (MCN) and the inferior calcaneal nerve (ICN). Despite a variable origin (tibial n. (TN) or lateral plantar n. (LPN)), the medial calcaneal nerve branches which lay superficial to the abductor hallucis muscle (AH) were quite constant. The medial calcaneal nerve gave branches to the abductor hallucis muscle and innervated the posterior part of the medial face of the heel. It terminated in the superficial heel pad at the inferior part of the heel. In our study, the inferior calcaneal nerve always originated from the lateral plantar nerve. Its relationship to the deep fascia of the abductor hallucis muscle and anterior tubercle of calcaneus may explain the entrapment syndrome of the inferior calcaneal nerve. PMID:10431329

Louisia, S; Masquelet, A C



Bronchiolitis obliterans syndrome: the Achilles' heel of lung transplantation.  


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

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



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

SciTech Connect

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

McDaniel, L.B.



Screening Rural and Urban Indian Population for Osteoporosis Using Heel Ultrasound Bone Densitometer  

Microsoft Academic Search

Osteoporosis is more common in India. It predominantly affects postmenopausal women, and elderly of both sexes. The mal-nutrition, and smoking, consumption of liquor and tobacco may have an effect on bone mineral density (BMD). The aim of this study was to screen the rural as well as urban population for osteoporosis using a portable ultrasound heel bone densitometer; A total

Samar; Dev Maletia; Kribakaran Venkatesan; Savita Rana; M. Anburajan



Effects of Different Cyclic Pressurization and Relief Patterns on Heel Skin Blood Perfusion  

Microsoft Academic Search

OBJECTIVE: It was hypothesized that a device or support surface providing inter- mittent cycles of pressurization and pressure relief might minimize the impact of blood flow deficits in the heels resulting from the application of pressure. Because this possibility depends on whether pressure-relief hyperemia can adequately compensate for blood flow deficits, the main objective was to determine how dif- ferent

Harvey N. Mayrovitz; Nancy Sims



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.

Daničle Pacaud


Author's personal copy The most temperature-adapted corals have an Achilles' Heel  

E-print Network

time, similarly adapt to survive even in an impover- ished form, under conditions of acidification is mediated by oceanic currents and the heat-adapted trait can be imparted to reefs further afield throughAuthor's personal copy The most temperature-adapted corals have an Achilles' Heel S.J. Purkis , D

Purkis, Sam


Normal anatomy of the heel entheses: anatomical and ultrasonographic study of their blood supply  

Microsoft Academic Search

The purpose of this study was first to determine the normal blood supply of the heel entheses with cadaver injection, and second, to identify by means of ultrasound (US) this blood supply in healthy volunteers before and after the intravenous injection of a US contrast agent (SonoVue). Twenty cadaver lower limbs were cut into sagittal, coronal, or axial sections after

M. Morel; N. Boutry; X. Demondion; I. Legroux-Gerot; H. Cotten; A. Cotten



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

ERIC Educational Resources Information Center

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

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



Measurement of lumbar lordosis in static standing posture with and without high-heeled shoes  

PubMed Central

Objective Some doctors and therapists believe that wearing high-heeled shoes causes increased lumbar lordosis and that this may be a cause of low back pain. The purpose of this study was to evaluate whether high-heeled shoes increase lumbar lordosis and to do so with more reliable methods and a larger sample size than used in previous studies. Methods Fifty participants from a chiropractic university were included in a test group (32 female and 18 male) and 9 in a control group (3 female and 6 male). A Spinal Mouse was used to measure lumbar lordosis in test participants barefoot and then again with 3- or 4-in high-heeled shoes after a 10-minute adaptation period of walking and sitting and standing while wearing the shoes. Reliability of the testing conditions was evaluated with 9 barefoot control participants before and after an identical adaptation period, and intra- and interexaminer reliability of Spinal Mouse measurements was tested by use of a wooden model built to mimic the proportions of a human spine. Results Both groups showed non-significant decreases in lordosis between the first and second scans (high heels: 23.4° to 22.8°, P = .17; control: 18.8° to 17.6°, P = .16). Scans of the wooden spine model were highly reliable (intra- and interexaminer intraclass correlation coefficients > .999). Conclusions Consistent with most previous studies, high-heeled shoes did not affect lumbar lordosis in most people while standing. Future research could investigate the effect of shoes during dynamic conditions or identify affected subgroups. PMID:23449540

Russell, Brent S.; Muhlenkamp, Kimberly A.; Hoiriis, Kathryn T.; DeSimone, Carolyn M.



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

Microsoft Academic Search

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

V. Michel




E-print Network

CAN A PLANTAR PRESSURE­BASED TONGUE-PLACED ELECTROTACTILE BIOFEEDBACK IMPROVE POSTURAL CONTROL pressure­ based tongue-placed electrotactile biofeedback on postural control during quiet standing under and Extended head postures and two conditions of No- biofeedback and Biofeedback. The underlying principle

Payan, Yohan


A Plantar-pressure Based Tongue-placed Tactile Biofeedback System for Balance Improvement  

E-print Network

A Plantar-pressure Based Tongue-placed Tactile Biofeedback System for Balance Improvement N an original biofeedback system [1] whose underlying principle consists in supplying the user were asked to stand as immobile as possible with their eyes closed in two conditions of No-Biofeedback

Paris-Sud XI, Université de


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



Proportional EMG Control of Ankle Plantar Flexion in a Powered Transtibial Prosthesis  

E-print Network

Proportional EMG Control of Ankle Plantar Flexion in a Powered Transtibial Prosthesis Jing Wang to control a powered ankle- foot prosthesis using a volitional electromyographic (EMG) control to directly speeds by volitionally modulating calf EMG activity. The modulation of these key gait parameters is shown

Herr, Hugh


Between-day reliability of repeated plantar pressure distribution measurements in a normal population  

Microsoft Academic Search

The objective of this study was to determine the reliability of repeated plantar pressure distribution measurements during normal gait across multiple testing sessions. Testing sessions were conducted on 5 separate days at approximately the same time of day. Nine subjects (five males, four females, age 26±8.4 years) who were free of any musculoskeletal injury were recruited. A capacitive pressure distribution

Jason K. Gurney; Uwe G. Kersting; Dieter Rosenbaum



Frequency content of normal and diabetic plantar pressure profiles: Implications for the selection of transducer sizes  

Microsoft Academic Search

How small do pressure transducers need to be in order to faithfully measure the plantar pressure profiles (PPPs) under normal and diabetic feet? In this study, pressures were collected from five diabetic and six non-diabetic subjects using a commercial measurement system with 25 mm2 transducers. Discrete Fourier Transform techniques were then used to determine (i) the spatial frequency content of

Brian L. Davis; Robert M. Cothren; Peter Quesada; Shaun B. Hanson; Julie E. Perry



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. PMID:23730598

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



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

PubMed Central

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

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



A planar electric vehicle with differential steering and a plantar command  

Microsoft Academic Search

This paper focuses on a new electric and compact vehicle with a differential steering and a sensitive plantar as driving command. The mechanical, electronic and software architecture are presented. A special focus is given to the sensitive surface of the vehicle chassis which allows the user to drive the vehicle by unbalancing his or her center-of-gravity (COG). The design of

Cristiano Spelta; Ivo Boniolo; Giovanni Alli; Sergio M. Savaresi; Massimo Vanzulli



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, Joăo Paulo



Dorsiflexion deficit during jogging with chronic ankle instability  

Microsoft Academic Search

The purpose of the study was to determine whether individuals with chronic ankle instability (CAI) demonstrate altered dorsiflexion\\/plantar flexion range of motion (ROM) compared to controls during jogging. The case control study took place in a university motion analysis laboratory. Fourteen volunteers participated in the study, seven suffered from CAI (age 25±4.2 years, height 173±9.4cm, mass 71±8.1kg) and seven were

Lindsay K. Drewes; Patrick O. McKeon; D. Casey Kerrigan; Jay Hertel



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


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




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.



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. PMID:24456691



Cyclic impacts on heel strike: A possible biomechanical factor in the etiology of degenerative disease of the human locomotor system  

Microsoft Academic Search

The cyclic impacts induced by heel strike when walking were studied using both a high-resonance-frequency force plate and a low-mass skin-mounted accelerometer. The data were computer analyzed. The results showed that during normal human walking, the locomotor system is subjected to repetitive impact loads at heel strike, lasting about 5 ms and consisting of frequency spectra up to and above

Yoram Folman; Joseph Wosk; Arkady Voloshin; Shimon Liberty



The Effects of Lower Extremity Angle According to Heel-height Changes in Young Ladies in Their 20s during Gait  

PubMed Central

[Purpose] The purpose of this study was to compare the effects of heel-height changes on the low joint angles of the lower extremities of women in their 20s during gait. [Subjects and Methods] Qualisys Track Manager Software ver. 2.8 (Qualisys, Sweden) was used to perform measurements on 14 female university students in their 20s. To measure movements, the subjects were asked to walk while wearing high-heeled shoes and reflective stickers on their hip joints, knee joints, and ankle joints, the changes in joint angles were measured at heel strike, foot flat, and toe off. [Results] Analysis of the amount of change according to heel height changes during gait showed that the angle of the hip joints was reduced with an increase in heel-height. Although the changes were not significant, the angle of the knee joints was reduced during heel strike, foot flat, and midstance, and it was increased during toe off. In contrast, the angle of the ankle joints was increased by a significant amount during heel strike, foot flat, midstance, and toe off. [Conclusions] During gait with high heels, the movements of the lower extremities of women in their 20s were reduced significantly with an increase in heel height. Therefore, it is concluded that the restrictions on gait can only be reduced by wearing low-heeled shoes. PMID:25140096

Lee, ChangRyeol



Heel-ball (HB) index: sexual dimorphism of a new index from foot dimensions.  


The present research is aimed to introduce Heel-ball (HB) index from foot dimensions and determine whether this index exhibits sexual dimorphism. The study was conducted on a sample of 303 North Indian individuals (154 men, and 149 women) aged between 13 and 18 years. The stature, body weight, foot breadth at the ball (BBAL), and foot breadth at heel (BHEL) were measured. The HB index was derived by the formula BHEL × 100/BBAL. Although the mean HB index was larger in women in both feet it showed statistically significant sex differences in the right foot only. The study shows that while the foot dimensions show a positive correlation with stature and weight, the HB index is independent of the stature and weight of an individual. This novel index (HB index) may be utilized in sex determination when a part of the foot is brought for medico-legal investigation. PMID:22074354

Krishan, Kewal; Kanchan, Tanuj; Passi, Neelam; DiMaggio, John A



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



Power-Efficient AND-EXOR-INV Based Realization of Achilles' heel Logic Functions  

Microsoft Academic Search

This paper deals with a power-conscious AND- EXOR-Inverter type logic implementation for a complex class of Boolean functions, namely Achilles' heel functions. Different variants of the above function class have been considered viz. positive, negative and pure horn for analysis and simulation purposes. The proposed realization is compared with the decomposed implementation corresponding to an existing standard AND-EXOR logic minimizer;

Padmanabhan Balasubramanian; R. Chinnadurai


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


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. QUS might be used for screening purposes to identify people with intellectual disability with poor bone status, who are in need of supplementary examination and treatment. To investigate feasibility of QUS in this group, QUS of the heel bone was performed on-site in 151 people with ID living in residential care. Measurements were successfully performed in at least one foot in 94.7%, were interpretable (resulting in a stiffness index) in 91.6%, and induced barely or no stress in 90.4% of the study population. Measurements generally took less than 10 min. In 93 persons bone status of both feet had been measured. The "mean percentage of the absolute difference" between outcomes of both feet was 15.5% (±15.3% SD, range 0-76.5%). Ultrasound measurement of the heel bone is a feasible and non-stressful method for measuring bone status in people with ID. Since the mean difference between outcomes of the left and right foot were large, measurement of both feet is recommended to prevent inaccurate interpretation. PMID:20800437

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



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. PMID:19490654

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



Yield of the sural/radial ratio versus the medial plantar nerve in sensory neuropathies with a normal sural response.  


The electrodiagnostic yield of the medial plantar nerve action potential (NAP) amplitude versus the sural/radial amplitude ratio (SRAR) was determined in 110 consecutive patients with clinically diagnosed distal sensory polyneuropathy (SN) and normal sural responses. Forty-five consecutive patients with clinically diagnosed lumbosacral radiculopathy served as disease controls. Of the 110 SN patients, 32 were classified clinically as SN with large-fiber involvement (SN-LFI), whereas 78 had clinically pure small-fiber SN. Plantar NAP amplitudes were abnormal in 18 of 32 patients (56%) with SN-LFI, and 15 of 78 (19%) with small-fiber SN. A SRAR <0.21 (fifth percentile of normal) was found in 7 of 32 patients (22%) with SN-LFI and 8 of 78 (10%) with small-fiber SN. In the control group, the medial plantar NAP was normal in all 45 subjects (100%), whereas the SRAR was >0.21 in 43 subjects (96%). Thus, for a 50% pretest probability of SN-LFI, the positive predictive value of an abnormal medial plantar was 100% versus 85% for a SRAR <0.21. The medial plantar NAP amplitude is a more useful measure of SN, than is the SRAR, in patients under age 70, with suspected SN-LFI. The yield of the SRAR and plantar NAP amplitude is poor when clinical signs of large-fiber sensory dysfunction are lacking. PMID:18340276

Sullivan, John P; Logigian, Eric L; Kocharian, Naira; Herrmann, David N



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

PubMed Central

The goal of this project was to examine the effects of artificial gravity (AG) on skeletal muscle strength and key anabolic/catabolic markers known to regulate muscle mass. Two groups of subjects were selected for study: 1) a 21 day-bed rest (BR) group (n = 7) and 2) an AG group (n = 8), which was subjected to 21 days of 6° head-down tilt bed rest plus daily 1-h exposures to AG (2.5 G at the feet). Centrifugation was produced using a short-arm centrifuge with the foot plate ?220 cm from the center of rotation. The torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre- and posttreatment. Muscle biopsy samples obtained from the vastus lateralis and soleus muscles were used for a series of gene expression analyses (mRNA abundance) of key factors implicated in the anabolic vs. catabolic state of the muscle. Post/pre torque-velocity determinations revealed greater decrements in knee extensor performance in the BR vs. AG group (P < 0.04). The plantar flexors of the AG subjects actually demonstrated a net gain in the torque-velocity relationship, whereas in the BR group, the responses declined (AG vs. BR, P < 0.001). Muscle fiber cross-sectional area decreased by ?20% in the BR group, whereas no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity were higher in the AG group, whereas catabolic markers were elevated in the BR group. Importantly, these patterns were seen in both muscles. We conclude that paradigms of AG have the potential to maintain the functional, biochemical, and structural homeostasis of skeletal muscle in the face of chronic unloading. PMID:19286573

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



Extracorporeal Shockwave Therapy (ESWT) in the Treatment of Plantar Fasciitis – A Biometrical Review  

Microsoft Academic Search

:   The application of extracorporeal shockwave therapy (ESWT) as a treatment for conservatively unsuccessfully treated plantar\\u000a fasciitis has experienced a rapid increase over the last years. However, the efficacy of ESWT has not yet been established\\u000a unequivocally, as published studies have led to inconsistent results. Furthermore, reviews on clinical trials on ESWT are\\u000a either not up to date, incomplete, or

I. R. Böddeker; H. Schäfer; M. Haake



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


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



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

Microsoft Academic Search

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

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



Plantar Loading During Cutting While Wearing a Rigid Carbon Fiber Insert.  


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:24520831

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



Morphological Pattern Classification System for Plantar Thermography of Patients with Diabetes  

PubMed Central

Background A plantar temperature distribution can be obtained by thermography; however, the advantage has not been effectively utilized in the past. We previously proposed a classification method based on the angiosome concept, but the method was insufficient because it was too subjective and complicated for clinicians. In this study, we propose a new classification system of plantar forepart thermographic patterns using an image segmentation technique. Methods A cross-sectional observational study was conducted including 32 healthy volunteers and 129 patients with diabetes mellitus (DM). Individual thermographic variations and trends were evaluated. A comparison was conducted between the patterns obtained by our previous angiosome-based research and the patterns found by the new classification system. Results The system objectively found wider variations of the plantar forepart thermographic patterns in the patients with DM compared with those in the control subjects. In patients with DM, the system showed that the whole-high pattern was most frequent (46%), followed by the butterfly pattern (12%). In the control group, the butterfly pattern was most frequent (44%), followed by the whole-high pattern (19%). Both ankle and toe brachial indices were higher in feet with high temperature area in the inner side of the plantar. Conclusions Thermographic patterns found by the new computer-based system were similar to those obtained in our previous subjective work. The classification system found forefoot-low pattern and tiptoe-low pattern objectively. The system based on infrared thermography will be a screening tool to assess circulatory status in daily foot care of patients with DM. PMID:24124935

Mori, Taketoshi; Nagase, Takashi; Takehara, Kimie; Oe, Makoto; Ohashi, Yumiko; Amemiya, Ayumi; Noguchi, Hiroshi; Ueki, Kohjiro; Kadowaki, Takashi; Sanada, Hiromi



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


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



Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot  

Microsoft Academic Search

Diabetes mellitus (type 2) is the most frequent cause of non-traumatic lower-limb amputations. The major cause of impairment to the feet of diabetics is persistent hyperglycemia, potentially leading to peripheral neuropathy as well as to pathological changes in plantar soft tissue, which stiffen its structure and diminish its ability to effectively distribute foot-ground contact loads. In this study, a computational

Amit Gefen



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. 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. PMID:24519200

da Silva Costa, Altair; Leăo, Luiz Eduardo Villaça; Succi, José Ernesto; Perfeito, Joao Aléssio Juliano; Filho, Adauto Castelo; Rymkiewicz, Erika; Filho, Marco Aurelio Marchetti



One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy  

PubMed Central

OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment. PMID:24037003

Grecco, Marcus Vinicius; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andrea



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


Spatial and temporal plantar pressure distributions are important and useful measures in footwear evaluation, athletic training, clinical gait analysis, and pathology foot diagnosis. However, present plantar pressure measurement and analysis systems are more or less uncomfortable to wear and expensive. This paper presents an in-shoe plantar pressure measurement and analysis system based on a textile fabric sensor array, which is soft, light, and has a high-pressure sensitivity and a long service life. The sensors are connected with a soft polymeric board through conductive yarns and integrated into an insole. A stable data acquisition system interfaces with the insole, wirelessly transmits the acquired data to remote receiver through Bluetooth path. Three configuration modes are incorporated to gain connection with desktop, laptop, or smart phone, which can be configured to comfortably work in research laboratories, clinics, sport ground, and other outdoor environments. A real-time display and analysis software is presented to calculate parameters such as mean pressure, peak pressure, center of pressure (COP), and shift speed of COP. Experimental results show that this system has stable performance in both static and dynamic measurements. PMID:20071266

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



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. PMID:24453656

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



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)



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

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.

Sams, Terry L. [Washington River Protection Solutions, LLC, Richland, WA (United States); Kirch, N. W. [Washington River Protection Solutions, LLC, Richland, WA (United States); Reynolds, Jacob G. [Washington River Protection Solutions, LLC, Richland, WA (United States)



Plantar molluscum contagiosum: a case report of molluscum contagiosum occurring on the sole of the foot and a review of the world literature.  


Molluscum contagiosum (MC) is a skin infection caused by the double-stranded DNA virus of the family Poxviridae that typically presents as flesh-colored asymptomatic umbilicated papules. Plantar MC is uncommon. We describe a 23-year-old man who presented with multiple plantar MC. We also summarize the epidemiologic features of the 34 previously reported patients with plantar MC and discuss the clinical characteristics, differential diagnosis, and treatment of plantar MC. The patients were immunocompetent and the median age at diagnosis was 21 years. Although the plantar MC were asymptomatic in some individuals, a common presenting symptom was pain while walking. Patients had 1 lesion (23/35), 2 lesions (5/35), 3 lesions (4/35), or more than 5 lesions (3/35). Giant MC (>or=1 cm in diameter) was observed in more than 75% (a minimum of 27/35) of patients. At the initial patient evaluation, plantar verruca often was suspected; subsequently, light and/or electron microscopy of the plantar lesion confirmed the diagnosis of plantar MC. Removal or destruction of the lesion resulted in definitive treatment of the plantar MC. PMID:22908731

Cohen, Philip R; Tschen, Jaime A



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


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



The cold plate as a test of nociceptive behaviors: description and application to the study of chronic neuropathic and inflammatory pain models  

Microsoft Academic Search

A cold plate apparatus was designed to test the responses of unrestrained rats to low temperature stimulation of the plantar aspect of the paw. At plate temperatures of 10°C and 5°C, rats with either chronic constriction injury (CCI) of the sciatic nerve or complete Freund's adjuvant (CFA) induced inflammation of the hindpaw displayed a stereotyped behavior. Brisk lifts of the

Luc Jasmin; Lynn Kohan; Michelle Franssen; Gabriella Janni; Jonathan R Goff




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.



Results of Characterization and Retrieval Testing on Tank 241-C-110 Heel Solids  

SciTech Connect

Nine samples of heel solids from tank 241-C-110 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, the sample solids were primarily white to light-brown with minor dark-colored inclusions. The maximum dimension of the majority of the solids was <2 mm; however, numerous pieces of aggregate, microcrystalline, and crystalline solids with maximum dimensions ranging from 5-70 mm were observed. In general, the larger pieces of aggregate solids were strongly cemented. Natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}?19H{sub 2}O] was the dominant solid phase identified in the heel solids. Results of chemical analyses suggested that 85-87 wt% of the heel solids were the fluoridephosphate double salt. The average bulk density measured for the heel solids was 1.689 g/mL; the reference density of natrophosphate is 1.71 g/mL. Dissolution tests on composite samples indicate that 94 to 97 wt% of the tank 241-C-110 heel solids can be retrieved by dissolution in water. Dissolution and recovery of the soluble components in 1 kg (0.59 L) of the heel solids required the addition of ≈9.5 kg (9.5 L) of water at 15 ?C and ≈4.4 kg (4.45 L) of water at 45 ?C. Calculations performed using the Environmental Simulation Program indicate that dissolution of the ≈0.86 kg of natrophosphate in each kilogram of the tank 241-C-110 heel solids would require ≈9.45 kg of water at 15 ?C and ≈4.25 kg of water at 45 ?C. The slightly larger quantities of water determined to be required to retrieve the soluble components in 1 kg of the heel solids are consistent with that required for the dissolution of solids composed mainly of natrophosphate with a major portion of the balance consisting of highly soluble sodium salts. At least 98% of the structural water, soluble phosphate, sodium, fluoride, nitrate, carbonate, nitrite, sulfate, oxalate, and chloride in the test composites was dissolved and recovered in the dissolution tests. Most of the {sup 99}Tc and {sup 137}Cs present in the initial heel solids composites was removed in the water dissolution tests. The estimated activities/weights of {sup 129}I, {sup 234}U, {sup 235}U, {sup 236}U, and {sup 238}U in the dry residual solids were <25% of the weights/activities in the initial composite solids. Gibbsite and nordstrandite [both Al(OH){sub 3}] were the major solid phases identified in the solids remaining after completion of the dissolution tests. Chemical analysis indicated that the residual solids may have contained up to 62 wt% Al(OH){sub 3}. Significant quantities of unidentified phosphate-, iron-, bismuth-, silicon-, and strontium- bearing species were also present in the residual solids. The reference density of gibbsite (and nordstrandite) is 2.42 g/mL. The measured density of the residual solids, 2.65 g/mL, would be a reasonable value for solids containing gibbsite as the major component with minor quantities of other, higher density solids. Sieve analysis indicated that 22.2 wt% of the residual solids were discrete particles >710 μm in size, and 77.8 wt% were particulates <710 μm in size. Light-scattering measurements suggested that nearly all of the <710-μm particulates with diameters >12 μm were weakly bound aggregates of particles with diameters <2 μm. The <710-μm residual solids settled very slowly when dispersed in reagent water. The physical appearance of a suspension containing ≈0.4 vol% of the solids in pure water changed very little over a period of 46.5 hours. It should be noted that the distribution of particle sizes in the residual solids and the observed settling behavior were both strongly influenced by the procedures followed in the dissolution tests.

Callaway, William S.



Effect of non-sucrose sweet tasting solution on neonatal heel prick responses.  


A substance commercially described as 'sugar free,' used as a sweetener for paracetamol suspension, was evaluated on measures of neonatal pain. Sixty infants were randomly allocated to receive one of four solutions before heel stab blood sampling: sterile water (placebo); 25 or 50% sucrose (weight/volume); and the commercial sweet-tasting solution. There was a significant reduction in crying time and pain score 3 minutes after the painful stimulus in all groups compared with the controls. It is concluded that this sweet-tasting solution has analgesic effects as potent as those of concentrated sucrose solutions. PMID:8777661

Ramenghi, L A; Griffith, G C; Wood, C M; Levene, M I



[Shewanella algae infection after surgical treatment of Haglund's heel and rupture of the Achilles tendon.  


This is a case report of soft tissue infection with the marine bacterium Shewanella algae that is rare in Denmark. The patient was a 43-year-old male and he was treated surgically for Haglund's heel, a bony protrusion at the calcaneus. After clinical healing the patient suffered a rupture of the Achilles tendon, which was treated surgically as well. The post-operative healing process proved to be protracted with a number of surgical wound revisions being necessary. A microbiology culture showed the presence of S. algae and after proper antibiotic treatment the patient recovered quickly. PMID:25353681

Prischl, Clemens; Bendtsen, Michael Melchior; Laursen, Malene



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


The purpose of this report is to describe a case in which a heel ulcer with atypical features, i.e., large size and rapid progression, led to diagnosis of squamous cell carcinoma. Patient management was based on specialist advice obtained by "tele-dermatology" based on pictures and comments transmitted over the Internet. However, due to the risk of spreading and impossibility of providing other medical treatment (radiotherapy-chemotherapy), the lower limb was amputated at the top of the thigh. PMID:21585103

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



Topical Adapalene in the Treatment of Plantar Warts; Randomized Comparative Open Trial in Comparison with Cryo-Therapy  

PubMed Central

Background: Various therapeutic modalities, which are available for treating plantar wart, have not been successful every time. Aims: To evaluate topical adapalene under occlusion in the treatment of plantar warts and compare it with cryo-therapy. Materials and Methods: 50 patients with 424 plantar warts were included in this single center, two arm, prospective, randomized, control, open study. Patients were allocated randomly into two groups consisting of 25 patients each. Group A patients having 299 plantar warts were treated using adapalene gel 0.1% under occlusion while Group B patients having 125 warts were treated using cryo-therapy. All the patients were evaluated weekly till the clearance of all the warts and the results compared. Result: All the warts of 25 patients of Group A that were treated using adapalene gel 0.1% cleared in 36.71 ± 19.24 (55.95-17.47) days except those in one patient. In Group B, warts in all except one treated by cryo-therapy cleared in 52.17 ± 30.06 (82.23-22.11) days. There were no side effects like scar formation, irritation, erythema, or infections with adapalene group while in the cryo group scar was seen in 2 patients, pain in 24, erythema in 10, and infection in 3 patients. Conclusion: Adapalene gel 0.1% under occlusion is an effective, safe and easy to use treatment for plantar warts and may help clear lesions faster than cryo-therapy. PMID:25657417

Gupta, Ramji; Gupta, Sarthak



Musculoskeletal modelling deconstructs the paradoxical effects of elastic ankle exoskeletons on plantar-flexor mechanics and energetics during hopping.  


Experiments have shown that elastic ankle exoskeletons can be used to reduce ankle joint and plantar-flexor muscle loading when hopping in place and, in turn, reduce metabolic energy consumption. However, recent experimental work has shown that such exoskeletons cause less favourable soleus (SO) muscle-tendon mechanics than is observed during normal hopping, which might limit the capacity of the exoskeleton to reduce energy consumption. To directly link plantar-flexor mechanics and energy consumption when hopping in exoskeletons, we used a musculoskeletal model of the human leg and a model of muscle energetics in simulations of muscle-tendon dynamics during hopping with and without elastic ankle exoskeletons. Simulations were driven by experimental electromyograms, joint kinematics and exoskeleton torque taken from previously published data. The data were from seven males who hopped at 2.5 Hz with and without elastic ankle exoskeletons. The energetics model showed that the total rate of metabolic energy consumption by ankle muscles was not significantly reduced by an ankle exoskeleton. This was despite large reductions in plantar-flexor force production (40-50%). The lack of larger metabolic reductions with exoskeletons was attributed to increases in plantar-flexor muscle fibre velocities and a shift to less favourable muscle fibre lengths during active force production. This limited the capacity for plantar-flexors to reduce activation and energy consumption when hopping with exoskeleton assistance. PMID:25278469

Farris, Dominic James; Hicks, Jennifer L; Delp, Scott L; Sawicki, Gregory S



Influence of the calcaneus morphology on the risk of posterior heel ulcer creation Vincent Luboz, Antoine Perrier, Marek Bucki, Bruno Diot, Francis Cannard, Nicolas Vuillerme,  

E-print Network

Influence of the calcaneus morphology on the risk of posterior heel ulcer creation Vincent Luboz percent of the reanimation or geriatric patients develop a pressure ulcer, of which 40 % are posterior heel ulcers. The main suspected causes are the excessive pressure intensity (leading to internal

Payan, Yohan


Chronic ankle instability.  


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

Gerstner Garces, Juan Bernardo



[To reduce the pain of heel prick in the newborn: comparison of six types of lancets].  


Heel prick is an usual method performed to get a blood sample for newborn screening. Its wide use justifies the effort in reducing the pain as much as possible and some simple steps, including the use of spring heelsticks, are recommended by national and international guide-lines. But not all the heelsticks cause the same pain and allow to get enough blood for the screening. The aim of this work was to test six automatic heelstick devices with regard to the pain in heel prick measured with NIPS scale and, at the same time, to value their effectiveness in getting a blood sample suitable for filter paper for newborn screening. The following devices were assessed: Amnes Minilet Lancets, Wuxi Xinda Ltd, Exxe Safe Blade, Lifescan Stik Johnson & Johnson, One Touch Ultra Soft, Accu-Chek Safe T Pro Plus. The device Exxe Safe Blade statistically differs from all others: it is the least painful and it doesn't need any prick repetition. PMID:23173410

Ballardini, G; Spruzzola, A; Boneschi, L; Visentin, R; Boscardini, L; Barbaglia, M; Guala, L A



The effects of fatigue of the plantar flexors on peak torque and voluntary activation in untrained and resistance-trained men.  


The purpose of this study was to compare the effects of fatigue of the plantar flexors on peak torque and voluntary activation in untrained (UT) and resistance-trained (RT) men. Six men with no previous resistance training experience and 8 men with similar histories of chronic resistance training (9.8 ± 5.9 years, 3.8 ± 0.7 days/week) volunteered for this study. Subjects performed isometric maximal voluntary contractions (MVCs) before and immediately after unilateral dynamic isotonic contractions performed at 40% of MVC until volitional exhaustion. Voluntary activation of the plantar flexors was assessed using the interpolated twitch method (ITT) and central activation ratio (CAR). Surface electromyographic (EMG) amplitude of the soleus and medial gastrocnemius (MG) was measured during the MVC. There were significant reductions in MVC torque in both UT and RT groups after the fatiguing exercise (-10.7 ± 6.8%, p < 0.02; -9.1 ± 8.7%, p < 0.02, respectively), with no difference in the number of repetitions performed between groups. The UT and RT men experienced a significant decrease in ITT after the fatiguing exercise bout (-14.2 ± 11.8%, p = 0.03; -7.8 ± 9.3%, p = 0.045, respectively). The UT group experienced a significant decrease in CAR (99.5 ± 0.8% to 91.4 ± 6.4%, p = 0.025) with no change (p > 0.05) in the RT group. There was also a fatigue-induced decrease in normalized EMG amplitude for the soleus and MG muscles in both groups (p < 0.05). However, no differences were determined between groups for ITT, CAR, or EMG. Despite similar reductions in MVC torque postexercise, the UT men had a significant decrease in CAR and experienced nearly twice the decline in ITT than the RT men. These results indicate that the neural adaptations associated with chronic resistance training may lead to less susceptibility to central fatigue as measured by ITT and CAR. PMID:20512071

Hartman, Michael J; Ryan, Eric D; Cramer, Joel T; Bemben, Michael G



Real-Time Patient-Specific Evaluation of Deep Plantar Tissue Stresses in Diabetic and Healthy Subjects Using the Hertz Contact Theory  

E-print Network

-life activities, in order to test whether the monitor can distinguish between diabetics and normals. METHODSReal-Time Patient-Specific Evaluation of Deep Plantar Tissue Stresses in Diabetic and INTRODUCTION Elevated stresses in deep plantar tissue of diabetic naturopathic patients were associated

Gefen, Amit


At Home Diabe,c Plantar Ulcer Detec,on Device Mri%ka Bhaumik, Ma-Biegler, Mark Loh, Robert Mohard, Allison Tran and Alex Yoshikawa  

E-print Network

At Home Diabe,c Plantar Ulcer Detec,on Device Mri%ka Bhaumik, Ma- Biegler The objec%ve of the project was to develop an at home diabe%c plantar ulcer detec the forma%on of ulcers. Our device would reduce the number of required doctor

McGaughey, Alan


Plantar loading during jumping while wearing a rigid carbon graphite footplate.  


Fifth metatarsal stress fractures are common in sports and often result in delayed and non-union. The purpose of this study was to examine the effect of a rigid carbon graphite footplate (CGF) on plantar loading during take-off and landing from a jump. Nineteen recreational male athletes with no history of lower extremity injury in the past 6 months and no foot or ankle surgery in the past 3 years participated in this study. Subjects completed 7 jumping tasks while wearing a standard running shoe and then the shoe plus the CGF while plantar loading data was recorded. A series of paired t-tests were used to examine differences between the two footwear conditions independently for both takeoff and landing (a = 0.05). The contact area in the medial midfoot (p < .001) and forefoot (p = .010) statistically decreased when wearing the CGFP. The force–time integral was significantly greater when wearing the CGFP in the middle (p < .001) and lateral forefoot (p = .019). Maximum force was significantly greater beneath the middle (p < .001) and lateral forefoot (p < .001) when wearing the CGFP, while it was decreased beneath the medial midfoot (p < .001). During landing, the contact area beneath the medial (p = .017) and lateral midfoot (p = .004) were significantly decreased when wearing the CGFP. The force– time integral was significantly decrease beneath the medial midfoot (p < .001) when wearing the CGFP. The maximum force was significantly greater beneath the medial (p = .047) and middle forefoot (p = .001) when the subject was wearing the CGFP. The maximum force beneath the medial midfoot (p < .001) was significantly reduced when wearing the carbon graphite footplate. The results of the study indicate that the CGF is ineffective at reducing plantar loading during jumping and landing. PMID:24611163

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



Between-day reliability of repeated plantar pressure distribution measurements in a normal population.  


The objective of this study was to determine the reliability of repeated plantar pressure distribution measurements during normal gait across multiple testing sessions. Testing sessions were conducted on 5 separate days at approximately the same time of day. Nine subjects (five males, four females, age 26+/-8.4 years) who were free of any musculoskeletal injury were recruited. A capacitive pressure distribution platform (EMED AT, Novel GmbH, Munich, Germany), sampling at 50Hz was used to collect plantar pressure patterns during barefoot walking at a self-selected speed. Four parameters were investigated: peak pressure, maximum force, impulse, and contact time, and these were investigated in 10 areas of the foot after using the PRC mask method of subdividing the foot into ten anatomical areas of interest. Individual means of all the five repeated trials for each foot were calculated, and these values were used to calculate intraclass correlation coefficients (ICC) and coefficients of variation (CoV) for all parameters. The results of this investigation show a generally good level of reliability, the quality of which is dependent on the region of the foot and the parameter investigated. Areas with typically high loading characteristics, such as the central forefoot showed a higher level of reliability in the ICC's (>0.9) than less loaded areas such as the medial midfoot (<0.8). The conclusion of this study is that plantar pressure distribution measurements can be used in comparative evaluations since the measures of repeatability are satisfactory for the parameters and foot regions usually used in the investigation of clinical populations such as neuropathic diabetics. PMID:17693087

Gurney, Jason K; Kersting, Uwe G; Rosenbaum, Dieter



Repeatability of Infrared Plantar Thermography in Diabetes Patients: A Pilot Study  

PubMed Central

Objective Infrared (IR) thermography has been used as a complementary diagnostic method in several pathologies, including distal diabetic neuropathy, by tests that induce thermoregulatory responses, but nothing is known about the repeatability of these tests. This study aimed to assess the repeatability of the rewarming index in subjects with type 2 diabetes mellitus (T2DM) and nondiabetic control subjects. Methods Using an IR camera, plantar IR images were collected at baseline (pre-) and 10 min after (post-) cold stress testing on two different days with 7 days interval. Plantar absolute average temperatures pre- and post-cold stress testing, the difference between them (?T), and the rewarming index were obtained and compared between days. Repeatability of the rewarming index after the cold stress test was assessed by Bland–Altman plot limits of agreement. Results Ten T2DM subjects and ten nondiabetic subjects had both feet analyzed. Mean age did not differ between groups (p = .080). Absolute average temperatures of plantar region pre- (p = .033) and post-cold stress test (p = .019) differed between days in nondiabetic subjects, whereas they did not differ in T2DM subjects (pretest, p = .329; post-test, p = .540). ?T and rewarming index did not differ between days for both groups, and the rewarming index presented a 100% agreement of day-to-day measurements from T2DM subjects and 95% with nondiabetic subjects. Conclusions The rewarming index after cold stress testing presented good repeatability between two days a week in both groups. Despite T2DM subjects presenting no differences on absolute temperature values between days, ?T or rewarming index after cold stress testing remain recommended beside absolute temperature values for clinical use. PMID:24124938

Balbinot, Luciane Fachin; Robinson, Caroline Cabral; Achaval, Matilde; Zaro, Milton Antônio; Brioschi, Marcos Leal



The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial.  


Study Design A single-blind randomized controlled trial. Objective To evaluate the efficacy of ankle and midfoot mobilization on pain and function of patients with plantar fasciitis (PF). Background Plantar fasciitis is a degenerative process of the plantar fascia, with a lifetime prevalence of approximately 10%. Limited ankle dorsiflexion is a common finding and apparently acts as a contributing factor to the development of PF. Methods Fifty patients with PF, aged 23 to 73 years, were randomly assigned to either the intervention or control group. Both groups received 8 treatments, twice a week, consisting of stretching exercises and ultrasound. In addition, the intervention group received mobilization of the ankle and midfoot joints. Dorsiflexion range of motion was measured at the beginning and at the end of treatment. The results were evaluated by 3 outcomes: the numeric pain-rating scale, Lower Extremity Functional Scale, and algometry. Results No significant difference was found between groups in any of the outcomes. Both groups showed a significant difference in the numeric pain-rating scale and Lower Extremity Functional Scale. Both groups significantly improved in dorsiflexion range of motion, with no difference between groups. Conclusion The addition of ankle and foot joint mobilization aimed at improving dorsiflexion range of motion is not more effective than stretching and ultrasound alone in treating PF. The association between limited ankle dorsiflexion and PF is most probably due to soft tissue limitations, not the joints. Trial registered at (registration number NCT01439932). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2015;45(4):265-272. Epub 4 Mar 2015. doi:10.2519/jospt.2015.5155. PMID:25739844

Shashua, Anat; Flechter, Shlomo; Avidan, Liat; Ofir, Dani; Melayev, Alex; Kalichman, Leonid



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. PMID:23295596

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



Plantar Static Pressure Distribution in Healthy Individuals: Percentiles for the Evaluation of Forefoot Loading.  


In literature, one finds little scientific statements regarding plantar static pressure distribution in healthy individuals. Miscellaneous studies, however, characterize pathologies of feet and associate those with abnormal static or dynamic plantar load sharing. Our study reveals that healthy individuals show significant age-dependent differences in forefoot and rear foot load measured in standing position. The forefoot and rear foot load of 238 female and 193 male individuals aged between 2 and 69 years were measured. Using a pressure distribution measurement platform, the measurements were taken barefooted in standing position. Those measurements are presented as percentage of the overall load. The measurements within the age groups A1 (2-6 years), A2 (7-10 years), and A3 (11-69 years) showed significantly different forefoot loading means of the left foot (A1, 19.9%; A2, 28.2%; A3, 39.7%) and the right foot (A1, 22.6%; A2, 29.7%; A3, 39.6%). The forefoot loadings are graphically displayed as a function of the percentiles 5, 10, 25, 50, 75, 90, and 95. Forefoot loadings are referred to as "prominent" if the measured values lie off the interquartile range; if either below the percentile 10 or above 90 the loadings are referred to as "very prominent." Our study contains significant data regarding the extent of the static load sharing of the forefoot and rear foot of healthy individuals; the data are suited for being standard values to evaluate plantar load sharing. PMID:24756116

Pomarino, David; Pomarino, Andrea



A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers  

PubMed Central

Background Offloading is key to preventing or healing plantar neuropathic foot ulcers in diabetes. Total contact casts or walkers rendered irremovable are recommended in guidelines as first-line options for offloading, however the use of such devices has been found to be low. This study aimed to investigate offloading practices for diabetes-related plantar neuropathic ulcers. Methods An online survey of closed and open-ended questions was administered via SurveyMonkey®. Forty-one podiatrists experienced in high-risk foot practice, from 21 high-risk foot services around Australia, were approached to participate. Results The response rate was 88%. Participants reported using 21 modalities or combinations of modalities, for offloading this ulcer type. The most frequently used modalities under the forefoot and hallux were felt padding, followed by removable casts or walkers, then non-removable casts or walkers. Participants indicated that many factors were considered when selecting offloading modality, including: compliance, risk of adverse effects, psycho-social factors, restrictions on activities of daily living, work needs and features of the wound. The majority of participants (83%) considered non-removable casts or walkers to be the gold-standard for offloading this ulcer type, however they reported numerous, particularly patient-related, barriers to their use. Conclusions Selecting offloading for the management of foot ulceration is complex. Felt padding, not the gold-standard non-removable cast or walker, was reported as the most commonly selected modality for offloading plantar neuropathic ulceration. However, further evaluation of felt padding in high quality clinical trials is required to ascertain its effectiveness for ulcer healing. PMID:25694793



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


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

Cottom, James M



Control of the motion of the body's center of mass in relation to the center of pressure during high-heeled gait.  


High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. Knowledge of the motion of the body's center of mass (COM) with respect to the center of pressure (COP) during high-heeled gait may offer insights into the balance control strategies and provide a basis for approaches that minimize the risk of falling and associated adverse effects. The study aimed to investigate the influence of the base and height of the heels on the COM motion in terms of COM-COP inclination angles (IA) and the rate of change of IA (RCIA). Fifteen females who regularly wear high heels walked barefoot and with narrow-heeled shoes with three heel heights (3.9cm, 6.3cm and 7.3cm) while kinematic and ground reaction force data were measured and used to calculate the COM and COP, as well as the temporal-distance parameters. The reduced base of the heels was found to be the primary factor for the reduced normalized walking speed and the reduced frontal IA throughout the gait cycle. This was achieved mainly through the control of the RCIA during double-leg stance (DLS). The heel heights affected mainly the peak RCIA during DLS, which were not big enough to affect the IA. These results suggest young adults adopt a conservative strategy for balance control during narrow-heeled gait. The results will serve as baseline data for future evaluation of patients and/or older adults during narrow-heeled gait with the aim of reducing the risk of falling. PMID:23337731

Chien, Hui-Lien; Lu, Tung-Wu; Liu, Ming-Wei



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.



Excision of a dermatobia hominis larva from the heel of a south american traveler: A case report  

Microsoft Academic Search

Although foot and ankle specialists are well versed in treating insect bites and foreign bodies, many physicians in the United States are unfamiliar with parasitic organisms that are common in other parts of the world. This article presents a case of a patient inoculated in the posterior heel with the larva of a Dermatobia hominis, or human bot fly. Excision

Donald W Adams; Ryan T Cooney



Constitutive formulation and numerical analysis of the biomechanical behaviour of forefoot plantar soft tissue.  


The aim of this work is to provide a numerical approach for the investigation of the mechanical behaviour of the forefoot soft tissues. The development of reliable numerical models of biological structures requires the definition of constitutive formulations that actually interpret the mechanical response of the constituent biological tissues and their structural arrangement. A specific visco-hyperelastic constitutive model is provided to account for the typical features of soft plantar tissue mechanics, as geometric and material non-linearity, almost-incompressible behaviour and time-dependent phenomena. Constitutive parameters are evaluated by the analysis of experimental data from compression and stress relaxation tests on tissue samples. A three-dimensional finite element model of the forefoot region is developed starting from the analysis of biomedical images, leading to the evaluation of overall structural response. The reliability of model and analyses is assessed by the comparison of experimental and numerical results pertaining to indentation tests. The numerical model developed allows to evaluate the mechanical response of plantar soft tissue in terms of stress and strain distribution. PMID:25313025

Fontanella, Chiara Giulia; Favaretto, Elena; Carniel, Emanuele Luigi; Natali, Arturo Nicola



Ketoprofen Produces Modality-Specific Inhibition of Pain Behaviors in Rats After Plantar Incision  

PubMed Central

Background Postoperative pain remains a significant problem despite optimal treatment with current drugs. Nonsteroidal antiinflammatory drugs reduce inflammation and provide analgesia, but are associated with adverse side effects. Methods We tested low doses (0.5 – 5 mg/kg) of parenteral ketoprofen against pain related behaviors after plantar incision in rats. To further evaluate the potential sites of action of ketoprofen in our model, a novel, sustained-release microparticle formulation of ketoprofen was placed into the wound, and tested for its effects on pain behaviors. Intrathecal ketoprofen (150 mcg) was also studied. Plasma samples were assayed for drug concentrations. Results We found that low doses of parenterally administered ketoprofen produced a modality specific effect on pain behaviors; guarding after incision was decreased, whereas no inhibition of exaggerated responses to heat or mechanical stimuli was evident. Very low doses, 0.5 mg/kg, could produce inhibition of guarding. The locally applied sustained release ketoprofen-eluting microparticles and intrathecally administered ketoprofen also produced a modality-specific effect on pain behaviors after incision, inhibiting only guarding. Plasma levels of ketoprofen after parenteral or local administration were in the range of therapeutic blood levels in postoperative patients. Conclusions This study demonstrates that ketoprofen is an effective analgesic for nonevoked guarding in rats after plantar incision. There was no effect on mechanical or heat responses, which highlights the importance of multiple modality testing of pain behaviors for drug evaluation. We found efficacy at doses used clinically in postoperative patients. PMID:19923531

Spofford, Christina M.; Ashmawi, Hazem; Subieta, Alberto; Buevich, Fatima; Moses, Arikha; Baker, Max; Brennan, Timothy J.



Instrument-assisted Soft Tissue Mobilization: Effects on the Properties of Human Plantar Flexors.  


The effect of instrument-assisted soft tissue mobilization (ISTM) on passive properties and inflammation in human skeletal muscle has not been evaluated. Passive properties of muscle, inflammatory myokines and subjective reporting of functional ability were used to identify the effects of ISTM on the plantar flexors. 11 healthy men were measured for passive musculotendinous stiffness (MTS), passive range of motion (PROM), passive resistive torque (PASTQ) and maximum voluntary contraction peak torque (MVCPT) for plantar flexor muscles of the lower leg. Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-?) were measured from muscle biopsies from the gastrocnemius, and subjective measurements of functional ability were taken using the perception of functional ability questionnaire (PFAQ). MTS, PROM, PRT and MVCPT were measured in the treatment leg (TL) and control leg (CL) before, immediately after, 24?h, 48?h and 72?h following IASTM. Biopsies for IL-6 and TNF-? and PFAQ responses were collected before as well as 24?h, 48?h and 72?h after IASTM. There were no significant differences in MTS, PROM, PASTQ, MVCPT, IL-6 and TNF-? between the TL or CL. A significant decrease in the perception of function and a significant increase in pain for the TL were found following IASTM. PMID:25347141

Vardiman, J P; Siedlik, J; Herda, T; Hawkins, W; Cooper, M; Graham, Z A; Deckert, J; Gallagher, P



[Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy.  


Percutaneous surgical techniques are suitable for the correction of the hallux valgus deformity. Satisfactory aesthetic and functional results obtained with the Reverdin- Isham osteotomy have been reported. The aim of this study was to describe dynamic plantar pressure redistribution after the correction of the deformity using this technique. A sample of 20 feet with mild or moderate hallux valgus was conformed and surgically treated using the Reverdin-Isham osteotomy. Clinical, radiological, surface and pressure assessments were performed pre and postoperatively. Postoperative mean (± SD) values of the American Orthopaedic Foot and Ankle Society (AOFAS) score, metatarsophalangeal, first intermetatarsal and proximal articular sect angles were 95.7 (3.3), 15.5° (5.4), 9.5° (1.5) y 5.3° (3.0), respectively. A significant decrease was observed in surface values of both lateral (P = 0.003) and medial (P = 0.001) masks of the forefoot. Mean pressure values of the lateral forefoot region denoted a significant increase (P < 0.001) while the medial forefoot region showed no change (P = 0.137). There is evidence that this particular surgical technique promotes a new plantar pressure pattern in the foot that might significantly favour the increase of the pressure observed under the lesser metatarsal heads and might not induce meaningful changes in the mean pressure registered under the first metatarsal head and hallux. PMID:25264801

Rodríguez-Reyes, Gerardo; López-Gavito, Eduardo; Pérez-Sanpablo, Alberto Isaac; Galván Duque-Gastélum, Carlos; Alvarez-Camacho, Michelín; Mendoza-Cruz, Felipe; Parra-Téllez, Patricia; Vázquez-Escamilla, Jesús; Quińones-Urióstegui, Ivett



Effectiveness of moulded insoles in reducing plantar pressure in diabetic patients.  


For an effective prevention of foot sole ulcers in diabetic patients, the Bioengineering and Signal processing group of the Electronics Department of the Pontificia Universidad Javeriana developed a novel method for the computer assisted design and production of therapeutic insoles, integrating several technologies, such as: CAD/CAM registration of pressure on the foot sole, Podoscopy, and an expert system based on knowledge. The afore mentioned method allows topographical modeling of the insoles starting by the digitization in 3D of a cast of the foot sole surface of the patient and its computer assisted design taking into account the recommendations of the knowledge based system. The aim of this study was to evaluate the effect on plantar pressure distribution of different insoles prescribed and manufactured with various techniques on a random group of patients with diabetes mellitus in the early stages of the disease. Four different types of insoles were manufactured by methods available in the market and by the computer model system proposed on a previous research, which was used in order to design and manufacture one of the insoles evaluated. The differences between the four types of insoles were established by comparing their effectiveness in plantar pressure reduction. PMID:18003048

Zequera, M; Stephan, S; Paul, J



[Clinical application of retrograde island flap carrying plantar metatarsal arteries as pedicle].  


The skin and soft tissue defects or ulceration of the wight-bearing part of the sole was difficult to repair with medial plantar island flap, but would be treated with retrograde island flap carrying plantar metatarsal arteries as pedicle. Ten flaps were applied in 9 patients. They had either indolent ulcer or skin defect secondary to excision of painful corn or callosities of the front part of the sole. The flaps were 3 cm to 5 cm long and 3 cm to 4 cm wide, and they all survived following retrograde transfer. The patients were followed up for 1 to 10 years. It was found that the patients could bear weight on the operated foot and could walk without pain or lameness. The flaps were resistant to abrasion from long-time walking. It was concluded that this kind of flap was best suitable to repair the ulcers and defects over the front part of the sole despite there were some minor shortcomings such as the size of the flaps available was small and the donor site required split skin graft for coverage. PMID:9867961

Luo, Y; Wang, T; Fang, H



Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick  

PubMed Central

Abstract Background Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed. Objective The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. Design This was a descriptive study performed to assess the safety of using a transcutaneous electrical nerve stimulation (TENS) unit to deliver NESAP to neonates. Setting/Subjects The subjects were healthy newborn infants<3 days old before hospital discharge. Intervention The intervention was NESAP delivered via a TENS unit, administered before, during, and after heel stick. The electrodes of the TENS unit were applied at four acupuncture points. Settings were gradually increased: 6 infants received 1.0 mA, 2 Hz; the second 6 infants received 2.0 mA, 10 Hz; and the last 18 infants received 3.5 mA, 10?Hz. Main Outcome Measures Three main measures were used: (1) skin assessment (2) vital signs; (3) pain scores using the Premature Infant Pain Profile (PIPP). Results There were no significant changes in vital signs during and after NESAP. There were no changes in PIPP scores in the first 12 infants after initiation of NESAP. A slight but nonsignificant increase in PIPP scores (from 2.65 to 3.5 on a scale of 0–18) occurred in the last 18 infants. There were no adverse events during or after NESAP. Conclusions NESAP is safe for infants with low settings on a TENS unit. PMID:24761178

Mitchell, Anita J.; Lowe, Leah M.; Lee, Amy; Hall, Richard W.



Heel bone strength is related to lifestyle factors in Okinawan men with type 2 diabetes mellitus  

PubMed Central

Aims/Introduction Although male diabetic patients have an increased risk of fracture, there is little information about this in the literature. The association between heel bone stiffness and the lifestyle of male patients with diabetes was evaluated. Materials and Methods The study included 108 participants with type 2 diabetes mellitus patients and 168 age-adjusted, healthy male volunteers. None of the participants had a history of osteoporosis or other severe diseases. Heel bone stiffness was examined by quantitative ultrasound, and each participant completed a health interview survey questionnaire. Bone stiffness was taken as an indicator of bone strength. Stepwise regression analysis was used to investigate associations between bone stiffness and lifestyle-related factors, such as sunlight exposure, intake of milk or small fish, regular exercise, cigarette smoking, consumption of alcohol, and number of remaining teeth. Results Bone stiffness showed a significant negative association with cigarette smoking [standardized coefficient (SC) = ?0.297, F-value (F) = 10.059] and age (SC = ?0.207, F = 7.565) in diabetic patients. Bone stiffness showed a significant negative association with age (SC = ?0.371, F = 12.076) and height (SC = ?0.193, F = 7.898), as well as a significant positive association with sunlight exposure (SC = 0.182, F = 9.589) and intake of small fish (SC = 0.170, F = 7.393) in controls. Conclusions These findings suggest that cigarette smoking and age are negatively associated with bone stiffness in Okinawan male patients with type 2 diabetes mellitus.

Gushiken, Michiko; Komiya, Ichiro; Ueda, Shinichiro; Kobayashi, Jun



Isokinetic profile of dorsiflexors and plantar flexors of the ankle--a comparative study of élite 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. PMID:8044488

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



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

Microsoft Academic Search

BACKGROUND: Low-dye (LD) taping is commonly used to reduce rearfoot pronation. No studies have previously investigated the effectiveness of LD taping using both plantar pressure distribution (F-Scan) and 3-D (CODA) analysis of rearfoot motion. METHODS: 20 healthy subjects with a navicular drop test exceeding 10 mm participated in the study. T tests were used to determine whether significant (p <

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



Independent effects of weight and mass on plantar flexor activity during walking: implications for their contributions to body support  

E-print Network

.2008.--The ankle plantar flexor mus- cles, gastrocnemius (Gas) and soleus (Sol), have been shown to play this hypothesis by measuring muscle activity while experimentally manipulating body weight and mass by 1 and mass). The rationale for this study was that muscles that provide body support would be sensitive


Investigation into the effect of static stretching on the active stiffness and damping characteristics of the ankle joint plantar flexors  

Microsoft Academic Search

Objective: The purpose of the study was to investigate the effect of static stretching on the active stiffness and damping characteristics of the ankle joint plantar flexors. Design: The study was an experimental design. Background: Flexibility has static and active components. Little information is available regarding the effect of static stretching on the active stiffness of the muscle tendon unit.

D. Glenn Hunter; Vince Coveney; Jonathon Spriggs



Age-Related Differences in the Force Generation Capabilities and Tendon Extensibilities of Knee Extensors and Plantar Flexors in Men  

Microsoft Academic Search

Background. Recently, the number of elderly individuals who participate in sports has increased, thus injuries from overuse are now becoming recognized in the elderly population. Therefore, it is important to determine which muscle groups and tendons are most affected with aging to plan appropriate exercise interventions for elderly individuals. In particular, muscles and tendons in knee extensors and plantar flexors

Keitaro Kubo; Yoshie Ishida; Teruaki Komuro; Naoya Tsunoda; Hiroaki Kanehisa; Tetsuo Fukunaga



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


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

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



The influence of gait cadence on the ground reaction forces and plantar pressures during load carriage of young adults.  


Biomechanical gait parameters-ground reaction forces (GRFs) and plantar pressures-during load carriage of young adults were compared at a low gait cadence and a high gait cadence. Differences between load carriage and normal walking during both gait cadences were also assessed. A force plate and an in-shoe plantar pressure system were used to assess 60 adults while they were walking either normally (unloaded condition) or wearing a backpack (loaded condition) at low (70 steps per minute) and high gait cadences (120 steps per minute). GRF and plantar pressure peaks were scaled to body weight (or body weight plus backpack weight). With medium to high effect sizes we found greater anterior-posterior and vertical GRFs and greater plantar pressure peaks in the rearfoot, forefoot and hallux when the participants walked carrying a backpack at high gait cadences compared to walking at low gait cadences. Differences between loaded and unloaded conditions in both gait cadences were also observed. PMID:25766421

Castro, Marcelo P; Figueiredo, Maria Cristina; Abreu, Sofia; Sousa, Helena; Machado, Leandro; Santos, Rubim; Vilas-Boas, Joăo Paulo



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. PMID:25075224



Chronic Migraine  


Home » Chronic Migraine Chronic Migraine Submitted by Admin on Thu, 2007-10-25 18:01 Chronic migraine (CM) best characterizes those patients with a history of migraine who experience headache more than half the time. ...


Plantar fasciitis  


... Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 82. Abu-Laban ... Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 58. Wapner KL, ...


Plantar Wart  


... counter wart removers have a high percentage of salicylic acid and work by dissolving away the layer of ... if it touches unaffected skin around it; 40% salicylic acid self-stick pads appear to be one of ...


Sensory Re-Weighting in Human Bipedal Postural Control: The Effects of Experimentally-Induced Plantar Pain  

PubMed Central

The present study was designed to assess the effects of experimentally-induced plantar pain on the displacement of centre of foot pressure during unperturbed upright stance in different sensory conditions of availability and/or reliability of visual input and somatosensory input from the vestibular system and neck. To achieve this goal, fourteen young healthy adults were asked to stand as still as possible in three sensory conditions: (1) No-vision, (2) Vision, and (3) No-vision – Head tilted backward, during two experimental conditions: (1) a No-pain condition, and (2) a condition when a painful stimulation was applied to the plantar surfaces of both feet (Plantar-pain condition). Centre of foot pressure (CoP) displacements were recorded using a force platform. Results showed that (1) experimentally-induced plantar pain increased CoP displacements in the absence of vision (No-vision condition), (2) this deleterious effect was more accentuated when somatosensory information from the vestibular and neck was altered (No-vision – Head tilted backward condition) and (3) this deleterious effect was suppressed when visual information was available (Vision condition). From a fundamental point of view, these results lend support to the sensory re-weighting hypothesis whereby the central nervous system dynamically and selectively adjusts the relative contributions of sensory inputs (i.e. the sensory weightings) in order to maintain balance when one or more sensory channels are altered by the task (novel or challenging), environmental or individual conditions. From a clinical point of view, the present findings further suggest that prevention and treatment of plantar pain may be relevant for the preservation or improvement of balance control, particularly in situations (or individuals) in which information provided by the visual, neck proprioceptive and vestibular systems is unavailable or disrupted. PMID:23840337

Pradels, Antoine; Pradon, Didier; Hlava?ková, Petra; Diot, Bruno; Vuillerme, Nicolas



Muscle oxidative metabolism accelerates with mild acidosis during incremental intermittent isometric plantar flexion exercise  

PubMed Central

Background It has been thought that intramuscular ADP and phosphocreatine (PCr) concentrations are important regulators of mitochondorial respiration. There is a threshold work rate or metabolic rate for cellular acidosis, and the decrease in muscle PCr is accelerated with drop in pH during incremental exercise. We tested the hypothesis that increase in muscle oxygen consumption (o2mus) is accelerated with rapid decrease in PCr (concomitant increase in ADP) in muscles with drop in pH occurs during incremental plantar flexion exercise. Methods Five male subjects performed a repetitive intermittent isometric plantar flexion exercise (6-s contraction/4-s relaxation). Exercise intensity was raised every 1 min by 10% maximal voluntary contraction (MVC), starting at 10% MVC until exhaustion. The measurement site was at the medial head of the gastrocnemius muscle. Changes in muscle PCr, inorganic phosphate (Pi), ADP, and pH were measured by 31P-magnetic resonance spectroscopy. o2mus was determined from the rate of decrease in oxygenated hemoglobin and/or myoglobin using near-infrared continuous wave spectroscopy under transient arterial occlusion. Electromyogram (EMG) was also recorded. Pulmonary oxygen uptake (o2pul ) was measured by the breath-by-breath gas analysis. Results EMG amplitude increased as exercise intensity progressed. In contrast, muscle PCr, ADP, o2mus, and o2pul did not change appreciably below 40% MVC, whereas above 40% MVC muscle PCr decreased, and ADP, o2mus, and o2pul increased as exercise intensity progressed, and above 70% MVC, changes in muscle PCr, ADP, o2mus, and o2pul accelerated with the decrease in muscle pH (~6.78). The kinetics of muscle PCr, ADP, o2mus, and o2pul were similar, and there was a close correlation between each pair of parameters (r = 0.969~0.983, p < 0.001). Conclusion With decrease in pH muscle oxidative metabolism accelerated and changes in intramuscular PCr and ADP accelerated during incremental intermittent isometric plantar flexion exercise. These results suggest that rapid changes in muscle PCr and/or ADP with mild acidosis stimulate accelerative muscle oxidative metabolism. PMID:15720727

Homma, Toshiyuki; Hamaoka, Takafumi; Sako, Takayuki; Murakami, Motohide; Esaki, Kazuki; Kime, Ryotaro; Katsumura, Toshihito



Controlling posture using a plantar pressure-based, tongue-placed tactile biofeedback system  

E-print Network

The present paper introduces an original biofeedback system for improving human balance control, whose underlying principle consists in providing additional sensory information related to foot sole pressure distribution to the user through a tongue-placed tactile output device. To assess the effect of this biofeedback system on postural control during quiet standing, ten young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements were recorded using a force platform. Results showed reduced CoP displacements in the Biofeedback relative to the No-biofeedback condition. The present findings evidenced the ability of the central nervous system to efficiently integrate an artificial plantar-based, tongue-placed tactile biofeedback for controlling control posture during quiet standing.

Vuillerme, Nicolas; Demongeot, Jacques; Payan, Yohan



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


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



Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes  

PubMed Central

BACKGROUND Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP) and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. SUBJECTS AND METHODS A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS), for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan). The studied patients were grouped into: (1) diabetic control group (DC), which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ?2; (2) diabetic neuropathy group (DN), which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3) diabetic ulcer group (DU), which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. RESULTS PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP), rearfoot peak plantar pressure (RFPPP), forefoot/rearfoot ratio (F/R), forefoot peak pressure gradient (FFPPG) rearfoot peak pressure gradient (RFPPG), and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG) (P < 0.05). FFPPP and F/R were significantly higher in the DU group compared to the DN and DC groups (P < 0.05), with no significant difference between DN and DC. FFPPG was significantly higher in the DU and DN groups compared to the DC group (P < 0.05). RFPPP and FFPPG/RFPPG were significantly higher in the DU and DN groups compared to the DC group (P < 0.05) with no significant difference between the DN and DU groups (P > 0.05). FFPPP, F/R ratio, FFPPG, and FFPPG/RFPPG correlated significantly with the severity of neuropathy according to MNDS (P < 0.05). These same variables as well as MNDS were also significantly higher in patients with foot deformity compared to those without deformity (P < 0.05). Using the receiver operating characteristic analysis, the optimal cut-point of PPP for ulceration risk, as determined by a balance of sensitivity, specificity, and accuracy was 335 kPa and was found at the forefoot. Multivariate logistical regression analysis for ulceration risk was statistically significant for duration of diabetes (odds ratio [OR] = 0.8), smoking (OR = 9.7), foot deformity (OR = 8.7), MNDS (OR = 1.5), 2-h postprandial plasma glucose (2 h-PPG) (OR = 0.9), glycated hemoglobin (HbA1c) (OR = 2.1), FFPPP (OR = 1.0), and FFPPG (OR = 1.0). CONCLUSION In conclusion, persons with diabetes having neuropathy and/or ulcers have elevated PPP. Risk of ulceration was highly associated with duration of diabetes, smoking, severity of neuropathy, glycemic control, and high PP variables especially the FFPPP, F/R, and FFPPG. We suggest a cut-point of 355 kPa for FFPPP to denote high risk for ulceration that would be more valid when used in conjunction with other contributory risk factors, namely, duration of diabetes, smoking, glycemic load, foot deformity, and severity of neuropathy. PMID:25520564

Fawzy, Olfat A; Arafa, Asmaa I; El Wakeel, Mervat A; Abdul Kareem, Shaimaa H



Plantar Fibroma and Plantar Fibromatosis  


... to help prevent blood clot formation and delayed wound healing. Return to unrestricted activity and shoewear is in the one- to two-month range. Recurrence is rare for fibromas but more ... complications include wound drainage or infection, a healed but painful wound, ...


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?




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



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


This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45 years old). Quantitative ultrasound (QUS) of the heel by Hologic's Sahara Sonometer was used to measure BMD. The mean age was 45.2 (SD 13.7)?years, and the majority of participants were female (208, 94 %). A significant difference between mean BMD and high-heel use was not found. Independent correlations existed between fair skinned/sunburn easily and BMD, r(212)?=?-0.14, p?=?0.038, as well as history of smoking and BMD, r(212)?=?-0.14, p?=?0.042. Bone health risk score was strongly correlated with heel use binary variable "yes/no," r(210)?=?0.21, p?=?0.003. Our study suggests that wearing high-heeled shoes does not lead to appreciable differences in BMD among community health fair participants as assessed by QUS. PMID:22983265

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



In vitro evaluation of the antiviral effects of the homeopathic preparation Gripp-Heel on selected respiratory viruses.  


Gripp-Heel is a homeopathic preparation frequently used in the treatment of respiratory viral infections such as various types of influenza and the common cold. The antiviral activity of Gripp-Heel was studied in vitro on human pathogenic enveloped and nonenveloped RNA and DNA viruses. Before the antiviral assays, in vitro cytotoxicity of Gripp-Heel was determined with cells used for the infection experiments (HeLa, HEp-2, MDCK, BGM) as well as with mitogen-stimulated peripheral blood mononuclear leukocytes. A concentration of 0.5 of the commercially available product slightly reduced cell viability and proliferative capacity, and experiments on antiviral activity were determined starting with a dilution of 0.2 of the commercially available product. The antiviral activity was determined against a broad panel of enveloped and nonenveloped DNA and RNA viruses with plaque reduction assay, cytopathogenic assays, virus titrations, analysis of the viral proteins in virus-specific enzyme immunoassays, and haemagglutination tests. Control substances were acyclovir (10 microg/mL), ribavirin (6 microg/mL), and amantadine hydrochloride (5 microg/mL), depending on the virus type. Gripp-Heel demonstrated dose-dependent in vitro activity (significant reductions of infectivity by 20% to 40%) against Human herpesvirus 1, Human adenovirus C serotype 5, Influenza A virus, Human respiratory syncytial virus, Human parainfluenza virus 3, Human rhinovirus B serotype 14, and Human coxsackievirus serotype A9. The mechanisms of this antiviral activity are still unclear, but type I interferon induction might be a possible explanation. Further research on this homeopathic preparation seems warranted. PMID:18066110

Glatthaar-Saalmüller, Bernadette



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. PMID:24915443

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



A comparison of the effectiveness of extracorporeal shock wave and ultrasound therapy in the management of heel pain  

NASA Astrophysics Data System (ADS)

The aim of this study was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and ultrasound therapy (US) for managing heel pain. Thirty-seven subjects received either: ESWT (once a week), US (three times a week), or CONTROL (no treatment) for 3 consecutive weeks and were followed-up for 3 more weeks. A visual analogue scale (VAS), the maximum tolerable duration for prolonged walking or standing, and the Mayo clinical scoring system (MCSS) were evaluated. Mixed models treating baseline measures as covariates were adopted for statistical analysis. By week 3, intensity of heel pain on palpation was reduced by 37% (VAS score from 7.5 to 4.6) in the ESWT group, 24% (from 5.3 to 4.2) in the US group, and increased by 3% (5.6-5.7) in the control group; this difference was significant after adjusting for baseline VAS scores ( p = 0.022). The improvements in the maximum tolerable duration of prolonged walking or standing was only significant in the ESWT group (157% increase, p = 0.043) but not the other two groups. Both active treatment groups maintained the treatment effect at the three-week follow-up. We conclude that ESWT is potentially more effective in reducing heel pain than ultrasound therapy but additional evidence is needed due to the various limitations of the study.

Cheing, G. L. Y.; Chang, H.; Lo, S. K.



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

PubMed Central

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

Abdel-aziem, Amr Almaz; Mohammad, Walaa Sayed



Successful treatment of hydroxyurea-associated chronic leg ulcers associated with squamous cell carcinoma.  


Hydroxyurea (HU) is an antineoplastic drug used in the treatment of chronic myeloproliferative neoplasms (MPNs). HU is associated with cutaneous adverse effects, whereas severe complications such as leg ulcers and non-melanoma skin cancers (NMSCs) are rare and only observed after long-term treatment. We herein report a patient with essential thrombocythemia (ET) treated chronically with HU, and who developed refractory bilateral leg ulcers complicated by squamous cell carcinoma (SCC) over both heels. The patient was successfully managed by multiple debridement stages and skin grafting surgeries. PMID:25467031

Antar, Ahmad; Ishak, Rim S; Otrock, Zaher K; El-Majzoub, Nadim; Ghosn, Samer; Mahfouz, Rami; Taher, Ali T




SciTech Connect

Mixtures of oxalic acid with nitric acid have been shown to be superior to oxalic acid alone for the dissolution of iron-rich High Level Waste sludge heels. Optimized conditions resulting in minimal oxalate usage and stoichiometric iron dissolution (based on added oxalate ion) have been determined for hematite (a primary sludge iron phase) in oxalic/nitric acid mixtures. The acid mixtures performed better than expected based on the solubility of hematite in the individual acids through a synergistic effect in which the preferred 1:1 Fe:oxalate complex is formed. This allows for the minimization of oxalate additions to the waste stream. Carbon steel corrosion rates were measured in oxalic/nitric acid mixtures to evaluate the impacts of chemical cleaning with these solutions on waste tank integrity. Manageable corrosion rates were observed in the concentration ranges of interest for an acid contact timescale of 1 month. Kinetics tests involving hematite and gibbsite (a primary sludge aluminum phase) have confirmed that {ge}90% solids dissolution occurs within 3 weeks. Based on these results, the chemical cleaning conditions recommended to promote minimal oxalate usage and manageable corrosion include: 0.5 wt. % oxalic acid/0.175 M nitric acid mixture, 50 C, 2-3 week contact time with agitation.

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




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.



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

E-print Network

The purpose of the present study was to determine the effects of a plantar pressure-based, tongue-placed tactile biofeedback on postural control mechanisms during quiet standing. To this aim, sixteen young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements, recorded using a force platform, were used to compute the horizontal displacements of the vertical projection the centre of gravity (CoGh) and those of the difference between the CoP and the vertical projection of the CoG (CoP-CoGv). Altogether, the present findings suggest that the main way the plantar pressure-based, tongue-placed tactile biofeedback improves postural control during quiet standing is via both a reduction of the correction thresholds and an increased efficiency of the corrective mechanism involving the CoGh displacements.

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




PubMed Central

Purpose: To determine if heel height alters sagittal plane knee kinematics when landing from a forward hop or drop landing. Background: Knee angles close to extension during landing are theorized to increase ACL injury risk in female athletes. Methods: Fifty collegiate females performed two single-limb landing tasks while wearing heel lifts of three different sizes (0, 12 & 24 mm) attached to the bottom of a sneaker. Using an electrogoniometer, sagittal plane kinematics (initial contact [KAIC], peak flexion [KAPeak], and rate of excursion [RE]) were examined. Repeated measures ANOVAs were used to determine the influence of heel height on the dependent measures. Results: Forward hop task- KAIC with 0 mm, 12 mm, and 24 mm lifts were 8.88±6.5, 9.38±5.8 and 11.28±7.0, respectively. Significant differences were noted between 0 and 24 mm lift (p<.001) and 12 and 24 mm lifts (p=.003), but not between the 0 and 12 mm conditions (p=.423). KAPeak with 0 mm, 12 mm, and 24 mm lifts were 47.08±10.9, 48.18±10.3 and 48.88±9.7, respectively. A significant difference was noted between 0 and 24 mm lift (p=.004), but not between the 0 and 12 mm or 12 and 24 mm conditions (p=.071 and p=.282, respectively). The RE decreased significantly from 2128/sec±52 with the 12 mm lift to 1958/sec±55 with the 24 mm lift (p=.004). RE did not differ from 0 to 12 or 0 to 24 mm lift conditions (p=.351 and p=.086, respectively). Jump-landing task- No significant differences were found in KAIC (p=.531), KAPeak (p=.741), or the RE (p=.190) between any of the heel lift conditions. Conclusions: The addition of a 24 mm heel lift to the bottom of a sneaker significantly alters sagittal plane knee kinematics upon landing from a unilateral forward hop but not from a drop jump. PMID:21904697

Carcia, Christopher R.; Phelps, Amy L.; Martin, RobRoy L.; Burrows, Anne M.



Assessment of Diabetic Polyneuropathy and Plantar Pressure in Patients with Diabetes Mellitus in Prevention of Diabetic Foot  

PubMed Central

Introduction: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities. Material and methods: In the prospective research to assessed diabetic neuropathy in diabetic patients, to determined the dynamic function of the foot (plantar pressure), by using pedobarography (Group I), and after the use of orthopedic insoles with help of pedobarography, to determined the connection between the risk factors: deformity of the foot, limited joint movements, diabetic polyneuropathy, plantar pressure in effort preventing changes in the diabetic foot. Results: Out of 1806 patients, who are registered in one Team of family medicine examined 100 patients with diabetes mellitus Type 2. The average age of subjects was 59.4, SD11.38. The average HbA1c was 7.78% SD1.58. Combining monofilament and tuning fork tests, the diagnosis of polyneuropathy have 65% of patients. Comparing Test Symptom Score individual parameters between the first and second measurement, using pedobarography, in Group I, statistically significant difference was found for all of the assessed parameters: pain, burning sensation, paresthesia and insensitivity (p<0,05). The measurements of peak pressure, both first and the second measurement, for all of the subjects in Group I(45) show values above 200kPa. That’s a level of pressure that needs to be corrected. The study finds correlation between the foot deformation, diabetic polyneuropathy and plantar pressure (p>0,05). Conclusion: A detail clinical exam of diabetic food in a family doctor office equipped with pedobarography (plantar pressure measurements), use of orthopedic insoles, significantly reduces clinical symptoms of diabetic polyneuropathy in patients with diabetes. PMID:25650237

Skopljak, Amira; Sukalo, Aziz; Batic-Mujanovic, Olivera; Muftic, Mirsad; Tiric-Campara, Merita; Zunic, Lejla



Chronic sorrow  

Microsoft Academic Search

The concept of chronic sorrow has been used to describe the reaction of parents to the ongoing losses associated with caring for a child with chronic illness or disability. A middle-range theory of chronic sorrow provides a framework for further understanding of this phenomenon. This theory is applied to a case of a family burdened with the unrelenting stress of

Jean M. Scornaienchi



Interdigital dermatitis, heel horn erosion, and digital dermatitis in 14 Norwegian dairy herds.  


The aim of this study was to assess infectious foot diseases, including identification and characterization of Dichelobacter nodosus and Treponema spp., in herds having problems with interdigital dermatitis (ID) and heel horn erosion (E) and in control herds expected to have few problems. We also wanted to compare diseased and healthy cows in all herds. The study included 14 dairy herds with a total of 633 cows. Eight herds had a history of ID and E, and 6 were control herds. All cows were scored for lameness, and infectious foot diseases on the hind feet were recorded after trimming. Swabs and biopsies were taken from the skin of 10 cows in each herd for bacterial analyses. In total, samples were taken from 34 cows with ID, 11 with E, 40 with both ID and E, and 8 with digital dermatitis (DD), and from 47 cows with healthy feet. Swabs were analyzed for identification and characterization of D. nodosus by PCR, culture, virulence testing, and serotyping. Biopsies were analyzed by fluorescent in situ hybridization regarding histopathology, identification, and characterization of Treponema spp., and identification of D. nodosus. Interdigital dermatitis was the most frequent foot disease, with a prevalence of 50.4% in problem herds compared with 26.8% in control herds. Heel horn erosion was recorded in 34.8% of the cows in problem herds compared with 22.1% in control herds. Dichelobacter nodosus was detected in 97.1% of the cows with ID, in 36.4% with E, in all cows with both ID and E, in all cows with DD, and in 66.0% of cows with healthy feet. All serogroups of D. nodosus except F and M were detected, and all isolates were defined as benign by the gelatin gel test. Treponema spp. were detected in 50.0% of the cows with ID, in 9.1% with E, in 67.5% with ID and E, in all cows with DD, and in 6.4% of those with healthy feet. In total, 6 previously described phylotypes (PT) of Treponema were detected: PT1, PT3, PT6, PT13, and PT15 in cows with ID, PT1 in a cow with E, and PT1, PT2, PT3, PT6, and PT13 in cows with both ID and E. One new phylotype (PT19) was identified. The epidermal damage score was higher but the difference in inflammatory response of the dermis was minor in cows with ID versus those with healthy feet. Fisher's exact test revealed an association between ID and D. nodosus, and between ID and Treponema spp. Logistic regression revealed an association between both ID and E and dirty claws (odds ratios=1.9 and 2.0, respectively). Our study indicates that D. nodosus, Treponema spp., and hygiene are involved in the pathogenesis of ID. PMID:24140335

Knappe-Poindecker, M; Gilhuus, M; Jensen, T K; Klitgaard, K; Larssen, R B; Fjeldaas, T



Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function.  


A specific training program emphasizing the neuromuscular recruitment of the plantar intrinsic foot muscles, colloquially referred to as "short foot" exercise (SFE) training, has been suggested as a means to dynamically support the medial longitudinal arch (MLA) during functional tasks. A single-group repeated measures pre- and post-intervention study design was utilized to determine if a 4-week intrinsic foot muscle training program would impact the amount of navicular drop (ND), increase the arch height index (AHI), improve performance during a unilateral functional reaching maneuver, or the qualitative assessment of the ability to hold the arch position in single limb stance position in an asymptomatic cohort. 21 asymptomatic subjects (42 feet) completed the 4-week SFE training program. Subject ND decreased by a mean of 1.8 mm at 4 weeks and 2.2 mm at 8 weeks (p < 0.05). AHI increased from 28 to 29% (p < 0.05). Intrinsic foot muscle performance during a static unilateral balancing activity improved from a grade of fair to good (p < 0.001) and subjects experienced a significant improvement during a functional balance and reach task in all directions with the exception of an anterior reach (p < 0.05). This study offers preliminary evidence to suggest that SFE training may have value in statically and dynamically supporting the MLA. Further research regarding the value of this exercise intervention in foot posture type or pathology specific patient populations is warranted. PMID:23632367

Mulligan, Edward P; Cook, Patrick G



Characterization of SPINK9, a KLK5-specific inhibitor expressed in palmo-plantar epidermis.  


SPINK9, a Kazal-type serine protease inhibitor, is almost exclusively expressed in the palmo-plantar epidermis. SPINK9 selectively inhibits kallikrein-related peptidase 5 (KLK5), no other target enzyme is known at present. In this study, we defined the reactive loop to residues 48 and 49 of SPINK9 and characterized the inhibition and binding of different SPINK9 variants towards KLK5, KLK7, KLK8 and KLK14. Substitutions of single amino acids in the reactive loop had a large impact on both inhibitory efficiency and specificity. Binding studies showed that it is mainly the dissociation rate that is affected by the amino acid substitutions. The inhibitory effect of wild-type SPINK9 was clearly pH-dependent with an improved effect at a pH similar to that of the outer layers of the skin. Modeling of the enzyme-inhibitor complexes showed that the reactive loop of SPINK9 fits very well into the deep negatively charged binding pocket of KLK5. A decrease in pH protonates His48 of the wild-type protein resulting in a positively charged residue, thereby explaining the observed decreased dissociation rate. Interestingly, substitution with a positively charged amino acid at position 48 resulted in a more efficient inhibitor at higher pH. PMID:22505519

Brännström, Kristoffer; Ohman, Anders; von Pawel Rammingen, Ulrich; Olofsson, Anders; Brattsand, Maria



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. PMID:24688595

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



[Systemic infusion therapy versus retrograde intravenous perfusion: comparative results in patients with diabetic neuropathic plantar ulcer].  


Concerning the resistance of diabetic neuropathic plantar ulcers (DNPU) against systemically applied drugs, the "Retrograde Venous Perfusion" (RVP) was introduced as a therapeutic alternative by C. P. Ferreira in 1988. An isotonic saline solution containing gentamycin, buflomedil, dexamethasone, heparin and lignocain is injected into a dorsal foot vein under arterial occlusion of the lower leg. In the present study RVP treatment was done in 20 patients with DNPU and the results were compared to a group treated with systemic intravenous infusions (SVI; n = 20). After 10 days of treatment, 8 out of 20 ulcers were closed (SVI: 4). In 9 ulcers (SVI: 4) size had diminuted by > 30%. Non responders were not observed under RVP in contrast to SVI (7/20 cases). In 4 of 5 patients with osteolytic bone lesions (SVI: 0/7), partial restoration was observed. Rate of toe amputation dropped to 0% (SVI: 20%). Considering the striking differences between either regimen, RVP can be recommended for treatment of DNPU especially when complicated by osteomyelitis. PMID:8379178

Seidel, C; Bühler-Singer, S; Richter, U G; Hornstein, O P



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


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

Trégouët, Paul; Merland, François



Correlation between maximum in-shoe plantar pressures and clubhead speed in amateur golfers.  


Disagreements exist in the literature regarding the manner in which weight should be dynamically shared during the golf swing, both within-feet and between the back- and target-foot, to generate maximal clubhead speed. The purpose of this study was to determine whether preferential foot-loading locations underlie weight sharing by examining the correlation between clubhead speed and maximum plantar pressure (PP) distributions. Thirty-two amateur golfers with handicap indexes ranging from 2.7 to 25 performed 10 driver swings on artificial turf following a warm-up. PP distributions were recorded at 100 Hz, and clubhead speed was recorded using a ball-tracking Doppler radar system. Maximum PPs were extracted from a 2-s window approximately centred on ball contact and were regressed against clubhead speed. Significance was assessed over the entire foot surface using statistical parametric mapping (SPM), a spatially continuous technique. SPM revealed, at relatively high anatomical resolution, significant positive correlations between clubhead speed and PPs in the lateral target-foot (P < 0.05). This suggests that not only weight transfer but also weight-transfer location may be an important determinant of clubhead speed in amateur golfers. PMID:25010946

Pataky, Todd Colin



Palmar-plantar erythrodysesthesia (PPE): a literature review with commentary on experience in a cancer centre.  


Palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome (HFS) is a relatively common side effect of cytotoxic chemotherapy. Many cytotoxic drugs have been reported to cause the condition but it is more frequently associated with 5 fluorouracil (5FU), liposomal doxorubicin and cytarabine. The oral 5FU precursor, capecitabine is frequently associated with PPE and with the recent extension of its use to adjuvant treatment, the incidence of PPE is likely to increase. The initial symptoms are dysesthesia and tingling in the palms, fingers and soles of feet and erythema, which may progress to burning pain with dryness, cracking, desquamation, ulceration and oedema. Palms of the hands are more frequently affected than soles of the feet. This condition is painful and distressing to patients and in some incidences it results in patients not being able to work or perform normal daily activities. It can also result in treatment interruptions which impact on the efficacy of the treatment regimen. Effective and appropriate patient education from a specialist nurse prior to treatment is an essential part of patient management which will facilitate early identification of the symptoms and therefore prevent treatment delays and PPE progression. This article reviews current knowledge of the condition, including classification, and discussion of the findings of a clinical audit in a cancer centre. It includes the incidence, grading, management and impact of PPE on normal daily activities. PMID:17350337

Webster-Gandy, Joan D; How, Chris; Harrold, Karen



A two-phase model of plantar tissue: a step toward prediction of diabetic foot ulceration.  


A new computational model, based on the thermodynamically constrained averaging theory, has been recently proposed to predict tumor initiation and proliferation. A similar mathematical approach is proposed here as an aid in diabetic ulcer prevention. The common aspects at the continuum level are the macroscopic balance equations governing the flow of the fluid phase, diffusion of chemical species, tissue mechanics, and some of the constitutive equations. The soft plantar tissue is modeled as a two-phase system: a solid phase consisting of the tissue cells and their extracellular matrix, and a fluid one (interstitial fluid and dissolved chemical species). The solid phase may become necrotic depending on the stress level and on the oxygen availability in the tissue. Actually, in diabetic patients, peripheral vascular disease impacts tissue necrosis; this is considered in the model via the introduction of an effective diffusion coefficient that governs transport of nutrients within the microvasculature. The governing equations of the mathematical model are discretized in space by the finite element method and in time domain using the ?-Wilson Method. While the full mathematical model is developed in this paper, the example is limited to the simulation of several gait cycles of a healthy foot. PMID:24841993

Sciumč, G; Boso, D P; Gray, W G; Cobelli, C; Schrefler, B A



An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heel strike and midstance of gait.  


Presently, there are multiple nonoperative techniques a surgeon can use to alleviate the pain of an osteoarthritic joint including: oral medications, physical therapy, injections and off-loading knee braces. The objective of this study was to analyze subjects under in vivo, dynamic conditions using fluoroscopy to determine if off-loading knee braces actually separate the femoral condyle from the tibial plateau during the mid-stance and heel-strike phases of gait. Forty subjects with substantial unicompartmental osteoarthritis were studied under fluoroscopic surveillance in the frontal plane while performing normal gait on a treadmill. The subjects were patients of one surgeon and were all clinically diagnosed to have marked unicompartimental degenerative joint space narrowing. Initially, each subject was asked to perform normal gait on a treadmill under fluoroscopic surveillance in the frontal plane. An offloading osteoarthritic knee brace was then fixated on the osteoarthritic knee joint. The subjects were then asked to walk on level ground while wearing the brace to rate the effectiveness of the brace in alleviating pain. The subjects were then asked to perform normal gait on a treadmill while wearing the brace. Successive fluoroscopic images of each patient at mid-stance and heel-strike (with and without a brace) were downloaded to a workstation computer. The captured fluoroscopic images were then analyzed using digitization. Thirty-four of forty subjects (85%) judged the osteoarthritic knee brace effective in reducing knee pain. Six of the subjects (15%) were not able to detect a change in knee pain. All of these subjects were overweight resulting in suboptimal brace fixation. Thirty-one of forty subjects (78%) demonstrated articular separation of the degenerative knee compartment at heel-strike and 28/40 (70%) at midstance. Thirty-one of forty subjects (78%) experienced an angular change at heel-strike, while 37/40 experienced an angular change at mid-stance. The average amount of change in condylar separation (A) was 1.7 mm (0.0-6.4) at heel-strike and 1.9 mm (0.0-7.9) at mid-stance. The average amount of change in angle ?S was 2.0 degrees (0.0-4.8 degrees) at heel-strike and 1.6 degrees (0.0-5.1) at mid-stance. Previous biomechanical studies have documented excessive loads in degenerative compartments of patients with unicompartmental arthrosis and associated angular deformities. Offloading braces have been developed to attempt to lessen loads in the degenerative compartment with subsequent reductions in knee pain. This present study demonstrates in vivo articular separation of degenerative knee compartments can be achieved with offloading braces with subsequent subjective relief of knee pain. These braces may have limited effectiveness in obese patients. Key words: osteoarthritis of the knee, a knee brace, conservative treatment. PMID:20478172

Dennis, A D; Komistek, R D



A new ankle spanning fixator construct for distal tibia fractures: optimizing visualization, minimizing pin problems, and protecting the heel.  


Pilon and ankle fractures and ligamentous injuries about the ankle often require external fixation to allow for soft tissue stabilization before definitive surgery. Often used external fixator constructs can cause obscuring of the site of injury on radiographs, pin tract infections, loosening of calcaenal pin fixation, and heel ulcerations. A novel and simple technique of placing the calcaneal pins posteriorly and using a U-shaped bar allows for a construct that reduces or eliminates many of these drawbacks during the time it takes for soft tissue swelling to permit definitive fixation. PMID:22648040

Ziran, Bruce H; Morrison, Troy; Little, Jill; Hileman, Barbara



Monochloroacetic Acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: a randomized controlled trial.  


Cryotherapy and salicylic acid (SA) often fail as treatments for skin warts. We examined the effectiveness of monochloroacetic acid (MCA) for patients with common or plantar warts. Consecutive patients aged 4 years and older with one or more newly diagnosed common or plantar warts were recruited in 53 Dutch general practices. We randomly allocated eligible patients to 13-week treatment protocols of office-applied MCA versus liquid nitrogen cryotherapy every 2 weeks for patients with common warts (n=188), and MCA versus cryotherapy combined with daily SA self-application for patients with plantar warts (n=227). The primary outcome was the proportion of patients whose warts were all cured at 13 weeks. In the common wart group, cure rates were 40/92 (43%, 95% confidence interval 34-54) for MCA and 50/93 (54%, 44-64) for cryotherapy (risk difference (RD) -10%, -25-4.0, P=0.16). In the plantar wart group, cure rates were 49/106 (46%, 37-56) for MCA and 45/115 (39%, 31-48) for cryotherapy combined with SA (RD 7.1, 5.9-20, P=0.29). For common warts, MCA is an effective alternative to cryotherapy to avoid pain during the treatment, although pain after the treatment is similar. For plantar warts, office-applied MCA may be preferred over cryotherapy combined with SA, on the basis of comparable effectiveness, less treatment pain, and less treatment burden. PMID:25584800

Bruggink, Sjoerd C; Gussekloo, Jacobijn; Egberts, Paulette F; Bavinck, Jan Nico Bouwes; de Waal, Margot W M; Assendelft, Willem J J; Eekhof, Just A H



A pilot study of a plantar sensory evaluation system for early screening of diabetic neuropathy in a weight-bearing position.  


The purpose of this study is to develop smart equipment to quantify plantar tactile sensibility for the early diagnosis and tracking of peripheral neuropathy caused by diabetes mellitus. In this paper, we offer a new testing system that is composed of a plantar tactile stimulation platform with a small moving contactor to stretch the skin tangentially, a response switch for each tactile stimulus, a motor control box, and a personal computer (PC) for psychophysical data processing. This quantitative sensory testing system has detailed measurements available and is easy to use compared with the conventional testing devices, such as von Frey monofilaments, pin-prick testing devices, and current perception threshold testers. When using our testing system in a weight-bearing position, we observed that the plantar tactile thresholds for the tangential stretching stimulus on the plantar surface of the foot ranged from approximately 10 um to 30 um for healthy subjects. However, the threshold for a subject with diabetes was nearly three times higher than that for healthy subjects. The significant difference between these values suggests that the plantar sensory evaluation system using the lateral skin stretch stimulation can be used for early diagnosis, for the accurate staging of diabetic neuropathy, and for evaluating its progression noninvasively in a clinic and at home. PMID:25570747

Ino, Shuichi; Chikai, Manabu; Takahashi, Noriyo; Ohnishi, Tadasuke; Doi, Kohki; Nunokawa, Kiyohiko



Chronic kidney disease  


Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure ... Chronic kidney disease (CKD) slowly gets worse over months or years. you may not notice any symptoms for some ...



SciTech Connect

During sluicing operations of tank 241-C-110, a significant amount of solids were unable to be retrieved. These solids (often referred to as the tank 'heel') were sampled in 2010 and chemically and mineralogically analyzed in the 222-S Laboratory. Additionally, dissolution tests were performed to identify the amount of undissolvable material after using multiple water contacts. This report covers the solid phase characterization of six samples from these tests using scanning electron microscopy, polarized light microscopy, and X-ray diffraction. The chemical analyses, particle size distribution analysis, and dissolution test results are reported separately. Two of the samples were from composites created from as-received material - Composite A and Composite B. The main phase in these samples was sodium-fluoride-phosphate hydrate (natrophosphate) - in the X-ray diffraction spectra, this phase was the only phase identifiable. Polarized light microscopy showed the presence of minor amounts of gibbsite and other phases. These phases were identified by scanning electron microscopy - energy dispersive X-ray spectroscopy as sodium aluminosilicates, sodium diuranate, and sodium strontium phosphate hydrate (nastrophite) crystals. The natrophosphate crystals in the scanning electron microscopy analysis showed a variety of erosive and dissolution features from perfectly shaped octahedral to well-rounded appearance. Two samples were from water-washed Composites A and B, with no change in mineralogy compared to the as-received samples. This is not surprising, since the water wash had only a short period of water contact with the material as opposed to the water dissolution tests. The last two samples were residual solids from the water dissolution tests. These tests included multiple additions of water at 15 C and 45 C. The samples were sieved to separate a coarser fraction of > 710 {mu}m and a finer fraction of < 710 {mu}m. These two fractions were analyzed separately. The coarser fraction contained mostly gibbsite with minor amounts of sodium aluminosilicates (cancrinite) and bismuth aluminum-rich phases. The finer fraction was mostly composed of gibbsite, the sodium alumino silicate phase, cancrinite, and a poorly crystalline to non-crystalline phase containing varying amounts of iron, bismuth, aluminum, and phosphorus.




Bats go head-under-heels: the biomechanics of landing on a ceiling.  


Bats typically roost head-under-heels but they cannot hover in this position, thus, landing on a ceiling presents a biomechanical challenge. To land, a bat must perform an acrobatic flip that brings the claws of the toes in contact with the ceiling and do so gently enough as to avoid injury to its slender hindlimbs. In the present study, we sought to determine how bats land, to seek a link between landing kinematics and ceiling impact forces, and to determine whether landing strategies vary among bat species. To do this, we measured the kinematics and kinetics of landing behaviour in three species of bats as they landed on a force-measuring platform (Cynopterus brachyotis, N=3; Carollia perspicillata, N=5; Glossophaga soricina, N=5). Kinematics were similar for all bats within a species but differed among species. C. brachyotis performed four-point landings, during which body pitch increased until the ventral surface of the body faced the ceiling and the thumbs and hindlimbs simultaneously grasped the surface. Bats of the other two species performed two-point landings, whereby only the hindlimbs made contact with the ceiling. During these two-point landings, the hindlimbs were drawn up the side of the body to come in contact with the ceiling, causing simultaneous changes in body pitch, roll and yaw over the course of the landing sequence. Right-handed and left-handed forms of the two-point landing were observed, with individuals often switching back and forth between them among landing events. The four-point landing of C. brachyotis resulted in larger peak forces (3.7+/-2.4 body weights; median +/- interquartile range) than the two-point landings of C. perspicillata (0.8+/-0.6 body weights) or G. soricina (0.8+/-0.2 body weights). Our results demonstrate that the kinematics and kinetics of landing vary among bat species and that there is a correlation between the way a bat moves its body when it lands and the magnitude of peak impact force it experiences during that landing. We postulate that these interspecific differences in impact force could result because of stronger selective pressure for gentle landing in cave-roosting (C. perspicillata, G. soricina) versus foliage-roosting (C. brachyotis) species. PMID:19282491

Riskin, Daniel K; Bahlman, Joseph W; Hubel, Tatjana Y; Ratcliffe, John M; Kunz, Thomas H; Swartz, Sharon M



Segmental near nerve sensory conduction studies of the medical and lateral plantar nerve.  


Tarsal Tunnel Syndrome (TTS) can be difficult to diagnose: electrophysiologic corroboration is important and has therapeutic implications. Conventional electrodiagnostic techniques are insensitive: motor latency abnormalities exist in only 52%; sensory responses are frequently absent (a nonlocalizing finding). Additionally, previously described near nerve techniques do not isolate conduction velocity (CV) measurement to the short segment across the flexor retinaculum (FR), which would theoretically improve sensitivity. We describe a technique which allows for the determination of segmental sensory CVs of the medial (MP) and lateral (LP) plantar nerves, both below (BFR) and across (AFR) the FR. Seventeen normal patients (age 22-45) were studied. Near nerve recording electrodes were positioned close to the specified nerve below and above the FR. Ring electrode stimulation (RES) of digits I (MP) or V (LP) and direct near nerve stimulation (NNS) BFR were performed. With RES digit I (n = 17), mean CV (toe to BFR) was 39.0 +/- 7.1 m/s; CV (AFR) 47.9 +/- 6.2 m/s. CV (AFR) following NNS (MP) (n = 16) was 49.4 +/- 5.1 m/s. With RES digit V (n = 10), mean CV (toe to BFR) was 36.4 +/- 3.4 m/s; CV (AFR) 57.5 +/- 6.9 m/s. CV (AFR) with NNS (LP) (n = 14) was 59.8 +/- 6.2 m/s. In conclusion, segmental MP and LP sensory CVs can be reliably obtained with near nerve technique. This approach may improve the diagnostic sensitivity of EMG in TTS. PMID:8957166

David, W S; Doyle, J J



Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait  

Microsoft Academic Search

The purposes of this study were to determine the effects of tendon Achilles lengthening (TAL) on ambulatory plantar pressures and ankle range of motion, moment, and power, and to determine whether changes in forefoot pressure after treatment of a neuropathic ulcer are related to changes in ankle dorsiflexion range of motion (DFROM) or plantar flexor (PF) power during gait. Pressure

K. S. Maluf; M. J. Mueller; M. J Strube; J. R. Engsberg; J. E. Johnson



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. PMID:21803954

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



Effectiveness of Removable Walker Cast Versus Nonremovable Fiberglass Off-Bearing Cast in the Healing of Diabetic Plantar Foot Ulcer  

PubMed Central

OBJECTIVE To evaluate the efficacy of a removable cast walker compared with that of a nonremovable fiberglass off-bearing cast in the treatment of diabetic plantar foot ulcer. RESEARCH DESIGN AND METHODS Forty-five adult diabetic patients with nonischemic, noninfected neuropathic plantar ulcer were randomly assigned for treatment with a nonremovable fiberglass off-bearing cast (total contact cast [TCC] group) or walker cast (Stabil-D group). Treatment duration was 90 days. Percent reduction in ulcer surface area and total healing rates were evaluated after treatment. RESULTS A total of 48 patients were screened; however, 2 patients in the TCC group and 1 patient in the Stabil-D group did not complete the study and were considered dropouts. There were no significant differences in demographic and clinic characteristics of the 45 patients completing the study. Ulcer surface decreased from 1.41 to 0.21 cm2 (P < 0.001) in the TCC group and from 2.18 to 0.45 cm2 (P < 0.001) in the Stabil-D group, with no significant differences between groups (P = 0.722). Seventeen patients (73.9%) in the TCC group and 16 patients (72.7%) in the Stabil-D group achieved healing (P = 0.794). Average healing time was 35.3 ± 3.1 and 39.7 ± 4.2 days in the TCC and Stabil-D group, respectively (P = 0.708). CONCLUSIONS The Stabil-D cast walker, although removable, was equivalent in efficacy to the TCC in terms of ulcer size reduction and total healing rate. The easier use of Stabil-D may help increase the use of off-loading devices in the management of plantar neuropathic diabetic foot ulcers. PMID:20357377

Faglia, Ezio; Caravaggi, Carlo; Clerici, Giacomo; Sganzaroli, Adriana; Curci, Vincenzo; Vailati, Wanda; Simonetti, Daniele; Sommalvico, Francesco



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


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

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



Plantar pressure relief under the metatarsal heads - Therapeutic insole design using three-dimensional finite element model of the foot.  


Therapeutic footwear with specially-made insoles is often used in people with diabetes and rheumatoid arthritis to relieve ulcer risks and pain due to high pressures from areas beneath bony prominences of the foot, in particular to the metatarsal heads (MTHs). In a three-dimensional finite element study of the foot and footwear with sensitivity analysis, effects of geometrical variations of a therapeutic insole, in terms of insole thicknesses and metatarsal pad (MP) placements, on local peak plantar pressure under MTHs and stress/strain states within various forefoot tissues, were determined. A validated musculoskeletal finite element model of the human foot was employed. Analyses were performed in a simulated muscle-demanding instant in gait. For many design combinations, increasing insole thicknesses consistently reduce peak pressures and internal tissue strain under MTHs, but the effects reach a plateau when insole becomes very thick (e.g., a value of 12.7mm or greater). Altering MP placements, however, showed a proximally- and a distally-placed MP could result in reverse effects on MTH pressure-relief. The unsuccessful outcome due to a distally-placed MP may attribute to the way it interacts with plantar tissue (e.g., plantar fascia) adjacent to the MTH. A uniform pattern of tissue compression under metatarsal shaft is necessary for a most favorable pressure-relief under MTHs. The designated functions of an insole design can best be achieved when the insole is very thick, and when the MP can achieve a uniform tissue compression pattern adjacent to the MTH. PMID:25620685

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



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

PubMed Central

Background There is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Aims were to assess differences and variability between and within the disciplines. The relationship between the importance of pressure reduction and the effect on peak pressure was also evaluated. Methods Each therapist examined all three patients and was asked to rate the 'importance of pressure reduction' through a visual analogue scale. The orthoses were evaluated twice in two sessions while the patient walked on a treadmill. Plantar pressures were recorded with an in-sole measuring system. Patients scored walking convenience per orthosis. The effects of the orthoses on peak pressure reduction were calculated for the whole plantar surface of the forefoot and six regions: big toe and metatarsal one to five. Results Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p < .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and pedorthotists. Conclusion The large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups. PMID:16368005

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



Comparison of the analgesic effect of ultrasound and low-level laser therapy in patients suffering from plantar fasciitis (calcar calcanei)  

NASA Astrophysics Data System (ADS)

To compare the effectiveness of the two therapeutic approaches, ultrasound and low level laser (LLLT) used in 181 patients suffering from calcar calcanei-plantar fasciitis. The effectiveness of the treatment was determined according to the evaluation of the patient using certain criteria described in the table. The complete disappearance of pain was seen in 50% of 60 patients treated with US and partial improvement in 16.6% and 69 patients were treated with LLLT from which 67% described complete pain relief, and 20% partial improvement. The results show that the LLLT is a good therapeutic approach in the treatment of pain in patients suffering from calcar calcanei-plantar fasciitis. The treatment with laser was significantly more successful then the ultrasound therapy, which is currently the most common therapy used for plantar fasciitis.

Navratil, Leos; Skopek, Jiri; Hronkova, Hana; Kymplova, Jaroslava; Knizek, Jiri



Nurses' use of water-filled gloves in preventing heel pressure ulcer in the University College Hospital, Ibadan, Nigeria.  


This cross-sectional descriptive survey examined use (knowledge, perception and practices) of water-filled gloves (WFGs) by nurses in the prevention of heel pressure ulcer (PU) in the University College Hospital (UCH), Ibadan, Nigeria. Participants were 250 purposively selected nurses working in the Neurosciences and Surgical units. Quantitative data were generated through the administration of a semi-structured questionnaire, whereas the qualitative data were collected through in-depth interview. Hypotheses were tested using chi-square analysis at a significance level of 0.05, whereas the manual content analysis was used to analyse the qualitative data. Results showed that a significant number of nurses at UCH, Ibadan, were knowledgeable about WFGs and actually used them in their clinical practice. Years of experience in clinical practice was found to be significantly related to knowledge and use of WFGs in heel PU (X(2) = 41·677; DF = 5; P = 0·001). Nurses with adequate knowledge of risk factors in the development of PU used WFGs more than those who were not aware (X(2) = 44·907; DF = 3; P = 0·009). Nurses' perception about WFGs was also significantly related to its use (X(2) = 4·527; DF = 1; P = 0·033). Although knowledge level and perception of WFGs and its use by nurses was fairly adequate, continuous education for practicing nurses should be encouraged in resource-limited settings. PMID:21073682

Adejumo, Prisca Olabisi; Ingwu, Justin Agorye



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


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



A case of tumour necrosis factor-? inhibitor- and rituximab-induced plantar pustular psoriasis that completely resolved with tocilizumab.  


Rituximab, a chimeric B-cell-depleting monoclonal antibody, is a well-established therapy for rheumatoid arthritis. It is emerging that classical psoriatic lesions and plantar pustular psoriasis (PPP) are cutaneous side-effects of this drug. Antitumour necrosis factor (anti-TNF) therapies have multiple documented side-effects including PPP and psoriasis. We report a patient who has rheumatoid arthritis, who failed on anti-TNF therapies and then was commenced on rituximab. Subsequently she developed localized PPP. Due to deterioration of her joint disease she was switched to the interleukin-6 blocker tocilizumab, and the PPP resolved. PMID:24890762

Jayasekera, P; Parslew, R; Al-Sharqi, A



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


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

Fitzgerald, Ryan H; Vedpathak, Anuja



Chronic pancreatitis  

PubMed Central

Purpose of review We review selected important clinical observations reported in 2012. Recent findings Celiac disease is a risk factor for pancreatitis. Patients with recurrent acute pancreatitis likely have chronic pancreatitis, do not benefit from pancreatic sphincterotomy, and may not benefit from biliary sphincterotomy. Analysis of endoscopic ultrasonography (EUS) images with an artificial neural network (ANN) program may improve chronic pancreatitis diagnosis compared with clinical interpretation of images. In a multicenter, randomized controlled trial of chronic pancreatitis patients, 90 000 USP U of pancreatin with meals decreased fat malabsorption compared with placebo. Detection of visceral pain in chronic pancreatitis predicts pain relief from various treatments, but nonvisceral pain due to altered central pain processing may respond to agents such as pregabalin. Predictors of surgical pain relief include onset of symptoms less than 3 years and preoperatively no opioid use and less than five endoscopic procedures. Total pancreatectomy for presumed painful chronic pancreatitis remains controversial. Summary Celiacs are at risk for pancreatitis. The diagnosis of chronic pancreatitis may be enhanced by ANN analysis of EUS imaging. Treatment of fat malabsorption requires 90 000 USP U of lipase with meals. Relief of pain from organ directed treatment of chronic pancreatitis may depend upon timing of interventions and whether pain is visceral or nonvisceral. PMID:23852141

DiMagno, Matthew J.; DiMagno, Eugene P.



Correlation between Plantar Foot Temperature and Diabetic Neuropathy: A Case Study by Using an Infrared Thermal Imaging Technique  

PubMed Central

Background Diabetic neuropathy consists of multiple clinical manifestations of which loss of sensation is most prominent. High temperatures under the foot coupled with reduced or complete loss of sensation can predispose the patient to foot ulceration. The aim of this study was to look at the correlation between plantar foot temperature and diabetic neuropathy using a noninvasive infrared thermal imaging technique. Methods Infrared thermal imaging, a remote and noncontact experimental tool, was used to study the plantar foot temperatures of 112 subjects with type 2 diabetes selected from a tertiary diabetes centre in South India. Results Patients with diabetic neuropathy (defined as vibration perception threshold (VPT) values on biothesiometry greater than 20 V) had a higher foot temperature (32–35 °C) compared to patients without neuropathy (27–30 °C). Diabetic subjects with neuropathy also had higher mean foot temperature (MFT) (p = .001) compared to non-neuropathic subjects. MFT also showed a positive correlation with right great toe (r = 0.301, p = .001) and left great toe VPT values (r = 0.292, p = .002). However, there was no correlation between glycated hemoglobin and MFT. Conclusion Infrared thermal imaging may be used as an additional tool for evaluation of high risk diabetic feet. PMID:21129334

Bagavathiappan, Subramnaiam; Philip, John; Jayakumar, Tammana; Raj, Baldev; Rao, Pallela Narayana Someshwar; Varalakshmi, Muthukrishnan; Mohan, Viswanathan



Cortical and spinal excitability during and after lengthening contractions of the human plantar flexor muscles performed with maximal voluntary effort.  


This study was designed to investigate the sites of potential specific modulations in the neural control of lengthening and subsequent isometric maximal voluntary contractions (MVCs) versus purely isometric MVCs of the plantar flexor muscles, when there is enhanced torque during and following stretch. Ankle joint torque during maximum voluntary plantar flexion was measured by a dynamometer when subjects (n = 10) lay prone on a bench with the right ankle tightly strapped to a foot-plate. Neural control was analysed by comparing soleus motor responses to electrical nerve stimulation (M-wave, V-wave), electrical stimulation of the cervicomedullary junction (CMEP) and transcranial magnetic stimulation of the motor cortex (MEP). Enhanced torque of 17 ± 8% and 9 ± 8% was found during and 2.5-3 s after lengthening MVCs, respectively. Cortical and spinal responsiveness was similar to that in isometric conditions during the lengthening MVCs, as shown by unchanged MEPs, CMEPs and V-waves, suggesting that the major voluntary motor pathways are not subject to substantial inhibition. Following the lengthening MVCs, enhanced torque was accompanied by larger MEPs (p ? 0.05) and a trend to greater V-waves (p ? 0.1). In combination with stable CMEPs, increased MEPs suggest an increase in cortical excitability, and enlarged V-waves indicate greater motoneuronal output or increased stretch reflex excitability. The new results illustrate that neuromotor pathways are altered after lengthening MVCs suggesting that the underlying mechanisms of the enhanced torque are not purely mechanical in nature. PMID:23166794

Hahn, Daniel; Hoffman, Ben W; Carroll, Timothy J; Cresswell, Andrew G



Test-retest reliability of dynamic plantar loading and foot geometry measures in diabetics with peripheral neuropathy.  


Pedobarography is commonly employed in patients with diabetic peripheral neuropathy (DPN). However there is no evidence regarding test-retest reliability of this technique in this population, and therefore it was the purpose of the current study to address this clear gap. Dynamic plantar loading and foot geometry data were collected during barefoot gait with the EMED platform (Novel GmbH, Germany) from 10 patients with DPN over two sessions, separated by 28 days. Intra-class Correlation Coefficients (ICCs) and Coefficients of Variation (CoVs) were calculated to determine test-retest reliability. For dynamic plantar loading, reliability differed by outcome measure and foot region, with ICCs of >0.8 and CoVs of <15% observed in most cases. For dynamic foot geometry, ICCs of >0.88 and CoVs of <3% were observed for hallux angle, arch index and coefficient of spreading, while sub-arch angle was less reliable (ICC 0.76, CoV 23%). Overall, the current study observed high levels of test-retest reliability which were generally commensurate with that previously reported in healthy populations. PMID:22819069

Gurney, J K; Marshall, P W M; Rosenbaum, D; Kersting, U G



Treatment of the Secondary Defect on the First Metatarsophalangeal Joint Using the Medial Plantar Hallucal Artery Dorsal Perforator Flap.  


Injuries or burns to the dorsum of the first metatarsophalangeal (MTP) joint may develop scar formation, resulting in hyperextension contracture. Surgical correction of the deformity often produces a secondary defect. The purpose of this study is to report on the use of the medial plantar hallucal artery dorsal perforator flap for the treatment of such defect. From February 2010 to June 2011, 16 patients were treated. The mean preoperative hyperextension of the first MTP joint was 48 degrees. The mean size of the defects was 3.6 × 6 cm. The mean flap size was 4 × 6.5 cm. The mean pedicle length was 4 cm. All flaps survived completely. Patient follow-up lasted a mean of 14 months. At the final follow-up, the mean hyperextension of the first MTP joint was 9 degrees. After surgery, the mean Foot Function Index improved from 62 to 7. Almost all patients were satisfied with the results. Transferring the medial plantar hallucal artery dorsal perforator flap is a useful and reliable technique for the reconstruction of the secondary defect on the first MTP joint. PMID:25275474

Zhang, Xu; Bai, Guangqi; Zhang, Zhihong; Chen, Chao; Yu, Yadong; Shao, Xinzhong



Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?  

PubMed Central

Background The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics. Methodology/Principal Findings Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters. Conclusion/s Significance There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot. PMID:24278219

Deschamps, Kevin; Matricali, Giovanni Arnoldo; Roosen, Philip; Desloovere, Kaat; Bruyninckx, Herman; Spaepen, Pieter; Nobels, Frank; Tits, Jos; Flour, Mieke; Staes, Filip



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


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

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



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. PMID:17566048

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




PubMed Central

Background: Limited dorsiflexion range of motion (ROM) has been linked to lower limb injuries. Improving limited ankle ROM may decrease injury rates. Static stretching (SS) is ubiquitously used to improve ROM but can lead to decreases in force and power if performed prior to the activity. Thus, alternatives to improve ROM without performance decrements are needed. Objectives/Purpose: To compare the effects of SS and self massage (SM) with a roller massage of the calf muscles on ankle ROM, maximal voluntary contraction (MVC) force F100 (force produced in the first 100 ms of the MVC), electromyography (EMG of soleus and tibialis anterior) characteristics of the plantar flexors, and a single limb balance test. Methods: Fourteen recreationally trained subjects were tested on two separate occasions in a randomized cross?over design. After a warm up, subjects were assessed for passive dorsiflexion ROM, MVC, and a single?limb balance test with eyes closed. The same three measurements were repeated after 10 minutes (min) of rest and prior to the interventions. Following the pre?test, participants randomly performed either SS or SM for 3 sets of 30 seconds (s) with 10s of rest between each set. At one and 10 min post?interventions the participants repeated the three measurements, for a third and fourth cycle of testing. Results: Roller massage increased and SS decreased maximal force output during the post?test measurements, with a significant difference occurring between the two interventions at 10 min post?test (p < 0.05, ES = 1.23, 8.2% difference). Both roller massage (p < 0.05, ES = 0.26, ~4%) and SS (p < 0.05, ES = 0.27, ~5.2%) increased ROM immediately and 10 min after the interventions. No significant effects were found for balance or EMG measures. Conclusions: Both interventions improved ankle ROM, but only the self?massage with a roller massager led to small improvements in MVC force relative to SS at 10 min post?intervention. These results highlight the effectiveness of a roller massager relative to SS. These results could affect the type of warm?up prior to activities that depend on high force and sufficient ankle ROM. Level of Evidence: 2c PMID:24567860

Halperin, Israel; Aboodarda, Saied Jalal; Button, Duane C.; Andersen, Lars L.



Large heel soft tissue defects managed successfully with reverse medial crural fasciocutaneous flap: a 7-year single-center experience with 21 consecutive cases.  


The medial crural fasciocutaneous flap is a reliable cutaneous flap that can be used for soft tissue reconstruction in the extremities. The purpose of this article is to evaluate the application and clinical significance of this surgical technique in the reconstruction of heel soft tissue defects. Twenty-one cases of heel soft tissue defect between March 2005 and March 2012 were included in this study. Wound sizes varied from 5.0 × 5.5 to 7.5 × 10.0 cm. All cases were managed with a reverse medial crural fasciocutaneous flap. Patient demographics and case information were analyzed and are reported. The sizes of the reverse medial crural fasciocutaneous flap varied from 6.5 × 10.0 to 9.0 × 15.0 cm; the average size was 7.7 × 13.8 cm. Out of the 21 consecutive cases, 20 flaps survived intact and one flap underwent partial necrosis. Follow-up observations were conducted for 6-36 months. The cosmetic results were satisfactory, without apparent bulkiness; the weight-bearing outcomes were satisfactory. The donor site can be closed primarily or by skin graft. Reverse medial crural fasciocutaneous flap transfer is appropriate for the reconstruction of heel soft tissue defects. The method is safe and can cover large heel defects. PMID:25448373

Jing-Chun, Zhao; Kai, Shi; Jia-Ao, Yu; Chun-Jing, Xian; Lai-Jin, Lu; Chun-Hui, Xie



The Daily Tar Heel URL:  

E-print Network

The Daily Tar Heel URL: Current Date: Sun, 26 Sep 2010 13:05:26 -0400 Grant money to help scholars To benefit biomedical students in biology, physics and chemistry, as well as high-level math and applied sciences courses. The grant money

Sekelsky, Jeff


Chronic obstructive pulmonary disease  


COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... heart swelling and heart failure due to chronic lung disease) Pneumonia Pneumothorax Severe weight loss and malnutrition Thinning ...


Chronic Meningitis  


... not infections can cause chronic meningitis. They include sarcoidosis and certain disorders that cause inflammation, such as ... For disorders that are not infections, such as sarcoidosis and Behçet syndrome: Corticosteroids or other drugs that ...


Chronic pain.  


Essential facts Chronic pain is pain that persists or recurs for more than three months. It may be related to a condition, or may be pain from an injury or operation that continues after healing would usually take place. According to guidance from the Scottish Intercollegiate Guidelines Network (SIGN), around 18 per cent of Europe's population are currently affected by moderate to severe chronic pain. It has a considerable effect on quality of life, and can cause significant suffering and disability. PMID:25783253



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. PMID:23895323



A comparative study evoking a sensory action potential from the medial and lateral plantar nerves using the probe and ring method of stimulation.  


Nerve conduction studies (NCS) aid in the detection of foot nerve pathologies. However, there has been a debate on method of plantar nerves stimulation that is more effective; the ring method of stimulation or probe method of stimulation. This study aims at determining the one method that is more effective among the two methods of stimulating for eliciting proper responses. Thirty healthy adults, aged 19 to 55 years, free of any neurological disease were the subjects of the study. Values considered for determining the effectiveness of the stimulating technique were mean amplitudes of the evoked responses from medial and lateral plantar nerves. A significant increase in amplitude difference was noted in favor of the probe stimulation method. The amplitude difference noted in favor of the probe method of stimulation was double the values elicited by the ring method of stimulation in both the medial and lateral plantar nerves. Results suggest that the direct probe method of stimulation may be a more effective method of stimulating for the medial and lateral plantar nerves studies. PMID:20508349

Adam, Jamila K; Bechoo, Reneal; Rmaih, Wafaa S



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

SciTech Connect

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

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



Distribution of plantar pressures during gait in different zones of the foot in healthy children: the effects of laterality.  


Summary.-The objective was to determine whether gait is symmetric in healthy children 6-7 years of age and to assess the effects of laterality and the anatomical zone of the foot. 46 children were subjected to gait symmetry analysis in which the plantar and lateral pressures associated with kicking a ball, static balance, and dynamic support were measured. There were no significant differences in the average pressure exerted by the right and left feet based on the laterality of the child. Independent of each laterality test, a greater pressure on the right rearfoot was observed compared to the left rearfoot and on the left midfoot and forefoot compared to the right. PMID:25668074

Mayolas Pi, C; Arrese, A Legaz; Aparicio, A Villarroya; Masiŕ, J Reverter



[Chronic diarrhea].  


Defined by lasting more than four weeks - is a common but often challenging clinical scenario. It is important to be aware that diarrhoea means different things to different patients. The evaluation of chronic diarrhoea depends on taking an excellent history and careful physical examination as well as planning investigations thoughtfully. Functional diarrhea ist the most common cause of chronic diarrhea in the developed countries and motility disorders are more common than inflammatory, osmotic or secretory causes. In some cases categorizing patients by their stool characteristics can be helpful in directing further evaluation. PMID:25154689

Stelzer, Teresa; Heuss, Ludwig Theodor



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


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, Ĺsa; 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



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


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. PMID:24852223

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



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. PMID:24736650

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



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. PMID:23772163

Moon, Il Soo; Park, In-Sick



B cell receptor signaling in chronic lymphocytic leukemia  

PubMed Central

BCR signaling plays an important pathogenic role in chronic lymphocytic leukemia (CLL) and B cell lymphomas, based on structural restrictions of the BCR, and BCR-dependent survival and growth of the malignant B cells. In CLL and lymphoma subtypes, ligand-independent (“tonic”) and ligand-dependent BCR signaling have been characterized, which can involve mutations of BCR pathway components or be triggered by (auto-) antigens present in the tissue microenvironment. In CLL, based on high response rates and durable remissions in early-stage clinical trials, there is rapid clinical development of inhibitors targeting BCR-associated kinases (BTK, PI3K?), which will change treatment paradigms in CLL and other B cell malignancies. Here, we discuss the evolution of this field, from BCR-related prognostic markers, to mechanisms of BCR activation, and targeting of BCR-associated kinases, the emerging Achilles’ heel in CLL pathogenesis. PMID:23928062

Burger, Jan A.; Chiorazzi, Nicholas



Chronic Pain  

Microsoft Academic Search

The primary purposes of acute pain and the reason it is noxious are to interrupt ongoing activity in order to warn the sufferer of tissue damage, to discourage movement that might exacerbate injury or prevent healing, and to teach the organism to avoid the pain-producing circumstances. Therefore, it is no wonder that when pain persists to become chronic, many sufferers

Malcolm H. Johnson


Chronic Fatigue Syndrome  


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


Chronic Eosinophilic Leukemia  


... Espańol Chronic Myeloproliferative Neoplasms Treatment (PDQ®) Chronic Eosinophilic Leukemia Key Points for This Section Chronic eosinophilic leukemia ... include fever and feeling very tired. Chronic eosinophilic leukemia is a disease in which too many white ...


Chronic pain - resources  


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


Ear infection - chronic  


Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection ... Kerschner JE. Otitis media. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders ...


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. PMID:1970697

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



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


Chronic berylliosis  

Microsoft Academic Search

1.The key cases in terms of which the concept chronic berylliosis originally was formulated have been reviewed.2.Of 58 cases there was acceptable proof of exposure to beryllium agents in only 40.3.Beryllium was found in the lungs in only 20 instances, but had previously been reported in 8 additional cases.4.New diagnoses have been suggested for the remaining 30 of the original

G. W. H. Schepers



The stabilizing effect of orthotic devices on plantar flexion/dorsal extension and horizontal rotation of the ankle joint. An experimental cadaveric investigation.  


The mechanical stabilizing effect of nine different orthotic devices on physiological and pathological plantar flexion/dorsal extension and horizontal rotation of the ankle joint subjected to artificial lateral ligament lesions was investigated in 20 cadaveric ankle joints under standardized conditions using an experimental apparatus. All of the braces tested significantly reduced plantar flexion/dorsal extension, as well as internal/external/external horizontal rotation, under the experimental conditions. In so far as these results can be transposed into a clinical setting, our data favour that bracing significantly reduces the instability. But, other criteria, such as the stabilizing effect on talar tilt and anterior drawer sign, the price and the convenience of wearing such devices have to be taken into consideration when choosing the optimal brace. PMID:8973984

Bruns, J; Scherlitz, J; Luessenhop, S



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-Lefčvre 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-Lefčvre syndrome. We report herein a rare case of chronic arsenicosis in a patient from rural Bengal, whose all features mimic Papillon-Lefčvre syndrome. It is probably the first case of Papillon-Lefevre syndrome-like presentation in chronic arsenicosis from India. PMID:23776326

Das, Somak K.; Nath, Tanusree; Ghosal, Anirban; Jana, Chanchal K.



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


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



Comparison of plantar flexor musculotendinous stiffness, geometry, and architecture in male runners with and without a history of tibial stress fracture.  


Greater lower extremity joint stiffness may be related to the development of tibial stress fractures in runners. Musculotendinous stiffness is the largest contributor to joint stiffness, but it is unclear what factors contribute to musculotendinous stiffness. The purpose of this study was to compare plantar flexor musculotendinous stiffness, architecture, geometry, and Achilles tendon stiffness between male runners with and without a history of tibial stress fracture. Nineteen healthy runners (age = 21 ± 2.7 years; mass = 68.2 ± 9.3 kg; height = 177.3 ± 6.0 cm) and 19 runners with a history of tibial stress fracture (age = 21 ± 2.9 years; mass = 65.3 ± 6.0 kg; height = 177.2 ± 5.2 cm) were recruited from community running groups and the university's varsity and club cross-country teams. Plantar flexor musculotendinous stiffness was estimated from the damped frequency of oscillatory motion about the ankle follow perturbation. Ultrasound imaging was used to measure architecture and geometry of the medial gastrocnemius. Dependent variables were compared between groups via one-way ANOVAs. Previously injured runners had greater plantar flexor musculotendinous stiffness (P < .001), greater Achilles tendon stiffness (P = .004), and lesser Achilles tendon elongation (P = .003) during maximal isometric contraction compared with healthy runners. No differences were found in muscle thickness, pennation angle, or fascicle length. PMID:25320911

Pamukoff, Derek N; Blackburn, J Troy



A multidisciplinary team approach to hydroxyurea-associated chronic wound with squamous cell carcinoma.  


Hydroxyurea (HU) has been shown to induce a variety of cutaneous adverse reactions, including severe leg ulcers. This report shows a successful treatment of a HU-induced chronic wound associated with squamous cell carcinomas (SCC). A 62-year-old patient affected with polycythemia vera and treated with HU for 10 years, presented with a non healing ulcer on a left heel. The patient gave a history of suffering from the wound for over 2 years. Biopsy showed evidence of invasive SCC. The patient underwent Mohs surgery and a greater saphenous vein ablation for polycythemia vera-associated vascular complications. The wound consistently decreased in size following successive debridements and coverage with human skin equivalent. The wound healed completely after a 6-month period. A multidisciplinary team approach to the treatment proved to be effective resulting in healing of this multifactorial chronic ulcer. PMID:22099725

Stone, Tamar; Berger, Alexandra; Blumberg, Sheila; O'Neill, Daniel; Ross, Frank; McMeeking, Alexander; Chen, Weiliam; Pastar, Irena



Effects of long-term wearing of high-heeled shoes on the control of the body's center of mass motion in relation to the center of pressure during walking.  


High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. This study investigated the effects of habitual wearing of high-heeled shoes on the body's center of mass (COM) motion relative to the center of pressure (COP) during gait. Fifteen female experienced wearers and 15 matched controls walked with high-heeled shoes (7.3cm) while kinematic and ground reaction force data were measured and used to calculate temporal-distance parameters, joint moments, COM-COP inclination angles (IA) and the rate of IA changes (RCIA). Compared with inexperienced wearers, experienced subjects showed significantly reduced frontal IA with increased ankle pronator moments during single-limb support (p<0.05). During double-limb support (DLS), they showed significantly increased magnitudes of the frontal RCIA at toe-off and contralateral heel-strike, and reduced DLS time (p<0.05) but unaltered mean RCIA over DLS. In the sagittal plane experienced wearers showed significantly increased mean RCIA (p<0.05) and significant differences in the RCIA at toe-off and contralateral heel-strike (p<0.05). Significantly increased hip flexor moments and knee extensor moments at toe-off (p<0.05) were needed for forward motion of the trailing limb. The current results identified the change in the balance control in females after long-term use of high-heeled shoes, providing a basis for future design of strategies to minimize the risk of falling during high-heeled gait. PMID:24508016

Chien, Hui-Lien; Lu, Tung-Wu; Liu, Ming-Wei



Pathogenesis of canine interdigital palmar and plantar comedones and follicular cysts, and their response to laser surgery.  


This study documents the presence of comedones and follicular cysts of palmar and plantar interdigital skin as an underlying cause of recurrent dermatitis, and describes the use of a carbon dioxide laser to surgically remove lesions. The 28 dogs included in the study had: (i) recurrent lameness, pain, and nodules, or draining sinuses in the dorsal interdigital skin, (ii) failed to respond to antibiotic therapy, and (iii) were negative for Demodex mites and dermatophytes. All 28 had laser surgery; nine dogs had two surgical procedures and two dogs had three surgical procedures for lesion recurrence. Fifteen dogs had skin samples collected for histopathology. Clinical features in ventral interdigital skin included alopecia, callus-like thickening, and comedones. Histological features included hyperkeratosis, acanthosis, comedones and follicular cysts, furunculosis, draining sinuses, and scarring. Surface trauma to the ventral interdigital skin appeared to contribute to lesion development. Laser surgery allowed removal of multiple layers of cysts and adjacent hair follicles and the tracking and removal of sinuses. One dog was euthanized for orthopaedic lameness 1 month after laser surgery, but post-surgical follow-up (1.0-8.0 years - mean 3 years) from the remaining 27 dogs revealed that laser therapy of affected skin and adjacent hair follicles resulted in resolution of interdigital lesions in 25. Two dogs continued to develop interdigital cysts. PMID:18477329

Duclos, David D; Hargis, Ann M; Hanley, Patrick W



Velocity during Strength and Power Training of the Ankle Plantar and Dorsiflexor Muscles in Older Patients Attending Day Hospital Rehabilitation  

PubMed Central

Power training has been proposed as a more effective type of resistance training for older adults for functional performance. It is not yet known whether older adults respond appropriately to instructions for power versus strength training. The purpose of this study was to determine the velocity during strength and power training, with elastic resistance bands, in older adults attending a geriatric rehabilitation day program. It was hypothesized that power training would be faster than strength training, but that there would be large interindividual differences. Nine older patients (70 to 86 years) performed power and strength training of the ankle dorsiflexor and plantar flexor muscles using elastic resistance bands. Training sessions were filmed to assess the velocity of training. Power training occurred at faster velocities as compared to strength training (P < 0.01) for both muscle groups. However, a wide variation was observed between participants in the training velocities. Older adults attending geriatric rehabilitation do have the potential to develop faster contractions during power training as compared to strength training. Nevertheless, the actual velocities achieved differed between individuals. This could explain some of the mixed findings of studies on power training. Hence, researchers should monitor velocity when comparing different types of resistance training. PMID:25802760

Porter, Michelle M.



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. PMID:24847201

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



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

NASA Astrophysics Data System (ADS)

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

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



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

NASA Astrophysics Data System (ADS)

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

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



Musculoskeletal Adaptations in Chronic Spinal Cord Injury: Effects of Long-term Soleus Electrical Stimulation Training  

PubMed Central

Objective The purpose of this study was to determine whether long-term electrical stimulation training of the paralyzed soleus could change this muscle’s physiological properties (torque, fatigue index, potentiation index, torque-time integral) and increase tibia bone mineral density. Methods Four men with chronic (>2 years) complete spinal cord injury (SCI; American Spinal Injury Association classification A) trained 1 soleus muscle using an isometric plantar flexion electrical stimulation protocol. The untrained limb served as a within-subject control. The protocol involved ~30 minutes of training each day, 5 days a week, for a period of 6 to 11 months. Mean compliance over 11 months of training was 91% for 3 subjects. A fourth subject achieved high compliance after only 5 months of training. Mean estimated compressive loads delivered to the tibia were ~110% of body weight. Over the 11 months of training, the muscle plantar flexion torque, fatigue index, potentiation index, and torque-time integral were evaluated periodically. Bone mineral density (dual-energy x-ray absorptiometry) was evaluated before and after the training program. Results The trained limb fatigue index, potentiation index, and torque-time integral showed rapid and robust training effects (P < .05). Soleus electrical stimulation training yielded no changes to the proximal tibia bone mineral density, as measured by dual-energy x-ray absorptiometry. The subject with low compliance experienced fatigue index and torque-time integral improvements only when his compliance surpassed 80%. In contrast, his potentiation index showed adaptations even when compliance was low. Conclusions These findings highlight the persistent adaptive capabilities of chronically paralyzed muscle but suggest that preventing musculoskeletal adaptations after SCI may be more effective than reversing changes in the chronic condition. PMID:17312092

Shields, Richard K.; Dudley-Javoroski, Shauna



Chronic pancreatitis.  


Chronic pancreatitis is a progressive fibroinflammatory disease that exists in large-duct (often with intraductal calculi) or small-duct form. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals) and genetic factors (eg, mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator); a few patients have hereditary or autoimmune disease. Pain in the form of recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells) or constant and disabling pain is usually the main symptom. Management of the pain is mainly empirical, involving potent analgesics, duct drainage by endoscopic or surgical means, and partial or total pancreatectomy. However, steroids rapidly reduce symptoms in patients with autoimmune pancreatitis, and micronutrient therapy to correct electrophilic stress is emerging as a promising treatment in the other patients. Steatorrhoea, diabetes, local complications, and psychosocial issues associated with the disease are additional therapeutic challenges. PMID:21397320

Braganza, Joan M; Lee, Stephen H; McCloy, Rory F; McMahon, Michael J



5-HT2 and 5-HT7 receptor agonists facilitate plantar stepping in chronic spinal rats through actions on different populations of spinal neurons  

PubMed Central

There is considerable evidence from research in neonatal and adult rat and mouse preparations to warrant the conclusion that activation of 5-HT2 and 5-HT1A/7 receptors leads to activation of the spinal cord circuitry for locomotion. These receptors are involved in control of locomotor movements, but it is not clear how they are implicated in the responses to 5-HT agonists observed after spinal cord injury. Here we used agonists that are efficient in promoting locomotor recovery in paraplegic rats, 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OHDPAT) (acting on 5-HT1A/7 receptors) and quipazine (acting on 5-HT2 receptors), to examine this issue. Analysis of intra- and interlimb coordination confirmed that the locomotor performance was significantly improved by either drug, but the data revealed marked differences in their mode of action. Interlimb coordination was significantly better after 8-OHDPAT application, and the activity of the extensor soleus muscle was significantly longer during the stance phase of locomotor movements enhanced by quipazine. Our results show that activation of both receptors facilitates locomotion, but their effects are likely exerted on different populations of spinal neurons. Activation of 5-HT2 receptors facilitates the output stage of the locomotor system, in part by directly activating motoneurons, and also through activation of interneurons of the locomotor central pattern generator (CPG). Activation of 5-HT7/1A receptors facilitates the activity of the locomotor CPG, without direct actions on the output components of the locomotor system, including motoneurons. Although our findings show that the combined use of these two drugs results in production of well-coordinated weight supported locomotion with a reduced need for exteroceptive stimulation, they also indicate that there might be some limitations to the utility of combined treatment. Sensory feedback and some intraspinal circuitry recruited by the drugs can conflict with the locomotor activation. PMID:25191231

S?awi?ska, Urszula; Miazga, Krzysztof; Jordan, Larry M.



Changes in length of the plantar aponeurosis during the stance phase of gait--an in vivo dynamic fluoroscopic study.  


In locomotion, ligaments and muscles have been recognized to support the arch of the foot. However, it remains unclear to what extent the passive and active structures of the lower extremity support the longitudinal arch of the foot during walking. In this study, the mechanical function of the plantar aponeurosis (PA) is investigated by elongation measurements in vivo during the stance phase of gait, in combination with measurements of the mechanical properties of the PA in vitro. Fluoroscopy was used to measure the dynamic changes in PA length and the angular motion of the metatarsophalangeal joint of the first ray, measured during the stance phase (StPh) in 11 feet. Simultaneously, ground forces were measured. Additionally, four cadaver feet delivered topographic information relating to the PA, and three autopsy specimens of PA served to determine the in vitro mechanical properties of PA. The present study revealed a non-significant peak average PA shortening of 0.48% at about 32.5% StPh, followed by a significant average peak elongation of 3.6% at 77.5% StPh. This average peak elongation of 3.6% corresponds to a force of 292N, as estimated by mechanical testing of the autopsy PA specimens. Considering the maximum peak elongation measured in one volunteer of 4.8% at 76% StPh, a peak PA load of 488N might be expected. Hence, with an average body weight of 751N, as allocated to the 11 investigated feet, this maximum peak force would correspond to about 0.65×body weight. As far as we are aware, this is the first report on a dynamic fluoroscopic study of the PA in gait with an appreciable number of feet (11 feet). In conclusion, muscles contribute to support of the longitudinal arch of the foot and can possibly relax the PA during gait. The 'windlass effect' for support of the arch in this context is therefore questionable. PMID:25113063

Fessel, G; Jacob, H A C; Wyss, Ch; Mittlmeier, Th; Müller-Gerbl, M; Büttner, A



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. PMID:23321218

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



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. PMID:24668379

Périard, Julien D; Girard, Olivier; Racinais, Sébastien



Dynamic 3D shape of the plantar surface of the foot using coded structured light: a technical report  

PubMed Central

Background The foot provides a crucial contribution to the balance and stability of the musculoskeletal system, and accurate foot measurements are important in applications such as designing custom insoles/footwear. With better understanding of the dynamic behavior of the foot, dynamic foot reconstruction techniques are surfacing as useful ways to properly measure the shape of the foot. This paper presents a novel design and implementation of a structured-light prototype system providing dense three dimensional (3D) measurements of the foot in motion. The input to the system is a video sequence of a foot during a single step; the output is a 3D reconstruction of the plantar surface of the foot for each frame of the input. Methods Engineering and clinical tests were carried out to test the accuracy and repeatability of the system. Accuracy experiments involved imaging a planar surface from different orientations and elevations and measuring the fitting errors of the data to a plane. Repeatability experiments were done using reconstructions from 27 different subjects, where for each one both right and left feet were reconstructed in static and dynamic conditions over two different days. Results The static accuracy of the system was found to be 0.3 mm with planar test objects. In tests with real feet, the system proved repeatable, with reconstruction differences between trials one week apart averaging 2.4 mm (static case) and 2.8 mm (dynamic case). Conclusion The results obtained in the experiments show positive accuracy and repeatability results when compared to current literature. The design also shows to be superior to the systems available in the literature in several factors. Further studies need to be done to quantify the reliability of the system in clinical environments. PMID:24456711



Chronic Pancreatitis  

PubMed Central

Purpose of review We review important new clinical observations in chronic pancreatitis (CP) reported in 2011. Recent findings Smoking increases the risk of non-gallstone acute pancreatitis (AP) and the progression of AP to CP. Binge drinking during Oktoberfest did not associate with increased hospital admissions for AP. The unfolded protein response is an adaptive mechanism to maintain pancreatic health in response to noxious stimuli such as alcohol. Onset of diabetes mellitus in CP is likely due to progressive disease rather than individual variables. Insufficient pancreatic enzyme dosing is common for treatment of pancreatic steatorrhea; 90,000 USP U of lipase should be given with meals. Surgical drainage provides sustained, superior pain relief compared to endoscopic treatment in patients advanced CP with a dilated main duct +/? pancreatic stones. The central acting gabapentoid pregabalin affords a modest 12% pain reduction in patients with CP but ~30% of patients have significant side effects. Summary Patients with non-gallstone related AP or CP of any etiology should cease smoking. Results of this year’s investigations further elucidated the pancreatic pathobiology due to alcohol, onset of diabetes mellitus in CP, and the mechanisms and treatment of neuropathic pain in CP. PMID:22782018

DiMagno, Matthew J.; DiMagno, Eugene P.




PubMed Central

Chronic urticaria (CU) is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal disease. A multitude of etiologies have been implicated in the causation of CU, including physical, infective, vasculitic, psychological and idiopathic. An autoimmune basis of most of the ‘idiopathic’ forms is now hypothesized. Histamine released from mast cells is the major effector in pathogenesis and it is clinically characterized by wheals that have a tendency to recur. Laboratory investigations aimed at a specific etiology are not always conclusive, though may be suggestive of an underlying condition. A clinical search for associated systemic disease is strongly advocated under appropriate circumstances. The mainstay of treatment remains H1 antihistaminics. These may be combined with complementary pharmacopeia in the form of H2 blockers, doxepin, nifedipine and leukotriene inhibitors. More radical therapy in the form of immunoglobulins, plasmapheresis and cyclophosphamide may be required for recalcitrant cases. Autologous transfusion and alternative remedies like acupuncture have prospects for future. A stepwise management results in favorable outcomes. An update on CU based on our experience with patients at a tertiary care centre is presented. PMID:22345759

Sachdeva, Sandeep; Gupta, Vibhanshu; Amin, Syed Suhail; Tahseen, Mohd



The validity and reliability of a portable slip meter for determining floor slipperiness during simulated heel strike.  


A previously developed test rig was used as starting point for designing a portable slip meter with two new features. First, an inflatable pneumatic test wheel, consisting of six slider units, was introduced as the impacting contact element relative to floor surface. Second, an inductive trigger was built into the system to facilitate a precise timing of the slider-floor contact during the test. This new test rig was designed to measure transitional friction properties of contaminated floor surfaces during simulated heel strike, which is considered the most critical phase of gait from the slip and fall point of view. Another objective was to quantify the validity and reliability of this test method in the laboratory, but not yet in the field. The measurement process was evaluated on eight wet and oily floor surfaces (vinyl and ceramic tile floorings) using two slider materials (plain, profiled), two normal loads (100, 200 N), and two sliding velocities (0.15, 0.30 m/s) as independent variables. The outputs of the portable slip meter, in terms of transitional friction coefficients, were compared to force platform-based friction values and to slip resistance values obtained with a slip simulator apparatus for laboratory testing of shoes and floor surfaces. The outputs were also evaluated against slipperiness ratings made by three male subjects in paired comparison trials, in which the subjects walked over eight wet floor surfaces wearing shoes with the plain soling material. The results showed that test option 200 N and 0.15m/s led to optimum validity despite its tendency to promote frictional vibrations (stick-slip) in the contact surface. Compared to the lower sliding speed, the higher speed reduced both stick-slip and measurement bias. Test option 200 N and 0.30 m/s was the most reliable one in this experiment. It yielded lower friction coefficients than any other test option and reduced the likelihood of underestimating slip and fall hazards. The results implied that the minimum friction coefficient was 0.25 for preventing a fall on wet floor surfaces, whereas the limit for preventing a slip was in the range 0.30-0.35. Transitional friction measurement was found to be a valid and reliable indicator for slip resistance. A more accurate control of the normal force during testing is needed for actual field use of the test method. PMID:12504142

Grönqvist, Raoul; Hirvonen, Mikko; Rajamäki, Erkki; Matz, Simon



Skin conductance and behaviour during sensory stimulation of preterm and term infants  

Microsoft Academic Search

Aim: To investigate the responses to painful and tactile stimulation in preterm and term infants in terms of changes in the plantar skin conductance activity (SCA) and behavioural state. Plantar SCA reflects activity in the sympathetic nervous system. Design: The plantar SCA and behavioural state in response to nociceptive (the heel prick for blood samples, or immunization) and tactile (routine

B. C Hellerud; H Storm



Calcaneus (Heel Bone) Fractures  


... are many types of calcaneus fractures, including: Stable fracture. This type of fracture is nondisplaced. The broken ... bones usually stay in place during healing. Displaced fracture. When a bone breaks and is displaced, the ...


Inter-individual variability in sensory weighting of a plantar pressure-based, tongue-placed tactile biofeedback for controlling posture  

E-print Network

The purpose of the present experiment was to investigate whether the sensory weighting of a plantar pressure-based, tongue-placed tactile biofeedback for controlling posture could be subject to inter-individual variability. To achieve this goal, 60 young healthy adults were asked to stand as immobile as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements were recorded using a force platform. Overall, results showed reduced CoP displacements in the Biofeedback relative to the No-biofeedback condition, evidencing the ability of the central nervous system to efficiently integrate an artificial plantar-based, tongue-placed tactile biofeedback for controlling posture during quiet standing. Results further showed a significant positive correlation between the CoP displacements measured in the No-biofeedback condition and the decrease in the CoP displacements induced by the use of the biofeedback. In other words, the degree of postural stab...

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



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.  


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. Retrospective chart review identified prompt healing of the flap in both patients. Neither patient experienced recurrent ulcers or required subsequent surgery within the first 12 months postoperatively. PMID:23910736

Boffeli, Troy J; Reinking, Ryan



Test-retest reliability of an insole plantar pressure system to assess gait along linear and curved trajectories  

PubMed Central

Background Previous studies have assessed reliability of insole technology for evaluating foot pressure distribution during linear walking. Since in natural motion straight walking is intermingled with turns, we determined the test-retest reliability of insole assessment for curved as well as linear trajectories, and estimated the minimum number of steps required to obtain excellent reliability for each output variable. Methods Sixteen young healthy participants were recruited. Each performed, two days apart, two sessions of three walking conditions: linear (LIN) and curved, clockwise (CW) and counter-clockwise (CCW). The Pedar-X system was used to collect pressure distribution. Foot print was analyzed both as a whole and as subdivided into eight regions: medial and lateral heel, medial and lateral arch, I metatarsal head, II-V metatarsal heads, hallux, lateral toes. Reliability was assessed by using intraclass correlation coefficient (ICC) for clinically relevant variables from analysis of 50 steps per trajectory: Peak Force (PF); Peak Pressure (PP); Contact Area (CA); Stance Duration (S). Results When considering whole-foot, all variables showed an ICC >0.80, therefore highly reliable. This was true for both LIN and curved trajectories. There was no difference in ICC of the four variables between left and right foot. When collapsing foot and trajectories, S had a lower ICC than PP and CA, and PP lower than CA. Mean percent error between the values of first and second session was <5%. When separately considering the eight foot regions, ICCs of PF, PP and CA for all regions and trajectories were generally >0.90, indicating excellent reliability. In curved trajectories, S showed smaller ICCs. Since the least ICC value for S was 0.60 in LIN trajectory, we estimated that to achieve an ICC ?0.90 more than 200 steps should be collected. Conclusions High reliability of insole dynamic variables (PF, PP, CA) is obtained with 50 steps using the Pedar-X system. On the contrary, high reliability of temporal variable (S) requires a larger step number. The negligible differences in ICC between LIN and curved trajectory allow use of this device for gait assessment along mixed trajectories in both clinical and research setting. PMID:24903003



Evaluation of Dried Whole Blood Spots Obtained by Heel or Finger Stick as an Alternative to Venous Blood for Diagnosis of Human Immunodeficiency Virus Type 1 Infection in Vertically Exposed Infants in the Routine Diagnostic Laboratory  

Microsoft Academic Search

The diagnostic accuracy of the Roche Amplicor human immunodeficiency virus type 1 DNA PCR assay (version 1.5) on DNA extracted from pediatric heel prick dried blood spots using Roche MagNA Pure nucleic acid purification technology was evaluated. The methodologies transfer successfully from the labor-intensive research laboratory to the high-throughput automated routine laboratory.

Janet C. Patton; Eveline Akkers; Ashraf H. Coovadia; Tammy M. Meyers; Wendy S. Stevens; Gayle G. Sherman



Chronic Conditions and School  


... Issues Listen Chronic Conditions and School Article Body My child has a chronic health condition. What do ... the school right away when contact information has changed. Make a health plan . If your child takes ...


Chronic fatigue syndrome - resources  


Resources - chronic fatigue syndrome; CFS resources ... The following organizations provide information on chronic fatigue syndrome : CFIDS Association of America - U.S. Centers for Disease Control and Prevention -


Chronic fatigue syndrome  


CFS; Fatigue - chronic; Immune dysfunction syndrome; Myalgic encephalomyelitis (ME) ... The exact cause of chronic fatigue syndrome (CFS) is unknown. Some theories suggest CFS may be due to: Epstein-Barr virus or human herpes virus-6 (HHV- ...


Understanding Chronic Bronchitis  


... news is that chronic bronchitis can be found early and there is much that can be done to treat and help manage the disease. What Causes Chronic Bronchitis? Cigarette smoking is by far the most common cause of ...


Sleep and Chronic Disease  


... visit this page: About . Sleep and Sleep Disorders Share Compartir Sleep and Chronic Disease As chronic ... of depression be monitored among persons with a sleep disorder. 4, 5 References Knutson KL, Ryden AM, Mander ...


Chronic Urticaria (Hives)  


... chronic hives may be diagnosed with Chronic Idiopathic Urticaria (CIU). Angioedema is a form of hives where ... hour after exposure. For example: people with pressure urticaria get hives on certain parts of the body ...


Chronic myelogenous leukemia (CML)  


... leukemia is grouped into several phases: Chronic Accelerated Blast crisis The chronic phase can last for months ... a swollen spleen . Untreated CML leads to the blast crisis phase. Bleeding and infection may occur due ...


Chronic Kidney Diseases  


... for a long time, doctors call it a chronic kidney disease. Children's kidney problems may be congenital (say: kun- ... Do Doctors Treat Kidney Problems? The treatment for chronic kidney ... bone disease. Sometimes unhealthy kidneys have problems producing a hormone ...


The effects of a plantar pressure-based, tongue-placed tactile biofeedback system on the regulation of the centre of foot pressure displacements during upright quiet standing: a  

E-print Network

The effects of a plantar pressure-based, tongue-placed tactile biofeedback system on the regulation 38706, La Tronche Cedex, France E-mail: {firstname.lastname} Abstract A biofeedback system whose with this biofeedback system. Ten young healthy adults were asked to stand as immobile as possible with their eyes

Payan, Yohan


What Is Chronic Myeloid Leukemia?  


... about chronic myeloid leukemia? What is chronic myeloid leukemia? Chronic myeloid leukemia (CML), also known as chronic ... is the same as for adults. What is leukemia? Leukemia is a cancer that starts in the ...


The use of specific binding of peptide-nucleic acid to DNA in the {open_quotes}Achilles heel{close_quotes} method  

SciTech Connect

The `Achilles heel` method (AHM) is used in the design of random-cleavage restriction endonucleases. These promising compounds can be widely used in practice, particularly for genomic DNA mapping. DNA is complexed with a site-specific DNA-binding reagent (protein or oligonucleotide) and then treated with methylase. The methylation sites overlapping with or adjacent to the DNA-binding sites of the reagent are protected from methylation. Thereafter, methylase is inactivated, the DNA-binding reagent is removed, and DNA is cleaved by the restriction endonuclease corresponding to the methylase used. As a result, DNA is cleaved only at those restriction sites that were protected by the DNA-binding reagent from methylation. Until now, proteins or oligonucleotides were used as site-specific DNA-binding reagents. Here, we report on the use of a peptide-nucleic acid (PNA) in AHM. 7 refs., 4 figs.

Krasil`nikova, M.M.; Izvol`skii, K.I.; Krupnik, O.V.; Lazurkin, Yu.S. [Institute of Molecular Genetics, Moscow (Russian Federation)



Medial Plantar Nerve Entrapment  


... Drug Information, Search Drug Names, Generic and Brand Natural Products, Search Drug ... symptoms, drugs, procedures, news and more, written in everyday language. * This page is for Consumers * Doctors: Tap here ...


Environmental pollution and chronic arsenicosis in south Calcutta.  

PubMed Central

Careless handling of industrial wastes often creates problems for human health and the environment. Chronic arsenic toxicity, resulting from household use of arsenic-contaminated water occurred in 53 out of 79 members (67%) of 17 families residing in South Calcutta close to a factory that manufactured Paris-green (copper acetoarsenite). Clinical investigation of 20 of these affected persons showed typical skin pigmentation as well as palmar and plantar keratosis in all of them, while gastrointestinal symptoms, anaemia and signs of liver disease and peripheral neuropathy were seen in many. The water used by the affected families for drinking and cooking had been taken from shallow tubewells and had arsenic levels from 5.0 to 58 mg/l (WHO permissible limit, 0.05 mg/l). Other residents in the same area whose drinking-water came from deep tubewells or from tap water supplied by the Calcutta Municipal Corporation (arsenic levels, less than 0.05 mg/l) were not affected. The study confirms that arsenic in the shallow tubewells was due to the waste discharged by the factory producing Paris-green. PMID:1394782

Mazumder, D. N.; Das Gupta, J.; Chakraborty, A. K.; Chatterjee, A.; Das, D.; Chakraborti, D.



Management of Chronic Pressure Ulcers  

PubMed Central

Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis Objective The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions? Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? Background A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency and duration of hospitalization, and to decrease the quality of life of affected patients. The cost of treating pressure ulcers has been estimated at approximately $9,000 (Cdn) per patient per month in the community setting. Considering the high prevalence of pressure ulcers in the Ontario health care system, the total cost of treating pressure ulcers is substantial. Technology Wounds normally heal in 3 phases (inflammatory phase, a proliferative phase of new tissue and matrix formation, and a remodelling phase). However, pressure ulcers often fail to progress past the inflammatory stage. Current practice for treating pressure ulcers includes treating the underlying causes, debridement to remove necrotic tissues and contaminated tissues, dressings to provide a moist wound environment and to manage exudates, devices and frequent turning of patients to provide pressure relief, topical applications of biologic agents, and nutritional support to correct nutritional deficiencies. A variety of adjunctive physical therapies are also in use. Method Health technology assessment databases and medical databases were searched from 1996 (Medline), 1980 (EMBASE), and 1982 (CINAHL) systematically up to March 2008 to identify randomized controlled trials (RCTs) on the following treatments of pressure ulcers: cleansing, debridement, dressings, biological therapies, pressure-relieving devices, physical therapies, nutritional therapies, and multidisciplinary wound care teams. Full literature search strategies are reported in appendix 1. English-language studies in previous systematic reviews and studies published since the last systematic review were included if they had more than 10 subjects, were randomized, and provided objective outcome measures on the healing of pressure ulcers. In the absence of RCTs, studies of the highest level of evidence available were included. Studies on wounds other than pressure ulcers and on surgical treatment of pressure ulcers were excluded. A total of 18 systematic reviews, 104 RCTs, and 4 observational



[Physical-technical principles of extracorporeal shockwave therapy (ESWT)].  


Extracorporeal shock waves in orthopaedics are currently applied in the treatment of chronic enthesiopathies such as lateral epicondylitis, plantar heel spur, as well as in calcifying tendinitis of the shoulder or in bony nonunions. Detailed knowledge of physical parameters and properties of shock waves appear to be necessary to determine clinically relevant dose-effect relations and to make shock wave devices, clinical results, and basic science in shock wave therapy more comparable. This study gives an overview of physical parameters and properties in shock wave therapy. Measurement technologies, types of shock wave devices, and mechanisms of shock waves are also described. PMID:12219657

Gerdesmeyer, L; Maier, M; Haake, M; Schmitz, C



A Comprehensive Review on Marjolin's Ulcers: Diagnosis and Treatment.  


Despite the misnomer, Marjolin's ulcers really reflect malignant degeneration arising within a pre-existing cicatrix or scar. In most instances, biopsied lesions demonstrate well-differentiated squamous cell tumors, although other epidermoid lesions are occasionally encountered. The lesions are rare and are most commonly found in the lower extremity, especially the heel and plantar foot. In light of the close association of these lesions with scarred tissues associated with various chronic lower-extremity wounds, those involved in health care delivery to these patients must be aware of Marjolin's ulcer, its manifestations and potential ramifications. PMID:24525526

Pekarek, Brian; Buck, Stacie; Osher, Lawrence



A Comprehensive Review on Marjolin's Ulcers: Diagnosis and Treatment  

PubMed Central

Despite the misnomer, Marjolin's ulcers really reflect malignant degeneration arising within a pre-existing cicatrix or scar. In most instances, biopsied lesions demonstrate well-differentiated squamous cell tumors, although other epidermoid lesions are occasionally encountered. The lesions are rare and are most commonly found in the lower extremity, especially the heel and plantar foot. In light of the close association of these lesions with scarred tissues associated with various chronic lower-extremity wounds, those involved in health care delivery to these patients must be aware of Marjolin's ulcer, its manifestations and potential ramifications. PMID:24525526

Pekarek, Brian; Buck, Stacie; Osher, Lawrence



The Acute Effects of Unilateral Ankle Plantar Flexors Static- Stretching on Postural Sway and Gastrocnemius Muscle Activity During Single-Leg Balance Tasks  

PubMed Central

The aim of this study was to investigate the acute effects of unilateral ankle plantar flexors static- stretching on surface electromyography (sEMG) and the center of pressure (COP) during a single-leg balance task in both lower limbs. Fourteen young healthy, non-athletic individuals performed unipodal quiet standing for 30s before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch) a unilateral ankle plantar flexor static- stretching protocol [6 sets of 45s/15s, 70-90% point of discomfort (POD)]. Postural sway was described using the COP area, COP speed (antero-posterior and medio-lateral directions) and COP frequency (antero-posterior and medio-lateral directions). Surface EMG (EMG integral [IEMG] and Median frequency[FM]) was used to describe the muscular activity of gastrocnemius lateralis. Ankle dorsiflexion passive range of motion increased in the stretched limb before and after the static-stretching protocol (mean ± SD: 15.0° ± 6.0 and 21.5° ± 7.0 [p < 0.001]). COP area and IEMG increased in the stretch limb between pre-stretching and immediately post-stretching (p = 0.015 and p = 0.036, respectively). In conclusion, our static- stretching protocol effectively increased passive ankle ROM. The increased ROM appears to increase postural sway and muscle activity; however these finding were only a temporary or transient effect. Key Points The postural control can be affected by static- stretching protocol. The lateral gastrocnemius muscle action was increased after the static- stretching protocol. The static- stretching effects remain for less than 10 minutes. PMID:25177183

Lima, Bráulio N.; Lucareli, Paulo R.G.; Gomes, Willy A.; Silva, Josinaldo J.; Bley, Andre S.; Hartigan, Erin H.; Marchetti, Paulo H.



Chronic Urticaria: Recent Advances  

Microsoft Academic Search

Chronic urticaria is an umbrella term, which encompasses physical urticarias, chronic “idiopathic” urticaria and urticarial\\u000a vasculitis. It is important to recognize patients with physical urticarias as the investigation and treatment differs in important\\u000a ways from patients with idiopathic chronic urticaria or urticarial vasculitis. Although relatively uncommon, urticarial vasculitis\\u000a is an important diagnosis to make and requires histological confirmation by biopsy.

Malcolm W. Greaves; Kian Teo Tan



[Chronic wounds: differential diagnosis].  


Wound is a disruption of anatomic and physiologic continuity of the skin. According to the healing process, wounds are classified as acute and chronic wounds. A wound is considered chronic if standard medical procedures do not lead to the expected healing, or if the wound does not heal within six weeks. Chronic wounds are classified as typical and atypical. Typical wounds include ischemic, neurotrophic and hypostatic wounds. Diabetic foot and decubitus ulcers stand out as a specific entity among typical wounds. About 80 percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the remainder are mostly neuropathic ulcers. About 95 percent of chronic wounds manifest as one of the above-mentioned entities. Other forms of chronic wounds are atypical chronic wounds, which can be caused by autoimmune disorders, infectious diseases, vascular diseases and vasculopathies, metabolic and genetic diseases, neoplasm, external factors, psychiatric disorders, drug related reactions, etc. Numerous systemic diseases can present with atypical wounds. The primary cause of the wound can be either systemic disease itself (Crohn's disease) or aberrant immune response due to systemic disease (pyoderma gangrenosum, paraneoplastic syndrome). Although atypical wounds are a rare cause of chronic wounds, it should always be taken in consideration during diagnostic procedure. PMID:24371971

Situm, Mirna; Koli?, Maja



Chronic thyroiditis (Hashimoto disease)  


Hashimoto thyroiditis; Chronic lymphocytic thyroiditis; Autoimmune thyroiditis ... cases, the condition is called type 2 polyglandular autoimmune syndrome (PGA II). Less commonly, Hashimoto disease occurs ...


Supportive Care for Chronic Lymphocytic Leukemia  


... lymphocytic leukemia treated? Chemotherapy for chronic lymphocytic leukemia Monoclonal antibodies for chronic lymphocytic leukemia Targeted therapy for chronic lymphocytic leukemia Surgery for chronic lymphocytic ...


Chronic Disease Indicators  

NSDL National Science Digital Library

The Chronic Disease Indicators (CDI) is a cross-cutting set of 97 indicators that were developed by consensus and that allows states and territories and large metropolitan areas to uniformly define, collect, and report chronic disease data that are important to public health practice and available for states, territories and large metropolitan areas. 

Center for Disease Control


Chronic Lymphocytic Leukemia (CLL)  


What is chronic lymphocytic leukemia (CLL)? The most common type of leukemia, this slow-growing cancer is a blood and bone marrow disease. About 15, ... and Lymphoma Society). Type the keywords chronic lymphocytic leukemia into the search box. What kinds of questions ...


Lactoferrin in Chronic Pancreatitis  

Microsoft Academic Search

Summary The present review is focused on the clinical significance of lactoferrin in pancreatic secretions and stone formation in chronic pancreatitis, and of serum anti-lactoferrin antibody in autoimmune pancreatitis. Lactoferrin secretion is increased in pancreatic secretions in calcified and non-calcified chronic pancreatitis. Lactoferrin, pancreatic stone protein and trypsin are present in pancreatic stones. We cannot conclude which protein is more

Chun Xiang Jin; Tetsuo Hayakawa; Motoji Kitagawa; Hiroshi Ishiguro



What Is Chronic Lymphocytic Leukemia?  


... key statistics for chronic lymphocytic leukemia? What is chronic lymphocytic leukemia? Chronic lymphocytic leukemia (CLL) is a type of ... and other tissues. Are there different types of CLL? Doctors have found that there seem to be ...


Chronic daily headaches  

PubMed Central

Chronic Daily Headache is a descriptive term that includes disorders with headaches on more days than not and affects 4% of the general population. The condition has a debilitating effect on individuals and society through direct cost to healthcare and indirectly to the economy in general. To successfully manage chronic daily headache syndromes it is important to exclude secondary causes with comprehensive history and relevant investigations; identify risk factors that predict its development and recognise its sub-types to appropriately manage the condition. Chronic migraine, chronic tension-type headache, new daily persistent headache and medication overuse headache accounts for the vast majority of chronic daily headaches. The scope of this article is to review the primary headache disorders. Secondary headaches are not discussed except medication overuse headache that often accompanies primary headache disorders. The article critically reviews the literature on the current understanding of daily headache disorders focusing in particular on recent developments in the treatment of frequent headaches. PMID:23024563

Ahmed, Fayyaz; Parthasarathy, Rajsrinivas; Khalil, Modar



Chronic gastritis - an update.  


Helicobacter pylori is the main aetiologic factor for chronic gastritis worldwide. The degree of inflammation and the evolution of this form of chronic gastritis can vary largely depending on bacterial virulence factors, host susceptibility factors and environmental conditions. Autoimmune gastritis is another cause of chronic inflammation in the stomach, which can occur in all age groups. This disease presents typically with vitamin B12 deficiency and pernicious anaemia. The presence of anti-parietal cell antibodies is highly specific for the diagnosis. The role of H. pylori as a trigger for autoimmune gastritis remains uncertain. Other rare conditions for chronic gastritis are chronic inflammatory conditions such as Crohn's disease or on the background of lymphocytic or collagenous gastroenteropathies. PMID:25439069

Varbanova, Mariya; Frauenschläger, Katrin; Malfertheiner, Peter



Chronic diarrhea in tropics.  


Diarrheal diseases continue to be very frequent in the tropics. Upto 40% of mortality associated with diarrheal diseases is associated with prolonged episodes of diarrhea and accompanying malnutrition. Prolonged diarrheal episodes can basically be divided into three main types: a) acute onset prolonged diarrhea or persistent diarrhea; b) insidious onset chronic diarrhea and c) recurrent diarrhea. Epidemiology, risk factors, etiological factors, gut pathophysiology and management of persistent diarrhea has been extensively reviewed in the article. Chronic diarrhea in tropics has entirely different etiological considerations than those observed in Western countries. Most of these factors are associated with poor sanitary and living conditions and gastrointestinal infections. Celiac disease is also identified as an important cause of chronic diarrhea in Indian settings. Chronic diarrhea needs to be differentiated from chronic non specific diarrhea wherein no adverse nutritional effects are seen in the patient. PMID:11132468

Mittal, S K



Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)  


NINDS Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Information Page Table of Contents (click to jump to sections) What is Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)? Is there any treatment? ...


Assessment of forearm and plantar foot load in the elderly using a four-wheeled walker with armrest and the effect of armrest height  

PubMed Central

Background Patients with hand and/or wrist pathology are recommended to have a four-wheeled walker with an arm rest (FWW-AR) rather than a standard walker or a standard four-wheeled walker (FWW). However, only a few quantitative studies have been performed to compare upper and lower extremity weight bearing. The aim of this study was to evaluate forearm and foot weight bearing using a FWW-AR and the effect of the armrest height. Methods Eleven elderly women (mean age 80.1±5.3 years; mean height 148.5±4.0 cm; mean weight 51.2±9.0 kg) were enrolled. The subjects walked with an FWW-AR, with the elbow in either 90 degree (D90) or 130 degree (D130) flexion, for a distance of 10 m. Surface electromyographic signals were recorded for the upper, middle, and lower trapezius, anterior deltoid, and erector spinae muscles; walking velocity was measured with the subjects weight bearing on their feet and forearms while walking. Simultaneously, the maximum plantar and forearm loads during walking with an FWW-AR were measured. Results The normalized foot plantar loads were lower at D90 than at D130, while the normalized forearm load was higher at D90 than at D130 (all P<0.05; left foot, 7.9±0.1 N/kg versus 8.8±0.1 N/kg; right foot, 8.6±0.2 N/kg versus. 9.6±0.1 N/kg; left forearm, 1.8±0.5 N/kg versus 0.8±0.2 N/kg; and right forearm, 2.0±0.5 N/kg versus 1.0±0.2 N/kg, respectively). The surface electromyographic activity of the muscles involved in shoulder elevation and the walking velocity were both lower with the elbow at D90 than at D130 (all P<0.05; left upper trapezius, 98.7%±19.5% versus 132.6%±16.9%; right upper trapezius, 83.4%±10.6% versus 108.1%±10.5%; left anterior deltoid, 94.1%±12.8% versus 158.6%±40.4%; right anterior deltoid, 99.1%±15.0% versus 151.9%±19.4%; and velocity, 0.6±0.1 m/sec versus 0.7±0.1 m/sec, respectively). Conclusion Weight bearing on the lower extremities is significantly reduced when the upper extremities are supported during walking with an FWW-AR. Furthermore, the weight bearing profile is dependent on the armrest height. PMID:25342894

Ko, Chang-Yong; Kim, Sol-Bi; Choi, Hyuk-Jae; Chang, Yunhee; Kang, Sungjae; Heo, Yoon; Ryu, Jeicheong; Kim, Gyoosuk; Mun, Museong



[Chronic constipation in adults].  


Chronic constipation is a very common condition, which is responsible for a major socioeconomic burden. Primary management must rule out secondary constipation before recognizing chronic idiopathic constipation, which is the most common diagnosis. Initial treatment frequently associates simple lifestyle modifications, whose efficacy is limited, with osmotic laxatives or bulking agents. If those measures do not relieve symptoms, a switch of laxatives or a combination must be proposed. Pharmacological treatments of constipation represent a new alternative approach in case of failure of previously mentioned measures. In case of chronic constipation reluctant to all conservative therapies, specific tests are required before considering biofeedback intervention or exceptionally a surgical option. PMID:23453994

Zeitoun, Jean-David; de Parades, Vincent



Chronic Fatigue Syndrome  


Chronic fatigue syndrome (CFS) is a disorder that causes extreme fatigue. This fatigue is not the kind of tired feeling that ... activities. The main symptom of CFS is severe fatigue that lasts for 6 months or more. You ...


Chronic Fatigue Syndrome  


... syndrome/myalgic encephalomyelitis. A primer for clinical practitioners Centers for Disease Control and Prevention (CDC) Phone Number: 800-232-4636 Chronic Fatigue Syndrome Advisory Committee, HHS Social Security Administration Revised Social Security Ruling about Evaluating Cases ...


Chronic Kidney Disease  


You have two kidneys, each about the size of your fist. Their main job is to filter wastes and excess water out of ... help control blood pressure, and make hormones. Chronic kidney disease (CKD) means that your kidneys are damaged ...


Chronic Beryllium Disease  


... 800.222.5864. References Mroz MM, Balkissoon R, Newman LS. Beryllium. In: Bringham E, Cohrssen B, Powell ... John Wiley & Sons 2001, 177-220. Balkissoon RC, Newman LS. Beryllium cooper alloy (2%) causes chronic beryllium ...


What Is Chronic Pain?  

MedlinePLUS Videos and Cool Tools

... Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ...


Employees with Chronic Pain  


Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information About Americans with Disabilities Act Accommodating Employees Resources References PDF Version DOC Version Share Introduction ...


American Chronic Pain Association  


... ACPA New resources to help you better communicate with your health care provider Download the app and take part in this clinical trial Opioid Safety - Public Service Announcement Our Mission To facilitate peer support and education for individuals with chronic ...


Chronic subdural hematoma  


... the dura and surface of the brain (bridging veins) tear and leak blood. This is usually the result of a ... the brain. In a chronic subdural collection, blood leaks from the veins slowly over time, or a fast hemorrhage is ...


Chronic Hypertension in Pregnancy  


... Hypertension? There are 2 types of chronic hypertension: essential hypertension and secondary hypertension. We do not know the cause of essential hypertension, but because hypertension commonly runs in families, we ...


Depression and Chronic Illness  


... and one-fifth with terminal cancer experience a depressive disorder. Sadly, less than half of those receive treatment for depression. Facing a chronic illness naturally leads to feelings of uncertainty, grief, sadness, anger or fear. But when these feelings ...


Anemia of chronic disease  


... ulcerative colitis Cancer , including lymphoma and Hodgkin disease Chronic kidney disease Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS , hepatitis B or hepatitis C


Chronic Kidney Disease  


... well as they should. Normal, healthy kidneys remove waste from the blood. The waste then leaves your body in your urine. The ... have chronic kidney disease, your kidneys cannot remove waste from the blood as well as they should. ...


Altering gait by way of stimulation of the plantar surface of the foot: the immediate effect of wearing textured insoles in older fallers  

PubMed Central

Background Evidence suggests that textured insoles can alter gait and standing balance by way of enhanced plantar tactile stimulation. However, to date, this has not been explored in older people at risk of falling. This study investigated the immediate effect of wearing textured insoles on gait and double-limb standing balance in older fallers. Methods Thirty older adults >65?years (21 women, mean [SD] age 79.0 [7.1]), with self-reported history of ?2 falls in the previous year, conducted tests of level-ground walking over 10?m (GAITRite system), and double-limb standing with eyes open and eyes closed over 30 seconds (Kistler force platform) under two conditions: wearing textured insoles (intervention) and smooth (control) insoles in their usual footwear. Results Wearing textured insoles caused significantly lower gait velocity (P?=?0.02), step length (P?=?0.04) and stride length (P?=?0.03) compared with wearing smooth insoles. No significant differences were found in any of the balance parameters (P?>?0.05). Conclusions A textured insole worn by older adults with a history of falls significantly lowers gait velocity, step length and stride length, suggesting that this population may not have an immediate benefit from this type of intervention. The effects of prolonged wear remain to be investigated. PMID:22546376