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1

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

PubMed Central

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

2010-01-01

2

Heel pain  

MedlinePLUS

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

3

Heel Pain in Recreational Runners.  

ERIC Educational Resources Information Center

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

Bazzoli, Allan S.; Pollina, Frank S.

1989-01-01

4

Pediatric heel pain.  

PubMed

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

Joseph, Alison M; Labib, Irene K

2013-10-01

5

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

PubMed

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

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

1993-01-01

6

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

PubMed

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

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

2013-01-01

7

Heel Pain in the Athlete  

PubMed Central

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

Hunt, Kenneth John; Anderson, Robert B.

2009-01-01

8

Making heel pricks less painful  

Microsoft Academic Search

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

V A Harpin; N Rutter

1983-01-01

9

Lung cancer presenting as heel pain: A case report  

PubMed Central

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

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

2014-01-01

10

Percutaneous drilling for chronic heel pain  

Microsoft Academic Search

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

Stefano Santini; Arturo Rebeccato; Roberto Schiavon; Livio Nogarin

2003-01-01

11

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

Microsoft Academic Search

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

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

1996-01-01

12

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

PubMed Central

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

Thapa, Deepak; Ahuja, Vanita

2014-01-01

13

Don't Ignore Your Kid's Heel Pain  

MedlinePLUS

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

14

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

PubMed

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

Seligman, Deborah A; Dawson, Deirdre R

2003-10-01

15

Infracalcaneal heel pain in the athlete.  

PubMed

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

Agostinelli, J; Ross, J A

1997-07-01

16

Aspects of treatment for posterior heel pain in young athletes  

PubMed Central

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

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

2010-01-01

17

Management of subcalcaneal pain and Achilles tendonitis with heel inserts  

PubMed Central

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

Maclellan, G. E.; Vyvyan, Barbara

1981-01-01

18

Calcaneal osteochondritis: a new overuse injury.  

PubMed

This is a case report of osteochondritis of the medial plantar apophysis of the calcaneus presenting as medial plantar heel pain in a 15-year-old basketball player. The lesion was detected radiographically and by increased focal uptake on bone scan. Conservative treatment resulted in complete pain relief and normal calcaneal appearance with union of the osteochondral fragment. No recurrence was noted during 3 years of follow-up. PMID:9702679

Lokiec, F; Wientroub, S

1998-07-01

19

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

PubMed Central

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

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

2008-01-01

20

Determinants of premature infant pain responses to heel sticks.  

PubMed

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

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

2010-01-01

21

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

Microsoft Academic Search

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

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

2000-01-01

22

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

Microsoft Academic Search

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

Pazit Levinger; Wendy L Gilleard

2005-01-01

23

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

Microsoft Academic Search

BACKGROUND: Plantar heel pain (plantar fasciitis) is a common and disabling condition, which has a detrimental impact on health-related quality of life. Despite the high prevalence of plantar heel pain, the optimal treatment for this disorder remains unclear. Consequently, an alternative therapy such as dry needling is increasingly being used as an adjunctive treatment by health practitioners. Only two trials

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

2011-01-01

24

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

PubMed Central

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

Stupar, Maja; Tibbles, Anthony

2008-01-01

25

Interventions for treating calcaneal fractures  

Microsoft Academic Search

Background: Fracture of the calcaneus (os calcis or heel bone) comprises one to two per cent of all fractures.Objectives: To identify and evaluate randomized trials of treatments for calcaneal fractures.Search strategy: MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and the Cochrane Musculoskeletal Injuries Group Trials Register were searched. We checked reference lists of relevant articles and contacted trialists and

S. A. Bridgman; K. M. Dunn; D. J. McBride; P. J. Richards

2002-01-01

26

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

Microsoft Academic Search

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

Matthew P Cotchett; Karl B Landorf; Shannon E Munteanu

2010-01-01

27

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

Microsoft Academic Search

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

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

2008-01-01

28

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

PubMed

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

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

2011-01-01

29

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

PubMed

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

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

2011-01-01

30

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

PubMed Central

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

2011-01-01

31

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

PubMed Central

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

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

2014-01-01

32

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

PubMed

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

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

1990-01-01

33

Heel Injuries and Disorders  

MedlinePLUS

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

34

Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate.  

PubMed

Objective: Debate continues regarding the management of calcaneal fractures, between open reduction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of comminution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97), with 86% having excellent to good results and 2 (7.7%) and 1 (3.7%) having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30 degrees. Average subtalar range of motion was 17 degrees The mean Bohler's angle, mean Gissane's angle, calcaneal height and width were 25.47 degrees 121.3 degrees 4.32 cm and 3.81 cm respectively at final follow-up. Three patients had flap necrosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome, i.e. restoring anatomically reconstruction of height, width, Bohler's and Gissiane's angles of the calcaneum, and allowing early mobilization. PMID:24295583

Jain, Saurabh; Jain, Anil Kumar; Kumar, Ish

2013-12-01

35

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

PubMed Central

Background Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors. Methods Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched by age (± 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test. Results Univariate analysis demonstrated that the CPHP group had significantly greater BMI (29.8 ± 5.4 kg/m2 vs. 27.5 ± 4.9 kg/m2; P < 0.01), a more pronated foot posture (FPI score 2.4 ± 3.3 vs. 1.1 ± 2.3; P < 0.01) and greater ankle dorsiflexion ROM (45.1 ± 7.1° vs. 40.5 ± 6.6°; P < 0.01) than the control group. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. Multivariate logistic regression revealed that those with CPHP were more likely to be obese (BMI ? 30 kg/m2) (OR 2.9, 95% CI 1.4 – 6.1, P < 0.01) and to have a pronated foot posture (FPI ? 4) (OR 3.7, 95% CI 1.6 – 8.7, P < 0.01). Conclusion Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress may not play a role in CPHP.

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

2007-01-01

36

Association of calcaneal and spinal fractures.  

PubMed

Calcaneus fractures are common injuries that often lead to chronic pain and long-term disability. Appropriate initial management of calcaneal fractures involves assessment for concomitant trauma (polytrauma), and the vertebral column, in particular, the lumbar spine, is known to be especially vulnerable to simultaneous injury when the os calcis has been fractured. We undertook a retrospective cohort study that included 208 consecutive patients with data recorded in a radiographic database to determine the incidence of concomitant vertebral fracture in association with fracture of the calcaneus. A total of 15 calcaneal fractures (7.21%) were associated with concomitant vertebral fracture, and the lumbar spine was involved in 12 (80%) of these cases. The only clinical variable that was statistically significantly associated with the presence of concomitant calcaneal and vertebral fracture was localization of the vertebral fracture to the lumbar spine (p = .0001). The results of our investigation have indicated that the incidence of concomitant calcaneal and vertebral fractures was significantly lower clinically than the traditional 10% association described in previous studies. PMID:24618246

Walters, Jeremy L; Gangopadhyay, Paula; Malay, D Scot

2014-01-01

37

Black heel a minor hazard of sport.  

PubMed

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

Wilkinson, D S

1977-09-01

38

Percutaneous calcaneoplasty in displaced intraarticular calcaneal fractures.  

PubMed

The ideal treatment for displaced intraarticular calcaneal fractures is still under debate. Open reduction and internal fixation is the most popular surgical procedure; however, wound complications, hardware failure and infection remain a major concern. The aim of this study was to evaluate the results of a new minimally-invasive surgical procedure: closed reduction technique combined with balloon-assisted fracture augmentation with cement or calcium phosphate (minimally-invasive percutaneous calcaneoplasty). We retrospectively reviewed 11 patients that sustained Sander's type II and III calcaneal fractures treated in our institution from January 2008 to June 2010. The same approach and technique was utilized in all cases. Conventional X-rays and CT scan have been performed pre- and post-operatively. The average follow-up was 24 months. The American Orthopaedic Foot and Ankle Society ankle/hindfoot score has been utilized for clinical evaluation and Bohler's angle to assess bone reduction. All cases obtained bony union in 2/3 months, with average Bohler's angle of 22.97° (from 14.21° to 32.83°). No skin complications or adverse reactions were observed, with only one patient complaining of residual pain in the hindfoot. Minimally-invasive percutaneous calcaneoplasty can represent an alternative to open reduction internal fixation in the treatment of calcaneal fractures, allowing stable reduction without plating, early function recovery and short hospital stay. PMID:23744105

Biggi, Francesco; Di Fabio, Stefano; D'Antimo, Corrado; Isoni, Francesco; Salfi, Cosimo; Trevisani, Silvia

2013-12-01

39

Calcaneal Fractures in Diabetic Patients  

Microsoft Academic Search

We would like to present 23 calcaneal fractures in 22 patients of whom 21 had type I diabetes mellitus. There appear to be three basic fracture types: (1) a superiorly displaced extra-articular avulsion fracture of the posterior calcaneus (or Iowa fracture), which occurred in 12 patients (five men, seven women); (2) a mid-calcaneal compression fracture in six patients (four men,

Laura J Hedlund; Daniel D Maki; Harry J Griffiths

1998-01-01

40

The musculocutaneous sural artery flap for soft-tissue coverage after calcaneal fracture  

Microsoft Academic Search

Soft-tissue defects following calcaneal fractures can be covered in a relatively easy and safe procedure. We have modified\\u000a the familiar distally based sural artery flap by lifting a part of the gastrocnemius muscle. With an inferior pedicle, this\\u000a musulocutaneous flap can be rotated onto the defect on the sole of the foot and on the heel. Five patients with open

J. E. Mueller; T. Ilchmann; T. Lowatscheff

2001-01-01

41

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

PubMed

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

Grishkevich, Viktor M

2014-01-01

42

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

PubMed Central

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

2013-01-01

43

Calcaneal loading during walking and running  

Microsoft Academic Search

GIDDINGS, V. L., G. S. BEAUPRE ´, R. T. WHALEN, and D. R. CARTER. Calcaneal loading during walking and running.Med. Sci. Sports Exerc., Vol. 32, No. 3, pp. 627- 634, 2000. 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

VIRGINIA L. GIDDINGS; ROBERT T. WHALEN; DENNIS R. CARTER

2000-01-01

44

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

SciTech Connect

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

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

2012-11-15

45

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

PubMed Central

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

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

2005-01-01

46

Achilles Pain.  

ERIC Educational Resources Information Center

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…

Connors, G. Patrick

47

A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries  

PubMed Central

Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome.

Faroug, Radwane; Stirling, Paul; Ali, Farhan

2013-01-01

48

Tarsometatarsal joint arthrodesis with trephine joint resection and dowel calcaneal bone graft.  

PubMed

Arthritis of the tarsometatarsal joints is a challenging problem to treat. It can cause chronic foot pain and functional disability. We present a surgical technique for tarsometatarsal joint arthrodesis using a trephine to resect the articular surfaces and a dowel plug of an autogenous calcaneal graft with locking plate fixation. The procedure has been shown to result in osseous fusion, and it is technically relatively simple to complete. PMID:24388600

Withey, Christopher J; Murphy, Anthony L; Horner, Rebecca

2014-01-01

49

Calcaneal loading during walking and running  

NASA Technical Reports Server (NTRS)

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.

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

2000-01-01

50

Conservative treatment of calcaneal fractures: a preliminary report.  

PubMed

The authors report on the results of eight calcaneal fractures treated conservatively with the Robert-Jones compression dressing technique. They believe that conservative treatment of fractures of the calcaneous, the most frequently fractured tarsal bone, is successful and nonunions are rare. Also, the risk of complications is lessened and the results are uniformly satisfactory. PMID:3989228

Hanam, S R; Dale, S J

1985-01-01

51

Intra-articular calcaneal fractures: computed tomographic analysis  

Microsoft Academic Search

Computed tomography (CT) analysis of 21 intra-articular calcaneal fractures categorized according to the Essex-Lopresti classification revealed the following distribution: joint depression-type 57%, comminuted type 43%, tongue-type 0%. The posterior calcaneal facet was fractured and\\/or depressed in 100% of the cases while the medial facet was involved in only 25% of the cases.

Zehava Sadka Rosenberg; Frieda Feldman; Rolando D. Singson

1987-01-01

52

Computed tomography of calcaneal fractures  

SciTech Connect

Computed tomography (CT) of 25 fractured calcanei was performed to investigate the potential of CT in evaluating the pattern and biomechanics of these fractures. The characteristic findings of typical fractures are presented, including the number and type of principal fragments, size and dislocation of the sustentacular fragment, and involvement of the anterior and posterior facets of the subtalar joint. In 17 cases, the calcaneus consisted of four or more fragments. Furthermore, in 17 cases the sustentacular fragment included all or part of the posterior facet joint. In 18 of the 25 cases, the sustentacular fragment was displaced. It is concluded that well performed CT is an invaluable adjunct in understanding the fracture mechanism and in detecting pain-provoking impingement between the fibular malleolus and the tuberosity fragment.

Heger, L.; Wulff, K.; Seddiqi, M.S.A.

1985-07-01

53

Distal posterior tibial artery pseudoaneurysm after fracture calcaneous.  

PubMed

Here we report a case of pseudoaneurysm of distal posterior tibial artery following closed fracture of calcaneous. Association of pseudoaneurysm of posterior tibial artery with fracture of calcaneous is extremely uncommon. It is always suggested that pseudoaneurysm be treated by reconstruction, but here we present the case treated by ligation, obliteration and excision as it was situated distally and the plantar arch circulation was maintained. The purpose of this case report is to bring attention to this complication of vascular trauma, which may cause delayed symptoms long time after the injury as well as the rare incidence of posterior tibial artery involvement with fracture calcaneous. PMID:23133058

Dey, Subhajeet; Das, Anjan K; Dey, Rubi

2008-08-01

54

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

PubMed

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

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

2009-12-01

55

How I Manage Heel Spur Syndrome.  

ERIC Educational Resources Information Center

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

Seder, Joseph I.

1987-01-01

56

[Dwyer's calcaneal osteotomy for varus deformity of the foot. (A follow-up study including gait analysis) (author's transl)].  

PubMed

A follow-up study on 20 patients one to 9 years after lateral wedge resection of the calcaneus according to Dwyer is reported. In 18 feet with neurogenic varus deformity of the hind foot, the angle between the axis of the lower leg and the heel was altered from 11.4 degrees +/- 1.4 degrees SD varus to a normal value of 5.9 degrees +/- 0.9 degrees SD valgus. The position of the calcaneal tuberosity was changed from 6.7 degrees +/- 1.1 degree SD varus to 0.1 degree +/- SD varus in 7 congenital club feet. The osteotomy reduced accompanying deformities of pes cavus and pes adductus in the operated children. PMID:463210

Hehne, H J; Baumann, J U

1979-04-01

57

Percutaneous treatment of displaced intra-articular calcaneal fractures  

Microsoft Academic Search

Background  The outcome after displaced intra-articular calcaneal fractures is influenced by the condition of the surrounding soft tissues.\\u000a To avoid secondary soft tissue complications after surgical treatment, several less-invasive procedures for reduction and\\u000a fixation have been introduced. The percutaneous technique according to Forgon and Zadravecz is suitable for all types of displaced\\u000a intra-articular calcaneal fractures and was therefore introduced in our

Tim Schepers; Inger B. Schipper; Lucas M. M. Vogels; Abida Z. Ginai; Paul G. H. Mulder; Martin J. Heetveld; Peter Patka

2007-01-01

58

Optimized preoperative planning of calcaneal fractures using spiral computed tomography  

Microsoft Academic Search

.   The aim of this study was the evaluation of spiral-CT examinations in preoperative planning of calcaneal fractures supported\\u000a by 3D reconstructions after electronic disarticulation. We examined 45 patients with 47 calcaneal fractures with diagnostic\\u000a spiral-CT examinations in a prospective study. In addition to the conventional axial slices and sagittal reconstructions,\\u000a 3D reconstructions prior to and after electronic disarticulation were

M. Freund; M. Thomsen; B. Hohendorf; W. Zenker; M. Heller

1999-01-01

59

Helical CT of calcaneal fractures: technique and imaging features  

Microsoft Academic Search

Since the degree of comminution, fracture alignment, and articular congruity of intra-articular calcaneal fractures are important\\u000a determinants in surgical treatment and patient prognosis, we review helical computed tomographic (CT) technique and features\\u000a for detecting and assessing the extent of acute calcaneal fractures. Helical CT can be used to classify these fractures and\\u000a facilitate the surgeon’s understanding of the anatomy and

R. J. Wechsler; Mark E. Schweitzer; David Karasick; Diane M. Deely; William Morrison

1998-01-01

60

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

NASA Astrophysics Data System (ADS)

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

Cong, Yan; Lee, Winson; Zhang, Ming

2011-12-01

61

Pain  

MedlinePLUS

... of Orthropaedic and Sports Physical Therapy) [ PDF] Chronic Pain Management (Anesthesiology) [699KB PDF] Diagnosis and Treatment of Low- ... Journal of the American Osteopathic Association) [340KB PDF] Pain Management Task Force Final Report (Office of The Army ...

62

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

PubMed

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

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

2011-01-01

63

Practice Recommendations for Preventing Heel Pressure Ulcers  

Microsoft Academic Search

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

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

64

Wound complications following operative fixation of calcaneal fractures  

Microsoft Academic Search

The aim of our study was to find the incidence of wound complications following operative fixation of fractured calcanea and identify the risk factors contributing to them. We retrospectively reviewed the results of operative treatment of 33 calcaneal fractures in 30 patients over a 4-year period. We report an overall wound complication rate of 18.1%. Wound infection, haematoma, dehiscence and

M Al-Mudhaffar; C. V. R Prasad; A Mofidi

2000-01-01

65

Assessing outcome following calcaneal fracture: a rational scoring system  

Microsoft Academic Search

Six existing clinical scoring systems for assessing outcome after calcaneal fracture are reviewed. All were applied to a diverse group of 75 patients who had sustained this injury. Stepwise multiple regression analysis was used to identify the most relevant variables within these systems. Based on this, a simplified and rational outcome scoring system was devised. This system was then tested

P. S. Kerr; D. L. Prothero; R. M. Atkins

1996-01-01

66

Pain  

MedlinePLUS

... or pain in at least 11 of 18 “tender points,” specific spots on the neck, shoul- ders, ... other symptoms: • fatigue • trouble sleeping • morning stiffness Fibromyalgia Tender Points Treatment • • • • • Pregabalin (pre-gaB-uh-lin) and ...

67

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

PubMed

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

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

1993-01-01

68

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

PubMed

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

Jørgensen, U; Bojsen-Møller, F

1989-06-01

69

Knee–heel length measurement in healthy preterm infants  

Microsoft Academic Search

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

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

1999-01-01

70

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

PubMed

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

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

2013-01-01

71

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

PubMed Central

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

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

2008-01-01

72

Preoperative planning and intraoperative technique for accurate realignment of the Dwyer calcaneal osteotomy.  

PubMed

The Dwyer calcaneal osteotomy is an effective procedure for the correction of calcaneal varus deformity. However, no intraoperative method has been described to determine the amount of bone resection. We describe a simple intraoperative method for assuring accurate bone resection and measure the realignment effects of the Dwyer calcaneal osteotomy. We also review radiographic outcomes associated with 20 Dwyer calcaneal osteotomies (in 17 patients) using the intraoperative realignment technique described in this report. Preoperative and postoperative radiographs at a mean of 2.5 (range 1.5 to 5) years taken after Dwyer osteotomy were measured and compared, which revealed a mean reduction in calcaneal varus of 18° (range 2° to 36°) (p < .001), a mean decrease in the calcaneal inclination angle of 5° (range -40° to 7°) (p < .05), a mean decrease in medial calcaneal translation of 10 (range 0 to 18) mm (p < .001) relative to the tibia, and a mean dorsal translation of 2 (range 0 to 7) mm (p = .002). In an effort to attempt to structurally realign the calcaneus to a more rectus alignment, by means of Dwyer osteotomy, we recommend the use of the intraoperative bone wedge resection technique described in this report. Our experience with the patients described in this report demonstrates the usefulness of the intraoperative method that we describe in order to accurately restore the axial tibial and calcaneal relationship. PMID:22999297

Lamm, Bradley M; Gesheff, Martin G; Salton, Heather L; Dupuis, Travis W; Zeni, Ferras

2012-01-01

73

Complex calcaneal defect reconstruction with osteotomized free fibula-flexor hallucis longus osteomuscular flap.  

PubMed

Complex calcaneal defects represent a reconstructive challenge since calcaneous plays a key role in standing and gait. We report the case of a 35-year-old patient with a complex calcaneal defect due to chronic osteomyelitis after a high energy Gustillo type IIIB calcaneal fracture that was reconstructed with a free fibula-flexor hallucis longus osteomuscular flap. The fibula was osteotomized into two segments, which were used to reconstruct the bone defect, and the muscular component of the flap was used for coverage of the reconstructed calcaneal skeleton. Fifteen days later permanent skin coverage was ensured with a local random pattern rhomboid skin flap. Early and late postoperative periods were uneventful. Bone maturation was radiographically evident at a follow up of 12 weeks, and complete bone incorporation at 3 years. Full weight bearing was possible at 6 months postop. Final follow up, at 3 years postop, verified a very good functional and aesthetic outcome. PMID:23335391

Lykoudis, Efstathios G; Gantsos, Apostolos; Dimou, Apostolos Od

2013-01-01

74

Evolution and Allometry of Calcaneal Elongation in Living and Extinct Primates  

PubMed Central

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.

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

2013-01-01

75

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

PubMed Central

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

2014-01-01

76

Metastatic calcaneal lesion associated with uterine carcinosarcoma.  

PubMed

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

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

2014-01-01

77

Calcaneal fractures in occupants involved in severe frontal motor vehicle crashes.  

PubMed

The calcaneous is the largest tarsal bone in the foot and plays an important role in walking and running. Motor vehicle crashes and falls from elevation have been associated with calcaneal fractures. Although not life-threatening, these injuries may result in permanent disability. This study used the Crash Injury Research and Engineering Network (CIREN) database to describe calcaneal fractures and concomitant lower extremity skeletal injury patterns for occupants involved in motor vehicle crashes. Sixty-three drivers and 7 front row passengers with calcaneal fractures were identified in the CIREN database during 1997-2005. Almost all these occupants were involved in severe (based on the delta V and vehicle crush) frontal or off-set frontal crashes with toe pan intrusion. Eighty-four percent of the calcaneal fractures were intra-articular or partially articular. Overall, 93% of occupants also had injury to other body regions with 84% having other lower extremity fractures. One year after the crash, most occupants had not returned to their prior level of physical functioning. Surgically managing patients with calcaneal fractures for an optimal outcome remains a challenge for orthopedic surgeons. Because lower extremity injuries, including calcaneal fractures, may cause permanent disability, it is important to prevent these injuries through structural improvements in motor vehicle design. PMID:17250792

Benson, Emily; Conroy, Carol; Hoyt, David B; Eastman, A Brent; Pacyna, Sharon; Smith, Jeffrey; Kennedy, Frank; Velky, Tom; Sise, Michael

2007-07-01

78

Outcome of calcaneal fractures treated operatively and non-operatively. The effect of litigation on outcomes  

Microsoft Academic Search

Background  The optimum management of calcaneal fractures is controversial. These injuries are frequently associated with compensation\\u000a litigation, which effects the outcome.\\u000a \\u000a \\u000a \\u000a Aims  To assess the outcome of operatively and conservatively managed intra-articular calcaneal fractures and to examine the effect\\u000a of compensation litigation on outcome.\\u000a \\u000a \\u000a \\u000a Methods  This was a retrospective study of calcaneal fractures from a single regional trauma unit, with management decided by

B. S. Thornes; A. L. Collins; M. Timlin; J. Corrigan

2002-01-01

79

Subtalar versus triple arthrodesis after intra-articular calcaneal fractures  

PubMed Central

Depending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients with 37 secondary arthrodeses (17 subtalar and 20 triple) with a median follow-up of 116 months were asked to complete questionnaires regarding disease-specific functional outcome (Maryland Foot Score, MFS), quality of life (SF-36) and overall satisfaction with the treatment (Visual Analogue Scale, VAS). Patient groups were comparable considering median age at fracture, initial treatment (conservative or operative), time to arthrodesis, median follow-up, and post-arthrodesis radiographic angles. The MFS score was similar after subtalar versus triple arthrodesis (59 vs. 56 points; P = 0.79). No statistically significant difference was found for the SF-36 (84 vs. 83 points; P = 0.67) and the VAS (5 vs. 6; P = 0.21). Smoking was statistically significantly associated with a non-union (?2 = 6.60, P = 0.017). The current study suggests that there is no significant difference in functional outcome between an in situ subtalar or triple arthrodesis as a salvage technique for symptomatic arthrosis after an intra-articular calcaneal fracture. Smoking is a risk factor for non-union.

Kieboom, Brenda C. T.; Bessems, Gert H. J. M.; Vogels, Lucas M. M.; van Lieshout, Esther M. M.; Patka, Peter

2010-01-01

80

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

PubMed Central

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

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

2008-01-01

81

Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment  

Microsoft Academic Search

The purpose of this study was to evaluate spiral computed tomography and multislice CT (SCT\\/MSCT) with multiplanar reconstructions\\u000a (MPR) in the classification of calcaneal fractures according to a modified CT classification and to quantify fragment displacement\\u000a to guide surgical treatment. Forty-eight calcaneal fractures were examined by spiral CT (1- to 2-mm slice thickness, pitch=1.5)\\u000a with multiplanar reconstructions (MPR). Fractures were

Ulrich Linsenmaier; Ulrich Brunner; Alexander Schöning; Johannes Rieger; Michael Krötz; Wolf Mutschler; Klaus Jürgen Pfeifer; Maximilian Reiser

2003-01-01

82

Partial calcanectomy for the treatment of recalcitrant heel ulcerations.  

PubMed

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

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

2005-01-01

83

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

PubMed

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

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

1998-06-01

84

Waste Tank Heel Chemical Cleaning Summary  

SciTech Connect

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

Barnes, M.J.

2003-12-02

85

Structural analysis of the Heel Jet secondary catch mechanism.  

National Technical Information Service (NTIS)

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

B. L. Coverdell

1995-01-01

86

Reliability and Validity of the Standing Heel-Rise Test  

ERIC Educational Resources Information Center

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

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

2010-01-01

87

Diagnostic accuracy of heel pad palpation – A phantom study  

Microsoft Academic Search

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

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

2008-01-01

88

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

Microsoft Academic Search

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

Dieter Rosenbaum; Gerhard Bauer; Peter Augat; Lutz Claes

1996-01-01

89

Bone health comparison in seven Asian countries using calcaneal ultrasound  

PubMed Central

Background Bone density measurements by DXA are not feasible for large population studies, whereas portable ultrasound heel scanners can provide a practical way of assessing bone health status. The purpose of this study was to assess bone health in seven Asian countries using heel ultrasound. Methods Stiffness index (SI) was measured and T-scores generated against an Asian database were recorded for 598,757 women and 173,326 men aged over 21 years old using Lunar Achilles (GE Healthcare) heel scanners. The scanners were made available in public centres in Singapore, Vietnam, Malaysia, Taiwan, Thailand, Indonesia and the Philippines. Results The mean SI was higher for men than women. In women SI as well as T-scores declined slowly until approximately 45 years of age, then declined rapidly to reach a mean T-score of?80 years. Conclusions The heel scan data shows a high degree of poor bone health in both men and women in Asian countries, raising concern about the possible increase in fractures with ageing and the expected burden on the public health system.

2013-01-01

90

On muscle, tendon and high heels.  

PubMed

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

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

2010-08-01

91

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

PubMed Central

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

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

2012-01-01

92

An alternative method of fixation of calcaneal tuberosity fractures using the Tightrope(®) technique.  

PubMed

Calcaneal tuberosity fractures account for 1% to 3% of all calcaneal fractures. These fractures are frequently seen in the osteoporotic or diabetic elderly population. The patient's comorbidities, coupled with the usually osteoporotic bone, make fixing this fracture pattern a challenge. Numerous surgical techniques have been advocated for this fracture, including the standard lag screw fixation, tension band wiring, suture anchors, and direct suture repair. Whichever method is used, the construct must resist the massive pull of the gastrocnemius-soleus complex. We have described a method of fixing the avulsed calcaneal tuberosity using the TightRope(®) ankle syndesmosis fixation device (Arthrex(®), Naples, FL), which offers the advantages of allowing a robust and reliable fixation of a small or comminuted fragment. It is particularly advantageous in osteoporotic bone because of concern regarding the use of standard lag screw fixation, and it also may eliminate complications associated with retained hardware. PMID:24160723

Harb, Ziad; Dachepalli, Sunil; Mani, Ganapathyraman

2013-01-01

93

Radiographic evaluation of calcaneal fractures: to measure or not to measure  

Microsoft Academic Search

Objective  The aim of this study was to correlate the functional outcome after treatment for displaced intra-articular calcaneal fracture\\u000a with plain radiography.\\u000a \\u000a \\u000a \\u000a Design  The design was a prognostic study of a retrospective cohort with concurrent follow-up.\\u000a \\u000a \\u000a \\u000a Patients  A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. Patients filled\\u000a in three disease-specific questionnaires, graded their satisfaction

T. Schepers; A. Z. Ginai; P. G. H. Mulder; P. Patka

2007-01-01

94

Prediction of vertebral strength in vitro by spinal bone densitometry and calcaneal ultrasound.  

PubMed

Spinal bone mineral density (BMD) measurements and calcaneal ultrasound were compared in terms of their ability to predict the strength of the third lumbar vertebral body using specimens from 62 adult cadavers (28 females, 34 males). BMD was measured using dual X-ray absorptiometry (DXA) in both vertebra and calcaneus. Quantitative computed tomography (QCT) was used to determine trabecular BMD, cortical BMD, cortical area, and total cross-sectional area (CSA) of the vertebral body. Bone velocity (BV) and broadband ultrasonic attenuation (BUA) were measured in the right calcaneus. Vertebral strength was determined by uniaxial compressive testing. Vertebral ultimate load was best correlated with DXA-determined vertebral BMD (r2 = 0.64). Of the QCT parameters, the best correlation with strength was obtained using the product of trabecular BMD and CSA (r2 = 0.61). For vertebral ultimate stress, however, the best correlation was observed with QCT-measured trabecular BMD (r2 = 0.51); the correlation with DXA-determined BMD was slightly poorer (r2 = 0.44). Calcaneal ultrasound correlated only weakly with both ultimate load and stress with correlation coefficients (r2) of 0.10-0.17, as did calcaneal BMD (r2 = 0.18). Both spinal DXA and spinal QCT were significantly (p < 0.001) better predictors of L3 ultimate load and stress than were either calcaneal ultrasound or calcaneal DXA. Multiple regression analysis revealed that calcaneal ultrasound did not significantly improve the predictive ability of either DXA or QCT for L3 ultimate load or stress. Calcaneal DXA BMD, bone velocity, and BUA correlated well with each other (r2 = 0.67-0.76), but were only modestly correlated with the DXA and QCT measurements of the vertebra. These data indicate that spinal DXA and spinal QCT provide comparable prediction of vertebral strength, but that a substantial proportion (typically 40%) of the variability in vertebral strength is unaccounted for by BMD measurements. Ultrasonic measurements at the calcaneus are poor predictors of vertebral strength in vitro, and ultrasound does not add predictive information independently of BMD. These findings contrast with emerging clinical data, suggesting that calcaneal ultrasound may be a valuable predictor of vertebral fracture risk in vivo. A possible explanation for this apparent discrepancy between in vivo and in vitro findings could be that current clinical ultrasound measurements at the calcaneus reflect factors that are related to fracture risk but not associated with bone fragility. PMID:9333134

Cheng, X G; Nicholson, P H; Boonen, S; Lowet, G; Brys, P; Aerssens, J; Van der Perre, G; Dequeker, J

1997-10-01

95

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

Microsoft Academic Search

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

Nandha Handharu; Jungwon Yoon; Gabsoon Kim

2008-01-01

96

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

PubMed

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

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

2013-01-01

97

Hookah Smoking Popular Among Well-Heeled Teens  

MedlinePLUS

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

98

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

National Technical Information Service (NTIS)

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 (CBM...

T. M. Hutchinson R. T. Whalen T. M. Cleek J. M. Vogel S. B. Arnaud

1995-01-01

99

[Tibio-talo-calcaneal arthrodesis by retrograde intramedullary nail--a case report].  

PubMed

We described a case of 64 year old overweight women, who was treated with revision tibio-talo-calcaneal artrodesis with the use of retrograde intramedullary nail. The procedure was performed after failed primary arthrodesis with the use of lateral approach and fibula osteotomy. Stabilization with intramedullary nail gave good clinical and functional result with a good bone healing. PMID:22235644

Lipi?ski, ?ukasz; Synder, Marek; Sibi?ski, Marcin

2011-01-01

100

The use of subtalar arthroscopy in open reduction and internal fixation of intra-articular calcaneal fractures  

Microsoft Academic Search

Congruency of the subtalar joint is a major predictor of outcome after intra-articular calcaneal fractures. Because of the irregular shape of the posterior joint facet, minor steps may be overlooked with direct vision or intra-operative fluoroscopy during open reduction and internal fixation (ORIF). In a preliminary series of 15 subtalar arthroscopies during hardware removal after ORIF of intra-articular calcaneal fractures,

Johann M Gavlik; Stefan Rammelt; Hans Zwipp

2002-01-01

101

Nerve Injury and Pain after Operative Repair of Calcaneal Fractures: A Literature Review  

PubMed Central

Peripheral nerve injury is a common problem in foot and ankle surgery. We look at evidence of nerve injury as it relates to different operative approaches to the fractured calcaneus. The direct lateral, extended lateral, smile, sinus tarsi, and percutaneous approaches are discussed and the reported incidence of nerve injury in each is identified. We expect to identify divergent rates of injury between approaches and stimulate further investigation into prevention and treatment.

Haugsdal, Jaclyn; Dawson, Jeremiah; Phisitkul, Phinit

2013-01-01

102

Is heel prick as safe as we think?  

PubMed Central

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

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

2011-01-01

103

Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey  

Microsoft Academic Search

The treatment of intra-articular calcaneal fractures is controversial and randomised clinical trials are scarce. Moreover,\\u000a the socio-economic cost remains unclear. The aim of this study was to estimate the incidence, treatment preferences and socio-economic\\u000a cost of this complex fracture in the Netherlands. This data may aid in planning future clinical trials and support education.\\u000a The method of study was of

T. Schepers; E. M. M. van Lieshout; T. M. van Ginhoven; M. J. Heetveld; P. Patka

2008-01-01

104

Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures  

Microsoft Academic Search

A retrospective chart review was performed on patients treated at a level one trauma centre for displaced intra-articular calcaneal fractures by a single trauma surgeon between January 1998 and July 2007. Patients were treated with open reduction and internal fixation utilising the extended lateral incision and a new type of fixation not described before. Threaded 1.575mm (0.062in.) Kirschner wires (K-wires)

A. Ross Demcoe; Marieke Verhulsdonk; Richard E. Buckley

2009-01-01

105

Surgical treatment of intraarticular calcaneous fractures of sanders' types II and III. Systematic review  

PubMed Central

Objective This paper aims to identify the most effective surgical technique for intraarticular calcaneal fractures of Sanders' types II and III. Methods Systematic review of comparative randomized clinical trials on surgical treatment of the intraarticular fractures of the calcaneus (Sanders types II and III) that used the questionnaire of the American Orthopaedic Foot and Ankle Society. The studies were identified and retrieved in the following databases - LILACS, MEDLINE/PubMed, Cochrane Library, SciELO, EMBASE, Science Direct, Scopus, Journals@Ovid, ISI Web of Knowledge, Evidence Based Medicine, besides consulting the references of studies accessed. The keywords used Boolean logic (AND and OR): "calcaneus fracture, calcaneous, calcaneal; surgical treatment, management; open reduction, minimally invasive, percutaneous reduction; internal fixation, external fixation. Results We identified only three randomized comparative trials. Each study compared a different technique (external fixation, percutaneous fixation with Kirchner wires and cannulated screws fixation) to the open reduction with internal fixation using plate and screws (considered the standard technique). Conclusion Comparing the series, percutaneous fixation using Kirschner wires presented the best results, however, evidence is insufficient to assert superiority of this treatment in comparison with other surgical techniques.

Pelliccioni, Adriano Augusto Antoniazzi; Bittar, Cintia Kelly; Zabeu, Jose Luis Amim

2012-01-01

106

Early Weight-bearing Using Percutaneous External Fixator for Calcaneal Fracture  

PubMed Central

Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patients. We have used a biplanar percutaneous external fixator for treating calcaneal fractures without operative and per operative visualization of the fractures. We have treated 17 calcaneal fractures in 16 patients, 12 intra articular and five extra articular, with our percutaneous external fixator system without preoperative X-ray control or reduction. Functional outcome was measured using the American Orthopaedic Foot and ankle society Hind foot score. All fractures united with a mean of 55 days. Partial weight bearing was possible in a mean of 1.8 days and full bearing was possible in a mean of 11.6 days. All the patients were returned to their original work within six weeks. Minor infectious complications occurred in 17.6 percent of cases. The average AOFAS score at six months follow up was 83.8. We conclude that our percutaneous external fixator technique for fracture calcaneum is an effective alternative to the currently available – surgical and conservative treatment modalities especially in lower socio economic labor population who need to return to their job as early as possible. Level of Evidence – IV Case series.

Sengodan, Vetrivel Chezian; Sengodan, Mugundhan Moongilpatti

2012-01-01

107

Influence of birth weight on calcaneal bone stiffness in Belgian preadolescent children.  

PubMed

The aim of this study was to investigate the relation between birth weight and calcaneal bone stiffness in a large sample of Belgian, healthy, preadolescent children. Participants were 827 children (3.6-11.2 years, 51.6 % boys) from the Belgian cohort of the IDEFICS study. Birth weight was obtained using a parental questionnaire, and quantitative ultrasound (QUS) measurements were performed to determine calcaneal broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) using the Lunar Achilles device. Average birth weights were 3435.7 ± 512.0 g for boys and 3256.9 ± 471.1 g for girls. Average calcaneal QUS measurements were 89.6 ± 24.0 (23.3-153.9) dB/MHz for BUA, 1621.4 ± 49.6 (1516.3-1776.5) m/s for SOS, and 92.8 ± 15.6 (49.0-163.0) for SI. Birth weight was positively associated with BUA (r = 0.13, p = 0.002) and SOS (r = -0.16, p < 0.001). The associations remained after correcting for age and sex in multiple regression analyses but disappeared after correcting for anthropometric covariates. Our findings suggest that birth weight, as a rough proxy indicator for genetic and environmental influences during intrauterine life, is associated with BUA and SOS in preadolescent children and may therefore influence the risk of osteoporosis later in life. Further studies using QUS are needed to investigate the consistency of the results of this study. PMID:22911000

Van den Bussche, Karen; Michels, Nathalie; Gracia-Marco, Luis; Herrmann, Diana; Eiben, Gabriele; De Henauw, Stefaan; Sioen, Isabelle

2012-10-01

108

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

Microsoft Academic Search

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

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

2004-01-01

109

Biomechanical simulation of high-heeled shoe donning and walking.  

PubMed

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

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

2013-08-01

110

Imaging the shear modulus of the heel fat pads  

Microsoft Academic Search

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

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

2005-01-01

111

Gait analysis of the hemophilic ankle with silicone heel cushion.  

PubMed

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

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

1997-10-01

112

Diabetic heel ulcer in the Sudan: determinants of outcome.  

PubMed

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

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

2012-01-01

113

Calcaneal ultrasound attenuation in older African-American and Caucasian-American women.  

PubMed

The lower fracture rates among African-American women relative to Caucasian women may reflect their higher bone mass. However, bone mass is not the only determinant of bone strength: the quality and microarchitecture of the bone are also important. Quantitative ultrasound is believed to measure properties of bone strength that are independent of bone mass. To test the hypothesis that there are racial differences in quantitative ultrasound measures of bone, we recruited 154 African-American women age > or = 65 years. A random sample of 300 Caucasian women participating in the Study of Osteoporotic Fractures in Pittsburgh, Pennsylvania, was chosen for comparison. The Walker Sonix UBA 575+ was used to measure calcaneal broadband ultrasonic attenuation (BUA). Duplicate BUA measurements were obtained with a reproducibility of 5%. We measured bone mineral density (BMD) of the hip and calcaneus using single (calcaneus) or dual (hip) energy X-ray absorptiometry. The correlation between BUA and calcaneal BMD was similar in Caucasians (r = 0.66, p < 0.001) and African-Americans (r = 0.58, p < 0.001). Age-adjusted BUA (dB/MHz) was higher among the African-American women than Caucasian women (69.1 and 66.2, respectively), but these differences were not statistically significant, (p = 0.12). Adjustment for calcaneal BMD completely attenuated the racial differences in BUA. BMD at the femoral neck and calcaneus was higher among the African-American women, even after adjusting for age, height and weight. In conclusion, our results suggest that racial differences in rates of fracture cannot be explained by differences in bone quality as assessed by ultrasound attenuation. PMID:9166388

Cauley, J A; Danielson, M E; Gregg, E W; Vogt, M T; Zmuda, J; Bauer, D C

1997-01-01

114

Three-dimensional computed tomography is not indicated for the classification and characterization of calcaneal fractures.  

PubMed

This study determined inter- and intra-observer reliability for measurement of the angles of Böhler and Gissane, for the decision between surgical or conservative management and for the three mostly used classification systems for calcaneal fractures with the use of 2D-CT imaging versus 2D- and 3D-CT imaging. A consecutive series of 38 fractures in 36 patients, treated at a level II trauma centre between 2005 and 2008, were evaluated in two rounds by five observers. We measured the inter- and intraobserver reliability for the Sanders', Zwipp and Essex-Lopresti classification systems using the kappa values as described by Cohen. The intraclass correlation coefficient as described by Shrout and Fleiss was used to analyze inter- and intra-observer reliability of the angles of Böhler and Gissane. Usage of 2D-CT imaging interobserver reliability was fair for the Sanders' and Zwipp classifications and for measurement of the angle of Gissane, and it was moderate for measurement of the Essex-Lopresti classification system and measurement of the angle of Böhler. With the addition of 3D-CT imaging, the interobserver reliability was fair for the Sanders', Zwipp and Essex-Lopresti classification systems. The intraobserver reliability was fair for measurement of the angle of Gissane and it was moderate for the Sanders', Zwipp and Essex-Lopresti classification systems and for the measurement of the angle of Böhler. The addition of three-dimensional CT imaging did not increase inter- and intraobserver reliability for the classification of calcaneal fractures. Authors commented they experienced no additional benefit from 3D-CT imaging for the assessment of calcaneal fractures. PMID:24530220

Veltman, Ewout S; van den Bekerom, Michel P J; Doornberg, Job N; Verbeek, Diederik O; Rammelt, Stefan; Steller, Ernst Ph; Schepers, Tim

2014-07-01

115

Heel and toe driving on fuel cell vehicle  

DOEpatents

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

Choi, Tayoung; Chen, Dongmei

2012-12-11

116

The relationship between the calcaneal bone mineral density and the mental index in post-menopausal females  

PubMed Central

Objectives: The aim of the study was to determine the relationship between the bone mineral density in the calcaneus and the mental index (MI) of the mandible in post-menopausal females, and to evaluate the diagnostic threshold of the index. Methods: The post-menopausal females aged 50 years and older were examined using panoramic radiography of the mandible for mandibular cortical width measurements at the mental foramen (mental index, MI) determination and DXL Calscan P/N 031000 (Demetech AB, Solna, Sweden) for the examination of calcaneal bone mineral density (BMD). The statistical analysis was performed to determine the tendencies between the data. Results: According to the T-score values of calcaneal BMD, the subjects were distributed into T1, T2 and T3 groups. BMD differences between the groups were statistically significant (p?calcaneal BMD, T-score and MI (p?calcaneal BMD reduction.

Jagelaviciene, E; Krasauskiene, A; Zalinkevicius, R; Kubilius, R; Vaitkeviciene, I

2013-01-01

117

Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study  

Microsoft Academic Search

BACKGROUND: Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to

Emmanuel P Laabes; Dorothy J VanderJagt; Michael O Obadofin; Ayuba J Sendeht; Robert H Glew

2008-01-01

118

Review of the radiology in randomised controlled trials in open reduction and internal fixation (ORIF) of displaced intraarticular calcaneal fractures  

Microsoft Academic Search

The aim of this study was to assess the radiological evaluation of all prospective, randomised, controlled trails of displaced intraarticular calcaneal fractures. A systematic review of the literature, of which only three of 296 references were randomised and controlled, were examined in a blinded fashion. All had preoperative coronal CT for Sander's classification and used a lateral surgical approach or

Paula J. Richards; Stephen Bridgman

2001-01-01

119

The benefit of gait analysis in functional diagnostics in the rehabilitation of patients after operative treatment of calcaneal fractures  

Microsoft Academic Search

The purpose of our examinations is to determine whether mechanized functional diagnostics can provide evidence of functional deficits in patients after operative treatment of calcaneal fractures, and whether measurable parameters for rehabilitation result.This retrospective study reports on 30 patients with fractures of the calcaneus who were treated between May 1993 and November 1996 with closed and ‘semi-open’ repositioning of the

Niels Follak; Harry Merk

2003-01-01

120

Successful salvage of complicated calcaneal blastomycosis in disseminated disease with staged surgical reconstruction and local-systemic antifungal therapy.  

PubMed

Disseminated blastomycosis can be a devastating disease, affecting multiple organ systems, including the musculoskeletal system. Osteomyelitis from disseminated disease can be difficult to eradicate but is particularly important to successfully manage in the load-bearing bones of the lower extremity. We present a staged protocol for salvage of blastomycotic calcaneal osteomyelitis in the presence of disseminated disease. PMID:24726794

Bibbo, Christopher; Spellman, Jeanne

2014-01-01

121

Characterization of the calcaneal fat pad in diabetic and non-diabetic patients using magnetic resonance imaging  

Microsoft Academic Search

It is well known that diabetic patients have a high incidence of foot ulceration. The purpose of this study was to determine whether magnetic resonance (MR) imaging can detect changes in the composition of the calcaneal fat pad in diabetic feet. MR data were collected in vitro from amputated specimens (eight from diabetic patients and eight from non-diabetic patients) as

Patricia F Kao; Brian L Davis; Peter A Hardy

1999-01-01

122

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

PubMed

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

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

2014-01-01

123

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

NASA Astrophysics Data System (ADS)

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

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

2012-02-01

124

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

PubMed

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

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

1997-01-01

125

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 ...

126

A new radiologic measurement for the diagnosis of Haglund's deformity  

Microsoft Academic Search

Summary The authors describe a new method of radiologic measurement of “Haglund's deformity”, based on a radiologic study of 31 feet operated for posterior heel pain and more especially for calcaneal tendinopathies related to deformity of the calcaneus, and on a series of 60 asymptomatic feet. This angular approach requires a lateral weight-bearing view and proved positive in 85% of

D Chauveaux; P Liet; JC Le Huec; D Midy

1991-01-01

127

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

ERIC Educational Resources Information Center

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

Liu, Yuanlong; Wang, Yong Tai

2004-01-01

128

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

PubMed

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

Nigg, B M; Morlock, M

1987-06-01

129

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

Microsoft Academic Search

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

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

2007-01-01

130

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

Microsoft Academic Search

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

Jongsang Son; Hueseok Choi; Youngho Kim

2008-01-01

131

A Prospective Study of Calcaneal Bone Mineral Density in Acute Charcot Osteoarthropathy  

PubMed Central

OBJECTIVE To measure prospectively bone mineral density (BMD) of the Charcot and non-Charcot foot in 36 diabetic patients presenting with acute Charcot osteoarthropathy. RESEARCH DESIGN AND METHODS Calcaneal BMD was measured with quantitative ultrasound at presentation, at 3 months of casting, and at the time of the clinical resolution. RESULTS BMD of the Charcot foot was significantly reduced compared with BMD of the non-Charcot foot at presentation (P = 0.001), at 3 months of casting (P < 0.001), and at the time of clinical resolution (P < 0.001). Overall, from the time of presentation to the time of resolution there was a significant fall of BMD of the Charcot foot (P < 0.001) but not of the non-Charcot foot (P = 0.439). CONCLUSIONS Although the Charcot foot was treated with casting until clinical resolution, there was a significant fall of BMD only from presentation up until 3 months of casting.

Petrova, Nina L.; Edmonds, Michael E.

2010-01-01

132

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

PubMed

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

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

2008-11-01

133

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

NASA Technical Reports Server (NTRS)

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.

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

1995-01-01

134

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

PubMed

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

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

2011-05-01

135

Flank pain  

MedlinePLUS

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

136

An outcomes assessment of intra-articular calcaneal fractures, using patient and physician’s assessment profiles  

Microsoft Academic Search

Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes.Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment.All

J. G Kennedy; W. M Jan; A. J McGuinness; K Barry; J Curtin; W. F Cashman; G. B Mullan

2003-01-01

137

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

PubMed Central

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.

Chung, Hyung-Jin; Choo, Ji-Woong

2014-01-01

138

Relationship between markers of body fat and calcaneal bone stiffness differs between preschool and primary school children: results from the IDEFICS baseline survey.  

PubMed

The aim of this study was to investigate the relationship between markers of body fat and bone status assessed as calcaneal bone stiffness in a large sample of European healthy pre- and primary school children. Participants were 7,447 children from the IDEFICS study (spread over eight different European countries), age 6.1 ± 1.8 years (range 2.1-9.9), 50.5 % boys. Anthropometric measurements (weight, height, bioelectrical impedance, waist and hip circumference, and tricipital and subscapular skinfold thickness) as well as quantitative ultrasonographic measurements to determine calcaneal stiffness index (SI) were performed. Partial correlation analysis, linear regression analysis, and ANCOVA were stratified by sex and age group: preschool boys (n = 1,699) and girls (n = 1,599) and primary school boys (n = 2,062) and girls (n = 2,087). In the overall study population, the average calcaneal SI was equal to 80.2 ± 14.0, ranging 42.4-153. The results showed that preschool children with higher body fat had lower calcaneal SI (significant correlation coefficients between -0.05 and -0.20), while primary school children with higher body fat had higher calcaneal SI (significant correlation coefficients between 0.05 and 0.13). After adjusting for fat-free mass, both preschool and primary school children showed an inverse relationship between body fat and calcaneal stiffness. To conclude, body fat is negatively associated with calcaneal bone stiffness in children after adjustment for fat-free mass. Fat-free mass may confound the association in primary school children but not in preschool children. Muscle mass may therefore be an important determinant of bone stiffness. PMID:22907129

Sioen, Isabelle; Mouratidou, Theodora; Herrmann, Diana; De Henauw, Stefaan; Kaufman, Jean-Marc; Molnár, Dénes; Moreno, Luis A; Marild, Staffan; Barba, Gianvincenzo; Siani, Alfonso; Gianfagna, Francesco; Tornaritis, Michael; Veidebaum, Toomas; Ahrens, Wolfgang

2012-10-01

139

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

PubMed

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

Ko, Dong Yeol; Lee, Han Suk

2013-10-01

140

Influence of Inflammatory Polyarthritis on Quantitative Heel Ultrasound Measurements  

PubMed Central

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

2012-01-01

141

Quantitative heel ultrasound variables in powerlifters and controls  

PubMed Central

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

Jawed, S; Horton, B; Masud, T

2001-01-01

142

Cancer pain  

Microsoft Academic Search

This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

M. Swerdlow; V. Ventafridda

1987-01-01

143

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

PubMed

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

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

2012-01-01

144

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

PubMed Central

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

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

2014-01-01

145

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

PubMed

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

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

2012-01-01

146

Radiographic Texture Analysis of Densitometric Calcaneal Images: Relationship to Clinical Characteristics and to Bone Fragility  

PubMed Central

Osteoporotic fractures are related not only to bone mineral density (BMD) but also to bone structure or microarchitecture, which is not assessed routinely with currently available methods. We have developed radiographic texture analysis (RTA) for calcaneal images from a peripheral densitometer as an easy, noninvasive method for assessing bone structure. We conducted a cross-sectional study of the relationship between RTA and prevalent vertebral fractures (n = 148) among 900 subjects (ages 19 to 99 years, 94 males) referred for bone densitometry as part of their routine medical care. RTA features were derived from Fourier-based image analysis of the radiographic texture pattern (including root mean square, first moment, and power spectral analyses). RTA features were associated with age, weight, gender, and race, as well as glucocorticoid use. When controlling for clinical risk factors and BMD (or a summary measure calculated using FRAX algorithms), RTA features were significantly different for subjects with and without prevalent vertebral fractures [adjusted odds ratio (OR) = 1.5 per 1 standard deviation (SD) decrease in RTA feature beta, 95% confidence interval (CI) 1.2–1.8, p = .001]. Gender and use of pharmacologic therapy for osteoporosis did not significantly affect this association, suggesting that RTA can be applied to a wide range of densitometry patients. We conclude that RTA obtained using a portable instrument has a potential as a noninvasive method to enhance identification of patients at increased risk of osteoporotic fractures. Copyright © 2010 American Society for Bone and Mineral Research

Vokes, Tamara; Lauderdale, Diane; Ma, Siu-Ling; Chinander, Mike; Childs, Keona; Giger, Maryellen

2010-01-01

147

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

PubMed Central

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

Schaefer, Sabine; Lindenberger, Ulman

2013-01-01

148

Belly Pain  

MedlinePLUS

... is one of the most common reasons for abdominal pain. If you haven't had a bowel movement ( ... disease , or inflammatory bowel disease also can cause abdominal pain. Food. Some kids get abdominal pain because they ...

149

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 ...

150

Knee pain  

MedlinePLUS

... by: Anterior knee pain Arthritis -- including rheumatoid arthritis, osteoarthritis, and gout Baker's cyst -- a fluid-filled swelling ... This may reduce swelling and provide support. Take acetaminophen for pain or ibuprofen for pain and swelling. ...

151

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

SciTech Connect

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

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

2013-08-15

152

Calcaneal ultrasonometry: response to treatment in comparison with dual x-ray absorptiometry measurements of the lumbar spine and femur.  

PubMed

The object of this study was to determine the effectiveness of calcaneal ultrasonometry in the prediction of bone mineral changes in the lumbar spine and femoral neck in response to treatment of osteoporosis. There were 673 women in the study who had one or more follow-up measurements between 1 and 4 years after the initial baseline determination for a total of 881 same-day measurements of the calcaneus, spine, and femur. The LUNAR Achilles and LUNAR DPX (LUNAR Corporation, Madison, WI) were used. Patients were divided into three treatment time groups: Group 1, 1-<2 years, n = 461; Group 2, 2-<3 years, n = 278; Group 3, 3-<4 years, n = 142. There were significant increases in the bone mineral density (BMD) of the lumbar spine, femoral neck, and in the broadband ultrasonic attenuation (BUA) of the calcaneus for the three groups. In contrast, a significant decrease in speed of sound (SOS) was obtained in these time frames and the stiffness index remained unchanged. Spearmen correlations showed an inverse relationship between the percent changes in SOS and BUA, the reasons for which are speculative. Correlations between the percent changes in calcaneal parameters and the BMDs of the lumbar spine and femoral neck were weak, whether significant or not, rho varying from -0.12 to 0.20. There was a subset of 371 patient measurements that registered BMD increases in both the lumbar spine and femoral neck. This was considered to be an objective indication of adequate compliance with prescribed treatment. Analysis of this subset yielded parameter correlations similar to those of the entire group. It is concluded that changes in the calcaneal ultrasound parameters in response to treatment of osteoporosis are not a reflection of mineral changes occurring in the lumbar spine and femoral neck in a given individual, and in this regard, calcaneal ultrasonometry is not a substitute for direct-site dual X-ray absorptiometry (DXA) measurement of the lumbar spine and femur. PMID:10024375

Rosenthall, L; Caminis, J; Tenehouse, A

1999-03-01

153

Normative calcaneal quantitative ultrasound data for the indigenous Shuar and non-Shuar Colonos of the Ecuadorian Amazon  

Microsoft Academic Search

Summary  Minimal data on bone mineral density changes are available from populations in developing countries. Using calcaneal quantitative\\u000a ultrasound (QUS) techniques, the current study contributes to remedying this gap in the literature by establishing a normative\\u000a data set on the indigenous Shuar and non-Shuar Colonos of the Ecuadorian Amazon.\\u000a \\u000a \\u000a \\u000a \\u000a Purpose  The paucity of bone mineral density (BMD) data from populations in developing

Felicia C. Madimenos; J. Josh Snodgrass; Aaron D. Blackwell; Melissa A. Liebert; Tara J. Cepon; Lawrence S. Sugiyama

154

Back Pain  

MedlinePLUS

... are not usually advisable for acute back pain. Chronic Back Pain Treatment for chronic back pain falls into two basic categories: the ... some of the more commonly used treatments for chronic back pain. Nonsurgical Treatments Hot or cold: Hot or cold packs—or ...

155

An Achilles' Heel in an Amyloidogenic Protein and Its Repair  

PubMed Central

Insulin fibrillation provides a model for a broad class of amyloidogenic diseases. Conformational distortion of the native monomer leads to aggregation-coupled misfolding. Whereas ?-cells are protected from proteotoxicity by hexamer assembly, fibrillation limits the storage and use of insulin at elevated temperatures. Here, we have investigated conformational distortions of an engineered insulin monomer in relation to the structure of an insulin fibril. Anomalous 13C NMR chemical shifts and rapid 15N-detected 1H-2H amide-proton exchange were observed in one of the three classical ?-helices (residues A1–A8) of the hormone, suggesting a conformational equilibrium between locally folded and unfolded A-chain segments. Whereas hexamer assembly resolves these anomalies in accordance with its protective role, solid-state 13C NMR studies suggest that the A-chain segment participates in a fibril-specific ?-sheet. Accordingly, we investigated whether helicogenic substitutions in the A1–A8 segment might delay fibrillation. Simultaneous substitution of three ?-branched residues (IleA2 ? Leu, ValA3 ? Leu, and ThrA8 ? His) yielded an analog with reduced thermodynamic stability but marked resistance to fibrillation. Whereas amide-proton exchange in the A1–A8 segment remained rapid, 13C? chemical shifts exhibited a more helical pattern. This analog is essentially without activity, however, as IleA2 and ValA3 define conserved receptor contacts. To obtain active analogs, substitutions were restricted to A8. These analogs exhibit high receptor-binding affinity; representative potency in a rodent model of diabetes mellitus was similar to wild-type insulin. Although 13C? chemical shifts remain anomalous, significant protection from fibrillation is retained. Together, our studies define an “Achilles' heel” in a globular protein whose repair may enhance the stability of pharmaceutical formulations and broaden their therapeutic deployment in the developing world.

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

2010-01-01

156

Sexual pain.  

PubMed

Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs. This article provides a review of the terminology and definition of the condition, theories on the pathophysiology, diagnostic considerations, and recommendations on the management of female sexual pain. PMID:20393420

Boardman, Lori A; Stockdale, Colleen K

2009-12-01

157

Pain Management  

MedlinePLUS

... taking, including over-the-counter medications, supplements and herbal remedies. Sometimes there can be serious interactions. Your ... or call our Information Specialists for a copy. Side Effects of Pain Medication Some pain medications have ...

158

Pain Management  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a  \\u000a \\u000a Patients suffering with chronic diffuse pain who lack objective clinical and laboratory findings (e.g., fibromyalgia) frequently\\u000a are dismissed as not having real pain, which only perpetuates their illness.\\u000a \\u000a \\u000a \\u000a \\u000a  \\u000a \\u000a There are four principal categories of pain: nociceptive pain, neuropathic pain, chronic pain of complex etiology, and psychogenic\\u000a pain.\\u000a \\u000a \\u000a \\u000a \\u000a  \\u000a \\u000a Pain assessment should include attention to possible psychological and sociocultural

John B. Winfield

159

Painful swallowing  

MedlinePLUS

... ulcers Something stuck in the throat (for example, fish or chicken bones) Tooth infection or abscess ... with the painful swallowing, including: Abdominal pain Chills Cough Fever Heartburn Nausea or vomiting Sour taste in ...

160

Pelvic Pain  

MedlinePLUS

... ACOG practice bulletin no. 51. Chronic pelvic pain. Obstetrics & Gynecology, 103 ,589–605. [top] UCSF Medical Center. ( ... profile of women with chronic pelvic pain. Clinical Obstetrics and Gynecology, 33 ,130–136 [top] What are ...

161

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 ...

162

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

PubMed

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

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

2010-01-01

163

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

PubMed

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

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

2009-01-01

164

[Spontaneous pain attacks: neuralgic pain].  

PubMed

Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either be located in a healthy tooth or in the temporomandibular joint. Neuralgic pain is distinguished into trigeminal neuralgia, glossopharyngeal neuralgia, Horton's neuralgia, cluster headache and paroxysmal hemicrania. In 2 cases trigeminal neuralgia is successfully managed with a neurosurgical microvascular decompression procedure according to Jannetta. Characteristic pain attacks resembling neuralgic pain result from well understood pathophysiological mechanisms. Consequently, adequate therapy, such as a Janetta procedure and specific pharmacological therapy, is available. PMID:17147031

de Bont, L G M

2006-11-01

165

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

PubMed Central

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.

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

2013-01-01

166

Joint pain  

Microsoft Academic Search

Joint pain may result from traumas or repeated microtraumas, as in sports injuries. Pain in osteoarthritis starts before any\\u000a objective finding. It has been demonstrated that in the first stages of this disease, pain is due to intraosseous venous engorgement\\u000a for the earlier thickening of the cortical bone under the articular cartilage. The mechanisms of inflammatory pain are more\\u000a complex

Massimo Zoppi; Elisabetta Beneforti

1999-01-01

167

Neck pain  

MedlinePLUS

Pain - neck; Neck stiffness ... this as having a stiff neck. If neck pain involves nerves, you may feel numbness, tingling, or ... A common cause of neck pain is muscle strain or tension. Usually, ... Such activities include: Bending over a desk for hours Poor ...

168

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

PubMed

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

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

2010-02-01

169

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

PubMed

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

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

2014-06-01

170

The pain of painful bladder  

PubMed Central

Bladder pain can have a number of different etiologies. This brief summary provides an overview of bladder pain syndrome, including current evidence-based recommendations for diagnosis and management.

Payne, Christopher

2013-01-01

171

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

Microsoft Academic Search

During sluicing operations of tank 241-C-110, a significant amount of solids were unable to be retrieved. These solids (often referred to as the tank 'heel') were sampled in 2010 and chemically and mineralogically analyzed in the 222-S Laboratory. Additionally, dissolution tests were performed to identify the amount of undissolvable material after using multiple water contacts. This report covers the solid

PAGE JS; COOKE GA; PESTOVICH JA; HUBER HJ

2011-01-01

172

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

Microsoft Academic Search

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

Danièle Pacaud

173

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

Microsoft Academic Search

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

Meijiang Song; Jinzhong Yao; Yongsheng Lu

2008-01-01

174

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

National Technical Information Service (NTIS)

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

J. L. Steyn N. W. Hagood

2003-01-01

175

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

SciTech Connect

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

Batcheller, Thomas Aquinas

2000-09-01

176

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

SciTech Connect

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

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

2000-08-31

177

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

Microsoft Academic Search

Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus to prescription rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee and ankle) with the application of a negative heel rocker sole shoe under controlled lab conditions.

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

2006-01-01

178

Relationships among calcaneal backscatter, attenuation, sound speed, hip bone mineral density, and age in normal adult women.  

PubMed

The present study was undertaken in order to investigate the use of calcaneal ultrasonic backscatter for the application of diagnosis of osteoporosis. Broadband ultrasonic attenuation (BUA), speed of sound (SOS), the average backscatter coefficient (ABC), and the hip bone mineral density (BMD) were measured in calcanea in 47 women (average age: 58 years, standard deviation: 13 years). All three ultrasound variables had comparable correlations with hip BMD (around 0.5). As reported previously by others, BUA and SOS were rather highly correlated with each other. The logarithm of the ABC was only moderately correlated with the other two. The three ultrasound parameters exhibited similar moderate negative correlations with age. These results taken collectively suggest that the ABC may carry important diagnostic information independent of that contained in BUA and SOS and, therefore, may be useful as an adjunct measurement in the diagnosis of osteoporosis. PMID:11508981

Wear, K A; Armstrong, D W

2001-07-01

179

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

PubMed

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

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

2013-05-01

180

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

PubMed

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

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

2014-01-01

181

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

PubMed Central

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

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

2008-01-01

182

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

PubMed

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

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

1995-11-01

183

Neuropathic Pain  

PubMed Central

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.

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

2009-01-01

184

Developmental changes in the responses of preterm infants to a painful stressor  

Microsoft Academic Search

The purpose of this investigation was to examine longitudinally gestational age and developmental differences in preterm infants’ self-regulatory abilities in response to a painful stressor, as well as associations between behavioral and cardiovascular responses. Participants included 49 healthy premature infants. Behavioral and cardiovascular responses to a heel stick blood draw were compared between infants of 28–31 and 32–34 weeks’ gestation

Rachel Lucas-Thompson; Elise L. Townsend; Megan R. Gunnar; Michael K. Georgieff; Sixto F. Guiang; Raul F. Ciffuentes; Richard C. Lussky; Elysia Poggi Davis

2008-01-01

185

Impact of Age, Anthropometric Data and Body Composition on Calcaneal Bone Characteristics, as Measured by Quantitative Ultrasound (QUS) in an Older German Population  

Microsoft Academic Search

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

Christiane Brunner; Jörn Pons-Kühnemann; Monika Neuhäuser-Berthold

186

Pain Genes  

Microsoft Academic Search

Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating

Tom Foulkes; John N. Wood

2008-01-01

187

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

SciTech Connect

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

Fellinger, A.

2010-02-16

188

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

PubMed

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

Shahla, Ahmad

2009-07-01

189

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

PubMed

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

Cronin, Neil J

2014-04-01

190

Genome-wide linkage scan for quantitative trait loci underlying normal variation in heel bone ultrasound measures  

Microsoft Academic Search

Quantitative ultrasound (QUS) traits are correlated with bone mineral density (BMD), but predict risk for future fracture\\u000a independent of BMD. Only a few studies, however, have sought to identify specific genes influencing calcaneal QUS measures.\\u000a The aim of this study was to conduct a genome-wide linkage scan to identify quantitative trait loci (QTL) influencing normal\\u000a variation in QUS traits. QUS

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

191

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

PubMed

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

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

2014-02-01

192

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

Microsoft Academic Search

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

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

2010-01-01

193

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

PubMed Central

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

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

2014-01-01

194

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

PubMed Central

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

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

2009-01-01

195

Posterior subtalar fusion. A preliminary report on a modified Gallie's procedure.  

PubMed

A simple modification of Gallie's subtalar fusion is described as a salvage procedure in treating patients with pain from old fractures of the calcaneous involving the subtalar joint. Graft bone for the fusion is taken from the outer half of the calcaneus, thus avoiding disturbance of the tibia or iliac crest. Collapse of the donor site helps to narrow the widened heel present in these patients. The posterior approach allows the peroneal tendons to be freed from any adhesions, and at the same time release of the calcaneo-fibular ligament permits some correction of the valgus of the heel. The early results in six patients have been encouraging. PMID:330541

Kalamchi, A; Evans, J G

1977-08-01

196

Shoulder pain  

MedlinePLUS

... or damaged. This condition is called rotator cuff tendinitis . Shoulder pain may also be caused by: Arthritis ... recommend such exercises. If you are recovering from tendinitis, continue to do range-of-motion exercises to ...

197

Abdominal Pain  

MedlinePLUS

... simple and inexpensive, and works for some kids. Peppermint oil enteric-coated capsules often decrease pain in ... effective than adding fiber alone [6] . Enteric-coated peppermint oil While this study found that fiber and ...

198

Neuropathic Pain  

MedlinePLUS

... damaged, dysfunctional, or injured. These damaged nerve fibers send incorrect signals to other pain centers. The impact ... this short relaxation experience, you may want to send for the longer audio version, available in our ...

199

Wrist pain  

MedlinePLUS

... illness. Other common causes of wrist pain include: Gout -- this occurs when you produce too much uric ... care provider thinks that you have an infection, gout, or pseudogout, fluid may be removed from the ...

200

Feeling pain  

MedlinePLUS Videos and Cool Tools

... protective mechanism, alerting it to potential or actual damage to the body’s tissues. In the example of ... the pain receptors in the skin detect tissue damage from the bee sting. Then, the peripheral nerves ...

201

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 ...

202

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

SciTech Connect

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

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

2013-07-01

203

Characteristic trends of lower-extremity complex regional pain syndrome.  

PubMed

Complex regional pain syndrome (CRPS) is a multifaceted, progressive, and potentially devastating disorder generally affecting the extremities. In addition, scant information is available regarding the types of patients who develop lower-extremity CRPS. This is a retrospective chart review study of 64 patients who presented to a pain clinic with CRPS of the lower extremity. The study examined 23 variables broadly classified under demographic characteristics, CRPS characteristics, and healthcare utilization. The sample was found to consist of predominantly white, middle-aged women with CRPS I. Subjective complaints consisted of burning, sharp, throbbing, or aching pain with shooting symptoms. Initial presenting clinical findings included allodynia, edema, erythema, and hyperesthesia. The most common precipitating injuries were blunt trauma of the foot with or without fracture or ankle sprain. The most common inciting surgical events were bunionectomy, tarsal tunnel release, and heel-spur surgery. Referral to the pain clinic was delayed more commonly in trauma patients than in postsurgical patients, with a corresponding increase in pain clinic visits for treatment. This study may act as a guide for physicians treating the lower extremity to aid in the recognition of lower extremity complex regional pain syndrome and its characteristics. PMID:15480404

Harris, John; Fallat, Lawrence; Schwartz, Steven

2004-01-01

204

Shoulder pain.  

PubMed

Shoulder pain is a frequent complaint encountered in the emergency setting. A brief review of shoulder anatomy and physical examination sets the foundation for evaluation of shoulder pain. Considerations of patient's age are helpful to predict injuries. Fractured clavicles are often seen in traumatic injuries in children and young adults, whereas fractures of the humeral head are more often seen in the elderly from traumatic injuries. Shoulder dislocations are more common in teens to fourth decade. This article reviews specific acute injuries, chronic conditions, and radiologic considerations of patients with shoulder complaints encountered in emergency settings. PMID:21543907

Ramponi, Denise R

2011-01-01

205

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

PubMed

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

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

2005-12-01

206

Up-regulation of the chemo-attractive receptor ChemR23 and occurrence of apoptosis in human chondrocytes isolated from fractured calcaneal osteochondral fragments.  

PubMed

To study the expression level of a panel of pro/anti-apoptotic factors and inflammation-related receptors in chondral fragments from patients undergoing surgical treatment for intra-articular calcaneal fractures, cartilage fragments were retrieved from calcaneal fractures of 20 patients subjected to surgical treatment. Primary cultures were performed using chondral fragments from fractured and control patients. Chondrocyte cultures from each patient of the fractured and control groups were subjected to immunofluorescence staining and quantitatively analyzed under confocal microscopy. Proteins extracted from the cultured chondrocytes taken from the fractured and control groups were processed for Western blot experiments and densitometric analysis. The percentage of apoptotic cells was determined using the cleaved PARP-1 antibody. The proportion of labelled cells was 35% for fractured specimens, compared with 7% for control samples. Quantification of caspase-3 active and Bcl-2 proteins in chondrocyte cultures showed a significant increase of the apoptotic process in fractured specimens compared with control ones. Fractured chondrocytes were positively stained for ChemR23 with statistically significant differences with respect to control samples. Densitometric evaluation of the immunoreactive bands confirmed these observations. Human articular chondrocytes obtained from patients with intra-articular calcaneal fractures express higher levels of pivotal pro-apoptotic factors, and of the chemo-attractive receptor ChemR23, compared with control cultures. On the basis of these observations, the authors hypothesize that consistent prolonged chondrocyte death, associated with the persistence of high levels of pro-inflammatory factors, could enhance the deterioration of cartilage tissue with consequent development of post-traumatic arthritis following intra-articular bone fracture. PMID:24689495

Sena, Paola; Manfredini, Giuseppe; Benincasa, Marta; Mariani, Francesco; Smargiassi, Alberto; Catani, Fabio; Palumbo, Carla

2014-06-01

207

Closed reduction and percutaneus Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2–10 years  

Microsoft Academic Search

Introduction  To reduce complications, a minimally invasive technique for the treatment of dislocated intraarticular fractures of the calcaneus\\u000a was used. Therefore previously described closed reduction and internal fixation techniques were combined and modified.\\u000a \\u000a \\u000a \\u000a Materials and methods  Sixty-seven out of 92 calcaneal fractures could be retrospectively evaluated with an average follow-up time of 5.7 years (minimum\\u000a 2–10 years follow-up). For radiographic evaluation, plain radiographs and

Tim Alexander Walde; B. Sauer; J. Degreif; H.-J. Walde

2008-01-01

208

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

PubMed Central

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.

Kobsar, Bradley; Alcantara, Joel

2009-01-01

209

Tibio-talo-calcaneal arthrodesis with retrograde compression intramedullary nail fixation for salvage of failed total ankle replacement: a systematic review.  

PubMed

Failed total ankle replacement is a complex problem that should only be treated by experienced foot and ankle surgeons. Significant bone loss can preclude revision total ankle replacement and obligate revision though a complex tibio-talo-calcaneal arthrodesis. A systematic review of the world literature reveals a nonunion rate of 24.2%. A weighted mean of modified American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Scale demonstrated fair patient outcomes of 58.1 points on an 86-point scale (67.6 points on a 100-point scale). Complications were observed in 38 of 62 (62.3%) patients reviewed, with the most common complication being nonunion. PMID:23465809

Donnenwerth, Michael P; Roukis, Thomas S

2013-04-01

210

SLUDGE HEEL REMOVAL BY ALUMINUM DISSOLUTION AT SAVANNAH RIVER SITE 12390  

SciTech Connect

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

Keefer, M.

2012-01-12

211

Managing Pain  

MedlinePLUS

... itching to the hospice nurse. Often such side effects can be treated and may stop after taking the medication for a few days. • Other things that might make the pain better are: - Relaxing activities - Distracting activities such as watching TV, listening to music or playing a game - Heat (such as a ...

212

[Social pain].  

PubMed

This chapter focuses on what social pain is and how it should be managed. In order to understand social pain in a cancer patient, it is necessary to recognize the change in the patient's daily life after the diagnosis of cancer. Because the degree of suffering and the relationships with family members and the people he or she worked with differ from patient to patient, it is important to note that the context of social pain is different in each patient. Five points shown below are essential in managing social pain. 1. Economical suffering may be alleviated by utilization of the social security system while taking into account each patient's standard of living. 2. Burdens on family members should be lessened, such as by not having them stay at the patient's bedside every day and letting them go home occasionally. 3. The normal patterns of communication, support, and conflict in the family should be identified, and the extent to which they have been disrupted by the illness should be assessed. 4. It is important to understand the ethnic, cultural, and religious background of the patient and the potential impact of their influence on the individual and the illness. 5. Practical or emotional unfinished business that the patient has needs to be identified, and efforts should be made to support fulfillment. PMID:21950034

Shimoyama, Naohito; Shimoyama, Megumi

2011-09-01

213

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

PubMed

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

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

2013-09-01

214

Patellofemoral Pain Syndrome  

MedlinePLUS

... right foot back until you can feel a stretch in your calf muscle. Keep your left leg bent, with your knee lined up over your toes. Keep your right heel on the ground to feel the back of the leg stretch. Hold for 10 to 20 seconds. Do the ...

215

Determination of calcaneal ultrasound properties ex situ: reproducibility, effects of storage, formalin fixation, maceration, and changes in anatomic measurement site.  

PubMed

The objective of this study was to determine the reproducibility of ultrasonic bone properties with a system for measuring calcanei ex situ; the influence of changes of the measurement site; and the effects of fixation, storage, and maceration. We examined 14 fixed calcanei and 12 fresh bones. Ultrasonic measurements were performed ex situ after degassing, using an Achilles+ system and a special positioning device. The instrument precision was 0.16% for speed of sound (SOS), 1.4% for broadband ultrasonic attenuation (BUA), and 1. 8% for the stiffness index (SI). The short-term precision was 0.54%, 1.9%, and 2.8%, respectively. A defined shift of the measurement site (5 mm distal of the middle) led to unpredictable changes in ultrasound (US) properties (r = 0.65 for SOS, 0.82 for BUA, and 0.75 for SI). Embalment with 4% formalin/96% alcohol caused a systematic decrease in SOS, an increase in BUA, and a decrease in SI (mean = -12.7 units; P < 0.001), the effect increasing with time. However, values at 6 months of fixation and later were highly correlated with those in fresh specimens (r = 0.95 for the SI). Two weeks storage in degassed and normal solution had only modest effects on ultrasound properties. Maceration did not lead to a systematic increase or decrease of ultrasound variables, but introduced unpredictable changes (r = 0.64-0.94). We conclude that in comparative biomechanical studies it is feasible to measure calcaneal specimens embalmed in formalin/alcohol ex situ, if the primary interest is not in the absolute values but in the correlation with mechanical failure loads at other skeletal sites. PMID:10441649

Pöpperl, G; Lochmüller, E; Becker, H; Mall, G; Steinlechner, M; Eckstein, F

1999-09-01

216

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

NASA Technical Reports Server (NTRS)

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.

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

2002-01-01

217

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

PubMed

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

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

2012-04-01

218

Closed reduction and percutaneus Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2-10 years  

PubMed Central

Introduction To reduce complications, a minimally invasive technique for the treatment of dislocated intraarticular fractures of the calcaneus was used. Therefore previously described closed reduction and internal fixation techniques were combined and modified. Materials and methods Sixty-seven out of 92 calcaneal fractures could be retrospectively evaluated with an average follow-up time of 5.7 years (minimum 2–10 years follow-up). For radiographic evaluation, plain radiographs and CT scans were obtained. The Zwipp score was used for clinical evaluation. Sanders type II, III and IV fractures were diagnosed. Results Length of surgery averaged 61 min (range 20–175 min). The incidence of subtalar arthritis was correlated to the severity of fracture. Böhler’s angle was restored in 70.1% (47 of 67) of the cases. On the last follow-up evaluation the average Zwipp score was 130 points (range 48–186 points). The majority (77.7%) of patients were content with their treatment result. The rate of significant complications was 6.5%. Discussion Compared to open techniques the presented minimally invasive technique showed comparable results with a low rate of serious complications and is a viable alternative for the treatment of intraarticular, dislocated calcaneal fractures.

Sauer, B.; Degreif, J.; Walde, H.-J.

2008-01-01

219

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

PubMed Central

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

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

2012-01-01

220

Paining Out: An Integrative Pain Therapy Model  

Microsoft Academic Search

This article describes and evaluates an integrative pain therapy model as a beneficial form of pain-management for chronic\\u000a pain. The author based his model on cognitive-behavioral modalities, progressive relaxation combined with art therapy, sensory\\u000a awareness combined with indirect clinical hypnosis, formal clinical hypnosis and self-hypnosis. Those techniques were applied\\u000a in small group settings to systematically alter pain perception, pain interpretations

Mirko Pavlek

2008-01-01

221

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

SciTech Connect

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

Callaway, William S.

2013-09-26

222

Urologic myofascial pain syndromes  

Microsoft Academic Search

Treatment of pain of urogenital origin, chronic pelvic pain syndrome, can be frustrating for patients and physicians. The\\u000a usual approaches do not always produce the desired results. Visceral pain from pelvic organs and myofascial pain from muscle\\u000a trigger points share common characteristics. Referred pain from myofascial trigger points can mimic visceral pain syndromes\\u000a and visceral pain syndromes can induce trigger

Ragi Doggweiler-Wiygul

2004-01-01

223

Painful hypoadrenalism  

PubMed Central

A 61-year-old man presented with diffuse myalgia and arthralgia. The physical examination showed diffuse musculoskeletal tenderness and joint stiffness without the presence of synovitis or arthritis. Nerve conduction study showed combined mild axonal degenerative and demyelinating change. Muscle biopsy analysis showed unspecific mild muscle atrophy with myopathic changes found on electromyography. A diagnosis of isolated adrenocorticotropic hormone deficiency was made on the basis of endocrinological evaluation. The widespread musculoskeletal pain resolved as a result of administration of physiological dose of hydrocortisone replacement. In a patient with unexplained rheumatic symptoms, adrenocortical insufficiency should be considered in the possible aetiology.

Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru

2011-01-01

224

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

PubMed Central

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

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

2010-01-01

225

Gabapentin in Pain Management  

Microsoft Academic Search

role of gabapentin in pain treatment will be discussed with an attempt to identify pain symptoms that are likely to be responsive to gabapentin; 2) animal stud- ies of gabapentin on neuropathic pain and other pain behaviors will be evaluated; and 3) possible mecha- nisms of gabapentin actions will be considered in re- lation to mechanisms of neuropathic pain in

Jianren Mao; Lucy L. Chen

2000-01-01

226

Medications for back pain  

MedlinePLUS

... help with your back pain. Over-the-counter pain relievers Over-the-counter pain relievers can help with your back pain. Over-the- ... your health care provider. If you are taking pain relievers for more than a week, tell your doctor. ...

227

When Sex Is Painful  

MedlinePLUS

How common is painful sex? Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during ... a long-term problem. What causes pain during sex? Pain during sex may be a sign of ...

228

Neuropathic cranial pain  

Microsoft Academic Search

Neuropathic cranial pain, i.e. pain due to central or peripheral nervous system damage localized in cranial area, is a clinical challenge for the neurologist. Despite major advances in knowledge of physiology and biochemistry of pain, relief for many patients suffering from neuropathic pain remains incomplete. Adjuvant analgesics play a key role in the management of neuropathic pain. The introduction in

B. Colombo; P. O. L. Annovazzi; G. Comi

2003-01-01

229

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

PubMed

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

Cowen, Leah E

2013-08-01

230

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

PubMed

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

Iwegbu, C G

1990-07-01

231

Pain drawings in somatoform-functional pain  

PubMed Central

Background Pain drawings are a diagnostic adjunct to history taking, clinical examinations, and biomedical tests in evaluating pain. We hypothesized that somatoform-functional pain, is mirrored in distinctive graphic patterns of pain drawings. Our aim was to identify the most sensitive and specific graphic criteria as a tool to help identifying somatoform-functional pain. Methods We compared 62 patients with somatoform-functional pain with a control group of 49 patients with somatic-nociceptive pain type. All patients were asked to mark their pain on a pre-printed body diagram. An investigator, blinded with regard to the patients’ diagnoses, analyzed the drawings according to a set of numeric or binary criteria. Results We identified 13 drawing criteria pointing with significance to a somatoform-functional pain disorder (all p-values???0.001). The most specific and most sensitive criteria combination for detecting somatoform-functional pain included the total number of marks, the length of the longest mark, and the presence of symmetric patterns. The area under the ROC-curve was 96.3% for this criteria combination. Conclusion Pain drawings are an easy-to-administer supplementary technique which helps to identify somatoform-functional pain in comparison to somatic-nociceptive pain.

2012-01-01

232

American Chronic Pain Association  

MedlinePLUS

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

233

What Is Chronic Pain?  

MedlinePLUS Videos and Cool Tools

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

234

Overview of Neck Pain  

MedlinePLUS

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

235

Runner's Knee (Patellofemoral Pain)  

MedlinePLUS

... and soccer players put heavy stress on their knees. Runner's knee is a term used to refer to a ... that cause pain around the front of the knee (patellofemoral pain). These conditions include anterior knee pain ...

236

Central Pain Syndrome  

MedlinePLUS

... Mingled with the burning may be sensations of "pins and needles;" pressing, lacerating, or aching pain; and brief, intolerable bursts of sharp pain similar to the pain caused by a dental probe on an exposed nerve. Individuals may have ...

237

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 ... of the most frequently asked questions. Ideas about management are one of the frequent topics of conversation ...

238

What a Pain! Kids and Growing Pains  

MedlinePLUS

... Games Kids' Medical Dictionary En Español What Other Kids Are Reading Swimming Going Away to Camp Swimmer's ... Page The Pink Locker Society What a Pain! Kids and Growing Pains KidsHealth > Kids > Illnesses & Injuries > Aches, ...

239

Peripheral Pain Mechanisms in Chronic Widespread Pain  

PubMed Central

Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxious (allodynia). For example, patients with muscle hyperalgesia will rate painful muscle stimuli higher than normal controls, whereas patients with allodynia may perceive light touch as painful, something that a “normal” individual will never describe as painful. The pathogenesis of such peripheral and/or central nervous system changes in CWP is unclear, but peripheral soft tissue changes have been implicated. Indirect evidence from interventions that attenuate tonic peripheral nociceptive impulses in patients with CWP syndromes like FM suggest that overall FM pain is dependent on peripheral input. More importantly, allodynia and hyperalgesia can be improved or abolished by removal of peripheral impulse input. Another potential mechanism for CWP pain is central disinhibition. However, this pain mechanism also depends on tonic impulse input, even if only inadequately inhibited. Thus a promising approach to understanding CWP is to determine whether abnormal activity of receptors in deep tissues is fundamental to the development and maintenance of this chronic pain disorder. Conclusions Most CWP patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. While not predictive for the development of CWP these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, ATP, and cytokines seem to play an important role in sensitizing deep tissue nociceptors of CWP patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for wide-spread chronic pain disorders including FM.

Staud, Roland

2011-01-01

240

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

SciTech Connect

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

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

2009-03-01

241

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

SciTech Connect

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

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

2000-05-17

242

Understanding Cancer Pain.  

National Technical Information Service (NTIS)

This booklet is designed to give you important information about pain related to cancer. It will help you understand why patients have pain, the different ways pain can be treated, and what you need to do when you have pain. Your doctor, nurse, or social ...

2000-01-01

243

Mechanisms of neuropathic pain  

Microsoft Academic Search

Neuropathic pain is defined as 'pain initiated or caused by a primary lesion or dysfunction in the nervous system'.94 The spectrum of neuropathic pain covers a variety of disease states (Table 1) and presents in the clinic with a variety of symptoms.145 Neuropathic pain is often reported as having a lancinating or continuous burning character and is often associated with

D. Bridges; S. W. N. Thompson; A. S. C. Rice

2001-01-01

244

Pathobiology of neuropathic pain  

Microsoft Academic Search

This review deals with physiological and biological mechanisms of neuropathic pain, that is, pain induced by injury or disease of the nervous system. Animal models of neuropathic pain mostly use injury to a peripheral nerve, therefore, our focus is on results from nerve injury models. To make sure that the nerve injury models are related to pain, the behavior was

Manfred Zimmermann

2001-01-01

245

Facial expression accompanying pain  

Microsoft Academic Search

The study of facial expression accompanying pain is of both practical and theoretical importance. It has been suggested that nonverbal behavior may provide accurate information on pain states to supplement self-report and that perhaps facial expressions could even serve as accurate measures of pain in the absence of verbal report. Recent studies of specific facial expressions accompanying pain have benefited

Linda LeResche; Samuel F. Dworkin

1984-01-01

246

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

Microsoft Academic Search

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

S. Mobeen Fatemi; Benyamin Yadali Jamaloei

2011-01-01

247

Breakthrough cancer pain.  

PubMed

Breakthrough pain is a distinct pain state that is common in patients with cancer pain and which is associated with significant morbidity in this group of patients. The aim of this article is to highlight important journal articles relating to breakthrough pain that have been published within the last year, including a systematic review of the epidemiology of breakthrough pain, the largest-ever study of the clinical features of breakthrough pain, and a network meta-analysis of the treatment of breakthrough pain. PMID:24760489

Davies, Andrew N

2014-06-01

248

Patients with chronic pain.  

PubMed

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

Salama-Hanna, Joseph; Chen, Grace

2013-11-01

249

Inferior Calcaneal Bursitis  

MedlinePLUS

... Resources for Help and Information The One-Page Merck Manual of Health Medical Terms Conversion Tables Manuals ... Corns and Calluses Bunion Hammer Toe Plantar Fibromatosis Merck Manual > Patients & Caregivers > Bone, Joint, and Muscle Disorders > ...

250

Growing pains in children  

PubMed Central

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.

Uziel, Yosef; Hashkes, Philip J

2007-01-01

251

Pathophysiology of Neuropathic Pain  

Microsoft Academic Search

Cerebral responses to pain are complex and dynamic in nature and in the case of chronic pain, especially neuropathic pain,\\u000a changes involved are more profound and they are characterized by the involvement of entire pain-related peripheral and central\\u000a nervous system. Functional magnetic resonance imaging studies identified a number of cerebral, cortical, and subcortical structures\\u000a that are activated during pain stimuli.

Misha-Miroslav Backonja

252

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

PubMed Central

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

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

2013-01-01

253

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

SciTech Connect

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

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

2009-12-18

254

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

PubMed

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

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

2013-01-01

255

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

SciTech Connect

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

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

2010-12-10

256

Psychological aspects of pain.  

PubMed

Introduction. Pain is defined "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Pain is a sensation of the body, and is always an unpleasant emotional experience. The role of psychology is auxiliary and supplemental to medicine. This is an aid addressed to the patient, physician and patient's caregivers: professional caregivers, family members and significant others. At each stage of the diagnostic and therapeutic process, psychology offers help, both from the cognitive and practical aspects. Objective. The objective of the article is to present important psychological aspects of studies concerning pain, and the psychological methods and techniques of pain treatment. State of knowledge. Pain is the leading reason for patients seeking medical care and is one of the most disabling, burdensome, and costly conditions. Pain accompanies many diseases, each one of which generates unique/separate diagnostic, therapeutic and research problems. Depression and related psychical disorders. There is a significant relationship between depression and pain symptoms, as well as between pain and suicidal thoughts. Patients with a long history of pain disorders also have increased depression and anxiety symptoms, as well as suicidal thoughts. Patients with more severe depression and anxiety symptoms also have an increase in pain problems. The intensity of pain correlates with the intensity of psychopathological symptoms - both with mood lowering and with anxiety symptoms and worry. Active pain coping strategies strive to function in spite of pain, or to distract oneself from pain, are associated with adaptive functioning. Passive strategies involve withdrawal or relinquishing control to an external force or agent and are related to greater pain and depression. Pain catastrophizing is a negatively distorted perception of pain as awful, horrible and unbearable. Catastrophizing is strongly associated with depression and pain. Studies in which functional magnetic resonance imaging (fMRI) was used showed that pain catastrophizing, independent of the influence of depression, was significantly associated with increased activity in brain areas related to anticipation of pain, attention to pain, emotional aspects of pain and motor control. Pain behaviour is a conditioned pain. Care and concern on the part of others, secondarily enhance a patient's pain behaviours, which lead to an increase in the intensity of the pain experienced. A history of early life adversity (ELA) - rejection, neglect, physical or sexual abuse is related to the development of irritable bowel syndrome (IBS) in adulthood. Ovarian hormones have been shown to modulate pain sensitivity. Imaging of the human brain in chronic pain. Acute pain and chronic pain are encoded in different regions of the brain. Chronic pain can be considered a driving force that carves cortical anatomy and physiology, creating the chronic pain brain/ mind state. Cognitive-behavioural methods of pain treatment in domains of pain experience, cognitive coping and appraisal (positive coping measures), and reduced pain experience are effective in reducing pain in patients. PMID:25000837

Gorczyca, Rafa?; Filip, Rafa?; Walczak, Ewa

2013-12-30

257

[Botulinum toxins for pain].  

PubMed

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

Soinila, Seppo; Haanpää, Maija

2011-01-01

258

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

PubMed Central

Purpose Genome-wide association studies (GWAS) have identified 6q25, which incorporates the oestrogen receptor ? 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.

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

259

Sickle Cell Pain  

MedlinePLUS

... manage pain. Distraction – engaging activities (such as hobbies, video games and movies) that change the patient's focus can help relieve stress and pain. Psychotherapy – speaking with a mental health professional about the stress and frustration of sickle ...

260

Chest Pain, Chronic  

MedlinePLUS

... Yes Your pain may be caused by POSTHERPETIC NEURALGIA, a condition that can remain after the shingles infection. See your doctor. In many cases, postherpetic neuralgia can be treated with over-the-counter pain ...

261

Abdominal Pain Syndrome  

MedlinePLUS

... of the structures within the abdomen or the abdominal wall. In addition, pain messages originating in the chest, ... lungs) Pulmonary embolism (blood clots to the lungs) Abdominal or chest wall pain: Shingles (herpes zoster infection) Costochondritis (inflammation of ...

262

Animals, pain and morality.  

PubMed

While it is widely agreed that the infliction upon innocents of needless pain is immoral, many have argued that, even though nonhuman animals act as if they feel pain, there is no reason to think that they actually suffer painful experiences. And if our actions only appear to cause nonhuman animals pain, then such actions are not immoral. On the basis of the claim that certain behavioural responses to organismic harm are maladaptive, whereas the ability to feel pain is itself adaptive, this article argues that the experience of pain should be viewed as the proximate cause of such occasionally maladaptive behaviour. But as nonhuman animals also display such maladaptive traits, we have reason to conclude that they feel pain. Hence, we have reason to hold that it is indeed possible to inflict needless pain on nonhuman animals, which would be immoral. PMID:15948329

Carter, Alan

2005-01-01

263

Adolescent Anterior Knee Pain  

MedlinePLUS

... pain in the front and center of the knee (anterior knee pain) is common among active, healthy young people, ... not caused by any particular abnormality in the knee and does not mean that the knee will ...

264

Diclofenac Topical (osteoarthritis pain)  

MedlinePLUS

... gel (Voltaren) is used to relieve pain from osteoarthritis (arthritis caused by a breakdown of the lining ... Diclofenac topical liquid (Pennsaid) is used to relieve osteoarthritis pain in the knees. Diclofenac is in a ...

265

What Is Back Pain?  

MedlinePLUS

... any treatment, but you may want to take acetaminophen, aspirin, or ibuprofen to help ease the pain. ... medications are over-the-counter drugs such as acetaminophen and aspirin or prescription pain medications. Topical analgesics ...

266

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

PubMed

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

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

2010-03-01

267

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

PubMed

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

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

2010-03-01

268

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

PubMed Central

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

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

2014-01-01

269

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

PubMed Central

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

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

2013-01-01

270

Posttonsillectomy pain in children.  

PubMed

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

Sutters, Kimberly A; Isaacson, Glenn

2014-02-01

271

Cancer pain and anxiety  

Microsoft Academic Search

Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and\\u000a behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than\\u000a cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree\\u000a of anxiety is a normal response to

Paul D. Thielking

2003-01-01

272

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

PubMed Central

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

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

2012-01-01

273

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

PubMed

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

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

2012-10-01

274

NEUROMODULATION AND CHRONIC PAIN  

Microsoft Academic Search

Neuromodulation and Chronic Pain Theodosiadis P, Samoladas E, Grosomanidis V, Karakoulas K, Vasilakos D Chronic pain causes extreme suffering for millions of people worldwide. It is the leading cause for lost workdays and patients often undergo expensive courses of treatment. Because chronic pain is often difficult to relieve for sustained periods of time, it can have a significant impact on

Theodosiadis Panagiotis; Samoladas Efthimios; Grosomanidis Vasilis; Elliot S. Krames

2008-01-01

275

Pediatric Procedural Pain  

ERIC Educational Resources Information Center

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…

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

2006-01-01

276

Functional Abdominal Pain Syndrome  

Microsoft Academic Search

Functional abdominal pain syndrome (FAPS) differs from the other functional bowel disorders; it is less common, symptoms largely are unrelated to food intake and defecation, and it has higher comorbidity with psy- chiatric disorders. The etiology and pathophysiology are incompletely understood. Because FAPS likely repre- sents a heterogenous group of disorders, peripheral neu- ropathic pain mechanisms, alterations in endogenous pain

DOUGLAS A. DROSSMAN; EMERAN A. MAYER; QASIM AZIZ; DAN L. DUMITRASCU; HUBERT MÖNNIKES; BRUCE D. NALIBOFF

2004-01-01

277

Treating myofascial pain  

Microsoft Academic Search

SummaryNeuropathic pain invariably affects the musculoskeletal system, causing muscle contracture and shortening: “Myofascial Pain”. Spondylosis, the universal outcome of age, wear and tear, is probably the most common cause of neuropathic pain. By irritating nerve roots, spondylosis can lead to peripheral neuropathy and muscle shortening. Many myofascial syndromes (from Achilles Tendonitis to Tennis Elbow) caused by muscle shortening of spondylotic

C Chan Gunn

1996-01-01

278

Paine Appointed Administrator  

NASA Technical Reports Server (NTRS)

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

1969-01-01

279

Definitions and Types of Pain  

MedlinePLUS

... Types of Pain Defining Pain Pain is a perception that signals the individual that tissue damage has ... in the body that are involved in the perception of pain are called "nociception." Basic and clinical ...

280

Ethnic differences in pain and pain management  

PubMed Central

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.

Campbell, Claudia M; Edwards, Robert R

2012-01-01

281

A total dietary program emphasizing magnesium instead of calcium. Effect on the mineral density of calcaneous bone in postmenopausal women on hormonal therapy.  

PubMed

The use of calcium supplementation for the management of primary postmenopausal osteoporosis (PPMO) has increased significantly in the past few years. A review of the published data does not support calcium megadosing during postmenopause. Controlled studies showed no significant effect of calcium intake on mineral density of trabecular bone and a slight effect on cortical bone. Since PPMO is predominantly due to demineralization of trabecular bone, there is no justification for calcium megadosing in postmenopausal women. Soft tissue calcification is a serious risk factor during calcium megadosing under certain conditions. A total dietary program emphasizing magnesium instead of calcium for the management of PPMO takes into account the available data on the effects of magnesium, life-style and dietary habits on bone integrity and PPMO. When this dietary program was tested on 19 postmenopausal women on hormonal replacement therapy who were compared to 7 control postmenopausal women, a significant increase in mineral bone density of the calcaneous bone (BMD) was observed within one year. Fifteen of the 19 women had had BMD below the spine fracture threshold before treatment; within one year, only 7 of them still had BMD values below that threshold. PMID:2352244

Abraham, G E; Grewal, H

1990-05-01

282

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

Microsoft Academic Search

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

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

2007-01-01

283

Musculoskeletal chest wall pain  

PubMed Central

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

Fam, Adel G.; Smythe, Hugh A.

1985-01-01

284

Greater trochanteric hip pain.  

PubMed

In the patient with lateral hip pain, there is a broad differential diagnosis, making appropriate evaluation and management challenging. Greater trochanteric pain syndrome is a term used to denote chronic lateral hip pain and encompasses several painful soft tissue diagnoses including coxa saltans, trochanteric bursitis, and gluteus minimus and medius tendon tears. An overview of these common causes is presented through a series of cases that encompass the anatomic associations, classic presentations, diagnostic tests, and management strategies unique to each disorder. By reviewing this information, we hope to provide clinicians with the tools to evaluate greater trochanteric pain syndrome efficiently and effectively. PMID:24651142

Kimpel, Diane M; Garner, Chadwick C; Magone, Kevin M; May, Jedediah H; Lawless, Matthew W

2014-01-01

285

Posterior knee pain  

PubMed Central

Posterior knee pain is a common patient complaint. There are broad differential diagnoses of posterior knee pain ranging from common causes such as injury to the musculotendinous structures to less common causes such as osteochondroma. A precise understanding of knee anatomy, the physical examination, and of the differential diagnosis is needed to accurately evaluate and treat posterior knee pain. This article provides a review of the anatomy and important aspects of the history and physical examination when evaluating posterior knee pain. It concludes by discussing the causes and management of posterior knee pain.

Perret, D.

2010-01-01

286

Skin conductance and the stress response from heel stick in preterm infants  

Microsoft Academic Search

AIMTo evaluate whether spontaneous skin conductance activity is an objective method for measuring the stress response to painful stimuli in premature infants. The number and amplitude of the waves and the baseline increase with the activity of the sympathetic nervous system.METHODSIn 20 preterm infants of gestational age ? 29 weeks, behavioural state and spontaneous skin conductance activity variables were measured

H Storm

2000-01-01

287

Avicenna's concept of pain  

PubMed Central

Ibn Sina (Latin name – Avicenna, 980–1037) 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.

Tashani, Osama A.; Johnson, Mark I.

2010-01-01

288

Heart Rate Variability in Response to Pain Stimulus in VLBW Infants Followed Longitudinally During NICU Stay  

PubMed Central

The objective of this longitudinal study, conducted in a neonatal intensive care unit, was to characterize the response to pain of high-risk very low birth weight infants (< 1500 g) from 23 through 38 weeks post-menstrual age (PMA) by measuring heart rate variability (HRV). Heart period data were recorded before, during, and after a heel lanced or wrist venipunctured blood draw for routine clinical evaluation. Pain response to the blood draw procedure and age-related changes of HRV in low-frequency and high-frequency bands were modeled with linear mixed-effects models. HRV in both bands decreased during pain, followed by a recovery to near-baseline levels. Venipuncture and mechanical ventilation were factors that attenuated the HRV response to pain. HRV at the baseline increased with post-menstrual age but the growth rate of high-frequency power was reduced in mechanically ventilated infants. There was some evidence that low-frequency HRV response to pain improved with advancing PMA.

Padhye, Nikhil S; Williams, Amber L; Khattak, Asif Z; Lasky, Robert E

2009-01-01

289

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

PubMed

Unfamiliar or sudden exercise can induce delayed onset muscle soreness (DOMS) within 12-24 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

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

2014-04-01

290

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

PubMed Central

Unfamiliar or sudden exercise can induce delayed onset muscle soreness (DOMS) within 12–24 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.

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

2014-01-01

291

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

PubMed

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

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

1992-03-01

292

Broadband ultrasound attenuation (BUA) of the heel bone and its correlates in men and women in the EPIC-Norfolk cohort: a cross-sectional population-based study  

Microsoft Academic Search

Osteoporotic fractures have substantial clinical and public health impact. Bone quality is an important determinant of fracture risk. Quantitative ultrasound (QUS) of bone measured as broadband ultrasound attenuation (BUA) has been shown to predict fracture risk. However, there have been very few large population studies, particularly in men. We investigated the correlates of calcaneal BUA using a CUBA clinical machine

Ailsa Welch; Joanna Camus; Nichola Dalzell; Suzy Oakes; Jonathan Reeve; K. T. Khaw

2004-01-01

293

Pain after earthquake  

PubMed Central

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.

2012-01-01

294

Neurological diseases and pain  

PubMed Central

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.

2012-01-01

295

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

PubMed

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

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

2009-12-01

296

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

PubMed

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

Besser, Marcus; Marpet, Mark; Medoff, Howard

2008-01-01

297

Painful hip arthroplasty: definition  

PubMed Central

Summary Total hip arthroplasty (THA) has been indicated as the surgical intervention with greatest improvement in pain and physical function. However some patients continue to experience hip pain after elective surgery. We investigate prognostic factors that negatively affect treatment effectiveness and the patient outcome. The “hip region” constitutes the groin, buttock, upper lateral thigh, greater trochanteric area, and the iliac crest. Pain originating from various sources and not directly linked to prosthesis may be perceived here and includes the lumbosacral spine, referred pain from abdominal organs and soft tissue sources such as trochanteric bursitis, tendinitis, hip abductor dysfunction, and inguinal hernia. An accurate assessment of the pain cause is extremely difficult to construct and a complete differential diagnosis is fundamental. We assess all the possible causes of hip pain after THA and we divide them depending on the presence or absence of radiographic signs.

Ferrata, Paolo; Carta, Serafino; Fortina, Mattia; Scipio, Daniele; Riva, Alberto; Di Giacinto, Salvatore

2011-01-01

298

Pain and functional imaging.  

PubMed Central

Functional neuroimaging has fundamentally changed our knowledge about the cerebral representation of pain. For the first time it has been possible to delineate the functional anatomy of different aspects of pain in the medial and lateral pain systems in the brain. The rapid developments in imaging methods over the past years have led to a consensus in the description of the central pain responses between different studies and also to a definition of a central pain matrix with specialized subfunctions in man. In the near future we will see studies where a systems perspective allows for a better understanding of the regulatory mechanisms in the higher-order frontal and parietal cortices. Also, pending the development of experimental paradigms, the functional anatomy of the emotional aspects of pain will become better known.

Ingvar, M

1999-01-01

299

[Neuromusculoskeletal chest pain].  

PubMed

To determine frequency of neuromusculoskeletal etiology of chest pain is performed. By means of a retrospective analysis and on the basis of the history of the patients' disease, data were collected after chest pain had been medically worked out. The causes to chest pain were in 82% of cardial etiology, in 9% of neuromusculoskeletal etiology, in 6% of gastrointestinal etiology and 3% others. All the patients suffering from neuromusculoskeletal causes to chest pain were, besides anti-rheumatic therapy, also treated by certain form of cardiac therapy. The task of a doctor is to accurately recognize serious disorders as possible causes to chest pain. However, the doctor must not make wrong diagnosis of potentially dangerous conditions thus causing unwanted psychological and economical consequences. In order to realize this, adequate diagnostic possibilities are necessary besides the knowledge about all possible causes to chest pain. PMID:15067819

Horvat, Davor

2003-01-01

300

[Buttocks sciatic pain].  

PubMed

Confusion between radicular and nerve trunk syndrome is not rare. With sciatic pain, any nerve trunk pain or an atypical nerve course should suggest nerve trunk pain of the sciatic nerve in the buttocks. The usual reflex with sciatic pain is vertebral-radicular conflict. The absence of spinal symptoms and the beginning of pain in the buttocks and not in the lumbar region should reorient the etiologic search. Once a tumor of the nerve trunk has been ruled out (rarely responsible for pain other than that caused by tumor pressure), a myofascial syndrome should be explored searching for clinical, electrophysiological, and radiological evidence of compression of the sciatic trunk by the piriform muscle but also the obturator internus muscle. Hamstring syndrome may be confused with this syndrome. Treatment is first and foremost physical therapy. Failures can be treated with classical CT-guided infiltrations with botulinum toxin. Surgery should only be entertained when all these solutions have failed. PMID:19744678

Labat, J-J; Robert, R; Riant, T; Louppe, J-M; Lucas, O; Hamel, O

2009-10-01

301

Pain management: pharmacological approaches  

Microsoft Academic Search

\\u000a More than three quarters of patients with advanced cancer experience chronic pain that is severe enough to warrant therapy\\u000a with opioid drugs [1,2]. The most prevalent pain syndromes are disease related in adults and treatment related in children\\u000a [3,4]. In adults with metastatic solid tumors, disease-related pains are usually persistent and often progressive, a pattern\\u000a that reflects the limited availability

Russell K. Portenoy; Gerri Frager

302

Managing Breakthrough Pain  

Microsoft Academic Search

Breakthrough cancer pain (BTcP) has been defined as a transitory increase in pain intensity on a baseline pain of moderate\\u000a intensity in patients on regularly administered analgesic treatment. This review provides updated information about the classification,\\u000a assessment, and treatment of BTcP, with special emphasis on the use of opioids. Due to its slow onset to effect, oral opioids\\u000a cannot be

Sebastiano Mercadante

303

Management of Pain in the Cancer Patient.  

National Technical Information Service (NTIS)

Contents: Cancer pain management--diagnosis and evaluation; Cancer pain management--multidisciplinary pain clinics; Cancer pain management--psychologic technics; Cancer pain management--pharmacologic technics; Cancer pain management--neurosurgical technic...

1984-01-01

304

NECK AND SHOULDER PAIN  

PubMed Central

Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions. There may be similarities in the anatomicophysiological mechanism of pain production and in the clinical picture in many of these conditions. Many of the vague and refractory cases of neck and shoulder pain and of migraine may be due to cervical disc disease. Scalenus anticus syndrome and cardiac disease can be diagnosed or differentiated from cervical disc syndrome only by thorough investigation. Proper treatment of neck and shoulder pain is dependent upon correct diagnosis through complete history, physical examination and laboratory tests, as described in this presentation.

Fields, Albert; Hoesley, John

1949-01-01

305

Painful Boney Metastases  

PubMed Central

Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics.

Smith, Howard S.

2013-01-01

306

Painful boney metastases.  

PubMed

Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. PMID:23861996

Smith, Howard S; Mohsin, Intikhab

2013-07-01

307

[Enduring pain II. Treatment].  

PubMed

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

Baldessarini, Ross; Selle, Valerio; Vigo, Daniel V

2013-01-01

308

Pain in Sjögren's syndrome.  

PubMed

Sjögren's syndrome (SjS) is an autoimmune disease that affects the salivary and lacrimal glands, but it can also have extra-glandular manifestations. Although pain has not yet been fully studied and characterized, it is a symptom that can be often found in patients with SjS, who mainly complain of neuropathic pain, followed by nociceptive pain. The latter when combined with widespread dysfunctional symptoms is defined fibromyalgia. The aim of this work is to analyze the scientific literature on the presence of pain in patients with primary Sjögren's syndrome. PMID:24938195

Giacomelli, C; Talarico, R; Baldini, C; Bazzichi, L

2014-01-01

309

Association of calcaneal quantitative ultrasound parameters with metabolic syndrome in middle-aged and elderly Chinese: a large population-based cross-sectional study  

PubMed Central

Background The possible association between metabolic syndrome (MS) and bone mineral density (BMD) has been highlighted recently. However, the exact effects of MS on calcaneal quantitative ultrasound (QUS) parameters remains uncertain. The aim of this study was to assess the impact of MS states, different componets of MS, as well as the number of MS componets on QUS. Methods A total of 7489 Chinese adults aged 40 years or older in Nanjing were enrolled in this cross-sectional study. MS was defined according to recommendations generated by the International Diabetes Federation (IDF) in 2005. QUS was measured for each participant. Results The prevalence of MS was 34.6% in men and 42.8% in women (over 40 years old). In postmenopausal women with MS, 25-hydroxyvitamin D[25(OH)D], age adjusted quantitative ultrasound index (QUI) and broadband ultrasound attenuation (BUA) were all lower than those without (p?

2014-01-01

310

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

Microsoft Academic Search

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

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

2011-01-01

311

Block That Pain!  

MedlinePLUS

... of capsaicin—the substance that makes chili peppers hot—and a drug called QX-314. This combination produces a unique effect, blocking pain-sensing neurons without impairing signals from other cells. In contrast, most pain relievers used for surgical ...

312

Loin pain haematuria syndrome  

Microsoft Academic Search

Loin pain haematuria syndrome is a descriptive diagnosis of recurrent episodes of loin pain accompanied by haematuria, in which investigations do not reveal adequate pathology to account for the symptoms. The majority of patients present between 20 and 40 years, but onset may occur in older children. A significant number of patients show psychological and psychopathological features. Renal histology may

John R. Burke; Ian R. Hardie

1996-01-01

313

Opioids in pain management  

Microsoft Academic Search

Dose titration and differences between clinical and laboratory pharmacology The clinical use of opioids shows a difference between their clinical pharmacology and their laboratory pharmacology. What happens when opioids are given to someone in pain is different from what happens when they are given to someone not in pain. The respiratory depression that results from the acute use of opioids

Henry McQuay

1999-01-01

314

Patients' perspectives on pain.  

PubMed

Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are dissatisfied with their pain management and with the information given to them about their pain, and they want to know more about causes and strategies to manage pain. They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice. PMID:23459087

Norrbrink, Cecilia; Löfgren, Monika; Hunter, Judith P; Ellis, Jaqueline

2012-01-01

315

Hypnosis and Clinical Pain  

Microsoft Academic Search

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute

David R. Patterson; Mark P. Jensen

2003-01-01

316

Sleep and pain  

Microsoft Academic Search

Noxious stimuli and painful disorders interfere with sleep, but disturbances in sleep also contribute to the experience of pain.Chronic paroxysmal hemicrania and possibly cluster headaches are related to REM sleep. Whereas headache is associated with snoring and sleep apnea, morning headaches are not specific for any primary sleep disorder. Nevertheless, the management of the sleep disorder ameliorates both morning headache

Harvey Moldofsky

2001-01-01

317

MAP kinase and pain  

PubMed Central

Mitogen-activated protein kinases (MAPKs) are important for intracellular signal transduction and play critical roles in regulating neural plasticity and inflammatory responses. The MAPK family consists of three major members: extracellular signal-regulated kinases (ERK), p38, and c-Jun N-terminal kinase (JNK), which represent three separate signaling pathways. Accumulating evidence shows that all three MAPK pathways contribute to pain sensitization after tissue and nerve injury via distinct molecular and cellular mechanisms. Activation (phosphorylation) of MAPKs under different persistent pain conditions results in the induction and maintenance of pain hypersensitivity via non-transcriptional and transcriptional regulation. In particular, ERK activation in spinal cord dorsal horn neurons by nociceptive activity, via multiple neurotransmitter receptors, and using different second messenger pathways plays a critical role in central sensitization by regulating the activity of glutamate receptors and potassium channels and inducing gene transcription. ERK activation in amygdala neurons is also required for inflammatory pain sensitization. After nerve injury, ERK, p38, and JNK are differentially activated in spinal glial cells (microglia vs astrocytes), leading to the synthesis of proinflammatory/pronociceptive mediators, thereby enhancing and prolonging pain. Inhibition of all three MAPK pathways has been shown to attenuate inflammatory and neuropathic pain in different animal models. Development of specific inhibitors for MAPK pathways to target neurons and glial cells may lead to new therapies for pain management. Although it is well documented that MAPK pathways can increase pain sensitivity via peripheral mechanisms, this review will focus on central mechanisms of MAPKs, especially ERK.

Ji, Ru-Rong; Gereau, Robert W.; Malcangio, Marzia; Strichartz, Gary R.

2008-01-01

318

Chronic idiopathic anal pain  

Microsoft Academic Search

PURPOSE: This study was undertaken to analyze whether intra-anal ultrasound examination, anorectal physiologic evaluation, and histopathologic examination in patients with chronic idiopathic anal pain presented any common features and whether the results of different treatment modalities correlated with these findings. METHODS: Eighteen patients who met the criteria for chronic idiopathic anal pain were studied. All had an intra-anal ultrasound examination

J. Christiansen; E. Bruun; B. Skjoldbye; K. Hagen

2001-01-01

319

Recurrent Abdominal Pain  

ERIC Educational Resources Information Center

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…

Banez, Gerard A.; Gallagher, Heather M.

2006-01-01

320

Painful diabetic neuropathy  

Microsoft Academic Search

Chronic painful diabetic neuropathy can cause a variety of challenges, particularly in successful treatment. The pain, which can last for years, can severely impair quality of life. Management is difficult, although the careful use of drugs can be significantly beneficial. Tricyclic and anticonvulsant drugs may be effective, with a variety of drugs available as second line agents. Newer non-drug systems

S. J. Benbow; I. A. MacFarlane

1999-01-01

321

Does Pain Relief Improve Pain Behavior and Mood in Chronic Pain Patients?  

Microsoft Academic Search

Chronic pain is a subjective experience and has not only physical, but also psychological and social dimensions. In the present study, we sought to determine whether an ef- fective pain reduction would improve mood, behavioral, and cognitive outcome measures in chronic pain patients. Four-hundred-seventy-seven patients entering pain ther- apy at our university pain center were prospectively stud- ied during the

Sabine M. Sator-Katzenschlager; Andreas W. Schiesser; Sibylle A. Kozek-Langenecker; Gerhard Benetka; Gudrun Langer; Hans-Georg Kress

2003-01-01

322

An archaeology of pain  

NASA Astrophysics Data System (ADS)

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.

Gruber, Dennis Michael

323

Pain in systemic sclerosis.  

PubMed

Chronic pain is a healthcare problem that significantly affects the mental health, and the professional and private life of patients. It can complicate many disorders and represents a common symptom of rheumatologic diseases, but the data on its prevalence is still limited. Pain is a ubiquitous problem in systemic sclerosis (SSc). SSc-related pain has been studied on the basis of biomedical models and is considered a symptom caused by the disease activity or previous tissue damage. Effective pain management is a primary goal of the treatment strategy, although this symptom in SSc has not yet been investigated in detail. However, these patients do not all respond adequately to pharmacological pain therapies, therefore in these cases a multimodal approach needs to be adopted. PMID:24938196

Stisi, S; Sarzi-Puttini, P; Benucci, M; Biasi, G; Bellissimo, S; Talotta, R; Atzeni, F

2014-01-01

324

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

NASA Astrophysics Data System (ADS)

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

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

2010-10-01

325

Facts and Figures on Pain  

MedlinePLUS

... at least 100 million adult Americans have common chronic pain conditions, a conservative estimate because it does not include acute pain or children. ( 20 ) Pain is a significant public health problem ...

326

The Measurement of Suprathreshold Pain.  

National Technical Information Service (NTIS)

The study of both subjective and physiological responses to painful stimulation is fraught with a number of difficulties, one of which is the difference in functional relationships between the threshold and suprathreshold of pain, such as surgical pain. B...

J. Voevodsky L. M. Cooper A. H. Morgan E. R. Hilgard

1967-01-01

327

Federal Pain Research Database Launched  

MedlinePLUS

... Release: Tuesday, May 27, 2014 Federal pain research database launched Multi-agency effort combines pain research information in easy-to-use database The Interagency Pain Research Portfolio (IPRP), a database ...

328

Pain: You Can Get Help  

MedlinePLUS

... one or more of the following pain medications. Acetaminophen is good for all types of pain, especially ... to moderate pain. It is not habit-forming. Acetaminophen is found in over-the-counter and prescription ...

329

Back pain among echocardiographers  

PubMed Central

Objective—By having to adopt unnatural postures, echocardiographers place themselves at risk of back injury. The present study sought to document the incidence and severity of back pain among echocardiographers, and to identify personal, lifestyle, and occupational characteristics that may predict risk of back pain. Design—A questionnaire concerning occupational, personal, and lifestyle characteristics, as well as the extent and severity of back pain was completed and returned by 183 echocardiographers. Results—The standard echocardiography examination position of “machine on the left, patient on the right, and transducer held in the right hand” (used by 66% of respondents) greatly increased the risk of back pain (odds ratio (OR) = 4·9; 95% confidence interval (95%CI) = 1·49?16·4). Echocardiographers with more than 11 years experience in the field were also at risk of back pain (OR = 3·4; 95%CI = 0·97?11·6). The intensity of back pain was strongly associated with the amount of time spent on echocardiography examinations (P = 0·035), limitation of lifestyle (P ? 0·001), and interference with work (P ? 0·001). There was a significantly higher relative risk of back pain for the respondents whose job involved frequent or occasional lifting compared with nonlifters (P = 0·01; OR = 4·8, 95%CI = 1·25?18·7). At least some limitation of lifestyle from back pain was reported by 56% of the respondents. Conclusions—There is a high incidence of back pain among echocardiographers, and specific tasks and activities increase the risk of back pain. Further research should focus on preventative measures and optimum work station designs that may serve as a guide to echocardiography departments.

Solanki, Mina; Carr, Douglas; Martin, Michael

1997-01-01

330

Painful boney metastases.  

PubMed

Up to 90% of patients with metastatic or advanced stage cancer will experience significant cancer-related pain. Approximately half or more of patients diagnosed with cancer may experience bone pain. It has been estimated that tumor metastases to the skeleton affects roughly 400,000 US citizens annually. Carcinoma from breast, lung, and prostate cancers account for approximately 80% of secondary metastatic bone disease. Bone metastases may cause devastating clinical complications associated with dramatic reductions in quality of life, mobility, and independence, as well as excruciating refractory pain. Associated complications from osseous metastases also present a substantial economic burden. Currently, there are still a significantly high number of patients suffering with unrelieved pain from osseous metastases. Treatments for painful osseous metastases may not only diminish pain but also may improve quality of life and independence/mobility, and reduce skeletal morbidity, potential pathologic fractures, spinal cord compression, and other "skeletal-related events." Treatment strategies for painful osseous metastases include the following: systemic analgesics, intrathecal analgesics, glucocorticoids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation and cryoablation), bisphosphonates, chemotherapeutic agents, inhibitors of RANKL-RANK interaction (eg, denosumab), hormonal therapies, interventional techniques (eg, kyphoplasty), and surgical approaches. Although the mechanisms underlying the development of bone metastases remain incompletely understood, there appears to be important bi-directional interactions between the tumor and the bone microenvironment. A greater understanding of the pathophysiology of painful osseous metastases may lead to better and more selective targeted analgesic therapy. Additionally, potential future therapeutic approaches to painful osseous metastases may revolutionize approaches to analgesia for this condition, leading to optimal outcomes with maximal pain relief and minimal adverse effects. PMID:23344095

Smith, Howard S; Barkin, Robert L

2014-01-01

331

Myofascial pain: Diagnosis and management  

Microsoft Academic Search

Clinical understanding and management of myofascial pain is overlooked frequently when dealing with pain. Myofascial pain\\u000a is defined as pain or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger point\\u000a is a focus of hyperirritability in the muscle that, when compressed, is locally tender and, if sensitized, gives rise to referred\\u000a pain and tenderness. The pain

Steven B. Graff-Radford

2004-01-01

332

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

PubMed

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

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

2012-09-01

333

An Evaluation of the Rearfoot Posture in Individuals with Patellofemoral Pain Syndrome  

PubMed Central

Structural abnormalities of the foot may cause abnormal subtalar joint compensatory motion in order to attain normal function of the lower extremity during gait although studies have not been conclusive. Current conflict in the literature may be related to the differing measures focused on the varying protocols and also the absence of a control group in some studies. This study investigated the rearfoot posture including Subtalar Joint Neutral Position (STJN) and Relaxed Calcaneal Standing (RCS) measurements in patellofemoral pain syndrome (PFPS) and healthy subjects. The angle of STJN during non-weight bearing position and the two dimensional (2D) rearfoot RCS posture was measured using a goniometer in 14 healthy females and 13 females with PFPS. The RCS posture was also measured three dimensionally (3D) by attaching external markers to a tibia shell and the calcaneus and videoing with a four-camera three-dimensional motion analysis system. A one way ANOVA was used to assess the differences between the groups. The 2D and 3D RCS were significantly different between the groups (p ? 0.001) with mean -0.23° ± 1.35° , 2.52° ± 3.11° for the control group and 2.35° ± 1.4°, 7.02° ± 3.33° for the clinical group respectively. STJN showed a slight rearfoot varus (although significant p = 0.04) in PFPS (-2.20° ± 1.51° ) compared to the control group (-1.00° ± 1.36°). Negative values indicated inversion and positive values indicated eversion. The 2D and 3D RCS showed a significantly more everted posture of the rearfoot for the PFPS group. Subtalar joint varus may contribute to the increased eversion during relaxed standing in the PFPS group. Rearfoot measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS. Key Points Rearfoot posture of PFPS subjects showed a small varus position of Subtalar Joint Neutral and a rearfoot valgus in relaxed standing posture. Relaxed Calcaneal Standing and Subtalar Joint Neutral Position measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS.

Levinger, Pazit; Gilleard, Wendy

2004-01-01

334

Loin pain haematuria syndrome: distress resolved by pain relief.  

PubMed

Loin pain haematuria syndrome (LPHS) is a syndrome of severe chronic pain of unknown aetiology. This study assessed pain, mood variables and psychiatric status in patients (n=26) with LPHS. Patients were assessed before and after treatment with capsaicin. Assessment inventories used were the McGill Pain Questionnaire, the Pain Discomfort Scale, the General Health Questionnaire and the Hospital Anxiety and Depression Scale. Pain relief was achieved in 65% of patients. In this group pain (P < 0.001) and psychiatric (P < 0.01) scores were significantly reduced. By comparison, in those patients who did not gain pain relief, scores remained steady (P > 0.05). In addition, most pain-free patients completely stopped their opiate analgesia without addictive symptoms. These results suggest an organic pathology to LPHS and militate against suggestions of primary psychological cause or drug addiction. The results also show that the psychiatric disturbances associated with this chronic pain disappear if the pain disappears. PMID:9696475

Bultitude, M; Young, J; Bultitude, M; Allan, J

1998-05-01

335

Basic aspects of musculoskeletal pain: from acute to chronic pain  

PubMed Central

The transition from acute to chronic musculoskeletal pain is not well understood. To understand this transition, it is important to know how peripheral and central sensitization are manifested and how they can be assessed. A variety of human pain biomarkers have been developed to quantify localized and widespread musculoskeletal pain. In addition, human surrogate models may be used to induce sensitization in otherwise healthy volunteers. Pain can arise from different musculoskeletal structures (e.g. muscles, joints, ligaments, or tendons), and differentiating the origin of pain from those different structures is a challenge. Tissue specific pain biomarkers can be used to tease these different aspects. Chronic musculoskeletal pain patients in general show signs of local/central sensitization and spread of pain to degrees which correlate to pain intensity and duration. From a management perspective, it is therefore highly important to reduce pain intensity and try to minimize the duration of pain.

Arendt-Nielsen, Lars; Fernandez-de-las-Penas, Cesar; Graven-Nielsen, Thomas

2011-01-01

336

Low back pain.  

PubMed Central

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.

Ehrlich, George E.

2003-01-01

337

Oral sucrose and a pacifier for pain relief during simple procedures in preterm infants: a randomized controlled trial  

PubMed Central

BACKGROUND AND OBJECTIVES: Previous randomized trials of the analgesic effects of sucrose, glucose, and a pacifier in term neonates have shown that the pacifier resulted in lower pain scores than glucose or sucrose, but the pacifier with and without sucrose did not differ. The current study was designed to assess the analgesic effect of pharmacologic (sucrose, water) and a non-pharmacologic measures (pacifier) in preterm infants and to find whether there is any synergism between these intervention in relieving pain during painful procedures. PATIENTS AND METHODS: In this double-blind, randomized, controlled study, 36 preterm infants (mean 31 weeks gestational age, range 27 to 36 weeks) were randomly allocated to six different regimens (0.5 mL sterile water with pacifier, 0.5 mL sterile water without pacifier, 0.5 mL sucrose 24% with pacifier, 0.5 mL sucrose 24% without pacifier, pacifier alone and control group) during a stay in intensive care of up to 15 days. Pain scores were measured with the Premature Infant Pain Profile (PIPP), a validated behavioral acute pain scale. RESULTS: Of all the regimens, the lowest pain scores occurred with the use of 24% sucrose solution combined with pacifier. The mean pain score for the combination of sucrose with pacifier was 0.7 as compared to 1.4 for the sterile water with pacifier group (P<.05). CONCLUSION: The synergistic effect of the combination of sucrose and non-nutritive sucking was clinically effective and safe in relieving the pain of simple procedures such as venipuncture or heel stick in preterm and term infants, but further research is needed on these interventions alone and in combination with other behavioral interventions in neonates.

Elserafy, Fathia A.; Alsaedi, Saad A.; Louwrens, Julita; Sadiq, Bakr Bin; Mersal, Ali Y.

2009-01-01

338

Painful Bladder Syndrome  

Microsoft Academic Search

\\u000a Painful bladder syndrome\\/interstitial cystitis (PBS\\/IC), also known as bladder pain syndrome (BPS\\/IC), is primarily based\\u000a on symptoms of urgency, frequency, and pain in the bladder and\\/or pelvis. Its etiology is not known and clinical characteristics\\u000a vary among patients. Early recognition of BPS\\/IC is very important because the symptoms are quite disabling, affecting quality\\u000a of life and resulting in patients being

Mauro Cervigni; Franca Natale; Albert Mako; Loredana Nasta

339

Animal Models of Cancer Pain  

PubMed Central

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.

Pacharinsak, Cholawat; Beitz, Alvin

2008-01-01

340

The painful face: pain expression recognition using active appearance models  

Microsoft Academic Search

Pain is typically assessed by patient self-report. Self-reported pain, however, is difficult to interpret and may be impaired or not even possible, as in young children or the severely ill. Behavioral scientists have identified reliable and valid facial indicators of pain. Until now they required manual measurement by highly skilled observers. We developed an approach that automatically recognizes acute pain.

Ahmed Bilal Ashraf; Simon Lucey; Jeffrey F. Cohn; Tsuhan Chen; Zara Ambadar; Ken Prkachin; Patty Solomon; Barry-john Theobald

2007-01-01

341

Improving paediatric pain management: introducing the 'Pain Passport'.  

PubMed

The 'Pain Passport' is a novel method of improving the management of pain in children. It consists of a leaflet carried by the patient which records serial pain scores. It attempts to empower patients and prompt medical and nursing staff to evaluate the child's pain. Preliminary audit data in support of this concept are encouraging. PMID:22396384

Newstead, Beth A; Armitage, Sarah; Appelboam, Andrew

2013-01-01

342

Growing Pains (For Parents)  

MedlinePLUS

... Parents Are Reading Q&A: Obamacare Finding Affordable Health Care Eating Well & Staying Fit Flu Vaccine: How Many Doses? Connect With Us: Social Media Pregnant? Your Baby's Growth Growing Pains KidsHealth > Parents > ...

343

[Greater trochanteric pain syndrome].  

PubMed

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

Gollwitzer, H; Opitz, G; Gerdesmeyer, L; Hauschild, M

2014-01-01

344

Pain: Hope through Research  

MedlinePLUS

... inflammatory diseases affect the body's soft tissues, including tendonitis and bursitis. Back pain has become the high ... caused by chronic overextension of the wrist and tendonitis or tenosynovitis, affecting one or more tendons. Sciatica ...

345

Exercise and Shoulder Pain  

MedlinePLUS

... Diabetic Complications: Can cause frozen shoulder • Rotator Cuff Tendonitis: Irritation and swelling of tendons of rotator cuff ... tendons beneath joint structures and surfaces), rotator cuff tendonitis (inflammation, pain and swelling), and rotator cuff tears ( ...

346

Patient Education on Pain  

MedlinePLUS Videos and Cool Tools

... Annual Meeting Media Policies Prevent Drug Abuse Patient Education on Pain AAPM Past President, Perry G. Fine, ... Home Member Center Patient Center Library Advocacy Practice Management CME Annual Meeting Contact Us Members' Community Privacy ...

347

Knee pain (image)  

MedlinePLUS

... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

348

Hepatitis C: Managing Pain  

MedlinePLUS

... National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ... symptoms of depression, you can make a big impact on your pain. Conventional medical interventions Your health ...

349

Chest Pain, Acute  

MedlinePLUS

... a deep breath? Yes Your pain may indicate PNEUMOTHORAX, a condition in which air leaks from a ... breathe. See your doctor right away. Treatment of pneumothorax may require hospitalization. No 8. Do you experience ...

350

Mechanism of Cancer Pain  

PubMed Central

Ongoing and breakthrough pain is a primary concern for the cancer patient. Although the etiology of cancer pain remains unclear, animal models of cancer pain have allowed investigators to unravel some of the cancer-induced neuropathologic processes that occur in the region of tumor growth and in the dorsal horn of the spinal cord. Within the cancer microenvironment, cancer and immune cells produce and secrete mediators that activate and sensitize primary afferent nociceptors. Pursuant to these peripheral changes, nociceptive secondary neurons in spinal cord exhibit increased spontaneous activity and enhanced responsiveness to three modes of noxious stimulation: heat, cold, and mechanical stimuli. As our understanding of the peripheral and central mechanisms that underlie cancer pain improves, targeted analgesics for the cancer patient will likely follow.

Schmidt, Brian L.; Hamamoto, Darryl T.; Simone, Donald A.; Wilcox, George L.

2010-01-01

351

Biologic poisons for pain.  

PubMed

Pain therapies from natural sources date back thousands of years to the use of plant and animal extracts for a variety of painful conditions and injuries. We certainly are all familiar with modern uses of plant-derived analgesic compounds such as opium derivatives from papaverum somniferum and salicylates from willow bark (Salix species). Local anesthetics were isolated from coca leaves in the late 1800s. Sarapin, derived from carnivorous pitcher plants, has been injected for regional analgesia in human and veterinary medicine, but efficacy is controversial. Biologic organisms can play important roles in developing an understanding of pain mechanisms, either from isolation of compounds that are analgesic or of compounds that produce pain, hyperalgesia, and allodynia. PMID:15509455

Reisner, Lori

2004-12-01

352

Low back pain.  

PubMed

Low back pain is a common, frequently recurring condition that often has a nonspecific cause. Most nonspecific acute low back pain will improve within several weeks with or without treatment. The diagnostic workup should focus on evaluation for evidence of systemic or pathologic causes. Psychosocial distress, poor coping skills, and high initial disability increase the risk for a prolonged disability course. All patients with acute or chronic low back pain should be advised to remain active. The treatment of chronic nonspecific low back pain involves a multidisciplinary approach targeted at preserving function and preventing disability. Surgical referral is indicated in the presence of severe or progressive neurologic deficits or signs and symptoms of cauda equina syndrome. PMID:24758954

Golob, Anna L; Wipf, Joyce E

2014-05-01

353

Pain in MS  

MedlinePLUS

... facial pain of trigeminal neuralgia, which usuallyresponds to carbamazepine. Lhermittes sign is a stabbing,electric-shock-like ... such as aspirin). Drugsthat treat seizures (for example carbamazepine) and antidepressants(such as amitriptyline) are often effective ...

354

Employees with Chronic Pain  

MedlinePLUS

... employee Move workstation close to other work areas, office equipment, and break rooms Muscle Pain and Stiffness: Implement ergonomic workstation design, e.g., ergonomic chair and adjustable workstation to ...

355

Pain in Parkinson's Disease.  

PubMed

Pain is reported by nearly 50% of patients with Parkinson's disease. In some patients, it can be more debilitating than the motor deficits. In order to identify the appropriate treatment strategy for each patient, it is useful to categorize pain syndromes as follows: 1) low DOPA (end of dose wearing off, diphasic, or early morning) painful states are associated with inadequate levels of dopamine receptor stimulation; 2) high DOPA (peak dose) painful states occur at times of maximum levodopa efficacy; and 3) many patients report pain that has no obvious relation to dopaminergic medications or may even be caused by other conditions. Low DOPA painful states are best treated by trying to provide more continuous dopaminergic stimulation and thereby reduce or prevent the number and duration of "off" periods. Adding or increasing the dose of direct-acting dopamine receptor agonists or of catechol-o-methyl transferase inhibitors is the best first-line strategy. Other approaches include increasing the frequency of immediate-release levodopa preparations or using controlled-release preparations. More invasive approaches should be considered only when simpler methods fail. These include deep brain stimulation to the pallidum or the subthalamic nucleus, or direct duodenal continuous infusion of levodopa in patients who are unable to undergo surgery. Pain associated with excessive dopaminergic stimulation usually is a result of dystonia or severe chorea. Reduction of levodopa is the first step in attempting to diminish high DOPA states, followed by reduction or cessation of other dopaminergic agents such as selegiline, catechol-o-methyl transferase inhibitors, or direct-acting dopamine receptor agonists. Adding amantadine can reduce chorea significantly and it should be tried if the potential and actual side effects are tolerable to the patient. Deep brain stimulation is a good final option if medication adjustments are ineffective. Nonspecific pains of Parkinson's disease can be difficult to treat. The effective use of central pain suppressant or analgesics is anecdotal and difficult to verify. In untreated early disease, generalized pain or pain related to joint or muscle immobility may be reduced by effective treatment of the underlying Parkinson's disease. PMID:15043802

Sage, Jacob I.

2004-05-01

356

Over-the-counter pain relievers  

MedlinePLUS

... Acetaminophen; NSAID; Non-steroidal 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 ...

357

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

PubMed

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

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

2014-06-01

358

Low Back Pain  

PubMed Central

Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention.

Reuler, James B.

1985-01-01

359

Low back pain (acute)  

PubMed Central

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).

2011-01-01

360

Sympathetically maintained pain  

Microsoft Academic Search

Reflex sympathetic dystrophy (RSD) is a controversial condition, redefined in 1996 by an ad hoc International Association\\u000a for the Study of Pain (IASP) task force. One of the strongest critiques against the entire concept of sympathetic-dependent\\u000a pain is that patients labeled as having RSD harbor in reality a somatoform disorder. Here clinical cases are described to\\u000a prove that other organic

Paolo Marchettini; Marco Lacerenza; Fabio Formaglio

2000-01-01

361

Exercise-induced pain intensity predicted by pre-exercise fear of pain and pain sensitivity  

PubMed Central

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.

Bishop, Mark D; Horn, Maggie E; George, Steven Z

2011-01-01

362

Associations among pain, pain attitudes, and pain behaviors in patients with metastatic breast cancer.  

PubMed

Metastatic breast cancer (MBC) patients often experience pain which can trigger pain behaviors, such as distorted ambulation. Psychological variables, such as individuals' attitudes toward pain, play a role in pain intervention. In this study, we used the cognitive-behavioral model of pain to examine the influence of patients' attitudes toward pain (as measured by the survey of pain attitudes or SOPA) on their pain behaviors (as measured by the pain behaviors checklist). Two hundred-one MBC patients completed surveys at treatment initiation and again 3 and 6 months later. Linear Mixed Model with repeated measures analyses showed that SOPA-solicitude, SOPA-emotions, SOPA-cure, SOPA-disability, and SOPA-medication pain attitudes were consistently significantly associated with pain behaviors at each assessment time point. Additionally, the belief that a medical cure for pain exists buffered the positive association between pain severity and pain behaviors. Our findings support and extend the cognitive-behavioral model of pain and suggest that it may be useful to target pain attitudes in pain management interventions for MBC patients. PMID:23943140

Shen, Megan Johnson; Redd, William H; Winkel, Gary; Badr, Hoda

2014-08-01

363

[Pain management in dentistry].  

PubMed

The aim of the study was to determine the most effective dose of Ibuprofen - one of the non-steroidal anti-inflammatory drugs frequently used in dental practice for pain management. According to our observations, Ibuprofen markedly softens and quickly reduces procedural pain in 55 (91.67%) patients and post-procedural pain in 44 (73.33%) patients, reduces the post-procedural need for or the amount of the drug, removes the fear of anesthesia and endodontic treatment; with irreversible pulpits significantly increases the efficiency of the inferior alveolar nerve block by local anesthetics. Our clinical observation of taking ibuprofen pre-procedurally demonstrates its effectiveness not only as a means for the relief of pain episodes, but also as an excellent anti-inflammatory treatment for chronic toothache Based on our research, the appointment of non-steroidal anti-inflammatory drugs before dental interventions, in this case - Ibuprofen turned out to be the key to the success of effective pain management. We suggest that administration of analgesics in order to relieve and effectively pre-empt pain before, during or after treatment should start before surgery and furthermore, this treatment should be extended into the postoperative period. Premedication with ibuprofen significantly increased the success rates of inferior alveolar nerve block anesthesia in teeth with irreversible pulpitis. PMID:24423675

2013-12-01

364

Cognitive Hypnotherapy for Pain Management  

Microsoft Academic Search

Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for

Gary Elkins; Aimee Johnson; William Fisher

2012-01-01

365

Pain Assessment for Older Adults  

Microsoft Academic Search

WHY: Studies on pain in older adults (persons 65 years of age and older) have demonstrated that 25%-50% of community dwelling older people have persistent pain. Additionally, 45-80% of nursing home residents report pain that is often left untreated. Pain is strongly associated with depression and can result in decreased socialization, impaired ambulation and increased healthcare utilization and costs. Older

Ellen Flaherty

366

Pain following spinal cord injury  

Microsoft Academic Search

Chronic pain is an important problem following spinal cord injury (SCI) and is a major impediment to effective rehabilitation. The reported prevalence of chronic SCI pain is variable but averages 65% with around one third of these people rating their pain as severe. The mechanisms responsible for the presence of pain are poorly understood. However, evidence from clinical observations and

PJ Siddall; JD Loeser

2001-01-01

367

New therapy for neuropathic pain.  

PubMed

Neuropathic pain is one of the worst painful symptoms in clinic. It contains nerve-injured neuropathy, diabetic neuropathy, chronic inflammatory pain, cancer pain, and postherpes pain, and is characterized by a tactile allodynia and hyperalgesia. Neuropathic pain, especially the nerve-injured neuropathy, the diabetic neuropathy, and the cancer pain, is opioid resistant pain. Since the downregulation of mu-opioid receptors is observed in dorsal spinal cord, morphine and fentanyl could not provide marked antihyperalgesic/antiallodynic effects in the course neuropathic pain states. The downregulation of mu-opioid receptors is suggested to be mediated through the activation of NMDA receptors. Moreover, at the neuropathic pain states, the increased expression of voltage-dependent Na+ channels and Ca2+ channels are observed. Based on the above information concerned with the pathophysiology of neural changes in neuropathic pain states, new drug treatments for neuropathic pain, using ketamine, methadone, and gabapentin, have been developed. These drugs show remarkable effectiveness against hyperalgesia and allodynia during neuropathic pain states. Oxycodone is a mu-opioid receptor agonist, which has different pharmacological profiles with morphine. The remarkable effectiveness of oxycodone for neuropathic pain provides the possibility that mu-opioid receptor agonists, which have different pharmacological profile with morphine, can be used for the management of neuropathic pain. PMID:19607975

Mizoguchi, Hirokazu; Watanabe, Chizuko; Yonezawa, Akihiko; Sakurada, Shinobu

2009-01-01

368

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

Microsoft Academic Search

The objective of this study was to determine whether stopping smoking between the first prenatal care visit and the 32nd week of pregnancy affects the smoking-associated changes in five infant anthropometric indices. The study population consisted of 15,185 births in the Swedish Medical Birth Register from 1991 and 1992. The associations between birth weight, crown-heel length, head circumference, ponderal index,

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

369

[Chest pain evaluation project].  

PubMed

The evaluation of acute chest pain remains challenging, despite many insights and innovations over the past two decades. The percentage of patients presenting at the emergency department with acute chest pain who are subsequently admitted to the hospital appears to be increasing. Patients with acute coronary syndromes who are inadvertently discharged from the emergency department have an adverse short-term prognosis. However, the admission of a patient with chest pain who is at low risk for acute coronary syndrome can lead to unnecessary tests and procedures, with their burden of costs and complications. Therefore, with increasing economic pressures on health care, physicians and administrators are interested in improving the efficiency of care for patients with acute chest pain. Since the emergency department organization (i.e. the availability of an intensive observational area) and integration of care and treatment between emergency physicians and cardiologists greatly differ over the national territory, the purpose of the present position paper is two-fold: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the basic critical pathways (describing key steps for care and treatment) that need to be implemented in order to standardize and expedite the evaluation of chest pain patients, making their diagnosis and treatment as uniform as possible across the country. PMID:19292020

Filippo, Ottani; Nicola, Binetti; Casagranda, Ivo; Cassin, Matteo; Cavazza, Mario; Grifoni, Stefano; Lenzi, Tiziano; Lorenzoni, Roberto; Sbrojavacca, Rodolfo; Tanzi, Pietro; Vergara, Giuseppe

2009-01-01

370

Neuropathic pain after dental treatment.  

PubMed

The head and neck regions are the most common sites of the human body to be involved in chronic pain conditions. Neuropathic pain is a chronic pain condition, and refers to all pain initiated or caused by a primary lesion or dysfunction or transitory perturbation in the peripheral or central nervous system (CNS). Trigeminal neuralgia, atypical odontalgia (phantom tooth pain), burning mouth syndrome, traumatic neuropathies, postherpetic neuralgias and complex regional pain syndrome are neuropathic pain conditions in the orofacial region that can be encountered in pain and dental clinics. The majority of the time this problem is misdiagnosed by the dentist, which can lead to unnecessary treatments. These treatments may include endodontic treatment and extraction of the tooth or teeth in the region. In this review, only post-traumatic peripheral pain neuropathies seen after dental treatments will be discussed. PMID:23588863

T?nastepe, Neslihan; Oral, Koray

2013-01-01

371

Pain, Cancer, and Older Adults (CE)  

Microsoft Academic Search

Pain is the most common symptom associated with cancer. Despite the fact that appropriate pain management exists, cancer pain often is inadequately controlled. Sixty percent to 85% of individuals with advanced cancer have either severe or chronic pain. Issues associated with cancer pain and pain management in later life include the effect of pain on the person, friends, and family;

Anita C. All; LaRae I. Huycke

1999-01-01

372

Evidence-based integrative pain medicine  

Microsoft Academic Search

Integrative medicine is already, consciously or unconsciously, widely practised in pain medicine. However, a large part of practised pain medicine is not evidence-based.In this article, the evidence for different forms of conventional pain therapy (pharmacological, psychological, physical and interventional) as well as CAM for the pain conditions cancer pain, neuropathic pain, low back pain, and fibromyalgia syndrome is reviewed. The

Benno Rehberg

2010-01-01

373

Resolution of pain after childbirth  

PubMed Central

Background Chronic pain after surgery occurs in 10-40% of individuals, including 5-20% of women after cesarean delivery in previous reports. Pain and depression 2 months after childbirth are independently associated with more severe acute post-delivery pain. Here we examine other predictors of pain at 2 months and determine the incidence of pain at 6 and 12 months after childbirth. Methods Following Institutional Review Board approval, 1228 women were interviewed within 36 hr of delivery. Of these, 937 (76%) were successfully contacted by telephone at 2 months, and, if they had pain, at 6 and 12 months after delivery. The primary outcome measure was presence of pain which began at the time of delivery. We also generated a model of severity of acute post-delivery pain and 2 month pain and depression. Results Pain which began at the time of delivery was remarkably rare 6 and 12 months later (1.8% and 0.3% [upper 95% confidence limit, 1.2%], respectively). Past history of pain and degree of tissue damage at delivery accounted for 7.0% and 16.7%, respectively of one aspect in the variability in acute post-delivery pain. Neither of these factors was associated with incidence of pain 2 months later. Conclusions Using a definition of new onset pain from delivery, we show a remarkably low incidence of pain 1 year after childbirth, including those with surgical delivery. Additionally, degree of tissue trauma and history of chronic pain, risk factors for pain 2 months after other surgery, were unimportant to pain 2 months after cesarean or vaginal delivery.

Eisenach, James C.; Pan, Peter; Smiley, Richard M.; Lavand'homme, Patricia; Landau, Ruth; Houle, Timothy T.

2012-01-01

374

Investigation of central pain processing in shoulder pain: converging results from two musculoskeletal pain models  

PubMed Central

Recent reports suggest deficits in conditioned pain modulation (CPM) and enhanced suprathreshold heat pain response (SHPR) potentially play a role in the development of chronic pain. The purpose of this study was to investigate whether central pain processing was altered in 2 musculoskeletal shoulder pain models. The goals of this study were to determine whether central pain processing: 1) differs between healthy subjects and patients with clinical shoulder pain, 2) changes with induction of exercise induced muscle pain (EIMP), and 3) changes 3 months after shoulder surgery. Fifty eight patients with clinical shoulder pain and 56 age and sex matched healthy subjects were included in these analyses. The healthy cohort was examined before inducing EIMP, and 48 and 96 hours later. The clinical cohort was examined before shoulder surgery and 3 months later. CPM did not differ between the cohorts, however; SHPR was elevated for patients with shoulder pain compared to healthy controls. Induction of acute shoulder pain with EIMP resulted in increased shoulder pain intensity but did not change CPM or SHPR. Three months following shoulder surgery clinical pain intensity decreased but CPM was unchanged from pre-operative assessment. In contrast SHPR was decreased and showed values comparable with healthy controls at 3 months. Therefore, the present study suggests that: 1) clinical shoulder pain is associated with measurable changes in central pain processing, 2) exercise-induced shoulder pain did not affect measures of central pain processing, and 3) elevated SHPR was normalized with shoulder surgery. Collectively our findings support neuroplastic changes in pain modulation were associated with decreases in clinical pain intensity only, and could be detected more readily with thermal stimuli.

Valencia, Carolina; Kindler, Lindsay L.; Fillingim, Roger B.; George, Steven Z.

2011-01-01

375

TRPs and Pain.  

PubMed

Pain usually occurs as a result of tissue damage and has a role in healing and protection. However, in certain conditions it has no functional purpose and can become chronic and debilitating. A demand for more effective treatments to deal with this highly prevalent problem requires a better understanding of the underlying mechanisms. TRP channels are associated with numerous sensory functions across a wide range of species. Investigation into the expression patterns, electrophysiological properties and the effects of channel deletion in transgenic animal models have produced a great deal of evidence linking these channels to transduction of noxious stimuli as well as signalling within the pain system. PMID:24961972

Sexton, Jane E; Vernon, Jeffrey; Wood, John N

2014-01-01

376

Atazanavir and chest pain.  

PubMed

We present a case of a 41-year-old man complaining of chest pain, which he directly attributed to his antiretrovirals, specifically atazanavir and ritonavir. The chest pain resolved on stopping the treatment, and recurred when atazanavir was restarted, again resolving on discontinuation. Cardiovascular risk factors are an important consideration with any antiretroviral therapy but particularly with protease inhibitors. The association between atazanavir and cardiac arrhythmias has been reported elsewhere including the British National Formulary, and it may be good practice to perform electrocardiogram assessments in patients commencing and using atazanavir-based regimens. PMID:24108452

Phillips, Matthew; Saxon, Cara; Lee, Vincent

2014-05-01

377

Complex regional pain syndrome  

PubMed Central

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.

Sebastin, Sandeep J

2011-01-01

378

Pain management in neurocritical care.  

PubMed

The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the presentation, assessment, and development of pain in the clinical spectrum of patients with associated neurological problems seen in a general intensive care setting. Many conditions predispose to the development of chronic pain. There is evidence that swift and targeted pain management may improve the outcome. Importantly pain management is multidisciplinary. The available non-invasive, pharmacological, and invasive treatment strategies are discussed. PMID:23893074

Petzold, Axel; Girbes, Armand

2013-10-01

379

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

PubMed Central

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

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

2010-01-01

380

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

PubMed

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

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

2012-05-01

381

Chiropractic and Neck Pain: Conservative Care of Cervical Pain, Injury  

MedlinePLUS

... head, normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have ... are some of the most typical causes of neck pain: Injury and Accidents: A sudden forced movement of ...

382

Outcome of endoscopic decompression of retrocalcaneal bursitis  

PubMed Central

Background: Posterior heel pain due to retrocalcaneal bursitis, is a disabling condition that responds well to the conventional methods of treatment. Patients who do not respond to conservative treatment may require surgical intervention. This study evaluates the outcome of endoscopic decompression of retrocalcaneal bursitis, with resection of posterosuperior eminence of the calcaneum. Materials and Methods: This present study included 25 heels from 23 consecutive patients with posterior heel pain, who did not respond to conservative treatment and underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. The functional outcome was evaluated by comparing the pre and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores. The Maryland ankle and foot score was used postoperatively to assess the patient's satisfaction at the one-year followup. Results: The University of Maryland scores of 25 heels were categorized as the nonparametric categories, and it was observed that 16 patients had an excellent outcome, six good, three fair and there were no poor results. The AOFAS scores averaged 57.92 ± 6.224 points preoperatively and 89.08 ± 5.267 points postoperatively (P < 0.001), at an average followup of 16.4 months. The 12 heels having noninsertional tendinosis on ultrasound had low AOFAS scores compared to 13 heels having retrocalcaneal bursitis alone. At one year followup, correlation for preoperative ultrasound assessment of tendoachilles degeneration versus postoperative Maryland score (Spearman correlation) had shown a strong negative correlation. Conclusion: Endoscopic calcaneal resection is highly effective in patients with mild or no degeneration and yields cosmetically better results with fewer complications. Patients with degenerative changes in Achilles tendon had poorer outcomes in terms of subjective satisfaction.

Kondreddi, Vamsi; Gopal, R Krishna; Yalamanchili, Ranjith K

2012-01-01

383

Expressing pain: The communication and interpretation of facial pain signals  

Microsoft Academic Search

This article reviews recent theory and research on the origins, nature, and meaning of facial expressions of pain. A general model of pain expression, distinguishing experiential, encoding, and decoding processes involved in pain episodes, is proposed. Variables which are known to or may affect these processes are reviewed. Relationships between elements of the model and clinical phenomena of interest to

Kenneth M. Prkachin; Kenneth D. Craig

1995-01-01

384

The new JCAHO pain standards: Implications for pain management nurses  

Microsoft Academic Search

The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management. Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at

Patricia H Berry; June L Dahl

2000-01-01

385

Greek Brief Pain Inventory: Validation and Utility in Cancer Pain  

Microsoft Academic Search

Objective: The Brief Pain Inventory (BPI) is a pain assessment tool. It has been translated into and validated in several languages. The purpose of this study was the translation into and validation of the BPI in Greek. Moreover, we wanted to detect cultural and social differences, if any, of pain interference in patients’ lives. Methods: The translation and validation of

Kyriaki Mystakidou; Tito Mendoza; Eleni Tsilika; Sofia Befon; Efi Parpa; George Bellos; Lambros Vlahos; Charles Cleeland

2001-01-01

386

Pain symptomatology and pain medication use in civilian PTSD  

Microsoft Academic Search

The comorbidity of pain syndromes and trauma-related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma-related disorders such as posttraumatic stress disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for

Justine Phifer; Kelly Skelton; Tamara Weiss; Ann C. Schwartz; Aliza Wingo; Charles F. Gillespie; Lauren A. Sands; Saleem Sayyar; Bekh Bradley; Tanja Jovanovic; Kerry J. Ressler

2011-01-01

387

Pain without nociception?  

PubMed

We describe a young woman with complete cervical spinal cord transsection, who developed significant abdominal pain, triggered by gastric distension and deep abdominal palpation. On the basis of the nature of her spinal cord injury, her brain-gut axis was limited to vagal pathways. Studies in mammalian models of human visceral sensation consistently showed that the subdiaphragmatic vagus contains a homogeneous population of afferents that are activated by low-intensity stimuli, which are generally believed to be important in regulating autonomic function and perhaps contributing to visceral sensory experiences triggered by such low-intensity stimuli (e.g. fullness, nausea), but not pain, although many fibers encode stimuli well into the noxious range. In contrast, spinal afferent pathways include fibers with high-activation thresholds that are thought to represent specialized nociceptors. This illustrative case argues against an exclusive role of specialized nociceptive pathways in visceral pain, but supports a concept of intensity coding with the composite of vagal and spinal input contributing to conscious perception and pain. PMID:22266836

Levinthal, David J; Bielefeldt, Klaus

2012-03-01

388

[Chronic thoracic pain].  

PubMed

The etiological diagnosis of chronic thoracic pain is wide, from benign mechanical disorders to tumors. Reaching the exact diagnosis in often time consuming. Despite the availability of new techniques of imagery, a meticulous clinical history and physical examination remain mandatory. They will lead the exploration. Idiopathic intercostal neuralgia does not exist. PMID:12143167

Malaise, M G; Kaye, O; Radermecker, M; Duysinx, B; Hustinx, R; Hermans, G; de Leval, L

2002-05-01

389

PainPsychologist  

Cancer.gov

The Departments of Psychiatry and Anesthesiology, Boston Children’s Hospital are seeking a pediatric psychologist for a full time position in the Pediatric Pain Rehabilitation Center at Boston Children’s Hospital Waltham. This is a primarily clinical position with opportunities to participate in ongoing clinical research within this innovative program and potential to develop independent research projects.

390

Painful bladder: Case studies  

PubMed Central

As part of the program at the 3rd Annual Canadian Urology Forum (2013), participants engaged in interactive discussions of difficult cases throughout the event. The following is a summary of discussions pertaining to two cases illustrating the difficulties in diagnosis and management of bladder pain symptoms.

Bailly, Greg

2013-01-01

391

Painful bladder: Case studies.  

PubMed

As part of the program at the 3(rd) Annual Canadian Urology Forum (2013), participants engaged in interactive discussions of difficult cases throughout the event. The following is a summary of discussions pertaining to two cases illustrating the difficulties in diagnosis and management of bladder pain symptoms. PMID:24523849

Bailly, Greg

2013-01-01

392

Chronic throat pain.  

PubMed

Case study A woman aged 62 years presented with chronic throat pain on the right tonsillar area that had started approximately 2 years earlier. During the 2 years, she visited several local clinics, including internal medicine, family medicine and otolaryngology clinics, and underwent various tests, including esophagogastroduodenoscopy. However, there was no improvement in the symptom and the cause was not identified. She was referred by her family doctor to our hospital for further evaluation and proper management. The pain was characterised by an intermittent, needle-like, piercing pain on the right tonsillar area and could be worsened by swallowing and neck rotation. There was no history of any medical problems, trauma or surgery. Careful visual examination of the oral cavity and oropharynx revealed no particular abnormalities. During pharyngeal palpation, a hard mass was felt on the right tonsillar area and she complained of severe pain when turning her neck to the right. A radiographic study (reverse Towne's view) was performed (Figure 1). PMID:25006607

Kim, Kyung Soo; Lim, Su Jin; Yang, Hoon Shik

2014-07-01

393

ASSESSMENT OF BACK PAIN  

PubMed Central

Chiropractors and Osteopaths are routinely involved in the assessment and treatment of patients with back pain. An overview of pertinent laboratory studies is presented to facilitate a better understanding of the use and value of these procedures toward improved patient management and enhanced communication with other health care professionals, in particular medical practitioners, as some patients may benefit from a combined management approach.

de la Harpe, David

1994-01-01

394

Managing osteoarthritic knee pain.  

PubMed

Osteoarthritis is one of the most common forms of arthritis seen in primary care practice. Pain associated with this condition is the chief complaint of most patients, prompting them to seek medical attention. Pain can originate from the synovial membrane, joint capsule, periarticular muscles and ligaments, and periosteum and subchondral bone, among other sources. Although osteoarthritis is traditionally thought of as a noninflammatory type of arthritis, inflammatory mechanisms can be present. Therefore, management of osteoarthritic pain involves both nonpharmacologic and pharmacologic modes of therapy. Nonpharmacologic approaches include osteopathic manipulative treatment, physical therapy, exercise, use of assistive devices, and weight reduction. Pharmacologic options may be topical, intra-articular, or oral in route of administration and include acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids. Patients often benefit from combinations of therapeutic modalities. Although pain relief is a chief motivator for patients with osteoarthritis to seek medical attention, a secondary benefit of successful treatment is slowing the decrease in patients' quality of life. PMID:17986674

Barron, Melanie C; Rubin, Bernard R

2007-11-01

395

Writing: A Painful Process.  

ERIC Educational Resources Information Center

Based on the observation that freshman composition students associate writing with pain and unpleasantness and have been given little opportunity to engage in enjoyable writing, this paper advocates a method for making freewriting and the journal central and integral dimensions of the writing class. After discussing the techniques and the benefits…

Moss, Anita

396

Descending control of pain  

Microsoft Academic Search

Upon receipt in the dorsal horn (DH) of the spinal cord, nociceptive (pain-signalling) information from the viscera, skin and other organs is subject to extensive processing by a diversity of mechanisms, certain of which enhance, and certain of which inhibit, its transfer to higher centres. In this regard, a network of descending pathways projecting from cerebral structures to the DH

Mark J. Millan

2002-01-01

397

Understanding the cancer pain experience.  

PubMed

Cancer pain management is a major element of successful cancer survivorship. Regardless of where someone is along the cancer experience, from a newly diagnosed patient to long-term survivor, pain is a potential treatment-related effect that can have a significant impact on a survivor's life. Quality pain management for cancer survivors is complicated by the fact that cancer-related pain can be due to the tumor, surgery, radiation, and/or chemotherapy. Additionally, the pain experience is related to many psychosocial/spiritual factors. Despite almost 40 years of attention devoted to improving cancer pain management, many cancer survivors are less than optimally treated, often owing to survivor and healthcare provider knowledge barriers. This article reviews some of the latest research related to cancer pain management treatment options, measurement/assessment, and interventions. Progress has been made in understanding new aspects of the pain experience, but more work is yet to be done. PMID:24925442

Schreiber, Judith A

2014-08-01

398

Pain Management and the Amputee  

MedlinePLUS

... Purdue Pharma L.P. A7158 6/03 Pain Management This Fact Sheet provides important—and practical—information ... more information about your condition, treatment, and pain management. Remember: You have a right to ask questions ...

399

Interstitial Cystitis / Painful Bladder Syndrome  

MedlinePLUS

... urinary tract infections and bladder cancer. In men, common diseases include chronic prostatitis or chronic pelvic pain syndrome. In women, endometriosis is a common cause of pelvic pain. IC/PBS is not ...

400

Other Causes of Leg Pain  

MedlinePLUS

... Past Issues Special Section Other Causes of Leg Pain Past Issues / Summer 2008 Table of Contents For ... a crowd of people walking. Photo: iStock Leg pain can come from a variety of causes. Your ...

401

Breastfeeding FAQs: Pain and Discomfort  

MedlinePLUS

Breastfeeding FAQs: Pain and Discomfort KidsHealth > Parents > Pregnancy & Newborn Center > Newborn Care > Breastfeeding FAQs: Pain and Discomfort ... have. Is it normal to have cramps while nursing? Yes. During the first few days to weeks ...

402

Acute pain management in infants and children-part 1: pain pathways, pain assessment, and outpatient pain management.  

PubMed

The field of pediatric pain management continues to evolve, with ongoing changes in our appreciation of the impact of pain on our fragile patients, a better understanding of how to assess pain, and refinements of the medications and techniques used to provide analgesia to patients with acute pain of various etiologies. The following article reviews the techniques for the assessment of pain, including various age-specific pain scoring systems. The pharmacological management of pain is discussed, including the use of agents that inhibit prostaglandin formation-nonsteroidal anti-inflammatory agents and acetaminophen-as well as the "weak opioids" that are commonly used when oral administration is feasible for the treatment of mild to moderate pain. [Pediatr Ann. 2014; 43(7):e163-e168.]. PMID:24977679

Tobias, Joseph D

2014-07-01

403

Dyspareunia: Painful Sex for Women  

MedlinePLUS

... part of the genitals can cause pain during sex. Some conditions affect the skin around the vagina. ... types of birth control) does not fit correctly, sex may also be painful. Vaginismus (say: "vag-in- ...

404

[Persistent pain following endodontic treatment].  

PubMed

Dental pain is a very common pain in the orofacial area. Patients sometimes experience persistent pain following endodontic treatment. The cause of this pain can be found in the endodontically treated tooth itself when the pain persists after an inadequately performed treatment. Persistent pain is also possible after an apparently adequate endodontic treatment. Moreover the pain can have an odontogenic origin, in cases where the diagnostic procedure may have failed. A non-odontogenic cause can be located in proximate or more remote structures, which may be a question of systemic diseases or pain from neuropathic, neurovascular and/or psychogenic conditions. A thorough clinical examination forms the basis for the establishment of a valid diagnosis. PMID:25026740

Warnsinck, C J; Shemesh, H; Lobbezoo, F

2013-10-01

405

How Do Pain Relievers Work?  

MedlinePLUS

... two pain relievers kids take most often are ibuprofen (say: i-byoo-PRO-fen) and acetaminophen (say: ... away! When you take a pain reliever like ibuprofen, it keeps injured or damaged cells from making ...

406

Pain Reactivity and Kinesthetic Aftereffect.  

National Technical Information Service (NTIS)

The previously reported relationship between reaction to suprathreshold pain and kinesthetic aftereffect was substantiated, the pain being induced by exposure of the hand to cold air. Three groups (ni = 9) constructed to represent three levels of reported...

D. R. Sweeney

1966-01-01

407

Back pain during growth.  

PubMed

It is wrong to believe that back pain only burdens adults: the yearly incidence during growth ranges from 10-20%, continuously increasing from childhood to adolescence. Rapid growth-related muscular dysbalance and insufficiency, poor physical condition in an increasingly sedentary adolescent community or - vice versa - high level sports activities, account for the most prevalent functional pain syndromes. In contrast to adults the correlation of radiographic findings with pain is high: the younger the patient, the higher the probability to establish a rare morphologic cause such as benign or malignant tumours, congenital malformations and infections. In children younger than 5 years old, the likelihood is more than 50%. The following red flags should lower the threshold for a quick in-depth analysis of the problem: Age of the patient <5 years, acute trauma, functional limitation for daily activities, irradiating pain, loss of weight, duration >4 weeks, history of tumour, exposition to tuberculosis, night pain and fever. High level sport equals a biomechanical field test which reveals the biologic individual response of the growing spine to the sports-related forces. Symptomatic or asymptomatic inhibitory or stimulatory growth disturbances like Scheuermann disease, scoliosis or fatigue fractures represent the most frequent pathomorphologies. They usually occur at the disk-growth plate compound: intraspongious disk herniation, diminuition of anterior growth with vertebral wedging and apophyseal ring fractures often occur when the biomechanical impacts exceed the mechanical resistance of the cartilaginous endplates. Spondylolysis is a benign condition which rarely becomes symptomatic and responds well to conservative measures. Associated slippage of L5 on S1 is frequent but rarely progresses. The pubertal spinal growth spurt is the main risk factor for further slippage, whereas sports activity - even at a high level - is not. Therefore, the athlete should only be precluded from training if pain persists or in case of high grade slips. Perturbance of the sagittal profile with increase of lumbar lordosis, flattening of the thoracic spine and retroflexion of the pelvis with hamstrings contractures are strong signs for a grade IV olisthesis or spondyloptosis with subsequent lumbosacral kyphosis. Idiopathic scoliosis is not related to pain unless it is a marked (thoraco-) lumbar curve or if there is an underlying spinal cord pathology. Chronic back pain is an under recognised entity characterised by its duration (>3 months or recurrence within 3 months) and its social impacts such as isolation and absence from school or work. It represents an independent disease, uncoupled from any initial trigger. Multimodal therapeutic strategies are more successful than isolated, somatising orthopaedic treatment. Primary and secondary preventive active measures for the physically passive adolescents, regular sports medical check-up's for the young high level athletes, the awareness for the rare but potentially disastrous pathologies and the recognition of chronic pain syndromes are the cornerstones for successful treatment of back pain during growth. PMID:23299906

Hasler, Carol C

2013-01-01

408

Substance Abuse in Cancer Pain  

Microsoft Academic Search

In the oncology community, opioids recently have become the cornerstone of cancer pain management. This has led to a rapid\\u000a increase in opioid prescribing in an effort to address the growing public health problem of chronic pain. A new paradigm in\\u000a noncancer pain management has emerged, that of risk assessment and stratification in opioid therapy. Techniques foreign to\\u000a cancer pain

Tatiana D. Starr; Lauren J. Rogak; Steven D. Passik

2010-01-01

409

Pain Catastrophizing and Pain-Related Fear in Osteoarthritis Patients: Relationships to Pain and Disability  

PubMed Central

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all P's ? 0.05) of variance in measures of pain (partial r2 [pr2] = 0.10), psychological disability (pr2 = 0.20), physical disability (pr2 = 0.11), and gait velocity at normal (pr2 = 0.04), fast (pr2 = 0.04), and intermediate speeds (pr2 = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr2 = 0.07) and walking at a fast speed (pr2 = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.

Somers, Tamara J.; Keefe, Francis J.; Pells, Jennifer J.; Dixon, Kim E.; Waters, Sandra J.; Riordan, Paul A.; Blumenthal, James A.; McKee, Daphne C.; LaCaille, Lara; Tucker, Jessica M.; Schmitt, Daniel; Caldwell, David S.; Kraus, Virginia B.; Sims, Ershela L.; Shelby, Rebecca A.; Rice, John R.

2009-01-01

410

Computed tomography of calcaneal fractures  

Microsoft Academic Search

Computed tomography (CT) of 25 fractured calcanei was performed to investigate the potential of CT in evaluating the pattern and biomechanics of these fractures. The characteristic findings of typical fractures are presented, including the number and type of principal fragments, size and dislocation of the sustentacular fragment, and involvement of the anterior and posterior facets of the subtalar joint. In

Laos Heger; Knster Wulff; M. S. A. Seddiqi

1985-01-01

411

Loin pain hematuria syndrome-visceral or neuropathic pain syndrome?  

PubMed

Loin pain hematuria syndrome (LPHS) is a rare pain syndrome, which is somewhat poorly characterized and challenging to treat. The condition of LPHS is still controversial and there is no consensus of validated diagnostic criteria or optimal treatment strategies. The epidemiology of LPHS is unknown and the mechanisms/etiologies contributing to LPHS remain uncertain. There exists some debate whether LPHS represents neuropathic pain or visceral pain. Curiously, for such a controversial pain syndrome there is substantially more written in the literature regarding surgical-type treatments than conservative treatments. A brief review of LPHS potential pathophysiology and potential treatment approaches is presented. PMID:22699133

Smith, Howard S; Bajwa, Zahid H

2012-09-01

412

Functional Abdominal Pain in Children  

MedlinePLUS

... causes that should be considered when evaluating a child with chronic abdominal pain. Some of those causes are not very serious ... none of these more severe problems cause abdominal pain in most children with chronic or recurrent bellyaches. Instead, the pain is usually “ ...

413

Neurofibromatosis and the Painful Neuroma.  

National Technical Information Service (NTIS)

Pain is a common and distressing symptom that impacts the quality of life of many patients with neurofibromatosis. The pain is often due to the formation of a neuroma. To understand better how neuromas cause pain and what treatments may be provided, we ha...

A. J. Belzberg

2007-01-01

414

Neurofibromatosis and the Painful Neuroma.  

National Technical Information Service (NTIS)

Pain is a common and distressing symptom that impacts the quality of life of many patients with neurofibromatosis. The pain is often due to the formation of a neuroma. To understand better how neuromas cause pain and what treatments may be provided, we ha...

A. J. Belzberg

2008-01-01

415

Neurofibromatosis and the Painful Neuroma.  

National Technical Information Service (NTIS)

Pain is a common and distressing symptom that impacts the quality of life of many patients with neurofibromatosis. The pain is often due to the formation of a neuroma. To understand better how neuromas cause pain and what treatments may be provided, we ha...

A. J. Belzberg B. Murrinson L. Chen R. Meyer

2009-01-01

416

Central Neuroplasticity and Pathological Pain  

Microsoft Academic Search

The traditional specificity theory of pain perception holds that pain involves a direct transmission system from somatic receptors to the brain. The amount of pain perceived, moreover, is assumed to be directly proportional to the extent of injury. Recent research, however, indicates far more complex mechanisms. Clinical and experimental evidence shows that noxious stimuli may sensitize central neural structures involved

Ronald Melzack; Terence J. Coderre; Joel Katz; Anthony L. Vaccarino

2006-01-01

417

Spectroelectrochemical characterization of pain biomarkers  

Microsoft Academic Search

This article reports the first electrochemical characterization of pain biomarkers that include arachidonic acid (AA), prostaglandin G2 (PGG2), and cyclooxygenase 2 (COX-2). These biomarkers are mediators of pathophysiology of pain, inflammation, and cell proliferation in cancer. The article also reports the development of an electrochemical immunosensor for monitoring these pain biomarkers. The results revealed that direct electron transfer between AA

Marcells A. Omole; Naumih Noah; Lisa Zhou; Anas Almaletti; Omowunmi A. Sadik; Helen N. Asemota; Elvira S. William; Jason Gilchrist

2009-01-01

418

Ethical dilemmas in pain management  

Microsoft Academic Search

The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that

Betty R. Ferrell; Diane Novy; Mark D. Sullivan; John Banja; Michel Y. Dubois; Melvin C. Gitlin; Daniel Hamaty; Allen Lebovits; Arthur G. Lipman; Philipp M. Lippe; Jeffrey Livovich

2001-01-01

419

Dealing with Persistent Pain in Older Adults  

MedlinePLUS

... Related Topics Arthritis Cancer COPD Diabetes Joint Problems Pain Management Related Documents PDF Dealing with Persistent Pain in ... provider may also refer you to a special pain management center. Some persistent pain problems are very complex ...

420

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 s/he can describe it to you. Here are different kinds of pain: ...

421

Non-Drug Pain Relief: Imagery  

MedlinePLUS

... and language needs, call (614) 293-3259. Non-Drug Pain Relief: Imagery Relaxation helps lessen tension. One ... your pain. Imagery does not replace your pain medicine. It works with your pain medicine to help ...

422

Pain Control: Support for People with Cancer  

MedlinePLUS

Pain Control: Support for People with Cancer In English En español Posted: 07/16/2012 Pain Control: ... Kindle Download to other E-readers Share Cancer Pain Can Be Managed Pain Control: Support for People ...

423

Dopamine Precursor Depletion Influences Pain Affect Rather than Pain Sensation  

PubMed Central

Pain is a multidimensional experience, which includes sensory, cognitive, and affective aspects. Converging lines of evidence indicate that dopaminergic neurotransmission plays an important role in human pain perception. However, the precise effects of dopamine on different aspects of pain perception remain to be elucidated. To address this question, we experimentally decreased dopaminergic neurotransmission in 22 healthy human subjects using Acute Phenylalanine and Tyrosine Depletion (APTD). During APTD and a control condition we applied brief painful laser stimuli to the hand, assessed different aspects of pain perception, and recorded electroencephalographic responses. APTD-induced decreases of cerebral dopaminergic activity did not influence sensory aspects of pain perception. In contrast, APTD yielded increases of pain unpleasantness. The increases of unpleasantness ratings positively correlated with effectiveness of APTD. Our finding of an influence of dopaminergic neurotransmission on affective but not sensory aspects of phasic pain suggests that analgesic effects of dopamine might be mediated by indirect effects on pain affect rather than by direct effects on ascending nociceptive signals. These findings contribute to our understanding of the complex relationship between dopamine and pain perception, which may play a role in various clinical pain states.

Schulz, Enrico; Baumkotter, Jochen; Ploner, Markus

2014-01-01

424

Pediatric pain management: a review.  

PubMed

Although the occurrence of pain in hospitalized children is common, assessment and treatment of pain presents unique challenges to practitioners who care for pediatric patients. Knowledge of drug mechanisms as well as metabolic differences in infants and children compared with adults is necessary for the successful treatment of acute and chronic pain syndromes. Recent reports of adverse events in children receiving both opioid and non-opioid analgesics have prompted re-examination of some long standing pain medication regimens and prescribing practices. We review advances in diagnosis and management of pain in pediatric populations. PMID:25011346

O'Donnell, Frederick T; Rosen, Kathleen R

2014-01-01

425

Acculturation and Cancer Pain Experience  

PubMed Central

Purpose: Using a feminist perspective, the relationship between acculturation and cancer pain experience was explored. Design: This was a cross-sectional, correlational Internet study among 104 Hispanic and 114 Asian cancer patients. The instruments included both unidimensional and multidimensional cancer pain measures. Findings: There were significant differences in cancer pain scores by country of birth. Yet, there was no significant association of acculturation to cancer pain scores. Discussion and Conclusions: This study indicated inconsistent findings. Implications for Practice: To provide directions for adequate cancer pain management, further studies with a larger number of diverse groups of immigrant cancer patients are needed.

Im, Eun-Ok; Ho, Tsung-Han; Brown, Adama; Chee, Wonshik

2009-01-01

426

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

PubMed

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

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

2012-06-01

427

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

PubMed Central

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

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

2014-01-01

428

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

PubMed

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

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

2014-01-01

429

The clinical picture of neuropathic pain  

Microsoft Academic Search

Neuropathic pains refer to a heterogenous group of pain conditions characterised by lesion or dysfunction of the normal sensory pathways. Clinical characteristics include: delayed onset of pain after nervous system lesion, pain in area of sensory loss, spontaneous and different evoked types of pains. It has so far only been possible to classify these pains on basis of underlying cause

Troels Staehelin Jensen; Hanne Gottrup; Søren Hein Sindrup; Flemming Winther Bach

2001-01-01

430

Groin pain in athletes.  

PubMed

Groin pain in athletes is one of the most difficult to treat clinical entities in sports medicine. The reasons are the amount of differential diagnoses, complexity of pathophysiologic causes and the long time of limited participation in sport. In order to maximize efficient treatment, thorough diagnostics and a clear therapeutic regimen are crucial. To succeed with this issue, a close cooperation between physicians and radiologists is mandatory. MRI is gold standard in the diagnostic work-up of the principal differential diagnoses, such as muscle tears, avulsion injuries, stress fractures, tears of acetabular labrum, and osteitis pubis. The article gives a comprehensive overview of the special anatomy and biomechanics of the pubic region and of typical MRI findings in athletes with groin pain. The use of dedicated imaging protocols is also discussed. PMID:23893752

Weber, M-A; Rehnitz, C; Ott, H; Streich, N

2013-12-01

431

Behavioural assessment of pediatric pain  

PubMed Central

Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress associated with acute medical procedures, postoperative pain, critical care, analogue pain induction procedures and other sources. Two recent scholarly reviews of behavioural assessment methods were conducted by the Society of Pediatric Psychology Evidence-Based Assessment Task Force and the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, which classified various instruments as well established, approaching well established or promising. The characteristics of the eight behavioural assessment scales that were recommended by one of these task forces are further reviewed in the present paper. The results indicate that behavioural assessment scales have been used flexibly to assess pain in a wide variety of situations, across different pediatric populations and for patients of different ages. In the present review, there appears to be no basis for designating the scales as measures of distress versus pain; both emotional and sensory components of pain seem to be assessed by each of the scales. There is considerable overlap among the behavioural indicators of pain used in the different scales. Furthermore, the behavioural codes indicative of pain may occur before, during and after painful events. Recommendations for future research are provided, including using behavioural assessment to focus on children’s coping and adults’ behaviours, as well as pain.

Blount, Ronald L; Loiselle, Kristin A

2009-01-01

432

Recurrent limb pain in schoolchildren.  

PubMed Central

OBJECTIVES: To determine the prevalence, causes and clinical features of short lasting recurrent limb pain (recurrent limb pain) in children. DESIGN: Population-based study in two stages, with an initial screening questionnaire followed by clinical interviews and physical examination of symptomatic children. SETTING: 67 primary and secondary schools in the city of Aberdeen. SUBJECTS: 2165 children representing a random 10% sample of all schoolchildren aged between 5-15 years. MAIN OUTCOME MEASURES: (a) The causes of limb pain in children, (b) the prevalence of recurrent limb pain in schoolchildren, (c) the relationship of recurrent limb pain to childhood migraine. RESULTS: Sports and playground injuries were the most common cause of limb pain, affecting 9% of all children. The prevalence rate of recurrent limb pain was 2.6% (95% confidence interval 1.9 to 3.4). Episodes of recurrent limb pain had similar trigger factors, associated symptoms, and relieving factors to episodes of headache in children with migraine. CONCLUSIONS: Recurrent limb pain is a common cause of limb pain, with a prevalence rate of 2.6%. The close clinical and epidemiological similarities between recurrent limb pain and childhood migraine suggest a common pathogenesis.

Abu-Arafeh, I; Russell, G

1996-01-01

433

Pain perception during menstrual cycle.  

PubMed

Sexual hormones influence complex brain function and pain perception. Many psychophysical studies attempted to establish pain perception changes across menstrual cycle in animal models and healthy women or those with chronic pain. General results are quite uncertain in regard to consistent menstrual-related fluctuations of pain perception. The few studies applying neurophysiological procedures to test pain-related changes during menstrual cycle suggested a fluctuation of central modulation of pain across phases, with a prevalence of excitatory versus inhibitory control in the premenstrual period, which may explain the cyclic worsening of many syndromes, such as migraine. Whatever is the relevance of menstrual cycle on individual painful symptoms, it should be accepted as one of the numerous factors influencing mechanisms of neuromodulation. PMID:21556710

de Tommaso, Marina

2011-10-01

434

Mild analgesics in postoperative pain  

PubMed Central

1 The intensity of postoperative pain is influenced by many factors, for example, individual variation, site of incision and type of operation, anaesthetic technique, and the interval from the end of operation to the appearance of pain. 2 These factors affect the efficacy of analgesics. 3 Mild analgesics provide adequate pain relief in half of our patients in the immediate postoperative phase when the pain is slight to moderate. 4 The maximum effect of mild analgesics corresponds to that produced by morphine 6-10 mg. Adequate analgesia may not therefore be provided for the treatment of severe postoperative pain unless narcotic analgesics have been used peroperatively. 5 When mild analgesics are combined with narcotics synergism is achieved. 6 As postoperative pain decreases with time, mild analgesics usually provide adequate pain relief on the first and following postoperative days.

Tammisto, T.; Tigerstedt, I.

1980-01-01

435

Emerging therapies for neuropathic pain.  

PubMed

Neuropathic pain develops as a result of damage to either the peripheral or central nervous system. It is characterised by spontaneous burning pain and/or ongoing pain with accompanying hyperalgesia and allodynia. Neuropathic pain is difficult to treat as it is often refractory to conventional analgesic treatments, with most patients obtaining only partial relief. At present, there are four major medication categories that are considered first-line treatment for neuropathic pain: antidepressants, anticonvulsants, local anaesthetic/topical agents and opioids. The efficacy of these treatments in neuropathic pain, excepting opioids, has been discovered serendipitously. However, responder rates and overall efficacy is poor with these agents and tolerability or side effects are often limiting. This update will review existing treatment options for neuropathic pain, and highlight more recent advances in the development of novel analgesics to treat this chronic disorder. PMID:15757406

Collins, Susanne D; Chessell, Iain P

2005-02-01

436

[Immunomodulation of pain].  

PubMed

Review of the interacting elements of nociceptive, neuroimmune and neuroendocrine systems with a stress on sympathetic innervation of the lymphoid organs. Special attention is given to dysfunctions within the nociceptive, neuroendocrine and immune systems due to: damage to the: 1) afferent fibers; 2) sympatho-adrenal system; 3) structure of the hypothalamo-pituitary-adrenal axis. The role of peripheral immunocytes in the generation of pain, including local cytokines, opioids and CRF is also discussed. PMID:11016266

Kostarczyk, E

2000-01-01

437

[Management of cancer pain  

PubMed

The morphin-analogue, Durogesic, has robust analgetic effect without repeated side-effects and is suitable for special applications providing it as the first choice for therapy of cancer pain and as an acceptable alternative for CR morphin. Clinical studies not only provided evidences for the pharmacological effectivity of Durogesic but suggested that the quality of life of cancer patients improved significantly as well. PMID:12050733

Borbényi, I; Dank, M; Makó, E

2001-01-01

438

Beyond pleasure and pain  

Microsoft Academic Search

People approach pleasure and avoid pain. To discover the true nature of approach-avoidance motivation, psy-chologists need to move beyond this hedonic principle to the principles that underlie the different ways that it operates. One such principle is regulatory focus, which distinguishes self-regulation with a promotion focus (ac-complishments and aspirations)from self-regulation with a prevention focus (safety and responsibilities). This principle is

E. Tory Higgins

1997-01-01

439

[Congenital insensitivity to pain].  

PubMed

Congenital insensitivity to pain belongs to rare diseases called hereditary sensory neuropathy (HSN). The disturbance of sense and secondary harms are creating clinical picture. The aim of this report was to describe therapeutic problems with which we met with a three siblings with congenital insensitivity to pain. The authors have described three children with congenital insensitivity to pain. The disease was diagnosed at the age of 3-5. These children painlessly have broken their lower limbs. These fractures were late diagnosed what resulted in a badly healed deformation of legs. For this reason, the right knee of the oldest boy had to be stiffened. This boy had also late diagnosed the left hip luxation, and hematomas had arisen, which become filled with pus. The boy was in sepsis and a dramatic life-and-death struggle was performed. A purulent focuses were removed from abdomen and femoral head was also resected. The other two siblings had fractures and infections, but not such severe as the oldest boy. It is well known that a causal treatment of this disease in unknown. Patients must learn to avoid mechanical and thermal trauma. It is the only way to prevent complications of this disease. PMID:24720108

Popko, Janusz; Karpi?ski, Micha?; Guszczyn, Tomasz

2014-02-01

440

[Polypharmacy and pain treatment].  

PubMed

Pain is a frequent symptom in clinical practice. Elderly and chronically ill patients are particularly affected. On account of the high prevalence of polypharmacy among these patients, pharmacological pain therapy becomes a challenge for physicians. Drug side effects and drug-drug interactions have to be taken into account so as to minimize the health risk for these patients. Especially the group of NSAID has a high risk of adverse drug reactions and drug interactions. The gastrointestinal, the cardiovascular, the renal and the coagulation system are particularly affected. Except for the toxic effect on the liver (in a high dose) Paracetamol (acetaminophen) has similar risks, to a minor degree, though. According to current data Metamizol is actually better than its reputation. The risk of potential drug interactions seems to be low. Beside the risk of sedation in combination with other drugs, Tramadol and other opioids such as Pethidin may induce the Serotonin syndrome. In order to avoid dangerous drug interactions and adverse side effects in the case of polypharmacy, it is recommended to prefer individual choices instead of sticking to the pain management as proposed by the WHO. PMID:20640926

Gosch, Markus; Böhmdorfer, Birgit; Benvenuti-Falger, Ursula; Dovjak, Peter; Iglseder, Bernhard; Lechleitner, Monika; Otto, Ronald; Roller, Regina E; Sommeregger, Ulrike

2010-06-01

441

Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review.  

PubMed

Development of patellofemoral pain syndrome (PFPS) is considered to be multifactorial. The aims of this systematic review were to (i) summarise and critique the body of literature addressing kinematic gait characteristics associated with PFPS; and (ii) provide recommendations for future research addressing kinematic gait characteristics associated with PFPS. A comprehensive search of MEDLINE, EMBASE, CINAHL, and Current Contents revealed 561 citations for review. Each citation was assessed for inclusion and quality using a modified version of the 'Quality Index' and a novel inclusion/exclusion criteria checklist by two independent reviewers. A total of 24 studies were identified. No prospective studies with adequate data to complete effect size calculations were found. Quality of included case-control studies varied, with a number of methodological issues identified. Heterogeneity between studies made meta-analysis inappropriate. Reductions in gait velocity were indicated during walking, ramp negotiation, and stair negotiation in individuals with PFPS. Findings indicated delayed timing of peak rearfoot eversion and increased rearfoot eversion at heel strike transient during walking; and delayed timing of peak rearfoot eversion, increased rearfoot eversion at heel strike, reduced rearfoot eversion range, greater knee external rotation at peak knee extension moment, and greater hip adduction during running in individuals with PFPS. There is a clear need for prospective evaluation of kinematic gait characteristics in a PFPS population to distinguish between cause and effect. Where possible, future PFPS case-control studies should consider evaluating kinematics of the knee, hip and foot/ankle simultaneously with larger participant numbers. Completing between sex comparisons when practical and considering spatiotemporal gait characteristics during methodological design and data analysis is also recommended. PMID:19651515

Barton, Christian J; Levinger, Pazit; Menz, Hylton B; Webster, Kate E

2009-11-01

442

Cross-cultural conceptions of pain and pain control  

PubMed Central

Pain is a ubiquitous feature of the human experience. This paper presents an anthropology of pain. Anthropology is defined as the cross-cultural and comparative study of human behavior. Pain can be acute and episodic, and pain can be constant and uninterrupted. Acute pain, lasting for minutes or hours, is reported at some time by virtually all adults and by most juveniles and is indicated by the cries and facial expressions of toddlers and infants. This universality of pain as a part of the human condition has been established by the research of many biological, physical, and social scientists. Ethnographers, physicians, and public health experts describe pain complaints for a variety of modern, industrial societies and traditional, undeveloped societies. Pain is the most frequent complaint brought to the offices of physicians in North America, and it is a focus of attention in the literate medical traditions of China, India, and Islamic cultures. Hence, the study of pain and the cultural perceptions of pain are prominent foci of anthropologists. Given that the goal of medicine is to offer medical care to all people who seek it, the practice of modern medicine may be assisted by an exploration of the possibility of cultural differences in medical beliefs and practices in the multiethnic and racially diverse patient populations today.

2002-01-01

443

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

PubMed Central

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

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

2001-01-01

444

Increased anandamide uptake by sensory neurons contributes to hyperalgesia in a model of cancer pain.  

PubMed

Opioids do not effectively manage pain in many patients with advanced cancer. Because anandamide (AEA) activation of cannabinoid type-1 receptors (CB1R) on nociceptors reduces nociception, manipulation of AEA metabolism in the periphery may be an effective alternative or adjuvant therapy in the management of cancer pain. AEA is hydrolyzed by the intracellular enzyme fatty acid amide hydrolase (FAAH), and this enzyme activity contributes to uptake of AEA into neurons and to reduction of AEA available to activate CB1R. We used an in vitro preparation of adult murine dorsal root ganglion (DRG) neurons co-cultured with fibrosarcoma cells to investigate how tumors alter the uptake of AEA into neurons. Evidence that the uptake of [(3)H]AEA into dissociated DRG cells in the co-culture model mimicked the increase in uptake that occurred in DRG cells from tumor-bearing mice supported the utility of the in vitro model to study AEA uptake. Results with the fluorescent AEA analog CAY10455 confirmed that an increase in uptake in the co-culture model occurred in neurons. One factor that contributed to the increase in [(3)H]AEA uptake was an increase in total cellular cholesterol in the cancer condition. Treatment with the FAAH inhibitor URB597 reduced CAY10455 uptake in the co-culture model to the level observed in DRG neurons maintained in the control condition (i.e., in the absence of fibrosarcoma cells), and this effect was paralleled by OMDM-1, an inhibitor of AEA uptake, at a concentration that had no effect on FAAH activity. Maximally effective concentrations of the two drugs together produced a greater reduction than was observed with each drug alone. Treatment with BMS309403, which competes for AEA binding to fatty acid binding protein-5, mimicked the effect of OMDM-1 in vitro. Local injection of OMDM-1 reduced hyperalgesia in vivo in mice with unilateral tumors in and around the calcaneous bone. Intraplantar injection of OMDM-1 (5?g) into the tumor-bearing paw reduced mechanical hyperalgesia through a CB1R-dependent mechanism and also reduced a spontaneous nocifensive behavior. The same dose reduced withdrawal responses evoked by suprathreshold mechanical stimuli in naive mice. These data support the conclusion that OMDM-1 inhibits AEA uptake by a mechanism that is independent of inhibition of FAAH and provide a rationale for the development of peripherally restricted drugs that decrease AEA uptake for the management of cancer pain. PMID:23644187

Khasabova, Iryna A; Holman, Michelle; Morse, Tim; Burlakova, Natalya; Coicou, Lia; Harding-Rose, Catherine; Simone, Don A; Seybold, Virginia S

2013-10-01

445

Pain and Inflammatory Bowel Disease  

PubMed Central

Abdominal pain is a common symptom of inflammatory bowel disease (IBD: Crohn’s disease, ulcerative colitis). <