Science.gov

Sample records for heel pain calcaneal

  1. Calcaneal osteosarcoma: a rare cause of heel pain in the paediatric population

    PubMed Central

    Taslakian, Bedros; Issa, Ghada; Saab, Raya; Jabbour, Mark N; Khoury, Nabil J

    2013-01-01

    Osteosarcoma is the most common primary non-haemopoietic malignant bone tumour in children and adolescents. However, it rarely occurs in the calcaneus with only a few case reports in the literature. We report a case of a 14-year-old boy with calcaneal osteosarcoma, who presented with heel pain followed by swelling. The pain was initially thought to be related to a benign process and treated with analgesics, delaying the diagnosis. We discuss the clinical presentation, the differential diagnosis, multi-imaging and pathological findings of a calcaneal osteosarcoma, its clinical outcome and the importance of early diagnosis to improve outcome. PMID:23386499

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

    PubMed Central

    2010-01-01

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

  3. Heel pain

    MedlinePLUS

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

  4. Isolated Calcaneal Metastasis: An Unusual Presentation of Lung Carcinoma as Heel Pain.

    PubMed

    Singh, Charanjeet; Gupta, Mamta; Singh, Jagadeesh; Ali, Amjad

    2016-03-01

    A 63-year-old woman initially presented with progressive left foot pain for 3 months, not responding to conservative management. MRI of the left foot showed a suspicious lesion in calcaneus. An open biopsy was consistent with metastatic lung adenocarcinoma. Tc-MDP total-body bone scintigraphy was ordered for possible other bony lesions, and only left calcaneus lesion was identified on bone scan. CT scan of the chest revealed a soft tissue mass in the superior aspect of the right lower lobe. Staging FDG PET/CT showed hypermetabolic right lung mass and left calcaneus lesion. She received chemotherapy and local radiation to the left calcaneus metastatic lesion. PMID:26562577

  5. Heel Pain in Recreational Runners.

    ERIC Educational Resources Information Center

    Bazzoli, Allan S.; Pollina, Frank S.

    1989-01-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2015-06-01

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

  8. Modified Dwyer osteotomy with rotation and reinsertion of autograft bone wedge for residual heel deformity despite previous delayed subtalar joint arthrodesis after calcaneal fracture.

    PubMed

    Boffeli, Troy J; Abben, Kyle W

    2014-01-01

    Calcaneal fracture patterns vary widely, and many factors determine the type and timing of the treatment rendered. Severe calcaneus fractures involving joint damage, loss of heel height, and varus deformity of the tuberosity are ideally treated with open reduction and internal fixation to repair the joint surface and re-establish anatomic structure. This is not always possible owing to delayed presentation, soft tissue compromise, unrelated injuries, unstable medical condition, or lack of expertise by the treating physician. We present the case of a patient who had residual forefoot and rearfoot deformity despite undergoing delayed subtalar joint arthrodesis at an outside hospital 10 years before for a calcaneal fracture that was initially treated nonoperatively. At 4 years of follow-up after modified Dwyer calcaneal osteotomy with rotation and reinsertion of the autograft bone wedge and Cotton midfoot osteotomy, the postoperative gait was relatively normal, other than the expected lack of hindfoot mobility. The lateral column pain was resolved. The patient remained highly satisfied with the outcome at long-term follow-up of 48 months, with improved heel alignment, lack of a wide stance gait, a functional medial column, and a relatively normal gait. This case demonstrates the value of periarticular calcaneal osteotomies without the need to revise the subtalar joint arthrodesis for this challenging clinical situation. PMID:25217369

  9. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Severs disease): a systematic review

    PubMed Central

    2013-01-01

    Background Calcaneal apophysitis, also commonly known as severs disease, is a condition seen in children usually aged between 815?years. Conservative therapies, such as taping, heel lifts and orthotic intervention are accepted management practices for calcaneal apophysitis, though there is very little high quality research examining the efficacy of such treatment modalities. Previous narrative literature reviews and opinion pieces provide some evidence for the use of heel raises or orthoses. The aim of this manuscript was to complete a systemic review on the treatment options for calcaneal apophysitis as measured by pain reduction and maintenance of physical activity. Methods A search strategy completed by two reviewers examined nine databases from inception to May 2012. Search terms included heel pain, children, adolescent, calcaneal apophysitis, severs disease, treatment, and management (full text publications, human studies). Systematic reviews, randomised control trials, case series, and case studies were included. The reference lists of the selected articles were also examined. The methodology, quality and risk of bias was examined and assessed using the PEDro scale. Results Nine articles were retrieved including three clinical trials involving randomisation, two case series, two retrospective case reviews, and two case reports. Effect size calculations and a meta analysis were unable to be completed due to the limited data reported within the literature. Numerous treatment options were reported throughout the literature, though few were examined against a control or alternate treatment option in well-designed trials. The limited evidence indicated that orthoses provided greater short-term pain relief than heel raises. Health practitioners should view these results with caution, as there were apparent methodological problems with the employed study design and limited follow-up of participants. Conclusion There is limited evidence to support the use of heel raises and orthoses for children who have heel pain related to calcaneal apophysitis. Further research is needed to generate higher quality evidence with larger sample sizes, and validated measures of pain and function to establish effective treatment approaches for children with calcaneal apophysitis. PMID:23641779

  10. Heel pain-plantar fasciitis: revision 2014.

    PubMed

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

    2014-11-01

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

  11. Don't Ignore Your Kid's Heel Pain

    MedlinePLUS

    ... to raise the heel, especially in flat-footed cleats • Discard shoes that caused pain. Don’t use ... well-constructed shoes designed for specific sports • Switch cleats often because they are not supportive shoes. Don’ ...

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

    PubMed Central

    Maclellan, G. E.; Vyvyan, Barbara

    1981-01-01

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

  13. Cushioning effect of heel cups.

    PubMed

    Wang, C L; Cheng, C K; Tsuang, Y H; Hang, Y S; Liu, T K

    1994-09-01

    Three types of heel cups, two rubber and one plastic, were evaluated in this study. The vertical forces under the heel were monitored using the Computer Dyno Graphy system in 16 normal subjects. Peak force reduction in walking and running after heel cup use was found for all three types of heel cups. The shock absorbency (peak force reduction as a ratio) of heel cups was better in walking (3.5 km h(-1)) than in running (10 km h(-1)). Pressure-sensitive film under the heel revealed that the pressure concentration at the location of calcaneal tuberosity could be smoothed out by the use of heel cups. When plastic heel cups were used, pedobarography showed that the contact area of the heel while standing decreased to 61% of that when barefoot. Roentgenographic study in six patients with heel pain syndrome showed that the thickness of the heel pad increased from 14.4 mm (SD 1.4 mm) to 17.0 mm (SD 1.2 mm) when plastic heel cups were used. PMID:23916298

  14. Efficacy of a single-formula acupuncture treatment for horses with palmar heel pain.

    PubMed

    Robinson, Katherine A; Manning, Stephen T

    2015-12-01

    Acupuncture is used without strong scientific evidence to treat many diseases of the horse, including palmar heel pain. Research is needed to provide evidence for the application of these treatments. Within the confines of our study, acupuncture did not reliably modulate palmar heel pain in horses. PMID:26663921

  15. Pressure-relieving properties of various shoe inserts in older people with plantar heel pain.

    PubMed

    Bonanno, Daniel R; Landorf, Karl B; Menz, Hylton B

    2011-03-01

    Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar() system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain. PMID:21256025

  16. An avulsion fracture of the calcaneal tuberosity: delay of treatment causes the 'Achilles heel' of optimal recovery.

    PubMed

    Bosman, Willem-Maarten; Leijnen, Michiel; van den Bremer, Jephta; Ritchie, Ewan D

    2016-01-01

    A 72-year-old woman was diagnosed with an avulsion fracture of the tuberosity of the calcaneus. The fracture was planned for elective fixation 12 days after the accident. The planned open reduction and internal fixation was not possible due to a decubital wound on the Achilles heel as a result of pressure on the skin of the fractured tuberosity. Closed reduction and internal fixation was performed, leading to an acceptable outcome. Avulsion fractures of the tuberosity of the calcaneus are rare injuries, and delay in treatment should be avoided as it may lead to preventable complications. PMID:26759395

  17. Management of pain from heel stick in neonates: an analysis of research conducted in Thailand.

    PubMed

    Prasopkittikun, Tassanee; Tilokskulchai, Fongcum

    2003-01-01

    The heel stick procedure is the most common painful procedure performed in preterm and full-term neonates. Various nonpharmacologic interventions have been used for pain relief. However, the magnitude of the effect of different interventions has received little attention. In this study, 4 eligible studies conducted in Thailand, focusing on the effects of interventions on pain responses to heel stick procedure in neonates, were obtained for analysis. Swaddling in full-term newborns was found to have the largest mean effect size (dmn = 0.79). However, the moderate-to-large effect sizes (dmn = 0.5-0.75) of positioning in preterm newborns tended to exist throughout the poststick period while the effect sizes of other interventions decreased over time. The effect sizes of these interventions for physiological responses varied. PMID:14655790

  18. Anterior subtalar dislocation with comminuted fracture of the anterior calcaneal process.

    PubMed

    Hui, Siu Hung Kenneth; Lui, Tun Hing

    2016-01-01

    Anterior subtalar dislocation is a very rare injury. We report a case of an 81-year-old woman who had her right foot injured during a motor vehicle accident. Radiographs showed anterior subtalar dislocation with comminuted fracture of the anterior calcaneal process. The dislocation was closely reduced and protected by a short leg cast. One year postinjury, the patient had only mild pain when walking on uneven ground. There was mild tenderness over the lateral heel. Subtalar motion was mildly painful. There was no pain with ankle motion. PMID:26887882

  19. Calcaneal fractures: selection bias is key.

    PubMed

    Pearce, C J; Wong, K L; Calder, J D F

    2015-07-01

    In this paper, we critically appraise the recent publication of the United Kingdom Heel Fracture Trial, which concluded that when patients with an absolute indication for surgery were excluded, there was no advantage of surgical over non-surgical treatment in the management of calcaneal fractures. We believe that selection bias in that study did not permit the authors to reach a firm conclusion that surgery was not justified for most intra-articular calcaneal fractures. PMID:26130340

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

    PubMed

    Yoo, Won-Gyu

    2016-01-01

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

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

    PubMed Central

    Yoo, Won-Gyu

    2016-01-01

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

  2. Heel Pain

    MedlinePLUS

    ... outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls ... including gout, which usually manifests itself in the big toe joint; an inflamed bursa (bursitis), a small, ...

  3. Use of Lateral Calcaneal Flap for Coverage of Hindfoot Defects: An Anatomical Appraisal

    PubMed Central

    Zygouris, Panagiotis; Michalinos, Adamantios; Protogerou, Vassilis; Kotsiomitis, Evangelos; Mazarakis, Antonios; Dimovelis, Ioannis; Troupis, Theodore

    2015-01-01

    Lateral calcaneal flap is an established surgical option for coverage of lateral calcaneum and posterior heel defects. Lateral calcaneal flap vascularization and innervations are based on lateral calcaneal artery neurovascular bundle, that is, lateral calcaneal artery, small saphenous vein, and sural nerve. Anatomical research has allowed exploration of its many advantages but can also lead to its various modifications, permitting a wide variety of clinical applications. In this paper the authors report an anatomical and clinical study on lateral calcaneal artery course and lateral calcaneal flap clinical applications. Anatomic part of our study focused on lateral calcaneal artery course and optimization of surgical technique for flap harvesting. Data were used for design of lateral calcaneal flap in 5 patients. Our results were satisfactory in terms of coverage adequacy, perioperative morbidity, and functional and aesthetical outcome. PMID:26640707

  4. Three-dimensional printed calcaneal prosthesis following total calcanectomy?

    PubMed Central

    Imanishi, Jungo; Choong, Peter F.M.

    2015-01-01

    Introduction The majority of patients with extremity sarcoma can be surgically treated without amputation. However, limb-salvage surgery for foot sarcomas including the calcaneus remains challenging. Presentation of case A 71-year-old man presented with a 5-year history of right heel persistent pain. Imaging studies revealed an osteolytic, destructive and highly metabolic lesion in the right calcaneus. Computed tomography guided core needle biopsy confirmed the diagnosis of grade 2 chondrosarcoma. A total calcanectomy was performed, and the defect was reconstructed with a patient matched three-dimensional printed titanium calcaneal prosthesis. Intra-operatively, ligaments including the Achilles tendon, and plantar fascia were reattached. The post-operative course was uneventful, and at the 5-month clinical follow-up, the patient was fully weightbearing, with a mobile ankle without pain. Discussion This case is the first to use additive manufacturing to create a prosthetic calcaneus. The complex peri-calcaneal articular surfaces and reattachment of tendinous structures facilitate efforts to stabilize the prosthesis in situ. Conclusion Three-dimensional-printed prosthesis of the calcaneus is a viable alternative to amputation. PMID:25827294

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

    NASA Astrophysics Data System (ADS)

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

    2007-11-01

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

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

    PubMed Central

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

    2007-01-01

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

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

    PubMed Central

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

    2005-01-01

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

  8. Cracked Heels

    MedlinePLUS

    The official consumer website of: Visit ACFAS.org | About ACFAS | Informacin en Espaol Advanced Search Home Foot & Ankle Conditions Cracked Heels Text Size Print Bookmark Cracked Heels There are many potential causes of " cracked heels ." Dry skin (xerosis) is common and can ...

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

    PubMed Central

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

    2015-01-01

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

  10. Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia

    PubMed Central

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

    2015-01-01

    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

  11. Pediatric calcaneal fractures

    PubMed Central

    Summers, Hobie; Ann Kramer, Patricia; Benirschke, Stephen K.

    2009-01-01

    Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular) and severity (displaced vs. nondisplaced) have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Bhler's angle on the injured side was ?5 (range: ?35 +35) compared to 31 (range: +22 +47) on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.304.3 years). Maintenance of reduction was confirmed on follow-up radiographs with an average Bhler's angle of 31 (range: +22 +49). We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same. PMID:21808673

  12. Plating for intra-articular calcaneal fractures. Is it an overkill?

    PubMed Central

    Kulkarni, Himanshu Gurunath; Mane, Vilas S.; Gaonkar, Kiran L.; Patil, Pravin P.; Shaha, Mandar S.; Patel, Nirav S.; Desai, Nagesh R.

    2015-01-01

    Objectives Even after evolution of computerized tomography and improved surgical measures, treatment of intraarticular calcaneal fractures remains a controversy. Hence this study was carried out to compare functional outcomes of displaced intraarticular calcaneal fractures, treated with operative management with plating and conservative management with cast. Material and methods This study was carried out as a prospective, comparative study. Twenty nine (30 fractures) patients with acute, displaced intraarticular fractures of calcaneum aged 1850 years, were enrolled in the study. Open fractures and fractures older than two weeks were excluded. 30 fractures were divided into two groups (operative and conservative; n=15 in each). Evaluation in form of post treatment restoration of Bohler's angle, heel varus angle and with CreightonNebraska (CN) score for functional outcome was done at the end of 12 months. Results When we consider the clinical evaluation under the CN score, the results of operatively managed calcaneal fractures are slightly better than those of the conservative group. But this did not have any statistical significance. Also, there was significant difference in pre and post treatment Bohler's angle and heel varus angle in operative group. Three cases of plating suffered from post-operative wound dehiscence. Conclusion A relatively better functional outcome was observed in displaced and comminuted fractures in plating, provided that the Bohler's angle was restored. In conservative group, functional outcome of minimally displaced fractures were better than displaced comminuted fractures. Post treatment Bohlers angle has prognostic importance in functional outcome. PMID:26155050

  13. Calcaneal chondroblastoma with pathologic fracture and recurrence.

    PubMed

    Dutt, Laksha; Schade, Valerie L; Manoso, Mark W

    2015-01-01

    Chondroblastomas account for <2% of all bone tumors. The calcaneus is the fifth most common location of occurrence. Males in their second decade of life are most often affected, presenting with an insidious onset of localized pain, swelling, and tenderness. The finding of associated pathologic fracture has been rare. Imaging studies can aid in the formulation of the differential diagnosis and surgical plan. The definitive diagnosis requires histologic examination. Curettage and bone grafting is curative in >80% of cases. Local recurrence rates of ≤38% have been reported, most often because of inadequate resection, and have been associated with malignant conversion and metastasis. Adjuvant therapies can help minimize the incidence of local recurrence. Long-term follow-up examinations are recommended, given the protracted interval that can exist between recurrence and the potential for malignant conversion and metastasis. We present the case of a young, healthy, active male with a calcaneal chondroblastoma and associated pathologic fracture whose initial treatment consisted of curettage, hydrogen peroxide lavage, and allogeneic bone grafting. Recurrence developed at 15 months postoperatively and was treated with repeat curettage, high-speed burring, and reconstruction with steel Steinman pins and polymethylmethacrylate, resulting in no pain or recurrence at the 5-month follow-up point. PMID:25624038

  14. Corrective Osteotomies for Malunited Tongue-Type Calcaneal Fractures.

    PubMed

    Yu, Guang-Rong; Zhang, Ming-Zhu; Yang, Yun-Feng

    2016-03-01

    Displaced tongue-type fractures of the calcaneus can lead to severe pain and disability if not treated appropriately. Failure to reduce articular displacement may require subtalar joint arthrodesis with subsequent loss of function. The subtalar joint is crucial for normal foot and ankle function. In selected cases, if the malunited joint is still in good condition, it is preserved by corrective osteotomy. A joint-preserving osteotomy with axial realignment is a treatment option for malunited tongue-type calcaneal fractures encountered early on, before the development of subtalar arthrosis in carefully selected patients. PMID:26915783

  15. Kinetics of high-heeled gait.

    PubMed

    Esenyel, Meltem; Walsh, Katlen; Walden, Judith Gail; Gitter, Andrew

    2003-01-01

    A within-subject comparative study of walking while wearing low-heeled sports shoes versus high-heeled dress shoes was performed to identify and describe changes in lower-extremity joint kinetics associated with wearing high-heeled shoes during level overground walking. A volunteer sample of 15 unimpaired female subjects recruited from the local community underwent quantitative measurement of sagittal and frontal plane lower-extremity joint function, including angular motion, muscular moment, power, and work. When walking in high-heeled shoes, a significant reduction in ankle plantar flexor muscle moment, power, and work occurred during the stance phase, whereas increased work was performed by the hip flexor muscles during the transition from stance to swing. In the frontal plane, increased hip and knee varus moments were present. These differences demonstrate that walking in high-heeled shoes alters lower-extremity joint kinetic function. Reduced effectiveness of the ankle plantar flexors during late stance results in a compensatory enhanced hip flexor "pull-off" that assists in limb advancement during the stance-to-swing transition. Larger muscle moments and increased work occur at the hip and knee, which may predispose long-term wearers of high-heeled shoes to musculoskeletal pain. PMID:12533553

  16. Dual energy x-ray laser measurement of calcaneal bone mineral density

    NASA Astrophysics Data System (ADS)

    Hakulinen, M. A.; Saarakkala, S.; Tyrs, J.; Krger, H.; Jurvelin, J. S.

    2003-06-01

    In dual energy x-ray absorptiometry (DXA) the photon attenuation is assumed to be similar in soft tissue overlying, adjacent to and inside the measured bone. In the calcaneal dual energy x-ray laser (DXL) technique, this assumption is not needed as attenuation by soft tissues at the local bone site is determined by combining DXA and heel thickness measurements. In the present study, 38 subjects were measured with DXL Calscan, Lunar PIXI and Lunar DPX-IQ DXA instruments and Hologic Sahara ultrasound instrument, and the performance and agreement of the instruments were analysed. Furthermore, numerical simulations on the effect of non-uniform fat-to-lean tissue ratio within soft tissue in heel were conducted. In vivo short-term precision (CV%, sCV%) of DXL Calscan (1.24%, 1.48%) was similar to that of Lunar PIXI (1.28%, 1.60%). Calcaneal areal bone mineral densities (BMD, g cm-2) measured using DXL Calscan and Lunar PIXI predicted equally well variations in BMD of femoral neck (r2 = 0.63 and 0.52, respectively) or lumbar spine (r2 = 0.61 and 0.64, respectively), determined with Lunar DPX-IQ. BMD values measured with DXL Calscan were, on average, 19% lower (p < 0.01) than those determined with Lunar PIXI. Interestingly, the difference in BMD values between instruments increased as a function of body mass index (BMI) (r2 = 0.17, p < 0.02) or heel thickness (r2 = 0.37, p < 0.01). Numerical simulations suggested that the spatial variation of soft tissue composition in heel can induce incontrollable inaccuracy in BMD when measured with the DXA technique. Theoretically, in contrast to DXA instruments, elimination of the effect of non-uniform soft tissue is possible with DXL Calscan.

  17. Bilateral calcaneal stress fractures in two cats.

    PubMed

    Cantatore, M; Clements, D N

    2015-06-01

    Two cats that developed bilateral calcaneal stress fractures are reported. One cat developed lameness associated with incomplete fractures at the base of both calcanei, both of which progressed to acute, complete fractures 2 months later. The second cat presented with acute complete calcaneal fracture, with evidence of remodelling of the contralateral calcaneus, which subsequently fractured two years later. The calcaneal fractures were successfully stabilised with lateral bone plates in each case. Stress fractures were suspected because of the bilateral nature, the simple and similar configuration, the consistent location of the fractures, the absence of other signs of trauma in both cases and the suspected insidious onset of the lameness. The feline calcaneus is susceptible to stress fracture, and cats presenting with calcaneal fractures without evidence of trauma should be evaluated for concurrent skeletal pathology. PMID:25929309

  18. Multidetector CT evaluation of calcaneal fractures.

    PubMed

    Badillo, Kenneth; Pacheco, Jose A; Padua, Samuel O; Gomez, Angel A; Colon, Edgar; Vidal, Jorge A

    2011-01-01

    As the largest tarsal bone and the most inferior bone in the body, the calcaneus is responsible for supporting the axial load from the weight of the body. It is most commonly fractured after a fall from a height in which axial loads exceed its support capacity. Calcaneal fractures account for 60% of all tarsal fractures. Conventional radiography is commonly used for initial evaluation of calcaneal injury but has the typical disadvantages of two-dimensional imaging. Modern assessment of calcaneal fractures relies heavily on multidetector computed tomography (CT), which allows better visualization and characterization of fracture lines and fragment displacement. Calcaneal fractures observed at CT have been divided into intra- and extraarticular fractures on the basis of subtalar joint involvement. The Sanders classification system for intraarticular fractures is the most commonly used system because it correlates with clinical outcomes and involves less interobserver variability. The classification of extraarticular fractures has been less controversial and makes use of anatomic landmarks on the calcaneus to divide the bone into anterior, middle, and posterior areas. Soft-tissue involvement is an important aspect of calcaneal fracture assessment because it has been linked with poor functional outcomes. Familiarity with the normal anatomy of the calcaneus, the classification of calcaneal fractures, and the various complications of these fractures is essential for treatment assessment, especially if surgical intervention is required. PMID:21257934

  19. Total calcanectomy for the treatment of chronic calcaneal osteomyelitis.

    PubMed

    Baumhauer, J F; Fraga, C J; Gould, J S; Johnson, J E

    1998-12-01

    The purpose of this study is to present the surgical and functional results of a total calcanectomy procedure as a foot salvage alternative in patients with extensive chronic osteomyelitis of the calcaneus. A retrospective review identified eight patients treated with a total calcanectomy for a chronic nonhealing plantar ulcer of the heel and osteomyelitis of the calcaneus. The primary diagnosis was insulin-dependent diabetes mellitus (six patients), pneumococcal septicemia (one patient), and an open calcaneal fracture (one patient). The average age of the patients was 52 years. Prior procedures included irrigation and debridement of the heel ulcer (seven patients), partial calcanectomy (three patients), and split thickness skin grafting (two patients). The vascular status of each limb was assessed preoperatively. Distal extremity bypass surgery was performed on two patients before calcanectomy. Osteomyelitis of the calcaneus was diagnosed by magnetic resonance imaging alone in three patients, and by technetium/indium scans and magnetic resonance imaging in five patients. The average follow-up duration was 27.3 months (range, 6-57 months). Infection at the plantar heel was controlled in all patients. In all eight cases the incisions were closed primarily. During a prolonged time of total contact casting to facilitate wound healing, one patient developed an anterior tibial ulcer that progressed to osteomyelitis and underwent below-knee amputation. Talonavicular subluxation occurred as a late complication in one patient. This was treated with a talonavicular arthrodesis and subsequent bracing for a nonunion. An assessment of functional ambulation was performed on all eight patients. Four patients maintained the same ambulation level postoperatively in a modified heel-containment orthosis. Two patients decreased one functional ambulation level, and one patient decreased two levels. One patient underwent below-knee amputation and is currently ambulatory with a prothesis. Assessment of ankle strength and range of motion of the surgical limb demonstrated decreased dorsiflexion and plantarflexion strength and a variable range of motion compared to the contralateral limb. Total calcanectomy is an alternative procedure to transtibial amputation in patients with chronic osteomyelitis of the calcaneus. Eradication of infection and preservation of the functional ambulation is achieved. PMID:9872473

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

    SciTech Connect

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

    2012-11-15

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

  1. Achilles Pain.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

  2. Achilles Pain.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon

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

    PubMed Central

    Han, Dongwook

    2015-01-01

    [Purpose] This study researched the effects of different types of high heels on the muscles surrounding the cervical spine, the thoracic spine, and the lumbar spine by analyzing muscle activation of the paraspinal muscles during standing while wearing high heels. The high heels were all of the same height: 8?cm. [Subjects and Methods] The 28 subjects in this experiment were females in their 20s with a foot size of 225230?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

  4. Heel pressure ulcers: purple heel and deep tissue injury.

    PubMed

    Salcido, Richard; Lee, Augustine; Ahn, Chulhyun

    2011-08-01

    The heel is a frequent site of pressure ulcer formation, in particular, the development of suspected deep tissue injury. This article reviews the epidemiology, pathophysiology and prevention of heel pressure ulcers. Also, the related concept of purple heel, a not-well-recognized entity, is introduced. PMID:21768788

  5. Correlation between Parameters of Calcaneal Quantitative Ultrasound and Hip Structural Analysis in Osteoporotic Fracture Patients

    PubMed Central

    Zheng, Hailiang; Li, Ming; Yin, Pengbin; Peng, Ye; Gao, Yuan; Zhang, Lihai; Tang, Peifu

    2015-01-01

    Background Calcaneal quantitative ultrasound (QUS), which is used in the evaluation of osteoporosis, is believed to be intimately associated with the characteristics of the proximal femur. However, the specific associations of calcaneal QUS with characteristics of the hip sub-regions remain unclear. Design A cross-sectional assessment of 53 osteoporotic patients was performed for the skeletal status of the heel and hip. Methods We prospectively enrolled 53 female osteoporotic patients with femoral fractures. Calcaneal QUS, dual energy X-ray absorptiometry (DXA), and hip structural analysis (HSA) were performed for each patient. Femoral heads were obtained during the surgery, and principal compressive trabeculae (PCT) were extracted by a three-dimensional printing technique-assisted method. Pearson’s correlation between QUS measurement with DXA, HSA-derived parameters and Young’s modulus were calculated in order to evaluate the specific association of QUS with the parameters for the hip sub-regions, including the femoral neck, trochanteric and Ward’s areas, and the femoral shaft, respectively. Results Significant correlations were found between estimated BMD (Est.BMD) and BMD of different sub-regions of proximal femur. However, the correlation coefficient of trochanteric area (r = 0.356, p = 0.009) was higher than that of the neck area (r = 0.297, p = 0.031) and total proximal femur (r = 0.291, p = 0.034). Furthermore, the quantitative ultrasound index (QUI) was significantly correlated with the HSA-derived parameters of the trochanteric area (r value: 0.315–0.356, all p<0.05) as well as with the Young’s modulus of PCT from the femoral head (r = 0.589, p<0.001). Conclusion The calcaneal bone had an intimate association with the trochanteric cancellous bone. To a certain extent, the parameters of the calcaneal QUS can reflect the characteristics of the trochanteric area of the proximal hip, although not specifically reflective of those of the femoral neck or shaft. PMID:26710123

  6. Treatment of Calcaneal Fracture With Severe Soft Tissue Injury and Osteomyelitis: A Case Report.

    PubMed

    Karns, Michael; Dailey, Steven K; Archdeacon, Michael T

    2015-01-01

    Advancements in surgical technique have resulted in the ability to reconstruct lower extremity injuries that would have previously been treated by amputation. Currently, a paucity of data is available specifically addressing limb amputation versus reconstruction for calcaneal fractures with severe soft tissue compromise. Reconstruction leaves the patient with their native limb; however, multiple surgeries, infections, chronic pain, and a poor functional outcome are very real possibilities. We present the case of a complex calcaneal fracture complicated by soft tissue injury and osteomyelitis that highlights the importance of shared decision-making between patient and surgeon when considering reconstruction versus amputation. This case exemplifies the need for open communication concerning the risks and benefits of treatment modalities while simultaneously considering the patient's expectations and desired outcomes. PMID:25128313

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

    PubMed

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

    2012-06-01

    Although wearing high-heeled shoes has long been considered a risk factor for the development for patellofemoral pain (PFP) in women, patellofemoral joint kinetics during high-heeled gait has not been examined. The purpose of this study was to determine if heel height increases patellofemoral joint loading during walking. Eleven healthy women (mean age 25.03.1 yrs) participated. Lower extremity kinematics and kinetics were obtained under 3 different shoe conditions: low heel (1.27 cm), medium heel (6.35 cm), and high heel (9.53 cm). Patellofemoral joint stress was estimated using a previously described biomechanical model. Model outputs included patellofemoral joint reaction force, patellofemoral joint stress and utilized contact area as a function of the gait cycle. One-way ANOVAs with repeated measures were used to compare the model outputs and knee joint angles among the 3 shoe conditions. Peak patellofemoral joint stress was found to increase significantly (p=0.002) with increasing heel height (low heel: 1.90.7 MPa, medium heel: 2.61.2 MPa, and high heel: 3.61.5 MPa). The increased patellofemoral joint stress was mainly driven by an increase in joint reaction force owing to higher knee extensor moments and knee flexion angles. Our findings support the premise that wearing high-heeled shoes may be a contributing factor with respect to the development of PFP. PMID:22520457

  8. Superior peroneal retinacular injuries in calcaneal fractures.

    PubMed

    Kwaadu, Kwasi Yiadom; Fleming, Justin James; Florek, Derek

    2015-01-01

    Calcaneal fractures are injuries that occur generally as the result of high-energy mechanisms, and, as such, the presence of concurrent injuries should be suspected. The presence of peroneal tendon and superior retinacular injuries has been underreported. We sought to report the incidence of peroneal tendon pathologic features in our population of patients with calcaneal fractures, with emphasis on the method of identification. Furthermore, we sought to identify whether specific fracture patterns were more commonly associated with this pathologic finding. Of the 97 cases, 13 (13.4%) required repair of the superior peroneal retinaculum, 11 of which demonstrated the Sanders A fracture line. Our findings have demonstrated an incidence of pathologic features, in particular, with the presence of the Sanders A fracture line, that warrants attention to potentially help improve the outcome of these devastating injuries. PMID:25726126

  9. Calcaneal loading during walking and running

    NASA Technical Reports Server (NTRS)

    Giddings, V. L.; Beaupre, G. S.; Whalen, R. T.; Carter, D. R.

    2000-01-01

    PURPOSE: This study of the foot uses experimentally measured kinematic and kinetic data with a numerical model to evaluate in vivo calcaneal stresses during walking and running. METHODS: External ground reaction forces (GRF) and kinematic data were measured during walking and running using cineradiography and force plate measurements. A contact-coupled finite element model of the foot was developed to assess the forces acting on the calcaneus during gait. RESULTS: We found that the calculated force-time profiles of the joint contact, ligament, and Achilles tendon forces varied with the time-history curve of the moment about the ankle joint. The model predicted peak talocalcaneal and calcaneocuboid joint loads of 5.4 and 4.2 body weights (BW) during walking and 11.1 and 7.9 BW during running. The maximum predicted Achilles tendon forces were 3.9 and 7.7 BW for walking and running. CONCLUSIONS: Large magnitude forces and calcaneal stresses are generated late in the stance phase, with maximum loads occurring at approximately 70% of the stance phase during walking and at approximately 60% of the stance phase during running, for the gait velocities analyzed. The trajectories of the principal stresses, during both walking and running, corresponded to each other and qualitatively to the calcaneal trabecular architecture.

  10. Joint-Preserving Osteotomies for Malaligned Intraarticular Calcaneal Fractures.

    PubMed

    Benirschke, Stephen K; Kramer, Patricia A

    2016-03-01

    Intraarticular calcaneal fracture treatments that result in malalignment often require reconstructive surgery. Seven cases are used to demonstrate the intricacies of reconstructive case management. Reestablishment of calcaneal height, length, orientation, and position relative to the other tarsals is necessary to reestablish appropriate foot function. Inherent or acquired gastrocnemius equinus should be treated with recession to reduce destructive forces on the reconstruction. PMID:26915782

  11. Rearward movement of the heel at heel strike.

    PubMed

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

    2008-11-01

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

  12. Heel pain and Achilles tendonitis - aftercare

    MedlinePLUS

    ... MR, Zachazewski J, Stone DA, eds. Instructions for Sports Medicine Patients . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013: ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ...

  13. High Heels Increase Women's Attractiveness.

    PubMed

    Guéguen, Nicolas

    2015-11-01

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

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

    PubMed

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

    2009-12-01

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

  15. How I Manage Heel Spur Syndrome.

    ERIC Educational Resources Information Center

    Seder, Joseph I.

    1987-01-01

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

  16. Comparison of lateral opening wedge calcaneal osteotomy and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy for correction of planovalgus foot deformity in children.

    PubMed

    Kim, Jung Ryul; Shin, Sung Jin; Wang, Sung-Il; Kang, Sang Min

    2013-01-01

    The purpose of the present study was to compare the clinical and radiographic results between 2 procedures, lateral opening wedge calcaneal osteotomy (LCL) and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy (3C) in patients with planovalgus foot deformity. A total of 38 patients who underwent either LCL (18 patients, 28 feet) or 3C (20 patients, 32 feet) were included in the present study. The etiology of the planovalgus foot deformity was idiopathic in 16 feet and cerebral palsy in 44 feet. The 2 procedures used in the present study were indicated in symptomatic (pain or callus) children in whom conservative treatment, such as shoe modifications or orthotics, had been applied for more than 1 year but had failed. The patients were evaluated preoperatively, postoperatively, and at the last follow-up visit, both clinically and radiologically, and the interval to union and postoperative courses were compared between the 2 groups. In the LCL group, 19 of the 28 feet (68%) showed a satisfactory outcome and 9 (32%) an unsatisfactory outcome. In the 3C group, 28 of the 32 feet (88%) showed a satisfactory outcome and 4 (12%) an unsatisfactory outcome. The clinical results were not significantly different between the 2 groups, with mild to moderate pes planovalgus deformity. However, the clinical results were better in the 3C group with severe pes planovalgus deformity than in the LCL group with severe pes planovalgus deformity. All 4 radiographic parameters were improved at the last follow-up visit in both groups. In particular, the talar-first metatarsal angle and the calcaneal pitch angle on the weightbearing lateral radiographs were significantly improved in the 3C group with mild to moderate planovalgus foot deformity. All 4 parameters were significantly improved in the 3C group with severe planovalgus foot deformity. No significant differences were observed between the 2 groups in terms of the interval to union and postoperative care. No case of postoperative deep infection or nonunion was encountered in either group. 3C is a more effective procedure than LCL for the correction of pes planovalgus deformity in children, especially severe pes planovalgus deformities. PMID:23333282

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

    PubMed Central

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

    2015-01-01

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

  18. Hypertrophic osteoarthropathy manifested with isolated calcaneal periostitis in bone scintigraphy.

    PubMed

    Moralidis, Efstratios; Gerasimou, Georgios; Theodoridou, Athina; Hilidis, Ilias; Mylonaki, Efrosyni; Gotzamani-Psarrakou, Anna

    2010-05-01

    Hypertrophic osteoarthropathy (HOA) is an incompletely understood syndrome characterized by digital clubbing and periosteal proliferation of long bones and it is commonly associated with primary lung tumors. Bone scintigraphy is a sensitive method in detecting HOA and characteristic findings have been reported. We present the case of a man with newly diagnosed non-small cell lung cancer, unremarkable clinical examination and blood tests and no digital clubbing. During disease staging, however, bone scintigraphy showed intense calcaneal cortical proliferation bilaterally without involvement of other parts of the skeleton. Cortical reaction of both calcanei resolved significantly after chemotherapy. This case indicates that HOA may manifest with isolated calcaneal periostitis bilaterally, which is a new addition to the literature. PMID:20127294

  19. Fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve).

    PubMed

    Zeng, Rong; Frederick-Dyer, Katherine; Ferguson, N Lynn; Lewis, James; Fu, Yitong

    2012-09-01

    Fibrolipomatous hamartoma (FLH) is a rare, benign lesion of the peripheral nerves most frequently involving the median nerve and its digital branches (80 %). Pathognomonic MR features of FLH such as coaxial-cable-like appearance on axial planes and a spaghetti-like appearance on coronal planes have been described by Marom and Helms, obviating the need for diagnostic biopsy. We present a case of fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve) with associated subcutaneous fat proliferation. PMID:22526881

  20. Biomechanics of calcaneal fractures: a model for the motor vehicle.

    PubMed

    Seipel, R C; Pintar, F A; Yoganandan, N; Boynton, M D

    2001-07-01

    Changes in legislation, availability of passive or active restraint systems, or both, together with increased public awareness for safety and the need for use of restraint, have shifted the spectrum of trauma in motor vehicle crashes from the head and torso to other regions. Lower extremity trauma in motor vehicle crashes continues to be a significant problem. The objective of this study was to investigate the biomechanics of the human foot and ankle complex under impact loading and replicate calcaneal fractures routinely seen in motor vehicle crashes. Twenty-two unembalmed cadaver lower extremity specimens were subjected to dynamic loads using a minisled pendulum device. Input and output forces and results of pathologic analysis were obtained using load cell data, radiographs obtained before and after testing, and gross dissection. The intraarticular fracture patterns produced were similar to those seen clinically and described in the literature. Maximum forces ranged from 3.6 to 11.4 kN for the fracture, and 0.5 to 7.3 kN for the nonfracture groups. Logistic regression analysis revealed a 50% probability of calcaneal fracture at 5.5 kN and a 25% probability at 4.0 kN. These studies will lead to an understanding of the tolerance of the lower extremity in sustaining calcaneal fractures under impact. Implications of the work are in the design of crash test dummies, data acquisition, and modifications in motor vehicle design and safety. PMID:11451123

  1. Intraoperative Three-Dimensional Imaging in Calcaneal Fracture Treatment

    PubMed Central

    Gwak, Heui-Chul; Kim, Jung-Han; Roh, Sang-Myung

    2015-01-01

    Background To compare the effectiveness of intraoperative three-dimensional (3D) image and conventional two-dimensional (2D) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. Methods We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital. The patients were divided into two groups. Only 2D fluoroscopy was used to evaluate 20 patients of group 1. On the other hand, 3D fluoroscopy was performed on the remaining 20 patients of group 2; 3D fluoroscopy was performed on these patients after they were extensively evaluated by 2D fluoroscopy during surgery. We reviewed the radiographic and clinical outcomes of these patients, whose average follow-up period was 42.6 months. Results In group 2, 3D fluoroscopy detected four cases (20%) of articular incongruence and screw misplacement. All these complicated cases were corrected during surgery. At the final follow-up session, the mean American Orthopedic Foot and Ankle Society (AOFAS) hind foot score was 78.3 (range, 65 to 95) in group 1 and 82.3 (range, 68 to 95) in group 2. Conclusions Intraoperative 3D imaging of calcaneal fractures is considered to be useful in evaluating the congruence of joints and the placement of implants. PMID:26640632

  2. Anatomy of the subtalar joint and imaging of talo-calcaneal coalition.

    PubMed

    Linklater, J; Hayter, C L; Vu, D; Tse, K

    2009-05-01

    Talo-calcaneal coalitions may be intra-articular or extra-articular in position and may be classified as fibrous, cartilaginous or osseous in morphology. Fibrous coalitions, particularly extra-articular talo-calcaneal coalitions, may have cross-sectional imaging findings that resemble normal anatomic variants, particularly the medial talo-calcaneal ligament and to a lesser extent the presence of an accessory articular facet between the posterior margin of the sustentaculum and postero-medial process of the talus. Typically, in the adult fibrous coalition, there will be some osseous deformity at the entheses, allowing differentiation from a medial talo-calcaneal ligament. The anatomy of the subtalar joint and its ligamentous supports, normal anatomic variations and their corresponding imaging appearance are reviewed in the first part of this article. In the second part, the various forms of talo-calcaneal coalition and their imaging appearance are reviewed. PMID:19096839

  3. Evolution and Allometry of Calcaneal Elongation in Living and Extinct Primates

    PubMed Central

    Boyer, Doug M.; Seiffert, Erik R.; Gladman, Justin T.; Bloch, Jonathan I.

    2013-01-01

    Specialized acrobatic leaping has been recognized as a key adaptive trait tied to the origin and subsequent radiation of euprimates based on its observed frequency in extant primates and inferred frequency in extinct early euprimates. Hypothesized skeletal correlates include elongated tarsal elements, which would be expected to aid leaping by allowing for increased rates and durations of propulsive acceleration at takeoff. Alternatively, authors of a recent study argued that pronounced distal calcaneal elongation of euprimates (compared to other mammalian taxa) was related primarily to specialized pedal grasping. Testing for correlations between calcaneal elongation and leaping versus grasping is complicated by body size differences and associated allometric affects. We re-assess allometric constraints on, and the functional significance of, calcaneal elongation using phylogenetic comparative methods, and present an evolutionary hypothesis for the evolution of calcaneal elongation in primates using a Bayesian approach to ancestral state reconstruction (ASR). Results show that among all primates, logged ratios of distal calcaneal length to total calcaneal length are inversely correlated with logged body mass proxies derived from the area of the calcaneal facet for the cuboid. Results from phylogenetic ANOVA on residuals from this allometric line suggest that deviations are explained by degree of leaping specialization in prosimians, but not anthropoids. Results from ASR suggest that non-allometric increases in calcaneal elongation began in the primate stem lineage and continued independently in haplorhines and strepsirrhines. Anthropoid and lorisid lineages show stasis and decreasing elongation, respectively. Initial increases in calcaneal elongation in primate evolution may be related to either development of hallucal-grasping or a combination of grasping and more specialized leaping behaviors. As has been previously suggested, subsequent increases in calcaneal elongation are likely adaptations for more effective acrobatic leaping, highlighting the importance of this behavior in early euprimate evolution. PMID:23844094

  4. Evolution and allometry of calcaneal elongation in living and extinct primates.

    PubMed

    Boyer, Doug M; Seiffert, Erik R; Gladman, Justin T; Bloch, Jonathan I

    2013-01-01

    Specialized acrobatic leaping has been recognized as a key adaptive trait tied to the origin and subsequent radiation of euprimates based on its observed frequency in extant primates and inferred frequency in extinct early euprimates. Hypothesized skeletal correlates include elongated tarsal elements, which would be expected to aid leaping by allowing for increased rates and durations of propulsive acceleration at takeoff. Alternatively, authors of a recent study argued that pronounced distal calcaneal elongation of euprimates (compared to other mammalian taxa) was related primarily to specialized pedal grasping. Testing for correlations between calcaneal elongation and leaping versus grasping is complicated by body size differences and associated allometric affects. We re-assess allometric constraints on, and the functional significance of, calcaneal elongation using phylogenetic comparative methods, and present an evolutionary hypothesis for the evolution of calcaneal elongation in primates using a Bayesian approach to ancestral state reconstruction (ASR). Results show that among all primates, logged ratios of distal calcaneal length to total calcaneal length are inversely correlated with logged body mass proxies derived from the area of the calcaneal facet for the cuboid. Results from phylogenetic ANOVA on residuals from this allometric line suggest that deviations are explained by degree of leaping specialization in prosimians, but not anthropoids. Results from ASR suggest that non-allometric increases in calcaneal elongation began in the primate stem lineage and continued independently in haplorhines and strepsirrhines. Anthropoid and lorisid lineages show stasis and decreasing elongation, respectively. Initial increases in calcaneal elongation in primate evolution may be related to either development of hallucal-grasping or a combination of grasping and more specialized leaping behaviors. As has been previously suggested, subsequent increases in calcaneal elongation are likely adaptations for more effective acrobatic leaping, highlighting the importance of this behavior in early euprimate evolution. PMID:23844094

  5. Metastatic calcaneal lesion associated with uterine carcinosarcoma.

    PubMed

    Rice, Brittany M; Todd, Nicholas W; Jensen, Richard; Rush, Shannon M; Rogers, William

    2014-01-01

    Metastatic lesions of uterine carcinosarcoma most commonly occur in the abdomen and lungs and less frequently in highly vascularized bone. We report a rare case of an 86-year-old female with uterine carcinosarcoma with metastasis to the left calcaneus. The patient had a history of uterine carcinosarcoma with hysterectomy and bilateral salpingo-oophorectomy, along with bilateral pelvic and aortic lymphadenectomy, with no adjuvant therapy. The initial pedal complaint was that of left foot pain. The initial radiographic findings were negative; however, magnetic resonance imaging scans revealed a substantial area of marrow edema in the calcaneus. An excisional biopsy was performed, and histopathologic analysis revealed adenocarcinoma with features consistent with the patient's previous uterine tumor specimen. The patient was given one treatment of chemotherapy and was discharged to a hospice, where she died of her disease 2 weeks later. PMID:23871174

  6. Pain.

    PubMed

    Lefaucheur, Jean-Pascal

    2013-01-01

    Invasive stimulation of the motor (precentral) cortex using surgically implanted epidural electrodes is indicated for the treatment of neuropathic pain that is refractory to medical treatment. Controlled trials have demonstrated the efficacy of epidural motor cortex stimulation (MCS), but MCS outcome remains variable and validated criteria for selecting good candidates for implantation are lacking. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive approach that could be used as a preoperative tool to predict MCS outcome and also could serve as a therapeutic procedure in itself to treat pain disorders. This requires repeated rTMS sessions and a maintenance protocol. Other studies have also demonstrated the efficacy of transcranial direct current stimulation (tDCS) in relieving chronic pain syndromes. The most studied target is the precentral cortex, but other targets, such as the prefrontal and parietal cortices, could be of interest. The analgesic effects of cortical stimulation relate to the activation of various circuits modulating neural activities in remote structures, such as the thalamus, limbic cortex, insula, or descending inhibitory controls. In addition to the treatment of refractory neuropathic pain by epidural MCS, new developments of this type of strategy are ongoing, for other types of pain syndrome and stimulation techniques. PMID:24112914

  7. Corrective Osteotomies for Malunited Extra-Articular Calcaneal Fractures.

    PubMed

    Ketz, John; Clare, Michael; Sanders, Roy

    2016-03-01

    The most effective way to treat calcaneal malunions is avoidance. With any articular fracture, progressive arthrosis and dysfunction are common. By restoring the anatomy initially through reduction, late reconstructive options become less complicated. Numerous studies have shown that restoration of the anatomic alignment either through percutaneous or open techniques is effective. In patients with no or minimal articular degeneration, extrarticular joint-sparing procedures can be performed. This represents a small select group who may benefit from simple osteotomy procedures with associated soft tissue reconstruction, if needed. PMID:26915784

  8. Presence of a long accessory flexor tendon of the toes in surgical treatment for tendinopathy of the insertion of the calcaneal tendon: case report☆

    PubMed Central

    Gomes Júnior, Nelson Pelozo; Andreoli, Carlos Vicente; Pochini, Alberto de Castro; Raduan, Fernando Cipolini; Ejnisman, Benno; Cohen, Moisés

    2015-01-01

    The presence of accessory tendons in the foot and ankle needs to be recognized, given that depending on their location, they may cause disorders relating either to pain processes or to handling of the surgical findings. We describe the presence of an accessory flexor tendon of the toes, seen in surgical exposure for transferring the long flexor tendon of the hallux to the calcaneus, due to the presence of a disorder of tendinopathy of the insertion of the calcaneal tendon in association with Haglund's syndrome.

  9. Clinical Allograft of a Calcaneal Tendon in a Rhesus Macaque (Macaca mulatta)

    PubMed Central

    Lemoy, Marie-Josee; Summers, Laura; Colagross-Schouten, Angela

    2014-01-01

    A 5.5-y-old male rhesus monkey (Macaca mulatta) housed in an outdoor field cage presented for severe trauma involving the left calcaneal tendon. Part of the management of this wound included an allograft of the calcaneal tendon from an animal that was euthanized for medical reasons. This case report describes the successful medical and surgical management of a macaque with a significant void of the calcaneal tendon. To our knowledge, this report is the first description of a successful tendon allograft in a rhesus macaque for clinical purposes. PMID:25255076

  10. ASSESSMENT OF REPRODUCIBILITY OF SANDERS CLASSIFICATION FOR CALCANEAL FRACTURES

    PubMed Central

    Piovesana, Lucas Gonzaga; Lopes, Hériston Cristovam; Pacca, Daniel Moreira; Ninomiya, André Felipe; Dinato, Mauro César Mattos e; Pagnano, Rodrigo Gonçalves

    2016-01-01

    Objective : To assess intra- and interobserver reproducibility of Sanders Classification System of calcaneal fractures among experienced and less experienced observers. Methods : Forty-six CT scans of intra-articular calcaneal fractures were reviewed. Four observers, two with ten years of experience in foot and ankle surgery and two third-year residents in Orthopedics and Traumatology classified the fractures on two separate occasions three weeks apart from each other. The intra and inter-observer reliability was analyzed using the Kappa index. Results : There was good intraobserver reliability for the two experienced observers and one less experienced observer (Kappa values 0.640, 0.632 and 0.629, respectively). The interobserver reliability was fair between the experienced observers (Kappa = 0.289) and moderate among the less experienced observers (Kappa = 0.527). Conclusions : The Sanders Classification System showed good intraobserver reliability, but interobserver reproducibility below the ideal level, both among experienced and less experienced observers. Level of Evidence III, Diagnostic Studies.

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

    PubMed Central

    Barnish, Maxwell S; Barnish, Jean

    2016-01-01

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

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

    PubMed

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

    2015-01-21

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

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

    PubMed Central

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

    2014-01-01

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

  14. The effect of age, weight, and lifestyle factors on calcaneal quantitative ultrasound: the ESOPO study.

    PubMed

    Adami, Silvano; Giannini, Sandro; Giorgino, Ruben; Isaia, GianCarlo; Maggi, Stefania; Sinigaglia, Luigi; Filipponi, Paolo; Crepaldi, Gaetano; Di Munno, Ombretta

    2003-05-01

    Quantitative ultrasound (QUS) techniques have been shown to be as good as bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA), in predicting fracture risk: QUS technique could increase substantially the accessibility to a reliable bone osteoporosis risk evaluation, but little is know regarding the relationship of QUS to risk factors that have been found to predict DXA-BMD values and this is even more true in men. We studied 6,811 postmenopausal women 40 to 80 years of age and 4,981 men 60-80 years of age representative of the general population of all regions of Italy. All participants were questioned on lifestyle habits and on their medical history. After a physical examination "bone stiffness" (called here for simplicity, stiffness), which is derived from the values of broadband ultrasound attenuation (BUA) and speed of sounds (SoS) was measured by a heel QUS device (Achilles apparatus, Lunar, Madison, USA). The most common recognized determinants of bone mass (either categorical or continuous variables) were modeled with stiffness by multiple regression analysis or ANOVA. Stiffness was strongly related to age and weight. After adjusting for these variables, the women who had taken hormone replacement therapy for more than a year had significantly higher stiffness values. The difference versus nonusers remained significant for up to 20 years-since-menopause (YSM). This effect was so strong that for further analysis these women were excluded. By multivariate analysis, stiffness was then found to be significantly related to recalled body weight at 25 years of age, actual and past cigarettes smoked per day, and dairy calcium intake. Stiffness was also associated with a number of categorial factors adjusted for age, weight, and YSM: prior ovariectomy, history of more than 2 months confined to bed, outdoor physical activity, smoking, chronic use of any drug, and past corticosteroid use. All these categorial and continuous variables predicted stiffness equally in men and women. In conclusion, QUS bone measurements discriminate postmenopausal women according to past use of hormone replacement therapy. Risk factors usually associated to BMD as measured by DXA are also associated to calcaneal bone stiffness as measured by QUS, and most risk factors for osteoporosis usually observed in women are equally applicable to men. PMID:12730794

  15. Calcaneal robusticity in Plio-Pleistocene hominins: implications for locomotor diversity and phylogeny.

    PubMed

    Prang, Thomas C

    2015-03-01

    A key pedal adaptation to bipedality is a relatively large, weight-bearing calcaneus. The earliest evidence for a human-like, robust calcaneus is at 3.2 Ma in Australopithecus afarensis (A.L. 333-8, A.L. 333-55, A.L. 333-37) from Hadar, Ethiopia. Australopithecus sediba at 1.98 Ma from Malapa, South Africa displays a unique combination of primitive australopith features and more derived Homo-like features, but surprisingly is characterized by a gracile, chimpanzee-like calcaneus. The differences in calcaneal morphology suggest that these taxa differed in the frequency of arboreality and in the manner of foot function during terrestrial bipedal locomotion. This study examines calcaneal morphology in extant hominids (i.e., great apes and humans; N = 95) and fossil hominins (N = 5) to better understand the evolutionary development of calcaneal robusticity in early hominins. In particular, this study focuses on two additional fossil hominin calcanei that have not figured prominently in previous discussions of calcaneal robusticity: StW 352 and Omo 33-74-896. A measure of calcaneal robusticity was quantified as the ratio of calcaneal tuber cross-sectional area to calcaneal tuber length, which significantly differs between humans and non-humans using a sequential Bonferroni alpha adjustment for multiple comparisons. Additional multivariate analyses using Mosimann shape variables show that StW 352 and Omo 33-74-896 are more similar to Au. sediba in calcaneal tuber morphology than to Au. afarensis, suggesting that the latter taxon is better adapted for terrestrial bipedalism than at least some later species of Australopithecus. This finding implies the possibility of several complex evolutionary scenarios involving either multiple reversals in postcranial morphology in Australopithecus or the independent acquisition of adaptations to terrestrial bipedalism in Au. afarensis and Homo. PMID:25440133

  16. Internal and external fixation approaches to the surgical management of calcaneal fractures.

    PubMed

    Stapleton, John J; Kolodenker, Gennady; Zgonis, Thomas

    2010-07-01

    Calcaneal fractures are one of the most difficult fractures to surgically manage and often require a steep learning curve to achieve consistent results. They usually occur in young individuals with labor intensive occupations and are associated with major complications. Conservative treatment of intraarticular calcaneal fractures with displacement often results in significant deformity, bone loss, and posttraumatic arthrosis. Optimally, an open approach is required in most cases to achieve anatomic reduction and successful long-term outcomes. PMID:20691371

  17. The Heel Pad in Congenital Idiopathic Clubfoot: Implications of Empty Heel for Clinical Severity Assessment

    PubMed Central

    Adegbehingbe, Olayinka O.; Asuquo, J. E.; Joseph, Mejabi O.; Alzahrani, Mohammed; Morcuende, Jose A.

    2015-01-01

    Background Clubfoot has been evaluated in many ways, including the most common classifications of clubfoot, described by Caterrall and Piraniis based on six clinical signs. The purpose of this study was to gain better understanding of the heel pad in relation to the term empty heel, and to propose modification of clubfoot severity scoring system based on empty heel. Methods A combination of prospective study of 79 clubfoot patients treated with Ponseti method and literature review of heel pad anatomy and biomechanics. The setting was a university teaching hospital. The ethical research committee approved study protocol and informed consent of patients' parent obtained. The selection criteria included patients' diagnosed congenital idiopathic clubfoot, age < 2years, no history of previous treatment and tenotomy indicated. An evaluation of patient was assessed by orthopaedic surgeons trained on Ponseti method and has above 5 years experience. Data analysis performed on the age, sex, Pirani scores at onset of treatment, tenotomy, and 6 month after initial full correction. Results One hundred and thirty-two clubfeet in 79 patients (56 males, 23 females) completed Ponseti protocol. The median age at presentation was 5.2 months (range 0.123.7 months). The mean right foot abduction after correction 57.30(S.D. 9.20), and for the left foot, was 56.30 (S.D. 9.40). The mean right foot dorsiflexion was ?13.70 (S.D. 18.40) before correction while after correction, it was 20.00 (S.D. 4.50) and for the left, the mean was ?8.50 (S.D. 9.60) before correction and 21.00 (S.D. 4.30) after correction. Eighteen (22.8%) patients (10 bilateral, 9 unilateral) had clubfeet with empty heel score above zero point at initial full correction (p<0.001). Clinic anatomy shows the heel pad is a solid complex structure existing in normal, moderate and severe atrophied form. Heel pad is attached tightly to calcaneus without a cavity for the calcaneus to drop. Conclusions Heel pad probably could replace empty heel in modify Pirani scoring system. Clinical indication for repeat tenotomy should be based on equinus, not on the feeling of an empty heel, and families can be advised that the heel pad has a tendency to remodel over time to a normal shape. Level of Evidence Level II Clinical Relevance Empty heel feeling at initial full correction of congenital idiopathic clubfoot based on Ponseti protocol is not indication for repeat tenotomy. PMID:26361461

  18. The use of calcaneal anatomic plate in arthroscopically-assisted open reduction and internal fixation of intra-articular calcaneal fractures.

    PubMed

    Wang, Hong; Zhang, Qingsong; Duan, Deyu; Yan, Lijun

    2006-01-01

    To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months (range 12-30 months). The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation (P < 0. 01), the total excellent and fine rate was 91.86%. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication. PMID:16961281

  19. Ulceroproliferative growth on the heel: epithelioma cuniculatum.

    PubMed

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

    2006-01-01

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

  20. Improved method for determining tank heel volumes

    SciTech Connect

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

    1994-07-01

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

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

    PubMed Central

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

    2008-01-01

    Background It has been proposed that high-heeled shoes may contribute to the development and progression of knee pain. However, surprisingly little research has been carried out on how shoe heel height affects muscle activity around the knee joint. The purpose of this study was to investigate the effect of differing heel height on the electromyographic (EMG) activity in vastus medialis (VM) and vastus lateralis (VL) during a sit to stand activity. This was an exploratory study to inform future research. Methods A repeated measures design was used. Twenty five healthy females carried out a standardised sit to stand activity under 4 conditions; barefoot, and with heel wedges of 1, 3, and 5 cm in height. EMG activity was recorded from VM and VL during the activity. Data were analysed using 1 4 repeated measures ANOVA. Results Average rectified EMG activity differed with heel height in both VM (F2.2, 51.7 = 5.24, p < 0.01), and VL (F3, 72 = 5.32, p < 0.01). However the VM: VL EMG ratio was not significantly different between conditions (F3, 72 = 0.61, p = 0.609). Conclusion We found that as heel height increased, there was an increase in EMG activity in both VM and VL, but no change in the relative EMG intensity of VM and VL as measured by the VM: VL ratio. This showed that no VM: VL imbalance was elicited. This study provides information that will inform future research on how heel height affects muscle activity around the knee joint. PMID:18186937

  2. Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction.

    PubMed

    Chadwick, C; Whitehouse, S L; Saxby, T S

    2015-03-01

    Flexor digitorum longus transfer and medial displacement calcaneal osteotomy is a well-recognised form of treatment for stage II posterior tibial tendon dysfunction. Although excellent short- and medium-term results have been reported, the long-term outcome is unknown. We reviewed the clinical outcome of 31 patients with a symptomatic flexible flat-foot deformity who underwent this procedure between 1994 and 1996. There were 21 women and ten men with a mean age of 54.3 years (42 to 70). The mean follow-up was 15.2 years (11.4 to 16.5). All scores improved significantly (p < 0.001). The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up. The mean pain component improved from 12.3 to 35.2 (20 to 40). The mean function score improved from 35.2 to 45.6 (30 to 50). The mean visual analogue score for pain improved from 7.3 to 1.3 (0 to 6). The mean Short Form-36 physical component score was 40.6 (sd 8.9), and this showed a significant correlation with the mean AOFAS score (r = 0.68, p = 0.005). A total of 27 patients (87%) were pain free and functioning well at the final follow-up. We believe that flexor digitorum longus transfer and calcaneal osteotomy provides long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction. PMID:25737518

  3. The relationship of heel contact in ascent and descent from jumps to the incidence of shin splints in ballet dancers.

    PubMed

    Gans, A

    1985-08-01

    I conducted a study to determine whether ballet dancers with a history of shin splints make heel contact on ascent and descent from jumps less often than dancers without this history. Sixteen dancers were filmed as they executed a sequence of jumps at two different speeds. Eight of the subjects had a history of shin-splint pain; eight had no such history. The film was viewed on a Super 8 movie projector. Heel contacts on ascent and descent from jumps were counted. Double heel strikes (heel rise between landing and pushing off) were also counted. A nonparametric t test showed no differences between the two groups in the number of contacts on ascent or descent. The dancers with a history of shin splints, however, demonstrated more double heel strikes (p = .02) than the other group. Clinically, this finding may represent a lack of control or a tight Achilles tendon or both. Further study is necessary to confirm these theories. For treatment and prevention of shin splints, a clinician must evaluate a dancer's jumping technique and then provide systematic training to develop the skin strength, flexibility, and coordination that make up control. PMID:4023066

  4. Use of Allograft in Skeletally Immature Patients for Calcaneal Neck Lengthening Osteotomy

    PubMed Central

    Kwak, Yoon Hae; Park, Kun Bo; Park, Hui Wan

    2008-01-01

    Purpose To date, there have been no studies evaluating the usefulness of allograft as a substitute for autograft in calcaneal neck lengthening osteotomy. This retrospective study examined the results of calcaneal neck lengthening osteotomy using allograft for pathologic flatfoot deformity in children and adolescents with various neuromuscular diseases. Materials and Methods 118 feet in 79 children treated surgically between Mar 2000 and July 2005 were reviewed. The mean age at the time of the operation was 9 + 3 years (range, 3 - 17 years) and follow-up averaged 15.4 months (range, 13 - 21 months) postoperatively. Talo-1st metatarsal angle, talo-calcaneal angle, calcaneal pitch were measured before and after operation and bony union was estimated. Results Bony union was noted at the latest follow-up and there were no postoperative complications such as reduction loss, infection, nonunion, delayed union or graft loss during the follow-up period in all but one foot. All radiographic indices were improved postoperatively in all cases. Conclusion Our results indicate that use of allograft in calcaneal neck lengthening osteotomy is a useful option for correction of the planovalgus deformity in skeletally immature patients whose enough autobone can not be obtained. PMID:18306473

  5. Reductions in heel bone quality across gestation are attenuated in pregnant adolescents with higher prepregnancy weight and greater increases in PTH across gestation.

    PubMed

    Whisner, Corrie M; Young, Bridget E; Witter, Frank R; Harris, Zena Leah; Queenan, Ruth A; Cooper, Elizabeth M; O'Brien, Kimberly O

    2014-09-01

    Few studies have examined the effect of maternal calcium intake and vitamin D status on bone health across gestation in pregnant adolescents. This study aimed to characterize maternal bone quality and determinants of bone-quality change across gestation in pregnant adolescents. Healthy pregnant adolescents (n?=?156; aged 13 to 18 years) with singleton pregnancies and at 12 to 30 weeks gestation at enrollment were recruited from two urban maternity clinics in Baltimore, MD, and Rochester, NY, for this prospective longitudinal study. Maternal serum was collected at midgestation and at delivery for assessment of bone biomarkers and calcitropic hormones. Maternal bone quality (assessed by heel ultrasound) and sonographic fetal biometry were measured up to three times across pregnancy. Racially diverse teens (64.7% African American, 35.3% white) were followed from 21.0 (interquartile range [IQR] 17.3, 27.0) weeks of gestation until delivery at 40.0 (IQR 39.0, 40.7) weeks. Significant decreases in calcaneal speed of sound (SOS), broadband ultrasound attenuation (BUA), and quantitative ultrasound index (QUI) (-9.2??16.1?m/s, -3.2 (-8.0, 2.1) dB/MHz and -5.3??8.8, respectively) were evident across pregnancy. Multivariate analysis controlling for baseline measures and measurement intervals was used to identify independent predictors of normalized (per week) calcaneal bone loss. Weekly decreases in bone quality were not significantly associated with maternal calcium intake or 25(OH)D concentration. Greater weekly reductions in calcaneal bone quality were evident in teens with lower prepregnancy weight (BUA, p?=?0.006 and QUI, p?=?0.012) and among those with lower weekly increase in PTH (SOS, p?=?0.046). Overall, significant decreases in calcaneal bone quality occurred across pregnancy in adolescents, but the magnitude of this loss was attenuated in those with greater prepregnancy weight and weekly increases in PTH. Further studies are needed to understand the role of elevated PTH and greater prepregnancy weight in preserving adolescent bone during pregnancy. PMID:24676885

  6. Temporary external fixation facilitates open reduction and internal fixation of intra-articular calcaneal fractures.

    PubMed

    Elgamal, Tarek A; Tanagho, Andy E; Ferdinand, Rupert D

    2013-12-01

    Management of intra-articular calcaneal fractures during the past years has ranged from the nihilistic approach of no active treatment to open reduction and internal fixation or even to early subtalar arthrodesis. Operative treatment presents the surgeon with many challenges. Good results require atraumatic exposure, anatomic reduction, rigid fixation and early mobilization. We describe the use of a temporary external fixator as an intraoperative aid in the open reduction and internal fixation of intra-articular calcaneal fractures. We propose this operative strategy as an option for the treatment of calcaneal fractures. The controlled distractive force provides numerous benefits. These include improved exposure of the subtalar joint, correction of angulation and maintenance of temporary stability prior to definitive fixation. We have found this technique applicable and easily reproducible. PMID:24563983

  7. Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis?

    PubMed

    Thomsen, K; Jepsen, D B; Matzen, L; Hermann, A P; Masud, T; Ryg, J

    2015-05-01

    Calcaneal quantitative ultrasound (QUS) is attractive as a prescreening tool for osteoporosis, alternative to dual-energy X-ray absorptiometry. We investigated the literature of the usability of calcaneal QUS. We found large heterogeneity between studies and uncertainty about cutoff, device, and measured variable. Despite osteoporosis-related fractures being a major health issue, osteoporosis remains underdiagnosed. Dual-energy X-ray absorptiometry (DXA) of the hip or spine is currently the preferred method for diagnosis of osteoporosis, but the method is limited by low accessibility. QUS is a method for assessing bone alternative to DXA. The aim of this systematic review was to explore the usability of QUS as a prescreen stratification tool for assessment of osteoporosis. Studies that evaluated calcaneal QUS with DXA of the hip or spine as the gold standard was included. We extracted data from included studies to calculate number of DXAs saved and misclassification rates at cutoffs equal to high sensitivity and/or specificity. The number of DXAs saved and percentage of persons misclassified were measures of usability. We included 31 studies. Studies were heterogeneous regarding study characteristics. Analyses showed a wide spectrum of percentage of DXAs saved (2.7-68.8%) and misclassification rates (0-12.4%) depending on prescreen strategy and study characteristics, device, measured variable, and cutoff. Calcaneal QUS is potentially useful as a prescreen tool for assessment of osteoporosis. However, there is no consensus of device, variable, and cutoff. Overall, there is no sufficient evidence to recommend a specific cutoff for calcaneal QUS that provides a certainty level high enough to rule in or out osteoporosis. Calcaneal QUS in a prescreen or stratification algorithm must be based on device-specific cutoffs that are validated in the populations for which they are intended to be used. PMID:25634771

  8. Transcalcaneal talonavicular dislocation associated with an open comminuted calcaneal fracture: a case report.

    PubMed

    Galanakos, Spyridon P; Papathanasiou, Vassilios; Sofianos, Ioannis P

    2011-08-01

    The combination of dorsal dislocation of the navicular from the talus and a comminuted fracture of the calcaneus (transcalcaneal talonavicular dislocation) is an unusual and severe injury. It occurs due to a forced plantarflexion of the talar head through the anterior portion of the calcaneum and is usually associated with a potential for skin and neurovascular compromise. Few cases have been reported in the literature. This article reports an unusual case of an open transcalcaneal talonavicular dislocation associated with the presence of a calcaneal comminuted calcaneal fracture. PMID:21944406

  9. Body mass index, calcium intake, and physical activity affect calcaneal ultrasound in healthy Greek males in an age-dependent and parameter-specific manner.

    PubMed

    Babaroutsi, Eirini; Magkos, Faidon; Manios, Yannis; Sidossis, Labros S

    2005-01-01

    Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity for the assessment of skeletal status. This study was carried out to examine the effect of anthropometric, dietary, physical activity, and other lifestyle factors on QUS parameters in healthy Greek males of various ages, including children (n=192), adults (n=106), and elderly (n=86) subjects. Calcaneal QUS measurements were performed with the Sahara device (Hologic), which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS) through the os calcis. A composite parameter, the quantitative ultrasound index (QUI), and an estimate of heel bone mineral density (eBMD) were also derived. BUA correlated positively with height, weight, and body mass index, as well as waist and hip circumferences (P<0.001), but this was not the case for SOS. QUI and eBMD were inconsistently related with anthropometric characteristics. Overweight and obese males had significantly higher BUA than normal-weight subjects (P<0.05), but similar SOS, QUI, and eBMD; this held true for all age groups. Boys participating in organized physical activities had significantly higher SOS, QUI, and eBMD than those who did not (P<0.05), although BUA was similar in the two groups; no differences according to organized physical activity were detected in adults and the elderly. On the other hand, adult men devoting at least some time to non-organized physical activities had significantly higher QUS values than their non-exercising peers (P<0.05); no such effects, however, were seen in children and the elderly. Adult men with calcium intakes above 800 mg/day had significantly higher SOS, QUI, and eBMD than those consuming less calcium (P<0.05), and also tended towards higher BUA (P=0.079); no such differences were observed among children and elderly men. The effects of physical activity and calcium intake on heel QUS persisted even after controlling for body size. Overall, body weight was the sole significant positive determinant of BUA (beta=0.373; t=6.589; P<0.001), explaining approximately 14% of the total variance, while age was the sole significant negative determinant of SOS (beta=-0.198; t=-3.321; P=0.001), albeit explaining only less than 4% of the total variance. In conclusion, body size, dietary calcium intake, and physical activity patterns seem to inconsistently and age-dependently influence heel QUS among healthy Greek males in a parameter-specific manner. PMID:15750695

  10. Waste Tank Heel Chemical Cleaning Summary

    SciTech Connect

    Barnes, M.J.

    2003-12-02

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

  11. Reliability and Validity of the Standing Heel-Rise Test

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  12. Abductor digiti minimi muscle flap transfer to prevent wound healing complications after ORIF of calcaneal fractures

    PubMed Central

    Wang, Chao-Liang; Huang, Su-Fang; Sun, Xue-Sheng; Zhu, Tao; Lin, Chu; Li, Qiang

    2015-01-01

    Objectives: To examine the transfer of abductor digiti minimi (ADM) muscle flaps as a method for preventing wound healing complications in cases of closed calcaneal fractures treated with open reduction and internal fixation (ORIF). Method: Design: Retrospective review. Patients: Twenty-six cases of acute closed calcaneal fracture in patients at risk for serious wound complications or with serious fractures. Intervention: During the ORIF surgery, an ADM muscle flap was removed and used to cover the plate, filling the gap between the plate and skin. Main Outcome Measures: Wound healing rates, postoperative complications, and time to heal. Results: All wounds healed uneventfully, except for one case of minor superficial epithelial necrosis during the early postoperative period, which was treated conservatively. All patients regained ambulatory status with regular foot apparel. At last follow-up, the patients presented no clinical, laboratory, or radiological signs of complications. Conclusions: This ADM muscle flap transfer technique appeared to successfully prevent wound healing complications among patients undergoing ORIF for closed calcaneal fractures. This method offers a promising treatment option for calcaneal fractures in patients at high risk for serious wound complications, and future studies with greater numbers of cases are needed to further investigate its clinical application. PMID:26550221

  13. On muscle, tendon and high heels.

    PubMed

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

    2010-08-01

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

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

    SciTech Connect

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

    1987-03-01

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

  15. Subtalar Joint Distraction Arthrodesis to Correct Calcaneal Valgus in Pediatric Patients with Tarsal Coalition: A Case Series.

    PubMed

    Schwartz, Jaclyn M; Kihm, Carl A; Camasta, Craig A

    2015-01-01

    Subtalar joint middle facet coalitions commonly present in children who have a painful, rigid, pes planovalgus foot type. The middle facet coalition allows rearfoot forces to be distributed medially through the coalition, and this can result in arthritis or lateral tarsal wedging. The senior author has used a wedged bone graft distraction subtalar joint arthrodesis to correct calcaneal valgus and restore the talar height in these patients. The tight, press-fit nature of the tricortical iliac crest allograft provides stability and can negate the need for internal fixation. We retrospectively reviewed 9 pediatric subtalar joint distraction arthrodesis procedures performed on 8 patients during a 6-year period. All patients began weightbearing at 6weeks after surgery. All patients had osseous union, and no complications developed that required a second surgery. The clinical outcomes, assessed at a mean of 25.5 (range, 6.3 to 75.8) months postoperatively, were satisfactory. The mean American Orthopaedic Foot and Ankle Society score was 90.1 (range, 79 to 94), on a 94-point scale. The wedged distraction arthrodesis technique has not been previously described for correction of pediatric patients with lateral tarsal wedging, but it is an effective option and yields successful outcomes. PMID:25704449

  16. Comparison of open reduction internal fixation and conservative treatment plus open reduction internal fixation for calcaneal fractures

    PubMed Central

    Pan, Yongmiao; Yuan, Linyi; Ye, Chengfeng

    2014-01-01

    To compare the effect of open reduction internal fixation and conservative treatment combined with open reduction internal fixation for subjects with calcaneal fractures, 130 patients with calcaneal fractures were divided into observation group and control group. Observation group were treated with open reduction internal fixation and conservative treatment, control group treated as open reduction internal fixation. The healing related indicators, daily life activities ability score of observation group after treatment 6 months were significantly higher than that of the control group, there was no significant difference for the healing rate of excellent and good rate, the daily life activities ability score after one and three year between two groups. Open reduction internal fixation combined with conservative treatment in treatment of calcaneal fractures can clear anatomic structure and have fast function recovery. Thus, it should be as the preferred method for the treatment of calcaneal fractures. PMID:25550973

  17. Primary subtalar joint arthrodesis with internal and external fixation for the repair of a diabetic comminuted calcaneal fracture.

    PubMed

    Facaros, Zacharia; Ramanujam, Crystal L; Zgonis, Thomas

    2011-01-01

    Comminuted, intra-articular calcaneal fractures can cause severe lower extremity impairment and have devastating effects on a patient's well being. Diabetes is a multisystem process that may cause neuropathy and loss of protective sensation further complicating the prognosis. Not all calcaneal fractures are created equal and when considering the patient's overall presentation and extent of injury, the combined approach of internal and external fixation for fracture reduction may be beneficial for restoration of anatomic alignment and function. PMID:21276527

  18. Foot Skin Ischemic Necrosis following Heel Prick in a Newborn.

    PubMed

    Koklu, Esad; Ariguloglu, Erdal Avni; Koklu, Selmin

    2013-01-01

    There are only a few reports on side effects after heel prick in neonates although heel prick has been performed all over the world for many years. The medicine staff had obtained only a drop of blood by pricking the baby's heel using a lancet without compressing the heel or foot to measure his blood glucose level 3 hours after birth. However he developed a severe and hemorrhagic skin reaction on his entire left foot, beginning 30 minutes after obtaining the drop of blood by pricking the baby's heel using a lancet. The lesion, which was treated with topical mupirocin and povidone-iodine solution daily, slowly decreased in size and had almost fully resolved within 3 weeks. He was healthy and 9 months old at the time of writing this paper. We herein report a case of foot skin ischemic necrosis following heel prick in a newborn. To our knowledge this patient is the first case of foot skin ischemic necrosis due to heel prick in newborns. PMID:24288643

  19. The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: A finite element analysis

    PubMed Central

    Pang, Qing-Jiang; Yu, Xiao; Guo, Zong-Hui

    2014-01-01

    Objective: In the surgery of calcaneal fracture, whether the sustentaculum tali screw should always be placed is widely controversial. The aim of this study was to explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type II calcaneal fracture. Methods: The finite element analysis was used in this study. After the establishment of the finite element model of Sanders type II calcaneal fracture, the two internal fixation simulations were designed. In one model, the AO calcaneal plate was simulated on the lateral side of the calcanues with 7 screws being fixated at different position of the plate. In the other model, the calcaneus was fixated with the same AO calcaneal plate together with an additional screw being infiltrated into the sustentaculum tali. The two models were simulated under the same loading and the displacement of the fracture line and the stress distribution in the two models were calculated respectively. Results: The maximum principal stress focused on the cortical bone of sustentaculum tali in both the models under the same loading. The displacement of the fracture line, the maximum principal stress of calcaneus and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation. The stress in the model with sustentaculum screw fixation was more dispersed. Conclusions: The placement of sustentaculum tali screw is essential for fixation of type II calcaneal fracture to achieve the biomechanical stability. PMID:25225534

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

    PubMed

    Tamura, A; Takeuchi, Y; Yamakage, A

    1994-01-01

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

  1. Double-Shell Tank Retrieval Allowable Heel Trade Analysis

    SciTech Connect

    Grams, W.H.

    1995-09-27

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

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

    PubMed

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

    2013-01-01

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

  3. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

    PubMed Central

    Jeong, Min; Shin, Sung Jin; Kang, Byoung Youl

    2016-01-01

    Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures. PMID:26981521

  4. Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report

    PubMed Central

    Yi, Tae-Im; Choe, Yeo-Reum; Kim, Joo-Sup; Kwon, Kye-Won

    2016-01-01

    Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort. PMID:26949685

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

    PubMed

    Hapsari, Vaniessa Dewi; Xiong, Shuping

    2016-02-01

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

  6. The relationship of calcaneal apophyseal ossification and Sanders hand scores to the timing of peak height velocity in adolescents.

    PubMed

    Nicholson, A D; Sanders, J O; Liu, R W; Cooperman, D R

    2015-12-01

    The accurate assessment of skeletal maturity is essential in the management of orthopaedic conditions in the growing child. In order to identify the time of peak height velocity (PHV) in adolescents, two systems for assessing skeletal maturity have been described recently; the calcaneal apophyseal ossification method and the Sanders hand scores. The purpose of this study was to compare these methods in assessing skeletal maturity relative to PHV. We studied the radiographs of a historical group of 94 healthy children (49 females and 45 males), who had been followed longitudinally between the ages of three and 18 years with serial radiographs and physical examination. Radiographs of the foot and hand were undertaken in these children at least annually between the ages of ten and 15 years. We reviewed 738 radiographs of the foot and 694 radiographs of the hand. PHV was calculated from measurements of height taken at the time of the radiographs. Prior to PHV we observed four of six stages of calcaneal apophyseal ossification and two of eight Sanders stages. Calcaneal stage 3 and Sanders stage 2 was seen to occur about 0.9years before PHV, while calcaneal stage 4 and Sanders stage 3 occurred approximately 0.5 years after PHV. The stages of the calcaneal and Sanders systems can be used in combination, offering better assessment of skeletal maturity with respect to PHV than either system alone. Cite this article: Bone Joint J 2015;97-B:1710-17. PMID:26637689

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. Minimally Invasive Calcaneal Osteotomy: Does the Shannon Burr Endanger the Neurovascular Structures? A Cadaveric Study.

    PubMed

    Durston, Abigail; Bahoo, Rana; Kadambande, Sujit; Hariharan, Kartik; Mason, Lyndon

    2015-01-01

    Calcaneal osteotomies are used to correct hindfoot alignment. Traditional open procedures have been plagued with complications. Various minimally invasive techniques have been described but are laborious and time-consuming. A percutaneous technique using a side cutting "Shannon" burr offers a simple and reliable alternative; however, little evidence is available to address the safety concerns. The aim of the present study was to quantify the risk posed to the medial and lateral neurovascular structures using this technique. The study was performed at the anatomy department, University of Sussex, using 13 fresh-frozen, below-the-knee cadaveric specimens during a training session held by WG Healthcare UK, Ltd. (Letchworth, Herts). The participants were 11 consultant orthopedic surgeons, who were inexperienced in minimally invasive surgery, and 2 demonstrators. Each performed a chevron calcaneal osteotomy using a Shannon burr by way of a lateral percutaneous approach under fluoroscopic guidance. The authors subsequently dissected the specimens to identify the neurovascular structures, describe their anatomic relations and proximity to the burr, and note any damage incurred. No evidence was found of significant neurovascular injury. Two very small proximal branches of the sural nerve were transected, the nerve itself passing safely 9 to 21mm anterosuperior to the entry point. The medial neurovascular bundle crossed the path of the osteotomy in 4 specimens but was protected by the medial head of the quadratus plantae muscle. In conclusion, the Shannon burr for calcaneal osteotomy has the potential to minimize the surgical morbidity and maximize surgical efficiency without compromising safety in all patients with normal anatomy of the quadratus plantae muscle. PMID:26210080

  10. Screw placement relative to the calcaneal fracture constant fragment: an anatomic study.

    PubMed

    Bussewitz, Bradly W; Hyer, Christopher F

    2015-01-01

    Placement of a screw from the lateral wall of the calcaneus into the constant sustentaculum tali fragment can be difficult when surgically repairing a calcaneal fracture. This screw serves to compress the fracture fragments and support the posterior facet. This difficulty results from the small landing zone of the sustentaculum tali with its nearby vulnerable soft tissue structures. We present an anatomic study of 10 cadavers to determine a starting point and angle of screw advancement when placing a constant fragment screw. PMID:25441853

  11. Precise and feasible measurements of lateral calcaneal lengthening osteotomies by radiostereometric analysis in cadaver feet

    PubMed Central

    Martinkevich, P.; Rahbek, O.; Mller-Madsen, B.; Sballe, K.; Stilling, M.

    2015-01-01

    Objectives Lengthening osteotomies of the calcaneus in children are in general grafted with bone from the iliac crest. Artificial bone grafts have been introduced, however, their structural and clinical durability has not been documented. Radiostereometric analysis (RSA) is a very accurate and precise method for measurements of rigid body movements including the evaluation of joint implant and fracture stability, however, RSA has not previously been used in clinical studies of calcaneal osteotomies. We assessed the precision of RSA as a measurement tool in a lateral calcaneal lengthening osteotomy (LCLO). Methods LCLO was performed in six fixed adult cadaver feet. Tantalum markers were inserted on each side of the osteotomy and in the cuboideum. Lengthening was done with a plexiglas wedge. A total of 24 radiological double examinations were obtained. Two feet were excluded due to loose and poorly dispersed markers. Precision was assessed as systematic bias and 95% repeatability limits. Results Systematic bias was generally below 0.10 mm for translations. Precision of migration measurements was below 0.2 mm for translations in the osteotomy. Conclusion RSA is a precise tool for the evaluation of stability in LCLO. Cite this article: Bone Joint Res 2015;4:7883. PMID:25957380

  12. Protective Effect of Surgery Against Early Subtalar Arthrodesis in Displaced Intra-articular Calcaneal Fractures: A Meta-Analysis.

    PubMed

    Liu, Yueju; Li, Zhi; Li, Heng; Zhang, Yingze; Wang, Pengcheng

    2015-11-01

    The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014. The modified Jadad scale was used for trial quality and effective data were pooled for meta-analysis. Study results related to early subtalar arthrodesis were extracted and risk assessment was combined with surgical treatment and nonsurgical treatment. The primary analysis included 4 studies and 966 participants. The estimated overall risk ratio was 4.40 (95% confidence interval 2.67-7.39), indicating the incidence of early subtalar arthrodesis in nonsurgical group is 4.4 times the surgical group. The results showed that surgical treatment was superior to nonsurgical treatment in protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures (Z = 5.600, P < 0.001).Surgery offers protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures. PMID:26559281

  13. Pain Assessment

    MedlinePLUS

    Introduction Types of Pain Pain Assessment Pain Treatments Integrative Pain Therapy Pain Management Recommendations References March 30, 2016 Pain Assessment Effective pain management begins with a comprehensive assessment. This ...

  14. Comparative Study of Peroneal Tenosynovitis as the Complication of Intraarticular Calcaneal Fracture in Surgically and Non-Surgically Treated Patients

    PubMed Central

    Bahari Kashani, Mahmoud; Kachooei, Amir Reza; Ebrahimi, Hengameh; Peivandi, Mohammad Taghi; Amelfarzad, Sara; Bekhradianpoor, Nastoor; Azami, Mehran; Fatehi, Amirreza; Bahari Kashani, Golsa

    2013-01-01

    Background Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economical damages. Objectives In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients. Patients and Methods A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group. Results In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one. Conclusions Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur. PMID:24693362

  15. Biomechanical Performance of Lateral Versus Dual Locking Plates for Calcaneal Fractures.

    PubMed

    Maxwell, Abby B; Owen, John R; Gilbert, Todd M; Romash, Michael M; Wayne, Jennifer S; Adelaar, Robert S

    2015-01-01

    Given the high rates of wound complications with a standard lateral extensile incision, small dual incision techniques might result in less soft tissue destruction. The goal of the present study was to compare the biomechanical performance between a single locking plate and a dual locking plating system for an intra-articular calcaneal fracture model. A Sanders IIB type joint depression calcaneal fracture was created in 10 paired, fresh-frozen, cadaveric calcanei (age 47 ± 12, range 35 to 78 years). The calcanei of each pair were randomly assigned for fixation using either a lateral locking reconstruction plate or lateral and medial locking reconstruction plates. The specimens were axially loaded in cyclic fashion for 1000 cycles, followed by load to failure. The relative fragment movement was monitored optically in both the sagittal and the coronal planes. The amount of overall construct displacement increased with cycling, although no difference was found between the plating techniques. For fragment movement during cycling, the lateral joint fragment migrated anteroinferiorly along the fracture line relative to the tuberosity fragment for dual plated specimens by a small, but statistically significant, amount. This same translation was smaller for lateral plated specimens but was not found to be significant. During load to failure testing, no statistically significant differences were found for construct stiffness. A tendency was seen toward more interfragmentary motion in the sagittal plane (lateral joint fragment movement relative to the fracture line), with less movement overall in the coronal plane (anterior fragment translation and twist) for dual plating, although the difference from the lateral plate was not statistically significant. The present study demonstrated that for this calcaneal fracture model, the dual plating technique experienced a small amount of fragment translation during cycling that was significantly different statistically from that with lateral plating but was not clinically relevant. During the load to failure, the dual plating technique was comparable to the lateral plate. Thus, dual plating could be a viable biomechanical option for fracture reduction if avoidance of a large extensile lateral approach associated with lateral plating is warranted. PMID:25960057

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

    Valero, Jos; Salcini, Jos L.; Gordillo, Luis; Gallart, Jos; Gonzlez, David; Deus, Javier; Lahoz, Manuel

    2015-01-01

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

  18. Heel and toe driving on fuel cell vehicle

    DOEpatents

    Choi, Tayoung; Chen, Dongmei

    2012-12-11

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

  19. Biomechanical and biochemical properties of chicken calcaneal tendon under effect of age and nonforced active exercise.

    PubMed

    Nakagaki, Wilson Romero; Biancalana, Adriano; Benevides, Gustavo Pereira; Gomes, Laurecir

    2007-01-01

    This study investigated if nonforced active exercise alters the biomechanical and biochemical properties of calcaneal tendon during maturation. Chickens at 1, 5, and 8 months old were divided into two groups: caged and penned. Intact tendons were used for biomechanical analysis, but they were divided into tensile and compressive regions for quantification of hydroxyproline and glycosaminoglycans. The exercise increased tendon strength after the fifth month, energy absorption in the eighth month, and ultimate tensile stress in the first month. Age increased tendon strength and energy storage and reduced stiffness but did not alter stress. There was an increase in collagen content in the fifth month. Glycosaminoglycans showed a progressive decline in the tensile region. Thus, some biomechanical and biochemical changes depend on the maturation process itself and also are influenced by spontaneous exercise, showing that mechanical stimulation of low intensity may help to improve the quality of the tendon. PMID:17882697

  20. Medial plantar artery island flap for heel reconstruction.

    PubMed

    Schwarz, Richard J; Negrini, Jean-Francois

    2006-12-01

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

  1. Factors in Daily Physical Activity Related to Calcaneal Mineral Density in Men

    NASA Technical Reports Server (NTRS)

    Hutchinson, Teresa M.; Whalen, Robert T.; Cleek, Tammy M.; Vogel, John M.; Arnaud, Sara B.

    1995-01-01

    To determine the factors in daily physical activity that influence the mineral density of the calcaneus, we recorded walking steps and the type and duration of exercise in 43 healthy 26-to 51-yr-old men. Areal (g/sq cm) calcaneal bone mineral density (CBMD) was measured by single energy x-ray densitometry. Subjects walked a mean (+/- SD) of 7902(+/-2534) steps per day or approximately 3.9(+/-1.2) miles daily. Eight subjects reported no exercise activities. The remaining 35 subjects spent 143(2-772) (median and range) min/wk exercising. Twenty-eight men engaged in exercise activities that generate single leg peak vertical ground reaction forces (GRF(sub z)) of 2 or more body weights (high loaders, HL), and 15 reported exercise or daily activities that typically generate GRF(sub z) less than 1.5 body weights (low loaders, LL). CBMD was 12% higher in HL than LL (0.668 +/- 0.074 g/sq cm vs 0.597 +/- 0.062 g/sq cm, P less than 0.004). In the HL group, CBMD correlated to reported minutes of high load exercise (r = 0.41, P less than 0.03). CBMD was not related to the number of daily walking steps (N = 43, r = 0.03, NS). The results of this study support the concept that the dominant factor in daily physical activity relating to bone mineral density is the participation in site specific high loading activities, i.e., for the calcaneus, high calcaneal loads.

  2. Procedural Pain Management in Neonates, Infants and Children

    PubMed Central

    2011-01-01

    Neonates, infants and children all feel pain and require analgesia for painful procedures. Many painful procedures are associated with medical interventions, including immunisation, heel lance, venesection, IV cannulation and dressing change. Untreated pain can have short and long term effects, including sensitisation to pain episodes in later life. A range of non-pharmacological and pharmacological interventions have been shown to be effective for procedural pain management in infants and children, and are most effective when used in combination. Developmental changes in pain responses, analgesic response and drug pharmacokinetics need to be taken into account when planning procedural pain management for neonates. Comprehensive evidence based guidelines are available to guide effective procedural pain management in neonates, infants and older children. PMID:26526331

  3. Calcaneus, calcaneal tendon and retrocalcaneal bursa. Historical overview and plea for an accurate terminology.

    PubMed

    Kachlik, D; Musil, V; Vasko, S; Klaue, K; Stingl, J; Baca, V

    2010-01-01

    Diseases and injuries of several specific structures in the heel region have been an enduring focus of medicine: The anatomical terminology of many of these structures has not been established until recently. The aim of the study was a historical analysis of the advances of anatomical terminology of three selected morphological units in the heel region--the Achilles tendon, calcaneus and retrocalcaneal bursa. It starts with a critical evaluation of the mythological eposes, the Illiad and Odyssey, describing the exploits of heroes in the Trojan war, followed by a review of relevant terms used for the designation of selected heel structures in the Middle Ages as well as in the 18" and 19" centuries. Principal versions of Latin anatomical terms used for the denotation of the mentioned structures are discussed. Recently applicable Latin terms and their recommended English synonyms, according to the latest version of Terminologia Anatomica (1998) are summed up. It surveys examples of "not very appropriate" terms, which are frequently used in clinical literature. The authors consider the use of official anatomical terms (both Latin and English) as an important step for the improvement of the clinical expressions and formulations. PMID:20514849

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

    PubMed

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

    2014-01-01

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

  5. Intermediate term follow-up of calcaneal osteotomy and flexor digitorum longus transfer for treatment of posterior tibial tendon dysfunction.

    PubMed

    Fayazi, Amir H; Nguyen, Hoan-Vu; Juliano, Paul J

    2002-12-01

    Twenty-three patients with stage II posterior tibial tendon dysfunction who had failed non-surgical therapy were treated with flexor digitorum longus transfer and calcaneal osteotomy. At latest follow-up averaging 35 +/- 7 months (range, 24 to 51 months), 22 patients (96%) were subjectively "better" or "much better." No patient had difficulty with shoe wear; however, four patients (17%) required routine orthotic use consisting of a molded shoe insert. AOFAS scores were available on 21 patients and improved from a preoperative mean of 50 +/- 14 (range, 27 to 85) to a postoperative mean of 89 +/- 10 (range, 70 to 100). Our experience, at an intermediate date follow-up is that calcaneal osteotomy and flexor digitorum longus transfer is a safe and effective form of treatment for stage II posterior tibial tendon dysfunction. PMID:12503801

  6. Non-union of calcaneum - A rare complication of calcaneal fracture - A case report with brief review of literature.

    PubMed

    Kumar, Narinder

    2015-09-01

    Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literature available on calcaneal non-union is also briefly reviewed. Role of subtalar arthrodesis with internal fixation of fracture and bone grafting for successful management of this rare complication is highlighted along with the possibility of under-reporting of this relatively unknown complication. PMID:26155055

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

    PubMed

    Maquirriain, Javier

    2007-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

  9. Mid-Term Follow Up Results of Subtalar Distraction Arthrodesis Using a Double Bone-Block for Calcaneal Malunion

    PubMed Central

    Chung, Hyung-Jin; Choo, Ji-Woong

    2014-01-01

    Purpose This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. Materials and Methods From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. Results The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8° in talocalcaneal angle, 5.1° in talar declination angle and 5.3° in talo-first metatarsal angle. Conclusion Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis. PMID:24954341

  10. The correlation between calcaneal valgus angle and asymmetrical thoracic-lumbar rotation angles in patients with adolescent scoliosis

    PubMed Central

    Park, Jaeyong; Lee, Sang Gil; Bae, Jongjin; Lee, Jung Chul

    2015-01-01

    [Purpose] This study aimed to provide a predictable evaluation method for the progression of scoliosis in adolescents based on quick and reliable measurements using the naked eye, such as the calcaneal valgus angle of the foot, which can be performed at public facilities such as schools. [Subjects and Methods] Idiopathic scoliosis patients with a Cobb’s angle of 10° or more (96 females, 22 males) were included in this study. To identify relationships between factors, Pearson’s product-moment correlation coefficient was computed. The degree of scoliosis was set as a dependent variable to predict thoracic and lumbar scoliosis using ankle angle and physique factors. Height, weight, and left and right calcaneal valgus angles were set as independent variables; thereafter, multiple regression analysis was performed. This study extracted variables at a significance level (α) of 0.05 by applying a stepwise method, and calculated a regression equation. [Results] Negative correlation (R=−0.266) was shown between lumbar lordosis and asymmetrical lumbar rotation angles. A correlation (R=0.281) was also demonstrated between left calcaneal valgus angles and asymmetrical thoracic rotation angles. [Conclusion] Prediction of scoliosis progress was revealed to be possible through ocular inspection of the calcaneus and Adams forward bending test and the use of a scoliometer. PMID:26834376

  11. State of the science: procedural pain management in the neonate.

    PubMed

    D'Apolito, Karen C

    2006-01-01

    Neonates in the neonatal intensive care unit experience painful procedures. Over the last 10 years, investigators have examined several pharmacologic and nonpharmacolgic treatment strategies to decrease or eliminate the pain associated with mechanical ventilation, endotrachial intubation, insertion of percutaneous or central venous lines, heel stick, and venipuncture. These procedures and others are addressed as well as the reported severity of pain associated with these procedures. Progress has been made in the past decade to establish evidence-based treatments that will help the clinician more effectively relieve neonatal stress and pain when performing many routine procedures. PMID:16508464

  12. Groin pain

    MedlinePLUS

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg. This problem often occurs in people who play sports such as ...

  13. Effect of Kangaroo Care (skin contact) on crying response to pain in preterm neonates

    PubMed Central

    Kostandy, Raouth; Cong, Xiaomei; Abouelfettoh, Amel; Bronson, Carly; Stankus, Allison; Ludington, Susan M.

    2006-01-01

    Objectives When preterm infants experience heel stick, crying commonly occurs and has adverse physical effects. A reduction in crying is desired. Kangaroo Care, skin contact between mother and infant, reduces pain as measured by the Premature Infant Pain Profile, and may reduce crying time. The purpose of the pilot was to test Kangaroo Care's effect on the preterm infant's crying response to heel-stick. Methods A prospective cross-over study with 10 prematures 2-9 days old (30-32 weeks postmenstrual age) was conducted. Infants were randomly assigned to two sequences (Day 1 heel stick in Kangaroo Care [after 30 minutes of prone skin contact upright between maternal breasts] and Day 2 heel stick in incubator [inclined, nested and prone] or the opposite sequence) was conducted. Video tapes of Baseline, Heel Warming, Heel Stick, and Recovery phases were independently scored for audible and inaudible crying times by two research assistants. The audible and inaudible crying times for each subject in each phase were summed and the mean between the scorer's values was analyzed by repeated measures ANOVA. Results Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p ? 0.001). When in Kangaroo Care as compared to the incubator, crying time was less during the Heel stick (p = 0.001) and Recovery (p = 0.01) phases. Conclusion Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants who were 2-9 days old, a definitive study is recommended. PMID:18513662

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

    ERIC Educational Resources Information Center

    Liu, Yuanlong; Wang, Yong Tai

    2004-01-01

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

  15. Foot-Ankle Roll-Over Characteristics in Different Heel Heights during Walking.

    PubMed

    Choi, H; Park, H; Kim, Y

    2005-01-01

    In this study, a feasibility study was performed for biomechanical applications of foot-ankle roll-over characteristics in different heel height shoes during walking. Five nondisabled female volunteers were participated in gait experiments, wearing four pairs of shoes with different heel heights. Roll-over shapes of the foot-ankle systems were obtained using trajectories of ankle, knee and the center of pressure between initial contact (IC) and opposite initial contact(OIC). Results showed that roll-over trajectories moved downwards with higher heel shoes but roll-over characteristics, represented by an arc, did not change significantly with different heel heights. The present results also support that nondisabled humans automatically adapt their foot-ankle systems to varying heel height shoes under 6cm. Roll-over characteristics in human walking will contribute future designs of prosthetics and orthotics of lower extremity as well as orthopaedic shoes. PMID:17281856

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

    PubMed

    Hanna-Bull, Debbie

    2016-01-01

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

  17. Epidemiology of High-Heel Shoe Injuries in U.S. Women: 2002 to 2012.

    PubMed

    Moore, Justin Xavier; Lambert, Brice; Jenkins, Gabrielle P; McGwin, Gerald

    2015-01-01

    The purpose of the present study was to investigate the epidemiology of high-heel-related injuries among a nationally representative population of women in the United States and to analyze the demographic differences within this group. The data used in the present study were collected from the Consumer Product Safety Commission's National Electronic Injury Surveillance System. A total of 3294 injuries, representing an estimated 123,355 high-heel-related injuries, were treated in emergency departments within the United States from 2002 to 2012. The overall rate of high-heel-related injuries for the study was 7.32 per 100,000 females (95% confidence interval 7.08 to 7.56). The injury rate was greatest for young adult females, with the greatest rates observed for those aged 20 to 29 years (18.38 per 100,000 females) and those aged 30 to 39 years (11.07 per 100,000 females). The results from the present study suggest that high-heel-related injuries have nearly doubled during the 11-year period from 2002 to 2012. Injuries from high heels are differential by body region, with most injuries occurring as sprains and strains to the foot and ankle. Although high heels might be stylish, from a health standpoint, it could be worthwhile for females and those interested in wearing high heels to understand the risks of wearing high-heeled shoes and the potential harm that precarious activities in high-heeled shoes can cause. The results of the present study can be used in the development of a prospective cohort study to investigate the risk of injury from high-heeled shoes, accounting for the exposure time and studying differences in demographics (e.g., age and race). PMID:25977152

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

    PubMed

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

    2011-05-01

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

  19. Subjective results after surgical treatment for displaced intra-articular calcaneal fractures.

    PubMed

    Basile, Attilio

    2012-01-01

    We present a retrospective study investigating the results of the subjective assessment of displaced intra-articular calcaneal fractures in a selected cohort of 42 patients treated operatively, with a follow-up duration of at least 3 years. The adjusted American Orthopaedic Foot and Ankle Society questionnaire, Foot Function Index, and visual analog scale were used to quantify the subjective evaluations. Our hypothesis was that good subjective results could be predicted and obtained in patients with specific characteristics if anatomic reduction of the fracture was achieved. The results of the study confirmed our hypothesis. A number of specific subgroup analyses were undertaken. The study confirmed that Böhler angle restoration and the quality of reduction of the subtalar joint facet are important prognostic factors related to the outcome. In contrast, gender and Sanders type had less influence at the intermediate-term follow-up results. The main weaknesses of the present study included its retrospective nature, the lack of a control group managed nonoperatively for comparison, and the small sample size. Moreover, the operating surgeon performed the radiographic measurement and categorized the quality of the surgical reconstruction. PMID:22153661

  20. Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet

    PubMed Central

    Lee, Hong-Jae; Lim, Kil-Byung; Yoo, JeeHyun; Yun, Hyun-Ju; Jeong, Tae-Ho

    2015-01-01

    Objective To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis. Method A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic technique to control foot overpronation. Pain questionnaire was used to obtain pain sites, degree, and frequency. Balancing ability was determined using computerized posturography. These evaluations were performed prior to custom-molded foot orthoses, 1 month, and 3 months after fitting foot orthoses. Result Of 24 children with symptomatic flexible flat feet recruited for this study, 20 completed the study. Significant (p<0.001) improvements in pain degree and frequency were noted after 1 and 3 months of custom-molded foot orthoses. In addition, significant (p<0.05) improvement in balancing ability was found after 3 months of custom-molded foot orthoses. Conclusion Short-term use of custom-molded foot orthoses significantly improved foot pain and balancing ability in children with symptomatic flexible flat foot. PMID:26798604

  1. Administration of Tranexamic Acid Reduces Postoperative Blood Loss in Calcaneal Fractures: A Randomized Controlled Trial.

    PubMed

    Xie, Bing; Tian, Jing; Zhou, Da-peng

    2015-01-01

    The present randomized controlled trial was undertaken to evaluate the effect of tranexamic acid (TXA) on reducing postoperative blood loss in calcaneal fractures. A total of 90 patients with a unilateral closed calcaneal fracture were randomized to the TXA (n = 45) and control (n = 45) groups. The corresponding groups received 15 mg/kg body weight of TXA or placebo (0.9% sodium chloride solution) intravenously before the skin incision was made. Open reduction and internal fixation was performed for all patients and selective bone grafting was performed. The patients were examined 3 months after surgery. The intraoperative and postoperative blood loss, blood test results, and wound complications were compared between the 2 groups. The complications of TXA were also investigated. No statistically significant differences were found in the baseline characteristics between the TXA and control groups. Also, no significant difference was noted in the intraoperative blood loss between the 2 groups. However, in the TXA group, the postoperative blood loss during the first 24 hours was significantly lower than that in the control group (110.0 ± 160.0 mL versus 320.0 ± 360.0 mL; p < .001). The incidence of wound complications was also reduced compared with that in the control group (7.3% versus 23.8%; p = .036). No significant difference was found in the incidence of thromboembolic events or adverse drug reactions between the 2 groups. We concluded that preoperative single-dose TXA can effectively reduce postoperative blood loss and wound complications in patients with calcaneal fractures and that no significant side effects developed compared with the control group. PMID:26310621

  2. Radiation levels on empty cylinders containing heel material

    SciTech Connect

    Shockley, C.W.

    1991-12-31

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

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

    PubMed Central

    Stephens, Natalie A.; Kieft, Rudo; MacLeod, Annette; Hajduk, Stephen L.

    2015-01-01

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

  4. Abdominal pain

    MedlinePLUS

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  5. Flank pain

    MedlinePLUS

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  6. Pain (PDQ)

    MedlinePLUS

    ... moderate pain. 7 to 10 means severe pain. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to relieve mild pain. Acetaminophen and NSAIDs help relieve mild pain. They may ...

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

    PubMed Central

    Ko, Dong Yeol; Lee, Han Suk

    2013-01-01

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

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

    PubMed

    Yung-Hui, Lee; Wei-Hsien, Hong

    2005-05-01

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

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

    PubMed

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

    2012-03-01

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

  10. Ethnic dress, vitamin D intake, and calcaneal bone health in young women in the United Kingdom.

    PubMed

    Knoss, Robert; Halsey, Lewis G; Reeves, Sue

    2012-01-01

    Clothing styles that conceal skin from ultraviolet sun radiation contribute to vitamin D deficiency, especially in veiled female minorities in high latitudes. This is the first research into possible effects of ethnic dress on the os calcis and the first study outside North Africa and the Middle East to investigate whether discernible differences in bone quality exist between veiled and unveiled women. The limited previous research into clothing habits and bone health has been inconclusive. One hundred eight women aged 18--45yr living in the United Kingdom (around 51° north) were analyzed. Forty-three consistently covered arms, hair, and neck when outdoors, whereas 65 consistently had arms, hair, neck, and possibly legs exposed. The quantitative ultrasound scanning (QUS) measurements at the calcaneus were speed of sound (SOS) and broadband ultrasound attenuation (BUA), which were translated into a single clinical value, stiffness index (SI). Dietary intake of vitamin D and calcium was estimated using a validated food frequency questionnaire, and several other risk factors were assessed. There was no significant difference in SI between veiled and unveiled participants (101.30±1.71 vs 99.98±1.86; p=0.721); SOS and BUA were also not significantly different. However, smoking and long-term use of steroid medication were significant predictors of calcaneal bone quality, confirming existing research. Our analysis suggests that clothing style alone does not lead to appreciable differences in the quality of the os calcis in young women in the United Kingdom as assessed by QUS. PMID:22178237

  11. Lateral Calcaneal Artery Flaps in Atherosclerosis: Cadaveric Study, Vascular Assessment and Clinical Applications

    PubMed Central

    Tanthanatip, Pattaya; Kuhaphensaeng, Paiboon; Ruamthanthong, Anuchit; Pitiseree, Anont; Suwantemee, Chaichoompol

    2015-01-01

    Background: Soft tissue defects of the lateral malleolus (LM) and Achilles tendon pose difficult reconstructive problems due to the bony prominence and limited local tissue available. The objectives were to study the anatomical landmarks of the lateral calcaneal artery (LCA) and patency of LCA in atherosclerotic patients. Methods: Part I: Thirty-four cadaveric feet were dissected to identify the LCA. The distance between the LCA and the most prominent point of the LM was measured horizontally (LCAa-LM), obliquely (LCAb-LM), and vertically (LCAc-LM). Part II: Thirty-two patients were divided in 2 groups as nonatherosclerotic and atherosclerotic groups. The LCA was assessed by both Doppler ultrasonography and computed tomographic angiography (CTA). Part III: Clinical applications were demonstrated. Results: Part I: Mean distances of LCAa-LM, LCAb-LM, and LCAc-LM were 24.76, 33.68, and 35.03 mm, respectively. The LCA originated 94.12% from the peroneal artery. Part II: Doppler ultrasonography detected the LCA at 90.62% and 87.50% in nonatherosclerotic and atherosclerotic groups, respectively, whereas 100.00% and 93.75%, respectively, were detected by CTA. No statistically significant difference was found in the patency of the LCA between nonatherosclerotic and atherosclerotic patients. Part III: Clinical applications were performed in atherosclerotic patients. Conclusions: The LM is a reliable point to identify the LCA, and the LCA flap can be raised safely in atherosclerotic patients. Preoperative CTA should be performed in severely atherosclerotic patients or cases of major lower extremity vascular injuries. PMID:26495230

  12. Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment.

    PubMed

    De Boer, A Siebe; Van Lieshout, Esther M M; Den Hartog, Dennis; Weerts, Bas; Verhofstad, Michael H J; Schepers, Tim

    2015-01-01

    The aim of the present study was to compare the outcomes of patients with a displaced calcaneal fracture treated by open reduction and internal fixation (ORIF), percutaneous treatment, or nonoperative methods. A retrospective cohort study was conducted at a level I trauma center of patients with a displaced intra-articular calcaneal fracture treated from January 1, 2002 to December 31, 2011. The patient-reported outcome measures included the Foot Function Index, American Orthopaedic Foot and Ankle Society hindfoot scale, Short Form-36, the EQ-5D from the EuroQol Group, and a 10-point visual analog scale. Clinical data were collected from 169 patients, and questionnaires were obtained from 78 patients (18 nonoperatively, 27 ORIF, and 33 percutaneously). The late intervention rate was significantly greater in the percutaneous group (n = 18; 30%) than in the ORIF group (n = 6; 12%) or the nonoperative group (n = 8; 13%; p = .030). Significantly more disability was reported in the nonoperative group (median Foot Function Index score, 40 points) than in the ORIF group (median, 16 points; p = .010) or in the percutaneous group (median, 21 points; p = .034). In conclusion, the operatively treated patients (ORIF and percutaneous treatment) reported better functional outcome scores (Foot Function Index and American Orthopaedic Foot and Ankle Society hindfoot scale) than did the nonoperatively treated patients. PMID:24891090

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

    PubMed

    Agosti, Jennifer K; Chandler, Lois A

    2015-11-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2010-05-01

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

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

    PubMed Central

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

    2014-01-01

    Background The use of insoles may enhance postural stability and prevent falls. The aim of this study was to design a new insole and to explore the effectiveness of the insole on the standing balance of the healthy elderly. Methods The study was conducted at a community hospital. Patients older than 65 years at an outpatient clinic without abnormal gait patterns, lower limb deformities, or foot pain were enrolled. The participants were assigned to good- and poor-stability groups on the basis of the stability index (SI), using the Biodex Balance System. A heel cup with an arch support insole was provided. Participants wore the insole for 8 weeks for a minimum of 4 hours/day. A static balance test for SI was performed at the initial meeting and 8 weeks after the assigned insoles were worn for each participant. Results Five participants (10.0%) of 50 total did not finish the study. There were 25 patients in the good-stability group and 20 in the poor-stability group. The SI, before and after intervention, was significantly different for all 45 participants (3.2440.688 versus 3.0640.671; P<0.001). The differences in SI before and after the intervention both in the good-stability group (2.7640.546 versus 2.5920.538) and the poor-stability group (3.8450.188 versus 3.6550.128) were statistically significant (P<0.001). No statistically significant difference on changes of SI were seen between the two groups. Conclusion The results suggest a heel cup with arch support insole is effective in enhancing the standing balance of the elderly. This may be of benefit in preventing falls. PMID:24600215

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

    PubMed

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

    2012-01-01

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

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

    PubMed Central

    Schaefer, Sabine; Lindenberger, Ulman

    2013-01-01

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

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

    PubMed

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

    2012-10-01

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

  19. Back Pain

    MedlinePLUS

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain March 2015 Handout on Health: Back Pain This publication is for people who have back ... to discuss them with your doctor. What Is Back Pain? Back pain is an all-too-familiar problem ...

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

    PubMed Central

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

    2013-01-01

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

  1. Foetal pain?

    PubMed

    Derbyshire, Stuart W G

    2010-10-01

    The majority of commentary on foetal pain has looked at the maturation of neural pathways to decide a lower age limit for foetal pain. This approach is sensible because there must be a minimal necessary neural development that makes pain possible. Very broadly, it is generally agreed that the minimal necessary neural pathways for pain are in place by 24 weeks gestation. Arguments remain, however, as to the possibility of foetal pain before or after 24 weeks. Some argue that the foetus can feel pain earlier than 24 weeks because pain can be supported by subcortical structures. Others argue that the foetus cannot feel pain at any stage because it is maintained in a state of sedation in the womb and lacks further neural and conceptual development necessary for pain. Much of this argument rests on the definition of terms such as 'wakefulness' and 'pain'. If a behavioural and neural reaction to a noxious stimulus is considered sufficient for pain, then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. Regardless of how pain is defined, it is clear that pain for conceptual beings is qualitatively different than pain for non-conceptual beings. It is therefore a mistake to draw an equivalence between foetal pain and pain in the older infant or adult. PMID:20356798

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

    SciTech Connect

    Yu, Yongjian; Wang, Jue

    2013-08-15

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

  3. Pain Relievers

    MedlinePLUS

    Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

  4. Elbow pain

    MedlinePLUS

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  5. Neck pain

    MedlinePLUS

    ... causes of neck pain: Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen ( ... prescribe a muscle relaxant or a more powerful pain reliever. Over-the-counter medications often work as well ...

  6. Knee pain

    MedlinePLUS

    Pain - knee ... Knee pain can have different causes. Being overweight puts you at greater risk for knee problems. Overusing your knee can trigger knee problems that cause pain. If you have a history of arthritis, it ...

  7. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status

  8. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  9. An Achilles' Heel in an Amyloidogenic Protein and Its Repair

    PubMed Central

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

    2010-01-01

    Insulin fibrillation provides a model for a broad class of amyloidogenic diseases. Conformational distortion of the native monomer leads to aggregation-coupled misfolding. Whereas ?-cells are protected from proteotoxicity by hexamer assembly, fibrillation limits the storage and use of insulin at elevated temperatures. Here, we have investigated conformational distortions of an engineered insulin monomer in relation to the structure of an insulin fibril. Anomalous 13C NMR chemical shifts and rapid 15N-detected 1H-2H amide-proton exchange were observed in one of the three classical ?-helices (residues A1A8) of the hormone, suggesting a conformational equilibrium between locally folded and unfolded A-chain segments. Whereas hexamer assembly resolves these anomalies in accordance with its protective role, solid-state 13C NMR studies suggest that the A-chain segment participates in a fibril-specific ?-sheet. Accordingly, we investigated whether helicogenic substitutions in the A1A8 segment might delay fibrillation. Simultaneous substitution of three ?-branched residues (IleA2 ? Leu, ValA3 ? Leu, and ThrA8 ? His) yielded an analog with reduced thermodynamic stability but marked resistance to fibrillation. Whereas amide-proton exchange in the A1A8 segment remained rapid, 13C? chemical shifts exhibited a more helical pattern. This analog is essentially without activity, however, as IleA2 and ValA3 define conserved receptor contacts. To obtain active analogs, substitutions were restricted to A8. These analogs exhibit high receptor-binding affinity; representative potency in a rodent model of diabetes mellitus was similar to wild-type insulin. Although 13C? chemical shifts remain anomalous, significant protection from fibrillation is retained. Together, our studies define an Achilles' heel in a globular protein whose repair may enhance the stability of pharmaceutical formulations and broaden their therapeutic deployment in the developing world. PMID:20106984

  10. Shoulder pain

    MedlinePLUS

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  11. Pelvic Pain

    MedlinePLUS

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  12. Back Pain

    MedlinePLUS

    ... Awards Enhancing Diversity Find People About NINDS NINDS Back Pain Information Page Condensed from Low Back Pain Fact ... en Español Additional resources from MedlinePlus What is Back Pain? Acute or short-term low back pain generally ...

  13. Effect of antipronation foot orthosis geometry on compression of heel and arch soft tissues.

    PubMed

    Sweeney, Declan; Nester, Christopher; Preece, Stephen; Mickle, Karen

    2015-01-01

    This study aimed to understand how systematic changes in arch height and two designs of heel wedging affect soft tissues under the foot. Soft tissue thickness under the heel and navicular was measured using ultrasound. Heel pad thickness was measured when subjects were standing on a flat surface and standing on an orthosis with 4 and 8 degree extrinsic wedges and 4 mm and 8 mm intrinsic wedges (n = 27). Arch soft tissue thickness was measured when subjects were standing and when standing on an orthosis with -6 mm, standard, and +6 mm increments in arch height (n = 25). Extrinsic and intrinsic heel wedges significantly increased soft tissue thickness under the heel compared with no orthosis. The 4 and 8 degree extrinsic wedges increased tissue thickness by 28% and 27.6%, respectively, while the 4 mm and 8 mm intrinsic wedges increased thickness by 23% and 14.6%, respectively. Orthotic arch height significantly affected arch soft tissue thickness. Compared with the no orthosis condition, the -6 mm, standard, and +6 mm arch heights decreased arch tissue thickness by 9%, 10%, and 11.8%, respectively. This study demonstrates that change in orthotic geometry creates different plantar soft tissue responses that we expect to affect transmission of force to underlying foot bones. PMID:26465089

  14. A review of the surgical management of heel pressure ulcers in the 21st century.

    PubMed

    Bosanquet, David C; Wright, Ann M; White, Richard D; Williams, Ian M

    2016-02-01

    Heel ulceration, most frequently the result of prolonged pressure because of patient immobility, can range from the trivial to the life threatening. Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and II) or underlying fat (stage III), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage IV). These stage IV heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I-III heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage IV PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first-line procedure in certain high-risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients. PMID:25683573

  15. 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

    Yoo, Won-gyu

    2014-01-01

    [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

  16. Impact of age, anthropometric data and body composition on calcaneal bone characteristics, as measured by quantitative ultrasound (QUS) in an older German population.

    PubMed

    Brunner, Christiane; Pons-Khnemann, Jrn; Neuhuser-Berthold, Monika

    2011-12-01

    The impact of fat-free mass (FFM), fat mass (FM), body mass index (BMI), body mass and body height on calcaneal bone characteristics as measured with quantitative ultrasound (QUS) was investigated in 137 women and 85 men aged 62-92 years, considering age, smoking, waist-to-hip ratio (WHR) and physical activity level (PAL). In regression analyses using various models, in women, age was a negative predictor of speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI) and smoking was a negative predictor of SOS; positive predictors of SOS, BUA, and SI were BMI, body mass and FFM. In men, smoking was a negative predictor and BMI, body mass and FFM were positive predictors of BUA and SI. In both sexes, PAL, body height,WHR and FM had no effect on QUS parameters. The influence of BMI on calcaneal bone characteristics in elderly people depends on FFM rather than on FM. PMID:22036641

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

    PubMed Central

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

    2015-01-01

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

  18. Minimally Invasive Sinus Tarsi Approach With Cannulated Screw Fixation Combined With Vacuum-Assisted Closure for Treatment of Severe Open Calcaneal Fractures With Medial Wounds.

    PubMed

    Zhang, Taiyuan; Yan, Yan; Xie, Xinmin; Mu, Weidong

    2016-01-01

    The aim of our prospective study was to investigate the clinical results and advantages of a minimally invasive sinus tarsi approach with cannulated screw fixation combined with vacuum-assisted closure for the treatment of severe open calcaneal fractures with medial wounds. A total of 31 patients (32 feet) with open calcaneal fractures who were admitted to our hospital from January 2008 to May 2013 were selected for the study and randomly divided into 2 groups: the cannulated screw group (n = 16 patients, 16 feet) and the plate group (n = 15 patients, 16 feet). The Böhler and Gissane angles were compared before and after surgery. The clinical results were evaluated using according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the rate of infection. The follow-up duration for all patients ranged from 10 to 36 (mean 24) months. No statistically significant differences were found in the radiologic indicators, incidence of early postoperative complications, or American Orthopaedic Foot and Ankle Society ankle-hindfoot scores (p > .05) between the 2 groups. However, a statistically significant difference was seen in the duration of hospitalization (p < .05) between the 2 groups. A minimally invasive sinus tarsi approach with cannulated screw fixation combined with vacuum-assisted closure is an effective method for the treatment of severe open calcaneal fractures with medial wounds. It provides good reduction and requires fewer days of hospitalization. PMID:26372552

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

    SciTech Connect

    KRUMHANSL, JAMES L.

    2002-07-01

    The long-range objective of this study was to develop chemically assisted technologies for removing heels from tanks. In FY 01, the first two steps toward this objective were taken: (1) catalogue the occurrence and nature of tank heels and assess which materials are available for study and (2) develop methods for synthesizing non-radioactive surrogate heel materials for use in testing potential removal technologies. The chief finding of Task 1 was the existence of ''heels'', depending on the definition used. Hard materials that would be almost impossible to remove by sluicing are all but absent from the records of both Savannah River and Hanford. Historical usage suggests that the term ''heel'' may also apply to chunky, granular, or semi-solid pasty accumulations. These materials are documented and may also be difficult to remove by conventional sluicing technologies. Such heels may be comprised of normal sludge components, dominantly iron and aluminum hydroxides, or they may result from added materials which were not part of the normal fuel reprocessing operations: Portland cement, diatomaceous earth, sand and soil and spent zeolite ion exchange ''resins''. The occurrence and chemistry of the most notable ''heel'', that of the zeolite mass in Tank 19F at Savannah River, is reviewed in some detail. Secondly, no clear correlation was found between high tank temperatures and difficulties encountered in removing materials from a tank at a later date; nor did the sludges from these tanks give any indication of being particularly solid. Experimental studies to develop synthetic heel materials were caned out using a number of different approaches. For normal sludge materials settling, even when assisted by a centrifuge, it proved ineffective. The same result was obtained from drying sludge samples. Even exposing sludges to a molten salt melt at 233 C, only produced a fine powder, rather than a resilient ceramic which resisted disaggregation. A cohesive material, however, was produced by wicking the pore fluid out of a sludge gel (into packed diatomaceous earth), while simultaneously applying pressure to compact the sludge as it dehydrated. Osmotic gradients could provide the same function as the capillary forces provided by the diatomaceous earth sorbant placed in contact with the sludge. Tests on the anomalous materials added to the tanks all indicated potential problems. Hard granules, and maybe chunks, may be encountered where Portland cement was added to a tank. Sand, spent zeolite resin, and diatomaceous earth, will all react with the tank fluids to produce a sodalite/cancrinite material. The degree of reaction determines whether the grains become cemented together. SRS activities showed that heels formed when spent zeolites were added to tanks can be readily dislodged and it is expected that heels from sand would possess equal or less cohesion. Diatomaceous earth may form more resilient crusts or masses. To summarize, the existence of ''hard'' heels has yet to be documented. A broader definition suggests inclusion of poorly cohesive cancrinite-cemented masses and dense past-like accumulations of abnormally compacted ''normal'' sludges. Chemical treatments to remove these materials must focus on agents that are active against aluminosilicates and hydrous oxides of iron and aluminum. Exploiting the high pore-water content of these materials may provide a second avenue for dislodging such accumulations. Techniques were developed to produce synthetic sludges on which various removal technologies could be tried.

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

    PubMed

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

    2015-06-01

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

  1. A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates

    PubMed Central

    Bueno, Mariana; Yamada, Janet; Harrison, Denise; Khan, Sobia; Ohlsson, Arne; Adams-Webber, Thomasin; Beyene, Joseph; Stevens, Bonnie

    2013-01-01

    BACKGROUND: Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized. OBJECTIVE: To establish the efficacy of nonsucrose sweet-tasting solutions for pain relief during painful procedures in neonates. METHOD: The present article is a systematic review and meta-analyses of the literature. Standard methods of the Cochrane Neonatal Collaborative Review Group were used. Literature searches were reviewed for randomized controlled trials investigating the use of sweet solutions, except sucrose, for procedural pain management in neonates. Outcomes assessed included validated pain measures and behavioural and physiological indicators. RESULTS: Thirty-eight studies (3785 neonates) were included, 35 of which investigated glucose. Heel lancing was performed in 21/38 studies and venipuncture in 11/38 studies. A 3.6-point reduction in Premature Infant Pain Profile scores during heel lances was observed in studies comparing 20% to 30% glucose with no intervention (two studies, 124 neonates; mean difference ?3.6 [95% CI ?4.6 to ?2.6]; P<0.001; I2=54%). A significant reduction in the incidence of cry after venipuncture for infants receiving 25% to 30% glucose versus water or no intervention was observed (three studies, 130 infants; risk difference ?0.18 [95% CI ?0.31 to ?0.05]; P=0.008, number needed to treat = 6 [95% CI 3 to 20]; I2=63%). CONCLUSIONS: The present systematic review and meta-analyses demonstrate that glucose reduces pain scores and crying during single heel lances and venipunctures. Results indicate that 20% to 30% glucose solutions have analgesic effects and can be recommended as an alternative to sucrose for procedural pain reduction in healthy term and preterm neonates. PMID:23748256

  2. Low back pain - acute

    MedlinePLUS

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

  3. Neck Pain

    MedlinePLUS

    ... over-the counter medicine, such as acetaminophen or ibuprofen, to relieve pain, and apply heat to the ... an injury. Use anti-inflammatory medicines, such as ibuprofen and aspirin, to relieve pain and discomfort, and ...

  4. Finger pain

    MedlinePLUS

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  5. Orofacial Pain

    MedlinePLUS

    ... Neck, shoulder or back pain Dizziness ?xml:namespace> Sleep disorders ; If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing ...

  6. Chest pain

    MedlinePLUS

    ... your jaw, left arm, or between your shoulder blades. You have nausea, dizziness, sweating, a racing heart, ... such as: Is the pain between the shoulder blades? Under the breast bone? Does the pain change ...

  7. Ribcage pain

    MedlinePLUS

    ... not cause the pain in someone who has pleurisy (swelling of the lining of the lungs) or ... Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis Pleurisy (the pain is worse when breathing deeply)

  8. Breast pain

    MedlinePLUS

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  9. Belly Pain

    MedlinePLUS

    ... Medical Words En Espaol What Other Kids Are Reading Movie: Digestive System Winter Sports: Sledding, Skiing, Snowboarding, ... cause pain in your belly or abdomen. Keep reading to find out what belly pain is, what ...

  10. Back Pain

    MedlinePLUS

    ... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

  11. Pelvic Pain

    MedlinePLUS

    ... practice bulletin no. 51. Chronic pelvic pain. Obstetrics & Gynecology, 103 ,589–605. [top] UCSF Medical Center. (2012). ... women with chronic pelvic pain. Clinical Obstetrics and Gynecology, 33 ,130–136 [top] What are common symptoms? » ...

  12. Penis pain

    MedlinePLUS

    ... pain. If penis pain is caused by a sexually transmitted disease, it is important for your sexual partner to ... Are you at risk for exposure to any sexually transmitted diseases? What other symptoms do you have? The physical ...

  13. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

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

    PubMed

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

    2014-01-01

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

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

    SciTech Connect

    McDaniel, L.B.

    1998-04-17

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

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

    PubMed

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

    1982-09-01

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

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

    SciTech Connect

    Batcheller, Thomas Aquinas

    2000-09-01

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

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

    SciTech Connect

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

    2000-08-31

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  1. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  2. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  3. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  4. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  5. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

    PIERCE, RA

    2004-04-12

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

  8. Kinematics and Kinetics of Single-Limb Heel Rise in Diabetes Related Medial Column Foot Deformity

    PubMed Central

    Hastings, Mary K.; Woodburn, James; Mueller, Michael J.; Strube, Michael J; Johnson, Jeffrey E.; Sinacore, David R.

    2014-01-01

    Background Diabetes-related medial column foot deformities contribute to high plantar pressure, joint instability, ulceration and amputation. Impaired foot function may be an early indicator of foot structural incompetence and contribute to deformity progression. This study examines the ability of single-limb heel rise multi-segmental kinematics and kinetics to identify midfoot and hindfoot dysfunction in those with diabetes-related medial column foot deformity. Methods Single-limb heel rise foot kinematics and kinetics were examined in adults with diabetes mellitus and peripheral neuropathy with and without medial column foot deformity and age-, weight-matched controls. Findings Hindfoot relative to shank plantarflexion, peak and excursion, were reduced in bothdiabetes groups compared to controls (P<0.017). Controls' initial forefoot relative to hindfoot position was plantarflexed 31 degrees and plantarflexed an additional 13 degrees during heel rise. The initial forefoot relative to hindfoot position for the diabetes group without deformity was similarly plantarflexed as controls (34 degrees) while the diabetes deformity group was less plantarflexed (lower arch position: 23 degrees, P<0.017). During the heel rise task both diabetes groups demonstrated less ability to plantarflex the forefoot relative to the hindfoot compared to controls (2 and 5 degrees respectively, P<0.017). Ankle plantarflexion power was reduced in the diabetes deformity group compared to controls (P<0.017). Interpretation The single-limb heel rise task identified movement dysfunction in those with diabetes mellitus and peripheral neuropathy. Failure to plantarflex the forefoot relative to hindfoot may compromise midfoot joint stability and increase the risk of injury and arch collapse. PMID:25218437

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-12-01

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

  11. Recreational Sports Activities After Calcaneal Fractures and Subsequent Subtalar Joint Arthrodesis.

    PubMed

    Romeo, Giovanni; Martinelli, Nicol; Bonifacini, Carlo; Bianchi, Alberto; Sartorelli, Elena; Malerba, Francesco

    2015-01-01

    Subtalar joint arthrodesis is a common treatment for the management of hindfoot pathologic entities. Despite pain reduction, hindfoot stiffness is a common concern of active patients, who wish to continue or start exercising for fitness. The purpose of the present retrospective observational clinical study was to assess the rate and type of recreational sports activities in patients before and after subtalar joint arthrodesis and to correlate the clinical outcome and the level of sports activities. In 33 patients (22 males, 11 females) treated with subtalar joint arthrodesis, the pre- and postoperative participation in sports and recreational activities was evaluated. The American Orthopaedic Foot and Ankle Society hindfoot scale score, 36-item Short Form Health Survey, and a visual analog scale for pain were used as clinical outcome measures. The weekly session number, session time, and interval to activity recovery after surgery were registered. Patients with a subtalar joint arthrodesis returned to a satisfactory level of activity postoperatively. The sports participation almost reached levels similar to those preoperatively but with a shift from high- to low-impact activities. PMID:26210081

  12. Low back pain - chronic

    MedlinePLUS

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause ...

  13. Neuropathic Pain

    PubMed Central

    Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.

    2009-01-01

    Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk. PMID:19400724

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

    SciTech Connect

    Fellinger, A.

    2010-02-16

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

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

    PubMed

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

    2016-02-01

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

  16. Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon

    PubMed Central

    Kobsar, Bradley; Alcantara, Joel

    2009-01-01

    The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon. The care provided involves an array of modalities from exercise and rehabilitation to spinal manipulative therapy. PMID:19421349

  17. Bohler’s angle’s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study

    PubMed Central

    2013-01-01

    Background Controversy exits over the role of Böhler’s angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between Böhler’s angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of Böhler’s angle and functional outcome. Methods Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The Böhler’s angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of Böhler’s angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in Böhler’s angle by ratio was calculated by dividing the difference value of Böhler’s angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. Results 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative Böhler’s angle, difference value of Böhler’s angle between bilateral calcaneus, and change in Böhler’s angle by ratio each has a significant correlation with Sanders classification (rs=−0.178, P=0.003; rs=−0.174, P=0.004; rs=−0.172, P=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements were all found to have a significant correlation with American Orthopaedic Foot & Ankle Society hindfoot scores (rs=0.223, P<0.001; rs=0.224, P<0.001; rs=0.220, P<0.001, respectively). However, these correlations were all weak to low. Conclusions There was a significant correlation between preoperative Böhler’s angle and the injury severity of displaced intra-articular calcaneal fractures, but only postoperative Böhler’s angle parameters were found to have a significant correlation with the functional recovery. PMID:24330592

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

    PubMed

    Zhang, Xianyi; Li, Bo

    2014-04-01

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

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

    PubMed

    Shahla, Ahmad

    2009-07-01

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

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

    PubMed

    Cronin, Neil J

    2014-04-01

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

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

    PubMed

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

    1990-08-01

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

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

    SciTech Connect

    Bellomy, J.R.

    1994-09-01

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

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

    PubMed

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

    1997-11-01

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

  4. Pain frequency moderates the relationship between pain catastrophizing and pain

    PubMed Central

    Kjgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

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

    PubMed

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

    2009-01-01

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

  6. Inertial sensor based and shoe size independent gait analysis including heel and toe clearance estimation.

    PubMed

    Kanzler, Christoph M; Barth, Jens; Rampp, Alexander; Schlarb, Heiko; Rott, Franz; Klucken, Jochen; Eskofier, Bjoern M

    2015-08-01

    Falls are a major cause for morbidity and mortality in the ageing society. Inertial sensor based gait assessment including the analysis of the heel and toe clearance can be an indicator for the risk of falling. This paper presents a method for calculating the continuous heel and toe clearance without the knowledge of the shoe dimensions as well as the foot angle in the sagittal plane. These gait parameters were validated using an optical motion capture system. 20 healthy subjects from 3 different age groups (young, mid age, old) performed gait trials with different stride lengths and stride velocities. We obtained low mean absolute errors, low standard deviations and high Pearson correlations (0.91-0.99) for all gait parameters. In summary, we implemented a viable algorithm for the calculation of the heel and toe clearance without knowing the shoe dimensions as well as the foot angle in sagittal plane. We conclude that the given method is applicable for a mobile and unobtrusive gait assessment for healthy subjects from all age classes. PMID:26737518

  7. Discriminative capacity of calcaneal quantitative ultrasound and of osteoporosis and fracture risk factors in postmenopausal women with osteoporotic fractures.

    PubMed

    Hernndez, J L; Marin, F; Gonzlez-Macas, J; Dez-Prez, A; Vila, J; Gimnez, S; Galn, B; Arenas, M S; Surez, F; Gayola, L; Guilln, G; Sagredo, T; Belenguer, R; Moron, A; Arriaza, E

    2004-04-01

    Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a history of osteoporotic fracture. A cross-sectional analysis was made of a cohort of 5195 women aged 65 or older (mean +/- SD: 72.3 +/- 5.4 years) seen in 58 primary care centers in Spain. A total of 1042 women (20.1%) presented with a history of osteoporotic fracture. Most fractures (93%) were non-vertebral. Age-adjusted odds ratios corresponding to each decrease in one standard deviation of the different QUS parameters ranged from 1.47 to 1.55 (P < 0.001) for fractures. The age-adjusted multivariate analysis yielded the following risk factors independently associated with a history of osteoporotic fracture: number of fertile years, a family history of fracture, falls in the previous year, a history of chronic obstructive airway disease, the use of antiarrhythmic drugs, and a low value for any of the QUS parameters. The area under the receiver operating characteristic curve of the best model was 0.656. In summary, a series of easily assessable osteoporotic fracture risk factors has been identified. QUS was shown to discriminate between women with and without a history of fracture, and constitutes a useful tool for assessing fracture risk. Various of the vertebral and hip fracture risk factors frequently cited in North American and British populations showed no discriminative capacity in our series--thus suggesting that such factors may not be fully applicable to our population and/or to the predominant type of fractures included in the present study. PMID:15255073

  8. The X-ray attenuation characteristics and density of human calcaneal marrow do not change significantly during adulthood

    NASA Technical Reports Server (NTRS)

    Les, C. M.; Whalen, R. T.; Beaupre, G. S.; Yan, C. H.; Cleek, T. M.; Wills, J. S.

    2002-01-01

    Changes in the material characteristics of bone marrow with aging can be a significant source of error in measurements of bone density when using X-ray and ultrasound imaging modalities. In the context of computed tomography, dual-energy computed techniques have been used to correct for changes in marrow composition. However, dual-energy quantitative computed tomography (DE-QCT) protocols, while increasing the accuracy of the measurement, reduce the precision and increase the radiation dose to the patient in comparison to single-energy quantitative computed tomography (SE-QCT) protocols. If the attenuation properties of the marrow for a particular bone can be shown to be relatively constant with age, it should be possible to use single-energy techniques without experiencing errors caused by unknown marrow composition. Marrow was extracted by centrifugation from 10 mm thick frontal sections of 34 adult cadaver calcanei (28 males, 6 females, ages 17-65 years). The density and energy-dependent linear X-ray attenuation coefficient of each marrow sample were determined. For purposes of comparing our results, we then computed an effective CT number at two GE CT/i scan voltages (80 and 120 kVp) for each specimen. The coefficients of variation for the density, CT number at 80 kVp and CT number at 120 kVp were each less than 1%, and the parameters did not change significantly with age (p > 0.2, r2 < 0.02, power > 0.8 where the minimum acceptable r2 = 0.216). We could demonstrate no significant gender-associated differences in these relationships. These data suggest that calcaneal bone marrow X-ray attenuation properties and marrow density are essentially constant from the third through sixth decades of life.

  9. Spinal pain.

    PubMed

    Izzo, R; Popolizio, T; D'Aprile, P; Muto, M

    2015-05-01

    The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic pain, much more difficult to treat. The clinical assessment of pain source can be a challenge because of the complex anatomy and function of the spine; the advanced imaging methods are often not sufficient for a definitive diagnosis because similar findings could be present in either asymptomatic and symptomatic subjects: a clinical correlation is always mandatory and the therapy cannot rely uniquely upon any imaging abnormalities. Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. Special attention will be done to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. PMID:25824642

  10. Fetal pain?

    PubMed

    Vanhatalo, S; van Nieuwenhuizen, O

    2000-05-01

    During the last few years a vivid debate, both scientifically and emotionally, has risen in the medical literature as to whether a fetus is able to feel pain during abortion or intrauterine surgery. This debate has mainly been inspired by the demonstration of various hormonal or motor reactions to noxious stimuli at very early stages of fetal development. The aims of this paper are to review the literature on development of the pain system in the fetus, and to speculate about the relationship between "sensing" as opposed to "feeling" pain and the number of reactions associated with painful stimuli. While a cortical processing of pain theoretically becomes possible after development of the thalamo-cortical connections in the 26th week of gestation, noxious stimuli may trigger complex reflex reactions much earlier. However, more important than possible painfulness is the fact that the noxious stimuli, by triggering stress responses, most likely affect the development of an individual at very early stages. Hence, it is not reasonable to speculate on the possible emotional experiences of pain in fetuses or premature babies. A clinically relevant aim is rather to avoid and/or treat any possibly noxious stimuli, and thereby prevent their potential adverse effects on the subsequent development. PMID:10814894

  11. [Musculoskeletal pain].

    PubMed

    Casser, H-R; Schaible, H-G

    2015-10-01

    Among the clinically relevant pain conditions, pain in the musculoskeletal system is most frequent. This article reports extensive epidemiological data on musculoskeletal system pain in Germany and worldwide. Since back pain is most frequent, the diagnostics and therapeutic algorithms of acute, recurring, and chronic lower back pain in Germany will be particularly addressed. The importance of the physiologic-organic, the cognitive-emotional, the behavioral, and the social level to diagnostics and treatment will be discussed. We will also focus on osteoarthritic pain and address its epidemiology, clinical importance, and significance for the health care system. This article will list some reasons why the musculoskeletal system in particular is frequently the site of chronic pain. The authors believe that these reasons are to be sought in the complex structures of the musculoskeletal system; in the particular sensitivity of the deep somatic nociceptive system for long-term sensitization processes, as well as the ensuing nervous system reactions; and in the interactions between the nervous and immune systems. The article will give some insights into the research carried out on this topic in Germany. PMID:26351130

  12. What a Pain! Kids and Growing Pains

    MedlinePLUS

    ... Snowboarding, Skating Crushes What's a Booger? What a Pain! Kids and Growing Pains KidsHealth > For Kids > What a Pain! Kids and ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

  13. Use of calcaneal ultrasound and biochemical markers to assess the density and metabolic state of the bones of adults with hepatic cirrhosis.

    PubMed Central

    VanderJagt, Dorothy J.; Okeke, Edith; Calvin, Christine; Troncoso, Carmen; Crossey, Michael; Glew, Robert H.

    2007-01-01

    Bone loss has been shown to be associated with chronic liver disease (CLD) caused by ethanol consumption or viral infection, and trabecular bone is affected more than cortical bone. We therefore used calcaneal ultrasound to compare the bone status of 54 males and 20 females with CLD in northern Nigeria with 88 age- and gender-matched healthy controls. Serum levels of bone-specific alkaline phosphatase (BSAP) and the N-terminal telopeptide of type-1 collagen (NTx) were also measured to estimate relative rates of bone synthesis and turnover, respectively. The mean stiffness index (SI) of the males with CLD and the male controls were not different; however, the mean SI of the female subjects with CLD was lower than for the female controls (101 vs. 86, p=0.003). The levels of NTx and BSAP were markedly elevated in the males, but not in the females, with CLD. Liver function tests did not correlate with ultrasound parameters or biochemical markers of bone metabolism. These results show that Nigerian women, but not males, with CLD have decreased bone density as assessed by calcaneal ultrasound; however, the high rate of bone turnover in Nigerian males with CLD indicates that they are at risk for bone loss. PMID:17913112

  14. Chronic pain - resources

    MedlinePLUS

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

  15. Leg pain

    MedlinePLUS

    ... usually seen in boys and overweight children between ages 11 and 15 ... as much as possible. Elevate your leg. Apply ice for up to 15 minutes. ... Other homecare will depend on the cause of your leg pain.

  16. Face pain

    MedlinePLUS

    ... the body. Abscessed tooth (ongoing throbbing pain on one side of the lower face that gets worse with eating or touching) Cluster headache Herpes zoster (shingles) or herpes simplex (cold sores) infection Injury to the face Migraine ...

  17. Joint pain

    MedlinePLUS

    ... both rest and exercise are important. Warm baths, massage, and stretching exercises should be used as often ... Does keeping the joint elevated help? Do medicines, massage, or applying heat reduce the pain? What other ...

  18. Neuropathic Pain

    MedlinePLUS

    ... know that it can erode quality of life. Communication Tools View All Everyday Tools During Your Visit ... pain. Online Tool Printable Tool (PDF) Show More Communication Tools Where Does It Hurt? / Nerve Man With ...

  19. Abdominal Pain

    MedlinePLUS

    ... can I find more information and related topics? Functional Abdominal Pain (English, French or Spanish)—from The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Gastro Kids , a site for kids with ...

  20. Wrist pain

    MedlinePLUS

    ... wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... 37.7°C), and recent illness. Other Causes Gout : This occurs when your body produces too much ...

  1. Urination Pain

    MedlinePLUS

    ... small masses of minerals) in the urinary tract. Urinary tract infections (UTIs) are the most common cause of painful ... For Kids For Parents MORE ON THIS TOPIC Urinary Tract Infections A to Z: Dysuria Recurrent Urinary Tract Infections ...

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

    SciTech Connect

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

    2013-01-11

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

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

    PubMed Central

    Lockhart, Thurmon E.; Kim, Sukwon

    2010-01-01

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

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

    SciTech Connect

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

    2013-07-01

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

  5. [Pain therapy].

    PubMed

    Donnadieu, S; Djian, M C

    1998-12-12

    NEW OPIOID ANALGESICS: Progress in pain reliet has recently been achieved with the introduction of new opioid analgesics such as tramadol and the pediatric preparation of codeine phosphate as well as powerful long-release opioids which can be administered per os, or percutaneously for transdermal fentanyl. CO-ANALGESICS: Other drugs, mainly antidepressants and anti-convulsants, can be usefully combined with analgesics. New serotonin uptake inhibitors and anticonvulsants (gabapentin and lamotrigin) have the advantage of better tolerance. None of these drugs has marketing approval in France for their pain relieving effects. The same is true for clonidine and neostigmine which, after spinal infusion, potentialize opioids and for ketamine which can relieve neuropathy pain by dissociative anesthesia. NEW ANTI-MIGRAINE DRUGS: New drugs have been developed for specific types of pain such as migraine. The new "triptans" are tolerated better than sumatriptan and is reimbursed by the national social security. REFRACTORY NEUROPATHY PAIN: Indications for electrical stimulation techniques conducted in a neurosurgery unit have been identified. Stimulators may be implanted in spinal or supra-spinal localizations. REGULATORY ASPECTS: New legislation has reorganized health care for pain relief in France. The new texts take into consideration personnel training, the health care network and progress in therapeutics. PMID:9893699

  6. Neonatal pain

    PubMed Central

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

  7. THE INFLUENCE OF HEEL HEIGHT ON VERTICAL GROUND REACTION FORCE DURING LANDING TASKS IN RECREATIONALLY ACTIVE AND ATHLETIC COLLEGIATE FEMALES

    PubMed Central

    Carcia, Christopher R.

    2013-01-01

    Purpose: To determine if heel height alters vertical ground reaction forces (vGRF) when landing from a forward hop or drop landing. Background: Increased vGRF 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 athletic shoe. Using a force plate, peak vGRF at landing was examined. Repeated measures ANOVAs were used to determine the influence of heel height on the dependent measures. Results: Forward hop task? Peak vGRF (normalized for body mass) with 0 mm, 12 mm, and 24 mm lifts were 2.6130.498, 2.6160.497 and 2.4950.518% BW, respectively. Significant differences were noted between 0 and 24 mm lift (p<.001) and 12 and 24 mm lifts (p=.004), but not between the 0 and 12 mm conditions (p=.927). Jump?landing task? No significant differences were found in peak vGRF (p=.192) between any of the heel lift conditions. Conclusions: The addition of a 24 mm heel lift to the bottom of a sneaker significantly alters peak vGRF upon landing from a unilateral forward hop but not from a jumping maneuver. PMID:23439490

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

    PubMed

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

    2005-12-01

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

  9. Pain management.

    PubMed

    Wild, L

    1990-12-01

    Postoperative pain management in the critically ill patient is a challenge for nurses. Knowing the basis of pain transmission and mechanisms of action of interventions can assist the critical care nurse in making clinical decisions regarding pain control for individual patients. There are a number of modalities available to treat postoperative pain including both pharmacologic and nonpharmacologic interventions. Techniques such as PCA not only can provide good analgesia, but allow the critically ill patient at least one aspect of control in the otherwise highly controlled environment of the critical care unit. Epidural or intrathecal analgesia, using either opioids or LAAs alone or in combination, provides excellent analgesic effect (with minimal side effects) and may improve patient outcomes. Nonpharmacologic techniques, unfortunately, are commonly overlooked as adjuncts to traditional analgesia routines because of the nature of the illness in the critically ill patient. Nonpharmacologic techniques of pain management have a place in the care of the critically ill when applied based on the assessment of an individual patient's needs and abilities to participate in his or her care. Ensuring optimal patient comfort can benefit critically ill patients and improve clinical outcomes. PMID:2096859

  10. Pain management.

    PubMed

    Ripamonti, C I

    2012-09-01

    Despite published guidelines and educational programs on the assessment and treatment of cancer-related pain, in any stage of oncological disease, unrelieved pain continues to be a substantial worldwide public health concern either in patients with solid and haematological malignancies. The proper and regular self-reporting assessment of pain is the first step for an effective and individualized treatment. Opioids are the mainstay of analgesic therapy and can be associated with non-opioids drugs such as paracetamol or non-steroidal anti-inflammatory drugs and to adjuvant drugs (for neuropathic pain and symptom control). The role and the utility of weak opioids (i.e. codeine, dihydrocodeine, tramadol) are a controversy point. Morphine has been placed by World Health Organization on its Essential Drug List. In the comparative study with other strong opioids (hydromorphone, oxycodone), there is no evidence to show superiority or inferiority with morphine as the first choice opioid. Oral methadone is a useful and safe alternative to morphine. Methadone presents the potential to control pain difficult to manage with other opioids. although the oral route of opioid administration is considered the one of choice, intravenous, subcutaneous, rectal, transdermal, sublingual, intranasal, and spinal routes must be used in particular situation. Transdermal opioids such as fentanyl and buprenorphine are best reserved for patients whose opioid requirements are stable. Switching from one opioid to another can improve analgesia and tolerability. PMID:22987980

  11. SLUDGE HEEL REMOVAL BY ALUMINUM DISSOLUTION AT SAVANNAH RIVER SITE 12390

    SciTech Connect

    Keefer, M.

    2012-01-12

    High Level Waste (HLW) at the Savannah River Site (SRS) is currently stored in aging underground storage tanks. This waste is a complex mixture of insoluble solids, referred to as sludge, and soluble salts. Continued long-term storage of these radioactive wastes poses an environmental risk. Operations are underway to remove and disposition the waste, clean the tanks and fill with grout for permanent closure. Heel removal is the intermediate phase of the waste retrieval and tank cleaning process at SRS, which is intended to reduce the volume of waste prior to treatment with oxalic acid. The goal of heel removal is to reduce the residual amount of radioactive sludge wastes to less than 37,900 liters (10,000 gallons) of wet solids. Reducing the quantity of residual waste solids in the tank prior to acid cleaning reduces the amount of acid required and reduces the amount of excess acid that could impact ongoing waste management processes. Mechanical heel removal campaigns in Tank 12 have relied solely on the use of mixing pumps that have not been effective at reducing the volume of remaining solids. The remaining waste in Tank 12 is known to have a high aluminum concentration. Aluminum dissolution by caustic leaching was identified as a treatment step to reduce the volume of remaining solids and prepare the tank for acid cleaning. Dissolution was performed in Tank 12 over a two month period in July and August, 2011. Sample results indicated that 16,440 kg of aluminum oxide (boehmite) had been dissolved representing 60% of the starting inventory. The evolution resulted in reducing the sludge solids volume by 22,300 liters (5900 gallons), preparing the tank for chemical cleaning with oxalic acid.

  12. Low heel ultrasound parameters predict mortality in men: results from the European Male Ageing Study (EMAS)

    PubMed Central

    Pye, Stephen R.; Vanderschueren, Dirk; Boonen, Steven; Gielen, Evelien; Adams, Judith E.; Ward, Kate A.; Lee, David M.; Bartfai, Gyrgy; Casanueva, Felipe F.; Finn, Joseph D.; Forti, Gianni; Giwercman, Aleksander; Han, Thang S.; Huhtaniemi, Ilpo T.; Kula, Krzysztof; Lean, Michael E.; Pendleton, Neil; Punab, Margus; Wu, Frederick C.; O'Neill, Terence W.

    2015-01-01

    Background: low bone mineral density measured by dual-energy x-ray absorptiometry is associated with increased mortality. The relationship between other skeletal phenotypes and mortality is unclear. The aim of this study was to determine the relationship between quantitative heel ultrasound parameters and mortality in a cohort of European men. Methods: men aged 4079 years were recruited for participation in a prospective study of male ageing: the European Male Ageing Study (EMAS). At baseline, subjects attended for quantitative ultrasound (QUS) of the heel (HologicSAHARA) and completed questionnaires on lifestyle factors and co-morbidities. Height and weight were measured. After a median of 4.3 years, subjects were invited to attend a follow-up assessment, and reasons for non-participation, including death, were recorded. The relationship between QUS parameters (broadband ultrasound attenuation [BUA] and speed of sound [SOS]) and mortality was assessed using Cox proportional hazards model. Results: from a total of 3,244 men (mean age 59.8, standard deviation [SD] 10.8 years), 185 (5.7%) died during the follow-up period. After adjusting for age, centre, body mass index, physical activity, current smoking, number of co-morbidities and general health, each SD decrease in BUA was associated with a 20% higher risk of mortality (hazard ratio [HR] per SD = 1.2; 95% confidence interval [CI] = 1.01.4). Compared with those in higher quintiles (2nd5th), those in the lowest quintile of BUA and SOS had a greater mortality risk (BUA: HR = 1.6; 95% CI = 1.12.3 and SOS: HR = 1.6; 95% CI = 1.22.2). Conclusion: lower heel ultrasound parameters are associated with increased mortality in European men. PMID:26162912

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

    SciTech Connect

    Callaway, William S.

    2013-09-30

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

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

    PubMed

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

    2011-02-01

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

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

    SciTech Connect

    Callaway, William S.

    2013-09-26

    Eight samples of heel solids from tank 241-C-109 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, one-half to two-thirds of the solids were off-white to tan solids that, visually, were fairly evenly graded in size from coarse silt (30-60 μm) to medium pebbles (8-16 mm). The remaining solids were mostly strongly cemented aggregates ranging from coarse pebbles (16-32 mm) to fine cobbles (6-15 cm) in size. Solid phase characterization and chemical analysis indicated that the air-dry heel solids contained ≈58 wt% gibbsite [Al(OH){sub 3}] and ≈37 wt% natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}�19H{sub 2}O]. The strongly cemented aggregates were mostly fine-grained gibbsite cemented with additional gibbsite. Dissolution testing was performed on two test samples. One set of tests was performed on large pieces of aggregate solids removed from the heel solids samples. The other set of dissolution tests was performed on a composite sample prepared from well-drained, air-dry heel solids that were crushed to pass a �-in. sieve. The bulk density of the composite sample was 2.04 g/mL. The dissolution tests included water dissolution followed by caustic dissolution testing. In each step of the three-step water dissolution tests, a volume of water approximately equal to 3 times the initial volume of the test solids was added. In each step, the test samples were gently but thoroughly mixed for approximately 2 days at an average ambient temperature of 25 �C. The caustic dissolution tests began with the addition of sufficient 49.6 wt% NaOH to the water dissolution residues to provide ≈3.1 moles of OH for each mole of Al estimated to have been present in the starting composite sample and ≈2.6 moles of OH for each mole of Al potentially present in the starting aggregate sample. Metathesis of gibbsite to sodium aluminate was then allowed to proceed over 10 days of gentle mixing of the test samples at temperatures ranging from 26-30 �C. The metathesized sodium aluminate was then dissolved by addition of volumes of water approximately equal to 1.3 times the volumes of caustic added to the test slurries. Aluminate dissolution was allowed to proceed for 2 days at ambient temperatures of ≈29 �C. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.0 wt% of the tank 241-C-109 crushed heel solids composite test sample. The 20 wt% of solids remaining after the dissolution tests were 85-88 wt% gibbsite. If the density of the residual solids was approximately equal to that of gibbsite, they represented ≈17 vol% of the initial crushed solids composite test sample. In the water dissolution tests, addition of a volume of water ≈6.9 times the initial volume of the crushed solids composite was sufficient to dissolve and recover essentially all of the natrophosphate present. The ratio of the weight of water required to dissolve the natrophosphate solids to the estimated weight of natrophosphate present was 8.51. The Environmental Simulation Program (OLI Systems, Inc., Morris Plains, New Jersey) predicts that an 8.36 w/w ratio would be required to dissolve the estimated weight of natrophosphate present in the absence of other components of the heel solids. Only minor amounts of Al-bearing solids were removed from the composite solids in the water dissolution tests. The caustic metathesis/aluminate dissolution test sequence, executed at temperatures ranging from 27-30 �C, dissolved and recovered ≈69 wt% of the gibbsite estimated to have been present in the initial crushed heel solids composite. This level of gibbsite recovery is consistent with that measured in previous scoping tests on the dissolution of gibbsite in strong caustic solutions. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.3 wt% of the tank 241-C-109 aggregate solids test sample. The residual solids were 92-95 wt% gibbsite. Only a minor portion (≈4.5 wt%) of the aggregate solids was dissolved and recovered in the water dissolution test. Other than some smoothing caused by continuous mixing, the aggregates were essentially unaffected by the water dissolution tests. During the caustic metathesis/aluminate dissolution test sequence, ≈81 wt% of the gibbsite estimated to have been present in the aggregate solids was dissolved and recovered. The pieces of aggregate were significantly reduced in size but persisted as distinct pieces of solids. The increased level of gibbsite recovery, as compared to that for the crushed heel solids composite, suggests that the way the gibbsite solids and caustic solution are mixed is a key determinant of the overall efficiency of gibbsite dissolution and recovery. The liquids recovered after the caustic dissolution tests on the crushed solids composite and the aggregate solids were observed for 170 days. No precipitation of gibbsite was observed. The distribution of particle sizes in the residual solids recovered following the dissolution tests on the crushed heel solids composite was characterized. Wet sieving indicated that 21.4 wt% of the residual solids were >710 μm in size, and laser light scattering indicated that the median equivalent spherical diameter in the <710-μm solids was 35 μm. The settling behavior of the residual solids following the large-scale dissolution tests was also studied. When dispersed at a concentration of ≈1 vol% in water, ≈24 wt% of the residual solids settled at a rate >0.43 in./s; ≈68 wt% settled at rates between 0.02 and 0.43 in./s; and ≈7 wt% settled slower than 0.02 in./s.

  16. Painful menstrual periods

    MedlinePLUS

    Menstruation - painful; Dysmenorrhea; Periods - painful; Cramps - menstrual; Menstrual cramps ... a few days during each menstrual cycle. Painful menstruation is the leading cause of lost time from ...

  17. Facts and Figures on Pain

    MedlinePLUS

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Health Statistics survey indicated that low back pain was the most common (27%), followed by severe ...

  18. Shoulder Pain

    MedlinePLUS

    ... in my shoulder? A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) of the rotator cuff (the part of the shoulder that helps circular motion). Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest ...

  19. CHEMICAL SLUDGE HEEL REMOVAL AT THE SAVANNAH RIVER SITE F TANK FARM CLOSURE PROJECT 8183

    SciTech Connect

    Thaxton, D; Timothy Baughman, T

    2008-01-16

    Chemical Sludge Removal (CSR) is the final waste removal activity planned for some of the oldest nuclear waste tanks located at the Savannah River Site (SRS) in Aiken, SC. In 2008, CSR will be used to empty two of these waste tanks in preparation for final closure. The two waste tanks chosen to undergo this process have previously leaked small amounts of nuclear waste from the primary tank into an underground secondary containment pan. CSR involves adding aqueous oxalic acid to the waste tank in order to dissolve the remaining sludge heel. The resultant acidic waste solution is then pumped to another waste tank where it will be neutralized and then stored awaiting further processing. The waste tanks to be cleaned have a storage capacity of 2.84E+06 liters (750,000 gallons) and a target sludge heel volume of 1.89E+04 liters (5,000 gallons) or less for the initiation of CSR. The purpose of this paper is to describe the CSR process and to discuss the most significant technical issues associated with the development of CSR.

  20. Programmed death 1 blockade, an Achilles heel for MMR-deficient tumors?

    PubMed

    Lin, Andy Yingjie; Lin, Edward

    2015-01-01

    Program death receptor-1 (PD-1) is upregulated in many tumors and in tumor microenvironment, and PD-1 blockade has led to remarkable immune-based anti-tumor responses in across many tumor types. Pembrolizumab, an anti-programmed death 1 checkpoint inhibitor, resulted in a high rate of immune response in 41 patients with previously treated mismatch repair (MMR)-deficient tumor including colorectal cancer but not in MMR-stable tumor with expectant toxicities. Both immune-based progression-free and overall survival are quite promising and correlate with high mutation loads in the tumor. MMR-deficient tumors made up not an insignificant proportion of GI and GU cancers and are found mostly in younger patients who had better prognosis than MMR-stable tumors. However, MMR-deficient tumors do not respond to cytotoxic chemotherapy as these agents may require intact DNA mismatch repair to be effective. MMR deficiency occurred as a result of mutations in defined DNA repair complex mutations or epigenetics modifications and gene upstream of DNA repair complex. PD-1 blockade represents our first successful shot at one of the Achilles heels of this MMR-deficient tumor Goliath. Only coordinated attack on all of its Achilles heels and healing mechanisms can this tumor Goliath be brought down to its knees. PMID:26542241

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

    PubMed

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

    2015-05-01

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

  2. La ténorraphie percutanée dans les ruptures fraîches du tendon calcanéen: à propos de 67 cas

    PubMed Central

    Bessam, Aman; Hassani, Zouhir Ameziane; Kharmaz, Mohamed; Steinmetz, Alain

    2014-01-01

    La rupture du tendon calcanéen est une des lésions les plus fréquentes en pathologie du sport, les deux options thérapeutiques classiques sont le traitement orthopédique et la chirurgie à ciel ouvert. Dans le but de minimiser ces complications, des techniques mini-invasives de ténorraphie percutanée ont été proposées dont les résultats sont encourageants. Il s'agit d'une étude rétrospective d'une série de cas de rupture sous cutanée du tendon d'Achille s’étalant de Avril 2005 au Juin 2012 concernant 67 patients; 11 femmes et 56 hommes avec un âge moyen de 41 ans. La cause principale était un accident de sport dans 45 cas. Le diagnostic était évident à l'examen chez tous les patients. Dans deux cas il s'agissait d'une rerupture survenant à 1 et 5 ans d'un traitement orthopédique. Dans un cas il s'agissait d'une rerupture survenant après une ténorraphie percutanée. Dans deux cas il s'agissait d'une rupture sur tendinopathie chronique. Tous les patients avaient bénéficié d'une radio de la cheville qui avait montré une horizontalisation du calcanéum chez 5 patients et surtout elle n'avait pas montré de fracture associée, alors que 15 patients avaient bénéficié d'une échographie qui a confirmé le diagnostic. Tous les patients avaient été opérés dans un délai de moins de 48 heures Une ténorraphie percutanée a été pratiqué chez tous les patients. Le recul moyen est de 43 mois, trois patients ont été perdus de vue Nous avons noté une reprise des activités professionnelle effective en moyen 90 jours après l'intervention et celle des activités sportive à 6 mois en moyenne L’état cutané local a été jugée bon dans 63 cas. Par ailleurs les complications ont été marquées par un seul cas d'infection ayant nécessité une reprise chirurgical a été noté mise à plat, trois cas de rerupture repris par suture à ciel ouvert, un cas d'algodystrophie et un cas de tendinopathie Il n'y a eu aucune complication thromboembolique ni neurologique. Il n'existe pas de réel consensus concernant la prise en charge des ruptures du tendon calcanéen. Ainsi, La ténorraphie percutanée du tendon calcanéen est une méthode simple rapide et efficace, elle allie les avantages de la chirurgie à ciel ouvert en termes de pourcentage de rerupture et les avantages du traitement fonctionnel en rapport avec un faible risque infectieux. PMID:25332749

  3. What Is Chronic Pain?

    MedlinePLUS Videos and Cool Tools

    ... Management Tools Videos What Is Chronic Pain? What Is Chronic Pain? View Transcript Download Transcript If you ... with chronic pain, you know that chronic pain is different. Ed Covington, MD, director of the Cleveland ...

  4. Somatoform pain disorder

    MedlinePLUS

    Pain disorder ... thought to be related to emotional stress. The pain was often said to be "all in their head." However, patients with somatoform pain disorder seem to experience painful sensations in a ...

  5. Complex Regional Pain Syndrome

    MedlinePLUS

    Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

  6. Fighting Chronic Pain

    MedlinePLUS

    ... earache, toothache, sore throat, sinus pain, facial numbness Muscles and Bones: Arthritis, back pain, bone pain from spread of cancer, fibromyalgia, chronic fatigue syndrome Neurologic: "Phantom limb" pain after amputation, nerve ...

  7. American Chronic Pain Association

    MedlinePLUS

    ... ACPA Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  8. Back Pain During Pregnancy

    MedlinePLUS

    ... Management Education & Events Advocacy For Patients About ACOG Back Pain During Pregnancy Home For Patients Search FAQs Back ... Pain During Pregnancy FAQ115, January 2016 PDF Format Back Pain During Pregnancy Pregnancy What causes back pain during ...

  9. Prevent Back Pain

    MedlinePLUS

    ... Back Pain Print This Topic En español Prevent Back Pain Browse Sections The Basics Overview Types of Back ... 1 of 7 sections The Basics: Types of Back Pain There are different kinds of back pain. Back ...

  10. When Sex Is Painful

    MedlinePLUS

    ... AQ FREQUENTLY ASKED QUESTIONS GYNECOLOGIC PROBLEMS FAQ020 When Sex Is Painful • How common is painful sex? • What causes pain during sex? • Where is pain during sex felt? • When should ...

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

    PubMed Central

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

    2012-01-01

    The human locomotor system is flexible and enables humans to move without falling even under less than optimal conditions. Walking with high-heeled shoes constitutes an unstable condition and here we ask how the nervous system controls the ankle joint in this situation? We investigated the movement behavior of high-heeled and barefooted walking in eleven female subjects. The movement variability was quantified by calculation of approximate entropy (ApEn) in the ankle joint angle and the standard deviation (SD) of the stride time intervals. Electromyography (EMG) of the soleus (SO) and tibialis anterior (TA) muscles and the soleus Hoffmann (H-) reflex were measured at 4.0 km/h on a motor driven treadmill to reveal the underlying motor strategies in each walking condition. The ApEn of the ankle joint angle was significantly higher (p<0.01) during high-heeled (0.380.08) than during barefooted walking (0.280.07). During high-heeled walking, coactivation between the SO and TA muscles increased towards heel strike and the H-reflex was significantly increased in terminal swing by 40% (p<0.01). These observations show that high-heeled walking is characterized by a more complex and less predictable pattern than barefooted walking. Increased coactivation about the ankle joint together with increased excitability of the SO H-reflex in terminal swing phase indicates that the motor strategy was changed during high-heeled walking. Although, the participants were young, healthy and accustomed to high-heeled walking the results demonstrate that that walking on high-heels needs to be controlled differently from barefooted walking. We suggest that the higher variability reflects an adjusted neural strategy of the nervous system to control the ankle joint during high-heeled walking. PMID:22615997

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

    PubMed

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

    2013-07-01

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

  13. Neck pain

    PubMed Central

    2008-01-01

    Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy, physical treatments, postural techniques (yoga, pilates, Alexander technique), pulsed electromagnetic field (PEMF) treatment, soft collars and special pillows, spray and stretch, surgery, traction, and transcutaneous electrical nerve stimulation (TENS). PMID:19445809

  14. Pain Management: Post-Amputation Pain

    MedlinePLUS

    Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print page Save and share ... by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of the most ...

  15. Pain and Hand Function.

    PubMed

    Howland, Nicholas; Lopez, Mariela; Zhang, Andrew Y

    2016-02-01

    Pain is a unique somatosensory perception that can dramatically affect our ability to function. It is also a necessary perception, without which we would do irreparable damage to ourselves. In this article, the authors assess the impact of pain on function of the hand. Pain can be categorized into acute pain, chronic pain, and neuropathic pain. Hand function and objective measurements of hand function are analyzed as well as the impact of different types of pain on each of these areas. PMID:26611383

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

    PubMed

    Furukawa, M; Nakagawa, K; Hamada, T

    1993-04-01

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

  17. Laryngeal squamous cell carcinoma with knee and heel skin metastases: a case report.

    PubMed

    Kavgaci, Halil; Yildiz, Bulent; Cobanoglu, Umit; Fidan, Evren; Ozdemir, Feyyaz; Aydin, Fazil

    2010-01-01

    Distant metastases from laryngeal carcinoma are frequently seen in the lung, bone and liver, while skin metastases are rarely observed. In these cases presented as case reports in the literature, the supradiaphragmatic region is usually involved. Skin metastasis in lower extremity has only been reported in a few cases. While being an indicator of poor prognosis, skin metastasis is also considered as a messenger of distant organ metastasis. Survival is very short after development of skin metastasis. In our case, nodular skin metastasis was found both in the superior-lateral margin of the left patella and in the right heel. This is the first case reported in the literature on laryngeal carcinoma metastasizing to these localizations. PMID:20361886

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

    PubMed

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

    2013-03-01

    This study investigated the accuracy and reliability of four methods using force-plate data for detecting the swing heel-off (HO) time in gait initiation. Results of these methods were compared to those obtained by means of a reference method using a footswitch. Ten young healthy adults performed 18 forward gait initiation trials at self-selected speed and at maximal speed. Results showed that the method based on vertical impulse was the most accurate and reliable in determining HO in both speed conditions. The mean error obtained with this method was -810ms in the self-selected speed condition (-710ms in the maximal speed condition), with no significant effect of gait speed (P>0.05). These findings suggest that this method based on force-plate data is valid and reliable for detecting HO in forward gait initiation in the absence of additional hardware. PMID:22980912

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

    PubMed Central

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

    2015-01-01

    Aims/Introduction Although male diabetic patients have an increased risk of fracture, there is little information about this in the literature. The association between heel bone stiffness and the lifestyle of male patients with diabetes was evaluated. Materials and Methods The study included 108 participants with type 2 diabetes mellitus patients and 168 age-adjusted, healthy male volunteers. None of the participants had a history of osteoporosis or other severe diseases. Heel bone stiffness was examined by quantitative ultrasound, and each participant completed a health interview survey questionnaire. Bone stiffness was taken as an indicator of bone strength. Stepwise regression analysis was used to investigate associations between bone stiffness and lifestyle-related factors, such as sunlight exposure, intake of milk or small fish, regular exercise, cigarette smoking, consumption of alcohol, and number of remaining teeth. Results Bone stiffness showed a significant negative association with cigarette smoking [standardized coefficient (SC) = −0.297, F-value (F) = 10.059] and age (SC = −0.207, F = 7.565) in diabetic patients. Bone stiffness showed a significant negative association with age (SC = −0.371, F = 12.076) and height (SC = −0.193, F = 7.898), as well as a significant positive association with sunlight exposure (SC = 0.182, F = 9.589) and intake of small fish (SC = 0.170, F = 7.393) in controls. Conclusions These findings suggest that cigarette smoking and age are negatively associated with bone stiffness in Okinawan male patients with type 2 diabetes mellitus. PMID:25802722

  20. Central Neuropathic Pain Syndromes.

    PubMed

    Watson, James C; Sandroni, Paola

    2016-03-01

    Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury. This review focuses on unique clinical features that help distinguish central neuropathic pain. The most common clinical central pain syndromes-central poststroke pain, multiple sclerosis-related pain, and spinal cord injury-related pain-are reviewed in detail. Recent progress in understanding of the pathogenesis of central neuropathic pain is reviewed, and pharmacological, surgical, and neuromodulatory treatments of this notoriously difficult to treat pain syndrome are discussed. PMID:26944242

  1. Low Back Pain

    MedlinePLUS

    ... Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...

  2. Pain and pain management in dermatology.

    PubMed

    Beiteke, Ulrike; Bigge, Stefan; Reichenberger, Christina; Gralow, Ingrid

    2015-10-01

    It is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. -Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic -scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary -communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current -therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri- and postoperative pain management is briefly outlined. This article addresses: ? The fundamentals of the classification and neurophysiology of pain; ? Standards for pain documentation in children and adults; ? General standards for pharmaceutical pain management; ? Current specific treatment options for postherpetic neuralgia, leg ulcers, and -pyoderma gangrenosum in conjunction with the expanded WHO analgesic -ladder. PMID:26408457

  3. Pain and your emotions

    MedlinePLUS

    ... separated. The way your mind controls thoughts and attitudes affects the way your body controls pain. Pain ... Elsevier Saunders; 2012:chap 100. Turk DC. Psychosocial aspects of chronic pain. In: Benzon HT. Practical Management ...

  4. Central Pain Syndrome

    MedlinePLUS

    ... Enhancing Diversity Find People About NINDS NINDS Central Pain Syndrome Information Page Table of Contents (click to ... being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological condition ...

  5. Palliative care - managing pain

    MedlinePLUS

    End of life - pain management; Hospice - pain management ... Bookbinder M, McHugh ME. Symptom management in palliative care and end of life care. Nurs Clin North Am . 2010;45:271-327. Mercadente S. Challenging pain problems. In: ...

  6. Overview of Neck Pain

    MedlinePLUS

    ... Back) > Overview of Neck Pain Overview of Neck Pain Page Content Developing a Program That's Right for ... activity? What Kinds of Problems Might Cause Neck Pain? Treatment for any neck condition is recommended as ...

  7. Complex Regional Pain Syndrome

    MedlinePLUS

    ... Diversity Find People About NINDS NINDS Complex Regional Pain Syndrome Information Page Synonym(s): Reflex Sympathetic Dystrophy Syndrome, ... Additional resources from MedlinePlus What is Complex Regional Pain Syndrome? Complex regional pain syndrome (CRPS) is a ...

  8. Eldercare at Home: Pain

    MedlinePLUS

    ... nerve pain which work by changing how the brain and nerves perceive pain signals from the body. These can be taken in addition to usual pain blockers, but may have side effects of confusion, sleepiness or low blood pressure. As ...

  9. Pain: Hope through Research

    MedlinePLUS

    ... cells or body chemistry, thus producing pain relief. Marijuana or, by its Latin name, cannabis , continues to remain highly controversial as a pain ... eyes of many individuals campaigning on its behalf, marijuana rightfully belongs with other pain remedies. Scientific studies ...

  10. Low Back Pain

    MedlinePLUS

    ... Awards Enhancing Diversity Find People About NINDS Low Back Pain Fact Sheet See a list of all NINDS ... the body to the brain. What causes lower back pain? The vast majority of low back pain is ...

  11. Pain Information Brochure

    MedlinePLUS

    ... of Arthritis and Musculoskeletal and Skin Diseases Top Back Pain Back Pain Information Page National Institute of Neurological Disorders and Stroke Low Back Pain Fact Sheet National Institute of Neurological Disorders and ...

  12. What Is Back Pain?

    MedlinePLUS

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain PDF Version Size: 127 KB Audio Version Time: ... Size: 12.5 MB November 2014 What Is Back Pain? Fast Facts: An Easy-to-Read Series of ...

  13. The ESR1 (6q25) Locus Is Associated with Calcaneal Ultrasound Parameters and Radial Volumetric Bone Mineral Density in European Men

    PubMed Central

    Thomson, Wendy; Boonen, Steven; Borghs, Herman; Vanderschueren, Dirk; Gielen, Evelien; Huhtaniemi, Ilpo T.; Adams, Judith E.; Ward, Kate A.; Bartfai, Gyorgy; Casanueva, Felipe; Finn, Joseph D.; Forti, Gianni; Giwercman, Aleksander; Han, Thang S.; Kula, Krzysztof; Labrie, Fernand; Lean, Michael E. J.; Pendleton, Neil; Punab, Margus; Wu, Frederick C. W.; O'Neill, Terence W.

    2011-01-01

    Purpose Genome-wide association studies (GWAS) have identified 6q25, which incorporates the oestrogen receptor α gene (ESR1), as a quantitative trait locus for areal bone mineral density (BMDa) of the hip and lumbar spine. The aim of this study was to determine the influence of this locus on other bone health outcomes; calcaneal ultrasound (QUS) parameters, radial peripheral quantitative computed tomography (pQCT) parameters and markers of bone turnover in a population sample of European men. Methods Eight single nucleotide polymorphisms (SNP) in the 6q25 locus were genotyped in men aged 40–79 years from 7 European countries, participating in the European Male Ageing Study (EMAS). The associations between SNPs and measured bone parameters were tested under an additive genetic model adjusting for centre using linear regression. Results 2468 men, mean (SD) aged 59.9 (11.1) years had QUS measurements performed and bone turnover marker levels measured. A subset of 628 men had DXA and pQCT measurements. Multiple independent SNPs showed significant associations with BMD using all three measurement techniques. Most notably, rs1999805 was associated with a 0.10 SD (95%CI 0.05, 0.16; p = 0.0001) lower estimated BMD at the calcaneus, a 0.14 SD (95%CI 0.05, 0.24; p = 0.004) lower total hip BMDa, a 0.12 SD (95%CI 0.02, 0.23; p = 0.026) lower lumbar spine BMDa and a 0.18 SD (95%CI 0.06, 0.29; p = 0.003) lower trabecular BMD at the distal radius for each copy of the minor allele. There was no association with serum levels of bone turnover markers and a single SNP which was associated with cortical density was also associated with cortical BMC and thickness. Conclusions Our data replicate previous associations found between SNPs in the 6q25 locus and BMDa at the hip and extend these data to include associations with calcaneal ultrasound parameters and radial volumetric BMD. PMID:21760950

  14. Assessment of Pain

    PubMed Central

    Jeans, Mary-Ellen; Stratford, Joseph G.; Melzack, Ronald; Monks, Richard C.

    1979-01-01

    The assessment of pain presents a major problem in both research and clinical practice. Until recently our methods for evaluating pain were based on a sensory conceptual model of pain and an acute care approach to illness. These traditional views are often inadequate, particularly in relation to chronic pain syndromes. Clinical assessment of chronic pain must include extensive physical and psychological examination. New approaches to pain measurement and clinical assessment of the patient are discussed.

  15. Assessing cancer pain.

    PubMed

    Dalal, Shalini; Bruera, Eduardo

    2012-08-01

    Regular assessment for the presence of pain and response to pain management strategies should be high priority in cancer patients. Pain is a multidimensional experience in cancer patients. Pain management will be most effective when treatments are individualized after exploring the various physical and non-physical components of pain, and the patient and family are educated and involved in decision making. This article discusses the various issues that are pertinent to the assessment of pain in cancer patients. PMID:22585314

  16. What a Pain! Kids and Growing Pains

    MedlinePLUS

    ... More Quizzes Games Kids' Medical Dictionary En Espaol What Other Kids Are Reading Girls and Puberty Boys ... Digestive System How the Body Works Main Page What a Pain! Kids and Growing Pains KidsHealth > Kids > ...

  17. Psychophysiology of pain.

    PubMed

    Sternbach, R A

    1975-01-01

    The recent literature on pain states shows: pain thresholds are relatively constant for an individual, but pain tolerance is influenced by psychological state; the expression of pain is a function partly of ethnic membership and degree of extroversion; pain complaints are determined as well by cultural and extroversive factors, and also degree of neuroticism. Studies of pain patients reveals that those with acute pain tend to show normal personality profiles, but the degree of pain experienced is related to the degree of anxiety present. Most chronic pain patients, like those with psychogenic pain, show somatic preoccupations and reactive depression. The treatment and/or rehabilitation of pain patients has developed in three areas. In cases of peripheral neuropathy and some spinal cord lesions, electrical stimulation with "neural pacemakers" can often "close the gate" to pain signals and provide significant reduction or abolition of pain. Psychotropic medications, particularly the tricyclic antidepressants, sometimes in combination with phenothiazines and antihistamines, are effective in many instances of central pain, and help increase the pain tolerance and decrease the need for narcotics in other pain states. Operant conditioning, including the use of biofeedback, extinguishes pain behavior and increases pain-incompatible behaviors, with good long-term results. PMID:5384

  18. Pain and musculoskeletal pain syndromes in adolescents.

    PubMed

    Zapata, Aura Ligia; Moraes, Ana Julia Pantoja; Leone, Claudio; Doria-Filho, Ulysses; Silva, Clovis Artur Almeida

    2006-06-01

    The presence of musculoskeletal pain was evaluated in adolescents. Pain was reported by 40% of respondents, benign joint hypermobility syndrome by 10%, myofascial syndrome by 5%, tendonitis by 2%, and fibromialgia by 1%. Logistical regression analysis indicated that sex and age were predictive of pain. PMID:16730613

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

    SciTech Connect

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

    2009-03-01

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

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

    PubMed

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

    2013-01-01

    This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45years 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

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

    SciTech Connect

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

    2000-05-17

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

  2. Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph: A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan

    PubMed Central

    Yang, Chin-Hua; Chou, Kuei-Ting; Chung, Mu-Bai; Chuang, K. S.; Huang, Tzung-Chi

    2015-01-01

    Flatfoot (pes planus) is one of the most important physical examination items for military new recruits in Taiwan. Currently, the diagnosis of flatfoot is mainly based on radiographic examination of the calcaneal-fifth metatarsal (CA–MT5) angle, also known as the arch angle. However, manual measurement of the arch angle is time-consuming and often inconsistent between different examiners. In this study, seventy male military new recruits were studied. Lateral radiographic images of their right and left feet were obtained, and mutual information (MI) registration was used to automatically calculate the arch angle. Images of two critical bones, the calcaneus and the fifth metatarsal bone, were isolated from the lateral radiographs to form reference images, and were then compared with template images to calculate the arch angle. The result of this computer-calculated arch angle was compared with manual measurement results from two radiologists, which showed that our automatic arch angle measurement method had a high consistency. In addition, this method had a high accuracy of 97% and 96% as compared with the measurements of radiologists A and B, respectively. The findings indicated that our MI registration measurement method cannot only accurately measure the CA–MT5 angle, but also saves time and reduces human error. This method can increase the consistency of arch angle measurement and has potential clinical application for the diagnosis of flatfoot. PMID:26126115

  3. Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph: A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan.

    PubMed

    Yang, Chin-Hua; Chou, Kuei-Ting; Chung, Mu-Bai; Chuang, K S; Huang, Tzung-Chi

    2015-01-01

    Flatfoot (pes planus) is one of the most important physical examination items for military new recruits in Taiwan. Currently, the diagnosis of flatfoot is mainly based on radiographic examination of the calcaneal-fifth metatarsal (CA-MT5) angle, also known as the arch angle. However, manual measurement of the arch angle is time-consuming and often inconsistent between different examiners. In this study, seventy male military new recruits were studied. Lateral radiographic images of their right and left feet were obtained, and mutual information (MI) registration was used to automatically calculate the arch angle. Images of two critical bones, the calcaneus and the fifth metatarsal bone, were isolated from the lateral radiographs to form reference images, and were then compared with template images to calculate the arch angle. The result of this computer-calculated arch angle was compared with manual measurement results from two radiologists, which showed that our automatic arch angle measurement method had a high consistency. In addition, this method had a high accuracy of 97% and 96% as compared with the measurements of radiologists A and B, respectively. The findings indicated that our MI registration measurement method cannot only accurately measure the CA-MT5 angle, but also saves time and reduces human error. This method can increase the consistency of arch angle measurement and has potential clinical application for the diagnosis of flatfoot. PMID:26126115

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

    SciTech Connect

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

    2013-12-01

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

  5. Planus Foot Posture and Pronated Foot Function are Associated with Foot Pain: The Framingham Foot Study

    PubMed Central

    Menz, Hylton B.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.; Hannan, Marian T.

    2014-01-01

    Objective To examine the associations of foot posture and foot function to foot pain. Methods Data were collected on 3,378 members of the Framingham Study who completed foot examinations in 20022008. Foot pain (generalized and at six locations) was based on the response to the question On most days, do you have pain, aching or stiffness in either foot? Foot posture was categorized as normal, planus or cavus using static pressure measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the center of pressure excursion index from dynamic pressure measurements. Sex-specific multivariate logistic regression models were used to examine the effect of foot posture and function on generalized and location-specific foot pain, adjusting for age and weight. Results Planus foot posture was significantly associated with an increased likelihood of arch pain in men (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.01 1.90), while cavus foot posture was protective against ball of foot pain (OR 0.74, 95% CI 0.55 1.00) and arch pain (OR 0.64, 95% CI 0.48 0.85) in women. Pronated foot function was significantly associated with an increased likelihood of generalized foot pain (OR 1.28, 95% CI 1.04 1.56) and heel pain (OR 1.54, 95% CI 1.04 2.27) in men, while supinated foot function was protective against hindfoot pain in women (OR 0.74, 95% CI 0.55 1.00). Conclusion Planus foot posture and pronated foot function are associated with foot symptoms. Interventions that modify abnormal foot posture and function may therefore have a role in the prevention and treatment of foot pain. PMID:23861176

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

    SciTech Connect

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

    2009-12-18

    Preliminary studies in the EM-21 Alternative Chemical Cleaning Program have focused on understanding the dissolution of Hematite (a primary sludge heel phase) in oxalic acid, with a focus on minimizing oxalic acid usage. Literature reviews, thermodynamic modeling, and experimental results have all confirmed that pH control, preferably using a supplemental proton source, is critical to oxalate minimization. With pH control, iron concentrations as high as 0.103 M have been obtained in 0.11 M oxalic acid. This is consistent with the formation of a 1:1 (iron:oxalate) complex. The solubility of Hematite in oxalic acid has been confirmed to increase by a factor of 3 when the final solution pH decreases from 5 to below 1. This is consistent with literature predictions of a shift in speciation from a 1:3 to 1:1 as the pH is lowered. Above a solution pH of 6, little Hematite dissolves. These results emphasize the importance of pH control in optimizing Hematite dissolution in oxalic acid.

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

    PubMed Central

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

    2009-01-01

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

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

    SciTech Connect

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

    2010-12-10

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

  9. Dendritic cells as Achilles heel and Trojan horse during varicella zoster virus infection

    PubMed Central

    Schnrich, Gnther; Raftery, Martin J.

    2015-01-01

    Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently establishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article. PMID:26005438

  10. Achilles' heel of sociality revealed by energetic poverty trap in cursorial hunters.

    PubMed

    Rasmussen, Gregory S A; Gusset, Markus; Courchamp, Franck; Macdonald, David W

    2008-10-01

    This study empirically tests two foundation ecological theories: (1) pack hunting is a driver for the evolution of sociality; and (2) species have a finite energy potential, whereby increased maintenance costs result in decreased reproductive effort. Using activity and prey data from 22 packs of African wild dogs (Lycaon pictus), we parameterized a model detailing the energetic cost/benefit of cooperative hunting. Larger pack size increased foraging time, prey size, and capture probability while reducing chase distance, resulting in a rapidly increasing net rate of energy intake up to a pack size of five, which peaked at 10 individuals and then declined. With a streamlined body plan necessary for hypercursoriality limiting stomach capacity in smaller packs, it was demonstrated that the group hunting benefit will rather accrue to widely foraging predators than to "sit-and-wait" ones. Reproductive effort, measured by the number of pups born, revealed smaller litters with decreasing pack size, validated finite energy theory, and highlighted a "poverty trap" where smaller groups have lower foraging gains, smaller litters, and increased vulnerability to extirpation. Consequently, these results demonstrated a mechanistic example of pervasive selection for maximal body size (Cope's rule), leading to a macroevolutionary ratchet, where sociality linked to hypercursoriality is betrayed by an Achilles' heel. PMID:18729728

  11. A comparison of dorsal and heel plate foot tracking methods on lower extremity dynamics.

    PubMed

    Hashish, Rami; Samarawickrame, Sachithra D; Salem, George J

    2014-03-21

    The primary method to model ankle motion during inverse dynamic calculations of the lower limb is through the use of skin-mounted markers, with the foot modeled as a rigid segment. Motion of the foot is often tracked via the use of a marker cluster triad on either the dorsum, or heel, of the foot/shoe. The purpose of this investigation was to evaluate differences in calculated lower extremity dynamics during the stance phase of gait between these two tracking techniques. In an analysis of 7 subjects, it was found that sagittal ankle angles and sagittal ankle, hip and knee moments were strongly correlated between the two conditions, however, there was a significant difference in peak ankle plantar flexion and dorsiflexion angles. Frontal ankle angles were only moderately correlated and there was a significant difference in peak ankle eversion and inversion, resulting in moderate correlations in frontal plane moments and a significant difference in peak hip adductor moments. We demonstrate that the technique used to track the foot is an important consideration in interpreting lower extremity dynamics for clinical and research purposes. PMID:24556124

  12. Dendritic cells as Achilles' heel and Trojan horse during varicella zoster virus infection.

    PubMed

    Schönrich, Günther; Raftery, Martin J

    2015-01-01

    Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently establishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems' Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article. PMID:26005438

  13. Medications for back pain

    MedlinePLUS

    Back pain often goes away on its own over several weeks. In some people, back pain persists. It may not go away completely or ... at times. Medicines can also help with your back pain. OVER-THE-COUNTER PAIN RELIEVERS Over-the-counter ...

  14. Patients with chronic pain.

    PubMed

    Salama-Hanna, Joseph; Chen, Grace

    2013-11-01

    Preoperative evaluation of patients with chronic pain is important because it may lead to multidisciplinary preoperative treatment of patients' pain and a multimodal analgesia plan for effective pain control. Preoperative multidisciplinary management of chronic pain and comorbid conditions, such as depression, anxiety, deconditioning, and opioid tolerance, can improve patient satisfaction and surgical recovery. Multimodal analgesia using pharmacologic and nonpharmacologic strategies shifts the burden of analgesia away from simply increasing opioid dosing. In more complicated chronic pain patients, multidisciplinary treatment, including pain psychology, physical therapy, judicious medication management, and minimally invasive interventions by pain specialists, can improve patients' satisfaction and surgical outcome. PMID:24182727

  15. THE INFLUENCE OF HEEL HEIGHT ON SAGITTAL PLANE KNEE KINEMATICS DURING LANDING TASKS IN RECREATIONALLY ACTIVE AND ATHLETIC COLLEGIATE FEMALES

    PubMed Central

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

    2011-01-01

    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 8.886.5, 9.385.8 and 11.287.0, 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 47.0810.9, 48.1810.3 and 48.889.7, 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/sec52 with the 12 mm lift to 1958/sec55 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

  16. The Brain in Pain

    PubMed Central

    AHMAD, Asma Hayati; ABDUL AZIZ, Che Badariah

    2014-01-01

    Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies. PMID:25941463

  17. Hispanic Inpatient Pain Intensity.

    PubMed

    McDonald, Deborah Dillon; Ambrose, Margaret; Morey, Barbara

    2015-11-01

    Hispanic adults experience significant pain, but little is known about their pain during hospitalization. The purpose of this research was to describe Hispanic inpatients' pain intensity and compare their pain intensity with that of non-Hispanic patients. A post hoc descriptive design was used to examine 1,466 Hispanic inpatients' medical records (63.2% English speakers) and 12,977 non-Hispanic inpatients' medical records from one hospital for 2012. Mean documented pain intensity was mild for both Hispanic and non-Hispanic inpatients. Pain intensity was greater for English-speaking Hispanic patients than Spanish speakers. The odds of being documented with moderate or greater pain intensity decreased 30% for Spanish-speaking patients. Greater pain intensity documented for English-speaking Hispanic inpatients suggests underreporting of pain intensity by Spanish-speaking patients. Practitioners should use interpreter services when assessing and treating pain with patients who speak languages different from the practitioners' language(s). PMID:24958761

  18. Growing pains in children

    PubMed Central

    Uziel, Yosef; Hashkes, Philip J

    2007-01-01

    We review the clinical manifestations of "growing pains", the most common form of episodic childhood musculoskeletal pain. Physicians should be careful to adhere to clear clinical criteria as described in this review before diagnosing a child with growing pain. We expand on current theories on possible causes of growing pains and describe the management of these pains and the generally good outcome in nearly all children. PMID:17550631

  19. Determination of the augmentation effects of hyaluronic acid on different heel structures in amputated lower limbs of diabetic patients using ultrasound elastography.

    PubMed

    Hsu, Chih-Chin; Chen, Carl Pai-Chu; Lin, Shih-Cherng; Tsai, Wen-Chung; Liu, Hsien-Tao; Lin, Yi-Chia; Lee, Hsin-Jung; Chen, Weng-Pin

    2012-06-01

    This study measured tissue properties of different anatomies of heels in amputated lower limbs of diabetic patients before and after hyaluronic acid (HA) or normal saline (NS) injections. Seven amputated lower limbs from six diabetic patients constituted the experimental group and one amputated lower limb from a diabetic patient served as the control. The limbs were placed in a fixation platform. A 5-12 MHz linear-array ultrasound transducer controlled by a stepping motor was used to load and unload tested heels. The loading-unloading velocity was 6 mm/s and the maximum loading stress was 178 kPa. Loading-unloading tests were performed before and after 1 mL HA injections into heels in the experimental group. The control limb underwent the same test before and after 1 mL NS injection. The unloaded thickness and Young's modulus of the macrochambers, microchambers and heel pads were determined before and after the interventions. The unloaded thickness of the macrochambers and the heel pad increased significantly (p = 0.012) after HA injection. The Young's modulus of the macrochambers decreased nonsignificantly after HA injections. Similar thickness and tissue stiffness changes were observed in the control limb. The baseline heel-pad energy dissipation ratio (EDR(hp)) was 81.3 1.3% and decreased significantly (p = 0.012) to 73.1 1.7% after HA injections. The EDR(hp) in the control increased after NS injection. Histologic examinations revealed localized HA accumulation in the macrochambers with an extension into the adjacent fibrous septa. Injection of HA can increase tissue thickness and enhance heel-pad tissue resilience. PMID:22502884

  20. Cultural Influences on Pain

    PubMed Central

    Patel, Shilpa

    2008-01-01

    The relationship between pain and ethnicity is shaped by experience, learning and culture. Mistaken beliefs about the nature of pain and disability, resistance to treatment seeking, reluctance to comply with treatment and failure to accept responsibility of the treatment outcome are not culturally or sub-culturally specific obstacles to pain management. A cultural group's expectations and acceptance of pain as a normal part of life will determine whether pain is seen as a clinical problem that requires a clinical solution. The reviewed literature shows disparities in pain treatment based on ethnic background. Multidisciplinary research needs to investigate the models of pain and treatment in different cultural groups to allow us to understand how pain is presented and how beliefs and expectations about treatment can be married with practical solutions and effective evidence-based pain management. PMID:26525084

  1. Pain as a channelopathy

    PubMed Central

    Raouf, Ramin; Quick, Kathryn; Wood, John N.

    2010-01-01

    Mendelian heritable pain disorders have provided insights into human pain mechanisms and suggested new analgesic drug targets. Interestingly, many of the heritable monogenic pain disorders have been mapped to mutations in genes encoding ion channels. Studies in transgenic mice have also implicated many ion channels in damage sensing and pain modulation. It seems likely that aberrant peripheral or central ion channel activity underlies or initiates many pathological pain conditions. Understanding the mechanistic basis of ion channel malfunction in terms of trafficking, localization, biophysics, and consequences for neurotransmission is a potential route to new pain therapies. PMID:21041956

  2. [Pain on mandibular movements].

    PubMed

    Huddleston Slater, J J R; Stegenga, B

    2006-11-01

    Pain or fatigue in the masticatory muscles or pain in the temporomandibular joints are well-known complaints. Diagnosing these complaints, that have a relation with mandibular movements, can be challenging since they can arise from the teeth and surrounding tissues, the temporomandibular joints or other musculoskeletal structures. Also referred pains are a common finding in this area. Pain history and clinical examination are crucial for a comprehensive diagnosis. Besides the disorders underlying the pain (so called axis I), the impact of the pain on the patient's physical and psychosocial functioning can play an important role in the diagnosis (axis II). PMID:17147030

  3. Easing pain in children.

    PubMed

    Manley, L

    1997-01-01

    The assessment and management of pain in children has been essentially ignored until recently. Thankfully, these "dark ages of pain" are ending. The trauma nurse is an integral part of the pain management team and can have a positive impact on outcome by using a combination of relatively simple strategies. These include using multiple types of assessment to measure the severity of pain; providing adequate pain relief with a combination of pharmacologic and nonpharmacologic interventions; and carefully monitoring and documenting the efficacy of all pain management approaches. PMID:9391359

  4. [Botulinum toxins for pain].

    PubMed

    Soinila, Seppo; Haanp, Maija

    2011-01-01

    We review the evidence of botulinum toxins in the treatment of pain. Main indications of botulinum toxin treatment, dystonia and spasticity, involve pain. Increasing evidence suggests direct analgesic effects of botulinum. Botulinum inhibits release of pain mediators (substance P, CGRP, excitatory amino acids, ATP, noradrenaline). Clinical trials have consistently shown analgesic effect of botulinum toxin in post-stroke shoulder pain, bladder dysfunction, chronic migraine, neuropathic pain, bruxism and lateral epicondylitis. Other pain conditions have been studied with yet uncertain results. It seems that the number of patients who would benefit from botulinum toxin treatment will increase considerably in the future. PMID:22238920

  5. Pediatric pain management.

    PubMed

    Lederhaas, G

    1997-01-01

    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

  6. Managing your chronic back pain

    MedlinePLUS

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  7. Effects of low-intensity non-coherent light therapy on the inflammatory process in the calcaneal tendon of ovariectomized rats.

    PubMed

    Helrigle, Carla; de Carvalho, Paulo deTarso Camilo; Casalechi, Heliodora Leo; Leal-Junior, Ernesto Cesar Pinto; Fernandes, Guilherme Henrique Cardoso; Helrigel, Panmera Almeida; Rabelo, Rogrio Leo; de Oliveira Aleixo-Junior, Ivo; Aimbire, Flavio; Albertini, Regiane

    2016-01-01

    The aim of this experimental study was to investigate the effects of low-intensity light-emitting diode (LED) phototherapy on the inflammatory process in the calcaneal tendon of ovariectomized rats (OVX) through the involvement of the inflammatory mediators interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha (TNF-?). Thirty-five female Wistar rats were divided into 4 groups: 3 groups of OVX rats totaling 30 rats (untreated OVX rats [OVX injury group], treated OVX rats [OVX LED group], and control OVX rats; subgroups existed based on the sampling times, which were 3, 7, and 14days) and 1 group of non-OVX rats (not OVX; n?=?5). Tendon injury was induced by trauma using a 208-g mass placed at 20cm from the right tendon of each animal with energy of 0.70J. The animals were treated 12h after tendonitis with LED therapy and every 48h thereafter until euthanasia (at 3, 7, or 14days). The tendons were dissected and stored in liquid nitrogen at -196C, thawed only at the time of immunoenzymatic testing (ELISA). Groups treated with LED showed a decrease in the number of pro-inflammatory cells, IL-6, and TNF-? (p <0.05), and an increase in IL-10 (p?

  8. Syringing method as an alternative to ???ga therapy in V?taka??aka

    PubMed Central

    Joshi, Suma; Toshikhane, Sangeeta Hemant; Toshikhane, Hemant D.

    2014-01-01

    Calcaneus forms the bone of the foot. Due to abnormal pressures, foot muscles and ligaments are stretched beyond their normal limits that lead to chronic plantar heel pain, among which calcaneal spur tops the list. In Ayurveda, it can be correlated to V?taka??aka (pricking sensation in the foot)-a painful condition of heel caused by its improper placement on the ground. To assess the effect of syringing method (modified ???ga) in the treatment of V?taka??aka. A 10 ml syringe was for ease, hygiene, and to enable the case to be managed in the outpatient department. A diagnosed case of calcaneal spurs with pain, tenderness, and swelling visited KLE University's Shri BMK Ayurveda Hospital and Research Centre, Belgaum, Karnataka, India. After Snigdha Patrapo??ali sveda (a form of sudation therapy), bloodletting was performed by syringing method. In total procedure was performed for 4 times on the patient. Marked subjective relief was observed. Pain from 8 visual analog scale (VAS) came to 2 visual analog scale (VAS) and tenderness and swelling relived completely. PMID:25737611

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

    PubMed

    Hsue, Bih-Jen; Su, Fong-Chin

    2009-12-01

    The effect of the heel height on the temporal, kinematic and kinetic parameters was investigated in 16 young and 11 elderly females. Kinematic and kinetic data were collected when the subjects ascended stairs with their preferred speed in two conditions: wearing low-heeled shoes (LHS), and high-heeled shoes (HHS). The younger adults showed more adjustments in forces and moments at the knee and hip in frontal and transverse planes. Besides a few significantly changes in joint forces and moments, the elder group demonstrated longer cycle duration and double stance phase, larger trunk sideflexion and hip internal rotation, less hip adduction while wearing HHS. Most differences in joint motions between two groups were found at the hip and knee either in LHS or HHS condition. Instead, the differences in moment occurred at the hip joint and only in HHS. The interaction of the heel height and age showed the influences of heel height on trunk rotation, hip abduction/adduction, and knee and hip force and moment at the frontal plane depended on age. These phenomena suggest that younger and elderly women adapt their gait and postural control differently during stair ascent (SA) while wearing HHS. PMID:19054686

  10. Advanced Innovations for Pain.

    PubMed

    Lamer, Tim J; Deer, Timothy R; Hayek, Salim M

    2016-02-01

    Chronic pain represents one of the most important public health problems in terms of both the number of patients afflicted and health care costs. Most patients with chronic pain are treated with medications as the mainstay of therapy, and yet most medically treated patients continue to report ongoing pain. Additionally, adverse effects from pain medications represent a major challenge for clinicians and patients. Spinal cord stimulation and intrathecal drug delivery systems are well-established techniques that have been utilized for over 25 years. Intrathecal drug delivery systems have proven efficacy for a wide variety of intractable pain conditions and fewer adverse effects than systemic medical therapy in patients with refractory cancer-related pain. Spinal cord stimulation is cost-effective and provides improved pain control compared with medical therapy in patients with a variety of refractory pain conditions including complex regional pain syndrome, painful diabetic neuropathy, and chronic radiculopathy. Patients who have intractable pain that has not responded to reasonable attempts at conservative pain care measures should be referred to a qualified interventional pain specialist to determine candidacy for the procedures discussed in this article. PMID:26848005

  11. Fractional calculus in biomechanics: a 3D viscoelastic model using regularized fractional derivative kernels with application to the human calcaneal fat pad.

    PubMed

    Freed, A D; Diethelm, K

    2006-11-01

    A viscoelastic model of the K-BKZ (Kaye, Technical Report 134, College of Aeronautics, Cranfield 1962; Bernstein et al., Trans Soc Rheol 7: 391-410, 1963) type is developed for isotropic biological tissues and applied to the fat pad of the human heel. To facilitate this pursuit, a class of elastic solids is introduced through a novel strain-energy function whose elements possess strong ellipticity, and therefore lead to stable material models. This elastic potential - via the K-BKZ hypothesis - also produces the tensorial structure of the viscoelastic model. Candidate sets of functions are proposed for the elastic and viscoelastic material functions present in the model, including two functions whose origins lie in the fractional calculus. The Akaike information criterion is used to perform multi-model inference, enabling an objective selection to be made as to the best material function from within a candidate set. PMID:16575573

  12. Employees with Chronic Pain

    MedlinePLUS

    ... Solutions: An appointment secretary was reprimanded for poor attendance due to chronic pain. She was provided periodic ... flexible schedule to allow more time to access public transit. A switchboard operator with chronic pain and fibromyalgia was ... ...

  13. Pain in cancer survivors

    PubMed Central

    Ramirez, Juan D; Farquhar-Smith, Paul

    2014-01-01

    Cancer and its treatment exert a heavy psychological and physical toll. Of the myriad symptoms which result, pain is common, encountered in between 30% and 60% of cancer survivors. Pain in cancer survivors is a major and growing problem, impeding the recovery and rehabilitation of patients who have beaten cancer and negatively impacting on cancer patients quality of life, work prospects and mental health. Persistent pain in cancer survivors remains challenging to treat successfully. Pain can arise both due to the underlying disease and the various treatments the patient has been subjected to. Chemotherapy causes painful chemotherapy-induced peripheral neuropathy (CIPN), radiotherapy can produce late effect radiation toxicity and surgery may lead to the development of persistent post-surgical pain syndromes. This review explores a selection of the common causes of persistent pain in cancer survivors, detailing our current understanding of the pathophysiology and outlining both the clinical manifestations of individual pain states and the treatment options available. PMID:26516548

  14. Magnets for Pain Relief

    MedlinePLUS

    ... for any health-related purpose, yet static, or permanent, magnets are widely marketed for pain control. This fact ... Blackman MR, Kingman A, et al. Low intensity permanent magnets in the treatment of chronic lumbar radicular pain. ...

  15. Dysmenorrhea: Painful Periods

    MedlinePLUS

    ... dysmenorrhea? Glossary What is dysmenorrhea? Pain associated with menstruation is called dysmenorrhea . How common is dysmenorrhea? Dysmenorrhea ... the menstrual period? Pain usually occurs right before menstruation starts, as the level of prostaglandins increases in ...

  16. Patient Education on Pain

    MedlinePLUS Videos and Cool Tools

    ... People with Pain Press Room Position Statements Patient Education on Pain AAPM Past President, Perry G. Fine, ... Member Center Patient Center Research Advocacy Practice Management Education Annual Meeting Contact Us Privacy Policy Sitemap Close ...

  17. Complex Regional Pain Syndrome

    MedlinePLUS

    ... as dextromethorphan and ketamine nasal calcitonin, especially for deep bone pain, and topical local anesthetic creams and ... the parts of the brain that control pain (deep brain stimulation). A recent option involves the use ...

  18. Sacroiliac joint pain - aftercare

    MedlinePLUS

    ... only on one side Hip pain Discomfort with bending over or standing after sitting for long periods ... process. It will help relieve pain and increase strength. Talk to your doctor or physical therapist for ...

  19. Pain in Blood Cancers

    PubMed Central

    Niscola, Pasquale; Tendas, Andrea; Scaramucci, Laura; Giovannini, Marco; De Sanctis, Vitaliana

    2011-01-01

    Patients with blood-related cancers (BRC) suffer from a substantial symptom burden, including several pain syndromes sustained by different causes and pathogenetic mechanisms. So, with regard to pain, a multifaceted clinical scenario may be observed in this setting. Indeed, pain may be correlated to disease itself, to disease-associated complications, to iatrogenic causes or may be due to unrelated clinical conditions. A close diagnostic procedure for the assessment of the underlying causes of the pain and of its pathogenetic mechanisms may direct the treatment approach which should be based on a multidisciplinary management and requires the integration of etiology-targeted interventions and painkilling drugs. The World Health Organization's three-step analgesic ladder for cancer pain relief can provide adequate pain control using oral drugs in most patients with BRC on pain, although more complex interventions may be necessary for many difficult-to-treat pain syndromes which are not infrequently encountered in this setting. PMID:22346041

  20. The dynamic pain connectome.

    PubMed

    Kucyi, Aaron; Davis, Karen D

    2015-02-01

    Traditionally, studies of how pain and attention modulate one another involved explicit cognitive-state manipulations. However, emerging evidence suggests that spontaneous brain-wide network communication is intrinsically dynamic on multiple timescales, and attentional states are in constant fluctuation. Here, in light of studies on neural mechanisms of spontaneous attentional fluctuations and pain variability, we introduce the concept of a dynamic 'pain connectome' in the brain. We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain-attention interactions must be accounted for in the contemporary search for a 'neural signature' of the pain connectome. PMID:25541287

  1. Communicating about Cancer Pain

    Cancer.gov

    Patients with cancer may be reluctant to discuss their pain with their doctors for a variety of reasons. NCI sponsors research that examines the barriers that prevent patients from talking about pain.

  2. Pain in neonate.

    PubMed

    Kabra, N S; Udani, R H

    1999-01-01

    Anatomical, functional and neurochemical maturation of pain pathways is well developed in fetus and neonates. Various physiological and behavioural responses to painful stimuli in neonates substantiate their ability to feel pain. Biological effects of pain are systematically studied in human fetus and neonates. Pain expressions in the newborn not only reflect tissue damage but are a function of ongoing behavioural state. The ultimate aim should be to keep neonates free from pain and other stressful stimuli as far as possible, by advocating minimal handling protocol, giving comforts after painful procedures, local anesthesia while carrying out painful procedures like cutdown and insertion of chest tubes, and if a baby is ventilated fentanyl and/or midazalam infusion must be carried out during initial periods of ventilation. PMID:10798044

  3. Managing pain during labor

    MedlinePLUS

    ... it is good to prepare yourself for natural childbirth. ... The pain felt during childbirth is different for every woman. Some women choose natural childbirth, or giving birth without medicine for pain. If all goes ...

  4. American Pain Society

    MedlinePLUS

    ... Preserve Coverage for Spinal Injections - A Win for Back Pain Patients APS, a member of the Multi-society ... therapies for millions of people who suffer from back pain. Read More » Posted March 24, 2016 Leidos Launches ...

  5. NIH Pain Consortium

    MedlinePLUS

    ... was established to enhance pain research and promote collaboration among researchers across the many NIH Institutes and ... resources and tools, and hosts events to promote collaboration and highlight advances in pain research. Follow @NIHPainResearch ...

  6. Preliminary study report: topological texture features extracted from standard radiographs of the heel bone are correlated with femoral bone mineral density

    NASA Astrophysics Data System (ADS)

    Boehm, H. F.; Lutz, J.; Koerner, M.; Notohamiprodjo, M.; Reiser, M.

    2009-02-01

    With the growing number of eldery patients in industrialized nations the incidence of geriatric, i.e. osteoporotic fractures is steadily on the rise. It is of great importance to understand the characteristics of hip fractures and to provide diagnostic tests for the assessment of an individual's fracture-risk that allow to take preventive action and give therapeutic advice. At present, bone-mineral-density (BMD) obtained from DXA (dual-energy x-ray-absorptiometry) is the clinical standard of reference for diagnosis and follow-up of osteoporosis. Since availability of DXA - other than that of clinical X-ray imaging - is usually restricted to specialized medical centers it is worth trying to implement alternative methods to estimate an individual's BMD. Radiographs of the peripheral skeleton, e.g. the ankle, range among the most ordered diagnostic procedures in surgery for exclusion or confirmation of fracture. It would be highly beneficial if - as a by-product of conventional imaging - one could obtain a quantitative parameter that is closely correlated with femoral BMD in addition to the original diagnostic information, e.g. fracture status at the peripheral site. Previous studies could demonstrate a correlation between calcaneal BMD and osteoporosis. The objective of our study was to test the hypothesis that topological analysis of calcaneal bone texture depicted by a lateral x-ray projection of the ankle allows to estimate femoral BMD. Our analysis on 34 post-menopausal patients indicate that texture properties based on graylevel topology in calcaneal x-ray-films are closely correlated with BMD at the hip and may qualify as a substitute indicator of femoral fracture risk.

  7. Posttonsillectomy pain in children.

    PubMed

    Sutters, Kimberly A; Isaacson, Glenn

    2014-02-01

    Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence. PMID:24445532

  8. Pain Examination and Diagnosis.

    PubMed

    Curtin, Catherine

    2016-02-01

    Pain is a clinical challenge to health care providers who care for hand disorders. Pathologic pain that prevents recovery leads to dissatisfaction for both patients and providers. Despite pain being common, the root cause is often difficult to diagnose. This article reviews the examination and diagnostic tools that are helpful in identifying pathologic and neuropathic pain. This article provides tools to speed recognition of these processes to allow earlier intervention and better patient outcomes. PMID:26611385

  9. [Pain and cognition].

    PubMed

    Moroni, Christine; Laurent, Bernard

    2006-03-01

    Pain is a multidimensional subjective experience mediated by emotion, attitudes and other perceptual influences. The functional deficit of patients suffering from pain could be expressed by a cognitive complaint. In this paper, cognitive repercussions of pain, associated factors and iatrogenic factors are presented. According to all the relation between pain and cognition seems complex and involves factors such as depression, anxiety, and medical treatment among others. All these factors interact together and produce a specific cognitive complaint for each patient. PMID:16556515

  10. Ketogenic Diets and Pain

    PubMed Central

    Masino, Susan A.; Ruskin, David N.

    2014-01-01

    Ketogenic diets are well-established as a successful anticonvulsant therapy. Based on overlap between mechanisms postulated to underlie pain and inflammation, and mechanisms postulated to underlie therapeutic effects of ketogenic diets, recent studies have explored the ability for ketogenic diets to reduce pain. Here we review clinical and basic research thus far exploring the impact of a ketogenic diet on thermal pain, inflammation, and neuropathic pain. PMID:23680946

  11. [Osteoporosis pain management].

    PubMed

    Dinges, Gerhard

    2009-09-01

    Osteoporosis is a chronic disease with an enormous impact on health care costs. Approximately 8 Mio. people are affected in Germany. A reasonable part of them is suffering from acute and/or chronic pain due to osteoporotic bone fractures and musculoskeletal malfunctioning. Therefore, pain therapy is based on the principles of acute pain treatment and chronic pain therapy.Drug effects and side effects have to be considered with respect to fracture healing, bone mineral density and fracture risk. PMID:19750435

  12. Pediatric Procedural Pain

    ERIC Educational Resources Information Center

    Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.

    2006-01-01

    This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs

  13. Knee pain (image)

    MedlinePLUS

    The location of knee pain can help identify the problem. Pain on the front of the knee can be due to bursitis, arthritis, or ... synovial fluid) that forms behind the knee. Overall knee pain can be due to bursitis, arthritis, tears in ...

  14. Paine Appointed Administrator

    NASA Technical Reports Server (NTRS)

    1969-01-01

    President Richard M. Nixon announcing the appointment of Dr. Thomas O. Paine as Administrator for the National Aeronautics and Space Administration. The ceremony was held at the White House. Paine had been serving as acting administrator. From left to right: President Richard M. Nixon NASA Administrator Dr. Thomas O. Paine Vice President Spiro T. Agnew

  15. Pain and pain control in children.

    PubMed

    Schechter, N L

    1985-05-01

    Focused research on pain and pain control in children has developed primarily in the last 10 years and even now is woefully inadequate in relation to the magnitude of the problem. The available research, inferences from the adult literature, and anecdotal information all indicate the elusive nature of pain. Pain is not solely a fixed neurophysiologic response to a noxious stimulus but a product of the interaction of many variables such as age, cognitive set, personality, ethnic background, and emotional state. These factors exert a tremendous influence on the suffering which surrounds the pain message. Technology exists at present to eliminate or substantially reduce pain in almost all cases. There remains, however, a tendency, which is even more pronounced with respect to children, to underestimate or ignore pain. In an overall approach to pain in children, the following points should be considered: A high index of suspicion is necessary to determine if children are experiencing pain since they may have difficulty verbalizing their discomfort. In infants, physiologic variables should be considered (increased heart rate, palmar sweating, increased respiratory rate), and in preschoolers, time should be taken to ascertain that the child actually understands the word "pain" if it is used in questioning them. Some method of continuous monitoring, such as a visual analogue scan, should be considered as part of the treatment plan. Adequate analgesia should be provided. The appropriate dose should be administered at the appropriate pharmacokinetic time. Too little medication may cause obsessive attention to medication-related issues. Too much medication may cause sedation and lack of mental clarity, which is often anxiety-producing for both the parents and the child. The usefulness of p.r.n. medication has been seriously questioned and a time-contingent as opposed to pain-contingent strategy should be applied. Fears of addiction are generally unwarranted. Adjunctive medication may increase the value of offered narcotics and counteract some of their side effects. Although this monograph has focused more attention on pharmacologic than on nonpharmacologic approaches to pain, this is merely a reflection of available data and not necessarily of relative importance. The importance of distraction from pain by nursing, medical, or child life personnel using play techniques cannot be overestimated. Every attempt should be made to relax the child by using creative strategies. Preparation of the child for procedures is often helpful as some of the fear of the unknown is eliminated.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2861066

  16. Pain inhibits pain; human brainstem mechanisms.

    PubMed

    Youssef, A M; Macefield, V G; Henderson, L A

    2016-01-01

    Conditioned pain modulation is a powerful analgesic mechanism, occurring when a painful stimulus is inhibited by a second painful stimulus delivered at a different body location. Reduced conditioned pain modulation capacity is associated with the development of some chronic pain conditions and the effectiveness of some analgesic medications. Human lesion studies show that the circuitry responsible for conditioned pain modulation lies within the caudal brainstem, although the precise nuclei in humans remain unknown. We employed brain imaging to determine brainstem sites responsible for conditioned pain modulation in 54 healthy individuals. In all subjects, 8 noxious heat stimuli (test stimuli) were applied to the right side of the mouth and brain activity measured using functional magnetic resonance imaging. This paradigm was then repeated. However, following the fourth noxious stimulus, a separate noxious stimulus, consisting of an intramuscular injection of hypertonic saline into the leg, was delivered (conditioning stimulus). During this test and conditioning stimulus period, 23 subjects displayed conditioned pain modulation analgesia whereas 31 subjects did not. An individual's analgesic ability was not influenced by gender, pain intensity levels of the test or conditioning stimuli or by psychological variables such as pain catastrophizing or fear of pain. Brain images were processed using SPM8 and the brainstem isolated using the SUIT toolbox. Significant increases in signal intensity were determined during each test stimulus and compared between subjects that did and did not display CPM analgesia (p<0.05, small volume correction). The expression of analgesia was associated with reduction in signal intensity increases during each test stimulus in the presence of the conditioning stimulus in three brainstem regions: the caudalis subdivision of the spinal trigeminal nucleus, i.e., the primary synapse, the region of the subnucleus reticularis dorsalis and in the dorsolateral pons in the region of the parabrachial nucleus. Furthermore, the magnitudes of these signal reductions in all three brainstem regions were significantly correlated to analgesia magnitude. Defining conditioned pain modulation circuitry provides a framework for the future investigations into the neural mechanisms responsible for the maintenance of persistent pain conditions thought to involve altered analgesic circuitry. PMID:26343321

  17. Back Pain Facts and Statistics

    MedlinePLUS

    ... kidney stones, kidney infections, blood clots, or bone loss . Manipulation as a Treatment for Back Problems Used ... Maintain proper posture. Wear comfortable, low-heeled shoes . Sleep on a ... in oxygen and nutrient deprivation to spinal tissues. Work with your doctor of ...

  18. Ethnic differences in pain and pain management.

    PubMed

    Campbell, Claudia M; Edwards, Robert R

    2012-05-01

    Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers' treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes. PMID:23687518

  19. Ethnic differences in pain and pain management

    PubMed Central

    Campbell, Claudia M; Edwards, Robert R

    2012-01-01

    SUMMARY Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers’ treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes. PMID:23687518

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

    SciTech Connect

    PAGE JS; COOKE GA; PESTOVICH JA; HUBER HJ

    2011-12-01

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

  1. Psychological Aspects of Chronic Pain

    PubMed Central

    Jacobs, Rosevelt

    1983-01-01

    Since its inception in June 1979, over 500 patients have been treated at the King/Drew Pain Center in Los Angeles. Based upon the treatment and observations of this patient group, this paper describes the psychologic aspects in patients suffering from chronic abdominal pain, low back pain, phantom limb pain, chest pain, and arthritic pain. PMID:6864816

  2. Center of Pressure Displacement of Standing Posture during Rapid Movements Is Reorganised Due to Experimental Lower Extremity Muscle Pain

    PubMed Central

    Shiozawa, Shinichiro; Hirata, Rogerio Pessoto; Graven-Nielsen, Thomas

    2015-01-01

    Background Postural control during rapid movements may be impaired due to musculoskeletal pain. The purpose of this study was to investigate the effect of experimental knee-related muscle pain on the center of pressure (CoP) displacement in a reaction time task condition. Methods Nine healthy males performed two reaction time tasks (dominant side shoulder flexion and bilateral heel lift) before, during, and after experimental pain induced in the dominant side vastus medialis or the tibialis anterior muscles by hypertonic saline injections. The CoP displacement was extracted from the ipsilateral and contralateral side by two force plates and the net CoP displacement was calculated. Results Compared with non-painful sessions, tibialis anterior muscle pain during the peak and peak-to-peak displacement for the CoP during anticipatory postural adjustments (APAs) of the shoulder task reduced the peak-to-peak displacement of the net CoP in the medial-lateral direction (P<0.05). Tibialis anterior and vastus medialis muscle pain during shoulder flexion task reduced the anterior-posterior peak-to-peak displacement in the ipsilateral side (P<0.05). Conclusions The central nervous system in healthy individuals was sufficiently robust in maintaining the APA characteristics during pain, although the displacement of net and ipsilateral CoP in the medial-lateral and anterior-posterior directions during unilateral fast shoulder movement was altered. PMID:26680777

  3. Prediction of the strength of the elderly proximal femur by bone mineral density and quantitative ultrasound measurements of the heel and tibia.

    PubMed

    Bouxsein, M L; Coan, B S; Lee, S C

    1999-07-01

    Quantitative ultrasound (QUS) of the heel and tibia have recently been approved in the United States for diagnostic evaluation of low bone mass. The goal of this study was to use human cadaveric specimens to compare correlations among: a) strength of the proximal femur; b) bone mineral density of the femur, tibia, and heel; and c) QUS of the tibia and heel. We obtained 26 proximal femurs and intact lower limbs from 16 female and 10 male cadavers, with a mean age of 81+/-12 years. Bone mineral density (BMD, g/cm2) of the proximal femur and tibia were assessed using dual-energy x-ray absorptiometry, and BMD (g/cm) of the heel was measured using single-energy x-ray absorptiometry. Ultrasound velocity at the mid-tibia was determined using a contact, gel-coupled ultrasound device. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the heel were determined using a transmission ultrasound device with water-based coupling. The femurs were tested to failure in a configuration designed to simulate a fall to the side with impact to the greater trochanter. As in previous studies, the strength of the proximal femur was very strongly correlated with femoral BMD and heel BMD (r2 = 0.78-0.92, p < .0001 for all). BUA and SOS of the heel were also strongly correlated to femoral strength (r2 = 0.70 and 0.67, respectively, p < 0.0001 for both), whereas tibia SOS was only weakly correlated (r2 = 0.19, p = 0.03). The average coefficient of variation for triplicate tibial SOS measurements was 0.50%. This study indicates that, although tibial SOS measurements are precise, they are not strongly correlated with femoral BMD or strength. In contrast, heel QUS measurements are strongly correlated with the strength of the proximal femur. These findings imply that tibial SOS may be of limited use for assessing hip fracture risk. Prospective fracture risk data are needed to define further the clinical utility of tibia ultrasound measurements. PMID:10423021

  4. Reducing pain during procedures.

    PubMed

    Liebelt, E L

    1996-10-01

    There is an increasing focus on the recognition, assessment, and management of pain in children. Children undergo many painful procedures in different clinical environments and are frequently undertreated for their pain. The pediatrician should be familiar with general concepts about the perception of pain in children. Many pain-assessment tools have been developed and restructured to provide the clinician with valid and reliable scales to assess pain in children and assess the effect of interventions. New pharmacologic agents for conscious sedation are being used with increasing frequency in the pediatric outpatient setting for reducing pain and anxiety. Also there has been increasing use of regional anesthetic techniques for procedures once requiring general anesthesia. There has been an increase in the development of topical anesthetics as well as modifying injectable local anesthetic to decrease the pain of local infiltration. Nonpharmacologic methods of pain management are being tested, developed, and used alone or as adjuncts to pharmacologic therapy for children undergoing painful procedures. It is imperative that clinicians keep themselves informed about new advances pertaining to pain treatment and incorporate them into their practices. PMID:8946121

  5. [Pathophysiology of abdominal pain].

    PubMed

    Curatolo, Michele

    2011-08-01

    Abdominal pain can be induced by stimulation of visceral nociceptors. Activation of nociceptors usually requires previous sensitization by pathological events, such as inflammation, ischemia or acidosis. Although abdominal pain can obviously be caused by pathology of a visceral structure, clinicians frequently observe that such a pathology explains only part of the pain complaints. Occasionally, there is lack of objective signs of visceral lesions. There is clear evidence that pain states are associated with profound changes of the central processing of the sensory input. The main consequences of such alterations for patients are twofold: 1) a central sensitization, i.e. an increased excitability of the central nervous system; 2) an alteration of the endogenous pain modulation, which under normal conditions inhibits the processing of nociceptive signals in the central nervous system. Both phenomena lead to a spread of pain to other body regions and an amplification of the pain perception. The interactions between visceral pathology and alterations of the central pain processes represent an at least partial explanation for the discrepancy between objective signs of peripheral lesions and severity of the symptoms. Today, both central hypersensitivity and alteration in endogenous pain modulation can be measured in clinical practice. This information can be used to provide the patients with an explanatory model for their pain. Furthermore, first data suggest that alterations in central pain processing may represent negative prognostic factors. A better understanding of the individual pathophysiology may allow in the future the development of individual therapeutic strategies. PMID:21796591

  6. Pain in children.

    PubMed

    Eland, J M

    1990-12-01

    The assessment and management of children's pain is a topic that has received a great deal of attention since the late 1970s. Nurse researchers have played a dominant role in all areas of pediatric pain relief and likely will continue to do so. There are currently a number of pediatric pain assessment instruments developed that are used in selected practice settings, but their use should be extended to document the existence of pediatric pain and its relief. Pharmacologic interventions for pediatric pain relief have been hampered by incorrect beliefs about analgesic risks, prescribing and administrating habits, and a virtual explosion of information in the area of analgesics. Although nurses have traditionally used nonpharmacologic interventions for pain relief, these methods have not been well researched. Continued research efforts in this important area will result in improved diagnosis and management of pediatric pain. PMID:2235640

  7. Common medical pains

    PubMed Central

    Jacobson, Sheila

    2007-01-01

    Pain in infancy and childhood is extremely common. Sources of pain include illness, injury, and medical and dental procedures. Over the past two decades, tremendous progress has been made in the assessment, prevention and treatment of pain. It is important for the paediatric health care provider to be aware of the implications and consequences of pain in childhood. A multitude of interventions are available to reduce or alleviate pain in children of all ages, including neonates. These include behavioural and psychological methods, as well as a host of pharmacological preparations, which are safe and effective when used as indicated. Many complementary and alternative treatments appear to be promising in treating and relieving pain, although further research is required. The present article reviews the most common sources of pain in childhood and infancy, as well as current treatment strategies and options. PMID:19030348

  8. Preventing chronic postoperative pain.

    PubMed

    Reddi, D

    2016-01-01

    Chronic postoperative pain is common. Nerve injury and inflammation promote chronic pain, the risk of which is influenced by patient factors, including psychological characteristics. Interventional trials to prevent chronic postoperative pain have been underpowered with inadequate patient follow-up. Ketamine may reduce chronic postoperative pain, although the optimum treatment duration and dose for different operations have yet to be identified. The evidence for gabapentin and pregabalin is encouraging but weak; further work is needed before these drugs can be recommended for the prevention of chronic pain. Regional techniques reduce the rates of chronic pain after thoracotomy and breast cancer surgery. Nerve-sparing surgical techniques may be of benefit, although nerve injury is not necessary or sufficient for chronic pain to develop. PMID:26620149

  9. The Pain of Labour

    PubMed Central

    Labor, Simona

    2008-01-01

    Labour is an emotional experience and involves both physiological and psychological mechanisms. The pain of labour is severe but despite this its memory diminishes with time. Labour pain has two components: visceral pain which occurs during the early first stage and the second stage of childbirth, and somatic pain which occurs during the late first stage and the second stage. The pain of labour in the first stage is mediated by T10 to L1 spinal segments, whereas that in the second stage is carried by T12 to L1, and S2 to S4 spinal segments. Pain relief in labour is complex and often challenging without regional analgesia. Effective management of labour pain plays a relatively minor role in a woman's satisfaction with childbirth. PMID:26526404

  10. Avicenna's concept of pain

    PubMed Central

    Tashani, Osama A.; Johnson, Mark I.

    2010-01-01

    Ibn Sina (Latin name Avicenna, 9801037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire. PMID:21483573

  11. Three-dimensional morphology and strain of the human Achilles free tendon immediately following eccentric heel drop exercise.

    PubMed

    Obst, Steven J; Newsham-West, Richard; Barrett, Rod S

    2015-12-01

    Our understanding of the immediate effects of exercise on Achilles free tendon transverse morphology is limited to single site measurements acquired at rest using 2D ultrasound. The purpose of this study was to provide a detailed 3D description of changes in Achilles free tendon morphology immediately following a single clinical bout of exercise. Freehand 3D ultrasound was used to measure Achilles free tendon length, and regional cross-sectional area (CSA), medio-lateral (ML) diameter and antero-posterior (AP) diameter in healthy young adults (N=14) at rest and during isometric muscle contraction, immediately before and after 315 eccentric heel drops. Post-exercise reductions in transverse strain were limited to CSA and AP diameter in the mid-proximal region of the Achilles free tendon during muscle contraction. The change in CSA strain during muscle contraction was significantly correlated to the change in longitudinal strain (r=-0.72) and the change in AP diameter strain (r=0.64). Overall findings suggest the Achilles free tendon experiences a complex change in 3D morphology following eccentric heel drop exercise that manifests under contractile but not rest conditions, is most pronounced in the mid-proximal tendon and is primarily driven by changes in AP diameter strain and not ML diameter strain. PMID:26519510

  12. Effects of therapeutic massage on gait and pain after delayed onset muscle soreness

    PubMed Central

    Han, Jun-Ho; Kim, Min-Jeong; Yang, Hyuk-Jin; Lee, Yu-Jin; Sung, Yun-Hee

    2014-01-01

    Unfamiliar or sudden exercise can induce delayed onset muscle soreness (DOMS) within 1224 h. So, several researchers have reported various interventions to treat DOMS. Massage is generally known to eliminate muscle fatigue. However, effect of massage after DOMS is still not clear. We investigated whether the massage is effective on pain and gait after DOMS. The participants were divided into a control group (n= 10) with DOMS and an experimental group (n= 11) with the massage treated after DOMS. We induced DOMS by taking isotonic exercise with going up and down 20 times in 5-story building. We applied the massage and assessment on gastrocnemius of dominant foot. The change of gait and pain was assessed using gaitrite and algometer. In the present results, the massage on gastrocnemius after DOMS showed significant difference in pain (P< 0.05). Also, there was a significant difference in gait (P< 0.05), especially, spatial parameters (distance, step length, stride length) and temporal parameters (ambulation, heel on off time, stride velocity). Moreover, the pain relief after massage-treated in DOMS correlated with gait. These results suggest that the massage on gastrocnemius after DOMS has influence on pain and gait performance. Therefore, massage can be applied as intervention for delayed onset muscle soreness. PMID:24877051

  13. An equine pain face

    PubMed Central

    Gleerup, Karina B; Forkman, Björn; Lindegaard, Casper; Andersen, Pia H

    2015-01-01

    Objective The objective of this study was to investigate the existence of an equine pain face and to describe this in detail. Study design Semi-randomized, controlled, crossover trial. Animals Six adult horses. Methods Pain was induced with two noxious stimuli, a tourniquet on the antebrachium and topical application of capsaicin. All horses participated in two control trials and received both noxious stimuli twice, once with and once without an observer present. During all sessions their pain state was scored. The horses were filmed and the close-up video recordings of the faces were analysed for alterations in behaviour and facial expressions. Still images from the trials were evaluated for the presence of each of the specific pain face features identified from the video analysis. Results Both noxious challenges were effective in producing a pain response resulting in significantly increased pain scores. Alterations in facial expressions were observed in all horses during all noxious stimulations. The number of pain face features present on the still images from the noxious challenges were significantly higher than for the control trial (p = 0.0001). Facial expressions representative for control and pain trials were condensed into explanatory illustrations. During pain sessions with an observer present, the horses increased their contact-seeking behavior. Conclusions and clinical relevance An equine pain face comprising ‘low’ and/or ‘asymmetrical’ ears, an angled appearance of the eyes, a withdrawn and/or tense stare, mediolaterally dilated nostrils and tension of the lips, chin and certain facial muscles can be recognized in horses during induced acute pain. This description of an equine pain face may be useful for improving tools for pain recognition in horses with mild to moderate pain. PMID:25082060

  14. Pain in aquatic animals.

    PubMed

    Sneddon, Lynne U

    2015-04-01

    Recent developments in the study of pain in animals have demonstrated the potential for pain perception in a variety of wholly aquatic species such as molluscs, crustaceans and fish. This allows us to gain insight into how the ecological pressures and differential life history of living in a watery medium can yield novel data that inform the comparative physiology and evolution of pain. Nociception is the simple detection of potentially painful stimuli usually accompanied by a reflex withdrawal response, and nociceptors have been found in aquatic invertebrates such as the sea slug Aplysia. It would seem adaptive to have a warning system that allows animals to avoid life-threatening injury, yet debate does still continue over the capacity for non-mammalian species to experience the discomfort or suffering that is a key component of pain rather than a nociceptive reflex. Contemporary studies over the last 10?years have demonstrated that bony fish possess nociceptors that are similar to those in mammals; that they demonstrate pain-related changes in physiology and behaviour that are reduced by painkillers; that they exhibit higher brain activity when painfully stimulated; and that pain is more important than showing fear or anti-predator behaviour in bony fish. The neurophysiological basis of nociception or pain in fish is demonstrably similar to that in mammals. Pain perception in invertebrates is more controversial as they lack the vertebrate brain, yet recent research evidence confirms that there are behavioural changes in response to potentially painful events. This review will assess the field of pain perception in aquatic species, focusing on fish and selected invertebrate groups to interpret how research findings can inform our understanding of the physiology and evolution of pain. Further, if we accept these animals may be capable of experiencing the negative experience of pain, then the wider implications of human use of these animals should be considered. PMID:25833131

  15. Relation of the factor to menstrual pain and musculoskeletal pain

    PubMed Central

    Lee, Jang-Won; Park, Hye-Sang

    2015-01-01

    The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods (P< 0.05). The area of musculoskeletal pain and menstrual pain were found to be the same. PMID:25960984

  16. [Latest pain management for painful bony metastases].

    PubMed

    Ikenaga, Masayuki

    2006-04-01

    Pain management for painful bony metastases is the most important problem for symptom relief of terminally-ill cancer patients. Pathological fractures often decrease the activity of daily life (ADL) of patients, and cause deterioration of the quality of life (QOL) and prognosis. Basically pharmacological therapies of the World Health Organization (WHO) method are essential for symptom relief from cancer pain. This article provides the latest pain managements (palliative irradiation, bisphosphonate, orthopedic surgery, percutaneous vertebroplasty and radiopharmaceutical therapy) of bony metastases, and mentions the indications and the problems of these interventions. In consideration to prognosis, the QOL and patient's needs, medical staffs have to perform multidisciplinary approach for providing suitable palliative care. PMID:16582515

  17. The genetics of pain and pain inhibition.

    PubMed Central

    Mogil, J S; Sternberg, W F; Marek, P; Sadowski, B; Belknap, J K; Liebeskind, J C

    1996-01-01

    The present review summarizes the current state of knowledge about the genetics of pain-related phenomena and illustrates the scope and power of genetic approaches to the study of pain. We focus on work performed in our laboratories in Jastrzebiec, Poland; Portland, OR; and Los Angeles, which we feel demonstrates the continuing usefulness of classical genetic approaches, especially when used in combination with newly available molecular genetic techniques. PMID:8610166

  18. Management of sickle pain.

    PubMed

    Ballas, S K

    1997-03-01

    Sickle cell disease is characterized by recurrent episodes of acute pain. Some patients also suffer from chronic pain syndromes including avascular necrosis, leg ulcers, and intractable pain. Approaches to rational therapy of sickle pain include pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment of sickle pain entails the use of nonopioid analgesics, opioid analgesics, and adjuvants singly or in combination depending on the severity of pain. Meticulous evaluation and assessment of painful episodes should precede and accompany all approaches to management. The choice of the opioid analgesic, its route of administration, dose, and frequency of administration should be individualized on a case-by-case basis. Meperidine should be avoided whenever possible. Nonsteroidal anti-inflammatory drugs, meperidine, and morphine are contraindicated in the presence of renal failure. Administration of opioids on a fixed schedule or by patient-controlled analgesia is ideal for effective therapy. Nonpharmacologic approaches to manage sickle pain are underutilized and more studies are needed to determine their role in sickle pain. Preventive therapy of sickle pain is best achieved with hydroxyurea, which was found to decrease the frequency of crises significantly, decrease the incidence of acute chest syndrome, and decrease the need for blood transfusion. PMID:9107526

  19. Pain in Parkinson's disease.

    PubMed

    Ha, Ainhi D; Jankovic, Joseph

    2012-04-01

    Pain and other nonmotor symptoms in PD are increasingly recognized as a major cause of reduced health-related quality of life. Pain in PD may be categorized into a number of different subtypes, including musculoskeletal, dystonic, radicular neuropathic, and central pain. The onset of pain can vary in relation to motor symptoms, and may precede the appearance of motor symptoms by several years, or occur after the diagnosis of PD has been made. Pain in PD is frequently under-recognized and is often inadequately treated. Levodopa-related dystonia may respond to manipulation of dopaminergic medication. Dopaminergic therapy may also improve musculoskeletal pain related to rigidity and akinesia, as well as akathisia in PD. Botulinum toxin injections can be effective for treatment of painful focal dystonia. Pain and dysesthesia have been reported to improve with DBS, in some cases. Increased understanding of basal ganglia pathways has provided further insights into the pathogenesis of pain in PD, but the exact mechanism of pain processing and modulation remains unclear. PMID:21953990

  20. Pain Management in Newborns

    PubMed Central

    Hall, Richard W.; Anand, Kanwaljeet J. S.

    2014-01-01

    Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. Opioids form the mainstay for treatment of severe pain; morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress. PMID:25459780

  1. Mechanisms of cardiac pain.

    PubMed

    Foreman, Robert D; Garrett, Kennon M; Blair, Robert W

    2015-04-01

    Angina pectoris is cardiac pain that typically is manifested as referred pain to the chest and upper left arm. Atypical pain to describe localization of the perception, generally experienced more by women, is referred to the back, neck, and/or jaw. This article summarizes the neurophysiological and pharmacological mechanisms for referred cardiac pain. Spinal cardiac afferent fibers mediate typical anginal pain via pathways from the spinal cord to the thalamus and ultimately cerebral cortex. Spinal neurotransmission involves substance P, glutamate, and transient receptor potential vanilloid-1 (TRPV1) receptors; release of neurokinins such as nuclear factor kappa b (NF-kb) in the spinal cord can modulate neurotransmission. Vagal cardiac afferent fibers likely mediate atypical anginal pain and contribute to cardiac ischemia without accompanying pain via relays through the nucleus of the solitary tract and the C1-C2 spinal segments. The psychological state of an individual can modulate cardiac nociception via pathways involving the amygdala. Descending pathways originating from nucleus raphe magnus and the pons also can modulate cardiac nociception. Sensory input from other visceral organs can mimic cardiac pain due to convergence of this input with cardiac input onto spinothalamic tract neurons. Reduction of converging nociceptive input from the gallbladder and gastrointestinal tract can diminish cardiac pain. Much work remains to be performed to discern the interactions among complex neural pathways that ultimately produce or do not produce the sensations associated with cardiac pain. PMID:25880519

  2. Neurological diseases and pain

    PubMed Central

    2012-01-01

    Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain. PMID:22067541

  3. Pain in cancer survivors.

    PubMed

    Glare, Paul A; Davies, Pamela S; Finlay, Esm; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C; Paice, Judith A; Stubblefield, Michael D; Syrjala, Karen L

    2014-06-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  4. Pain in Cancer Survivors

    PubMed Central

    Glare, Paul A.; Davies, Pamela S.; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C.; Paice, Judith A.; Stubblefield, Michael D.; Syrjala, Karen L.

    2014-01-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  5. Pain after earthquake

    PubMed Central

    2012-01-01

    Introduction On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. Objectives This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009). Methods 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. Results A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%). Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. Conclusions This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations. PMID:22747796

  6. Cancer pain physiology

    PubMed Central

    Falk, Sarah; Bannister, Kirsty

    2014-01-01

    Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells. This precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined to the mouse femur. This model prompted related approaches, and we can now state that cancer pain may include elements of inflammatory and neuropathic pains but also unique changes in sensory processing. Cancer-induced bone pain results in progressive bone destruction, elevated osteoclast activity and distinctive nocifensive behaviours (indicating the triad of ongoing, spontaneous and movement-induced hyperalgesia). In addition, cancer cells induce an inflammatory infiltrate and release growth factors, cytokines, interleukins, chemokines, prostanoids and endothelins, resulting in a reduction of pH to below 5 and direct deformation of primary afferents within bone. These peripheral changes, in turn, drive hypersensitivity of spinal cord sensory neurons, many of which project to the parts of the brain involved in the emotional response to pain. Within the spinal cord, a unique neuronal function reorganization within segments of the dorsal horn of the spinal cord receiving nociceptive input from the bone are discussed. Changes in certain neurotransmitters implicated in brain modulation of spinal function are also altered with implications for the affective components of cancer pain. Treatments are described in terms of mechanistic insights and in the case of opioids, which modulate pain transmission at spinal and supraspinal sites, their use can be compromised by opioid-induced hyperalgesia. We discuss evidence for how this comes about and how it may be treated. PMID:26516549

  7. Abdominal pain - children under age 12

    MedlinePLUS

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can ... kinds of pain: Generalized pain or pain over more than half ...

  8. [Painful ischemic neuropathy].

    PubMed

    Lang, P M

    2015-02-01

    Chronic ischemia in patients with peripheral arterial disease (PAD) represents a common medical problem. Neuropathic changes and pain caused by chronic ischemia are often found in the lower extremities of these patients. Pain in patients with chronic critical limb ischemia fulfill the criteria of neuropathic pain. Diagnostic tools besides medical history and examination are questionnaires, quantitative sensory testing (QST) and measuring intraepidermal nerve fiber density (IENFD) when indicated. A pharmacological approach with non-opioids and opioids as well as antidepressive and anticonvulsive drugs (according to the recommendations for the therapy of neuropathic pain) seems to be indicated for treating painful ischemic neuropathy. Spinal cord stimulation (SCS) provides the best evidence for invasive procedures in treating chronic ischemic pain. PMID:25620734

  9. Neonatal pain management

    PubMed Central

    Bhalla, Tarun; Shepherd, Ed; Tobias, Joseph D.

    2014-01-01

    The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions. PMID:25538531

  10. Nonpharmacologic treatment of pain.

    PubMed

    Titler, M G; Rakel, B A

    2001-06-01

    Nonpharmacologic interventions for pain treatment are important complementary therapies but are not substitutes for pharmacologic management of pain. Use of nonpharmacologic pain treatments in critical care settings is helpful to decrease pain, but the challenge remains for nurses to have the knowledge, time, and skill to use these interventions in a busy daily practice with severely ill patients. Although numerous studies testing the effectiveness of nonpharmacologic interventions for pain management are available, the varying methods and interventions used in these studies make it difficult to draw conclusions. Further research on the use of these interventions for pain reduction is necessary to determine the most effective treatments and the conditions under which they should be used. PMID:11866404

  11. Amphibian pain and analgesia.

    PubMed

    Machin, K L

    1999-03-01

    Analgesics are often not provided to amphibians because the presence and severity of pain may not be recognized in these animals. In addition, there is little information on the mechanism of action of analgesic agents in amphibians. However, amphibians possess appropriate neurologic components for transmitting pain from peripheral receptors to the central nervous system and antinociceptive mechanisms to modulate pain. They are capable of displaying behavioral and physiologic modification of pain systems in response to analgesic pharmacologic agents. Therefore, pain perception in amphibians is likely analogous to that in mammals and invasive, potentially painful procedures should be accompanied by appropriate analgesia and anesthesia. Although specific doses have not been established in clinical trials, basic research into the mechanisms and regulation of endogenous opioid systems demonstrates the potential clinical benefit for the use of opioids in these animals. Other analgesics such as alpha2-agonists, ketamine, and tricaine methanesulfonate have also demonstrated analgesic potential. PMID:10367638

  12. Pain relief in Thailand.

    PubMed

    Spencer, Meg

    2003-01-01

    Pain is a complex problem, for both those who are enduring it and those trying to relieve it. Most people in the developed world have access to adequate treatment and management of pain, the availability of trained and educated doctors and nurses, feasible opioid prescribing policies, as well as ready access to appropriate medication. Often, this is not the case in developing countries such as Thailand. This paper is based on recent experience in the southeast of Thailand providing pain relief for persons with HIV and AIDS in Rayong Province at the Camillian Social Centre. The severity and frequency of pain endured by this group of individuals presented a daily challenge. Problems encountered in providing pain relief for these patients and some potential solutions are described. There is a lack of literature on pain relief in Thailand. PMID:15022951

  13. A Novel and Alternative Treatment Method for Diabetic Heel Ulceration Exposing the Calcaneus Which Is Not Suitable for Flap Surgery: Vacuum Assisted Sandwich Dermal Matrix

    PubMed Central

    Bingol, Ugur A.; Cinar, Can; Arslan, Hakan; Alt?ndas, Muzaffer

    2015-01-01

    Background. Currently, free flaps and pedicled flaps are the first treatment choices for large heel ulcer reconstruction. However, flap reconstruction of heel ulcerations cannot be performed in all diabetics especially with concurrent severe peripheral vascular disease because of higher flap failure rate. In recent years, the use of acellular dermal matrix (ADM) has emerged as an alternative treatment option for extremity ulcers. Methods. We present 13 diabetic patients with a large heel ulceration exposing the calcaneus, who were not eligible for flap surgery due to the presence of only one patent artery of trifurcation. These cases were treated with the vacuum assisted sandwich dermal matrix (VASDEM) method. Results. None of the patients required amputation. Skin grafting was successful in ten patients. Although partial losses were observed in three patients, they were healed spontaneously without surgical interventions. During the follow-up period none of the patients developed ulceration on the treatment area. All patients maintained their preoperative ambulatory ability. Conclusion. VASDEM is a novel method offering opportunity for treatment before proceeding to amputation in diabetic heel ulceration exposing the calcaneus which is not suitable for flap surgery. It also has the potential to close wounds of all sizes independent of the vessel status and wound size in selected diabetic patients. PMID:26516626

  14. A pedestrian dead-reckoning system that considers the heel-strike and toe-off phases when using a foot-mounted IMU

    NASA Astrophysics Data System (ADS)

    Ju, Hojin; Lee, Min Su; Park, So Young; Song, Jin Woo; Park, Chan Gook

    2016-01-01

    In this paper, we propose an advanced pedestrian dead-reckoning (PDR) algorithm that considers the heel-strike and toe-off phases. Generally, PDR systems that use a foot-mounted inertial measurement unit are based on an inertial navigation system with an extended Kalman filter (EKF). To reduce the influence of the bias and white noises in the gyroscope and accelerometer signals, a zero-velocity update is often adopted at the stance phase. However, transient and large acceleration, which cannot be measured by the accelerometer used in pedestrian navigation, occur momentarily in the heel-strike phase. The velocity information from integration of the acceleration is not reliable because the acceleration is not measured in the heel-strike phase. Therefore, the designed EKF does not correctly reflect the actual environment, because conventional algorithms do not take the non-measurable acceleration into consideration. In order to reflect the actual environment, we propose a PDR system that considers the non-measurable acceleration from the heel-strike impact. To improve the PDR system’s performance, the proposed algorithm uses a new velocity measurement obtained using the constraint between the surface and the foot during the toe-off phase. The experimental results show improved filter performance after comparison of the proposed algorithm and a conventional algorithm.

  15. Low-back pain.

    PubMed

    Violante, Francesco S; Mattioli, Stefano; Bonfiglioli, Roberta

    2015-01-01

    Low-back pain is one of the most common painful conditions experienced by humans throughout their life. Some occupational risk factors (namely, heavy manual material handling) may also contribute to the development of low-back pain: due to the high prevalence of both low-back pain and manual material handling in the adult working population, it has been estimated that low-back pain is probably the most common occupational disorder worldwide. Lifetime prevalence of low-back pain has been reported to be as high as 84%, depending on the case definition used, and no age group is spared, even children. Although low-back pain is not a lethal condition, it was estimated at the third rank among all diseases by disability-adjusted life-years in 2010 in the USA, after ischemic heart disease and chronic obstructive pulmonary disease, and at the first rank by years lived with disability. It also ranked high (13th) globally for the same year, in disability-adjusted life-years. Low-back pain is currently classified as nonspecific/specific as to putative cause and as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks) according to duration of symptoms. The distinction between nonspecific/specific and acute/subacute/chronic low-back pain is useful not only for epidemiologic studies, but also (mainly) for choosing the appropriate strategy for the diagnosis and treatment of the disorder. Workplace risk factors for low-back pain include manual lifting and whole-body vibration exposure. This chapter will provide an overview of modern concepts of low-back pain (in general) and will then outline some distinctive features of work-related low-back pain. PMID:26563799

  16. Somatization and chronic pain.

    PubMed

    Birket-Smith, M

    2001-10-01

    The experience of pain is related not only to tissue damage and physical illness, but also to mental phenomena including depression, anxiety and somatization. Somatization is common among chronic pain patients and presents special problems in management and treatment. Somatoform patients are often given inappropriate diagnoses, treated for non-existent depressive disorders, and exposed to multiple, superfluous investigations. Psychological models of chronic pain and somatization are presented, and treatment issues including psychotherapy and the use of antidepressants are discussed. PMID:11683662

  17. Differential diagnosis and treatment of iliotibial band pain secondary to a hypomobile cuboid in a 24-year-old female tri-athlete

    PubMed Central

    Brandon, Kristina; Patla, Catherine

    2013-01-01

    The purpose of this case report is to relate an episode of movement impairment at the cuboid calcaneal articulation leading to symptoms of iliotibial band (ITB) syndrome. An explanation of the etiology and clinical diagnosis in relation to the differential diagnosis, treatment techniques, and patient outcomes are described. The 24-year-old female tri-athlete reported pain at Gerdys tubercle and lateral femoral condyle areas occurring within 2 miles of a run. VAS score was 6/10 for the running activity and the lower extremity functional scale (LEFS) score was 93% (74/80). Over the previous 2 years, the ITB symptoms had failed to resolve with extensive conservative treatment at the knee. On weight bearing, the patient demonstrated pain free limitation of active midtarsal pronation more than supination, which correlated with a decrease in passive internal rotation of the cuboid. Symptoms resolved after one cuboid whip manipulation and the patient was able to run pain free. Post-manipulation treatment consisted of two more sessions, which included motor retraining for weight bearing active midtarsal pronation and supination. LEFS was 100% (80/80) and VAS 0/10 with running greater than 10 miles. While causality cannot be inferred from a single case, this report may foster further investigation regarding the differential diagnosis and treatment of a hypomobile cuboid. PMID:24421625

  18. Differential diagnosis and treatment of iliotibial band pain secondary to a hypomobile cuboid in a 24-year-old female tri-athlete.

    PubMed

    Brandon, Kristina; Patla, Catherine

    2013-08-01

    The purpose of this case report is to relate an episode of movement impairment at the cuboid calcaneal articulation leading to symptoms of iliotibial band (ITB) syndrome. An explanation of the etiology and clinical diagnosis in relation to the differential diagnosis, treatment techniques, and patient outcomes are described. The 24-year-old female tri-athlete reported pain at Gerdy's tubercle and lateral femoral condyle areas occurring within 2 miles of a run. VAS score was 6/10 for the running activity and the lower extremity functional scale (LEFS) score was 93% (74/80). Over the previous 2 years, the ITB symptoms had failed to resolve with extensive conservative treatment at the knee. On weight bearing, the patient demonstrated pain free limitation of active midtarsal pronation more than supination, which correlated with a decrease in passive internal rotation of the cuboid. Symptoms resolved after one cuboid whip manipulation and the patient was able to run pain free. Post-manipulation treatment consisted of two more sessions, which included motor retraining for weight bearing active midtarsal pronation and supination. LEFS was 100% (80/80) and VAS 0/10 with running greater than 10 miles. While causality cannot be inferred from a single case, this report may foster further investigation regarding the differential diagnosis and treatment of a hypomobile cuboid. PMID:24421625

  19. Managing Neuropathic Pain.

    PubMed

    Jones, Robert Carter Wellford; Lawson, Erin; Backonja, Miroslav

    2016-01-01

    Neuropathic pain (NP) arises from injuries or diseases affecting the somatosensory component of the nervous system at any level of the peripheral or central nervous system. NP is diagnosed based on common neurologic signs and symptoms. NP is best treated with a combination of multiple therapeutic approaches, and treatments include conservative, complementary, medical, interventional, and surgical treatment modalities. Goals of treatment are the same as in pain management and include improvement in pain control and in coping skills as well as restoration of functional status. Most patients with NP benefit most from an individualized, multimodal approach that emphasizes both pain and function. PMID:26614725

  20. [Imaging techniques and pain].

    PubMed

    Maihfner, C; Bingel, U

    2015-10-01

    Over the last 15years, functional brain imaging techniques have provided critical insights into cortical, subcortical and even spinal mechanisms involved in pain perception and pain modulation in humans. The pivotal contribution of brain imaging studies conducted in Germany have thereby been internationally acknowledged. One of the key challenges for the next decade is to shift the focus from studies in healthy volunteers to different clinical populations suffering from chronic pain to characterize CNS mechanisms, as well as neurobiological predictors and resilience factors of pain chronification. Ultimately, the knowledge gained by this work may help identify individual or syndrome-specific CNS changes as biomarkers to make therapeutic decisions. PMID:26351124

  1. [Enduring pain II. Treatment].

    PubMed

    Baldessarini, Ross; Selle, Valerio; Vigo, Daniel V

    2013-01-01

    Pain disorders present highly challenging therapeutic problems, owing in part to complex co-morbidities associated with pain disorders, notably including psychiatric disorders characterized by depressed mood or anxiety. Many treatments are employed to treat pain-disorder patients, and most are unsatisfactory. Virtually all analgesic medicines in long-term use provide only partial efficacy and present substantial risks of adverse effects, loss of benefit over time, or dependency and risk of abuse. Commonly employed drugs with analgesic properties include non-opioids (mainly nonsteroidal anti-inflammatory agents [NSAIDs] or acetaminophen), many natural or synthetic opioids (including opiates and phenylpiperidines), some antidepressants (especially those with noradrenergic activity), a few anticonvulsants, skeletal muscle relaxants or topical remedies, and a growing variety of experimental treatments. The major overlap between pain and psychiatric disorders, as well as the currently unsatisfactory state of treatments available for chronic pain syndromes, encourage a comprehensive approach to assessment and clinical management of patients with chronic pain. Many current treatment programs for pain disorder patients offer narrowly specialized and incomplete treatment options. Ideally however, such care should be provided by multi-disciplinary teams with expertise in neurology, general medicine, pain management, physical medicine and rehabilitation, as well as psychiatry. Psychiatrists as well as pain specialists can serve an essential role in leading comprehensive assessment and general management of such complex and challenging patients who are typically only partially responsive to available treatments. PMID:24312919

  2. Athletes' leg pains.

    PubMed Central

    Orava, S.; Puranen, J.

    1979-01-01

    The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. PMID:486888

  3. Coping with Chronic Pain

    MedlinePLUS

    ... Cart JOIN APA About APA Topics Publications & Databases Psychology Help Center News & Events Science Education Careers Membership Home // Psychology Help Center // Coping with chronic pain EMAIL PRINT ...

  4. Spinal cord injury pain.

    PubMed

    Saulino, Michael

    2014-05-01

    Chronic pain associated with traumatic spinal cord injury (SCI) can be quite challenging to the physiatrist. This highly prevalent condition within the SCI population requires an appropriate evaluative approach including a thorough history, a targeted physical examination, and appropriate use of diagnostic testing. The International Spinal Cord Injury Pain Classification allows for a reasonable categorization of the various pain syndromes and may assist in selecting a reasoned treatment strategy. A multitude of management approaches exist including nonpharmacologic, pharmacologic, and interventional approaches. This article provides an overview of the epidemiology, classification, evaluation, and management of SCI-associated pain. PMID:24787340

  5. Pain management of wound care.

    PubMed

    Senecal, S J

    1999-12-01

    Children and adults still suffer pain during wound dressing changes despite national guidelines. Assessing and managing pain are essential components of comprehensive wound care. Developmentally sensitive pain assessment tools are available to measure verbal, behavioral, and physiologic responses to pain. Holistic pain assessment includes pain intensity, location, description, relief measures, cultural background, and the patient's developmental level and anxiety. Pharmacologic and nonpharmacologic interventions should be combined to manage pain based upon patient's response and nursing assessment. Nurses with a fundamental knowledge of pain assessment and management provide their patients with pain and symptom relief during wound care. PMID:10523438

  6. Management of painful neuropathies.

    PubMed

    Brix Finnerup, Nanna; Hein Sindrup, Sren; Staehelin Jensen, Troels

    2013-01-01

    Neuropathic pain is the most common type of pain in neuropathy. In painful polyneuropathies the pain usually has a "glove and stocking" distribution. The pain may be predominantly spontaneous, e.g., with a burning, pricking, or shooting character or characterized by evoked pain such as mechanical or cold allodynia. In the clinical setting, the prevention of painful neuropathies and treatment of underlying neuropathy remains inadequate and thus symptomatic treatment of the pain and related disability needs to be offered. Most randomized, double-blind, placebo-controlled trials (RCTs) published in painful neuropathy have been conducted in patients with diabetes and to what extent a treatment which is found effective in painful diabetic polyneuropathy can be expected to relieve other conditions like chemotherapy- or HIV-induced neuropathy is unknown. Tricyclic antidepressants (TCAs), gabapentin, pregabalin, and serotonin noradrenaline reuptake inhibitors (SNRIs) are first drug choices. In patients with localized neuropathic pain, a topical lidocaine patch may also be considered. Second-line treatments are tramadol and other opioids. New types of treatment include botulinum toxin type A (BTX-A), high-dose capsaicin patches, and cannabinoids. Other types of anticonvulsant drugs such as lamotrigine, oxcarbazepine, and lacosamide have a more questionable efficacy in painful polyneuropathy but may have an effect in a subgroup of patients. Combination therapy may be considered in patients with insufficient effect from one drug. Treatment is usually a trial-and-error process and has to be individualized to the single patient, taking into account all comorbidities such as possible concomitant depression, anxiety, diseases, and drug interactions. Side-effects to antidepressants include dry mouth, nausea, constipation, orthostatic hypotension, and sedation. ECG should always be obtained prior to treatment with TCAs, which also should not be used in patients with cardiac incompensation and epilepsy. The most common side-effects of gabapentin and pregabalin are CNS-related side-effects with dizziness and somnolence. Peripheral edema, weight gain, nausea, vertigo, asthenia, dry mouth, and ataxia may also occur. Topical treatments are better tolerated due to lack of systemic side-effects but there is still limited evidence for the long-term efficacy of these drugs. With available drugs, the average pain reduction is about 20-30%, and only 20-35% of the patients will achieve at least 50% pain reduction, which stresses the need of a multidisciplinary approach to pain treatment. PMID:23931787

  7. Pain Characteristics and Pain Catastrophizing in Incarcerated Women with Chronic Pain

    PubMed Central

    Darnall, Beth D.; Sazie, Elizabeth

    2016-01-01

    Chronic pain in incarcerated women is understudied and poorly described. Study objectives were to describe pain characteristics, correlates, and predictors in a convenience sample of incarcerated women with chronic pain. A survey packet that included the Brief Pain Inventory Short Form (BPI-SF) and the Pain Catastrophizing Scale (PCS) was distributed to all inmates at a state prison for women. Those who self-identified as having chronic pain ≥4 on a 0–10 numeric rating scale were invited to complete the survey. Demographics and medical and psychiatric diagnoses were abstracted by chart review. Participants (N=159) rated their current and average pain intensity as severe. Pain catastrophizing was found to predict average pain intensity and level of pain-related interference in functioning. Pain catastrophizing is treatable with behavioral intervention in the general population. Findings suggest that pain catastrophizing may be an important target for research and treatment in incarcerated women with chronic pain. PMID:22643606

  8. A Cross-Sectional Study of the Association of VDR Gene, Calcium Intake, and Heel Ultrasound Measures in Early Adulthood.

    PubMed

    Correa-Rodrguez, Mara; Schmidt Rio-Valle, Jacqueline; Gonzlez-Jimnez, Emilio; Rueda-Medina, Blanca

    2016-03-01

    The acquisition of a high adult peak bone mass (PBM) is considered an important determinant of osteoporotic risk later in life. Genetic and environmental factors determine optimal PBM acquisition in early adulthood. The aim of this study was to test the association of vitamin D receptor (VDR) gene polymorphisms and dietary calcium intake with the bone mass of young adults. The study population comprised a total of 305 individuals (mean age 20.41; SD 2.36) whose bone mass was assessed through heel ultrasound [quantitative ultrasound measurements (QUS)] measurements (BUA, dB/MHz). The FokI G/A, rs9729 G/T, and TaqI G/A polymorphisms were selected as genetic markers of VDR. A significant difference in BUA values was observed according to gender (females 82.96; SD 15.89 vs. males 97.72; SD 16.50; p<0.00001). The mean dietary calcium intake of the study group (827.84mg/day; SD 347.04) was lower than the dietary reference intake for young adults (1000mg/day) and had no association with BUA. None of the three VDR polymorphisms tested showed an association with BUA. Similarly, the analysis of VDR 3' haplotypes, estimated using rs9729 and Taq1 as tag SNPs, did not reveal any significant association with QUS traits. Our results confirm the existence of different heel QUS for women and men, as well as a tendency towards low calcium consumption by young adults, and they also suggest that the VDR gene does not play a major role in the genetic determination of QUS parameter in early adulthood. PMID:26590811

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

    SciTech Connect

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

    1998-09-01

    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.

  10. TelePain: A Community of Practice for Pain Management

    PubMed Central

    Meins, Alexa R.; Doorenbos, Ardith Z.; Eaton, Linda; Gordon, Debra; Theodore, Brian; Tauben, David

    2015-01-01

    Introduction Comprehensive pain management services are primarily located in urban areas, limiting specialist consultation opportunities for community healthcare providers. A community of practice (CoP) for pain management could create opportunities for consultation by establishing professional relationships between community healthcare providers and pain management specialists. A CoP is a group of people with a common concern, set of problems, or a passion for something they do. Members of a CoP for pain management increase their knowledge of evidence-based pain management strategies in a way that is meaningful and relevant. In this article, we provide evidence that TelePain, an interdisciplinary, case-based pain management teleconference consultation program through the University of Washington, qualifies as a CoP and present preliminary evidence of TelePain's effectiveness as a CoP for pain management. Methods Specific behaviors and conversations gathered through participant observation during TelePain sessions were analyzed based on the 14 indicators Wegner developed to evaluate the presence of a CoP. To demonstrate preliminary effectiveness of TelePain as a CoP for pain management, descriptive statistics were used to summarize TelePain evaluation forms. Results TelePain is an example of a successful CoP for pain management as demonstrated by the presence of Wegner's 14 indicators. Additionally, evaluation forms showed that TelePain enhanced community healthcare providers' knowledge of pain management strategies and that continued participation in TelePain lead to community healthcare providers' increased confidence in their ability to provide pain management. Conclusion TelePain, a CoP for pain management, facilitates multidisciplinary collaboration and allows members to develop interdisciplinary care plans for complex pain patients through case study discussions. Evidence-based pain management strategies gained through CoP membership could be disseminated to other healthcare providers in members' clinics, which has the potential of improving the care of chronic pain patients. PMID:25964869

  11. The pain management approach to chronic pelvic pain.

    PubMed

    Rapkin, A J; Kames, L D

    1987-05-01

    Chronic pelvic pain remains a difficult management problem that is often refractory to traditional medical or surgical therapy. The pain management center approach used successfully for the treatment of cancer pain and headache can be adapted to the treatment of chronic pelvic pain. The results of this pilot study suggest that the multidisciplinary techniques of pain management promise to be an effective modality for the treatment of chronic pelvic pain. PMID:2439689

  12. Chemical Interventions for Pain.

    ERIC Educational Resources Information Center

    Aronoff, Gerald M.; And Others

    1986-01-01

    Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,…

  13. Chemical Interventions for Pain.

    ERIC Educational Resources Information Center

    Aronoff, Gerald M.; And Others

    1986-01-01

    Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,

  14. Recurrent Abdominal Pain

    ERIC Educational Resources Information Center

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols

  15. Complex Regional Pain Syndrome

    MedlinePLUS

    ... works, it may be repeated. Physical therapy and psychological counseling are also helpful. However, a treatment that ... my pain? If my injury has healed, why am I still in pain? Do I need any tests? What is the best treatment option for me? ...

  16. Pseudoachondroplasia and painful sequelae.

    PubMed

    Gamble, Candace; Nguyen, Joanne; Hashmi, S Shahrukh; Hecht, Jacqueline T

    2015-11-01

    Pseudoachondroplasia (PSACH) is a well-described autosomal dominant short limb dwarfing condition caused by mutations in the cartilage oligomeric matrix protein gene (COMP). The most debilitating complication of the disorder is joint pain starting in childhood, the extent and severity of which is poorly defined. The aim of this study was to fully assess the pain and identify additional clinical complications affecting those with PSACH. An online survey was distributed to individuals with PSACH. Of the 77 surveys analyzed, 83% reported chronic pain starting as early as the newborn period. Pain was most frequently reported in weight bearing joints including the knees, hips, and back, and significantly interfered with their overall quality of life. For pain relief, patients with PSACH used a wide variety of treatments. However, patients reported only a 60% resolution of pain with their current treatments. An increase in other comorbidities was not found, specifically osteoporosis was not increased. This study documents for the first time that pain is the most common presenting symptom in PSACH and is often overlooked until short stature becomes obvious. The recognition of chronic pain as one of the earliest manifestations of PSACH is important to allow for prompt diagnosis. PMID:26177939

  17. Lower Back Pain

    MedlinePLUS

    ... If your pain is severe, if you have lost feeling or movement, or if you have lost control of your bladder or bowels, see your ... If your pain is severe, if you have lost feeling or movement, or if you have lost ...

  18. Biomechanics of back pain.

    PubMed

    Adams, Michael A

    2004-12-01

    This paper offers a mechanistic account of back pain which attempts to incorporate all of the most important recent advances in spinal research. Anatomical and pain-provocation studies show that severe and chronic back pain most often originates in the lumbar intervertebral discs, the apophyseal joints, and the sacroiliac joints. Psychosocial factors influence many aspects of back pain behaviour but they are not important determinants of who will experience back pain in the first place. Back pain is closely (but not invariably) associated with structural pathology such as intervertebral disc prolapse and endplate fractures, although age-related biochemical changes such as those revealed by a 'dark disc' on MRI have little clinical relevance. All features of structural pathology (including disc prolapse) can be re-created in cadaveric specimens by severe or repetitive mechanical loading, with a combination of bending and compression being particularly harmful to the spine. Structural disruption alters the mechanical environment of disc cells in a manner that leads to cell-mediated degenerative changes, and animal experiments confirm that surgical disruption of a disc is followed by widespread disc degeneration. Some people are more vulnerable to spinal degeneration than others, largely because of their genetic inheritance. Age-related biochemical changes and loading history can also affect tissue vulnerability. Finally the concept of 'functional pathology' is introduced, according to which, back pain can arise because postural habits generate painful stress concentrations within innervated tissues, even though the stresses are not high enough to cause physical disruption. PMID:15628775

  19. Recurrent Abdominal Pain

    ERIC Educational Resources Information Center

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  20. Chronic Pain Medicines

    MedlinePLUS

    ... to take, ask your doctor or your pharmacist. Acetaminophen Acetaminophen (one brand name: Tylenol) helps many kinds of chronic pain. Remember, many over-the-counter and prescription pain medicines have acetaminophen in them. If you're not careful, you ...

  1. Post surgical pain treatment - adults

    MedlinePLUS

    Postoperative pain relief ... Pain that occurs after surgery is an important concern. Before your surgery, you and your surgeon may have discussed how much pain you should expect and how it will be ...

  2. Breastfeeding FAQs: Pain and Discomfort

    MedlinePLUS

    ... Your Child All About Food Allergies Breastfeeding FAQs: Pain and Discomfort KidsHealth > For Parents > Breastfeeding FAQs: Pain ... a smaller size. Is it normal to feel pain during or after nursing? If your baby is ...

  3. Epidural injections for back pain

    MedlinePLUS

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... procedure does not cure the cause of your back pain. You will need to continue back exercises and ...

  4. Back Pain Facts and Statistics

    MedlinePLUS

    ... Kids and Sports Exercising Outdoors with Baby Gardening Back Pain Facts and Statistics Although doctors of chiropractic (DCs) ... time. 1 A few interesting facts about back pain: Low back pain is the single leading cause of disability ...

  5. An archaeology of pain

    NASA Astrophysics Data System (ADS)

    Gruber, Dennis Michael

    Pain is a discursive construct of science and medicine. Through the discourses of biopower and technoscience pain is used to construct and maintain the social body. Biopower and technoscience are discursive practices that are enveloped within the disciplines of Western society. Specifically, the disciplines of education, science, and medicine use biopower and technoscience to normalize the body and construct binaries which create the abnormal. The cyborg is a discursive practice used to implode the binaries of the disciplines which maintain the social body. Through the implosion of binaries, the binary of mind/body is no longer plausible in the explanation of pain. Neuropathic chronic pain and phantom limb pain become cyborg discourses which operate to deconstruct the pedagogies of science and medicine.

  6. Musculoskeletal chest wall pain

    PubMed Central

    Fam, Adel G.; Smythe, Hugh A.

    1985-01-01

    The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

  7. Postoperative pain management

    PubMed Central

    Kolettas, Alexandros; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Lampaki, Sofia; Karavergou, Anastasia; Pataka, Athanasia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos

    2015-01-01

    Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects. PMID:25774311

  8. [Groin pain in athletes].

    PubMed

    Sanders, Rick J M; Kokshoorn, Arjan P J; Kolkman, Karel A; van der Wal, Wybren A; van Loon, Corn J M

    2014-01-01

    Groin pain in young athletes is a common problem, accounting for significant downtime in sports participation. It can be difficult to make the correct diagnosis as groin pain has a wide differential diagnosis, which encompasses acute as well as chronic causative factors. In this article this is illustrated by presenting three cases of patients who attended our hospital. In all three cases the main complaint was sports-related groin pain, and the patients presented with very similar symptoms. However, after further investigation the patients were diagnosed with three very different types of injury: sportsman's hernia; hip labral tear; and pubic osteitis. This emphasises the need for every general practitioner and medical specialist to understand that there is a wide differential diagnosis for groin pain in athletes, in order to be able to implement specific therapy targeting the actual cause of groin pain. PMID:25315329

  9. Pain phenomena and possible mechanisms in patients with painful polyneuropathy.

    PubMed

    Otto, Marit; Bak, Sren; Bach, Flemming W; Jensen, Troels S; Sindrup, Sren H

    2003-01-01

    Painful polyneuropathy is a common neuropathic pain condition characterized by different typical pain phenomena and symptoms. The present study determined the frequency of pain phenomena and signs in painful polyneuropathy, and compared the symptomatology in patients with signs of increased small fiber response with that in patients with signs of deafferentation. Eighty-one consecutive patients with painful polyneuropathy were studied. The most common pain phenomena were deep aching pain (88%) and pain on pressure (69%), followed by pain paroxysms (59%) and less frequently pain on light touch (31%). Patients with increased cold and heat detection thresholds were more likely to have pain paroxysms (odds ratio (OR) 2.5 and 5.2) and patients with pain summation on repetitive mechanical stimulation more often had touch-evoked pain (OR=4.0) than patients without these phenomena. Findings compatible with increased small fiber response were found in six patients (7.4%), in 41 (50.6%) unequivocal signs of deafferentation were found, and 34 patients (42%) could not be classified. There was no significant difference in presenting symptoms between these groups. In conclusion, in painful polyneuropathy, (1). deep aching pain is the most frequently reported pain symptom; (2). the association between pain paroxysms with decreased small fiber function and touch-evoked pain with abnormal pain summation on mechanical stimulation indicate that central nervous system mechanisms are responsible for these symptoms; (3). sensitized small fibers as the single mechanism of pain is rare; and (4). pain symptomatology cannot predict pain mechanisms as being mainly deafferentation or sensitized small fibers. PMID:12507713

  10. Spirituality and Religion in Pain and Pain Management

    PubMed Central

    Dedeli, Ozden; Kaptan, Gulten

    2013-01-01

    Pain relief is a management problem for many patients, their families, and the medical professionals caring for them. Although everyone experiences pain to some degree, responses to it vary from one person to another. Recognizing and specifying someone else’s pain is clinically a well know challenge. Research on the biology and neurobiology of pain has given us a relationship between spirituality and pain. There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelations among biological, psychological, social, and spiritual factors. Patients with pain use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual factors, such as prayers, and seeking spiritual support to manage their pain. This article provides an overview of the complex phenomenon of pain, with a focus on spiritual and religious issues in pain management. PMID:26973914

  11. Nonpharmacologic interventions for pain management.

    PubMed

    Doody, S B; Smith, C; Webb, J

    1991-03-01

    Managing pain is a complex and inexact science. Acute and chronic pain physically and psychologically affects and disables an overwhelming number of people. Nonpharmacologic interventions for pain management have been reviewed. These methods can be used independently or in combination with other nonpharmacologic or pharmacologic methods of pain control. The goals of nonpharmacologic interventions for pain management include the reduction of pain, minimal adverse effects, and allowing patients to become active participants in their own care. Nurses are called on many times to comfort patients in pain. It is through their expertise and intervention that the goals of pain management succeed. PMID:2043331

  12. Increased Pressure Pain Sensitivity in Women With Chronic Pelvic Pain

    PubMed Central

    As-Sanie, Sawsan; Harris, Richard E.; Harte, Steven E.; Tu, Frank F.; Neshewat, Gina; Clauw, Daniel J.

    2013-01-01

    OBJECTIVE To determine if women with chronic pelvic pain and variable degrees of endometriosis demonstrate altered pain sensitivity relative to pain-free healthy controls, and whether such differences are related to the presence or severity of endometriosis or comorbid pain syndromes. METHODS Four patient subgroups (endometriosis with chronic pelvic pain (n=42), endometriosis with dysmenorrhea (n=15), pain-free endometriosis (n=35), and chronic pelvic pain without endometriosis (n=22)) were each compared to 30 healthy controls in this cross-sectional study. All patients completed validated questionnaires regarding pain symptoms and underwent screening for comorbid pain disorders. Pain sensitivity was assessed by applying discrete pressure stimuli to the thumbnail using a previously validated protocol. RESULTS While adjusting for age and education, pain thresholds were lower in all subgroups of women with pelvic pain, relative to healthy controls (all p-values <0.01). There was no difference in pain thresholds when comparing endometriosis patients without pelvic pain to healthy controls (mean difference 0.02 kg/m2, 95% confidence interval -0.43, 0.47). The presence and severity of endometriosis and number of comorbid pain syndromes were not associated with a difference in pain thresholds. CONCLUSION Women with chronic pelvic pain demonstrate increased pain sensitivity at a nonpelvic site compared to healthy controls, which is independent of the presence or severity of endometriosis or comorbid pain syndromes. These findings support the notion that central pain amplification may play a role in the development of pelvic pain, and may explain why some women with pelvic pain do not respond to therapies aimed at eliminating endometriosis lesions. PMID:24104772

  13. Pain Catastrophising Affects Cortical Responses to Viewing Pain in Others

    PubMed Central

    Fallon, Nicholas

    2015-01-01

    Pain catastrophising is an exaggerated cognitive attitude implemented during pain or when thinking about pain. Catastrophising was previously associated with increased pain severity, emotional distress and disability in chronic pain patients, and is also a contributing factor in the development of neuropathic pain. To investigate the neural basis of how pain catastrophising affects pain observed in others, we acquired EEG data in groups of participants with high (High-Cat) or low (Low-Cat) pain catastrophising scores during viewing of pain scenes and graphically matched pictures not depicting imminent pain. The High-Cat group attributed greater pain to both pain and non-pain pictures. Source dipole analysis of event-related potentials during picture viewing revealed activations in the left (PHGL) and right (PHGR) paraphippocampal gyri, rostral anterior (rACC) and posterior cingulate (PCC) cortices. The late source activity (600–1100 ms) in PHGL and PCC was augmented in High-Cat, relative to Low-Cat, participants. Conversely, greater source activity was observed in the Low-Cat group during the mid-latency window (280–450 ms) in the rACC and PCC. Low-Cat subjects demonstrated a significantly stronger correlation between source activity in PCC and pain and arousal ratings in the long latency window, relative to high pain catastrophisers. Results suggest augmented activation of limbic cortex and higher order pain processing cortical regions during the late processing period in high pain catastrophisers viewing both types of pictures. This pattern of cortical activations is consistent with the distorted and magnified cognitive appraisal of pain threats in high pain catastrophisers. In contrast, high pain catastrophising individuals exhibit a diminished response during the mid-latency period when attentional and top-down resources are ascribed to observed pain. PMID:26186545

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

    PubMed Central

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

    2012-01-01

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

  15. Pain in the Elderly.

    PubMed

    Jones, Mark R; Ehrhardt, Ken P; Ripoll, Juan G; Sharma, Bharat; Padnos, Ira W; Kaye, Rachel J; Kaye, Alan D

    2016-03-01

    Pain management in the elderly has increasingly become problematic in the USA as the aged population grows. The proportion of the population over 65 continues to climb and may eclipse 20 % in the next decade. In order to effectively diagnosis and treat these patients, a proper history and physical exam remain essential; pain assessment scales such as the Verbal Descriptor Scales (VDS), the Numerical Rating Scales (NRS), and the Visual Analogue Scales (VAS) often but not always prove beneficial. The conditions most frequently afflicting this population include osteoarthritis, diabetic neuropathy, post-herpetic neuralgia, and lower back pain which include spondylosis and radiculopathies. While the normal aging process does not necessarily guarantee symptoms of chronic pain, elderly individuals are far more likely to develop these painful conditions than their younger counterparts. There are many effective treatment modalities available as potential therapeutic interventions for elderly patients, including but not limited to analgesics such as NSAIDs and opioids, as well as multiple interventional pain techniques. This review will discuss chronic pain in the elderly population, including epidemiology, diagnostic tools, the multitude of co-morbidities, and common treatment modalities currently available to physicians. PMID:26896947

  16. Neuropathic pain in leprosy.

    PubMed

    Raicher, Irina; Stump, Patrick Raymond Nicolas Andre Ghislain; Baccarelli, Rosemari; Marciano, Lucia H S C; Ura, Somei; Virmond, Marcos C L; Teixeira, Manoel Jacobsen; Ciampi de Andrade, Daniel

    2016-01-01

    Nerve impairment is a key clinical aspect of leprosy and may present the distribution of mononeuropathy or multiple nerve trunks, small cutaneous nerve fibers, and free nerve endings. The clinical range of leprosy is determined by individual cell-mediated immune response to infection that also may play a role in different types of pain syndromes in leprosy. Previous studies reported a high prevalence of neuropathic pain in leprosy. In an Ethiopian study with 48 patients, pure nociceptive pain was experienced by 43% of patients and pure neuropathic pain (NeP) by 11% of patients. In an Indian study, 21.8% of leprosy patients had pain with neuropathic characteristics. These rates underlie the need to develop tools for the early diagnosis and detection of infection and its complications, such as nerve damage and pain. In a larger sample with leprosy-associated NeP (n = 90), we have applied the Douleur Neuropathique en 4 questions (DN4) and found sensitivity = 97.1% and specificity = 57.9%. The high sensitivity of this tool in leprosy patients suggests that it could be a valuable tool to screen for neuropathic pain in this population and could be used as part of health care programs aimed at detecting, treating, and rehabilitating leprosy in endemic areas. PMID:26773624

  17. Assessment of pain

    PubMed Central

    Al-Quliti, Khalid W.; Alamri, Majed S.

    2015-01-01

    Objective: To present data on knowledge and attitudes toward pain assessment among health care providers in Almadinah Almunawwarah, Saudi Arabia. Methods: This exploratory study required at least 100 participants to attain an effect size of 0.2 or larger. A convenience sample was recruited from the major hospitals in Almadinah Almunawwarah, Saudi Arabia; King Fahad Hospital, Ohud Hospital, Alansar Hospital, Almeqat Hospital, and the Maternity Hospital. Data collection occurred between January and April 2014. Knowledge of pain assessment was examined by administering the Knowledge and Attitudes Survey Regarding Pain. Results: Data from 105 participants was collected. Seventy-three participants scored 44% or below (69.5%), and 32 participants scored 45% and above (30.5%). Additionally, only 6 participants (5.7%) scored above 60%. There were significant differences between male and female scores (p=0.05), physicians and nurses scores (p=0.001), and level of education (p=0.009). There were no significant differences in the passing scores across means of nationality, the department where participants worked, years of experience, and age of participants. Conclusion: There is a deficit in pain assessment knowledge, and pain management in the study group. Continuous education on pain assessment is required to increase the health care providers knowledge, and enhance their practices regarding pain assessment and treatment. PMID:25864065

  18. Low back pain.

    PubMed Central

    Ehrlich, George E.

    2003-01-01

    Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. PMID:14710509

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

    PubMed

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

    2014-06-01

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

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

    PubMed Central

    Moayyeri, Alireza; Hsu, Yi-Hsiang; Karasik, David; Estrada, Karol; Xiao, Su-Mei; Nielson, Carrie; Srikanth, Priya; Giroux, Sylvie; Wilson, Scott G.; Zheng, Hou-Feng; Smith, Albert V.; Pye, Stephen R.; Leo, Paul J.; Teumer, Alexander; Hwang, Joo-Yeon; Ohlsson, Claes; McGuigan, Fiona; Minster, Ryan L.; Hayward, Caroline; Olmos, Jos M.; Lyytikinen, 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, sa; Hicks, Andrew A.; Pludowski, Pawel; Scott, Rodney; Dhonukshe-Rutten, Rosalie A.M.; van der Velde, Nathalie; Khnen, Mika; Viikari, Jorma S.; Sievnen, Harri; Raitakari, Olli T.; Gonzlez-Macas, Jess; Hernndez, Jose L.; Mellstrm, Dan; Ljunggren, sten; Cho, Yoon Shin; Vlker, Uwe; Nauck, Matthias; Homuth, Georg; Vlzke, 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.; Lehtimki, Terho; Riancho, Jos 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, Franois; Orwoll, Eric; Cummings, Steven R.; Wareham, Nick J.; Rivadeneira, Fernando; Uitterlinden, Andre G.; Prince, Richard L.; Kiel, Douglas P.; Reeve, Jonathan; Kaptoge, Stephen K.

    2014-01-01

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

  1. Evaluating pain in intensive care.

    PubMed

    Suominen, Hanna; Lundgrn-Laine, Helj; Salanter, Sanna; Salakoski, Tapio

    2009-01-01

    Optimal pain management is essential for good care outcomes, but assessing pain is particularly complex in intensive care, as patients are often unable to communicate. We hypothesize that the task could be supported through human language technology. To evaluate the feasibility of such tools, we study how pain is documented in electronic Finnish free-text intensive care nursing notes by statistically comparing annotations of ten nursing professionals on a set of 1548 documents. The aspects considered include the amount and writing style of pain-related notes, pain intensity, and given pain care. More than half of the documents contained information relevant for patients' pain status but it was expressed usually indirectly. Also pain medication was commented as free-text. Although annotators' pain intensity evaluations diverged, the substantial amount of pain-related notes encourages developing computational tools for pain assessment. PMID:19592833

  2. Systematic pain assessment in horses.

    PubMed

    de Grauw, J C; van Loon, J P A M

    2016-03-01

    Accurate recognition and quantification of pain in horses is imperative for adequate pain management. The past decade has seen a much needed surge in formal development of systematic pain assessment tools for the objective monitoring of pain in equine patients. This narrative review describes parameters that can be used to detect pain in horses, provides an overview of the various pain scales developed (visual analogue scales, simple descriptive scales, numerical rating scales, time budget analysis, composite pain scales and grimace scales), and highlights their strengths and weaknesses for potential clinical implementation. The available literature on the use of each pain assessment tool in specific equine pain states (laminitis, lameness, acute synovitis, post-castration, acute colic and post-abdominal surgery) is discussed, including any problems with sensitivity, reliability or scale validation as well as translation of results to other clinical pain states. The review considers future development and further refinement of currently available equine pain scoring systems. PMID:26831169

  3. [Physiology of pain].

    PubMed

    Messlinger, K; Handwerker, H O

    2015-10-01

    Pain research is based broadly on physiological disciplines and its development follows the methodological progress of the era, from classical psychophysiology to electrophysiological investigations at peripheral and central nociceptive systems, single cells and ion channels to modern imaging of nociceptive processing. Physiological pain research in Germany has long been part of an interdisciplinary research network extending beyond all political boundaries, and this situation has continued since molecular techniques started to dominate all biomedical research. Current scientific questions, such as intracellular nociceptive signal mechanisms, interactions with other physiological systems including the immune system, or the genetic basis of epidemic and chronic pain diseases can only be solved interdisciplinary and with international collaboration. PMID:26351125

  4. [Chronic pain and depression].

    PubMed

    Rentsch, D; Piguet, V; Cedraschi, C; Desmeules, J; Luthy, C; Andreoli, A; Allaz, A F

    2009-06-17

    Chronic pain and depression are frequently associated. Links between them are numerous and well documented. It is known for example that depression is associated with a greater number and higher intensity of pain symptoms. Similarly the presence of pain complicates the diagnostic evaluation and aggravates the prognosis of depression. The question of the causality link has no clear answer. Taking care of these patients implies to acknowledge the different aspects of their suffering in a holistic bio-psycho-social model. Treatment or medication, for instance antidepressants, should be a post-scriptum to the construction of a therapeutic relationship. PMID:19626761

  5. Nonspecific Arm Pain

    PubMed Central

    Moradi, Ali; Ebrahimzadeh, Mohammad H; Ring, David

    2013-01-01

    Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness. PMID:25207288

  6. Animal Models of Cancer Pain

    PubMed Central

    Pacharinsak, Cholawat; Beitz, Alvin

    2008-01-01

    Modern cancer therapies have significantly increased patient survival rates in both human and veterinary medicine. Since cancer patients live longer they now face new challenges resulting from severe, chronic tumor-induced pain. Unrelieved cancer pain significantly decreases the quality of life of such patients; thus the goal of pain management is to not only to alleviate pain, but also to maintain the patient's physiological and psychological well-being. The major impediment for developing new treatments for cancer pain has been our limited knowledge of the basic mechanisms that drive cancer pain and the lack of adequate animal cancer pain models to study the molecular, biochemical and neurobiological pathways that generate and maintain cancer pain. However this situation has recently changed with the recent development of several novel animal models of cancer pain. This review will focus on describing these animal models, many of them in rodents, and reviewing some of the recent information gained from the use of these models to investigate the basic mechanims that underlie the development and maintenance of cancer pain. Animal models of cancer pain can be divided into the following five categories: bone cancer pain models, non-bone cancer pain models, cancer invasion pain models, cancer chemotherapeutic-induced peripheral neuropathy models, and spontaneous occurring cancer pain models. These models will be important not only for enhancing our knowledge of how cancer pain is generated, but more importantly for the development of novel therapeutic regimes to treat cancer pain in both domestic animals and humans. PMID:18589864

  7. Over-the-counter pain relievers

    MedlinePLUS

    ... Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine - over-the-counter; Pain medicine - OTC ... Pain medicines are also called analgesics. Each kind of pain medicine has benefits and risks. Some types of pain ...

  8. [Phantom limb pains].

    PubMed

    Giraux, Pascal

    2015-03-01

    With the radical experience of an amputation, the adaptation of body image is often incomplete. Some people experience phantom body perceptions, often painful and difficult to treat, after the amputation of a limb. PMID:26145132

  9. Hepatitis C: Managing Pain

    MedlinePLUS

    ... techniques are used together, they can make a big difference. A stretching and exercise routine Sometimes, working ... reduce symptoms of depression, you can make a big impact on your pain. Conventional medical interventions Your ...

  10. Pain Management Programs

    MedlinePLUS

    ... ideas and share insights is key to the team working together for the common good of those in ... things: Qualities of a Well-Functioning Interdisciplinary Pain Team Share ... centered Work together for common, agreed upon goals Develop treatment ...

  11. Diet and Pain

    MedlinePLUS

    ... By Emily McCloud, RD Rheumatoid Arthritis: Lifestyle Management Diet and Pain Many people who suffer from chronic ... and risks associated with diet restrictions. Vegan/Vegetarian Diets Vegan/Vegetarian diets are composed predominantly of plant ...

  12. Pain in Bali.

    PubMed

    Rajagopal, M R; Ito, Kurnia

    2015-12-01

    There is a lot of unrelieved pain in developing countries. Here is a story from Bali, Indonesia, about a woman with advanced malignancy, who is in unbelievable agony. Expensive chemotherapy is available to her. But although the necessary medications for relieving her pain are available in hospitals, they do not reach the patient, in her home, or even when she is admitted to the hospital, because of ignorance of the medical profession about pain management and because of unnecessary regulatory restrictions. The woman's pain affects the whole family, endangering the family's income and the future of her children. The intervention of palliative care during part of her life gives her some relief, only for the agony to be repeated by pointless chemotherapy and neglect of the suffering during admission to the hospital. Whatever relief could be given to her was because of the intervention of a volunteer with no schooling in medicine or palliative care. PMID:26654417

  13. Veterans and chronic pain

    PubMed Central

    Wilson, Sarah

    2013-01-01

    Summary points 1. Musculoskeletal problems are the commonest reason for medical discharge in all the British armed forces. By definition, these problems are chronic and resistant to treatment. 2. Pain is also common in veterans who have experienced severe injuries (polytrauma), often accompanied by post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) orpostconcussive syndrome. 3. In veterans seeking treatment for chronic pain, PTSD is common. There is also evidence for elevated levels of alcohol misuse in veterans who have been deployed to conflict. However, most veterans do not have pain, PTSD or alcohol problems. 4. Pain clinicians would benefit from training in meeting veterans’ needs, in order to promote their engagement and successful treatment. This should include countering stereotypes, information about the military and support for the assessment and onward referral of PTSD and alcohol problems. PMID:26516504

  14. Migraines: What a Pain!

    MedlinePLUS

    ... migrañas: ¡Vaya dolor! Emily remembers her first bad headache. "It was really scary. The pain was unbelievable ... But a migraine is worse than a regular headache. Migraines usually occur about one to four times ...

  15. Treating Low Back Pain

    MedlinePLUS Videos and Cool Tools

    ... health news that matters to you. Related MedlinePlus Health Topics Back Injuries Back Pain About MedlinePlus Site ... Rockville Pike, Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page ...

  16. [Greater trochanteric pain syndrome].

    PubMed

    Gollwitzer, H; Opitz, G; Gerdesmeyer, L; Hauschild, M

    2014-01-01

    Greater trochanteric pain is one of the common complaints in orthopedics. Frequent diagnoses include myofascial pain, trochanteric bursitis, tendinosis and rupture of the gluteus medius and minimus tendon, and external snapping hip. Furthermore, nerve entrapment like the piriformis syndrome must be considered in the differential diagnosis. This article summarizes essential diagnostic and therapeutic steps in greater trochanteric pain syndrome. Careful clinical evaluation, complemented with specific imaging studies and diagnostic infiltrations allows determination of the underlying pathology in most cases. Thereafter, specific nonsurgical treatment is indicated, with success rates of more than 90 %. Resistant cases and tendon ruptures may require surgical intervention, which can provide significant pain relief and functional improvement in most cases. PMID:24414233

  17. Pain in Parkinson's Disease

    MedlinePLUS

    ... emotional factors. Scientists have shown that depression, which affects approximately 40 percent of individuals diagnosed with Parkinson’s, plays an important role in the way people perceive pain. Similarly, tension and muscle stress caused by anxiety can compound ...

  18. Complex regional pain syndrome

    MedlinePLUS

    CRPS; RSDS; Causalgia - RSD; Shoulder-hand syndrome; Reflex sympathetic dystrophy syndrome; Sudeck atrophy ... Doctors are not sure what causes CRPS. In some cases, the sympathetic ... role in the pain. Another theory is that CRPS is caused by ...

  19. Evaluation of pain in healthy newborns and in newborns with developmental problems (Down syndrome).

    PubMed

    Aguilar Cordero, Maria José; Mur Villar, Norma; García García, Inmaculada

    2015-06-01

    Newborns are often subjected to invasive and painful medical procedures. This happens even more frequently when they require hospitalization. The aim of this paper was to evaluate pain in healthy newborns and in newborns with Down syndrome (DS). We performed a prospective cohort study in the neonatal service of the San Cecilio University Hospital in Granada (Spain) from January 2008 to September 2013. The universe of our study comprised a study group of 20 newborns with DS and a control group of 20 newborns without DS. All of the infants were hospitalized, and thus had to undergo painful medical procedures. The variables studied were basal recovery time (as reflected in crying and the normalization of biological constants), number of punctures, oxygen saturation, heartbeat, blood pressure, response to skin-to-skin contact, and gestational age. The evaluation was performed during blood extraction, vein canalization, and heel puncture. The significant differences in the basal recovery time between the two groups of newborns indicated that those with DS were slower to express pain, and when they did, their response was not as clearly defined as that of babies without DS. The oxygen saturation in babies with DS after the puncture was found to be significantly lower than that of the control group (p < .001). The results of this study revealed that babies with DS were not as quick to perceive pain after a puncture. However, when pain was finally perceived, it persisted for a longer time. This situation should be taken into account in the design of pharmacologic and nonpharmacologic therapies. PMID:25439126

  20. Exercise-induced pain intensity predicted by pre-exercise fear of pain and pain sensitivity

    PubMed Central

    Bishop, Mark D; Horn, Maggie E; George, Steven Z

    2011-01-01

    Objectives Our primary goals were to determine whether pre-existing fear of pain and pain sensitivity contributed to post-exercise pain intensity. Methods Delayed onset muscle pain was induced in the trunk extensors of 60 healthy volunteers using an exercise paradigm. Levels of fear of pain and experimental pain sensitivity were measured before exercise. Pain intensity in the low back was collected at 24 and 48 hours post-exercise. Participants were grouped based on pain intensity. Group membership was used as the dependent variable in separate regression models for 24 and 48 hours. Predictor variables included fear, pain sensitivity, torque lost during the exercise protocol, and demographic variables. Results The final models predicting whether a participant reported clinically meaningful pain intensity at 24 hours only included baseline fear of pain at each level of pain intensity tested. The final model at 48 hours included average baseline pain sensitivity and the loss of muscle performance during the exercise protocol for one level of pain intensity tested (greater than 35mm out of 100). Discussion Combined, these findings suggest that the initial reports of pain after injury maybe more strongly influenced by fear while the inflammatory process and pain sensitivity may play a larger role for later pain intensity reports. PMID:21415719

  1. Buprenorphine for chronic pain.

    PubMed

    Calderon, Raul; Copenhaver, David

    2013-12-01

    Questions from patients about pain conditions, analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The use of transdermal buprenorphine for chronic pain management is discussed. A brief history of the medication is provided. The use of the medication in opioid maintenance, and withdrawal and other concerns are discussed. Possible side effects are described. PMID:24245573

  2. Discogenic low back pain.

    PubMed

    Simon, Jeremy; McAuliffe, Matthew; Shamim, Fehreen; Vuong, Nancy; Tahaei, Amir

    2014-05-01

    Most lumbar disk herniations improve over time with or without medical treatment. Disk herniations and annular tears may not be symptomatic and are shown to exist in patients without any symptoms. In some patients, chronic low back pain may result from the syndrome of internal disk disruption. Treatment of chronic pain of diskal cause can be challenging and have varying results in terms of success. The diagnosis, cause, and treatment options are reviewed in this article. PMID:24787335

  3. Low back pain (acute)

    PubMed Central

    2011-01-01

    Introduction Low back pain affects about 70% of people in resource-rich countries at some point in their lives. Acute low back pain can be self-limiting; however, 1 year after an initial episode, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. Acute low back pain has a high recurrence rate; 75% of those with a first episode have a recurrence. Although acute episodes may resolve completely, they may increase in severity and duration over time. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatments for acute low back pain? What are the effects of local injections for acute low back pain? What are the effects of non-drug treatments for acute low back pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics (paracetamol, opioids), back exercises, back schools, bed rest, behavioural therapy, electromyographic biofeedback, epidural corticosteroid injections, lumbar supports, massage, multidisciplinary treatment programmes, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulation, temperature treatments (short-wave diathermy, ultrasound, ice, heat), traction, and transcutaneous electrical nerve stimulation (TENS). PMID:21549023

  4. Cancer treatment: dealing with pain

    MedlinePLUS

    ... is causing pain. Chemotherapy . These medicines can also shrink a tumor to reduce pain. Surgery . Your provider may use surgery to remove a tumor that is causing pain. In some cases, a type of brain surgery can cut the nerves that carry pain ...

  5. Chiropractic care for back pain

    MedlinePLUS

    ... for problems that might be adding to your back pain. Treatment begins at the first or second visit ... Chiropractic treatment is most effective for: Subacute back pain ... or less) Flare-ups of chronic (long-term) back pain Neck pain

  6. Outcome of neurolysis for failed tarsal tunnel surgery.

    PubMed

    Barker, Allison R; Rosson, Gedge D; Dellon, A Lee

    2008-02-01

    Revision tarsal tunnel surgery was performed on 44 patients (two bilaterally). The surgical procedure included a neurolysis of the tibial nerve in the tarsal tunnel, the medial plantar, lateral plantar, and calcaneal nerves in their respective tunnels, excision of the intertunnel septum, and neuroma resection as indicated. A painful tarsal tunnel scar or painful heel was treated, respectively, by resection of the distal saphenous nerve or a calcaneal nerve branch. Postoperative, immediate ambulation was permitted. Outcomes were assessed with a numerical grading scale that included neurosensory measurements. Outcomes were also assessed by patient satisfaction and their own estimate of residual pain and/or numbness. Mean follow-up time was 2.2 years. Outcomes in terms of patient satisfaction were 54% excellent, 24% good, 13% fair, and 9% poor results. The mean preoperative numerical score was 6.0 and the mean postoperative score was 2.7. There was a significant improvement seen, based on the median difference between scores (P<0.001). Prognostic indicators of poor results in our patient group were coexisting lumbosacral disc disease and/or neuropathy. An approach related to resecting painful cutaneous nerves and neurolysis of all tibial nerve branches at the ankle offers hope for relief of pain and recovery of sensation for the majority of patients with failed previous tarsal tunnel surgery. PMID:18473284

  7. Mechanisms of Myofascial Pain

    PubMed Central

    Jafri, M. Saleet

    2014-01-01

    Myofascial pain syndrome is an important health problem. It affects a majority of the general population, impairs mobility, causes pain, and reduces the overall sense of well-being. Underlying this syndrome is the existence of painful taut bands of muscle that contain discrete, hypersensitive foci called myofascial trigger points. In spite of the significant impact on public health, a clear mechanistic understanding of the disorder does not exist. This is likely due to the complex nature of the disorder which involves the integration of cellular signaling, excitation-contraction coupling, neuromuscular inputs, local circulation, and energy metabolism. The difficulties are further exacerbated by the lack of an animal model for myofascial pain to test mechanistic hypothesis. In this review, current theories for myofascial pain are presented and their relative strengths and weaknesses are discussed. Based on new findings linking mechanoactivation of reactive oxygen species signaling to destabilized calcium signaling, we put forth a novel mechanistic hypothesis for the initiation and maintenance of myofascial trigger points. It is hoped that this lays a new foundation for understanding myofascial pain syndrome and how current therapies work, and gives key insights that will lead to the improvement of therapies for its treatment. PMID:25574501

  8. Tradeoffs between impact loading rate, vertical impulse and effective mass for walkers and heel strike runners wearing footwear of varying stiffness.

    PubMed

    Addison, Brian J; Lieberman, Daniel E

    2015-05-01

    Humans experience repetitive impact forces beneath the heel during walking and heel strike running that cause impact peaks characterized by high rates and magnitudes of loading. Impact peaks are caused by the exchange of momentum between the ground and a portion of the body that comes to a full stop (the effective mass) during the period of the impact peak. A number of factors can influence this exchange of momentum, including footwear stiffness. This study presents and tests an impulse-momentum model of impact mechanics which predicts that effective mass and vertical impulse is greater in walkers and heel strike runners wearing less stiff footwear. The model also predicts a tradeoff between impact loading rate and effective mass, and between impact loading rate and vertical impulse among individuals wearing footwear of varying stiffness. We tested this model using 19 human subjects walking and running in minimal footwear and in two experimental footpads. Subjects walked and ran on an instrumented treadmill and 3D kinematic data were collected. As predicted, both vertical impulse (walking: F(2,54)=52.0, p=2.6E-13; running: F(2,54)=25.2, p=1.8E-8) and effective mass (walking: F(2,54)=12.1, p=4.6E-5; running: F(2,54)=15.5, p=4.7E-6) increase in less stiff footwear. In addition, there is a significant inverse relationship between impact loading rate and vertical impulse (walking: r=-0.88, p<0.0001; running: r=-0.78, p<0.0001) and between impact loading rate and effective mass (walking: r=-0.88, p<0.0001; running: r=-0.82, p<0.0001). The tradeoff relationships documented here raise questions about how and in what ways the stiffness of footwear heels influence injury risk during human walking and running. PMID:25814181

  9. Epigenetic regulation of persistent pain

    PubMed Central

    Bai, Guang; Ren, Ke; Dubner, Ronald

    2014-01-01

    Persistent or chronic pain is tightly associated with various environmental changes and linked to abnormal gene expression within cells processing nociceptive signaling. Epigenetic regulation governs gene expression in response to environmental cues. Recent animal model and clinical studies indicate that epigenetic regulation plays an important role in the development/maintenance of persistent pain and, possibly the transition of acute pain to chronic pain, thus shedding light in a direction for development of new therapeutics for persistent pain. PMID:24948399

  10. Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome.

    PubMed

    Simons, Laura E

    2016-02-01

    A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to downregulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, whereas high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear and evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with complex regional pain syndrome suggest breakthroughs in our ability to ameliorate these issues. PMID:26785161

  11. Pain hypervigilance is associated with greater clinical pain severity and enhanced experimental pain sensitivity among adults with symptomatic knee osteoarthritis

    PubMed Central

    Herbert, Matthew S.; Goodin, Burel R.; Pero, Samuel T.; Schmidt, Jessica K.; Sotolongo, Adriana; Bulls, Hailey W.; Glover, Toni L.; King, Christopher D.; Sibille, Kimberly T.; Cruz-Almeida, Yenisel; Staud, Roland; Fessler, Barri J.; Bradley, Laurence A.; Fillingim, Roger B.

    2014-01-01

    Background Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA). Purpose The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA. Methods We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization. Results Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain. Conclusions Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA. PMID:24352850

  12. Old proteins and the Achilles heel of mass spectrometry. The role of proteomics in the etiology of human cataract.

    PubMed

    Truscott, Roger J W; Friedrich, Michael G

    2014-04-01

    Proteomics may have enabled the root cause of a major human-blinding condition, age-related cataract, to be established. Cataract appears to result from the spontaneous decomposition of long-lived macromolecules in the human lens, and recent proteomic analysis has enabled both the particular crystallins, and the specific sites of amino acid modification within each polypeptide, to be identified. Analysis of proteins from cataract lenses has demonstrated that there are key sites on some structural proteins that show a consistently greater degree of deterioration than age-matched normal lenses. Proteomic analysis, using MS, revealed that the most abundant posttranslational modification of aged lens proteins is racemization. This is somewhat ironic, since structural isomers can be viewed as the "Achilles heel" of MS and there are typically few, if any, differences in the MS/MS spectra of tryptic peptides containing one d-amino acid. It is proposed that once a certain level of spontaneous PTM at key sites occurs, that protein-protein interactions are disrupted, and binding of complexes to cell membranes takes place that impairs cell-to-cell communication. These findings may apply more widely to age-related human diseases, in particular where the deterioration of long-lived proteins is a crucial component in the etiology. PMID:24458544

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

    PubMed

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

    2012-05-01

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

  14. [Neurobiology of visceral pain].

    PubMed

    Jnig, W

    2014-06-01

    Visceral pain is diffusely localized, referred into other tissues, frequently not correlated with visceral traumata, preferentially accompanied by autonomic and somatomotor reflexes, and associated with strong negative affective feelings. It belongs together with the somatic pain sensations and non-painful body sensations to the interoception of the body. (1) Visceral pain is correlated with the excitation of spinal (thoracolumbar, sacral) visceral afferents and (with a few exceptions) not with the excitation of vagal afferents. Spinal visceral afferents are polymodal and activated by adequate mechanical and chemical stimuli. All groups of spinal visceral afferents can be sensitized (e.g., by inflammation). Silent mechanoinsensitive spinal visceral afferents are recruited by inflammation. (2) Spinal visceral afferent neurons project into the laminae I, II (outer part IIo) and V of the spinal dorsal horn over several segments, medio-lateral over the whole width of the dorsal horn and contralateral. Their activity is synaptically transmitted in laminae I, IIo and deeper laminae to viscero-somatic convergent neurons that receive additionally afferent synaptic (mostly nociceptive) input from the skin and from deep somatic tissues of the corresponding dermatomes, myotomes and sclerotomes. (3) The second-order neurons consist of excitatory and inhibitory interneurons (about 90?% of all dorsal horn neurons) and tract neurons activated monosynaptically in lamina I by visceral afferent neurons and di- or polysynaptically in deeper laminae. (4) The sensitization of viscero-somatic convergent neurons (central sensitization) is dependent on the sensitization of spinal visceral afferent neurons, local spinal excitatory and inhibitory interneurons and supraspinal endogenous control systems. The mechanisms of this central sensitization have been little explored. (5) Viscero-somatic tract neurons project through the contralateral ventrolateral tract and presumably other tracts to the lower and upper brain stem, the hypothalamus and via the thalamus to various cortical areas. (6) Visceral pain is presumably (together with other visceral sensations and nociceptive as well as non-nociceptive somatic body sensations) primarily represented in the posterior dorsal insular cortex (primary interoceptive cortex). This cortex receives in primates its spinal synaptic inputs mainly from lamina I tract neurons via the ventromedial posterior nucleus of the thalamus. (7) The transmission of activity from visceral afferents to second-order neurons in spinal cord is modulated in an excitatory and inhibitory way by endogenous anti- and pronociceptive control systems in the lower and upper brain stem. These control systems are under cortical control. (8) Visceral pain is referred to deep somatic tissues, to the skin and to other visceral organs. This referred pain consists of spontaneous pain and mechanical hyperalgesia. The mechanisms underlying referred pain and the accompanying tissue changes have been little explored. PMID:24903037

  15. Painful Lumbosacral Plexopathy

    PubMed Central

    Ehler, Edvard; Vyata, Old?ich; V?elk, Radek; Pazdera, Ladislav

    2015-01-01

    Abstract Patients frequently suffer from lumbosacral plexus disorder. When conducting a neurological examination, it is essential to assess the extent of muscle paresis, sensory disorder distribution, pain occurrence, and blocked spine. An electromyography (EMG) can confirm axonal lesions and their severity and extent, root affliction (including dorsal branches), and disorders of motor and sensory fiber conduction. Imaging examination, particularly gadolinium magnetic resonance imaging (MRI) examination, ensues. Cerebrospinal fluid examination is of diagnostic importance with radiculopathy, neuroinfections, and for evidence of immunoglobulin synthesis. Differential diagnostics of lumbosacral plexopathy (LSP) include metabolic, oncological, inflammatory, ischemic, and autoimmune disorders. In the presented case study, a 64-year-old man developed an acute onset of painful LSP with a specific EMG finding, MRI showing evidence of plexus affliction but not in the proximal part of the roots. Painful plexopathy presented itself with severe muscle paresis in the femoral nerve and the obturator nerve innervation areas, and gradual remission occurred after 3 months. Autoimmune origin of painful LSP is presumed. We describe a rare case of patient with painful lumbar plexopathy, with EMG findings of axonal type, we suppose of autoimmune etiology. PMID:25929915

  16. 15. Amygdala pain mechanisms

    PubMed Central

    Neugebauer, Volker

    2015-01-01

    A limbic brain area the amygdala plays a key role in emotional responses and affective states and disorders such as learned fear, anxiety and depression. The amygdala has also emerged as an important brain center for the emotional-affective dimension of pain and for pain modulation. Hyperactivity in the laterocapsular division of the central nucleus of the amygdala (CeLC, also termed the nociceptive amygdala) accounts for pain-related emotional responses and anxiety-like behavior. Abnormally enhanced output from the CeLC is the consequence of an imbalance between excitatory and inhibitory mechanisms. Impaired inhibitory control mediated by a cluster of GABAergic interneurons in the intercalated cell masses (ITC) allows the development of glutamate- and neuropeptide-driven synaptic plasticity of excitatory inputs from the brainstem (parabrachial area) and from the lateral-basolateral amygdala network (LA-BLA, site of integration of polymodal sensory information). BLA hyperactivity also generates abnormally enhanced feedforward inhibition of principal cells in the medial prefrontal cortex (mPFC), a limbic cortical area that is strongly interconnected with the amygdala. Pain-related mPFC deactivation results in cognitive deficits and failure to engage cortically driven ITC-mediated inhibitory control of amygdala processing. Impaired cortical control allows the uncontrolled persistence of amygdala pain mechanisms. PMID:25846623

  17. Ocular neuropathic pain

    PubMed Central

    Rosenthal, Perry; Borsook, David

    2016-01-01

    As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional elements in the nociceptive system, it is itself a disease known as neuropathic pain. While the critical nociceptive system provides a number of protective functions, it is unique in its central role of monitoring, preserving and restoring the optical tear film in the face of evaporative attrition without which our vision would be non-functional. Meeting this existential need resulted in the evolution of the highly complex, powerful and sensitive dry eye alarm system integrated in the peripheral and central trigeminal sensory network. The clinical consequences of corneal damage to these nociceptive pathways are determined by the type and location of its pathological elements and can range from the spectrum known as dry eye disease to the centalised oculofacial neuropathic pain syndrome characterised by a striking disparity between the high intensity of symptoms and paucity of external signs. These changes parallel those observed in somatic neuropathic pain. When seen through the neuroscience lens, diseases responsible for inadequately explained chronic eye pain (including those described as dry eye) can take on new meanings that may clarify long-standing enigmas and point to new approaches for developing preventive, symptomatic and disease-modifying interventions for these currently refractory disorders. PMID:25943558

  18. Ocular neuropathic pain.

    PubMed

    Rosenthal, Perry; Borsook, David

    2016-01-01

    As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional elements in the nociceptive system, it is itself a disease known as neuropathic pain. While the critical nociceptive system provides a number of protective functions, it is unique in its central role of monitoring, preserving and restoring the optical tear film in the face of evaporative attrition without which our vision would be non-functional. Meeting this existential need resulted in the evolution of the highly complex, powerful and sensitive dry eye alarm system integrated in the peripheral and central trigeminal sensory network. The clinical consequences of corneal damage to these nociceptive pathways are determined by the type and location of its pathological elements and can range from the spectrum known as dry eye disease to the centalised oculofacial neuropathic pain syndrome characterised by a striking disparity between the high intensity of symptoms and paucity of external signs. These changes parallel those observed in somatic neuropathic pain. When seen through the neuroscience lens, diseases responsible for inadequately explained chronic eye pain (including those described as dry eye) can take on new meanings that may clarify long-standing enigmas and point to new approaches for developing preventive, symptomatic and disease-modifying interventions for these currently refractory disorders. PMID:25943558

  19. The use of oral sucrose for procedural pain relief in infants up to six months of age: a randomized controlled trial.

    PubMed

    Wilson, Sally; Bremner, Alexandra P; Mathews, Judy; Pearson, Diane

    2013-12-01

    The aim of this study was to evaluate the effectiveness of oral sucrose in decreasing pain during minor procedures in infants of 1-6 months corrected age. A blinded randomized controlled trial with infants aged 4-26 weeks who underwent venipuncture, heel lance or intravenous cannulation were stratified by corrected age into > 4-12 weeks and > 12-26 weeks. They received 2 mL of either 25% sucrose or sterile water orally 2 minutes before the painful procedure. Nonnutritional sucking and parental comfort, provided in adherence to hospital guidelines, were recorded. Pain behavior was recorded using a validated 10 point scale at baseline, during and following the procedure. Data collectors were blinded to the intervention. A total of 21 and 20 infants received sucrose and water, respectively, in the > 4-12-week age group, and 21 and 22, respectively, in the > 12-26-week age group. No statistical differences were found in pain scores between treatment and control groups at any data collection points in either age group. Infants aged > 4-12 weeks who did nonnutritional sucking showed statistically significantly lower median pain scores at 1, 2, and 3 minutes after the procedure than those who did not suck. Infants aged > 4-26 weeks exhibited pain behavior scores that indicated moderate to large pain during painful procedures; however, there was insufficient evidence to show that 2 mL 25% sucrose had a statistically significant effect in decreasing pain. Infants should be offered nonnutritional sucking in compliance with the Baby Friendly Health Initiative during painful procedures. PMID:24315282

  20. Positive Traits Linked to Less Pain through Lower Pain Catastrophizing

    PubMed Central

    Hood, Anna; Pulvers, Kim; Carrillo, Janet; Merchant, Gina; Thomas, Marie

    2011-01-01

    The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test- Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0º Celsius) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = −.41, p < .01) and MPQ-SF scores (r = −.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = −.44, p < .01) and MPQ-SF scores (r = −.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing. PMID:22199416

  1. Loin pain hematuria syndrome.

    PubMed

    Zubair, Adeel S; Salameh, Hassan; Erickson, Stephen B; Prieto, Mikel

    2016-02-01

    Loin pain hematuria syndrome (LPHS), first described in 1967, is a rare pain syndrome, which is not well understood. The syndrome is characterized by severe intermittent or persistent flank pain, either unilateral or bilateral, associated with gross or microscopic hematuria. LPHS is a diagnosis of exclusion as there still is not a consensus of validated diagnostic criteria, though several criteria have been proposed. The wide differential diagnosis would suggest a meticulous yet specific diagnostic work-up depending on the individual clinical features and natural history. Several mechanisms regarding the pathophysiology of LPHS have been proposed but without pinpointing the actual causative etiology, the treatment remains symptomatic. Treatment modalities for LPHS are diverse including simple analgesia, opioid analgesic and kidney autotransplantation. This review article summarizes the current understanding regarding the pathophysiology of LPHS along with the steps required for proper diagnosis and a discussion of the different therapeutic approaches for LPHS. PMID:26798473

  2. Loin pain hematuria syndrome

    PubMed Central

    Zubair, Adeel S.; Salameh, Hassan; Erickson, Stephen B.; Prieto, Mikel

    2016-01-01

    Loin pain hematuria syndrome (LPHS), first described in 1967, is a rare pain syndrome, which is not well understood. The syndrome is characterized by severe intermittent or persistent flank pain, either unilateral or bilateral, associated with gross or microscopic hematuria. LPHS is a diagnosis of exclusion as there still is not a consensus of validated diagnostic criteria, though several criteria have been proposed. The wide differential diagnosis would suggest a meticulous yet specific diagnostic work-up depending on the individual clinical features and natural history. Several mechanisms regarding the pathophysiology of LPHS have been proposed but without pinpointing the actual causative etiology, the treatment remains symptomatic. Treatment modalities for LPHS are diverse including simple analgesia, opioid analgesic and kidney autotransplantation. This review article summarizes the current understanding regarding the pathophysiology of LPHS along with the steps required for proper diagnosis and a discussion of the different therapeutic approaches for LPHS. PMID:26798473

  3. [Therapeutic agents for osteoporotic pain].

    PubMed

    Nakao, Shin-Ichi; Miyamoto, Erabu; Kawakami, Mamoru

    2015-10-01

    Low back pain (LBP) is one of the major symptoms of elderly patients with osteoporosis. Pain control is important because pain hinders quality of life. The pathogenesis of the osteoporosis-related LBP is divided as follows, (1) vertebral fracture with bone fragility, (2) imbalance of sagittal alignment, (3) osteoporotic bone pain, (4) reduction of the descending pain inhibition system of serotonine, (5) psychological condition, (6) neural pain. For the treatment of osteoporosis-related LBP, there are two types of medicine. One is a medicine for osteoporosis with an analgetic action, another is an analgetic agent. In this chapter, we explained various analgetic agents for osteoporosis-related LBP. PMID:26529934

  4. Pain pharmacology: focus on opioids

    PubMed Central

    Fornasari, Diego

    2014-01-01

    Summary The incidence of chronic pain is estimated to be 2025% worldwide. Although major improvements in pain control have been obtained, more than 50% of the patients reports inadequate relief. It is accepted that chronic pain, if not adequately and rapidly treated, can become a disease in itself, often intractable and maybe irreversible. This is mainly due to neuroplasticity of pain pathways. In the present review I will discuss about pain depicting the rational for the principal pharmacological interventions and finally focusing on opioids, that represent a primary class of drug to treat pain. PMID:25568646

  5. Myofascial pain syndrome treatments.

    PubMed

    Borg-Stein, Joanne; Iaccarino, Mary Alexis

    2014-05-01

    Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms. PMID:24787338

  6. Noncardiac Chest Pain

    PubMed Central

    Schey, Ron; Villarreal, Autumn

    2007-01-01

    Noncardiac chest pain (NCCP) is very common, affecting up to 25% of the adult population in the United States. Treatment for NCCP has markedly evolved in the past decade and is presently focused on gastroesophageal reflux disease (GERD) and visceral hypersensitivity. Aggressive treatment with proton pump inhibitors has become the standard of care for GERD-related NCCP. Pain modulators such as tricyclics, trazodone, and selective serotonin reuptake inhibitors are considered the mainstay of therapy for non-GERD-related NCCP Other therapeutic modalities such as botulinum toxin injections and hypnotherapy have demonstrated promise in small clinical trials. PMID:21960837

  7. Complex regional pain syndrome

    PubMed Central

    Sebastin, Sandeep J

    2011-01-01

    Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. CRPS is not uncommon after hand surgery and may complicate post-operative care. There is no specific diagnostic test for CRPS and the diagnosis is based on history, clinical examination, and supportive laboratory findings. Recent modifications to diagnostic criteria have enabled clinicians to diagnose this disease more consistently. This review gives a synopsis of CRPS and discusses the diagnosis, pathophysiology, and treatment options based on the limited evidence in the literature. PMID:22022040

  8. Treatment of cancer pain.

    PubMed

    Portenoy, Russell K

    2011-06-25

    In patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care. This strategy emphasises multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family. This review describes this framework, an approach to pain assessment, and widely accepted techniques to optimise the safety and effectiveness of opioid drugs and other treatments. The advances of recent decades suggest a future that includes increased evidence-based targeting of specific analgesic interventions within an individualised plan of care that is appropriate throughout the course of illness. PMID:21704873

  9. Reward and motivation in pain and pain relief

    PubMed Central

    Navratilova, Edita; Porreca, Frank

    2015-01-01

    Pain is fundamentally unpleasant, a feature that protects the organism by promoting motivation and learning. Relief of aversive states, including pain, is rewarding. The aversiveness of pain, as well as the reward from relief of pain, is encoded by brain reward/motivational mesocorticolimbic circuitry. In this Review, we describe current knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from preclinical models and from human neuroimaging. We highlight emerging clinical evidence suggesting that anatomical and functional changes in these circuits contribute to the transition from acute to chronic pain. We propose that assessing activity in these conserved circuits can offer new outcome measures for preclinical evaluation of analgesic efficacy to improve translation and speed drug discovery. We further suggest that targeting reward/motivation circuits may provide a path for normalizing the consequences of chronic pain to the brain, surpassing symptomatic management to promote recovery from chronic pain. PMID:25254980

  10. [Pain and Christianity. A symbol for overcoming pain?].

    PubMed

    Markschies, C

    2007-08-01

    Pain and Christianity appear to belong together: Christ's pain stands at the centre of God's healing; his pain leads to the salvation of mankind. We can learn from Jesus' example how to bear suffering and pain. In early Christian times, the belief that Jesus Christ suffered pain on the cross was usually not accepted. In line with the "apathy axiom", freedom from emotion was something to strive for at that time. Only after the acceptance of Christianity as the state religion of the Roman Empire in 380 AD did the pain of Christ again stand in the centre of the Christian doctrine of salvation. The memory of the fact that Jesus himself had to undergo the worst pain can still help people to overcome their pain and comfort them. PMID:17674055

  11. Vicarious pain while observing another in pain: an experimental approach

    PubMed Central

    Vandenbroucke, S.; Crombez, G.; Van Ryckeghem, D. M. L.; Brass, M.; Van Damme, S.; Goubert, L.

    2013-01-01

    Objective: This study aimed at developing an experimental paradigm to assess vicarious pain experiences. We further explored the putative moderating role of observer's characteristics such as hypervigilance for pain and dispositional empathy. Methods: Two experiments are reported using a similar procedure. Undergraduate students were selected based upon whether they reported vicarious pain in daily life, and categorized into a pain responder group or a comparison group. Participants were presented a series of videos showing hands being pricked whilst receiving occasionally pricking (electrocutaneous) stimuli themselves. In congruent trials, pricking and visual stimuli were applied to the same spatial location. In incongruent trials, pricking and visual stimuli were in the opposite spatial location. Participants were required to report on which location they felt a pricking sensation. Of primary interest was the effect of viewing another in pain upon vicarious pain errors, i.e., the number of trials in which an illusionary sensation was reported. Furthermore, we explored the effect of individual differences in hypervigilance to pain, dispositional empathy and the rubber hand illusion (RHI) upon vicarious pain errors. Results: Results of both experiments indicated that the number of vicarious pain errors was overall low. In line with expectations, the number of vicarious pain errors was higher in the pain responder group than in the comparison group. Self-reported hypervigilance for pain lowered the probability of reporting vicarious pain errors in the pain responder group, but dispositional empathy and the RHI did not. Conclusion: Our paradigm allows measuring vicarious pain experiences in students. However, the prevalence of vicarious experiences of pain is low, and only a small percentage of participants display the phenomenon. It remains however unknown which variables affect its occurrence. PMID:23781187

  12. Emotional pain without sensory pain--dream on?

    PubMed

    Borsook, David; Becerra, Lino

    2009-01-29

    The article by Danziger and colleagues in this issue of Neuron evaluates empathy in a unique population--individuals with congenital insensitivity to pain. As such, it provides insights into the brain's ability to evaluate others' feeling to observed pain without having a specific sensory experience of pain itself. PMID:19186157

  13. Parent Pain and Catastrophizing Are Associated With Pain, Somatic Symptoms, and Pain-Related Disability Among Early Adolescents

    PubMed Central

    Moss, Ashley; Palermo, Tonya M.; Fales, Jessica L.

    2014-01-01

    Objective?To examine associations between parental history of pain and catastrophizing and their adolescents pain, somatic symptoms, catastrophizing, and disability.?Methods?Participants included 178 youths aged 1114 years recruited through public schools. Adolescents completed measures assessing pain characteristics, somatic symptoms, and pain catastrophizing. Parents reported on their own pain, and catastrophizing about their adolescents pain.?Results?About one quarter of the adolescents and two thirds of parents reported having pain. Parent pain was associated with adolescent pain, somatic symptoms, and pain catastrophizing. Parent catastrophizing was a significant predictor of adolescent somatic symptoms and pain-related disability, beyond the contribution of parent pain. Adolescent catastrophizing mediated the association between parent catastrophizing and adolescent pain-related disability.?Conclusions?Parent history of pain and pain-related cognitions may contribute to adolescent risk for chronic pain. PMID:24369365

  14. Pain: You Can Get Help

    MedlinePLUS

    ... the amount of pain medicine your doctor prescribes. Mixing any pain medication with alcohol or other drugs, ... activities that you find relaxing, like listening to music or doing art, might help take your mind ...

  15. Functional Abdominal Pain in Children

    MedlinePLUS

    ... psychological state. The pain may interfere with school attendance, participation in sports and other extra-curricular activities. ... cause for abdominal pain is discovered during the evaluation, the physician will discuss specific management of conditions ...

  16. Widespread pain in temporomandibular disorders.

    PubMed

    Lim, Pei Feng; Maixner, William; Khan, Asma A

    2011-03-01

    SUMMARYChronic widespread pain (CWP) represents pain involving several regions of the body. Various psychological and social risk factors such as poor general health status, sleep disturbance, fatigue and high psychological distress have been identified for the development of CWP. Numerous chronic pain conditions are comorbid, resulting in the development of CWP in many of these patients. Temporomandibular disorder is one of the most extensively studied chronic musculoskeletal pain condition in terms of its comorbidity with CWP and fibromyalgia. It has been proposed that these comorbid pain disorders share common denominators, including exposure to certain environmental events, elevated psychological distress, pain amplification and genetic predisposition. Increased awareness of CWP is important for improved diagnoses and more effective pain management. Patients with CWP can be effectively managed in multidisciplinary pain clinics. PMID:24646357

  17. Taking narcotics for back pain

    MedlinePLUS

    ... is that narcotics can be addictive. To avoid narcotics addiction, take these drugs exactly as your health care ... provider, tell each one that you are taking narcotics for pain. Taking ... or addiction. When your pain begins to lessen, talk with ...

  18. Back Pain and Emotional Distress

    MedlinePLUS

    ... therapies that have been successfully used in the management of pain and anxiety. These include stress management, relaxation training, ... sleep problems, anxiety and depres- sion. Such comprehensive pain management pro- grams, when integrated with your medical care, ...

  19. Dealing with Pain during Childbirth

    MedlinePLUS

    ... and the stretching of the birth canal and vagina. Pain during labor is different for every woman. Although labor is often thought of as one of the more painful events in human experience, it ranges widely from woman to woman ...

  20. Vertebroplasty for Spine Fracture Pain

    MedlinePLUS

    MENU Return to Web version Vertebroplasty for Spine Fracture Pain Vertebroplasty for Spine Fracture Pain More than 40 million people in the ... bones that puts them at risk for spine fractures (broken bones). Thinning of the bones can occur ...