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Sample records for chronic plantar heel

  1. Plantar heel pain.

    PubMed

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

    2014-03-01

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

  2. Treatment of Chronic Plantar Heel Pain With Radiofrequency Neural Ablation of the First Branch of the Lateral Plantar Nerve and Medial Calcaneal Nerve Branches.

    PubMed

    Arslan, Aydın; Koca, Tuba Tulay; Utkan, Ali; Sevimli, Resit; Akel, İbrahim

    2016-01-01

    From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 ± 1.6 years; mean body mass index, 30.6 ± 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA.

  3. Treatment of Chronic Plantar Heel Pain With Radiofrequency Neural Ablation of the First Branch of the Lateral Plantar Nerve and Medial Calcaneal Nerve Branches.

    PubMed

    Arslan, Aydın; Koca, Tuba Tulay; Utkan, Ali; Sevimli, Resit; Akel, İbrahim

    2016-01-01

    From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 ± 1.6 years; mean body mass index, 30.6 ± 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA. PMID:27073185

  4. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial

    PubMed Central

    Eftekharsadat, Bina; Babaei-Ghazani, Arash; Zeinolabedinzadeh, Vahideh

    2016-01-01

    Background: This study examined the effects of dry needling on chronic heel pain due to plantar fasciitis. Methods: During this single-blinded clinical trial, 20 eligible patients were randomized into two groups: A case group treated with dry needling and a control group. Patients’ plantar pain severity, (using modified visual analog scale [VAS] scoring system), range of motion of ankle joint in dorsiflexion [ROMDF] and plantar extension[ROMPE] and foot function index (using standard questionnaires of SEM5 and MDC7) were assessed at baseline, four weeks after intervention and four weeks after withdrawing treatment. Independent sample t-test, Mann-Whitney U test, paired t-test, Wilcoxon signed rank tests, and chi square test were used for data analysis. Results: The mean VAS scores in the case group was significantly lower than the control group after four weeks of intervention (p<0.001). Comparison of the ROMDF and ROMPE did not reveal any significant changes after four weeks of intervention in the case and control groups (p=0.7 and p=0.65, respectively). The mean of MDC7 and SEM5 scores in the case group were significantly lower than the control group following four weeks of intervention (p<0.001). Conclusion: Despite the insignificant effect on ROMDF and ROMPE, trigger point dry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis.

  5. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial

    PubMed Central

    Eftekharsadat, Bina; Babaei-Ghazani, Arash; Zeinolabedinzadeh, Vahideh

    2016-01-01

    Background: This study examined the effects of dry needling on chronic heel pain due to plantar fasciitis. Methods: During this single-blinded clinical trial, 20 eligible patients were randomized into two groups: A case group treated with dry needling and a control group. Patients’ plantar pain severity, (using modified visual analog scale [VAS] scoring system), range of motion of ankle joint in dorsiflexion [ROMDF] and plantar extension[ROMPE] and foot function index (using standard questionnaires of SEM5 and MDC7) were assessed at baseline, four weeks after intervention and four weeks after withdrawing treatment. Independent sample t-test, Mann-Whitney U test, paired t-test, Wilcoxon signed rank tests, and chi square test were used for data analysis. Results: The mean VAS scores in the case group was significantly lower than the control group after four weeks of intervention (p<0.001). Comparison of the ROMDF and ROMPE did not reveal any significant changes after four weeks of intervention in the case and control groups (p=0.7 and p=0.65, respectively). The mean of MDC7 and SEM5 scores in the case group were significantly lower than the control group following four weeks of intervention (p<0.001). Conclusion: Despite the insignificant effect on ROMDF and ROMPE, trigger point dry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis. PMID:27683642

  6. Plantar and medial heel pain: diagnosis and management.

    PubMed

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

    2014-06-01

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

  7. Endoscopic Decompression of the First Branch of the Lateral Plantar Nerve and Release of the Plantar Aponeurosis for Chronic Heel Pain.

    PubMed

    Lui, Tun Hing

    2016-06-01

    Entrapment of the first branch of the lateral plantar nerve is a commonly missed cause of recalcitrant plantar heel pain. The diagnosis is made on a clinical ground with maximal tenderness at the site of nerve entrapment. Treatment of the nerve entrapment is similar to that for plantar fasciitis, with rest, activity modification, nonsteroidal anti-inflammatory drugs, stretching exercise, and local steroid injection. Surgical release of the deep abductor hallucis fascia is indicated when conservative treatment failed. Endoscopic release of the nerve through the dorsal and plantar portals, as well as endoscopic plantar aponeurosis release, is a feasible approach. PMID:27656382

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

    PubMed Central

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

    2012-01-01

    Summary Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient’s return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. Level of Evidence: II PMID:23738317

  9. Heel lipoma mimicking plantar fasciitis in a ballroom dancer.

    PubMed

    Taweel, Nicholas R; Raikin, Steven M

    2015-01-01

    The present case illustrates a lipoma as an unusual cause of heel pain. A 64-year-old female ballroom dancer presented with 8 months of pain that was unresponsive to previous treatment of plantar fasciitis. Magnetic resonance imaging revealed a heel lipoma. Her pain was fully resolved after surgical excision. Soft tissue tumors should be included in the differential diagnosis of heel pain, especially when symptoms and treatment response do not follow the typical course of plantar fasciitis.

  10. Clinical Characteristics of the Causes of Plantar Heel Pain

    PubMed Central

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

    2011-01-01

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

  11. Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy.

    PubMed

    Yanbin, Xu; Haikun, Chu; Xiaofeng, Ji; Wanshan, Yang; Shuangping, Liu

    2015-01-01

    Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p < .001) and no patient had developed symptom recurrence. Also, none of the patients had developed complex regional pain syndrome. All patients were able to return to regular shoe wear by 3 weeks postoperatively. The technique of plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis.

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

    PubMed

    Seligman, Deborah A; Dawson, Deirdre R

    2003-10-01

    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

  13. Heel pain-plantar fasciitis: revision 2014.

    PubMed

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

    2014-11-01

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

  14. Impaired Foot Plantar Flexor Muscle Performance in Individuals With Plantar Heel Pain and Association With Foot Orthosis Use.

    PubMed

    McClinton, Shane; Collazo, Christopher; Vincent, Ebonie; Vardaxis, Vassilios

    2016-08-01

    Study Design Controlled laboratory study. Background Plantar heel pain is one of the most common foot and ankle conditions seen in clinical practice, and many individuals continue to have persisting or recurrent pain after treatment. Impaired foot plantar flexor muscle performance is a factor that may contribute to limited treatment success, but reliable methods to identify impairments in individuals with plantar heel pain are needed. In addition, foot orthoses are commonly used to treat this condition, but the implications of orthosis use on muscle performance have not been assessed. Objectives To assess ankle plantar flexor and toe flexor muscle performance in individuals with plantar heel pain using clinically feasible measures and to examine the relationship between muscle performance and duration of foot orthosis use. Methods The rocker-board plantar flexion test (RBPFT) and modified paper grip test for the great toe (mPGTGT) and lesser toes (mPGTLT) were used to assess foot plantar flexor muscle performance in 27 individuals with plantar heel pain and compared to 27 individuals without foot pain who were matched according to age, sex, and body mass. Pain ratings were obtained before and during testing, and self-reported duration of foot orthosis use was recorded. Results Compared to the control group, individuals with plantar heel pain demonstrated lower performance on the RBPFT (P = .001), the mPGTGT (P = .022), and the mPGTLT (P = .037). Longer duration of foot orthosis use was moderately correlated to lower performance on the RBPFT (r = -0.52, P = .02), the mPGTGT (r = -0.54, P = .01), and the mPGTLT (r = -0.43, P = .03). Conclusion Ankle plantar flexor and toe flexor muscle performance was impaired in individuals with plantar heel pain and associated with longer duration of self-reported foot orthosis use. J Orthop Sports Phys Ther 2016;46(8):681-688. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6482. PMID:27374013

  15. A retrospective comparison of percutaneous plantar fasciotomy and open plantar fasciotomy with heel spur resection.

    PubMed

    Fallat, Lawrence M; Cox, J Todd; Chahal, Ruby; Morrison, Pamela; Kish, John

    2013-01-01

    Minimally invasive surgery for the treatment of recalcitrant heel pain is a relatively new approach. To compare the 2 approaches, a retrospective chart review was conducted of 53 patients (55 feet) who had undergone surgical treatment of plantar fasciitis by either open fasciotomy with heel spur resection or percutaneous medial fascial release. The outcomes measures included perioperative pain and the interval to return to full activity. Pain was measured on a subjective 10-point visual analog scale. Of the 55 fasciotomies performed, 23 were percutaneous and 32 were open, with adjunctive heel spur resection. The percutaneous group experienced a mean pain reduction of 5.69 points at the first postoperative visit, whereas open fasciotomy group experienced a mean pain reduction of 3.53 points. At 12 months postoperatively, no statistically significant difference was found in the pain levels between the 2 groups. The results also showed that the percutaneous group returned to normal activity an average of 2.82 weeks (p < .001) faster than the open group. In the patient cohorts studied, percutaneous medial fascial release was as effective at resolving recalcitrant plantar fasciitis pain as the open procedure and involved less postoperative pain and a faster return to full activity.

  16. An optimized design of in-shoe heel lifts reduces plantar pressure of healthy males.

    PubMed

    Zhang, Xianyi; Li, Bo; Liang, Kaiyun; Wan, Qiufeng; Vanwanseele, Benedicte

    2016-06-01

    Conventional heel lift with a flat surface increases the risk of foot problems related to higher plantar pressure and decreased stability. In this study, an optimized design of in-shoe heel lifts developed to maintain the midfoot function was tested to investigate if the plantar pressure distribution was improved. The design was based on three dimensional foot plantar contour which was captured by an Infoot 3D scanning system while the heel was elevated by a heel wedge. To facilitate midfoot function, an arch support was designed to support the lateral longitudinal arch, while allowing functional movement of the medial longitudinal arch. Twenty healthy male subjects were asked to walk along an 8m walkway while wearing high-cut footwear with and without the optimized heel lift. Peak pressure, contact area and force-time integral were measured using the Pedar insole system. Range and velocity of medial-lateral center of pressure during forefoot contact phase and foot flat phase were collected using a Footscan pressure plate. Compared to the shoe only condition, peak pressure under the rearfoot decreased with the optimized heel lift, while no increase of peak pressure was observed under the forefoot and midfoot regions, indicating improved plantar pressure distribution. The findings of this study suggest that this optimized heel lift has better biomechanical performance than a conventional flat heel lift. Results from this study may have implications for insole and shoe last design, especially for people who need additional heel height without sacrificing midfoot function.

  17. Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

    PubMed

    Cottom, James M; Baker, Joseph S

    2016-10-01

    When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot. PMID:27599439

  18. Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

    PubMed

    Cottom, James M; Baker, Joseph S

    2016-10-01

    When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot.

  19. Current approaches to the management of plantar heel pain syndrome, including the role of injectable corticosteroids.

    PubMed

    Pribut, Stephen M

    2007-01-01

    Plantar heel pain syndrome, which has a multifactorial and widely disputed etiology, affects more than 2 million people annually. A survey was conducted of members of the American Academy of Podiatric Sports Medicine about their strategies for managing plantar heel pain syndrome, especially the role of injectable corticosteroids. The respondents tended to be experienced (10-24 years in practice) podiatric physicians with a concentration in sports medicine. They reported that for early-stage plantar heel pain syndrome they generally recommend avoidance of wearing flat shoes and walking barefoot (92%), use of over-the-counter arch supports and heel cushions (90%), regular stretching of the calf muscles (88%), strapping of the foot (75%), cryotherapy applied directly to the affected part of the foot (67%), and nonsteroidal anti-inflammatory drug therapy (60%). When these measures fail to relieve heel pain, most of the responding podiatric physicians recommend using custom orthotic devices (60%) and corticosteroid injections (60%) as intermediate therapy. Surgical plantar fasciotomy (88%), cast immobilization (77%), and extracorporeal shockwave therapy (69%) are generally recommended as late-stage therapy for resistant cases. A staged approach seems to yield the best results in treatment of this common condition.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    2011-01-01

    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

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

    2010-01-01

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

  4. Plantar fasciitis

    PubMed Central

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

    2012-01-01

    Heel pain, mostly caused by plantar fasciitis (PF), is a common complaint of many patients who requiring professional orthopedic care and are mostly suffering from chronic pain beneath their heels. The present article reviews studies done by preeminent practitioners related to the anatomy of plantar fasciitis and their histo-pathological features, factors associated with PF, clinical features, imaging studies, differential diagnoses, and diverse treatment modalities for treatment of PF, with special emphasis on non-surgical treatment. Anti-inflammatory agents, plantar stretching, and orthosis proved to have highest priority; corticosteroid injection, night splints and extracorporeal shock wave therapy were of next priority, in patients with PF. In patients resistant to the mentioned treatments surgical intervention should be considered. PMID:23798950

  5. Diagnosis and treatment of plantar fasciitis.

    PubMed

    Goff, James D; Crawford, Robert

    2011-09-15

    Plantar fasciitis, a self-limiting condition, is a common cause of heel pain in adults. It affects more than 1 million persons per year, and two-thirds of patients with plantar fasciitis will seek care from their family physician. Plantar fasciitis affects sedentary and athletic populations. Obesity, excessive foot pronation, excessive running, and prolonged standing are risk factors for developing plantar fasciitis. Diagnosis is primarily based on history and physical examination. Patients may present with heel pain with their first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region. Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion. Diagnostic imaging is rarely needed for the initial diagnosis of plantar fasciitis. Use of ultrasonography and magnetic resonance imaging is reserved for recalcitrant cases or to rule out other heel pathology; findings of increased plantar fascia thickness and abnormal tissue signal the diagnosis of plantar fasciitis. Conservative treatments help with the disabling pain. Initially, patient-directed treatments consisting of rest, activity modification, ice massage, oral analgesics, and stretching techniques can be tried for several weeks. If heel pain persists, then physician-prescribed treatments such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections should be considered. Ninety percent of patients will improve with these conservative techniques. Patients with chronic recalcitrant plantar fasciitis lasting six months or longer can consider extracorporeal shock wave therapy or plantar fasciotomy.

  6. Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

    PubMed

    Mahindra, Pankaj; Yamin, Mohammad; Selhi, Harpal S; Singla, Sonia; Soni, Ashwani

    2016-01-01

    Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis. PMID:26913766

  7. Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

    PubMed

    Mahindra, Pankaj; Yamin, Mohammad; Selhi, Harpal S; Singla, Sonia; Soni, Ashwani

    2016-01-01

    Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis.

  8. Are Repeated Single-Limb Heel Raises and Manual Muscle Testing Associated With Peak Plantar-Flexor Force in People With Inclusion Body Myositis?

    PubMed Central

    Shrader, Joseph A.; Davenport, Todd E.; Joe, Galen; Rakocevic, Goran; McElroy, Beverly; Dalakas, Marinos

    2014-01-01

    Background Repeated heel raises have been proposed as a method of ankle plantar-flexor strength testing that circumvents the limitations of manual muscle testing (MMT). Objective The study objective was to examine the relationships among ankle plantar-flexion isometric maximum voluntary contraction (MVC), repeated single-limb heel raises (SLHRs), and MMT in people with myositis. Design This was a cross-sectional study with a between-group design. The ability to complete 1 SLHR determined group assignment (SLHR group, n=24; no-SLHR group, n=19). Methods Forty-three participants with myositis (13 women; median age=64.9 years) participated. Outcome measures included MVC, predicted MVC, Kendall MMT, and Daniels-Worthingham MMT. Results The Kendall MMT was unable to detect significant ankle plantar-flexor weakness established by quantitative methods and was unable to discriminate between participants who could and those who could not perform the SLHR task. Ankle plantar-flexion MVC was not associated with the number of heel-raise repetitions in the SLHR group (pseudo R2=.13). No significant relationship was observed between MVC values and MMT grades in the SLHR and no-SLHR groups. However, a moderate relationship between MVC values and MMT grades was evident in a combined-group analysis (ρ=.50–.67). Limitations The lower half of both MMT grading scales was not represented in the study despite the profound weakness of the participants. Conclusions Both Kendall MMT and Daniels-Worthingham MMT had limited utility in the assessment of ankle plantar-flexor strength. Repeated SLHRs should not be used as a proxy measure of ankle plantar-flexion MVC in people with myositis. PMID:24309617

  9. Extracorporeal shockwave therapy (ESWT) in patients with chronic proximal plantar fasciitis.

    PubMed

    Hammer, Dietrich S; Rupp, Stefan; Kreutz, Andreas; Pape, Dietrich; Kohn, Dieter; Seil, Romain

    2002-04-01

    The aim of this study was to compare the effect of extracorporeal shockwave therapy (ESWT) in patients with chronically painful proximal plantar fasciitis with a conventional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections and electrotherapy. Forty-seven patients (49 feet) with a previously unsuccessful conservative treatment of at least six months were randomized to two groups. Treatment of Group 1 (25 heels) started immediately with three sessions of ESWT (3000 shockwaves/session of 0.2 mJ/mm2) at weekly intervals. In the patients of Group 2 (24 heels) treatment was continued for 12 weeks. After this period they were treated using the protocol of Group 1. No significant difference of pain and walking time after further non-ESWT treatment (three months) was seen. Six months after ESWT pain decreased by 64% to 88% on the visual analog scale (VAS) and the comfortable walking time had increased significantly in both groups.

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

    PubMed Central

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

    2015-01-01

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

  11. Extracorporeal shockwave therapy for chronic proximal plantar fasciitis.

    PubMed

    Strash, Walter W; Perez, Richard R

    2002-10-01

    Although much enthusiasm surrounds applying extracorporeal shock wave therapy for various musculoskeletal conditions, its effects are not well understood and warrant continued study. Certain body tissues or organs may be damaged either acutely or chronically by ESWT; however, it is unequivocal that lung tissue may be damaged. It is theorized that neovascularization is responsible for improvement in symptoms of plantar fasciitis. Neovascularization is the direct effect of macrophage stimulation through cytokines. ESWT has effects at the cellular level--does it interfere with metabolic activity or enhance it? The noninvasive nature and minimal complications of appropriately applied ESWT are its primary advantages. Symptoms may continue to improve for three weeks to six months after treatment; the effects of shock wave therapy seem to be time dependent. ESWT is an effective form of treatment for proximal insertional plantar fasciitis after exhaustive, conservative forms of treatment have failed.

  12. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device.

    PubMed

    Gollwitzer, Hans; Diehl, Peter; von Korff, Alexej; Rahlfs, Volker W; Gerdesmeyer, Ludger

    2007-01-01

    Published data describing the efficacy of extracorporeal shock wave therapy for the treatment of plantar heel pain provide conflicting results, and optimal treatment guidelines are yet to be determined. To assess the efficacy and safety of extracorporeal shockwave therapy compared with placebo in the treatment of chronic painful heel syndrome with a new electromagnetic device, we undertook a prospective, double-blind, randomized, placebo-controlled trial conducted among 40 participants who were randomly allocated to either active, focused extracorporeal shockwave therapy (0.25 mJ/mm(2)) or sham shockwave therapy. Both groups received 3 applications of 2000 shockwave impulses, each session 1 week apart. The primary outcome was the change in composite heel pain (morning pain, pain with activities of daily living, and pain upon application of pressure with a focal force meter) as quantified using a visual analog pain scale at 12 weeks after completion of the interventions compared with baseline. Secondary endpoints included changes in morning pain, pain with activities of daily living, and pain upon application of pressure with a focal force meter, as measured on a visual analog pain scale, as well as the change in the Roles and Maudsley score, at 12 weeks after the baseline measurement. Active extracorporeal shockwave therapy resulted in a 73.2% reduction in composite heel pain, and this was a 32.7% greater reduction than that achieved with placebo. The difference was not statistically significant (1-tailed Wilcoxon Mann-Whitney U test, P =.0302), but reached clinical relevance (Mann-Whitney effect size = 0.6737). In regard to the secondary outcomes, active extracorporeal shockwave therapy displayed relative superiority in comparison with the sham intervention. No relevant adverse events occurred in either intervention group. The results of the present study support the use of electromagnetically generated extracorporeal shockwave therapy for the treatment of

  13. 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

    2013-01-01

    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

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

    PubMed Central

    2013-01-01

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

  15. Low-Level Laser Therapy at 635 nm for Treatment of Chronic Plantar Fasciitis: A Placebo-Controlled, Randomized Study.

    PubMed

    Macias, David M; Coughlin, Michael J; Zang, Kerry; Stevens, Faustin R; Jastifer, James R; Doty, Jesse F

    2015-01-01

    Plantar fasciitis affects nearly 1 million persons in the United States at any one time. Conservative therapies have been reported to successfully treat 90% of plantar fasciitis cases; however, for the remaining cases, only invasive therapeutic solutions remain. This investigation studied newly emerging technology, low-level laser therapy. From September 2011 to June 2013, 69 subjects were enrolled in a placebo-controlled, randomized, double-blind, multicenter study that evaluated the clinical utility of low-level laser therapy for the treatment of unilateral chronic fasciitis. The volunteer participants were treated twice a week for 3 weeks for a total of 6 treatments and were evaluated at 5 separate time points: before the procedure and at weeks 1, 2, 3, 6, and 8. The pain rating was recorded using a visual analog scale, with 0 representing "no pain" and 100 representing "worst pain." Additionally, Doppler ultrasonography was performed on the plantar fascia to measure the fascial thickness before and after treatment. Study participants also completed the Foot Function Index. At the final follow-up visit, the group participants demonstrated a mean improvement in heel pain with a visual analog scale score of 29.6 ± 24.9 compared with the placebo subjects, who reported a mean improvement of 5.4 ± 16.0, a statistically significant difference (p < .001). Although additional studies are warranted, these data have demonstrated that low-level laser therapy is a promising treatment of plantar fasciitis.

  16. How I Manage Heel Spur Syndrome.

    ERIC Educational Resources Information Center

    Seder, Joseph I.

    1987-01-01

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

  17. Collaboration for prevention of chronic disease in Kentucky: the Health Education Through Extension Leaders (HEEL) program.

    PubMed

    Riley, Peggy

    2008-09-01

    Health Education Through Extension Leaders (HEEL) is one of the solutions the University of Kentucky College of Agriculture has created to address the problem of chronic disease in Kentucky. Building on the land grant model for education, outreach, and prevention, HEEL collaborates and partners with the academic health centers, area health education centers, the Center for Rural Health, the Kentucky Cancer Program, the Markey Cancer Center, the University of Kansas Wellness Program, and the Kentucky Cabinet for Health and Family Services to implement research-based preventive programs to the county extension agents across Kentucky. Extension agents are an instrumental bridge between the communities across Kentucky and the educational resources provided by the HEEL program.

  18. Management of plantar fasciitis in the outpatient setting

    PubMed Central

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-01-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

  19. Management of plantar fasciitis in the outpatient setting.

    PubMed

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-04-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

  20. Management of plantar fasciitis in the outpatient setting.

    PubMed

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-04-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality.

  1. Primary Care Management of Plantar Fasciitis.

    PubMed

    Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D

    2015-01-01

    Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed.

  2. Primary Care Management of Plantar Fasciitis.

    PubMed

    Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D

    2015-01-01

    Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed. PMID:26665894

  3. Platelet-rich plasma and plantar fasciitis.

    PubMed

    Monto, Raymond R

    2013-12-01

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

  4. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. However, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: Swelling and pain in the Achilles tendon ...

  5. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial.

    PubMed

    Malay, D Scot; Pressman, Martin M; Assili, Amir; Kline, Jason T; York, Shane; Buren, Ben; Heyman, Eugene R; Borowsky, Pam; LeMay, Carley

    2006-01-01

    Extracorporeal shockwave therapy (ESWT) has demonstrated efficacy in the treatment of recalcitrant proximal plantar fasciitis. The objective of this investigation was to compare the outcomes of participants treated with a new ESWT device with those treated with placebo. A total of 172 volunteer participants were randomized in a 2:1 active-to-placebo ratio in this prospective, double-blind, multicenter trial conducted between October 2003 and December 2004. ESWT (n=115) or placebo control (n=57) was administered on a single occasion without local or systemic anesthesia or sedation, after which follow-up was undertaken. The primary outcomes were the blind assessor's objective, and the participant's subjective assessments of heel pain during the first 3 months of follow-up. Participants were also followed up to 1 year to identify any adverse outcomes that may have been related to the shockwave device. On the visual analog scale, the blind assessor's objective assessment of heel pain displayed a mean reduction of 2.51 in the shockwave group and 1.57 in the placebo group; this difference was statistically significant (P=.045). On the visual analog scale, the participant's self-assessment of heel pain displayed a mean reduction of 3.39 in the shockwave group and 1.78 in the placebo group; this difference was statistically significant (P<.001). No serious adverse events were observed at any time. It was concluded that ESWT was both efficacious and safe for participants with chronic proximal plantar fasciitis that had been unresponsive to exhaustive conservative treatment.

  6. Plantar fasciopathy.

    PubMed

    Rompe, Jan D

    2009-06-01

    Plantar fasciopathy is the most common cause of plantar heel pain. Featuring pain and tenderness on the medial plantar aspect of the calcaneus, clinical diagnosis seems straightforward. The role of various management strategies should be considered in the light of the selflimiting nature of plantar fasciopathy with more than 80% of patients experiencing resolution within 12 months, regardless of management. As there are no data from high-quality, randomized, controlled trials that support the efficacy of surgical management, the most prudent approach is to employ conservative modalities first. Recently, several randomized, controlled trials proved efficacy of extracorporeal shockwave treatment after the failure of more common conservative methods. Shockwave treatment helped to avoid surgery and its associated risks such as transient swelling of the heel pad, calcaneal fracture, injury of the posterior tibial nerve or its branches, and flattening of the longitudinal arch with resultant midtarsal pain. Surgical treatment is therefore considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months.

  7. Plantar fasciitis: a concise review.

    PubMed

    Schwartz, Emily N; Su, John

    2014-01-01

    One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis.

  8. Plantar Fasciitis: A Concise Review

    PubMed Central

    Schwartz, Emily N; Su, John

    2014-01-01

    One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis. PMID:24626080

  9. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients.

    PubMed

    Cottom, James M; Maker, Jared M; Richardson, Phillip; Baker, Joseph S

    2016-01-01

    Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes.

  10. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients.

    PubMed

    Cottom, James M; Maker, Jared M; Richardson, Phillip; Baker, Joseph S

    2016-01-01

    Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes. PMID:27066869

  11. Plantar fascia: imaging diagnosis and guided treatment.

    PubMed

    McNally, Eugene G; Shetty, Shilpa

    2010-09-01

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

  12. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis.

    PubMed

    Dizon, Jan Nathleen C; Gonzalez-Suarez, Consuelo; Zamora, Marcelle Theresa G; Gambito, Ephraim D V

    2013-07-01

    The objective of this study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in treating chronic plantar fasciitis. An online database search was conducted for studies using ESWT in managing chronic plantar fasciitis. Eleven high-quality randomized controlled trials were included in the meta-analysis and showed that ESWT was more effective in reducing morning pain (weighted mean difference, -0.77 [95% confidence interval {CI}, -1.30 to -0.25]; odds ratio, 0.65 [95% CI, 0.42-1.00]). Moderate-intensity ESWT was more effective in decreasing overall and activity pain (weighted mean difference, -6.6 [95% CI, -6.74 to -6.46], and weighted mean difference, 0.47 (95% CI, 0.30-0.74). Both moderate- and high-intensity ESWT were more effective in improving functional outcome, with odds ratios of 0.51 (95% CI, 0.30-0.84) and 0.47 (95% CI, 0.29-0.75). The adverse effects that were seen more in ESWT were pain on the calcaneal area and calcaneal erythema. This study concludes that moderate- and high-intensity ESWT were effective in the treatment of chronic plantar fasciitis.

  13. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

    PubMed Central

    Ribeiro, Ana P.; Sacco, Isabel C. N.; Dinato, Roberto C.; João, Silvia M. A.

    2016-01-01

    BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot. PMID:26786073

  14. Heel Pain

    MedlinePlus

    ... inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel ... heel spur; Haglund's deformity ("pump bump"), a bone enlargement at the back of the heel bone in ...

  15. Heel pain: A systematic review.

    PubMed

    Agyekum, Edward Kwame; Ma, Kaiyu

    2015-01-01

    Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger's heel, tennis heal, policeman's heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes: Plantar Fasciitis, Heel Spur, Sever's Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor's advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important. PMID:26643244

  16. Outcome after free flap reconstruction of the heel.

    PubMed

    Durham, J W; Saltzman, C L; Steyers, C M; Miller, B A

    1994-05-01

    We reviewed six free flap reconstructions of the weight-bearing surface of the heel. Patients were seen for clinical evaluation at a mean follow-up of 4.7 years (range 2.7-6.0 years). Functional results using a modified Boston Children's Hospital Ankle Score were 33% excellent, 33% good, 17% fair, and 17% poor. The excellent functional results were related to the absence of chronic draining flap ulcers. All flaps lacked protective sensation by Semmes-Weinstein monofilament testing. Weightbearing plantar pressures in the flaps were elevated in all patients. Sequential radiographs from the time of flap coverage revealed the development of a bony protuberance (stalactite) projecting from the undersurface of the calcaneus in all patients with injuries to the plantar cortex of the calcaneus. In patients with flap ulceration, these stalactites projected into the ulcer at the site of maximum plantar pressure. A combination of loss of plantar calcaneal integrity, elevated pressure concentrations, and flap insensitivity appear causally related to the development of heel free flap ulceration and outcome.

  17. Heel Pain in Recreational Runners.

    ERIC Educational Resources Information Center

    Bazzoli, Allan S.; Pollina, Frank S.

    1989-01-01

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

  18. Treatment of chronic plantar ulcer of the diabetic foot using an irremovable windowed fibreglass cast boot: prospective study of 177 patients.

    PubMed

    Ha Van, Georges; Michaux, Caroline; Parquet, Hugues; Bourron, Olivier; Pradat-Diehl, Pascale; Hartemann, Agnes

    2015-10-01

    The objective of this study was to evaluate the level of healing of chronic neuropathic plantar ulcers, using an irremovable windowed fibreglass cast boot, which is only opened after healing. A single-centre prospective study of a cohort of 177 diabetic patients with chronic neuropathic plantar ulcers was carried out. The duration of neuropathic plantar ulcers was 604 ± 808 days, with a mean surface area of 4.6 ± 6.5 cm(2) , a mean depth of 1.04 ± 1.08 cm and a mean volume of 5.9 ± 17.7 cm(3) . After a mean of 96 days of wearing a windowed fibreglass cast boot (min 9 days, max 664 days and median 68 days), the level of healing reached 83.6%, although 29 patients did not heal (16.4%). The compliance was at 95%. NPUs with bigger volumes (p = 0.037) and those located at the heels ( p = 0.004) had significantly lower healing levels. Twenty-one patients had moderate peripheral arterial disease (12%), and 24 patients were ostectomized for underlying osteomyelitis (14%), before inclusion. Moderate peripheral arterial disease (p = 0.970) or operated osteomyelitis (p = 0.128) did not modify the level of healing significantly, which were of 81% and 70.8%, respectively. Complications include 12 ulcers due to the windowed fibreglass cast boot (i.e. 7%) and two other ulcers being moderately infected, resulting in 2% of toe amputation, but there was no major amputation or phlebitis. The treatment of old and deep NPUs of the diabetic foot by wearing a windowed fibreglass cast boot without opening the boot prior to healing offers very high ulcer recovery levels. Windowed fibreglass cast boots were changed in only 26 cases (14.6%). In addition, compliance was excellent and of the order of 95%. Furthermore, moderate peripheral arterial disease or a recent ostectomy did not affect the efficacy of windowed fibreglass cast boot.

  19. Island medial plantar artery perforator flap for reconstruction of plantar defects.

    PubMed

    Koshima, Isao; Narushima, Mitsunaga; Mihara, Mokoto; Nakai, Ikuo; Akazawa, Satoshi; Fukuda, Norio; Watanabe, Yorikatsu; Nakagawa, Masahiro

    2007-11-01

    Three cases in which island medial plantar artery perforator flaps were successfully transferred for coverage of the plantar defects are described. This perforator flap is different from the medial plantar flap based on the medial plantar artery. The flap has no fascial component and is nourished only with the perforator of the medial plantar vessel. Therefore, transection of the medial plantar artery is usually unnecessary. This flap can cover defects on the forefoot and heel without transaction of the medial plantar system. The advantages of this flap are no need for deep or long dissection for the medial plantar vessel, no exposure of the plantar sensory nerve, a short time for flap elevation, minimal donor-site morbidity, relatively large flap survival, and no damage of both the posterior tibial and medial plantar neurovascular systems. PMID:17992152

  20. Heel pain--operative results.

    PubMed

    Baxter, D E; Thigpen, C M

    1984-01-01

    In 6 years through 1982, the authors performed 34 operative cases in 26 patients with recalcitrant heel pain. The operative procedure involves an isolated neurolysis of the mixed nerve supplying the abductor digiti quinti muscle as it passes beneath the abductor hallucis muscle and beneath the medial ridge of the calcaneus. The deep fascia of the abductor hallucis muscle is released routinely, and an impinging heel spur or tight plantar fascia is partially removed or released if it is causing entrapment of the nerve. The biomechanical pathogenesis of heel pain in relation to pes planus and pes cavus predisposing to an entrapment neuropathy is described, and the anatomy of the heel in relation to the nerve distribution is clarified and well illustrated. Of the 34 operated heels, 32 had good results and two had poor results. Heel pain can cause total disability in the working population and may jeopardize one's employment or professional athletic career. The authors believe operative treatment has a place in the care of recalcitrant heel pain and that an entrapment neuropathy is an etiological factor in heel pain.

  1. How We Manage Plantar Fasciitis.

    PubMed

    Tanner, S M; Harvey, J S; Garrick, J G

    1988-08-01

    In brief: Plantar fasciitis is a prolonged overuse injury that is potentially incapacitating and causes heel or arch pain. It is common among runners and athletes who participate in jumping sports such as basketball. The onset of pain is insidious, and an athlete may tolerate it for weeks before seeking medical advice. Although few runners can remember a particular moment or event when pain began, plantar fasciitis usually occurs after sudden increases in mileage, frequency of running, or running speed. Combined therapy, including relative rest, Achilles tendon stretching, medication, and heel cups, alleviates the pain in most athletes.

  2. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

    PubMed

    Cottom, James M; Maker, Jared M

    2016-01-01

    Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes.

  3. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

    PubMed

    Cottom, James M; Maker, Jared M

    2016-01-01

    Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. PMID:26952313

  4. Gastrocnemius shortening and heel pain.

    PubMed

    Solan, Matthew C; Carne, Andrew; Davies, Mark S

    2014-12-01

    Pain and reduced function caused by disorders of either the plantar fascia or the Achilles tendon are common. Although heel pain is not a major public health problem it affects millions of people each year. For most patients, time and first-line treatments allow symptoms to resolve. A proportion of patients have resistant symptoms. Managing these recalcitrant cases is a challenge. Gastrocnemius contracture produces increased strain in both the Achilles tendon and the plantar fascia. This biomechanical feature must be properly assessed otherwise treatment is compromised. PMID:25456718

  5. Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis

    PubMed Central

    Lewis, Rebecca D.; Wright, Paul; McCarthy, Laine H.

    2016-01-01

    Clinical Question In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Answer Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer A Search Terms Plantar fasciitis, heel pain, treatment, orthotics, Limits Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted January 16, 2014; updated January 20, 2015 Inclusion Criteria Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Exclusion Criteria Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis. PMID:26855444

  6. Effectiveness of extracorporeal shockwave treatment in 353 patients with chronic plantar fasciitis.

    PubMed

    Norris, Donald M; Eickmeier, Kimberly M; Werber, Bruce R

    2005-01-01

    A 16-question post-treatment survey was sent to 874 patients after extracorporeal shockwave treatment for chronic plantar fasciitis. Of the 377 surveys returned, 353 were used for analysis. These patients were treated by 169 physicians in 19 states using either electrohydraulic or electromagnetic extracorporeal shockwave equipment. Seventy-six percent of the patients underwent treatment after having had continued pain for a year or longer. Seventy percent of patients who rated their pretreatment pain level as severe (score >or= 8 on a scale from 1 to 10) experienced sharp declines in pain, with a sharp decline considered to be a difference in pain level before and after treatment of 3 or more. In addition, 66% of patients who rated their pretreatment immobility as severe (score >or= 8 on a scale from 1 to 10) experienced sharp declines in immobility. Of the patients who underwent extracorporeal shockwave treatment, 69% indicated that they would recommend this procedure to someone in a similar situation. If extracorporeal shockwave treatment were not available, 62% of patients indicated that they would have undergone open or invasive surgery, and 41% indicated that they would have continued with additional physician office visits.

  7. Cracked Heels

    MedlinePlus

    ... as diabetes or loss of nerve function (autonomic neuropathy). Heels should be kept well moisturized with a ... shoe materials to accommodate for conditions, such as neuropathy (numb feet), poor circulation and foot... Diabetic Peripheral ...

  8. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial

    PubMed Central

    Vahdatpour, Babak; Kianimehr, Lida; Ahrar, Mohmmad Hossein

    2016-01-01

    Background: Intralesional injection of autologous blood-derived products has recently gained attention as a potential treatment for plantar fasciitis (PF). We compared platelet-rich plasma (PRP) and whole blood (WB) for the treatment of chronic PF. Materials and Methods: Patients with chronic PF received either an intralesional injection of 3 cc PRP prepared by double centrifuge technique or WB (n = 17 in each group). Overall, morning and walking pain severity were assessed by 11-point numerical rating scale, and function was assessed by the Roles and Maudsley score (RMS) at baseline and 1-month and 3 months after treatment. Ultrasonography was performed to measure plantar fascia thickness at baseline and 3 months after treatment. Results: Pain scores were reduced over the study in the PRP (mean change = −5.00 ± 1.17 to −5.47 ± 1.46) and WB groups (mean change = −5.29 ± 2.56 to −6.47 ± 2.83), with no difference between groups (P > 0.05). One month and 3 months after treatment, successful treatment (RMS of ≤ 2) was respectively observed in 29.4% and 82.3% of the PRP and in 47.1% and 76.4% of the WB groups (P > 0.05). Also, fascia thickness was decreased in both the PRP and WB groups (mean change = −1.74 ± 1.11 vs. −1.21 ± 0.73 mm, respectively, P = 0.115). Conclusions: Significant improvement in pain and function, as well as decrease in plantar fascia thickness, was observed by intralesional injection of the PRP and WB in patients with chronic PF. The study results indicate similar effectiveness between PRP and WB for the treatment of chronic PF in short-term. PMID:27274499

  9. Plantar fasciitis: what is the diagnosis and treatment?

    PubMed

    Johnson, Rachel E; Haas, Kim; Lindow, Kyle; Shields, Robert

    2014-01-01

    Foot pain, specifically plantar heel pain, is a common complaint among patients in a podiatric or orthopaedic office setting but may be seen in primary care offices, urgent care centers, or emergency departments as well. There are numerous causes for heel pain, but plantar fasciitis is the most frequent cause. The diagnosis of plantar fasciitis is generally made clinically, but there are many diagnostic modalities that may be used to confirm the diagnosis. Treatment of plantar fasciitis ranges from conservative measures to surgical interventions, but most cases of plantar fasciitis can be managed conservatively. There is no definitive treatment proven to be the best option for plantar fasciitis. Treatment is patient dependent and commonly requires a combination of different modalities to successfully alleviate the symptoms. In this article, plantar fasciitis from defining the disorder, diagnosis, and treatment are discussed.

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

    PubMed Central

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

    2009-01-01

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

  11. Mechanical Information of Plantar Fascia during Normal Gait

    NASA Astrophysics Data System (ADS)

    Gu, Yaodong; Li, Zhiyong

    The plantar fascia is an important foot tissue in stabilizing the longitudinal arch of human foot. Direct measurement to monitor the mechanical situation of plantar fascia at human locomotion is difficult. The purpose of this study was to construct a three-dimensional finite element model of the foot to calculate the internal stress/strain value of plantar fascia during different stage of gait. The simulated stress distribution of plantar fascia was the lowest at heel-strike, which concentrated on the medial side of calcaneal tubercle. The peak stress of plantar fascia was appeared at push-off, and the value is more than 5 times of the heel-strike position. Current FE model was able to explore the plantar fascia tension trend at the main sub-phases of foot. More detailed fascia model and intrinsic muscle forces could be developed in the further study.

  12. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis.

    PubMed

    Alkhamaali, Zaied K; Crocombe, Andrew D; Solan, Matthew C; Cirovic, Srdjan

    2016-01-01

    Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot. PMID:26465270

  13. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis.

    PubMed

    Alkhamaali, Zaied K; Crocombe, Andrew D; Solan, Matthew C; Cirovic, Srdjan

    2016-01-01

    Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot.

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

    PubMed Central

    Miller, Larry E.; Latt, Daniel L.

    2015-01-01

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

  15. Plantar fasciitis

    MedlinePlus

    ... women. It is one of the most common orthopedic foot complaints. Plantar fasciitis was commonly thought to ... JA, Moeller JL, Hutchinson MR. Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine . ...

  16. Association of Achilles tendinopathy and plantar spurs.

    PubMed

    Vulcano, Ettore; Mani, Sriniwasan B; Mani, Sriniwasan; Do, Huong; Bohne, Walter H; Ellis, Scott J

    2014-10-01

    Plantar spurs and Achilles tendinopathy are common causes of heel pain. In the authors' practice, it was anecdotally noted that patients with Achilles tendinopathy often presented with plantar spurs. Nonetheless, there is a shortage of studies investigating whether Achilles tendinopathy and plantar spurs exist concomitantly. A better understanding of the association between the 2 pathologies might help physicians recognize and treat both conditions, educate patients about Achilles tendinopathy and plantar spurs, and ultimately investigate possible underlying causes of both pathologies that could be addressed together. The authors examined the prevalence of plantar spurs in patients diagnosed with Achilles tendinopathy as well as demographic differences within the unilateral and bilateral Achilles tendinopathy populations. A total of 785 patient records were retrospectively reviewed. Mean patient age was 56.2±15.5 years (46.9% men and 53.1% women). Seventy-two (9.2%) patients were affected bilaterally by Achilles tendinopathy. Lateral radiographs were reviewed by an orthopedic surgeon to identify the presence of plantar spurs. A total of 329 (41.9%) patients with Achilles tendinopathy were found to have a concomitant plantar spur. Patients with unilateral Achilles tendinopathy and a plantar spur were more likely to be women (58.7% vs 49.8%, P=.020) and older (62.7 vs 51.7 years, P<.001). In the bilateral Achilles tendinopathy group, there were 46 (63.9%) patients with at least one foot presenting with a plantar spur. The study's findings suggest a significant association between Achilles tendinopathy and plantar spurs. Older women with Achilles tendinopathy are at greater risk of being affected by plantar spurs. PMID:25275977

  17. [Controversies over heel pressure ulcers].

    PubMed

    Rueda López, J

    2013-02-01

    Article whose content was exposed in the workshops of the GNEAUPP Congress, held in Seville in November2012, and which refers to ulcers by pressure on the heels as a location exposed to the analysis. A pressure ulcer is a lesion located in skin I underlying tissue usually over a bone prominence, as a result of the pressure, or pressure in combination with the shears. A number of contributing factors or confounding factors are also associated with ulcers by pressure; the importance of these factors still not been elucidated. The heels are next to the sacred area, parts of the body that most frequently presents ulcers by pressure, The importance of the predisposing factors for ulcers in the sacral area as humidity has been studied in recent years, but in heels, remains one of the most important locations in the extremities, which entails adverse outcomes such as amputation in persons with comorbid diseases like Diabetes Mellitus (DM). The incidence of ulcers on heels in patients with DM and without it, is approximately 19-32%. Everything and be a problem associated with elderly people and chronic pathologies, in acute patients are a problem that this underrated, but not devoid of controversy. In hospitals of treble in 2006, the NPUAP encrypted the incidence of UPPin heels in a 43%; in one systematic review conducted by Reddy et al. (2006) puts revealed that 60% of pressure ulcers is produced. The problem of the UPP in heels is present in all the areas of intervention and particularly in paediatric units intensive care, where the first localization it is the occipital area followed by the heels.

  18. Heel Injuries and Disorders

    MedlinePlus

    ... spurs and deformities. Certain diseases, such as rheumatoid arthritis and gout, can also lead to heel problems. Treatments for heel problems might include rest, medicines, exercises, taping, and special shoes. Surgery is rarely needed.

  19. Bursitis of the heel

    MedlinePlus

    ... bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas ... the heel. It is where the large Achilles tendon connects the calf muscles to the heel bone. ...

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

    SciTech Connect

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

    2012-11-15

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

  1. Plantar fasciitis: diagnosis and therapeutic considerations.

    PubMed

    Roxas, Mario

    2005-06-01

    Plantar fasciitis is the most common cause of inferior heel pain. The pain and discomfort associated with this condition can have a dramatic impact on physical mobility. The etiology of this condition is not clearly understood and is probably multi-factorial in nature. Weight gain, occupation-related activity, anatomical variations, poor biomechanics, overexertion, and inadequate footwear are contributing factors. Although plantar fasciitis is generally regarded as a self-limited condition, it can take months to years to resolve, presenting a challenge for clinicians. Many treatment options are available that demonstrate variable levels of efficacy. Conservative therapies include rest and avoidance of potentially aggravating activities, stretching and strengthening exercises, orthotics, arch supports, and night splinting. Other considerations include use of anti-inflammatory agents, ultrasonic shockwave therapy, and, in the most extreme cases, surgery. This article reviews plantar fasciitis, presents the most effective treatment options currently available, and proposes nutritional considerations that may be beneficial in the management of this condition.

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

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

  3. Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging*

    PubMed Central

    Rodrigues, Rogéria Nobre; Lopes, Alexia Abuhid; Torres, Jardélio Mendes; Mundim, Marina Franco; Silva, Lênio Lúcio Gavio; Silva, Breno Rabelo de Carvalho e

    2015-01-01

    Objective To assess the prevalence of isolated findings of abnormalities leading to entrapment of the lateral plantar nerve and respective branches in patients complaining of chronic heel pain, whose magnetic resonance imaging exams have showed complete selective fatty atrophy of the abductor digiti quinti muscle. Materials and Methods Retrospective, analytical, and cross-sectional study. The authors selected magnetic resonance imaging of hindfoot of 90 patients with grade IV abductor digiti quinti muscle atrophy according to Goutallier and Bernageau classification. Patients presenting with minor degrees of fatty muscle degeneration (below grade IV) and those who had been operated on for nerve decompression were excluded. Results A female prevalence (78.8%) was observed, and a strong correlation was found between fatty muscle atrophy and plantar fasciitis in 21.2%, and ankle varices, in 16.8% of the patients. Conclusion Fatty atrophy of the abductor digiti quinti muscle is strongly associated with neuropathic alterations of the first branch of the lateral plantar nerve. The present study showed a significant association between plantar fasciitis and ankle varices with grade IV atrophy of the abductor digiti quinti muscle. PMID:26811554

  4. How We Manage Plantar Fasciitis (With Memory Jogger).

    ERIC Educational Resources Information Center

    Tanner, Suzanne M.; Harvey, Jack S.

    1988-01-01

    Common among runners and athletes who participate in jumping sports, plantar fasciitis is an overuse injury that is potentially incapacitating, causes heel and arch pain, and usually occurs after sudden increases in running mileage, frequency, or speed. Therapy is described. (Author/CB)

  5. Plantar Pressure Distribution Patterns of Individuals with Prediabetes in Comparison with Healthy Individuals and Individuals with Diabetes

    PubMed Central

    Robinson, Caroline Cabral; Balbinot, Luciane Fachin; Silva, Marcelo Faria; Achaval, Matilde; Zaro, Milton Antônio

    2013-01-01

    Background Since elevated mechanical stress along with loss of plantar protective sensation are considered relevant factors in skin breakdown resulting in diabetic foot ulcerations, the assessment of plantar pressure is important for the prevention of diabetic foot complications. Prediabetes subjects are at risk of chronic hyperglycemia complications, among them neuropathy, but information about plantar loading in this population is not available. We aimed to compare baropodometric parameters of individuals with prediabetes versus healthy persons and persons with diabetes mellitus (DM). Methods Baropodometric data from 73 subjects (15 with prediabetes (pre-DM), 28 with type 2 DM, 30 healthy) aged between 29 and 69 years of both genders were registered through a pressure platform with self-selected gait speed and first-step protocol. Peak plantar pressure, stance time, percentage of contact time, percentage of contact area and pressure-time integral were assessed in five plantar foot regions: heel, midfoot, metatarsals, hallux, and toes 2 to 5. Groups were compared by one-way analysis of variance with Scheffé post hoc (α = 0.05). Results Age, body mass index, gender, and arch height index did not differ between groups. Pre-DM and DM subjects presented increased peak pressure and pressure-time integral in metatarsals (p = .010; p > .001), as well as increased percentage of contact time in midfoot (p = .006) and metatarsals (p = .004) regions when compared with healthy subjects. Stance time was significantly higher (p = .017) in DM subjects. Conclusions Pre-DM subjects seem to exhibit an altered plantar pressure distribution pattern similar to that often found in DM subjects. PMID:24124936

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  7. Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience.

    PubMed

    Shah, Amit; Best, Alistair J; Rennie, Winston J

    2016-06-01

    Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (<5 mm), and preservation of the plantar fat pad by using a lateral heel approach.

  8. Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience.

    PubMed

    Shah, Amit; Best, Alistair J; Rennie, Winston J

    2016-06-01

    Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (<5 mm), and preservation of the plantar fat pad by using a lateral heel approach. PMID:27162283

  9. Variation of plantar pressure in Chinese diabetes mellitus.

    PubMed

    Yang, Chuan; Xiao, Huisheng; Wang, Chuan; Mai, LiFang; Liu, Dan; Qi, Yiqing; Ren, Meng; Yan, Li

    2015-01-01

    To investigate dynamic changes in plantar pressure in Chinese diabetes mellitus patients and to provide a basis for further preventing diabetic foot. This is a cross-sectional investigation including 649 Chinese diabetes mellitus patients (diabetes group) and 808 "normal" Chinese persons (nondiabetes group) with normal blood glucose levels. All the subjects provided a complete medical history and underwent a physical examination and a 75-g oral glucose tolerance test. All subjects walked barefoot with their usual gait, and their dynamic plantar forces were measured using the one-step method with a plantar pressure measurement instrument; 5 measurements were performed for each foot. No significant differences were found in age, height, body weight, or body mass index between the two groups. The fasting blood glucose levels, plantar contact time, maximum force, pressure-time integrals and force-time integrals in the diabetes group were significantly higher than those in the nondiabetes group (p < 0.05). However, the maximum pressure was significantly higher in the nondiabetes group than in the diabetes group (p < 0.05). No difference was found in the contact areas between the two groups (p > 0.05). The maximum plantar force distributions were essentially the same, with the highest force found for the medial heel, followed by the medial forefoot and the first toe. The peak plantar pressure was located at the medial forefoot for the nondiabetes group and at the hallucis for the diabetes group. In the diabetes group, the momentum in each plantar region was higher than that in the nondiabetes group; this difference was especially apparent in the heel, the lateral forefoot and the hallucis. The dynamic plantar pressures in diabetic patients differ from those in nondiabetic people with increased maximum force and pressure, a different distribution pattern and significantly increased momentum, which may lead to the formation of foot ulcers.

  10. Intraosseous lipoma of the calcaneus mimicking plantar fascitis.

    PubMed

    Karthik, K; Aarthi, S

    2011-06-01

    Benign lytic lesions of the calcaneus are rare and are usually asymptomatic. We report this case of a 55-year-old man with bilateral non-traumatic plantar heel pain, which was treated conservatively as plantar fasciitis. At three months follow-up, the patient had complete relief of symptoms in the left heel with partial relief of symptoms on the right side. However under the insistence of the patient an X-ray was taken, which revealed an expansile lytic lesion of the right calcaneus and a normal left heel. CT-scan revealed an expansile lytic lesion on the right calcaneus and an early lytic lesion in the left calcaneus. Following surgical intervention, the diagnosis was confirmed as intra-osseous lipoma and the patient was completely symptom free at two-year follow-up. Patients presenting with non-traumatic heel pain should be explained about the possible causes of heel pain, and should be offered X-ray at the first visit. In patients with X-ray showing unilateral lipoma of the calcaneus, CT scan should be offered to rule out involvement of the opposite side.

  11. Identification of Foot Pathologies Based on Plantar Pressure Asymmetry.

    PubMed

    Wafai, Linah; Zayegh, Aladin; Woulfe, John; Aziz, Syed Mahfuzul; Begg, Rezaul

    2015-08-18

    Foot pathologies can negatively influence foot function, consequently impairing gait during daily activity, and severely impacting an individual's quality of life. These pathologies are often painful and correspond with high or abnormal plantar pressure, which can result in asymmetry in the pressure distribution between the two feet. There is currently no general consensus on the presence of asymmetry in able-bodied gait, and plantar pressure analysis during gait is in dire need of a standardized method to quantify asymmetry. This paper investigates the use of plantar pressure asymmetry for pathological gait diagnosis. The results of this study involving plantar pressure analysis in fifty one participants (31 healthy and 20 with foot pathologies) support the presence of plantar pressure asymmetry in normal gait. A higher level of asymmetry was detected at the majority of the regions in the feet of the pathological population, including statistically significant differences in the plantar pressure asymmetry in two regions of the foot, metatarsophalangeal joint 3 (MPJ3) and the lateral heel. Quantification of plantar pressure asymmetry may prove to be useful for the identification and diagnosis of various foot pathologies.

  12. Identification of Foot Pathologies Based on Plantar Pressure Asymmetry

    PubMed Central

    Wafai, Linah; Zayegh, Aladin; Woulfe, John; Aziz, Syed Mahfuzul; Begg, Rezaul

    2015-01-01

    Foot pathologies can negatively influence foot function, consequently impairing gait during daily activity, and severely impacting an individual’s quality of life. These pathologies are often painful and correspond with high or abnormal plantar pressure, which can result in asymmetry in the pressure distribution between the two feet. There is currently no general consensus on the presence of asymmetry in able-bodied gait, and plantar pressure analysis during gait is in dire need of a standardized method to quantify asymmetry. This paper investigates the use of plantar pressure asymmetry for pathological gait diagnosis. The results of this study involving plantar pressure analysis in fifty one participants (31 healthy and 20 with foot pathologies) support the presence of plantar pressure asymmetry in normal gait. A higher level of asymmetry was detected at the majority of the regions in the feet of the pathological population, including statistically significant differences in the plantar pressure asymmetry in two regions of the foot, metatarsophalangeal joint 3 (MPJ3) and the lateral heel. Quantification of plantar pressure asymmetry may prove to be useful for the identification and diagnosis of various foot pathologies. PMID:26295239

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

    PubMed

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

    2013-01-01

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

  14. Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis.

    PubMed

    Zhou, Binghua; Zhou, You; Tao, Xu; Yuan, Chengsong; Tang, Kanglai

    2015-01-01

    Calcaneal spurs, as a cause of plantar fasciitis, are currently debatable. A prospective study was performed to classify calcaneal spurs according to the findings from an investigation of the relationship between calcaneal spurs and plantar fasciitis. Thirty patients with calcaneal spurs and plantar heel pain underwent calcaneal spur removal and endoscopic plantar fasciotomy. The relationship between the classification of calcaneal spurs and plantar fasciitis was evaluated by endoscopic findings, clinical symptoms, radiographic images, and biopsy findings. The visual analog scale for pain and the American Orthopedic Foot and Ankle Society ankle-hindfoot scores for functional evaluation were used preoperatively and postoperatively, respectively. The mean follow-up period was 24 months. Two separate types of calcaneal spurs were recognized. Type A calcaneal spurs were located superior to the plantar fascia insertion, and type B calcaneal spurs were located within the plantar fascia. Magnetic resonance imaging results showed a more severe plantar fasciitis grade in type B calcaneal spurs preoperatively. Histologic examination showed that the numbers of granulocytes per image in type B spurs were significantly increased compared with those in type A spurs. Statistically significant improvements were found in the mean visual analog scale and American Orthopedic Foot and Ankle Society scores and magnetic resonance imaging results in both groups. The amount of change in the visual analog scale score and American Orthopedic Foot and Ankle Society score, the number of granulocytes per image, and calcaneal spur length showed a high association with the classification of the calcaneal spurs. Calcaneal spurs were completely removed and did not recur in any of the patients on radiographic assessment during the follow-up period. Calcaneal spurs can be classified into 2 distinct types that are indicative of the severity of plantar fasciitis.

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

    SciTech Connect

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

    2013-12-01

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

  16. The effects of total contact casting materials on plantar pressures.

    PubMed

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

    2004-02-01

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

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

    PubMed

    Thapa, Deepak; Ahuja, Vanita

    2014-03-01

    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.

  18. Orthotic Heel Wedges Do Not Alter Hindfoot Kinematics and Achilles Tendon Force During Level and Inclined Walking in Healthy Individuals.

    PubMed

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

    2016-04-01

    Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges works remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modeling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12-mm orthotic heel wedges. Nineteen healthy volunteers walked on an inclinable walkway while optical motion, force plate, and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments; this resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced tibialis posterior and toe flexor muscle forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case.

  19. Orthotic Heel Wedges Do Not Alter Hindfoot Kinematics and Achilles Tendon Force During Level and Inclined Walking in Healthy Individuals.

    PubMed

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

    2016-04-01

    Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges works remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modeling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12-mm orthotic heel wedges. Nineteen healthy volunteers walked on an inclinable walkway while optical motion, force plate, and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments; this resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced tibialis posterior and toe flexor muscle forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case. PMID:26502456

  20. A novel treatment for refractory plantar fasciitis.

    PubMed

    Patel, Mihir M

    2015-03-01

    Chronic plantar fasciitis is a major health care problem worldwide and affects nearly 10% of the US population. Although most cases resolve with conservative care, the numerous treatments for refractory plantar fasciitis attest to the lack of consensus regarding these cases. The emerging goals for this condition are a minimally invasive percutaneous intervention that is safe, effective, and well-tolerated and has minimal morbidity and a low complication rate. We conducted a prospective study in which patients were allowed either to continue with noninvasive treatment or to undergo focal aspiration and partial fasciotomy with an ultrasonic probe. This is the first report of a plantar fascia partial release guided by ultrasonic energy delivered by a percutaneously inserted probe under local anesthesia. The procedure appears to be a safe, effective, well-tolerated treatment for a condition that is refractory to other options.

  1. Surgery for Patients With Recalcitrant Plantar Fasciitis

    PubMed Central

    Wheeler, Patrick; Boyd, Kevin; Shipton, Mary

    2014-01-01

    Background: Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes. Purpose: To assess the outcome following surgical intervention for patients with plantar fasciitis. Study Design: Case series; Level of evidence, 4. Methods: Seventy-nine patients were identified from operative diaries undergoing plantar fasciotomy surgery between 1993 and 2009. They were contacted to investigate long-term results using self-reported outcome measures. Results: Sixty-eight responses were received (86% response rate), with an average of 7 years (range, 1-15 years) of follow-up. Patients reported an average reduction in pain by visual analog scale of 79%, and 84% of patients were happy with the surgical results. Greater success was achieved in patients with shorter duration of symptoms preoperatively. No deterioration in success was seen over time. Conclusion: Plantar fasciotomy surgery for plantar fasciitis remains controversial, with biomechanical arguments against surgery; however, this article reports good success following surgery over a long follow-up period. The results of current operative techniques need to be fully investigated for longer term success, as do the outcomes of newer nonoperative management strategies. PMID:26535314

  2. Plantar fascia (image)

    MedlinePlus

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

  3. The compressive material properties of the plantar soft tissue.

    PubMed

    Ledoux, William R; Blevins, Joanna J

    2007-01-01

    The plantar soft tissue is the primary means of physical interaction between a person and the ground during locomotion. Dynamic loads greater than body weight are borne across the entire plantar surface during each step. However, most testing of these tissues has concentrated on the structural properties of the heel pad. The purpose of this study was to determine the material properties of the plantar soft tissue from six locations beneath: the great toe (subhallucal), the 1st, 3rd and 5th metatarsal heads (submetatarsal), the lateral midfoot (lateral submidfoot) and the heel (subcalcaneal). We obtained specimens from these locations from 11 young, non-diabetic donors; the tissue was cut into 2 cm x 2 cm blocks and the skin was removed. Stress relaxation experiments were conducted and the data were fit using the quasi-linear viscoelastic (QLV) theory. To determine tissue modulus, energy loss and the effect of test frequency, we also conducted displacement controlled triangle waves at five frequencies ranging from 0.005 to 10 Hz. The subcalcaneal tissue was found to have an increased relaxation time compared to the other areas. The subcalcaneal tissue was also found to have an increased modulus and decreased energy loss compared to the other areas. Across all areas, the modulus and energy loss increased for the 1 and 10 Hz tests compared to the other testing frequencies. This study is the first to generate material properties for all areas of the plantar soft tissue, demonstrating that the subcalcaneal tissue is different than the other plantar soft tissue areas. These data will have implications for foot computational modeling efforts and potentially for orthotic pressure reduction devices.

  4. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.

    PubMed

    Gerdesmeyer, Ludger; Mittermayr, Rainer; Fuerst, Martin; Al Muderis, Munjed; Thiele, Richard; Saxena, Amol; Gollwitzer, Hans

    2015-12-01

    Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy. PMID:26327530

  5. Platelet-Rich-Plasma injection seems to be effective in treatment of plantar fasciitis: a case series.

    PubMed

    van Egmond, Jeroen C; Breugem, Stefan J M; Driessen, Marcel; Bruijn, Daniel J

    2015-06-01

    Plantar fasciitis is the most common cause of heel pain. Diverse non-operative treatment options are available. The purpose of this study was to determine if a single platelet-rich-plasma injection at the origin of the plantar fascia in patients with plantar fasciitis gives a functional improvement. Patients with plantar fasciitis and failed conservative treatment were included in this retrospective study. Included patients were sent four questionnaires after platelet-rich-plasma injection. Primary outcome is functional improvement, determined by foot function index in which lower scores correlates with a better foot function. A total of 61 feet in 58 patients were included. The median foot function index before treatment was 69.4 and after treatment 31.8, which is a significant decrease. In 80.3% of the patients the foot function index decreased. Therefore platelet-rich-plasma injection seems to be effective in treatment of patients with plantar fasciitis when conservative treatment failed.

  6. Platelet-Rich-Plasma injection seems to be effective in treatment of plantar fasciitis: a case series.

    PubMed

    van Egmond, Jeroen C; Breugem, Stefan J M; Driessen, Marcel; Bruijn, Daniel J

    2015-06-01

    Plantar fasciitis is the most common cause of heel pain. Diverse non-operative treatment options are available. The purpose of this study was to determine if a single platelet-rich-plasma injection at the origin of the plantar fascia in patients with plantar fasciitis gives a functional improvement. Patients with plantar fasciitis and failed conservative treatment were included in this retrospective study. Included patients were sent four questionnaires after platelet-rich-plasma injection. Primary outcome is functional improvement, determined by foot function index in which lower scores correlates with a better foot function. A total of 61 feet in 58 patients were included. The median foot function index before treatment was 69.4 and after treatment 31.8, which is a significant decrease. In 80.3% of the patients the foot function index decreased. Therefore platelet-rich-plasma injection seems to be effective in treatment of patients with plantar fasciitis when conservative treatment failed. PMID:26280973

  7. Plantar Hyperhidrosis: An Overview.

    PubMed

    Vlahovic, Tracey C

    2016-07-01

    Plantar hyperhidrosis, excessive sweating on the soles of feet, can have a significant impact on patients' quality of life and emotional well-being. Hyperhidrosis is divided into primary and secondary categories, depending on the cause of the sweating, with plantar hyperhidrosis typically being primary and idiopathic. There is an overall increased risk of cutaneous infection in the presence of hyperhidrosis, including fungal, bacterial, and viral infections. This article discusses a range of treatment options including topical aluminum chloride, iontophoresis, injectable botulinum toxin A, glycopyrrolate, oxybutynin, laser, and endoscopic lumbar sympathectomy. Lifestyle changes regarding hygiene, shoe gear, insoles, and socks are also discussed. PMID:27215162

  8. Talalgia: plantar fasciitis☆

    PubMed Central

    Cardenuto Ferreira, Ricardo

    2014-01-01

    Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%). The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor. PMID:26229803

  9. Talalgia: plantar fasciitis.

    PubMed

    Cardenuto Ferreira, Ricardo

    2014-01-01

    Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%). The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor.

  10. Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound

    PubMed Central

    Moustafa, Asmaa Mahmoud Ali; Hassanein, Eshrak; Foti, Calogero

    2015-01-01

    Summary Background although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. Methods this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. Results increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. Conclusion US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis. PMID:26958538

  11. Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review.

    PubMed

    Mohseni-Bandpei, Mohammad Ali; Nakhaee, Masoomeh; Mousavi, Mohammad Ebrahim; Shakourirad, Ali; Safari, Mohammad Reza; Vahab Kashani, Reza

    2014-08-01

    Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS.

  12. Shockwave therapy for patients with plantar fasciitis: a one-year follow-up study.

    PubMed

    Wang, Ching-Jen; Chen, Han-Shiang; Huang, Ting-Wen

    2002-03-01

    The effect of shockwave therapy was investigated in 79 patients (85 heels) with plantar fasciitis with one-year follow-up. There were 59 women and 20 men with an average age of 47 (range, 15-75) years. Each patient was treated with 1000 impulses of shockwave at 14 kV to the affected heel. A 100-point scoring system was used for evaluation including 70 points for pain and 30 points for function. The intensity of pain was based on a visual analogue scale from 0 to 10. The overall results were 75.3% complaint-free, 18.8% significantly better, 5.9% slightly better and none unchanged or worse. The effect of shockwave therapy seemed cumulative and was time-dependent. The recurrence rate was 5%. There were no device-related problems, systemic or local complications. Shockwave therapy is a safe and effective modality in the treatment of patients with plantar fasciitis.

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

    PubMed Central

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

    2015-01-01

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

  14. On muscle, tendon and high heels.

    PubMed

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

    2010-08-01

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

  15. Differential effects of plantar cutaneous afferent excitation on soleus stretch and H-reflex.

    PubMed

    Sayenko, Dimitry G; Vette, Albert H; Obata, Hiroki; Alekhina, Maria I; Akai, Masami; Nakazawa, Kimitaka

    2009-06-01

    Previous studies have demonstrated that plantar cutaneous afferents can adjust motoneuron excitability, which may contribute significantly to the control of human posture and locomotion. However, the role of plantar cutaneous afferents in modulating the excitability of stretch and H-reflex with respect to the location of their excitation remains unclear. In the present study, it was hypothesized that electrical stimulation delivered to the sole of the foot might be followed by modulation of spinal excitability that depends on: (1) the stimulation location and (2) the reflex studied. In these experiments, conditioned and unconditioned stretch and H-reflexes were evoked in 16 healthy subjects in a seated position. Both reflexes were conditioned by non-noxious electrical plantar cutaneous afferent stimulation at two different sites, the heel and metatarsal regions, at four different conditioning-test (CT) intervals. The conditioning stimulation delivered to the heel caused a significant facilitation of the soleus stretch reflex for all CT intervals, whereas the soleus H-reflex had significant facilitation only at CT interval of 50 ms and significant inhibition at longer CT intervals. Stimulation delivered to the metatarsal region, however, resulted mainly in reduced stretch and H-reflex sizes. This study extends the reported findings on the contribution of plantar cutaneous afferents within spinal interneuron reflex circuits as a function of their location and the reflex studied. PMID:19260052

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

    PubMed

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

    2014-08-01

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

  17. Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy

    PubMed Central

    Savelberg, Hans HCM; Schaper, Nicolaas C; Willems, Paul JB; de Lange, Ton LH; Meijer, Kenneth

    2009-01-01

    Background Patients with diabetic polyneuropathy (DPN) are often confronted with ulceration of foot soles. Increased plantar pressure under the forefoot has been identified as a major risk factor for ulceration. This study sets out to test the hypothesis that changes in gait characteristics induced by DPN related muscle weakness are the origin of the elevated plantar pressures. Methods Three groups of subjects participated: people diagnosed with diabetes without polyneuropathy (DC), people diagnosed with diabetic polyneuropathy (DPN) and healthy, age-matched controls (HC). In all subjects isometric strength of plantar and dorsal flexors was assessed. Moreover, joint moments at ankle, knee and hip joints were determined while walking barefoot at a velocity of 1.4 m/s. Simultaneously plantar pressure patterns were measured. Results Compared to HC-subjects, DPN-participants walked with a significantly increased internal plantar flexor moment at the first half of the stance phase. Also in DPN-subjects the maximal braking and propelling force applied to the floor was decreased. Moreover, in DPN-subjects the ratio of forefoot-to-rear foot plantar pressures was increased. Body-mass normalized strength of dorsal flexors showed a trend to be reduced in people with diabetes, both DC and DPN, compared to HC-subjects. Plantar flexors tended to be less weak in DC compared to HC and in DPN relative to DC. Conclusion The results of this study suggest that adverse plantar pressure patterns are associated with redistribution of joint moments, and a consequent reduced capacity to control forward velocity at heel strike. PMID:19192272

  18. Using an optimization approach to design an insole for lowering plantar fascia stress--a finite element study.

    PubMed

    Hsu, Yu-Chun; Gung, Yih-Wen; Shih, Shih-Liang; Feng, Chi-Kuang; Wei, Shun-Hwa; Yu, Chung-Huang; Chen, Chen-Sheng

    2008-08-01

    Plantar heel pain is a commonly encountered orthopedic problem and is most often caused by plantar fasciitis. In recent years, different shapes of insole have been used to treat plantar fasciitis. However, little research has been focused on the junction stress between the plantar fascia and the calcaneus when wearing different shapes of insole. Therefore, this study aimed to employ a finite element (FE) method to investigate the relationship between different shapes of insole and the junction stress, and accordingly design an optimal insole to lower fascia stress.A detailed 3D foot FE model was created using ANSYS 9.0 software. The FE model calculation was compared to the Pedar device measurements to validate the FE model. After the FE model validation, this study conducted parametric analysis of six different insoles and used optimization analysis to determine the optimal insole which minimized the junction stress between plantar fascia and calcaneus. This FE analysis found that the plantar fascia stress and peak pressure when using the optimal insole were lower by 14% and 38.9%, respectively, than those when using the flat insole. In addition, the stress variation in plantar fascia was associated with the different shapes of insole.

  19. [Cover flaps for loss of substance on the heel. Apropos of 8 cases].

    PubMed

    Mulfinger, C; Bardot, J; Legre, R; Aubert, J P; Magalon, G; Bureau, H

    1993-10-01

    The anatomical and function characteristics of the heel region explain the large number of methods used and the differences of opinion particularly in relation to the repair of weightbearing zones. Our study is based on 28 patients in whom we performed: ten regional flaps, six cross-leg flaps, sixteen microsurgical flaps. The temporal fascia free flap provides good results on the posterior surface with minimal sequelae at the donor site. The medial plantar flap appears to be the most suitable flap for weight-bearing zones. Cross-lep flaps allow satisfactory repair of the weightbearing zone, but the scarred appearance of the donor site is inaesthetic and immobilisation is uncomfortable. The problem of large defects is still not resolved and no really satisfactory method is available among the various distant, skin, myocutaneous, pure muscle or cross-leg flaps. The solution may reside in a combination of two flaps allowing better adaptation to the morphology of the heel. The importance of heel sensation, particularly in the weight-bearing zone, led to the concept of the use of sensitive or resensitised flaps. After a review of the literature and our results, we did not find any correlation between the sensitivity obtained and the success of the reconstruction. It therefore seems useless to perform microscopic nerve sutures in order to resensitise distant heel flaps. The patient's cooperation is essential in every case to compensate for the decreased sensitivity by means of increased visual surveillance and the wearing of suitable shoes.

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

    PubMed Central

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

    2011-01-01

    Plantar fasciitis is a common cause of heel pain. It has been suggested that some acupoints have a specific effect on heel pain. The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n = 28) or control group (n = 25). The treatment group received needling at the acupoint PC 7, which is purported to have a specific effect for heel pain. The control group received needling at the acupoint Hegu (LI 4), which has analgesic properties. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. The primary outcome measure was morning pain on a 100-point visual analog scale (VAS) at one month post-treatment. Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain (20.3 ± 3.7 versus 9.5 ± 3.6) and pressure pain threshold (145.5 ± 32.9 versus −15.5 ± 39.4). No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain. PMID:19933769

  1. Computer Modeling Studies to Assess Whether a Prophylactic Dressing Reduces the Risk for Deep Tissue Injury in the Heels of Supine Patients with Diabetes.

    PubMed

    Levy, Ayelet; Gefen, Amit

    2016-04-01

    Heels are susceptible to pressure ulcer (PU) development. Some evidence suggests dressings may provide mechanical cushioning, reduce friction with support, and lower localized internal tissue loading, which together may minimize the risk for heel ulcers (HUs). To examine the effect of dressing application on pressure ulcer prevention, 20 computer simulations were performed. Volumetric exposure of soft tissues to effective and shear strains and stresses, with and without a multilayered foam dressing, were assessed, with the extent of tissue exposure considered as measures of the theoretical risk for PUs. The simulations, conducted using the finite element method, provided the mechanical strain and stress magnitudes and distributions in the weight-bearing tissues of the heel, which were visualized and analyzed post-hoc for comparing diabetic to healthy tissue loads with/without prophylactic dressings and at different foot (plantar flexion) postures. The volumetric exposure of the soft tissues of the heel to elevated strains and stresses was considerably reduced by the presence of the dressing, whether diabetic or nondiabetic tissue conditions existed, and for the entire range of the simulated plantar flexion positions. Further, greater plantar flexion, which occurs with elevation of the head of the bed, reduced the volumetric exposure of subcutaneous fat to increased effective strains and stresses, again, particularly when the dressing was on. Specifically, peak (maximum of raw data) effective strains in the soft tissues of the heel decreased by 14.8% and 13.5% with the use of the dressing for healthy persons and persons with diabetes, respectively. Additionally, volumetric exposures of the soft tissues to large effective strains, defined as exposures to >50% strain, decreased substantially, by at least a factor of 2, with the angle of plantar flexion and with respect to a neutral foot posture. Volumetric exposures to midrange (less than 50%) strains were more mildly

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

    PubMed

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

    2012-07-01

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

  3. Lateral plantar pain: diagnostic considerations.

    PubMed

    Bahel, Aditya; Yu, Joseph S

    2010-07-01

    Injuries that target the bones of the midfoot are important causes of pain. The medial aspect of the midfoot has been extensively studied but the lateral plantar region has not received as much attention. The objective of this article is to review the differential diagnosis of lateral plantar pain, emphasizing on the common mechanisms of injury, and to identify characteristic imaging findings for these pathologic conditions.

  4. Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study

    PubMed Central

    Malliaropoulos, Nikos; Meke, Maria; Korakakis, Vasileios; Nauck, Tanja; Lohrer, Heinz; Padhiar, Nat

    2016-01-01

    Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified in literature. Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive Spearman's rho correlation (r = 0.462, p < 0.001) was found between pretreatment pain duration and the total number of rESWT sessions applied. Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis. PMID:27478843

  5. Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study.

    PubMed

    Malliaropoulos, Nikos; Crate, Georgina; Meke, Maria; Korakakis, Vasileios; Nauck, Tanja; Lohrer, Heinz; Padhiar, Nat

    2016-01-01

    Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified in literature. Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive Spearman's rho correlation (r = 0.462, p < 0.001) was found between pretreatment pain duration and the total number of rESWT sessions applied. Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis. PMID:27478843

  6. Changes in plantar load distribution and gait pattern following foot drop correction in leprosy affected patients.

    PubMed

    Karmakar, Mrinmoy; Joshua, Jerry; Mahato, Nidhu

    2015-09-01

    This study was done to compare the changes in plantar load (weight distribution) and gait patterns before and after tibialis posterior transfer surgery in people affected by leprosy. Changes in gait patterns were observed and proportionate changes in plantar load were quantified using data captured by a baropodometer. All the eight patients who underwent tibialis posterior transfer surgery in 2013 in our hospital were included in the study. In addition to the regular pre-operative and post-operative assessments, the patients also underwent baropodometric evaluation. There was a significant change in plantar load at the heel, lateral border and forefoot. Using the foot pressure scan, it was noted that the progression of the centre of mass (displayed graphically as 'the gait line') was also affected by the altered pattern of weight distribution. This study reiterates the importance of tibialis posterior transfer because: it restores the normal gait pattern of 1, 2, 3 (where 1 is heel strike, 2 is mid foot contact and 3 is forefoot contact) and provides a more uniform distribution of planter load. PMID:26665356

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  9. A comparative study of efficacy of oral nonsteroidal antiinflammatory agents and locally injectable steroid for the treatment of plantar fasciitis

    PubMed Central

    Biswas, Chaitali; Pal, Anirban; Acharya, Amita

    2011-01-01

    Objectives: To compare the effectiveness of oral nonsteroidal antiinflammatory drugs (NSAIDs) and locally injectable steroid (methylprednisolone) in the treatment of plantar fasciitis. Materials and Methods: One hundred and twenty subjects with unilateral plantar fasciitis were recruited and randomly allocated to two study groups. Group I (NSAIDs group) (n=60) received oral tablet diclofenac (50 mg) and paracetamol (500 mg) twice a day (BD) along with tab. ranitidine 150 mg BD. Group II (injectable steroid group) (n=60) received injection of 1 ml of methylprednisolone (Depomedrol) (40 mg) and 2 ml of 0.5% bupivacaine into the inflammed plantar fascia. Pain intensity was measured using 10 cm visual analog scale (VAS). Subjects were evaluated clinically before, and 1 week, 2 weeks, 4 weeks, and 8 weeks (2 months) after the initiation of treatment in both the groups. The outcome was assessed in terms of VAS score and recurrence of the heel pain. Statistical Analysis Used: “Z” test and Chi-square test were used wherever applicable. Results: Pain relief was significant after steroid injection (P<0.001) and the improvement was sustained. The recurrence of heel pain was significantly higher in the oral NSAIDS group (P<0.001). Conclusion: Local injection of steroid is more effective in the treatment of plantar fasciitis than oral NSAIDs. PMID:25885380

  10. Effects of the height of shoe heels on muscle activation of cervical and lumbar spine in healthy women

    PubMed Central

    Park, Kisu; Kim, Young; Chung, Yijung; Hwang, Sujin

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of different height of high heels on muscle activation of the paraspinalis cervicis and erector spinae in healthy young women. [Subjects and Methods] Thirteen healthy women were recruited in this study. To examine the effects of different heights of heels on muscle activation, the paraspinalis cervicis (cervical spine) and erector spinae (lumbar spine) were measured at the time of heel strike and toe off during gait on three different conditions (barefoot, 4 cm high heels, and 10 cm high heels). There are no previous trials or reports that have evaluated this approach in patients with chronic neck pain. [Results] A significant increase in muscle activation of the paraspinalis cervicis and erector spinae at heel strike and toe off (except that of the paraspinalis cervicis at toe off in healthy subjects) was observed in the under 10 cm high heel condition as, compared to that with barefoot condition, in all the subjects. [Conclusion] The height of the high heels affects to the activation demand of the paraspinalis cervicis and erector spinae in patients with neck pain. PMID:27134392

  11. Plantar soft tissue thickness during ground contact in walking

    NASA Technical Reports Server (NTRS)

    Cavanagh, P. R.

    1999-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  13. Complete remission of plantar fasciitis with a gluten-free diet: relationship or just coincidence?

    PubMed

    Paoloni, Marco; Tavernese, Emanuela; Ioppolo, Francesco; Fini, Massimo; Santilli, Valter

    2014-09-01

    We report the case of a 46-year-old woman with no known history for gluten sensitivity who presented severe heel pain, and was successfully managed with a gluten-free diet. Previously she had been unsuccessfully treated with several conservative remedies. The presence of musculoskeletal problems in patients with gluten sensitivity is not rare. To the best of our knowledge, however, this is the first case report mentioning the successful management of plantar fasciitis with a gluten-free diet. The case report highlights the importance of considering gluten sensitivity among other possible differential diagnosis for musculoskeletal pain insensitive to traditional therapies.

  14. Duration of disease, neuropathic symptoms, and plantar sensitivity in patients with diabetes with and without previous plantar ulceration.

    PubMed

    de Almeida Bacarin, Tatiana; Akashi, Paula M H; de C N Sacco, Prof Isabel

    2008-02-01

     This study compared the duration of disease, the prevalence of neuropathy symptoms, and plantar insensitivity among subjects with diabetic neuropathy, with and without previous history of plantar ulcers, to a nondiabetic group of subjects. Correlations were made between the neuropathic symptoms observed and the results of sensory tests. Thermal and tactile sensitivities and sensitive chronaxie were measured in the control group (CG, n = 19), a diabetic neuropathic group (DG, n = 16), and a diabetic neuropathic group with previous history of plantar ulceration (UDG, n = 9). Plantar sensitivity was investigated in 5 areas of the plantar surface of both feet: heel, midfoot, lateral forefoot, medial forefoot, and hallux. The neuropathy symptoms were investigated using the Michigan Neuropathy Screening Instrument (MNSI). The neuropathic groups did not differ in duration of diabetes onset (DG = 13 years ± 8; UDG = 14 years ± 5; P = 0.243) and they presented similar mean for symptoms according to MNSI score (DG = 6.94 ± 1.81; UDG = 6.78 ± 2.44; P = 0.352). The frequency of subjects with abnormal sensitivity was higher in UDG. The MNSI showed moderate correlation with tactile sensitivity (r <-0.42, P <0.05). Patients with diabetic neuropathy and an ulcer had decreased sensitivity in their feet. The symptoms may indicate loss of sensation, but symptoms alone are not able to differentiate between neuropathic subjects with different progressions of diabetic peripheral neuropathy (DPN). Duration of diabetes and symptoms did not explain the severity of neuropathy in people with a diabetic ulcer.

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

    PubMed

    Jørgensen, U; Bojsen-Møller, F

    1989-06-01

    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.

  16. Plantar Fasciitis: Prescribing Effective Treatments.

    ERIC Educational Resources Information Center

    Shea, Michael; Fields, Karl B.

    2002-01-01

    Plantar fasciitis is an extremely common, painful injury seen among people in running and jumping sports. While prognosis for recovery with conservative care is excellent, prolonged duration of symptoms affects sports participation. Studies on treatment options show mixed results, so finding effective treatments can be challenging. A logical…

  17. Mutilating palmo-plantar keratoderma.

    PubMed

    Gamborg Nielsen, P

    1983-01-01

    A 36-year-old male, with no history of hereditary palmo-plantar keratoderma, showed at the age of 2-3 years a typical keratoderma of the Unna Thost variety on palms and soles. At the age of 16 years he developed mutilating symptoms localized to the fingers. Radiologic examination showed abnormally pointed end phalanges.

  18. The Association between Unilateral Heel-Rise Performance with Static and Dynamic Balance in Community Dwelling Older Adults

    PubMed Central

    Hashish, Rami; Samarawickrame, Sachithra D.; Wang, Man-Ying; Yu, Sean S-Y; Salem, George J.

    2014-01-01

    INTRODUCTION As a measure of both strength and muscle endurance of the plantar flexors, the unilateral heel rise (UHR) test has been suggested as a method to evaluate balance capabilities in older adults. Thus, the purpose of this study was to examine the association between UHR performance with biomechanical measures of balance in seniors. MATERIALS AND METHODS Twenty-two older adults completed two testing sessions. The first visit included UHR performance; the second visit included dynamic and static motion analysis. RESULTS UHR performance was significantly associated with dynamic balance capability as measured by medial-lateral inclination angle during gait. As indicated by an analysis of center of pressure, there were significant associations between UHR performance and measures of static balance. DISCUSSION AND CONCLUSION Balance is influenced by plantar flexor performance as measured by the UHR test. We therefore suggest incorporating the UHR test in analyses of balance in seniors. PMID:25457285

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

    PubMed

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

    2012-01-01

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

  20. Investigation of the mechanical behaviour of the plantar soft tissue during gait cycle: Experimental and numerical activities.

    PubMed

    Fontanella, Chiara G; Forestiero, Antonella; Carniel, Emanuele L; Natali, Arturo N

    2015-10-01

    The aim of this work is to investigate the mechanical response of the plantar soft tissue from the heel strike to the midstance, developing both experimental and numerical activities. Using force plates and motion tracking system, the dynamic and kinematic data of 10 subjects are evaluated. The average kinematics data obtained from the experimental tests are assumed as boundary and loading conditions for the computational analyses. A three-dimensional virtual solid model of the foot is developed from the analysis of Digital Imaging and Communications in Medicine images from computed tomography and magnetic resonance. Constitutive formulations that interpret the mechanical response of the biological tissues are defined. Because of the major role of plantar soft tissue in the proposed analysis, a specific visco-hyperelastic constitutive formulation is provided considering the typical features of the tissue mechanics. The three-dimensional numerical model permits to evaluate the capability of the plantar soft tissue to redistribute the deformations, especially during the midstance, and to define quantitative aspects related to the energy absorption. The numerical results highlight the stress distribution from the heel strike to the midstance. The values of stress and strain reached are more intensive during the midstance, when there is a single support of the foot.

  1. The Three Dimensional Conformal Radiotherapy for Hyperkeratotic Plantar Mycosis Fungoides

    PubMed Central

    Lee, Sun Young; Kwon, Hyoung Cheol; Cho, Yong-Sun; Nam, Kyung-Hwa; Ihm, Chull-Wan

    2011-01-01

    The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed. PMID:22028574

  2. Black heel a minor hazard of sport.

    PubMed

    Wilkinson, D S

    1977-09-01

    "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.

  3. The effect of customised and sham foot orthoses on plantar pressures

    PubMed Central

    2013-01-01

    Background The effectiveness of foot orthoses has been evaluated in many clinical trials with sham foot orthoses used as the control intervention in at least 10 clinical trials. However, the mechanical effects and credibility of sham orthoses has been rarely quantified. This study aimed to: (i) compare the effects on plantar pressures of three sham foot orthoses to a customised foot orthosis, and (ii) establish the perceived credibility and the expected benefit of each orthotic condition. Methods Thirty adults aged between 18 and 51 participated in this study. At 0 and 4 weeks, plantar pressure data were collected for the heel, midfoot and forefoot using the pedar®-X in-shoe system for the following five randomly assigned conditions: (i) shoe alone, (ii) customised foot orthosis, (iii) contoured polyethylene sham foot orthosis, (iv) contoured EVA sham foot orthosis, and (v) flat EVA sham foot orthosis. At the initial data collection session, each participant completed a Credibility/Expectancy Questionnaire (CEQ) to determine the credibility and expected benefit of each orthotic condition. Results Compared to the shoe alone at week 0, the contoured polyethylene sham orthosis was the only condition to not significantly effect peak pressure at any region of the foot. In contrast, the contoured EVA sham orthosis, the flat EVA sham orthosis and the customised orthosis significantly reduced peak pressure at the heel. At the medial midfoot, all sham orthoses provided the same effect as the shoe alone, which corresponded to effects that were significantly different to the customised orthosis. There were no differences in peak pressure between conditions at the other mask regions, the lateral midfoot and forefoot. When the conditions were compared at week 4, the differences between the conditions were generally similar to the findings observed at week 0. With respect to credibility and expected benefit, all orthotic conditions were considered the same with the exception

  4. Can We Measure the Heel Bump? Radiographic Evaluation of Haglund's Deformity.

    PubMed

    Bulstra, Gythe H; van Rheenen, Thijs A; Scholtes, Vanessa A B

    2015-01-01

    Haglund's deformity is a symptomatic posterosuperior deformity of the heel. The lateral radiograph of the ankle will show a prominent, large, posterosuperior part of the calcaneus, which can be measured using the Fowler and Philips angle (FPA, the angle between the posterior and plantar surface of the calcaneus) and the calcaneal pitch angle (CPA, the angle between the sole of the foot and the plantar part of the calcaneus). Although these angles are commonly used, these radiographic angle measurements have never shown a relationship with Haglund's deformity. In 78 patients (51% male) with symptomatic Haglund's deformity and a control group of 100 patients (41% male) with no heel complaints, we measured the FPA and CPA on weightbearing lateral radiographs of the foot. Using an unpaired t tests, no significant difference was found between the 2 groups in the FPA (p = .40). We measured a significant difference in the CPA between the Haglund group and the control group (p = .014). Subgroup analysis showed that this difference was mainly found in females (p < .00), with no significant difference seen in the males (p < .48). Females with Haglund's deformity will have a greater CPA than will females without Haglund's deformity. The CPA showed a difference between the Haglund and non-Haglund groups, although mainly in females. Although the evidence from our study is limited, it would be interesting to study the CPA further, because it implicates the verticalization of the calcaneus. This change in position results in extra traction on the Achilles tendon and can eventually cause tendinitis and bursitis. Radiographic measurement should be used as an auxiliary tool. If the calcaneus tends to change position, it would be interesting to understand this process, which could eventually lead to improvement in the treatment of Haglund's deformity.

  5. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis

    PubMed Central

    Ang, Teck Wee Andrew

    2015-01-01

    Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient’s daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4–12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks. PMID:26311907

  6. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis.

    PubMed

    Ang, Teck Wee Andrew

    2015-08-01

    Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks. PMID:26311907

  7. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis.

    PubMed

    Ang, Teck Wee Andrew

    2015-08-01

    Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

  8. Histomorphological Evaluation of Diabetic and Non-Diabetic Plantar Soft Tissue

    PubMed Central

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

    2014-01-01

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

  9. Effect of custom-made and prefabricated insoles on plantar loading parameters during running with and without fatigue.

    PubMed

    Lucas-Cuevas, Angel Gabriel; Pérez-Soriano, Pedro; Llana-Belloch, Salvador; Macián-Romero, Cecili; Sánchez-Zuriaga, Daniel

    2014-01-01

    Controversy exists whether custom-made insoles are more effective in reducing plantar loading compared to prefabricated insoles. Forty recreational athletes ran using custom-made, prefabricated, and the original insoles of their running shoes, at rest and after a fatigue run. Contact time, stride rate, and plantar loading parameters were measured. Neither the insole conditions nor the fatigue state modified contact time and stride rate. Addressing prevention of running injuries, post-fatigue loading values are of great interest. Custom-made insoles reduced the post-fatigue loading under the hallux (92 vs. 130 kPa, P < 0.05), medial midfoot (70 vs. 105 kPa, P < 0.01), and lateral midfoot (62 vs 96 kPa, P < 0.01). Prefabricated insoles provoked reductions in post-fatigue loading under the toes (120 vs. 175 kPa, P < 0.05), medial midfoot (71 vs. 105 kPa, P < 0.01), and lateral midfoot (68 vs. 96 kPa, P < 0.01). Regarding both study insoles, custom-made insoles reduced by 31% and 54% plantar loading under the medial and lateral heel compared to the prefabricated insoles. Finally, fatigue state did not influence plantar loading regardless the insole condition. In long-distance races, even a slight reduction in plantar loading at each foot strike may suppose a significant decrease in the overall stress experienced by the foot, and therefore the use of insoles may be an important protective mechanism for plantar overloading.

  10. Effect of custom-made and prefabricated insoles on plantar loading parameters during running with and without fatigue.

    PubMed

    Lucas-Cuevas, Angel Gabriel; Pérez-Soriano, Pedro; Llana-Belloch, Salvador; Macián-Romero, Cecili; Sánchez-Zuriaga, Daniel

    2014-01-01

    Controversy exists whether custom-made insoles are more effective in reducing plantar loading compared to prefabricated insoles. Forty recreational athletes ran using custom-made, prefabricated, and the original insoles of their running shoes, at rest and after a fatigue run. Contact time, stride rate, and plantar loading parameters were measured. Neither the insole conditions nor the fatigue state modified contact time and stride rate. Addressing prevention of running injuries, post-fatigue loading values are of great interest. Custom-made insoles reduced the post-fatigue loading under the hallux (92 vs. 130 kPa, P < 0.05), medial midfoot (70 vs. 105 kPa, P < 0.01), and lateral midfoot (62 vs 96 kPa, P < 0.01). Prefabricated insoles provoked reductions in post-fatigue loading under the toes (120 vs. 175 kPa, P < 0.05), medial midfoot (71 vs. 105 kPa, P < 0.01), and lateral midfoot (68 vs. 96 kPa, P < 0.01). Regarding both study insoles, custom-made insoles reduced by 31% and 54% plantar loading under the medial and lateral heel compared to the prefabricated insoles. Finally, fatigue state did not influence plantar loading regardless the insole condition. In long-distance races, even a slight reduction in plantar loading at each foot strike may suppose a significant decrease in the overall stress experienced by the foot, and therefore the use of insoles may be an important protective mechanism for plantar overloading. PMID:24823258

  11. Effect of arch type and Body Mass Index on plantar pressure distribution during stance phase of gait.

    PubMed

    O'Brien, Davida Louise; Tyndyk, Magdalena

    2014-01-01

    Several factors have been associated with the presence of abnormally high plantar foot pressure including: (i) increased body weight, (ii) foot structure and (iii) walking strategy. It is predicted that the biomechanics of the foot is influenced by the structure of the foot, primarily the Medial Longitudinal Arch. The objective of this study was to examine if Body Mass Index and the foot arch have a direct effect on dynamic peak plantar pressure for healthy subjects. Following a clinical lower limb examination, the Tekscan HR mat was utilised for this study, plantar pressure was profiled at specific events during stance phase of gait including heel strike, midstance and toe off. Results indicated to the preferable normal arch as this produced a low plantar pressure distribution in all cases. The 2nd and 3rd metatarsal head region recorded the highest pressure for all arch types during dynamic analysis. The lowest pressure for the normal and overweight BMI was at toe-off. While the obese BMI group showed highest pressure during toe-off. The obese BMI flat arch subcategory indicated to functional ambulation differences. Future work involves comparing this healthy database to a demographically matched diabetic group.

  12. Tyrosinemia without liver or renal damage with plantar and palmar keratosis and keratitis (hypertyrosinemia type II).

    PubMed

    Pelet, B; Antener, I; Faggioni, R; Spahr, A; Gautier, E

    1979-05-01

    A boy of 3 2/12 years of age with Richner-Hanhart syndrome (plantar and palmar keratosis and chronic keratitis) was found to have hypertyrosinemia and to excrete the hydroxyacids derived from tyrosine. A diet poor in phenylalanine and tyrosine cured the skin and corneal lesions. Clinical and biochemical observations are reported.

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

    PubMed Central

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

    2011-01-01

    Summary To determine the effect of clipless and toe-clipped pedals on plantar foot pressure while cycling. Seven bikers and 11 healthy volunteers were tested on a Giant ATX Team mountain bike, Tekscan Clinical 5.24 F-scan® system with an inner sole pressure sensor, a Tacx Cycle force One Turbo Trainer and a Cateye Mity 8 computerized speedometer were used. The subjects wore Shimano M037 shoes and used a standard clipless and toe-clipped pedal. The seat height was set at 100% of subject’s trochanteric height. Plantar pressures were recorded over 12 consecutive crank cycles at a constant speed for each of the power outputs. The videos were analysed to record the pressure exerted at 12 positions on the foot for each variable. Whether there is any dominance of any of the metatarsals, and any difference in plantar pressures between clipped and clipless pedal. There was a significant difference in the pressure at many positions of the foot, but the sites were different for each individual. General regression analysis indicated that pedal type had a statistically significant effect on plantar pressure at the sites of 1st metatarsal (p=0.042), 3rd metatarsal (p<0.001), 5th metatarsal (<0.001), 2nd (p=0.018) and 5th toe (p<0.001), lateral midfoot (p<0.001) and central heel (p<0.001) areas. Clipless pedals produce higher pressures which are more spread across the foot than toe-clipped pedals. This may have implications for their use in the prevention and/or management of overuse injuries in the knee and foot. PMID:23738240

  14. Quantifying Dynamic Changes in Plantar Pressure Gradient in Diabetics with Peripheral Neuropathy

    PubMed Central

    Lung, Chi-Wen; Hsiao-Wecksler, Elizabeth T.; Burns, Stephanie; Lin, Fang; Jan, Yih-Kuen

    2016-01-01

    Diabetic foot ulcers remain one of the most serious complications of diabetes. Peak plantar pressure (PPP) and peak pressure gradient (PPG) during walking have been shown to be associated with the development of diabetic foot ulcers. To gain further insight into the mechanical etiology of diabetic foot ulcers, examination of the pressure gradient angle (PGA) has been recently proposed. The PGA quantifies directional variation or orientation of the pressure gradient during walking and provides a measure of whether pressure gradient patterns are concentrated or dispersed along the plantar surface. We hypothesized that diabetics at risk of foot ulceration would have smaller PGA in key plantar regions, suggesting less movement of the pressure gradient over time. A total of 27 participants were studied, including 19 diabetics with peripheral neuropathy and 8 non-diabetic control subjects. A foot pressure measurement system was used to measure plantar pressures during walking. PPP, PPG, and PGA were calculated for four foot regions – first toe (T1), first metatarsal head (M1), second metatarsal head (M2), and heel (HL). Consistent with prior studies, PPP and PPG were significantly larger in the diabetic group compared with non-diabetic controls in the T1 and M1 regions, but not M2 or HL. For example, PPP was 165% (P = 0.02) and PPG was 214% (P < 0.001) larger in T1. PGA was found to be significantly smaller in the diabetic group in T1 (46%, P = 0.04), suggesting a more concentrated pressure gradient pattern under the toe. The proposed PGA may improve our understanding of the role of pressure gradient on the risk of diabetic foot ulcers. PMID:27486576

  15. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.

    PubMed

    Rathleff, M S; Mølgaard, C M; Fredberg, U; Kaalund, S; Andersen, K B; Jensen, T T; Aaskov, S; Olesen, J L

    2015-06-01

    The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.

  16. Extracorporeal shockwave therapy for plantar fasciitis and other musculoskeletal conditions utilizing the Ossatron--an update.

    PubMed

    Wilner, Joel M; Strash, Walter W

    2004-07-01

    Extracorporeal shockwave therapy for treatment of plantar fasciitis and other areas of the body has been well documented since the early 1990s. A high level of efficacy and patient satisfaction after undergoing electrohydraulic shock wave treatments has been reported not only for plantar fasciopathy but other musculoskeletal indications. Electrohydraulic devices have a bimodal response: early suppression of nocioceptor reactivity followed by subsequent target tissue remodeling and healing through neovascularization and recruitment of new tissue target specific cells. Both responses are not present with low energy electromagnetic devices. The focus of this article is treatment of chronic proximal plantar fasciitis; however, other pathologies of the lower extremity demonstrate great promise for this emerging technology.

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

    PubMed

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

    2013-09-01

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

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

    PubMed

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

    2013-09-01

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

  19. Waste Tank Heel Chemical Cleaning Summary

    SciTech Connect

    Barnes, M.J.

    2003-12-02

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

  20. Influence of patellofemoral pain syndrome on plantar pressure in the foot rollover process during gait

    PubMed Central

    Aliberti, Sandra; de S.X. Costa, Mariana; de Campos Passaro, Anice; Arnone, Antônio Carlos; Hirata, Rogério; Sacco, Isabel C N

    2011-01-01

    BACKGROUND: Patellofemoral Pain Syndrome is one of the most common knee disorders among physically active young women. Despite its high incidence, the multifactorial etiology of this disorder is not fully understood. OBJECTIVES: To investigate the influence of Patellofemoral Pain Syndrome on plantar pressure distribution during the foot rollover process (i.e., the initial heel contact, midstance and propulsion phases) of the gait. MATERIALS AND METHODS: Fifty-seven young adults, including 22 subjects with Patellofemoral Pain Syndrome (30 ± 7 years, 165 ± 9 cm, 63 ± 12 kg) and 35 control subjects (29 ± 7 years, 164 ± 8 cm, 60 ± 11 kg), volunteered for the study. The contact area and peak pressure were evaluated using the Pedar-X system (Novel, Germany) synchronized with ankle sagittal kinematics. RESULTS: Subjects with Patellofemoral Pain Syndrome showed a larger contact area over the medial (p = 0.004) and central (p = 0.002) rearfoot at the initial contact phase and a lower peak pressure over the medial forefoot (p = 0.033) during propulsion when compared with control subjects. CONCLUSIONS: Patellofemoral Pain Syndrome is related to a foot rollover pattern that is medially directed at the rearfoot during initial heel contact and laterally directed at the forefoot during propulsion. These detected alterations in the foot rollover process during gait may be used to develop clinical interventions using insoles, taping and therapeutic exercise to rehabilitate this dysfunction. PMID:21552657

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

    PubMed

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

    2009-07-01

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

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

    PubMed Central

    Son, Hohee

    2013-01-01

    [Purpose] The purpose of this study was to investigate the changes in muscle activation of the trunk and lower extremities and plantar foot pressure due to backpack loads of 0, 10, 15, and 20% of body weight during level walking in individuals with flatfoot. [Methods] Fourteen young flatfoot subjects and 12 normal foot subjects participated in this study. In each session, the subjects were assigned to carry a backpack load, and there were four level walking modes: (1) unloaded walking (0%), (2) 10% body weight (BW) load, (3) 15% BW load, and (4) 20% BW load. Trunk and lower extremity muscle activities were recorded by surface EMG, and contact area and plantar foot pressure were determined using a RS scan system. [Results] The erector spinae, vastus medialis, tibialis anterior and gastrocnemius muscle activities, but not the rectus femoris and rectus abdominis muscle activities of flatfoot subjects significantly and progressively increased as load increased in flatfoot subjects. Contact area and pressure of the lateral and medial heel zones were significantly increased too. [Conclusion] Based on this data, the weight of a backpack could influence muscle activation and plantar foot pressure in flatfoot. PMID:24396193

  3. Using an alternating pressure mattress to offload heels in ICU.

    PubMed

    Masterson, Sarah; Younger, Caroline

    2014-08-12

    The heel continues to be one of the most common sites of pressure damage. This article reviews the anatomy and physiology of the heel and explores significant risk factors, including those found in the critically ill patient. Interventions to prevent heel pressure ulceration by offloading the heel are explored. An evaluation of the Nimbus 4 alternating pressure mattress was undertaken within an intensive care unit (ICU) to consider the efficacy of its unique Wound Valve Technology, which is designed to help prevent heel pressure ulceration. During the evaluation period none of the patients using the Nimbus 4 developed a pressure ulcer. Staff observed that the Wound Valves provided effective pressure redistribution and, although the cells frequently needed to be adjusted, patient safety was maintained throughout. The Wound Valves were most effective on patients who were less prone to voluntary movement.

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

    SciTech Connect

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

    1987-03-01

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

  5. ULTRASONOGRAPHY, AN EFFECTIVE TOOL IN DIAGNOSING PLANTAR FASCIITIS: A SYSTEMATIC REVIEW OF DIAGNOSTIC TRIALS

    PubMed Central

    Wyland, Matthew; Applequist, Lee; Bolowsky, Erin; Klingensmith, Heather; Virag, Isaac

    2016-01-01

    Background Plantar fasciitis (PF) is the most common cause of heel pain that affects 10% of the general population, whether living an athletic or sedentary lifestyle. The most frequent mechanism of injury is an inflammatory response that is caused by repetitive micro trauma. Many techniques are available to diagnose PF, including the use of ultrasonography (US). Purpose The purpose of this study is to systematically review and appraise previously published articles published between the years 2000 and 2015 that evaluated the effectiveness of using US in the process of diagnosing PF, as compared to alternative diagnostic methods. Methods A total of eight databases were searched to systematically review scholarly (peer reviewed) diagnostic and intervention articles pertaining to the ability of US to diagnose PF. Results Using specific key words the preliminary search yielded 264 articles, 10 of which were deemed relevant for inclusion in the study. Two raters independently scored each article using the 15 point modified QUADAS scale. Discussion Six studies compared the diagnostic efficacy of US to another diagnostic technique to diagnose PF, and four studies focused on comparing baseline assessment of plantar fascia before subsequent intervention. The most notable US outcomes measured were plantar fascia thickness, enthesopathy, and hypoechogenicity. Conclusion US was found to be accurate and reliable compared to alternative reference standards like MRI in the diagnosis of PF. The general advantages of US (e.g. cost efficient, ease of administration, non-invasive, limited contraindications) make it a superior diagnostic modality in the diagnosis of PF. US should be considered in rehabilitation clinics to effectively diagnose PF and to accurately monitor improvement in the disease process following rehabilitation interventions. Level of Evidence 1A PMID:27757279

  6. Plantar decubitus ulcers in rats and rabbits.

    PubMed

    Honma, M; Kast, A

    1989-07-01

    A high incidence of plantar decubitus ulcers, 35% in males and 22 or 45% in females, respectively, occurred in rats of two carcinogenicity studies independent of the bedding used, hard or soft wood chips. Among rabbits kept in chrome-plated wire cages, about 2-year-old female breeders suffered from the plantar ulcers, but not their male partners of the same age group. The causes of the foot disease appear to be manifold, however, in our cases the lesions could be prevented in both species by housing on a cage floor made from flattened stainless wire.

  7. Could Insoles Offload Pressure? An Evaluation of the Effects of Arch-supported Functional Insoles on Plantar Pressure Distribution during Race Walking.

    PubMed

    Song, Qipeng; Xu, Kaisheng; Yu, Bing; Zhang, Cui; Sun, Wei; Mao, Dewei

    2015-01-01

    This study investigated the effectiveness of functional insoles on plantar pressure distribution during race walking so as to reduce the high plantar pressure and force on race walkers, who tend to suffer from overuse injury. A total of 20 male race walkers aged 21.19 ± 3.66 years and with a mean height of 178.85 ± 14.07 cm were recruited as participants. Each participant completed a race walking with functional or normal insoles. Plantar pressure insoles were used to collect vertical plantar pressure data. A two-way analysis of variance with a mixed design was used to determine the difference between the two conditions. Results showed that the use of functional insoles reduces the peak pressure and the impulse in the metatarsophalangeal joints and heels and thus suggest that functional insoles reduce the overuse injury risks of these parts. The first ground reaction force peak also decreased. This result suggested that functional insoles reduce the risks of foot and leg injuries.

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

    PubMed

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

    2013-01-01

    In contrast to western countries, foot complaints are rare in Africa. This is remarkable, as many African adults walk many hours each day, often barefoot or with worn-out shoes. The reason why Africans can withstand such loading without developing foot complaints might be related to the way the foot is loaded. Therefore, static foot geometry and dynamic plantar pressure distribution of 77 adults from Malawi were compared to 77 adults from the Netherlands. None of the subjects had a history of foot complaints. The plantar pressure pattern as well as the Arch Index (AI) and the trajectory of the center of pressure during the stance phase were calculated and compared between both groups. Standardized pictures were taken from the feet to assess the height of the Medial Longitudinal Arch (MLA). We found that Malawian adults: (1) loaded the midfoot for a longer and the forefoot for a shorter period during roll off, (2) had significantly lower plantar pressures under the heel and a part of the forefoot, and (3) had a larger AI and a lower MLA compared to the Dutch. These findings demonstrate that differences in static foot geometry, foot loading, and roll off technique exist between the two groups. The advantage of the foot loading pattern as shown by the Malawian group is that the plantar pressure is distributed more equally over the foot. This might prevent foot complaints.

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

    PubMed Central

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

    2013-01-01

    In contrast to western countries, foot complaints are rare in Africa. This is remarkable, as many African adults walk many hours each day, often barefoot or with worn-out shoes. The reason why Africans can withstand such loading without developing foot complaints might be related to the way the foot is loaded. Therefore, static foot geometry and dynamic plantar pressure distribution of 77 adults from Malawi were compared to 77 adults from the Netherlands. None of the subjects had a history of foot complaints. The plantar pressure pattern as well as the Arch Index (AI) and the trajectory of the center of pressure during the stance phase were calculated and compared between both groups. Standardized pictures were taken from the feet to assess the height of the Medial Longitudinal Arch (MLA). We found that Malawian adults: (1) loaded the midfoot for a longer and the forefoot for a shorter period during roll off, (2) had significantly lower plantar pressures under the heel and a part of the forefoot, and (3) had a larger AI and a lower MLA compared to the Dutch. These findings demonstrate that differences in static foot geometry, foot loading, and roll off technique exist between the two groups. The advantage of the foot loading pattern as shown by the Malawian group is that the plantar pressure is distributed more equally over the foot. This might prevent foot complaints. PMID:23468936

  10. The effects of orthotic intervention on multisegment foot kinematics and plantar fascia strain in recreational runners.

    PubMed

    Sinclair, Jonathan; Isherwood, Josh; Taylor, Paul J

    2015-02-01

    Chronic injuries are a common complaint in recreational runners. Foot orthoses have been shown to be effective for the treatment of running injuries but their mechanical effects are still not well understood. This study aims to examine the influence of orthotic intervention on multisegment foot kinematics and plantar fascia strain during running. Fifteen male participants ran at 4.0 m · s(-1) with and without orthotics. Multisegment foot kinematics and plantar fascia strain were obtained during the stance phase and contrasted using paired t tests. Relative coronal plane range of motion of the midfoot relative to the rearfoot was significantly reduced with orthotics (1.0°) compared to without (2.2°). Similarly, relative transverse plane range of motion was significantly lower with orthotics (1.1°) compared to without (1.8°). Plantar fascia strain did not differ significantly between orthotic (7.1) and nonorthotic (7.1) conditions. This study shows that although orthotics did not serve to reduce plantar fascia strain, they are able to mediate reductions in coronal and transverse plane rotations of the midfoot.

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

    PubMed Central

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

    2014-01-01

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

  12. Plantar fascia coronal length: a new parameter for plantar fascia assessment.

    PubMed

    Sari, Ahmet Sinan; Demircay, Emre; Cakmak, Gokhan; Sahin, M Sukru; Tuncay, I Cengiz; Altun, Suleyman

    2015-01-01

    The effects of gender and various anthropometric variables were previously reported as significant predictors of plantar fascia thickness. Although a strong correlation between either the body weight or body mass index (BMI) and plantar fascia thickness were not demonstrated, a moderate relation was stated. We retrospectively investigated the role of gender, height, weight, and body mass index on plantar fascia thickness at the calcaneal origin (PFCO) and 1 cm distal from the calcaneal origin (PF1cm) and the coronal length of the plantar fascia at the calcaneal origin (CLPF) in healthy subjects. The PFCO, PF1cm, and CLPF were retrospectively measured from magnetic resonance images of 100 healthy subjects. The gender, height, weight, and body mass index of the participants were also noted. Gender was a predictive factor for the length of the CLPF. The subjects with a BMI >25 kg/m(2) had a significantly greater PFCO, PF1cm, and CLPF. Height was mildly and BMI and weight were moderately related to the PFCO. However the CLPF showed a better correlation with height, BMI, and weight than that of plantar fascia thickness. CLPF better reflected the role of weight, BMI, and height than its thickness. It is a new parameter that could be valuable in the evaluation of plantar fascia disorders.

  13. PLANTAR THROMBOPHLEBITIS: MAGNETIC RESONANCE IMAGING FINDINGS

    PubMed Central

    Miranda, Frederico Celestino; Carneiro, Renato Duarte; Longo, Carlos Henrique; Fernandes, Túlio Diniz; Rosemberg, Laércio Alberto; de Gusmão Funari, Marcelo Buarque

    2015-01-01

    Objective: Demonstrate the magnetic resonance imaging (MRI) findings in plantar thrombophlebitis. Methods: Retrospective review of twenty patients with pain in the plantar region of the foot, in which the MRI findings indicated plantar thrombophlebitis. Results: A total of fourteen men and six women, mean age 46.7 years were evaluated. Eight of these patients also underwent Doppler ultrasonography, which confirmed the thrombophlebitis. The magnetic resonance images were evaluated in consensus by two radiologists with experience in musculoskeletal radiology (more than 10 years each), showing perivascular edema in all twenty patients (100%) and muscle edema in nineteen of the twenty patients (95%). All twenty patients had intraluminal intermediate signal intensity on T2-weighted (100%) and venous ectasia was present in seventeen of the twenty cases (85%). Collateral veins were visualized in one of the twenty patients (5%). All fourteen cases (100%), in which intravenous contrast was administered, showed perivenular tissues enhancement and intraluminal filling defect. Venous ectasia, loss of compressibility and no flow on Doppler ultrasound were also observed in all eight cases examined by the method. Conclusion: MRI is a sensitive in the evaluation of plant thrombophlebitis in patients with plantar foot pain. PMID:27047898

  14. Reliability and limitations of the durometer and PressureStat to measure plantar foot characteristics in Native Americans with diabetes.

    PubMed

    Cuaderes, Elena; Khan, Myrna M; Azzarello, Joseph; Lamb, W Lyndon

    2009-01-01

    Neuropathy with excessive weight-bearing activity may lead to foot changes that place it at risk for ulceration. Information about instruments to measure plantar skin hardness and pressures of the foot in adult Native Americans with diabetes is presented. Skin hardness was measured at 10 sites (plantar side of the hallux, third and fifth toes, first, third, and fifth metatarsal heads, medial and lateral midfoot, heel, and the dorsal aspect between the hallux and second toe) with a durometer. The PressureStat yielded data about barefoot, static pressures. The durometer was shown to be reliable (r = .62 to .91) at all sites of the foot except at the third and fifth toe, the medial midsection of both feet, and at the third metatarsal head and between the hallux and second toe, the dorsal aspect of the left foot. With four raters, concordance was found to be acceptable at the hallux, the third toe, the first, third, and fifth metatarsal heads and the heel (W = .61 to .86) for the PressureStat. Since most diabetic foot ulcers occur at the hallux, first, third, and fifth metatarsal heads, both the PressureStat and durometer may be reliable screening tools to determine the degree of risk. PMID:19902656

  15. Time to Onset of Pain: Effects of Magnitude and Location for Static Pressures Applied to the Plantar Foot

    PubMed Central

    Wiggermann, Neal; Keyserling, W. Monroe

    2016-01-01

    Mechanisms that cause foot discomfort during prolonged standing are poorly understood. There is currently no method for evaluating discomfort associated with low levels of static pressure that are typical during standing. Pain thresholds were measured for 20 healthy participants by applying five levels of static pressure at different plantar foot locations. A survival analysis was performed to determine the effects of pressure magnitude and foot location on the time until pain onset. Time to pain onset was significantly affected by pressure magnitude (P<0.001); time decreased as pressure increased. Foot location was also significant (P<0.001); greatest times to pain onset (least sensitive) were observed under the heel and fifth metatarsal head, shortest times (most sensitive) were found under the midfoot. This research presents a novel methodology for evaluating static pressure that may be applicable to product design. PMID:25118168

  16. The effect of the gastrocnemius on the plantar fascia.

    PubMed

    Pascual Huerta, Javier

    2014-12-01

    Although anatomic and functional relationship has been established between the gastrocnemius muscle, via the Achilles tendon, and the plantar fascia, the exact role of gastrocnemius tightness in foot and plantar fascia problems is not completely understood. This article summarizes past and current literature linking these 2 structures and gives a mechanical explanation based on functional models of the relationship between gastrocnemius tightness and plantar fascia. The effect of gastrocnemius tightness on the sagittal behavior of the foot is also discussed.

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

    PubMed

    Fabrikant, Jerry M; Park, Tae Soon

    2011-06-01

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

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

    PubMed

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

    2014-12-18

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

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

    NASA Astrophysics Data System (ADS)

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

    2006-03-01

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

  20. [Research on Adaptive Balance Reaction for Gait Slippery Instability Events on Level Walk Based on Plantar Pressure and Gait Parameter Analysis].

    PubMed

    Li, Yang; Zhang, Junxia; Si, Ying

    2015-12-01

    Nowadays, for gait instability phenomenon, many researches have been carried out at home and abroad. However, the relationship between plantar pressure and gait parameters in the process of balance adjustment is still unclear. This study describes the human body adaptive balance reaction during slip events on slippery level walk by plantar pressure and gait analysis. Ten healthy male subjects walked on a level path wearing shoes with two contrastive contaminants (dry, oil). The study collected and analyzed the change rule of spatiotemporal parameters, plantar pressure parameters, vertical ground reaction force (VGRF), etc. The results showed that the human body adaptive balance reaction during slip events on slippery level walk mainly included lighter touch at the heel strikes, tighter grip at the toe offs, a lower velocity, a shorter stride length and longer support time. These changes are used to maintain or recover body balance. These results would be able to explore new ideas and provide reference value for slip injury prevention, walking rehabilitation training design, research and development of walking assistive equipments, etc. PMID:27079090

  1. The in vivo plantar soft tissue mechanical property under the metatarsal head: implications of tissues׳ joint-angle dependent response in foot finite element modeling.

    PubMed

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

    2014-12-01

    Material properties of the plantar soft tissue have not been well quantified in vivo (i.e., from life subjects) nor for areas other than the heel pad. This study explored an in vivo investigation of the plantar soft tissue material behavior under the metatarsal head (MTH). We used a novel device collecting indentation data at controlled metatarsophalangeal joint angles. Combined with inverse analysis, tissues׳ joint-angle dependent material properties were identified. The results showed that the soft tissue under MTH exhibited joint-angle dependent material responses, and the computed parameters using the Ogden material model were 51.3% and 30.9% larger in the dorsiflexed than in the neutral positions, respectively. Using derived parameters in subject-specific foot finite element models revealed only those models that used tissues׳ joint-dependent responses could reproduce the known plantar pressure pattern under the MTH. It is suggested that, to further improve specificity of the personalized foot finite element models, quantitative mechanical properties of the tissue inclusive of the effects of metatarsophalangeal joint dorsiflexion are needed.

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

    PubMed

    Han, Dongwook

    2015-01-01

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

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

    PubMed Central

    Han, Dongwook

    2015-01-01

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

  4. The role of hamstring tightness in plantar fasciitis.

    PubMed

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

    2011-06-01

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

  5. Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study

    PubMed Central

    Ribeiro, Ana Paula; João, Silvia Maria Amado; Dinato, Roberto Casanova; Tessutti, Vitor Daniel; Sacco, Isabel Camargo Neves

    2015-01-01

    Aim/Hypothesis The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage. Objective Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners. Methods Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20–80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (p<0.05). Results Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic) compared with controls (p<0.01). Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01). Conclusion Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area. PMID:26375815

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

    PubMed Central

    2014-01-01

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

  7. Plantar pressure cartography reconstruction from 3 sensors.

    PubMed

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

    2014-01-01

    Foot problem diagnosis is often made by using pressure mapping systems, unfortunately located and used in the laboratories. In the context of e-health and telemedicine for home monitoring of patients having foot problems, our focus is to present an acceptable system for daily use. We developed an ambulatory instrumented insole using 3 pressures sensors to visualize plantar pressure cartographies. We show that a standard insole with fixed sensor position could be used for different foot sizes. The results show an average error measured at each pixel of 0.01 daN, with a standard deviation of 0.005 daN.

  8. Iontophoresis for palmar and plantar hyperhidrosis.

    PubMed

    Pariser, David M; Ballard, Angela

    2014-10-01

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

  9. Iontophoresis for palmar and plantar hyperhidrosis.

    PubMed

    Pariser, David M; Ballard, Angela

    2014-10-01

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

  10. Temperature as a predictive tool for plantar triaxial loading.

    PubMed

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

    2014-11-28

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

  11. Unilobed Rotational Flap for Plantar Hallux Interphalangeal Joint Ulceration Complicated by Osteomyelitis.

    PubMed

    Boffeli, Troy J; Hyllengren, Shelby B

    2015-01-01

    Diabetes-related neuropathic ulcers located at the plantar aspect of the hallux interphalangeal joint are often chronic or recurrent and frequently become complicated by osteomyelitis. Once infected, treatment will typically involve hallux amputation. Although intended as a definitive procedure, amputation of the first toe is not desirable from a cosmetic or functional standpoint and often leads to transfer ulcers at adjacent locations of the foot. Reconstructive wound surgery, combined with limited bone resection, is possible if the infection is caught early before the local tissue and bone have become necrotic. In addition to neuropathy, biomechanical issues, including ankle equinus, hallux limitus, hallux extensus, and hallux valgus, predispose patients with diabetes mellitus to developing plantar hallux ulcers. We commonly employ a proximal based unilobed plantar rotational flap combined with hallux interphalangeal joint arthroplasty as an alternative to hallux amputation. We present a typical case with long-term follow-up to highlight our flap protocol, including patient selection criteria, flap design, surgical technique, bone resection and biopsy pearls, staging timeline, and a typical postoperative course. Periodic follow-up during the next 72 months for unrelated conditions allowed long-term monitoring with no recurrence of osteomyelitis or subsequent amputation. The foot remained ulcer free 6 years later. The benefits of this surgical approach include complete excision of the ulcer, adequate exposure for bone resection, early bone biopsy before the spread of infection or necrosis of local tissue, flap coverage with viable soft tissue, and partial offloading of mechanical pressure at the plantar interphalangeal joint.

  12. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon

    PubMed Central

    Stecco, Carla; Corradin, Marco; Macchi, Veronica; Morra, Aldo; Porzionato, Andrea; Biz, Carlo; De Caro, Raffaele

    2013-01-01

    Although the plantar fascia (PF) has been studied quite well from a biomechanical viewpoint, its microscopic properties have been overlooked: nothing is known about its content of elastic fibers, the features of the extracellular matrix or the extent of innervation. From a functional and clinical standpoint, the PF is often correlated with the triceps surae muscle, but the anatomical grounds for this link are not clear. The aim of this work was to focus on the PF macroscopic and microscopic properties and study how Achilles tendon diseases might affect it. Twelve feet from unembalmed human cadavers were dissected to isolate the PF. Specimens from each PF were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle or foot pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and/or inflammation of the Achilles tendon. The thickness of PF and paratenon was assessed in the two groups and statistical analyses were conducted. The PF is a tissue firmly joined to plantar muscles and skin. Analyzing its possible connections to the sural structures showed that this fascia is more closely connected to the paratenon of Achilles tendon than to the Achilles tendon, through the periosteum of the heel. The PF extended medially and laterally, continuing into the deep fasciae enveloping the abductor hallucis and abductor digiti minimi muscles, respectively. The PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as ‘fasciacytes’. Nerve endings and Pacini and Ruffini corpuscles were present, particularly in the medial and lateral portions, and on the surface of the muscles, suggesting a role for the PF in the proprioception of foot. In the radiological study, 27 of the 52 MRI showed signs of Achilles tendon inflammation and/or degeneration, and the PF was 3.43 ± 0.48 mm

  13. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section... Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given normal operating condition or severe storm condition is the sum of the individual wind...

  14. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section... Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given normal operating condition or severe storm condition is the sum of the individual wind...

  15. A history of medical scientists on high heels.

    PubMed

    Linder, M; Saltzman, C L

    1998-01-01

    For 250 years medical scientists have propagandized about the health hazards of high-heeled shoes, which originated four centuries ago. Physicians, however, largely unaware of their own profession's tradition, keep reinventing the diagnostic wheel. This professional amnesia has held back the momentum of the process of educating the public. Consequently, despite these warnings, millions of women continue to wear high-heeled shoes. This article describes the history of the medical profession's recognition of this worldwide health problem and the current understanding of the deleterious and often irreversible biomechanical effects of high-heeled shoewear. The article emphasizes that the reemergence of high heels and of medical interest in them in the third quarter of the 19th century, following their disappearance in the wake of the French Revolution, was associated with increasing pressure by employers to wear such shoes for long hours at work. Although medical scientists have recognized this specifically occupational phenomenon for more than a century, full-scale epidemiological studies may be necessary to bring about substantial social-behavioral change.

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

    PubMed Central

    2010-01-01

    Background If conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporarily pain reduction, but no healing. Blood platelets initiate the natural healing rate. GPS® gives an eightfold concentrate platelets of patients own blood. Injection of these platelets in the attachment of the fascia to the os calcis might induce a healing rate. Methods and design A randomized controlled multi centre trial will be performed. The study population consists of 120 patients of 18 years and older. Patients with chronic plantar fasciitis will be allocated randomly to have a steroid injection or an autologous platelet concentrate injections. Data will be collected before the procedure, 4,8,12,26 weeks and 1 year after the procedure. The main outcome measures of this study are pain and function measured with questionnaires. Conclusion Recent literature show positive effects for the treatment of tendinosis with autologous platelet injections. The forthcoming trial will compare treatment for chronic plantar fasciitis with a steroid injection versus an autologous platelet injection. Our results will be published as soon as they become available. Trial Registration Trial registration number: http://www.clinicaltrials.gov NCT00758641. PMID:20398269

  17. High-Intensity Running and Plantar-Flexor Fatigability and Plantar-Pressure Distribution in Adolescent Runners

    PubMed Central

    Fourchet, François; Kelly, Luke; Horobeanu, Cosmin; Loepelt, Heiko; Taiar, Redha; Millet, Grégoire

    2015-01-01

    Context: Fatigue-induced alterations in foot mechanics may lead to structural overload and injury. Objectives: To investigate how a high-intensity running exercise to exhaustion modifies ankle plantar-flexor and dorsiflexor strength and fatigability, as well as plantar-pressure distribution in adolescent runners. Design: Controlled laboratory study. Setting: Academy research laboratory. Patients or Other Participants: Eleven male adolescent distance runners (age = 16.9 ± 2.0 years, height = 170.6 ± 10.9 cm, mass = 54.6 ± 8.6 kg) were tested. Intervention(s): All participants performed an exhausting run on a treadmill. An isokinetic plantar-flexor and dorsiflexor maximal-strength test and a fatigue test were performed before and after the exhausting run. Plantar-pressure distribution was assessed at the beginning and end of the exhausting run. Main Outcome Measure(s): We recorded plantar-flexor and dorsiflexor peak torques and calculated the fatigue index. Plantar-pressure measurements were recorded 1 minute after the start of the run and before exhaustion. Plantar variables (ie, mean area, contact time, mean pressure, relative load) were determined for 9 selected regions. Results: Isokinetic peak torques were similar before and after the run in both muscle groups, whereas the fatigue index increased in plantar flexion (28.1%; P = .01) but not in dorsiflexion. For the whole foot, mean pressure decreased from 1 minute to the end (−3.4%; P = .003); however, mean area (9.5%; P = .005) and relative load (7.2%; P = .009) increased under the medial midfoot, and contact time increased under the central forefoot (8.3%; P = .01) and the lesser toes (8.9%; P = .008). Conclusions: Fatigue resistance in the plantar flexors declined after a high-intensity running bout performed by adolescent male distance runners. This phenomenon was associated with increased loading under the medial arch in the fatigued state but without any excessive pronation. PMID:25531143

  18. Tissue augmentation and replacement of a heel fat pad with a decellularized sterile human dermal matrix.

    PubMed

    Mulder, Gerit

    2012-07-01

    The use of xenografts and allografts has been primarily direct- ed at chronic wounds and tendon repair. Currently, there are no known devices in this category that can successfully be used to augment tis- sue. Patients who have undergone trauma and subsequent surgery, par- ticularly in weight-bearing areas, may experience pain with pressure or ambulation at the site. This report illustrates the use of an allograft for tissue augmentation in a young individual who was involved in a motor vehicle accident resulting in loss of the plantar fat pad. An allograft was successfully used for tissue replacement, thereby reducing pain and facilitating weight-bearing ambulation. . PMID:25874540

  19. Foot Modeling and Smart Plantar Pressure Reconstruction from Three Sensors

    PubMed Central

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

    2014-01-01

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

  20. Heel and toe driving on fuel cell vehicle

    DOEpatents

    Choi, Tayoung; Chen, Dongmei

    2012-12-11

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

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

    PubMed Central

    Valero, José; Salcini, José L.; Gordillo, Luis; Gallart, José; González, David; Deus, Javier; Lahoz, Manuel

    2015-01-01

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

  2. [Experimental research of gaits based on young plantar pressure test].

    PubMed

    Meng, Qingyun; Tan, Shili; Yu, Hongliu; Shen, Lixing; Zhuang, Jianhai; Wang, Jinwu

    2014-10-01

    The present paper is to study the center line of the plantar pressure of normal young people, and to find the relation between center line of the plantar pressure and gait stability and balance. The paper gives the testing principle and calculating methods for geometric center of plantar pressure distribution and the center of pressure due to the techniques of footprint frame. The calculating formulas in both x direction and y direction are also deduced in the paper. In the experiments carried out in our laboratory, the gait parameters of 131 young subjects walking as usual speed were acquired, and 14 young subjects of the total were specially analyzed. We then provided reference data for the walking gait database of young people, including time parameters, space parameters and plantar pressure parameters. We also obtained the line of geometry center and pressure center under the foot. We found that the differences existed in normal people's geometric center line and the pressure center line. The center of pressure trajectory revealed foot movement stability. The length and lateral changes of the center line of the plantar pressure could be applied to analysis of the plantar pressure of all kinds of people. The results in this paper are useful in clinical foot disease diagnosis and evaluation of surgical effect.

  3. The effects of the application of low-dye taping on paretic side plantar pressure among patients with plantar fasciitis.

    PubMed

    Park, Chan; Lee, Sangyong; Kim, Shingyun; Hwangbo, Gak

    2015-11-01

    [Purpose] This study aimed to examine the effects of low-dye taping on paretic side plantar pressure in patients with plantar fasciitis. [Subjects] The 30 patients in this study were randomly allocated to a low-dye taping group (n = 15) or a conservative treatment group (n =15). [Methods] Both groups received treatment thrice a week for six weeks. BioRescue was used to measure the weight distribution of the patients' paretic side. [Results] Within-group comparison showed that the posterior weight distribution significantly increased among patients in both groups. However, comparison between the two groups showed that the low-dye taping group's posterior weight distribution was significantly higher than that of the conservative treatment group. [Conclusion] These findings show that the application of low-dye taping is an effective intervention for paretic-side plantar pressure among patients with plantar fasciitis.

  4. The effects of the application of low-dye taping on paretic side plantar pressure among patients with plantar fasciitis

    PubMed Central

    Park, Chan; Lee, Sangyong; Kim, Shingyun; Hwangbo, Gak

    2015-01-01

    [Purpose] This study aimed to examine the effects of low-dye taping on paretic side plantar pressure in patients with plantar fasciitis. [Subjects] The 30 patients in this study were randomly allocated to a low-dye taping group (n = 15) or a conservative treatment group (n =15). [Methods] Both groups received treatment thrice a week for six weeks. BioRescue was used to measure the weight distribution of the patients’ paretic side. [Results] Within-group comparison showed that the posterior weight distribution significantly increased among patients in both groups. However, comparison between the two groups showed that the low-dye taping group’s posterior weight distribution was significantly higher than that of the conservative treatment group. [Conclusion] These findings show that the application of low-dye taping is an effective intervention for paretic-side plantar pressure among patients with plantar fasciitis. PMID:26696737

  5. The effects of the application of low-dye taping on paretic side plantar pressure among patients with plantar fasciitis.

    PubMed

    Park, Chan; Lee, Sangyong; Kim, Shingyun; Hwangbo, Gak

    2015-11-01

    [Purpose] This study aimed to examine the effects of low-dye taping on paretic side plantar pressure in patients with plantar fasciitis. [Subjects] The 30 patients in this study were randomly allocated to a low-dye taping group (n = 15) or a conservative treatment group (n =15). [Methods] Both groups received treatment thrice a week for six weeks. BioRescue was used to measure the weight distribution of the patients' paretic side. [Results] Within-group comparison showed that the posterior weight distribution significantly increased among patients in both groups. However, comparison between the two groups showed that the low-dye taping group's posterior weight distribution was significantly higher than that of the conservative treatment group. [Conclusion] These findings show that the application of low-dye taping is an effective intervention for paretic-side plantar pressure among patients with plantar fasciitis. PMID:26696737

  6. Heel-region properties of prosthetic feet and shoes.

    PubMed

    Klute, Glenn K; Berge, Jocelyn S; Segal, Ava D

    2004-07-01

    The properties of the prosthetic components prescribed to amputees have the potential to ameliorate or exacerbate their comfort, mobility, and health. To measure the difference in heel-region structural properties of currently available prosthetic feet and shoes, we simulated the period of initial heel-ground contact with a pendulum apparatus. The energy dissipation capacity of the various prosthetic feet ranged from 33.6% to 52.6% of the input energy. Donning a shoe had a large effect. Energy dissipation of a Seattle Lightfoot 2 prosthetic foot was 45.3%, while addition of a walking, running, and orthopedic shoe increased energy dissipation to 63.0%, 73.0%, and 82.4%, respectively. The force versus deformation response to impact was modeled as a hardening spring in parallel with a position-dependent damping element. A nonlinear least-squares curve fit produced model coefficients useful for predicting the heel-region impact response of both prosthetic feet and shoes. PMID:15558382

  7. The mechanical properties of the heel pad in elderly adults.

    PubMed

    Kinoshita, H; Francis, P R; Murase, T; Kawai, S; Ogawa, T

    1996-01-01

    The shock absorbing characteristics of the heel pad in vivo were examined in two groups of active elderly individuals whose ages ranged between 60 and 67 years (n = 10) and between 71 and 86 years (n = 10). For comparative purposes, young adults (n = 10) aged between 17 and 30 years were also examined. A free-fall impact testing device which consisted of an instrumented shaft (mass 5 kg), accelerometer and position detection transducer was used to obtain deceleration and deformation of the heel during impact. The data were obtained from impact velocities of 0.57 m.s-1 (slow) and 0.94 m.s-1 (fast). Peak values of the deceleration and deformation, as well as the time to these peaks from onset of impact, and energy absorption were evaluated. At the slow impact velocity, no age effect was found for the parameters examined except for the energy absorption. At the fast impact velocity, there was higher peak deceleration and smaller deformation for the elderly than for the younger adults. The energy absorbed was less for the elderly than for the younger adults. It was concluded that the capacity for shock absorbency of the heel pad declines with age.

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

    PubMed Central

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

    2011-01-01

    Several studies have already reported that specific foot/ankle muscle reinforcement strategies induced strength and joint position sense performance enhancement. Nevertheless the effects of such protocols on sprint performance and plantar loading distribution have not been addressed yet. The objective of the study is to investigate the influence of a 5-wk foot/ankle strength training program on plantar loading characteristics during sprinting in adolescent males. Sixteen adolescent male athletes of a national training academy were randomly assigned to either a combined foot/ankle electromyostimulation and resistance training (FAST) or a control (C) group. FAST consisted of foot medial arch and extrinsic ankle muscles reinforcement exercises, whereas C maintained their usual training routine. Before and after training, in-shoe loading patterns were measured during 30-m running sprints using pressure sensitive insoles (right foot) and divided into nine regions for analysis. Although sprint times remained unchanged in both groups from pre- to post- training (3.90 ± 0.32 vs. 3.98 ± 0.46 s in FAST and 3.83 ± 0.42 vs. 3.81 ± 0.44 s in C), changes in force and pressure appeared from heel to forefoot between FAST and C. In FAST, mean pressure and force increased in the lateral heel area from pre- to post- training (67.1 ± 44.1 vs. 82.9 ± 28.6 kPa [p = 0.06]; 25.5 ± 17.8 vs. 34.1 ± 14.3 N [p = 0.05]) and did not change in the medial forefoot (151.0 ± 23.2 vs. 146.1 ± 30.0 kPa; 142.1 ± 29.4 vs. 136.0 ± 33.8; NS). Mean area increased in FAST under the lateral heel from pre- to post- (4.5 ± 1.3 vs. 5.7 ± 1.6 cm2 [p < 0.05]) and remained unchanged in C (5.5 ± 2.8 vs. 5.0 ± 3.0 cm2). FAST program induced significant promising lateral and unwanted posterior transfer of the plantar loads without affecting significantly sprinting performance. Key points We have evaluated the effects of a foot/ankle strength training program on sprint performance and on related

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

    PubMed

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

    2013-01-01

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

  10. Heart rate detection from plantar bioimpedance measurements.

    PubMed

    González Landaeta, R; Casas, O; Pallàs-Areny, R

    2006-01-01

    The heart rate is a basic health indicator, useful in both clinical measurements and home health care. Current home care systems often require the attachment of electrodes or other sensors to the body, which can be cumbersome to the patient. Moreover, some measurements are sensitive to movement artifacts, are not user-friendly and require a specialized supervision. In this paper, a novel technique for heart rate measurement for a standing subject is proposed, which is based on plantar bioimpedance measurements, such as those performed by some bathroom weighting scales for body composition analysis. Because of the low level of heart-related impedance variations, the measurement system has a gain of 1400. We have implemented a fully differential AC amplifier with a common-mode rejection ratio (CMRR) of 105 dB at 10 kHz. Coherent demodulation based on synchronous sampling yields a signal-to-noise ratio (SNR) of 55 dB. The system has a sensitivity of 1.9 V/Omega. The technique has been demonstrated on 18 volunteers, whose bioimpedance signal and ECG were simultaneously measured to validate the results. The average cross-correlation coefficient between the heart rates determined from these two signals was 0.998 (std. dev. 0.001). PMID:17946677

  11. Acral-lentiginous naevus of plantar skin.

    PubMed

    Clemente, C; Zurrida, S; Bartoli, C; Bono, A; Collini, P; Rilke, F

    1995-12-01

    In a consecutive series of 165 plantar naevi, a group of 36 benign naevi with sufficiently distinctive histopathological features to justify their classification as a special entity, here designated acral-lentiginous naevus, was identified. The main morphological features distinguishing the acral-lentiginous naevi from other acral non-lentiginous naevi are: elongation of rete ridges, continuous proliferation of melanocytes at the dermo-epidermal junction, presence of single scattered melanocytes, or less commonly small clusters, within the upper epidermis, poor or absent lateral circumscription, melanocytes with abundant pale cytoplasm and round to oval, sometimes hyperchromatic, nuclei and prominent nucleoli present at the dermo-epidermal junction. Some histological features of acral-lentiginous naevi are similar to those of dysplastic naevi: however, anastomosing rete ridges, cytological atypia and well-formed lamellar fibroplasia are absent. The histopathological criteria to distinguish these naevi from melanoma are: the lack of pagetoid lateral spread, the absence of mitotic activity in the deep dermal component and the evidence of dermal naevocytic differentiation. The identification of this benign acral naevus, that we have identified as the benign counterpart of acral lentiginous melanoma, is important in order to avoid misdiagnoses and consequent under- or over-treatment of doubtful pigmented lesions of acral skin.

  12. Anticancer Drug Induced Palmar Plantar Erythrodysesthesia

    PubMed Central

    Srinivasamurthy, Sureshkumar; Dubashi, Biswajit; Chandrasekaran, Adithan

    2014-01-01

    Background: Palmar plantar erythrodysesthesia (PPE) is a dose limiting toxicity of anticancer agents. In some cases it may mandate for discontinuation of anticancer agents. Evaluation of data of PPE among reported adverse drug reactions (ADRs) from the Department of Medical Oncology could quantify the burden. Aim: To evaluate and analyse the PPE among reported ADRs from medical Oncology. Materials and Methods: The data of all cases of reported PPE were collected during January 2012 to September 2013 and were analysed with WHO causality assessment scale. The severity was clinically graded. The follow-up data regarding outcome of ADRs were also noted. Results: During the study period of 21 months a total of 1418 ADRs have been reported from 1076 patients. Among them PPE was reported from 31 cases (2.9%). Majority (32.2%) of these patients were on chemotherapy for breast cancer. Patient’s age ranged from 17 to 68 y and the median age was 50 y. There were 18 female (58%) and 13 male patients (42%). Capecitabine was the leading drug involved in PPE, reported with 20 cases (64.5%), and followed by docetaxel with 5 cases (16.1%). Majority (67.7%) of the reactions was categorized as certain and 64.5% was grade II severity clinically. Conclusion: Our findings show that PPE accounts for 2.9% of total reported ADRs from Medical Oncology during 21 months. Majority of the reactions were classified as certain. Capecitabine is commonly implicated drug. PMID:25478366

  13. Variations in heel pad mechanical properties variation between children and young adults.

    PubMed

    Wang, C L; Hsu, T C; Shau, Y W; Wong, M K

    1998-12-01

    The purpose of this study was to compare the mechanical properties of the heel pads of adults and children, using ultrasound to assess the responses of the heel pad during compression. Thirty volunteers without heel problems, aged from 4 to 36 years, were recruited. There were 10 children (< 15 years old) and 20 adults (> 18 years old). A 7.5-MHz linear array ultrasound transducer was incorporated into a specially designed device to measure the thickness of the heel pad under different loads. The load on the heel pad was increased serially in increments of 0.5 kg, to a maximum of 3 kg, and then reduced sequentially. The load-displacement curve of the heel pad during a loading-unloading cycle was then plotted. Mechanical properties of the heel, including unloaded heel-pad thickness (UHPT), compressibility index, elastic modulus, and energy dissipation ratio (EDR), were calculated from the load-displacement curves. The average UHPT was 1.53 +/- 0.09 cm in children and 1.76 +/- 0.20 cm in adults (p < 0.001). The EDR, which represents the shock absorbency of the heel pad, was 13.5 +/- 2.0% in the children and 23.7 +/- 6.9% in adults (p < 0.001). The average compressibility index and elastic modulus were also higher in adults than in children, although the differences were not statistically significant. These findings suggest that the mechanical properties of the heel pad change from childhood to adulthood. Less energy is absorbed in the heel pad of children, which may partially explain why children tend to have fewer heel problems than adults.

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

    PubMed Central

    Sławińska, Urszula; Majczyński, Henryk; Dai, Yue; Jordan, Larry M

    2012-01-01

    Recent studies on the restoration of locomotion after spinal cord injury have employed robotic means of positioning rats above a treadmill such that the animals are held in an upright posture and engage in bipedal locomotor activity. However, the impact of the upright posture alone, which alters hindlimb loading, an important variable in locomotor control, has not been examined. Here we compared the locomotor capabilities of chronic spinal rats when placed in the horizontal and upright postures. Hindlimb locomotor movements induced by exteroceptive stimulation (tail pinching) were monitored with video and EMG recordings. We found that the upright posture alone significantly improved plantar stepping. Locomotor trials using anaesthesia of the paws and air stepping demonstrated that the cutaneous receptors of the paws are responsible for the improved plantar stepping observed when the animals are placed in the upright posture. We also tested the effectiveness of serotonergic drugs that facilitate locomotor activity in spinal rats in both the horizontal and upright postures. Quipazine and (±)-8-hydroxy-2-(dipropylamino)tetralin hydrobromide (8-OH-DPAT) improved locomotion in the horizontal posture but in the upright posture either interfered with or had no effect on plantar walking. Combined treatment with quipazine and 8-OH-DPAT at lower doses dramatically improved locomotor activity in both postures and mitigated the need to activate the locomotor CPG with exteroceptive stimulation. Our results suggest that afferent input from the paw facilitates the spinal CPG for locomotion. These potent effects of afferent input from the paw should be taken into account when interpreting the results obtained with rats in an upright posture and when designing interventions for restoration of locomotion after spinal cord injury. PMID:22351637

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

    PubMed

    Sławińska, Urszula; Majczyński, Henryk; Dai, Yue; Jordan, Larry M

    2012-04-01

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

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

    SciTech Connect

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

    1980-07-01

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

  17. Endoscopic Plantar Fasciotomy Improves Early Postoperative Results: A Retrospective Comparison of Outcomes After Endoscopic Versus Open Plantar Fasciotomy.

    PubMed

    Chou, Andrew Chia Chen; Ng, Sean Yung Chuan; Koo, Kevin Oon Thien

    2016-01-01

    Plantar fasciotomy is offered to patients with recalcitrant plantar fasciitis. Few studies have characterized the functional outcomes over time for the endoscopic approach compared with the open approach. We hypothesized that patients undergoing endoscopic surgery will have better postoperative functional outcomes early in the postoperative period but equivalent long-term outcomes compared with patients undergoing open surgery. We analyzed the prospectively collected data of all patients undergoing plantar fasciotomy at our institution from December 2007 to August 2014. A total of 42 feet of 38 patients were included in the analysis. The clinical data were collected preoperatively and at 3 and 6 months and 1 year. The functional outcomes analyzed included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, the Medical Outcomes Study, Short-Form, 36-item Health Survey, and patient satisfaction and expectations. Patients undergoing endoscopic surgery had significantly greater American Orthopaedic Foot and Ankle Society Ankle-Hindfoot and SF-36 Health Survey scores and lower pain scores at the 3-month period. They were also significantly more likely to be satisfied with and have had their expectations met by surgery. Compared with the open approach, the patients who had undergone endoscopic plantar fasciotomy experienced significantly greater improvements in the subjective and objective functional outcomes, with less pain and greater satisfaction, and had had their expectations met earlier in the recovery period, with equivalent long-term outcomes, compared with the patients who had undergone open plantar fasciotomy.

  18. Plantar Fat Grafting and Tendon Balancing for the Diabetic Foot Ulcer in Remission.

    PubMed

    Luu, Cynthia A; Larson, Ethan; Rankin, Timothy M; Pappalardo, Jennifer L; Slepian, Marvin J; Armstrong, David G

    2016-07-01

    We report on the use of free fat grafting as a means of redistributing normal and shear stress after healing of plantar diabetic foot wounds. Although fat augmentation (lipofilling) has been described previously as an approach to supplement defects and prevent atrophy, including use as an adjunct to wound healing and to mitigate pain in the foot, we are unaware of any reports in the medical literature that have described its use in the high-risk diabetic foot in remission. An active 37-year-old man with type 2 diabetes and neuropathy presented with gangrene of his fifth ray, which was amputated. He subsequently developed a chronic styloid process ulceration that progressed despite treatment. We performed a tibialis anterior tendon transfer and total contact casting. He went on to heal but with residual fat pad atrophy and recalcitrant preulcerative lesions. We then used autologous fat grafting for the plantar atrophy. The patient was able to successfully transition to normal shoe gear after 4 weeks with successful engraftment without complication or recurrence of the wound at 6 weeks. This therapy may provide a promising adjunct to increase ulcer-free days to the patient in diabetic foot remission. PMID:27536489

  19. Plantar Fat Grafting and Tendon Balancing for the Diabetic Foot Ulcer in Remission

    PubMed Central

    Luu, Cynthia A.; Larson, Ethan; Rankin, Timothy M.; Pappalardo, Jennifer L.; Slepian, Marvin J.

    2016-01-01

    Summary: We report on the use of free fat grafting as a means of redistributing normal and shear stress after healing of plantar diabetic foot wounds. Although fat augmentation (lipofilling) has been described previously as an approach to supplement defects and prevent atrophy, including use as an adjunct to wound healing and to mitigate pain in the foot, we are unaware of any reports in the medical literature that have described its use in the high-risk diabetic foot in remission. An active 37-year-old man with type 2 diabetes and neuropathy presented with gangrene of his fifth ray, which was amputated. He subsequently developed a chronic styloid process ulceration that progressed despite treatment. We performed a tibialis anterior tendon transfer and total contact casting. He went on to heal but with residual fat pad atrophy and recalcitrant preulcerative lesions. We then used autologous fat grafting for the plantar atrophy. The patient was able to successfully transition to normal shoe gear after 4 weeks with successful engraftment without complication or recurrence of the wound at 6 weeks. This therapy may provide a promising adjunct to increase ulcer-free days to the patient in diabetic foot remission. PMID:27536489

  20. Plantar Loading Reflects Ulceration Risks of Diabetic Foot with Toe Deformation

    PubMed Central

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

    2015-01-01

    Diabetes has been one of the most common chronic diseases all over the world. The purpose of this study was to quantitatively assess the foot loading characteristics of diabetic patients with fifth-toe deformity through a comparative analysis with diabetic patients with healthy and normal feet. Six neuropathic diabetic female subjects with the fifth-toe deformation and six age-matched neuropathic diabetic controls without any feet deformities participated in the walking test. Dynamic barefoot plantar pressure was measured with Novel EMED force plate. Peak pressure and pressure-time integral for all 7 foot regions (rearfoot, midfoot, lateral forefoot, central forefoot, medial forefoot, great toe, and other toes) were collected. Peak pressure was significantly higher in the patients with toe deformity in rearfoot, central forefoot, and great toe regions compared with the control group. Meanwhile, loading sustaining period extended longer in great toe region of deformed group than in that of the control group, and the center of pressure was nearly in the big toe region during toe offstage. Diabetic patients with fifth-toe deformity could have plantar contact area reduction in the other toes part and increased loading to the great toe part. The result showed that fifth-toe deformity was associated with potential ulceration risk especially in hallux region. PMID:25861622

  1. Palmar and plantar hyperhidrosis: best practice recommendations and special considerations.

    PubMed

    Glaser, Dee Anna; Hebert, Adelaide A; Pariser, David M; Solish, Nowell

    2007-05-01

    When topical therapy and tap water iontophoresis (TWI) fail, are unavailable, or are deemed unsatisfactory by patients with palmar or plantar hyperhidrosis (HH), the next logical treatment option is botulinum toxin type A (BTX-A). Skill and precision are required to treat palmar and plantar HH because of the dense innervation in the palms and soles. This article describes best practice techniques for BTX-A (Botox), including suggested dilution and syringe selection, injection technique, dose and injection grids, and anesthesia recommendations. In addition, general BTX-A background and special considerations for treating palmar and plantar HH are provided. Insurance reimbursement for treating HH with BTX-A can be challenging; navigating the insurance reimbursement process will be discussed.

  2. Evidence-based soft tissue rheumatology. V: plantar talalgia.

    PubMed

    Alvarez-Nemegyei, Jose; Canoso, Juan J

    2004-10-01

    Present evidence indicates that the main cause of plantar talalgia (PT) is a noninflammatory derangement at the proximal insertion of the plantar fascia. In athletes, predisposing ankle and rear-foot biomechanical abnormalities have been identified; in nonathletes, risk factors for the condition remain controversial. PT diagnosis is largely clinical, the key findings being pain and tenderness on the plantar aspect of the rear foot. Ultrasonography is a reliable confirmatory study in doubtful cases. Therapies in PT include nonsteroidal anti-inflammatory drugs, orthotic devices, night ankle dorsiflexion splints, physiotherapy, local glucocorticoid, and extracorporeal shockwave therapy. In recalcitrant cases, surgery may be offered. Of these therapies, only local glucocorticoid, as delivered by injection or iontophoresis, has shown short-term efficacy in controlled trials. The efficacy of ankle dorsiflexion splints and extracorporeal shockwave therapy is still controversial. Thus, important knowledge gaps remain on etiology, diagnosis, and treatment of PT.

  3. Abnormal attachments between a plantar aponeurosis and calcaneus

    PubMed Central

    KALNIEV, MANOL ANASTASOV; KRASTEV, DIMO; KRASTEV, NIKOLAY; VIDINOV, KALIN; VELTCHEV, LUDMIL; MILEVA, MILKA

    2013-01-01

    Background and aims The plantar aponeurosis or fascia is a thick fascial seal located on the lower surface of the sole. It consists of three parts central, lateral, and medial. The central portion is the thickest. It is narrow behind and wider in front. The central portion has two strong vertical intermuscular septa which are directed upward into the foot. The lateral and medial portions are thinner. The medial portion is thinnest. The lateral portion is thin in front and thick behind. The main function of the plantar fascia is to support the longitudinal arch of the foot. In May 2013 during a routine dissection in the section hall of the Department of Anatomy and Histology in Medical University – Sofia, Bulgaria we came across a very interesting variation of the plantar aponeurosis. Materials and methods For the present morphological study tissues from a human corpse material were used. This unusual anatomical variation was photographed using a Nikon Coolpix 995 camera with a 3.34 Megapixels. Results We found some fibrous strands which started from the proximal portion of the plantar aponeurosis on the left foot. The fibrous strands resembled the tentacles of an octopus and started from the proximal portion of the aponeurosis. Two of fibrous strands were directed laterally to adipose tissue and one was directed medially and backward. The first lateral fibrous strand was divided into several fascicles. We found very few data in literature about the varieties of the plantar fascia. Conclusion It is very important to consider the occurrence of above mentioned variations in the plantar aponeurosis when surgical procedures are performed on the sole. PMID:26527947

  4. Finite element analysis of heel pad with insoles.

    PubMed

    Luo, Gangming; Houston, Vern L; Garbarini, Mary Anne; Beattie, Aaron C; Thongpop, Chaiya

    2011-05-17

    To design optimal insoles for reduction of pedal tissue trauma, experimental measurements and computational analyses were performed. To characterize the mechanical properties of the tissues, indentation tests were performed. Pedal tissue geometry and morphology were obtained from magnetic resonance scan of the subject's foot. Axisymmetrical finite element models of the heel of the foot were created with 1/4 of body weight load applied. The stress, strain and strain energy density (SED) fields produced in the pedal tissues were computed. The effects of various insole designs and materials on the resulting stress, strain, and SED in the soft pedal tissues were analyzed. The results showed: (a) Flat insoles made of soft material provide some reductions in the maximum stress, strain and SED produced in the pedal tissues. These maximum values were computed near the calcaneus. (b) Flat insoles, with conical/cylindrical reliefs, provided more reductions in these maximum values than without reliefs. (c) Custom insoles, contoured to match the pedal geometry provide most reductions in the maximum stress, strain and SED. Also note, the maximum stress, strain and SED computed near the calcaneus were found to be about 10 times the corresponding peak values computed on the skin surface. Based on the FEA analysis, it can be concluded that changing insole design and using different material can significantly redistribute the stress/strain inside the heel pad as well as on the skin surface.

  5. Careful assessment the key to diagnosing adolescent heel pain.

    PubMed

    Davison, Martin J; David-West, S Kenneth; Duncan, Roderick

    2016-05-01

    The most common cause of adolescent heel pain is calcaneal apophysitis also known as Sever's disease. The condition may occur in adolescent athletes, particularly those involved in running or jumping activities, during the pubertal growth spurt. The mean age of presentation in Sever's disease is ten, (range 7-15). It presents with posterior heel pain that is worse with activity and relieved by rest in most cases. Sever's disease, Osgood Schlatter's disease (tibial tuberosity) and Sinding-Larsen Johansson syndrome (distal patella) are all overuse syndromes brought about by repetitive submaximal loading and microtrauma. They are, however, entirely self-limiting and resolve at skeletal maturity or earlier. Careful assessment is required to differentiate them from other rare pathologies. Achilles tendinitis is rare under the age of 14. As in Sever's disease, it may occur in jumping athletes, those who suddenly increase their sporting activities and in individuals with relative gastrosoleus tightness. It may also occur in those with inflammatory arthropathies and merit rheumatological investigation if there are other suggestive signs or symptoms. Benign and malignant tumours of the adolescent calcaneus are extremely rare In a unilateral case, atypical features such as night pain or absence of a precipitating activity should raise the index of suspicion. There may be localised swelling and bony expansion. PMID:27382917

  6. Does osteoporosis classification using heel BMD agree across manufacturers?

    PubMed

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

    2002-08-01

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

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

    PubMed Central

    Robinson, Katherine A.; Manning, Stephen T.

    2015-01-01

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

  8. Hyperkeratosis of the heels: treatment with salicylic acid in a novel delivery system.

    PubMed

    Bikowski, Joseph

    2004-01-01

    A 43-year-old woman presented with dryness and scaling of the lateral and posterior aspects of both heels, which was diagnosed as hyperkeratotic xerosis (Figure 1). Pertinent medical history included dry skin with winter exacerbation and painful hyperkeratosis of the heels present for many years. The patient applied a topical multivesicular cream formulation of 6% salicylic add (Salex, Healthpoint Ltd., Fort Worth, TX) to one foot b.i.d. The physician was blinded as to which foot was treated. After 2 weeks of treatment, it was apparent that the patient was applying the cream to the right foot, as evidenced by reduced dryness, scaling, and hyperkeratosis (Figure2). The patient continued treatment of the same foot for an additional 2 weeks, revealing a dramatic improvement of the right heel,which appeared smooth and soft and devoid of pain. No irritation was associated with treatment; the patient commented that this was the best her heel had been "in years." Subsequently, the patient treated both heels with salicylic acid 60%, multivesicular cream. A second patient, a 25-year-old woman, was treated for ichthyosis vulgaris and hyperkeratosis of both heels. She presented w ith multiple painful fissures and hyperkeratosis of the posterior heels bilaterally (Figure 3). After I week of topical treatment with salicylic add 6%, multivesicular cream applied b.i.d. to the left heel only, there was rapid resolution of both hyperkeratosis and pain (Figure 4).

  9. Nordic Walking Practice Might Improve Plantar Pressure Distribution

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  10. Innovations in plantar pressure and foot temperature measurements in diabetes.

    PubMed

    Bus, S A

    2016-01-01

    Plantar pressure and temperature measurements in the diabetic foot primarily contribute to identifying abnormal values that increase risk for foot ulceration, and they are becoming increasingly more integrated in clinical practice and daily life of the patient. While plantar pressure measurements have long been present, only recently evidence shows their importance in ulcer prevention, as a data-driven approach to therapeutic footwear provision. The long-term monitoring of plantar pressures with the option to provide feedback, when alarming pressure levels occur, is a promising development in this area, although more technical and clinical validation is required. Shear is considered important in ulcer aetiology but is technically difficult to measure. Innovative research is underway to assess if foot temperature can act as a useful surrogate for shear. Because the skin heats up before it breaks down, frequent monitoring of foot temperature can identify these warning signals. This approach has shown to be effective in preventing foot ulcers. Innovation in diagnostic methods for foot temperature monitoring and evidence on cost effectiveness will likely facilitate implementation. Finally, monitoring of adherence to offloading treatment using temperature-based sensors has proven to be a feasible and relevant method with a wide range of possible research and patient care applications. These innovations in plantar pressure and temperature measurements illustrate an important transfer in diabetic foot care from subjective to objective evaluation of the high-risk patient. They demonstrate clinical value and a large potential in helping to reduce the patient and economic burden of diabetic foot disease.

  11. The relationship between plantar pressure and footprint shape.

    PubMed

    Hatala, Kevin G; Dingwall, Heather L; Wunderlich, Roshna E; Richmond, Brian G

    2013-07-01

    Fossil footprints preserve the only direct evidence of the external foot morphologies and gaits of extinct hominin taxa. However, their interpretation requires an understanding of the complex interaction among foot anatomy, foot function, and soft sediment mechanics. We applied an experimental approach aimed at understanding how one measure of foot function, the distribution of plantar pressure, influences footprint topography. Thirty-eight habitually unshod and minimally shod Daasanach individuals (19 male, 19 female) walked across a pressure pad and produced footprints in sediment directly excavated from the geological layer that preserves 1.5 Ma fossil footprints at Ileret, Kenya. Calibrated pressure data were collected and three-dimensional models of all footprints were produced using photogrammetry. We found significant correlations (Spearman's rank, p < 0.0001) between measurements of plantar pressure distribution and relative footprint depths at ten anatomical regions across the foot. Furthermore, plantar pressure distributions followed a pattern similar to footprint topography, with areas of higher pressure tending to leave deeper impressions. This differs from the results of experimental studies performed in different types of sediment, supporting the hypothesis that sediment type influences the relationship between plantar pressure and footprint topography. Our results also lend support to previous interpretations that the shapes of the Ileret footprints preserve evidence of a medial transfer of plantar pressure during late stance phase, as seen in modern humans. However, the weakness of the correlations indicates that much of the variation in relative depths within footprints is not explained by pressure distributions under the foot when walking on firm ground, using the methods applied here. This warrants caution when interpreting the unique foot anatomies and foot functions of extinct hominins evidenced by their footprint structures. Further

  12. Radiation levels on empty cylinders containing heel material

    SciTech Connect

    Shockley, C.W.

    1991-12-31

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

  13. [Extracorporeal shockwave therapy in symptomatic heel spurs. An overview].

    PubMed

    Buch, M; Knorr, U; Fleming, L; Theodore, G; Amendola, A; Bachmann, C; Zingas, C; Siebert, W E

    2002-07-01

    Extracorporeal shock wave application (ESWA) has been successfully used for years in routine clinical management of plantar fasciitis. So far no clinical trails have shown the efficiency in placebo-controlled protocols. This paper presents an overview of conservative and operative treatment modalities with respect to their efficacy. Results of a prospective randomized placebo-controlled double-blind multicenter trial to show efficiency and safety of ESWT are presented. In patients treated conservatively without success, a single shock wave application can improve the condition significantly compared with placebo treatment (p = 0.0149). The Roles and Maudsley score also showed a significant improvement between the groups, with 61.6% good or excellent results in the verum group and 39.7% in the placebo group (p = 0.0128). Therapy-related side effects (local swelling, petechia) are rare. The data presented in this study led to FDA approval in January 2002 of the shock wave device used.

  14. Heel Ultrasound Scan in Detecting Osteoporosis in Low Trauma Fracture Patients.

    PubMed

    Hashmi, Faiz R; Elfandi, Khaled O

    2016-06-27

    Osteoporosis is the most common metabolic disease with significant impact on the morbidity and mortality of affected patients. Osteoporosis has a significant impact on the economy worldwide. The aim of this study was to find out whether heel ultrasound is as good as central bone densitometry scanning in diagnosing osteoporosis in patients who are at high risk of osteoporosis. This was a prospective study of patients comparing heel ultrasound to central bone densitometry scanning (dual X-ray absorptiometry, DEXA) in patients. The recruited patients attended for a DEXA scan of the left hip and lumbar spine. All subjects had an ultrasound of the left heel using the quantitative heel ultrasound machine. The results of DEXA scan were blinded from the results of ultrasound and vice versa. There were 59 patients who took part in the study, 12 men and 47 women. The mean age was 66 years (SD 11.9) and mean weight was 62.5 kg (SD 10.7). The sensitivity and specificity of the ultrasound heel test to predict osteoporosis were 53% (95%CI: 29-77) and 86% (95%CI: 75-96) respectively. Specificity for predicting bone mineral density (BMD)-defined osteoporosis was high (86%), but sensitivity was low (53%). A heel ultrasound result in the osteoporotic range was highly predictive of BMD-defined osteoporosis. A positive ultrasound heel test in high risk patients is more useful in ruling in osteoporosis than a negative test to rule out osteoporosis. PMID:27433300

  15. Heel Ultrasound Scan in Detecting Osteoporosis in Low Trauma Fracture Patients

    PubMed Central

    Hashmi, Faiz R.; Elfandi, Khaled O.

    2016-01-01

    Osteoporosis is the most common metabolic disease with significant impact on the morbidity and mortality of affected patients. Osteoporosis has a significant impact on the economy worldwide. The aim of this study was to find out whether heel ultrasound is as good as central bone densitometry scanning in diagnosing osteoporosis in patients who are at high risk of osteoporosis. This was a prospective study of patients comparing heel ultrasound to central bone densitometry scanning (dual X-ray absorptiometry, DEXA) in patients. The recruited patients attended for a DEXA scan of the left hip and lumbar spine. All subjects had an ultrasound of the left heel using the quantitative heel ultrasound machine. The results of DEXA scan were blinded from the results of ultrasound and vice versa. There were 59 patients who took part in the study, 12 men and 47 women. The mean age was 66 years (SD 11.9) and mean weight was 62.5 kg (SD 10.7). The sensitivity and specificity of the ultrasound heel test to predict osteoporosis were 53% (95%CI: 29-77) and 86% (95%CI: 75-96) respectively. Specificity for predicting bone mineral density (BMD)-defined osteoporosis was high (86%), but sensitivity was low (53%). A heel ultrasound result in the osteoporotic range was highly predictive of BMD-defined osteoporosis. A positive ultrasound heel test in high risk patients is more useful in ruling in osteoporosis than a negative test to rule out osteoporosis. PMID:27433300

  16. An inverse finite-element model of heel-pad indentation.

    PubMed

    Erdemir, Ahmet; Viveiros, Meredith L; Ulbrecht, Jan S; Cavanagh, Peter R

    2006-01-01

    A numerical-experimental approach has been developed to characterize heel-pad deformation at the material level. Left and right heels of 20 diabetic subjects and 20 nondiabetic subjects matched for age, gender and body mass index were indented using force-controlled ultrasound. Initial tissue thickness and deformation were measured using M-mode ultrasound; indentation forces were recorded simultaneously. An inverse finite-element analysis of the indentation protocol using axisymmetric models adjusted to reflect individual heel thickness was used to extract nonlinear material properties describing the hyperelastic behavior of each heel. Student's t-tests revealed that heel pads of diabetic subjects were not significantly different in initial thickness nor were they stiffer than those from nondiabetic subjects. Another heel-pad model with anatomically realistic surface representations of the calcaneus and soft tissue was developed to estimate peak pressure prediction errors when average rather than individualized material properties were used. Root-mean-square errors of up to 7% were calculated, indicating the importance of subject-specific modeling of the nonlinear elastic behavior of the heel pad. Indentation systems combined with the presented numerical approach can provide this information for further analysis of patient-specific foot pathologies and therapeutic footwear designs.

  17. Influence of heel lifts during standing in children with motor disorders.

    PubMed

    Bartonek, Asa; Lidbeck, Cecilia M; Pettersson, Robert; Weidenhielm, Eva Broström; Eriksson, Marie; Gutierrez-Farewik, Elena

    2011-07-01

    Heel wedges may influence standing posture but how and to what extent are unknown. Thirty-two children with motor disorders - 16 with arthrogryposis multiplex congenita (AMC) and 16 with cerebral palsy (CP) - and 19 control children underwent a three-dimensional motion analysis. Unassisted standing during 20s with shoes only and with heel lifts of 10, 20 and 30mm heights was recorded in a randomized order. The more weight-bearing limb or the right limb was chosen for analysis. In both the AMC and CP groups, significant changes were seen between various heel lifts in ankle, knee and pelvis, and in the control group in the ankle only. Between orthosis and non-orthosis users significant differences were seen between different heel lift conditions in ankle, knee and trunk in the AMC group and in the ankle in the CP group. Pelvis position changed toward less anterior tilt with increasing heel height, but led to increasing knee flexion in most of the children, except for the AMC Non-Ort group. Children with AMC and CP represent different motor disorders, but the heel wedges had a similar influence on pelvis, hip and knee positions in all children with CP and in the AMC orthosis users. A challenge is to apply heel heights adequate to each individual's orthopaedic and neurologic conditions to improve biomechanical alignment with respect to all body segments.

  18. Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.

    PubMed

    Kudo, Patricia; Dainty, Katie; Clarfield, Michael; Coughlin, Larry; Lavoie, Pauline; Lebrun, Constance

    2006-02-01

    Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.

  19. Presence of growth factors in palmar and plantar fibromatoses.

    PubMed

    Zamora, R L; Heights, R; Kraemer, B A; Erlich, H P; Groner, J P

    1994-05-01

    Palmar and plantar fibromatoses are disease processes in which the presence of certain growth factors has not been defined. Monoclonal antibodies against transforming growth factor-beta, epidermal growth factor, procollagen type 1, fibronectin, phosphotyrosine residues, and CD41 platelet antigen were used in standard immunoperoxidase staining to study 36 nodules and 24 cords obtained from patients with fibromatoses. The specimens were studied via light microscopy, and staining intensity was quantitated using a computer-enhanced video system. Transforming growth factor-beta staining paralleled procollagen I, fibronectin, and phosphotyrosine staining within the nodule (early stages) but not the cord (late stages) tissue. These factors showed significant increased staining in the early stage of fibromatosis when compared to the late stage. This study is a preliminary demonstration of the presence of transforming growth factor-beta in palmar and plantar fibromatoses.

  20. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  1. Heel ultrasound can assess maintenance of bone mass in women with breast cancer.

    PubMed

    Langmann, Gabrielle A; Vujevich, Karen T; Medich, Donna; Miller, Megan E; Perera, Subashan; Greenspan, Susan L

    2012-01-01

    Postmenopausal women with early stage breast cancer are at increased risk for bone loss and fractures. Bisphosphonates can prevent bone loss, but little data are available on changes in bone mass assessed by heel quantitative ultrasound (QUS). Our objectives were to determine if (1) heel QUS would provide a reliable and accessible method for evaluation of changes in bone mass in women with breast cancer when compared with the current standard of bone mass measurement, dual-energy X-ray absorptiometry (DXA) and (2) oral risedronate could affect these changes. Eighty-six newly postmenopausal (up to 8 yr) women with nonmetastatic breast cancer were randomized to risedronate, 35 mg once weekly or placebo. Outcomes were changes in heel QUS bone mass measurements and conventional DXA-derived bone mineral density (BMD). Over 2 yr, bone mass assessed by heel QUS remained stable in women on risedronate, whereas women on placebo had a 5.2% decrease (p ≤ 0.05) in heel QUS bone mass. Both total hip BMD and femoral neck BMD assessed by DXA decreased by 1.6% (p ≤ 0.05) in the placebo group and remained stable with risedronate. Spine BMD remained stable in both groups. Heel QUS was moderately associated with BMD measured by DXA at the total hip (r=0.50), femoral neck (r=0.40), and spine (r=0.46) at baseline (all p ≤ 0.001). In conclusion, risedronate helps to maintain skeletal integrity as assessed by heel QUS for women with early stage breast cancer. Heel QUS is associated with DXA-derived BMD at other major axial sites and may be used to follow skeletal health and bone mass changes in these women.

  2. Heel spur syndrome. Pathomechanics and nonsurgical treatment. Biomechanics Graduate Research Group for 1988.

    PubMed

    Scherer, P R

    1991-02-01

    In this study, the authors review the multitude of suspected etiologies of heel spur syndrome, propose a new pathomechanical theory, and apply a treatment plan to 84 patients with 133 painful heels. The study investigates whether there is a common foot type to the syndrome and whether factors such as sex, age, occupation, and weight influence incidence or treatment. A subgroup is established, consisting of subjects who only received mechanical treatment, to determine if a change in foot position can relieve symptoms.

  3. Toe and plantar dermatoglyphics in adult American Caucasians.

    PubMed

    Fox, K M; Plato, C C

    1987-09-01

    The scarcity of information on control data of toe and plantar dermatoglyphics led us to undertake this study of adult American Caucasians. Toe and sole prints of 168 male and 83 female participants of the Baltimore Longitudinal Study of Aging were analyzed. Toe pattern frequencies demonstrate that fibular loops are the most prevalent pattern on the toes in both males and females. Pattern distribution by digit shows that arches are most often located on the fifth toe while whorls are found with greatest frequency on the third toe. Plantar pattern frequencies indicate that the most common pattern found in the hallucal area is the distal loop. Open fields are frequently found in the II and IV interdigital areas while distal loops are prevalent in the III area. These results are compared to the finger and palmar patterns of the same individuals. The distribution of patterns on the toes and fingers of the same individuals appear to be quite different. Population comparisons did not demonstrate a clear racial difference in the toe pattern frequencies or in the plantar areas.

  4. A knowledge-based modeling for plantar pressure image reconstruction.

    PubMed

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

    2014-10-01

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

  5. The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management.

    PubMed

    Vlahovic, Tracey C; Khan, M Tariq

    2016-07-01

    Viral warts or verruca pedis (plantar warts) are common skin conditions seen in both children and adults. Human papilloma virus (HPV), a DNA virus, is responsible for plantar verrucae. It needs an epidermal abrasion and a transiently impaired immune system to inoculate a keratinocyte. These entities are a therapeutic conundrum for many practitioners. This article discusses HPV infiltration and its subtypes involved in plantar warts; the evaluation of patients with plantar warts; and subsequent treatment options, such as laser, Candida albicans immunotherapy, topical therapy such as phytotherapy, and surgical excision. PMID:27215155

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

    SciTech Connect

    Yu, Yongjian; Wang, Jue

    2013-08-15

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

  7. Chronic arsenicism: criminal poisoning or drug-intoxication? Report of two cases.

    PubMed

    Sass, U; Grosshans, E; Simonart, J M

    1993-01-01

    We report two cases with chronic arsenicism. The first one is a young 37-year-old woman who presents leucomelanoderma, plantar keratoderma, polyneuropathy of the legs and transversal striae of the nails. After investigations, criminal intoxication with arsenic caused by her own sister was discovered. The second case is a 42-year-old man who had developed plantar keratoderma, arsenical keratoses and two squamous cell epitheliomas 10 years after a 2-year treatment with Fowler's solution for androgenetic alopecia.

  8. Anode heel affect in thoracic radiology: a visual grading analysis

    NASA Astrophysics Data System (ADS)

    Mearon, T.; Brennan, P. C.

    2006-03-01

    For decades, the antero-posterior (AP) projection of the thoracic spine has represented a substantial challenge. Patient thickness varies substantially along the cranio-caudal axis resulting in images that are too dark for the upper vertebrae and too light, or with excessive quantum mottle, towards the 9th to 12th thoracic vertebra. The anode heel affect is a well known phenomenon, however there is a paucity of reports demonstrating its exploitation in clinical departments for optimising images. The current work, using an adult, tissue-equivalent anthropomorphic phantom, explores if appropriate positioning ofthe anode can improve image quality for thoracic spine radiology. At each of 5 kVps (70, 81, 90, 102, 109) thirty AP thoracic spine images were produced, 15 with the anode end of the tube towards the cranial part of the phantom and 15 with the anode end of the tube facing caudally. Visual grading analysis of the resultant images demonstrated significant improvements in overall image quality and visualisation of specific anatomical features for the cranially facing anode compared with the alternative position, which were most pronounced for the 1st to 4th and 9th to 12th vertebrae. These improvements were evident at 70, 81 and 90 kVp, but not for the higher beam energies. The results demonstrate that correct positioning of the X-ray tube can improve image quality for thoracic radiology at specific tube potentials. Further work is ongoing to investigate whether this easy to implement and cost-free technique can be employed for other examinations.

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

    PubMed

    Kirkland, Paul; Beeson, Paul

    2013-01-01

    Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option. PMID:24072372

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

    PubMed

    Kirkland, Paul; Beeson, Paul

    2013-01-01

    Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option.

  11. Expanded butterfly plots: A new method to analyze simultaneous pressure and shear on the plantar skin surface during gait.

    PubMed

    Berki, Visar; Boswell, Melissa A; Ciltea, Daniela; Guseila, Loredana M; Goss, Larry; Barnes, Scott; Berme, Necip; McMillan, Grant R; Davis, Brian L

    2015-07-16

    The current method of visualizing pressure and shear data under a subject's foot during gait is the Pedotti, or "butterfly" diagram. This method of force platform data visualization was introduced in the 1970s to display the projection of the ground reaction force vector in the sagittal plane. The purpose of the current study was to examine individual sub-components of the vectors displayed in Pedotti diagrams, in order to better understand the relationship between one foot region and another. For this, new instrumentation was used that allows multiple Pedotti diagrams to be constructed at any instant during the gait cycle. The custom built shear-and-pressure-evaluating camera system (SPECS) allows for simultaneous recordings of pressure and both components of the horizontal force vector (medio-lateral and antero-posterior) at distinctive regions under one's foot during gait. Data analysis of such recordings affirms three conclusions: (i) pressure and shear values on individual sites on the plantar surface of the foot are not associated in a linear manner, (ii) force vectors in the heel and forefoot regions exhibit horizontal force components that oppose one another, and similarly, (iii) force vectors in the frontal plane transecting the forefoot region also exhibit medial-lateral shear components that counteract one another. This approach sheds light on individual vectors that collectively sum to each vector displayed in a Pedotti diagram. The results indicate that shearing between the foot and the ground is not simply a passive event. The structures of the arches and/or muscular activities are major contributors to the observed interfacial stresses. PMID:25895644

  12. Flat Feet and a Diagnosis of Plantar Fasciitis in a Marine Corps Recruit.

    PubMed

    Lurati, Ann R

    2015-04-01

    A 22-year-old man sought care at an orthopedic clinic for acute plantar fasciitis. He reported that he had begun an intensive exercise program to prepare himself for Marine Corps Officer Candidate School. Pes Planus, or flat feet, was noted on physical examination. This article reviews the diagnoses of pes planus and plantar fasciitis as well as current intervention strategies.

  13. Imaging of Lesser Metatarsophalangeal Joint Plantar Plate Degeneration, Tear, and Repair.

    PubMed

    Linklater, James M; Bird, Stephen J

    2016-04-01

    Plantar plate degeneration and tear is a common cause of forefoot pain, typically involving the second metatarsophalangeal joint at the proximal phalangeal insertion laterally, frequently confused with the second web space Morton neuroma. The condition has received increased attention with the development of surgical techniques that can result in successful repair of the plantar plate and substantial improvement in patient symptoms. High-resolution MRI or ultrasound can confirm a diagnosis of plantar plate degeneration and tear and exclude other pathologies, particularly Morton neuroma. The normal plantar plate is a mildly hyperechoic structure on ultrasound and is hypointense on all conventional MR sequences. Plantar plate degeneration manifests on ultrasound as hypoechoic echotextural change and on MRI as mild signal hyperintensity on short TE sequences, becoming less conspicuous on long TE sequences. Adjacent entheseal bony irregularity is commonly present. Plantar plate tears on ultrasound may be seen as an anechoic cleft defect or area of heterogeneous echotexture, sometimes more conspicuous with dorsiflexion stress. Plantar plate tears demonstrate greater signal hyperintensity on proton-density sequences, becoming more conspicuous on fat-suppressed proton density and T2-weighted sequences. Edema and fibrotic change in the pericapsular fat plane is commonly seen in the setting of an adjacent plantar plate tear and should not be misinterpreted as reflecting a Morton neuroma.

  14. Gastrocnemius and soleus are selectively activated when adding knee extensor activity to plantar flexion.

    PubMed

    Suzuki, Takahito; Chino, Kentaro; Fukashiro, Senshi

    2014-08-01

    The gastrocnemius is a biarticular muscle that acts not only as a plantar flexor, but also as a knee flexor, meaning that it is an antagonist during knee extension. In contrast, the soleus is a monoarticular plantar flexor. Based on this anatomical difference, these muscles' activities should be selectively activated during simultaneous plantar flexion and knee extension, which occur during many activities of daily living. This study examined the selective activation of gastrocnemius and soleus activities when voluntary isometric activation of knee extensors was added to voluntary isometric plantar flexion. Ten male volunteers performed isometric plantar flexion at 10%, 20%, and 30% of maximum effort. During each plantar flexion task, isometric knee extension was added at 0%, 50%, and 100% of maximum effort. When knee extension was added, the average rectified value of the electromyographic activity of the medial gastrocnemius was significantly depressed (P=.002), whereas that of the soleus was significantly increased (P<.001) regardless of the plantar flexion level. These results suggest that plantar flexion with concurrent knee extensor activity leads to selective activation of the soleus and depression of the synergistic activity of the gastrocnemius.

  15. Plantar pressures and relative lesser metatarsal lengths in older people with and without forefoot pain.

    PubMed

    Menz, Hylton B; Fotoohabadi, Mohammad R; Munteanu, Shannon E; Zammit, Gerard V; Gilheany, Mark F

    2013-03-01

    Forefoot pain is a common problem in older people. We determined whether plantar pressures during gait and the relative lengths of the lesser metatarsals differ between older people with and without plantar forefoot pain. Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan® system in 118 community-dwelling older people (44 males and 74 females), mean age 74 (standard deviation=5.9) years, 43 (36%) of whom reported current or previous plantar forefoot pain. The relative lengths of metatarsals 1-5 were determined from weightbearing X-rays. Participants with current or previous plantar forefoot pain exhibited significantly (p=0.032) greater peak plantar pressure under metatarsal heads 3-5 (1.93 ± 0.41 kg/cm(2) vs. 1.74 ± 0.48 kg/cm(2) ). However, no differences were found in relative metatarsal lengths between the groups. These findings indicate that older people with forefoot pain generate higher peak plantar pressures under the lateral metatarsal heads when walking, but do not exhibit relatively longer lesser metatarsals. Other factors may be responsible for the observed pressure increase, such as reduced range of motion of the metatarsophalangeal joints and increased stiffness of plantar soft tissues.

  16. Prediction of plantar shear stress distribution by artificial intelligence methods.

    PubMed

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

    2009-09-01

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

  17. Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis.

    PubMed

    Weinberg, Tessa; Solish, Nowell; Murray, Christian

    2014-10-01

    Palmar and plantar hyperhidrosis is relatively common and can have severe psychological and medical consequences for those afflicted. A multitude of treatments exist but are often inadequate especially for those with significant disease. In these cases botulinum neurotoxin provides a reliable method for reducing the symptoms and improving quality of life. Although actual administration is relatively straightforward, pain management is a crucial component that requires a mastery of several techniques. Patients have a high degree of satisfaction with botulinum neurotoxin treatment and are motivated to come back for repeat treatments, usually every 6 months.

  18. Resistance exercise prevents plantar flexor deconditioning during bed rest

    NASA Technical Reports Server (NTRS)

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

    1997-01-01

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

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

    PubMed

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

    2016-02-01

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

  20. The use of a heel-mounted accelerometer as an adjunct measure of slip distance.

    PubMed

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

    2007-05-01

    A human-centered measure of floor slipperiness could be useful as an adjunct to conventional tribologic measures. This paper reports on the development and evaluation of a measure of slip distance based on variables derived from the signal of a heel-mounted accelerometer. Twenty-one participants walked on a laboratory runway under several surface slipperiness conditions at three walking speeds during a protocol designed to produce a wide range of slip distances at heel strike. Analysis of variance showed significant effects of slip distance (no-slip, micro-slip and slide), walking speed (1.52, 1.78 and 2.13 m/s) and their interactions on peak forward acceleration, peak vertical acceleration and deceleration time of the heel following heel strike in 704 trials. Regression analysis of slip distance and deceleration time showed the strongest relationship with R2=0.511. Large individual variation in the strength of this relationship was observed. The heel-mounted accelerometer may have utility as an adjunct measure in the evaluation of floor slipperiness, particularly for field applications where direct measurement may not be feasible.

  1. How Plantar Exteroceptive Efficiency Modulates Postural and Oculomotor Control: Inter-Individual Variability

    PubMed Central

    Foisy, Arnaud; Kapoula, Zoï

    2016-01-01

    In a previous experiment, we showed that among young and healthy subjects, thin plantar inserts improve postural control and modify vergence amplitudes. In this experiment, however, significant inter-individual variability was observed. We hypothesize that its origin could be attributed to a different reliance upon feet cutaneous afferents. In order to test this hypothesis, we re-analyzed the data relative to 31 young (age 25.7 ± 3.8) and healthy subjects who participated in the first experiment after having classified them into two groups depending on their Plantar Quotient (PQ = Surface area of CoPfoam/Surface area of CoPfirm ground × 100). Foam decreases the information arising from the feet, normally resulting in a PQ > 100. Hence, the PQ provides information on the weight of plantar cutaneous afferents used in postural control. Twelve people were Plantar-Independent Subjects, as indicated by a PQ < 100. These individuals did not behave like the Normal Plantar Quotient Subjects: they were almost insensitive to the plantar stimulations in terms of postural control and totally insensitive in terms of oculomotor control. We conclude that the inter-individual variability observed in our first experiment is explained by the subjects' degree of plantar reliance. We propose that plantar independence is a dysfunctional situation revealing inefficiency in plantar cutaneous afferents. The latter could be due to a latent somatosensory dysfunction generating a noise which prevents the CNS from correctly processing and using feet somatosensory afferents both for balance and vergence control: Plantar Irritating Stimulus. Considering the non-noxious nature and prevalence of this phenomenon, these results can be of great interest to researchers and clinicians who attempt to trigger postural or oculomotor responses through mechanical stimulation of the foot sole. PMID:27242490

  2. How Plantar Exteroceptive Efficiency Modulates Postural and Oculomotor Control: Inter-Individual Variability.

    PubMed

    Foisy, Arnaud; Kapoula, Zoï

    2016-01-01

    In a previous experiment, we showed that among young and healthy subjects, thin plantar inserts improve postural control and modify vergence amplitudes. In this experiment, however, significant inter-individual variability was observed. We hypothesize that its origin could be attributed to a different reliance upon feet cutaneous afferents. In order to test this hypothesis, we re-analyzed the data relative to 31 young (age 25.7 ± 3.8) and healthy subjects who participated in the first experiment after having classified them into two groups depending on their Plantar Quotient (PQ = Surface area of CoPfoam/Surface area of CoPfirm ground × 100). Foam decreases the information arising from the feet, normally resulting in a PQ > 100. Hence, the PQ provides information on the weight of plantar cutaneous afferents used in postural control. Twelve people were Plantar-Independent Subjects, as indicated by a PQ < 100. These individuals did not behave like the Normal Plantar Quotient Subjects: they were almost insensitive to the plantar stimulations in terms of postural control and totally insensitive in terms of oculomotor control. We conclude that the inter-individual variability observed in our first experiment is explained by the subjects' degree of plantar reliance. We propose that plantar independence is a dysfunctional situation revealing inefficiency in plantar cutaneous afferents. The latter could be due to a latent somatosensory dysfunction generating a noise which prevents the CNS from correctly processing and using feet somatosensory afferents both for balance and vergence control: Plantar Irritating Stimulus. Considering the non-noxious nature and prevalence of this phenomenon, these results can be of great interest to researchers and clinicians who attempt to trigger postural or oculomotor responses through mechanical stimulation of the foot sole.

  3. How Plantar Exteroceptive Efficiency Modulates Postural and Oculomotor Control: Inter-Individual Variability.

    PubMed

    Foisy, Arnaud; Kapoula, Zoï

    2016-01-01

    In a previous experiment, we showed that among young and healthy subjects, thin plantar inserts improve postural control and modify vergence amplitudes. In this experiment, however, significant inter-individual variability was observed. We hypothesize that its origin could be attributed to a different reliance upon feet cutaneous afferents. In order to test this hypothesis, we re-analyzed the data relative to 31 young (age 25.7 ± 3.8) and healthy subjects who participated in the first experiment after having classified them into two groups depending on their Plantar Quotient (PQ = Surface area of CoPfoam/Surface area of CoPfirm ground × 100). Foam decreases the information arising from the feet, normally resulting in a PQ > 100. Hence, the PQ provides information on the weight of plantar cutaneous afferents used in postural control. Twelve people were Plantar-Independent Subjects, as indicated by a PQ < 100. These individuals did not behave like the Normal Plantar Quotient Subjects: they were almost insensitive to the plantar stimulations in terms of postural control and totally insensitive in terms of oculomotor control. We conclude that the inter-individual variability observed in our first experiment is explained by the subjects' degree of plantar reliance. We propose that plantar independence is a dysfunctional situation revealing inefficiency in plantar cutaneous afferents. The latter could be due to a latent somatosensory dysfunction generating a noise which prevents the CNS from correctly processing and using feet somatosensory afferents both for balance and vergence control: Plantar Irritating Stimulus. Considering the non-noxious nature and prevalence of this phenomenon, these results can be of great interest to researchers and clinicians who attempt to trigger postural or oculomotor responses through mechanical stimulation of the foot sole. PMID:27242490

  4. Effect of shockwave therapy on plantar fasciopathy. A biomechanical prospective.

    PubMed

    Hsu, W-H; Lai, L-J; Chang, H-Y; Hsu, R W-W

    2013-08-01

    It has been suggested that extracorporeal shockwave therapy is a safe and effective treatment for pain relief from recalcitrant plantar fasciopathy (PF). However, the changes in gait and associated biomechanical parameters have not been well characterised. We recruited 12 female patients with recalcitrant PF who had a mean age of 59 years (50 to 70) and mean body mass index of 25 kg/m(2) (22 to 30). The patients reported a mean duration of symptoms of 9.3 months (6 to 15). Shockwave therapy consisting of 1500 impulses (energy flux density 0.26 mJ/mm(2)) was applied for three sessions, each three weeks apart. A pain visual analogue scale (VAS) rating, plantar pressure assessment and motion analysis were carried out before and nine weeks after first shock wave therapy. It was demonstrated that patients increased their walking velocity and cadence as well indicating a decrease in pain after shockwave therapy. In the symptomatic foot, the peak contact pressure over the forefoot increased and the contact area over the digits decreased. The total foot impulse also decreased as did stance duration. The duration the centre of pressure remained in the hindfoot increased in the symptomatic foot after shockwave therapy. The differences in centre of pressure trajectory at baseline decreased at final follow-up. In conclusion, shockwave therapy not only decreased the pain VAS rating but also improved the gait parameters of the symptomatic foot in PF patients.

  5. A comparative assessment of interface pressures generated by four surgical theatre heel pressure ulcer prophylactics.

    PubMed

    Malkoun, Mario; Huber, Jacqueline; Huber, David

    2012-06-01

    Current heel protection devices used in the operating room do not comply with the consensus document of the European and National (North American) Pressure Ulcer Advisory Panels. A complying prototype has been tested. Prospective cohort study comparing interface pressures. While using the prototype device, the heel interface pressure is significantly [mean 0·0 mmHg, standard deviation (SD) 0·0] less than the viscose elastic gel (VEG) mat (mean 174·8 mmHg, SD 64·5), the Action(®) heel block (mean 182·3 mmHg, SD 70·8) and the theatre table (mean 193·2 mmHg, SD 57·1). At the Achilles tendon, the prototype device (mean 16·2 mmHg, SD 19·0) is significantly superior to the Oasis (mean 183·7 mmHg, SD 67·4) and Action(®) heel blocks (mean 112·3 mmHg, SD 64·7). At the lateral malleolus, the prototype device (mean 0·0, SD 0·0) is better than the Action(®) (mean 24·3 mmHg, SD 53·4) and Oasis heel blocks (mean 20·9 mmHg, SD 49·2). At the calf, the prototype (mean 53·7 mmHg, SD 23·0) imposed more pressure than all other devices tested but was not statistically significant compared with the theatre table or the VEG mat. It is possible to design a device that protects the heel, lateral malleolus and Achilles tendon without causing hyperextension of the knee and consequent popliteal vein compression, thereby complying with the above guidelines.

  6. Clinical Importance of the Heel Drop Test and a New Clinical Score for Adult Appendicitis

    PubMed Central

    Ahn, Shin; Lee, Hyeji; Choi, Wookjin; Ahn, Ryeok; Hong, Jung-Suk; Sohn, Chang Hwan; Seo, Dong Woo; Lee, Yoon-Seon; Lim, Kyung Soo; Kim, Won Young

    2016-01-01

    Objective We tried to evaluate the accuracy of the heel drop test in patients with suspected appendicitis and tried to develop a new clinical score, which incorporates the heel drop test and other parameters, for the diagnosis of this condition. Methods We performed a prospective observational study on adult patients with suspected appendicitis at two academic urban emergency departments between January and August 2015. The predictive characteristics of each parameter, along with heel drop test results were calculated. A composite score was generated by logistic regression analysis. The performance of the generated score was compared to that of the Alvarado score. Results Of the 292 enrolled patients, 165 (56.5%) had acute appendicitis. The heel drop test had a higher predictive value than rebound tenderness. Variables and their points included in the new (MESH) score were pain migration (2), elevated white blood cell (WBC) >10,000/μL (3), shift to left (2), and positive heel drop test (3). The MESH score had a higher AUC than the Alvarado score (0.805 vs. 0.701). Scores of 5 and 11 were chosen as cut-off values; a MESH score ≥5 compared to an Alvarado score ≥5, and a MESH score ≥8 compared to an Alvarado score ≥7 showed better performance in diagnosing appendicitis. Conclusion MESH (migration, elevated WBC, shift to left, and heel drop test) is a simple clinical scoring system for assessing patients with suspected appendicitis and is more accurate than the Alvarado score. Further validation studies are needed. PMID:27723842

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

    PubMed

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

    2010-01-01

    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

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

    PubMed

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

    2010-01-01

    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'.

  9. The effects of shoe heel height and gait velocity on position sense of the knee joint and balance

    PubMed Central

    Jang, Il-Yong; Kang, Da-Haeng; Jeon, Jae-Keun; Jun, Hyun-Ju; Lee, Joon-Hee

    2016-01-01

    [Purpose] The aim of this study was to examine the effects of increased heel height and gait velocity on balance control and knee joint position sense. [Subjects and Methods] Forty healthy adults were randomly allocated to 4 groups: low-heel, low-speed group (3 cm, 2 km/h), low-heel, high-speed group (3 cm, 4 km/h), high-heel, low-speed group (9 cm, 2 km/h), high-heel, and high-speed group (9 cm, 4 km/h), with 10 subjects per group. Static and dynamic balance was evaluated using the I-Balance system and knee joint position sense using a goniometer. Measurements were compared using a pre- and posttest design. [Results] Increasing heel height and gait velocity decreased knee joint position sense and significantly increased the amplitude of body sway under conditions of static and dynamic balance, with highest sway amplitude induced by the high-heel, high-speed condition. [Conclusion] Increased walking speed in high heels produced significant negative effects on knee joint sense and balance control. PMID:27799675

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

    PubMed

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

    2002-04-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2007-01-01

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

  12. Case 13: chronic painful ulcer on the heel of a diabetic foot.

    PubMed

    Price, Juliet; Boulton, Zoe

    2016-03-01

    This painful ulcer, which had signs of biofilm, was covered in necrotic tissue. Octenilin Wound Gel was used to soften the necrosis in preparation for sharp debridement. Three weeks later, the devitalised tissue had been completely removed, while there was a 50% reduction in wound size at week 5.

  13. Lower limb mechanics during moderate high-heel jogging and running in different experienced wearers.

    PubMed

    Fu, Fengqin; Zhang, Yan; Shu, Yang; Ruan, Guoqing; Sun, Jianjun; Baker, Julien; Gu, Yaodong

    2016-08-01

    The aim of this study is to investigate the differences in lower limb kinematics and kinetics between experienced (EW) and inexperienced (IEW) moderate high-heel wearers during jogging and running. Eleven experienced female wearers of moderate high-heel shoes and eleven matched controls participated in jogging and running tests. A Vicon motion analysis system was used to capture kinematic data and a Kistler force platform was used to collect ground reaction force (GRF). There were no significant differences in jogging and running speed respectively. Compared with IEW, EW adopted larger stride length (SL) with lower stride frequency (SF) at each corresponding speed. During running, EW enlarged SL significantly while IEW increased both SL and SF significantly. Kinematic data showed that IEW had generally larger joint range of motion (ROM) and peak angles during stance phase. Speed effect was not obvious within IEW. EW exhibited a significantly increased maximal vertical GRF (Fz2) and vertical average loading rate (VALR) during running, which was potentially caused by overlong stride. These suggest that both EW and IEW are at high risk of joint injuries when running on moderate high heels. For wearers who have to do some running on moderate high heels, it is crucial to control joint stability and balance SL and SF consciously.

  14. Squamous cell carcinoma of the heel developing at site of previous frostbite1

    PubMed Central

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

    1982-01-01

    Ten cases of squamous cell carcinoma of the heel previously affected by frostbite are reported. They had a similar natural history, location and histological appearance. All were treated by excision, and follow up over periods of 2–5 years has not revealed metastases. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6. PMID:7120256

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

    PubMed Central

    Storm, H

    2000-01-01

    AIM—To 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.
METHODS—In 20 preterm infants of gestational age ⩾ 29 weeks, behavioural state and spontaneous skin conductance activity variables were measured for three minutes before, during, and for three minutes after heel stick.
RESULTS—The number of waves (p < 0.001), the amplitude of the waves (p = 0.001), and the level of the behavioural state (p < 0.001) increased during heel stick, and then decreased to levels found before the procedure. The baseline increased both during (p < 0.001) and after heel stick (p < 0.001), compared with levels before.
CONCLUSION—Spontaneous skin conductance activity reflects the stress response to heel stick in premature infants from at least 29 weeks of gestational age.
 PMID:10952711

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

    SciTech Connect

    Batcheller, Thomas Aquinas

    2000-09-01

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

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

    SciTech Connect

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

    2000-08-31

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

  18. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section 174.055 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO SPECIFIC VESSEL TYPES Special Rules Pertaining to Mobile Offshore...

  19. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section 174.055 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO SPECIFIC VESSEL TYPES Special Rules Pertaining to Mobile Offshore...

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    SciTech Connect

    McDaniel, L.B.

    1998-04-17

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

  2. Lower limb mechanics during moderate high-heel jogging and running in different experienced wearers.

    PubMed

    Fu, Fengqin; Zhang, Yan; Shu, Yang; Ruan, Guoqing; Sun, Jianjun; Baker, Julien; Gu, Yaodong

    2016-08-01

    The aim of this study is to investigate the differences in lower limb kinematics and kinetics between experienced (EW) and inexperienced (IEW) moderate high-heel wearers during jogging and running. Eleven experienced female wearers of moderate high-heel shoes and eleven matched controls participated in jogging and running tests. A Vicon motion analysis system was used to capture kinematic data and a Kistler force platform was used to collect ground reaction force (GRF). There were no significant differences in jogging and running speed respectively. Compared with IEW, EW adopted larger stride length (SL) with lower stride frequency (SF) at each corresponding speed. During running, EW enlarged SL significantly while IEW increased both SL and SF significantly. Kinematic data showed that IEW had generally larger joint range of motion (ROM) and peak angles during stance phase. Speed effect was not obvious within IEW. EW exhibited a significantly increased maximal vertical GRF (Fz2) and vertical average loading rate (VALR) during running, which was potentially caused by overlong stride. These suggest that both EW and IEW are at high risk of joint injuries when running on moderate high heels. For wearers who have to do some running on moderate high heels, it is crucial to control joint stability and balance SL and SF consciously. PMID:27101561

  3. [Simplification and codification of treatment for leprous plantar ulcers].

    PubMed

    Grauwin, M Y; Hirzel, C; Mane, I; Cartel, J L; Lepers, J P

    1997-01-01

    Practically leprous plantar ulcers (PU) are difficult to treat and heal under field condition. Considering the important number of patients showing a PU, the directors of national leprosy control programmes are determined, within the programmes on prevention of disabilities (POD), to treat the PU in the field. Therefore it appears to be essential to codify and simplify their treatment thus enabling it to be effective. The healing of PU being the only criteria of effectiveness of the technique. Four clinical stages were defined, each corresponding to a precise way of treatment using only essential and basic products at low cost. During the trainings about the treatment techniques and attitudes much emphasize is given on the discharge of the PU, on the trimming of the wound and on the products to use according to PU's evolutionary stage.

  4. Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot.

    PubMed

    Kadam, Dinesh

    2016-06-01

    Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1). The duration of the ulcer ranged from 1 to 18 years. Fifteen patients had associated systemic comorbidities and six had previous attempts. Free flaps used in reconstruction were the anterolateral thigh flap (n = 18), radial artery forearm flap (n = 4), and the gracilis muscle flap (n = 4). Recipient vessels were the posterior tibial artery (end to side) in 19 and the dorsalis pedis artery in 7. Results The average age at presentation was 44.6 years with mean duration of ulcer of 5.8 years predominantly located over weight-bearing areas. Mean size of ulcer was 59.45 cm(2) and mean follow-up period was 48 months. All flaps survived except a partial loss. Average time to resume ambulation was 6 weeks. Three patients had recurrence with mean follow-up of 48 months. Secondary flap reduction and bony resection was done in four. Conclusion Microvascular reconstruction of the sole has advantages of vascularity, adequate tissue, and leaving rest of the foot undisturbed for offloading. Three significant local conditions influencing selection and transfer of the flap include (1) distally located forefoot ulcers, (2) extensive subcutaneous fibrosis secondary to frequent inflammation, and (3) Charcot arthropathy. In our series, the anterolateral thigh flap is our first choice for reconstruction of these defects.

  5. Three-dimensional evaluation of heel raise test in pediatric planovalgus feet and normal feet.

    PubMed

    Krautwurst, Britta K; Wolf, Sebastian I; Dreher, Thomas

    2016-07-01

    Planovalgus foot is a common pediatric deformity which may be associated with pain. To evaluate flexibility of the foot, the heel raise test is used. During this test the arch and hindfoot are assessed. Several studies have described planovalgus foot based on 3D gait and standing analysis. However, no studies have evaluated foot flexibility during heel raise using an objective 3D analysis. Therefore, the purpose of this study is to evaluate the flexibility of planovalgus feet during the heel raise test using an objective 3D assessment and to determine whether any hypotheses can be generated about potential differences between painful and painless flexible planovalgus feet and reference feet. Here, 3D foot analysis was conducted in 33 children (7 reference feet, 16 painless, and 10 painful flexible planovalgus feet) during the heel raise test. To identify the characteristics of planovalgus foot, the concept of 3D projection angles was used as introduced in the Heidelberg Foot Measurement Method (HFMM), with a modified marker set. All feet showed dynamic movements of the medial arch and hindfoot from valgus to varus position during heel raise. Reference feet had the smallest range of motion, perhaps due to joint stability and absence of foot deformity. Painful and painless flexible planovalgus feet demonstrated similar movements. No significant differences were found between the painful and painless groups. However, the kinematics of the pain group seemed to differ more from those of the reference group than did kinematics of the painless group. This assessment is a new, practical, and objective method to measure the flexibility of small children's feet. PMID:27262407

  6. Three-dimensional evaluation of heel raise test in pediatric planovalgus feet and normal feet.

    PubMed

    Krautwurst, Britta K; Wolf, Sebastian I; Dreher, Thomas

    2016-07-01

    Planovalgus foot is a common pediatric deformity which may be associated with pain. To evaluate flexibility of the foot, the heel raise test is used. During this test the arch and hindfoot are assessed. Several studies have described planovalgus foot based on 3D gait and standing analysis. However, no studies have evaluated foot flexibility during heel raise using an objective 3D analysis. Therefore, the purpose of this study is to evaluate the flexibility of planovalgus feet during the heel raise test using an objective 3D assessment and to determine whether any hypotheses can be generated about potential differences between painful and painless flexible planovalgus feet and reference feet. Here, 3D foot analysis was conducted in 33 children (7 reference feet, 16 painless, and 10 painful flexible planovalgus feet) during the heel raise test. To identify the characteristics of planovalgus foot, the concept of 3D projection angles was used as introduced in the Heidelberg Foot Measurement Method (HFMM), with a modified marker set. All feet showed dynamic movements of the medial arch and hindfoot from valgus to varus position during heel raise. Reference feet had the smallest range of motion, perhaps due to joint stability and absence of foot deformity. Painful and painless flexible planovalgus feet demonstrated similar movements. No significant differences were found between the painful and painless groups. However, the kinematics of the pain group seemed to differ more from those of the reference group than did kinematics of the painless group. This assessment is a new, practical, and objective method to measure the flexibility of small children's feet.

  7. Surgical correction of metatarsophalangeal joint dislocation and arthritic deformity: the partial head and plantar condylectomy.

    PubMed

    Buxbaum, F D

    1979-01-01

    The partial head and plantar condylectomy has been presented as a procedure indicated in the correction of dislocated metatarsophalangeal joints. Although there may be a number of causes of dislocation, the surgical correction is the same. A skin plasty is useful in preventing a cocked-up toe, and this is performed at the plantar aspect of the base of the toe. A V-osteotomy, or other metatarsal dorsiflectory procedure, is recommended when the neighboring metatarsal is only slightly plantar flexed or greater. This prevents the occurrence of transfer lesions so commonly associated with this procedure. Two case studies have been presented demonstrating successful results when the procedure is performed on both the second and third metatarsophalangeal joints. We contend that the partial head and plantar condylectomy is a valuable procedure in reconstructive surgery of the foot. PMID:263016

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  10. Stimulation of the medial plantar nerve for complex regional pain syndrome.

    PubMed

    Mobbs, Ralph J; Lazarro, Amanda

    2010-11-01

    We describe a 47-year old male with complex regional pain syndrome II in the distribution of the medial plantar nerve following metatarsal fracture, which was treated with peripheral nerve stimulation. Using a new technique of nerve stimulation with a percutaneous-type electrode, the patient experienced sustained relief at 12 months follow-up. To our knowledge, this is the first report of peripheral neurostimulation effectively managing pain for the medial plantar nerve. PMID:20708936

  11. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis.

    PubMed

    Osborne, H R; Breidahl, W H; Allison, G T

    2006-06-01

    Plantar fasciitis is a clinical diagnosis and is often combined with some form of imaging to validate the diagnosis. The clinical utility of lateral X-rays lies in the fact that they are relatively inexpensive and may contribute to ruling out other osseous causes of pain. In this study 106 (27 plantar fasciitis (PF) and 79 controls) plain non-weight bearing lateral X-rays were examined by a blind examiner to document the key features of the lateral X-ray between images of individuals with and without plantar fasciitis. As expected calcaneal spurs were observed in both groups (85% PF and 46% controls). However, plantar fascia thickness and fat pad abnormalities resulted in the best group differentiation (p<0.0001) with sensitivity of 85% and specificity of 95% for plantar fasciitis. It was concluded that the key radiological features that differentiate the groups were not spurs but rather changes in the soft tissues. If it is deemed necessary to confirm the diagnosis of typical plantar fasciitis with imaging, a lateral non-weight bearing X-ray should be the first choice investigation especially if these key features are noted.

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

    PubMed

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

    2015-02-01

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

  13. Plantar Pressures During Long Distance Running: An Investigation of 10 Marathon Runners

    PubMed Central

    Hohmann, Erik; Reaburn, Peter; Tetsworth, Kevin; Imhoff, Andreas

    2016-01-01

    The objective of this study was to record plantar pressures using an in-shoe measuring system before, during, and after a marathon run in ten experienced long-distance runners with a mean age of 37.7 ± 11.5 years. Peak and mean plantar pressures were recorded before, after, and every three km during a marathon race. There were no significant changes over time in peak and mean plantar pressures for either the dominant or non-dominant foot. There were significant between foot peak and mean plantar pressure differences for the total foot (p = 0.0001), forefoot (p = 0.0001), midfoot (p = 0.02 resp. p = 0.006), hindfoot (p = 0.0001), first ray (p = 0.01 resp. p = 0.0001) and MTP (p = 0.05 resp. p = 0.0001). Long-distance runners do not demonstrate significant changes in mean or peak plantar foot pressures over the distance of a marathon race. However, athletes consistently favoured their dominant extremity, applying significantly higher plantar pressures through their dominant foot over the entire marathon distance. Key points Fatigue does not increase foot pressures Every runner has a dominant foot where pressures are higher and that he/she favours Foot pressures do not increase over the distance of a marathon run PMID:27274662

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

    SciTech Connect

    Fellinger, A.

    2010-02-16

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

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

    PubMed Central

    Barnish, Maxwell S; Barnish, Jean

    2016-01-01

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

  16. EFFECT OF SECOND TOE-TO-HAND TRANSFER ON THE PLANTAR PRESSURE DISTRIBUTION OF THE DONOR FOOT

    PubMed Central

    Li, Bing; Chen, Da-wei; Yang, Yun-feng; Yu, Guang-rong

    2016-01-01

    ABSTRACT Objective: To investigate the effect of second toe-to-hand transfer on the plantar pressure distribution of the donor foot. Methods: Twelve normal fresh-frozen cadaveric foot specimens were subjected to an axial load of 600 N. An F-Scan plantar pressure analysis system was used to measure the forefoot plantar pressure. The testing was performed under the conditions of intact second toe, second toe removal with the second metatarsal head reserved, and second toe removal in combination with the distal one-third of the second metatarsal, respectively. Results: The peak pressure of the second metatarsal head was greater than other four forefoot plantar regions. There was no statistically significant change in the forefoot plantar pressure distribution after the second toe was removed (p > 0.05). When the second toe and the distal one-third of the second metatarsal were removed, the forefoot plantar pressure distribution changed significantly (p < 0.05). Conclusions: An intact second metatarsal is essential for the normal distribution of plantar pressure. Removal of the second toe with the second metatarsal head reserved had little influence on the plantar pressure distribution of the donor foot. Removal of the second toe and distal one-third of the second metatarsal resulted in abnormal plantar pressure distribution. Level of Evidence II, Experimental Study. PMID:26997913

  17. Heel-shoe interactions and the durability of EVA foam running-shoe midsoles.

    PubMed

    Verdejo, R; Mills, N J

    2004-09-01

    A finite element analysis (FEA) was made of the stress distribution in the heelpad and a running shoe midsole, using heelpad properties deduced from published force-deflection data, and measured foam properties. The heelpad has a lower initial shear modulus than the foam (100 vs. 1050 kPa), but a higher bulk modulus. The heelpad is more non-linear, with a higher Ogden strain energy function exponent than the foam (30 vs. 4). Measurements of plantar pressure distribution in running shoes confirmed the FEA. The peak plantar pressure increased on average by 100% after 500 km run. Scanning electron microscopy shows that structural damage (wrinkling of faces and some holes) occurred in the foam after 750 km run. Fatigue of the foam reduces heelstrike cushioning, and is a possible cause of running injuries.

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

    PubMed

    Jung, Jaemin; Lee, Sang-Yeol

    2014-11-01

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

  19. The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running.

    PubMed

    McDonald, Kirsty A; Stearne, Sarah M; Alderson, Jacqueline A; North, Ian; Pires, Neville J; Rubenson, Jonas

    2016-01-01

    Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ) excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike) performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert), and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption) and the arch (energy production during recoil). This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running.

  20. The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running.

    PubMed

    McDonald, Kirsty A; Stearne, Sarah M; Alderson, Jacqueline A; North, Ian; Pires, Neville J; Rubenson, Jonas

    2016-01-01

    Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ) excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike) performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert), and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption) and the arch (energy production during recoil). This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running. PMID:27054319

  1. Saccadic Eye Movement Improves Plantar Sensation and Postural Balance in Elderly Women.

    PubMed

    Bae, Youngsook

    2016-01-01

    Vision, proprioception and plantar sensation contribute to the control of postural balance (PB). Reduced plantar sensation alters postural response and is at an increased risk of fall, and eye movements reduce the postural sway. Therefore, the aim of this study was to study the improvement of plantar sensation and PB after saccadic eye movement (SEM) and pursuit eye movement (PEM) in community-dwelling elderly women. Participants (104 females; 75.11 ± 6.25 years) were randomly allocated into the SEM group (n = 52) and PEM groups (n = 52). The SEM group performed eye fixation and SEM for 5 minutes, and the PEM group performed eye fixation and PEM for 5 minutes. The plantar sensation was measured according to the plantar surface area of the feet in contact with the floor surface before and after the intervention. Before and after SEM and PEM with the eyes open and closed, PB was measured as the area (mm(2)), length (cm), and velocity (cm/s) of the fluctuation of the center of pressure (COP). The plantar sensation of both feet improved in both groups (p < 0.01). Significant decreases in the area, length, and velocity of the COP were observed in the eye open and close in both groups (p < 0.01). The length and velocity of the COP significantly decreased in the SEM group compared to the PEM group (p < 0.05). In conclusion, SEM and PEM are effective interventions for improving plantar sensation and PB in elderly women, with greater PB improvement after SEM.

  2. The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running

    PubMed Central

    McDonald, Kirsty A.; Stearne, Sarah M.; Alderson, Jacqueline A.; North, Ian; Pires, Neville J.; Rubenson, Jonas

    2016-01-01

    Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ) excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike) performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert), and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption) and the arch (energy production during recoil). This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running. PMID:27054319

  3. An investigation into plantar pressure measurement protocols for footwear research.

    PubMed

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

    2014-09-01

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

  4. Intramedullary decompression with condylectomy for intractable plantar keratoma.

    PubMed

    Roven, M D

    1985-07-01

    A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated. This method has proved less traumatic than previous procedures, permitting immediate ambulation with little postoperative pain or edema. In a series of cases, I have compared this method with control studies on the same patient in which intramedullary metatarsal decompression was performed on one foot and a neck osteotomy on the opposite foot. Results with intramedullary metatarsal decompression have been comparable but have fewer postoperative sequelae. Exuberant bone callus formation dorsally and at the osteotomy site, lateral displacement of bone segments, frequency of transfer lesions, delayed healing or nonunion of the osteotomy site, and the possibility of synostosis when two adjacent bones were osteotomized are all decreased. A short review of the rationale, selection of cases, and criteria for orthotics is presented. The concept and simplified method of treatment applied in a series of cases is described. PMID:4028490

  5. Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.

    PubMed

    Palmanovich, Ezequiel; Shabat, Shay; Brin, Yaron S; Feldman, Viktor; Kish, Benny; Nyska, Meir

    2015-01-01

    Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn. PMID:26253476

  6. Influence of shoes and heel strike on the loading of the hip joint.

    PubMed

    Bergmann, G; Kniggendorf, H; Graichen, F; Rohlmann, A

    1995-07-01

    The forces and moments acting at the hip joint influence the long-term stability of the fixation of endoprostheses and the course of coxarthrosis. These loads may depend on the kind of footwear and the walking or running style. These factors were investigated in a patient with instrumented hip implants. He wore different sports shoes, normal leather shoes, hiking boots and clogs and walked barefoot with soft, normal and hard heel strikes. The loads were lowest while walking and jogging without shoes. All shoes increased the joint force and the bending moment at the implant slightly but the torsional moment rose by up to 50%. No relation was found between the different type of shoes and the load increase, only shoes with very hard soles were clearly disadvantageous. Soft heels, soles or insoles did not offer advantages. Gait stability seems to play the most important role in increasing the joint loading and should be the criterion for the choice of footwear. Smooth gait patterns with soft heel strikes are the only means to reduce joint loading during slow jogging. PMID:7657680

  7. Dynamic material characterization of the human heel pad based on in vivo experimental tests and numerical analysis.

    PubMed

    Kardeh, M; Vogl, T J; Huebner, F; Nelson, K; Stief, F; Silber, G

    2016-09-01

    A numerical-experimental, proof-of-concept approach is described to characterize the mechanical material behavior of the human heel pad under impact conditions similar to a heel strike while running. A 3D finite-element model of the right foot of a healthy female subject was generated using magnetic resonance imaging. Based on quasi-static experimental testing of the subject's heel pad, force-displacement data was obtained. Using this experimental data as well as a numerical optimization algorithm, an inverse finite-element analysis and the 3D model, heel pad hyperelastic (long-term) material parameters were determined. Applying the same methodology, based on the dynamic experimental data from the impact test and obtained long-term parameters, linear viscoelastic parameters were established with a Prony series. Model validation was performed employing quasi-static and dynamic force-displacement data. Coefficients of determination when comparing model to experimental data during quasi-static and dynamic (initial velocity: 1480mm/s) procedure were R(2) = 0.999 and R(2) = 0.990, respectively. Knowledge of these heel pad material parameters enables realistic numerical analysis to evaluate internal stress and strain in the heel pad during different quasi-static or dynamic load conditions.

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

    PubMed

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

    2010-11-01

    Shock absorption and stability during landings is provided by both, gymnast ability and mat properties. The aims of this study were to determine the influence of different mat constructions on their energy absorption and stability capabilities, and to analyse how these properties affect gymnast's plantar pressures as well as subjective mat perception during landing. Six mats were tested using a standard mechanical drop test. In addition, plantar pressures and subjective perception during landing were obtained from 15 expert gymnasts. The different mats influenced plantar pressures and gymnasts' subjective perception during landing of gymnasts. Significant correlations between plantar pressures at the medial metatarsal and lateral metatarsal zones of the gymnasts' feet with the different shock absorption characteristics of the mats were found. However, subjective perception tests were not able to discriminate mat functionality between the six mats as no significant correlations between the mechanical mat properties with the subjective perception of these properties were found. This study demonstrated that plantar pressures are a useful tool for discriminating different landing mats. Using similar approaches, ideally including kinematics as well, could help us in our understanding about the influences of different mats upon gymnast-mat interaction. PMID:21309299

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

    PubMed Central

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

    2014-01-01

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

  10. Foot posture, range of motion and plantar pressure characteristics in obese and non-obese individuals.

    PubMed

    Butterworth, Paul A; Urquhart, Donna M; Landorf, Karl B; Wluka, Anita E; Cicuttini, Flavia M; Menz, Hylton B

    2015-02-01

    Obesity is a world-wide health problem and is strongly associated with musculoskeletal disorders of the lower limb. The aim of this study was to evaluate plantar loading patterns in obese and non-obese individuals, while accounting for the contribution of foot structure, range of motion and walking speed. Sixty-eight participants (mean±SD age, 52.6±8.0 years), including 47 females (69%), underwent assessments of body mass index, foot pain and foot structure. Plantar pressures were also obtained, using a floor-mounted resistive sensor mat system. Multiple regression analysis was used to determine which variables were most strongly associated with plantar loading patterns. Obese individuals exhibited flatter feet, reduced inversion-eversion range of motion, and higher peak plantar pressures when walking. After accounting for foot structure and walking speed, bodyweight was found to be significantly associated with elevated loading of the foot, particularly the forefoot and midfoot. These findings suggest that obesity increases the stresses applied to the foot directly, via increased bodyweight, and indirectly, via alterations to foot structure, which may partly explain the link between obesity and the development of foot pain. Clinicians dealing with foot problems should consider the effect of increased bodyweight on plantar loading in obese patients.

  11. Three-dimensional morphology of heel fat pad: an in vivo computed tomography study

    PubMed Central

    Campanelli, Valentina; Fantini, Massimiliano; Faccioli, Niccolò; Cangemi, Alessio; Pozzo, Antonio; Sbarbati, Andrea

    2011-01-01

    Heel fat pad cushioning efficiency is the result of its structure, shape and thickness. However, while a number of studies have investigated heel fat pad (HFP) anatomy, structural behavior and material properties, no previous study has described its three-dimensional morphology in situ. The assessment of the healthy, unloaded, three-dimensional morphology of heel pad may contribute to deepen the understanding of its role and behavior during locomotion. It is the basis for the assessment of possible HFP morphological modifications due to changes in the amount or distribution of the loads normally sustained by the foot. It may also help in guiding the surgical reconstruction of the pad and in improving footwear design, as well as in developing a correct heel pad geometry for finite element models of the foot. Therefore the purpose of this study was to obtain a complete analysis of HFP three-dimensional morphology in situ. The right foot of nine healthy volunteers was scanned with computed tomography. A methodological approach that maximizes reliability and repeatability of the data was developed by building a device to lock the foot in a neutral position with respect to the scan planes during image acquisition. Scan data were used to reconstruct virtual three-dimensional models for both the calcaneus and HFP. A set of virtual coronal and axial sections were extracted from the three-dimensional model of each HFP and processed to extract a set of one- and two-dimensional morphometrical measurements for a detailed description of heel pad morphology. The tissue exhibited a consistent and sophisticated morphology that may reflect the biomechanics of the foot support. HFP was found to be have a crest on its anterior dorsal surface, flanges on the sides and posteriorly, and a thick portion that reached and covered the posterior surface of the calcaneus and the achilles tendon insertion. Its anterior internal portion was thinner and a lump of fat was consistently present in

  12. THE RELATIONSHIP BETWEEN ISOTONIC PLANTAR FLEXOR ENDURANCE, NAVICULAR DROP, AND EXERCISE-RELATED LEG PAIN IN A COHORT OF COLLEGIATE CROSS-COUNTRY RUNNERS

    PubMed Central

    Reinking, Mark F.; Rauh, Mitchell J.

    2012-01-01

    Purpose: The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP). Background: Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries. Methods: Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP. Results: While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2–38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1–48.9) more likely to develop an in-season occurrence of ERLP. Conclusion: While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP. Level of Evidence: 2b. PMID:22666641

  13. Extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis--a biometrical review.

    PubMed

    Böddeker, R; Schäfer, H; Haake, M

    2001-01-01

    The application of extracorporeal shockwave therapy (ESWT) as a treatment for conservatively unsuccessfully treated plantar fasciitis has experienced a rapid increase over the last years. However, the efficacy of ESWT has not yet been established unequivocally, as published studies have led to inconsistent results. Furthermore, reviews on clinical trials on ESWT are either not up to date, incomplete, or methodologically inadequate. As a consequence, a systematic literature search was conducted which yielded 21 relevant articles on ESWT in the treatment of plantar fasciitis. These were rated according to biometrical criteria for the conduct of therapeutic trials based on international guidelines. None of the rated trials fulfilled all of the criteria, and it is concluded that at this point the efficacy of ESWT can be neither confirmed nor excluded. Randomised and controlled clinical trials are required to adequately estimate the value of ESWT as a treatment for plantar fasciitis.

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

    PubMed

    Tatli, Yusuf Ziya; Kapasi, Sameer

    2009-03-01

    This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid therapy risks. The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection/iontophoresis. These modes were included based on the availability of double blinded randomized controlled trials. We noted the following findings. Orthoses, regardless of type, can improve pain levels. Plantar stretching shows limited short-term benefit (1 month), but can reflect significant long-term improvement (10 months). Extracorporeal shockwave therapy shows equivocal benefit with some studies showing significant improvement and others showing none. Although BTX-A injections were the least studied, significant pain improvement was demonstrated in the short and long term. Steroid injection/iontophoresis showed significant improvement in the short term (1 month). Steroid therapy, when coupled with plantar stretching, can provide efficacious pain relief; however, steroid injections should be combined with ultrasound monitoring to reduce complications.

  15. The football: an intuitive dressing for offloading neuropathic plantar forefoot ulcerations.

    PubMed

    Rader, Andrew J; Barry, Timothy P

    2008-03-01

    A reproducible, affordable, efficacious and safe modality for offloading neuropathic plantar foot ulcerations was previously presented in a pilot study. A follow-up retrospective multicentre analysis of the football dressing is now presented. Wound healing rates are compared with published data on the total contact cast (TCC) and instant total contact cast (iTCC). Overall wound healing rates for University of Texas Health Science Center class 1A, 1B, 1C, 1D, 2A, 2B, 2C and 3B plantar forefoot ulcerations is 2.91 weeks with a 95% confidence interval of 2.36-3.47 weeks for complete wound epithelialisation. The cost associated with this dressing technique is a fraction of that associated with the TCC and iTCC. The ease of application coupled with reliable healing rates and affordable materials makes the football dressing a worthy partner against the sequelae of plantar forefoot ulcerations.

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

    SciTech Connect

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

    2013-07-01

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

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

    SciTech Connect

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

    2013-01-11

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

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

    PubMed Central

    Lockhart, Thurmon E.; Kim, Sukwon

    2010-01-01

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

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

    PubMed

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

    2014-07-15

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

  20. Plantar shear stress distributions in diabetic patients with and without neuropathy

    PubMed Central

    Yavuz, Metin

    2014-01-01

    Background The exact pathology of diabetic foot ulcers remains to be resolved. Evidence suggests that plantar shear forces play a major role in diabetic ulceration. Unfortunately, only a few manuscripts exist on the clinical implications of plantar shear. The purpose of this study was to compare global and regional peak plantar stress values in three groups; diabetic patients with neuropathy, diabetic patients without neuropathy and healthy control subjects. Methods Fourteen diabetic neuropathic patients, 14 non-neuropathic diabetic control and 11 non-diabetic control subjects were recruited. Subjects walked on a custom-built stress plate that quantified plantar pressures and shear. Four stress variables were analyzed; peak pressure, peak shear, peak pressure-time and shear-time integral. Findings Global peak values of peak shear (p=0.039), shear-time integral (p=0.002) and pressure-time integral (p=0.003) were significantly higher in the diabetic neuropathic group. Local peak shear stress and shear-time integral were also significantly higher in diabetic neuropathic patients compared to both control groups, in particular, at the hallux and central forefoot. Local peak pressure and pressure-time integral were significantly different between the three groups at the medial and lateral forefoot. Interpretation Plantar shear and shear-time integral magnitudes were elevated in diabetic patients with peripheral neuropathy, which indicates the potential clinical significance of these factors in ulceration. It is thought that further investigation of plantar shear would lead to a better understanding of ulceration pathomechanics, which in turn will assist researchers in developing more effective preventive devices and strategies. PMID:24332719

  1. Misdiagnosis of plexiform neurofibroma of the medial plantar nerve: case report.

    PubMed

    D'Orazi, Valerio; Venditto, Teresa; Panunzi, Andrea; Anichini, Silvia; Manzini, Gabriele; Tallarico, Arturo; Bernetti, Andrea; Paoloni, Marco

    2014-09-01

    Plexiform neurofibromas are benign tumors of the peripheral nerve. Diagnosis may be challenging, if they present mimicking other peripheral nerve pathologies. We report the case of a patient who had severe foot pain, which progressively hampered her walking ability, erroneously attributed to recurrent Morton's neuroma. Diagnosis of plexiform neurofibroma of her right medial plantar nerve was made 15 years after the appearance of symptoms. Pain and function recovered after radical neurotomy of the medial plantar nerve. A correct diagnosis is an essential starting point in the treatment of neurofibromas and a misdiagnosis may lead to an inappropriate treatment.

  2. Correlation between interdental occlusal plane and plantar arches. An EMG study.

    PubMed

    Valentino, B; Melito, F; Aldi, B; Valentino, T

    2002-01-01

    The Authors carried out an experimental study on a homogeneous group of young people to provide evidence of functional correlation among masticatory muscles and, indirectly, between changes to the interdental occlusal plane and modifications of the plantar arches due to talipes valgus and flat foot. In the two analysed conditions, the masticatory muscles undergo different functional alterations. This is due to the fact that the mechanoreceptors in the tendons of the muscles governing the plantar arch configuration are stimulated in different ways during the activation of long osteoarthromuscular chains. Dental specialists will have to take these correlation into account when diagnosing TMJ disorders.

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

    PubMed

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

    2003-01-01

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

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

    PubMed Central

    Carcia, Christopher R.

    2013-01-01

    Purpose: To determine if heel height alters vertical ground reaction forces (vGRF) when landing from a forward hop or drop landing. Background: Increased vGRF during landing are theorized to increase ACL injury risk in female athletes. Methods: Fifty collegiate females performed two single‐limb landing tasks while wearing heel lifts of three different sizes (0, 12 & 24 mm) attached to the bottom of a athletic shoe. Using a force plate, peak vGRF at landing was examined. Repeated measures ANOVAs were used to determine the influence of heel height on the dependent measures. Results: Forward hop task‐ Peak vGRF (normalized for body mass) with 0 mm, 12 mm, and 24 mm lifts were 2.613±0.498, 2.616±0.497 and 2.495±0.518% BW, respectively. Significant differences were noted between 0 and 24 mm lift (p<.001) and 12 and 24 mm lifts (p=.004), but not between the 0 and 12 mm conditions (p=.927). Jump‐landing task‐ No significant differences were found in peak vGRF (p=.192) between any of the heel lift conditions. Conclusions: The addition of a 24 mm heel lift to the bottom of a sneaker significantly alters peak vGRF upon landing from a unilateral forward hop but not from a jumping maneuver. PMID:23439490

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

    PubMed Central

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

    2015-01-01

    Background: low bone mineral density measured by dual-energy x-ray absorptiometry is associated with increased mortality. The relationship between other skeletal phenotypes and mortality is unclear. The aim of this study was to determine the relationship between quantitative heel ultrasound parameters and mortality in a cohort of European men. Methods: men aged 40–79 years were recruited for participation in a prospective study of male ageing: the European Male Ageing Study (EMAS). At baseline, subjects attended for quantitative ultrasound (QUS) of the heel (Hologic—SAHARA) and completed questionnaires on lifestyle factors and co-morbidities. Height and weight were measured. After a median of 4.3 years, subjects were invited to attend a follow-up assessment, and reasons for non-participation, including death, were recorded. The relationship between QUS parameters (broadband ultrasound attenuation [BUA] and speed of sound [SOS]) and mortality was assessed using Cox proportional hazards model. Results: from a total of 3,244 men (mean age 59.8, standard deviation [SD] 10.8 years), 185 (5.7%) died during the follow-up period. After adjusting for age, centre, body mass index, physical activity, current smoking, number of co-morbidities and general health, each SD decrease in BUA was associated with a 20% higher risk of mortality (hazard ratio [HR] per SD = 1.2; 95% confidence interval [CI] = 1.0–1.4). Compared with those in higher quintiles (2nd–5th), those in the lowest quintile of BUA and SOS had a greater mortality risk (BUA: HR = 1.6; 95% CI = 1.1–2.3 and SOS: HR = 1.6; 95% CI = 1.2–2.2). Conclusion: lower heel ultrasound parameters are associated with increased mortality in European men. PMID:26162912

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

    SciTech Connect

    Keefer, M.

    2012-01-12

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

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

    SciTech Connect

    Callaway, William S.

    2013-09-26

    Eight samples of heel solids from tank 241-C-109 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, one-half to two-thirds of the solids were off-white to tan solids that, visually, were fairly evenly graded in size from coarse silt (30-60 μm) to medium pebbles (8-16 mm). The remaining solids were mostly strongly cemented aggregates ranging from coarse pebbles (16-32 mm) to fine cobbles (6-15 cm) in size. Solid phase characterization and chemical analysis indicated that the air-dry heel solids contained ≈58 wt% gibbsite [Al(OH){sub 3}] and ≈37 wt% natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}·19H{sub 2}O]. The strongly cemented aggregates were mostly fine-grained gibbsite cemented with additional gibbsite. Dissolution testing was performed on two test samples. One set of tests was performed on large pieces of aggregate solids removed from the heel solids samples. The other set of dissolution tests was performed on a composite sample prepared from well-drained, air-dry heel solids that were crushed to pass a 1/4-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

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

    SciTech Connect

    Callaway, William S.

    2013-09-30

    Nine samples of heel solids from tank 241-C-110 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, the sample solids were primarily white to light-brown with minor dark-colored inclusions. The maximum dimension of the majority of the solids was <2 mm; however, numerous pieces of aggregate, microcrystalline, and crystalline solids with maximum dimensions ranging from 5-70 mm were observed. In general, the larger pieces of aggregate solids were strongly cemented. Natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}°19H{sub 2}O] was the dominant solid phase identified in the heel solids. Results of chemical analyses suggested that 85-87 wt% of the heel solids were the fluoridephosphate double salt. The average bulk density measured for the heel solids was 1.689 g/mL; the reference density of natrophosphate is 1.71 g/mL. Dissolution tests on composite samples indicate that 94 to 97 wt% of the tank 241-C-110 heel solids can be retrieved by dissolution in water. Dissolution and recovery of the soluble components in 1 kg (0.59 L) of the heel solids required the addition of ≈9.5 kg (9.5 L) of water at 15 °C and ≈4.4 kg (4.45 L) of water at 45 °C. Calculations performed using the Environmental Simulation Program indicate that dissolution of the ≈0.86 kg of natrophosphate in each kilogram of the tank 241-C-110 heel solids would require ≈9.45 kg of water at 15 °C and ≈4.25 kg of water at 45 °C. The slightly larger quantities of water determined to be required to retrieve the soluble components in 1 kg of the heel solids are consistent with that required for the dissolution of solids composed mainly of natrophosphate with a major portion of the balance consisting of highly soluble sodium salts. At least 98% of the structural water, soluble phosphate, sodium, fluoride, nitrate, carbonate, nitrite, sulfate, oxalate, and chloride in the test composites was dissolved and recovered in the

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

    PubMed

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

    2013-02-04

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

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

    PubMed Central

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  12. Plantar flexor neuromuscular adjustments following match-play football in hot and cool conditions.

    PubMed

    Girard, O; Nybo, L; Mohr, M; Racinais, S

    2015-06-01

    We assessed neuromuscular fatigue and recovery of the plantar flexors after playing football with or without severe heat stress. Neuromuscular characteristics of the plantar flexors were assessed in 17 male players at baseline and ∼30 min, 24, and 48 h after two 90-min football matches in temperate (∼20 °C and 55% rH) and hot (∼43 °C and 20% rH) environments. Measurements included maximal voluntary strength, muscle activation, twitch contractile properties, and rate of torque development and soleus EMG (i.e., root mean square activity) rise from 0 to 30, -50, -100, and -200 ms during maximal isometric contractions for plantar flexors. Voluntary activation and peak twitch torque were equally reduced (-1.5% and -16.5%, respectively; P < 0.05) post-matches relative to baseline in both conditions, the latter persisting for at least 48 h, whereas strength losses (∼5%) were not significant. Absolute explosive force production declined (P < 0.05) 30 ms after contraction onset independently of condition, with no change at any other epochs. Globally, normalized rate of force development and soleus EMG activity rise values remained unchanged. In football, match-induced alterations in maximal and rapid torque production capacities of the plantar flexors are moderate and do not differ after competing in temperate and hot environments.

  13. Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

    PubMed Central

    Ribeiro, Ana Paula; Trombini-Souza, Francis; Tessutti, Vitor; Lima, Fernanda Rodrigues; de Camargo Neves Sacco, Isabel; João, Sílvia Maria Amado

    2011-01-01

    OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms. PMID:21808870

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

    PubMed Central

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

    2015-01-01

    Objective To investigate the correlation between the Foot Posture Index (FPI) (including talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, talonavicular bulging, congruence of the medical longitudinal arch, and abduction/adduction of the forefoot on the rare foot), plantar pressure distribution, and pediatric flatfoot radiographic findings. Methods Nineteen children with flatfoot (age, 9.32±2.67 years) were included as the study group. Eight segments of plantar pressure were measured with the GaitView platform pressure pad and the FPI was measured in children. The four angles were measured on foot radiographs. We analyzed the correlation between the FPI, plantar pressure characteristics, and the radiographic angles in children with flatfoot. Results The ratio of hallux segment pressure and the second through fifth toe segment pressure was correlated with the FPI (r=0.385, p=0.017). The FPI was correlated with the lateral talo-first metatarsal angle (r=0.422, p=0.008) and calcaneal pitch (r=-0.411, p=0.01). Conclusion Our results show a correlation between the FPI and plantar pressure. The FPI and pediatric flatfoot radiography are useful tools to evaluate pediatric flatfoot. PMID:25750866

  15. Light-Emitting Diode Versus Sham in the Treatment of Plantar Fasciitis: A Randomized Trial

    PubMed Central

    Higgins, Paul E.; Hews, Katherine; Windon, Lowell; Chasse, Patrick

    2015-01-01

    Objective The purpose of this preliminary study was to compare the application of the light emitting diode (LED) to sham LED in the treatment of plantar fasciitis. Methods Eighteen subjects met the inclusion criteria and were randomly assigned into 2 groups: light emitting diode or sham LED. The subjects received either the LED at 12 J/cm2 or sham LED along 2 points of the plantar fascia. Subjects in both groups received a 10 minute transverse friction massage and participated in 4 plantar fascia stretching exercises. All subjects received a total of 6 treatments over 3 weeks. Progress was assessed using the lower extremity functional and analog pain scale. Results No significant difference was found between treatment groups (P = .845). There was a significant difference in pain and outcome scores over time within both groups (P < .35). Conclusion Among patients with plantar fasciitis, the use of LED did not result in greater improvement in function or pain compared with sham treatment. The findings suggest that manual intervention and passive stretching activities may have provided significant pain relief and improvement in functional outcome scores. PMID:26644784

  16. The effect of age and body mass index on plantar cutaneous sensation in healthy women

    PubMed Central

    Yümin, Eylem Tütün; Şimşek, Tülay Tarsuslu; Sertel, Meral; Ankaralı, Handan

    2016-01-01

    [Purpose] This study was conducted to examine the effects of age and body mass index on plantar cutaneous sensation in healthy women. [Subjects and Methods] Two hundred and three healthy female volunteers over the age of 20 were included in the study. The statistical analyses were performed by considering the age and body mass index values of the individuals. The individuals were divided according to their ages and body mass index values. Foot pain was measured with a visual analogue scale and plantar cutaneous sensation using Semmes-Weinstein monofilaments. [Results] Fifty-six (27.5%) of the participants had normal weights, 67 (33%) were overweight, and 80 (39%) were obese. Statistical analysis revealed that as age and body mass index values increased, plantar sensitivity decreased and the frequency and severity of pain increased. [Conclusion] It is possible that healthy women may experience a decrease in foot plantar sensation with increasing weight and age. If women do not have any health problems, proprioception and sensory training must be focused on in order to prevent balance and falling problems. PMID:27799700

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

    PubMed

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

    2012-03-01

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

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

    ERIC Educational Resources Information Center

    Vidmar, Gaj; Novak, Primoz

    2009-01-01

    Plantar pressures measurement is a frequently used method in rehabilitation and related research. Metric characteristics of the F-Scan system have been assessed from different standpoints and in different patients, but not its reliability in rheumatoid arthritis patients. Therefore, our objective was to assess reliability of the F-Scan plantar…

  19. Use of the inverted “T” incision to approach a plantar nodular lesion*

    PubMed Central

    Sampaio, Felipe Maurício Soeiro; Gualberto, Gustavo Vieira; de Souza, Paulo Roberto Cotrim; Lourenço, Fabrício Tinoco; de Cerqueira, Fernando Gustavo Mósca

    2015-01-01

    Knowledge of the inverted "T" incision - used in plastic, oncologic and orthopedic surgery - has allowed its adaptation for the diagnostic assessment and therapeutical approach of acral, nodular lesions. The authors describe the use of this technique for the surgical approach of a patient with a plantar nodular lesion, further diagnosed as a calcified angioleiomyoma. PMID:25672316

  20. The prevalence of dermatophyte infections in hereditary palmo-plantar keratoderma.

    PubMed

    Gamborg Nielsen, P

    1983-01-01

    The prevalence of dermatophyte infections in hereditary palmo-plantar keratoderma of the Unna Thost variety was investigated. Sixty patients, who represented 7.5% of a well defined population, participated in the study. The prevalence was found to be about 40%. At the same time the correlation between direct microscopic examination and conventional culture methods was shown to be 88.5%.

  1. Stresses in the plantar region for long- and short-range throws in women basketball players.

    PubMed

    Pau, Massimiliano; Ciuti, Carla

    2013-01-01

    This study aimed to assess plantar pressure pattern modifications caused by short- and long-distance shots in women basketball players. To this end, 24 experienced national- and regional-level basketball players performed 3 trials of 4 technical gestures (free throw, jump stop shot, three-point shot and lay-up) barefoot on a pressure platform placed in fixed positions on the court. Raw data were processed to calculate location and magnitude of pressure peaks in three sub-regions (forefoot, midfoot and rearfoot), and the increase ratio was calculated relative to plantar pressure measured during a static bipedal and unipedal upright stance. The results showed significant increases (p<0.001) in plantar pressure peaks in forefoot (but not midfoot and rearfoot) for all the gestures that involved the use of both legs. Particularly large increases were detected for the three-point shot. All three sub-regions underwent significant changes of the pressure peak in the case of lay-up (forefoot and rearfoot: p<0.001, midfoot: p=0.002). The high levels of contact stress detected for routinely performed technical gestures suggest that a detailed knowledge of changes in the physiological patterns of plantar stresses that take place during play is crucial in reducing the risk of foot injuries and establishing proper training and rehabilitation protocols. PMID:24050476

  2. Stresses in the plantar region for long- and short-range throws in women basketball players.

    PubMed

    Pau, Massimiliano; Ciuti, Carla

    2013-01-01

    This study aimed to assess plantar pressure pattern modifications caused by short- and long-distance shots in women basketball players. To this end, 24 experienced national- and regional-level basketball players performed 3 trials of 4 technical gestures (free throw, jump stop shot, three-point shot and lay-up) barefoot on a pressure platform placed in fixed positions on the court. Raw data were processed to calculate location and magnitude of pressure peaks in three sub-regions (forefoot, midfoot and rearfoot), and the increase ratio was calculated relative to plantar pressure measured during a static bipedal and unipedal upright stance. The results showed significant increases (p<0.001) in plantar pressure peaks in forefoot (but not midfoot and rearfoot) for all the gestures that involved the use of both legs. Particularly large increases were detected for the three-point shot. All three sub-regions underwent significant changes of the pressure peak in the case of lay-up (forefoot and rearfoot: p<0.001, midfoot: p=0.002). The high levels of contact stress detected for routinely performed technical gestures suggest that a detailed knowledge of changes in the physiological patterns of plantar stresses that take place during play is crucial in reducing the risk of foot injuries and establishing proper training and rehabilitation protocols.

  3. Arch-Taping Techniques for Altering Navicular Height and Plantar Pressures During Activity

    PubMed Central

    Newell, Tim; Simon, Janet; Docherty, Carrie L.

    2015-01-01

    Context Arch tapings have been used to support the arch by increasing navicular height. Few researchers have studied navicular height and plantar pressures after physical activity. Objective To determine if taping techniques effectively support the arch during exercise. Design Crossover study. Setting Athletic training research laboratory. Patients or Other Participants Twenty-five individuals (13 men, 12 women; age = 20.0 ± 1.0 years, height = 172.3 ± 6.6 cm, mass = 70.1 ± 10.2 kg) with a navicular drop of more than 8 mm (12.9 ± 3.3 mm) volunteered. Intervention(s) All individuals participated in 3 days of testing, with 1 day for each tape condition: no tape, low dye, and navicular sling. On each testing day, navicular height and plantar pressures were measured at 5 intervals: baseline; posttape; and after 5, 10, and 15 minutes of running. The order of tape condition was counterbalanced. Main Outcome Measure(s) The dependent variables were navicular height in millimeters and plantar pressures in kilopascals. Plantar pressures were divided into 5 regions: medial forefoot, lateral forefoot, lateral midfoot, lateral rearfoot, and medial rearfoot. Separate repeated-measures analyses of variance were conducted for each dependent variable. Results Navicular height was higher immediately after application of the navicular-sling condition (P = .004) but was reduced after 5 minutes of treadmill running (P = .12). We observed no differences from baseline to posttape for navicular height for the low-dye (P = .30) and no-tape conditions (P = .25). Both the low-dye and navicular-sling conditions increased plantar pressures in the lateral midfoot region compared with the no-tape condition. The low-dye condition created decreased pressure in the medial and lateral forefoot regions compared with the no-tape condition. All changes were identified immediately after application and were maintained during running. No changes were noted in plantar pressures for the no

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

    SciTech Connect

    Thaxton, D; Timothy Baughman, T

    2008-01-16

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

  5. Chronic arsenic poisoning.

    PubMed

    Hall, Alan H

    2002-03-10

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

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

    PubMed

    Uhl, J-F; Gillot, C

    2012-08-01

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

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

    PubMed Central

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

    2012-01-01

    The human locomotor system is flexible and enables humans to move without falling even under less than optimal conditions. Walking with high-heeled shoes constitutes an unstable condition and here we ask how the nervous system controls the ankle joint in this situation? We investigated the movement behavior of high-heeled and barefooted walking in eleven female subjects. The movement variability was quantified by calculation of approximate entropy (ApEn) in the ankle joint angle and the standard deviation (SD) of the stride time intervals. Electromyography (EMG) of the soleus (SO) and tibialis anterior (TA) muscles and the soleus Hoffmann (H-) reflex were measured at 4.0 km/h on a motor driven treadmill to reveal the underlying motor strategies in each walking condition. The ApEn of the ankle joint angle was significantly higher (p<0.01) during high-heeled (0.38±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. PMID:22615997

  8. [Incurable keratitis and chronic palmoplantar hyperkeratosis with hypertyrosinemia. Cure using a tyrosine-restricted diet. Type II tyrosinemia].

    PubMed

    Hervé, F; Moreno, J L; Ogier, H; Saudubray, J M; De Prost, Y; Duffier, J L; Charpentier, C; Lemonnier, F; Frézal, J

    1986-01-01

    One should henceforth systematically search for hypertyrosinemia which, too often, goes unrecognized for years, in patients presenting chronic keratitis associated with palmar and plantar hyperkeratosis. As a matter of fact, this highly crippling disease may be cured with an appropriate diet and the diagnosis, once suspected, is easily confirmed by simple investigations.

  9. Use of IHF--mediated Achilles' heel cleavage (IHF-AC) method for mapping ihf sites.

    PubMed

    Kur, J

    1993-01-01

    We have shown that Integration Host Factor of E. coli can successfully be used in the IHF-mediated Achilles' Heel Cleavage (IHF-AC) technique (Kur et al., 1992b), for generating rare natural cleavage sites. The first step of this procedure is methylation of DNA in the presence of IHF, when the overlapping ihf/restriction sites are protected from methylation, and in the second step the DNA is cut by the cognate restriction enzyme. The extent of cleavage could be controlled by varying the IHF:DNA ratio and temperature. The aim of the present study is to demonstrate that IHF-AC procedure might serve as a useful tool for finding new protein-binding sites which overlap known restriction sites. I have used this approach in conjunction with several MTases to find several other unknown IHF-binding sites.

  10. Chronic pancreatitis

    MedlinePlus

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

  11. Effects of knee joint angle on the fascicle behavior of the gastrocnemius muscle during eccentric plantar flexions.

    PubMed

    Wakahara, Taku; Kanehisa, Hiroaki; Kawakami, Yasuo; Fukunaga, Tetsuo

    2009-10-01

    The present study aimed to clarify the effects of knee joint angle on the behavior of the medial gastrocnemius muscle (MG) fascicles during eccentric plantar flexions. Eight male subjects performed maximal eccentric plantar flexions at two knee positions [fully extended (K0) and 90 degrees flexed (K90)]. The eccentric actions were preceded by static plantar flexion at a 30 degrees plantar flexed position and then the ankle joint was forcibly dorsiflexed to 15 degrees of dorsiflexion with an isokinetic dynamometer at 30 degrees /s and 150 degrees /s. Tendon force was calculated by dividing the plantar flexion torque by the estimated moment arm of the Achilles tendon. The MG fascicle length was determined with ultrasonography. The tendon forces during eccentric plantar flexions were influenced by the knee joint angle, but not by the angular velocity. The MG fascicle lengths were elongated as the ankle was dorsiflexed in K0, but in K90 they were almost constant despite the identical range of ankle joint motion. These results suggested that MG fascicle behavior during eccentric actions was markedly affected by the knee joint angle. The difference in the fascicle behavior between K0 and K90 could be attributed to the non-linear force-length relations and/or to the slackness of tendinous tissues.

  12. Chemical and mechanical clogging of groundwater abstraction wells at well field Heel, the Netherlands

    NASA Astrophysics Data System (ADS)

    van Beek, C. G. E. M.; Hubeek, A. A.; de la Loma Gonzalez, B.; Stuyfzand, P. J.

    2016-09-01

    Well field Heel, in the south east of the Netherlands, consists of a row of wells drilled in an anoxic pyrite-containing aquifer alongside a former gravel pit, which now serves as a recharge basin, where water is actively aerated. All wells are seriously affected by chemical (screen slot) and/or mechanical (well bore) clogging. The objective of this study is to explain this combined occurrence. A combination of chemical, hydraulic and well-maintenance data indicate three groundwater quality types: (1) oxic basin water, (2) anoxic iron-containing basin water after oxidation of the traversed aquifer, and (3) deeply anoxic native groundwater. Wells abstracting a mixture of oxic basin water and anoxic basin water and/or native groundwater experience chemical well clogging, whereas wells abstracting (only or partly) native groundwater are vulnerable to mechanical well clogging. In the end, after oxic basin water has completely oxidized the traversed the aquifer, only two groundwater quality types will be present. Wells abstracting only oxic basin water will show no clogging, and wells abstracting a mixture of native groundwater and oxic basin water will experience chemical and possibly also mechanical well clogging. In this reasoning, the sequence in abstracted groundwater quality types coincides with a sequence in well clogging: from mechanical to chemical to no clogging. As well field Heel is situated in sloping terrain, the interplay between regional hydraulic gradient and different water qualities results in one-sided chemical clogging in the upper part of the well screen during abstraction, and in the lower part during the resting phase.

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

    PubMed Central

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

    2009-01-01

    There is evidence that appropriate footwear is an important factor in the prevention of foot pain in otherwise healthy people or foot ulcers in people with diabetes and peripheral neuropathy. A standard care for reducing forefoot plantar pressure is the utilization of orthotic devices such as total contact inserts (TCI) with therapeutic footwear. Most neuropathic ulcers occur under the metatarsal heads, and foot deformity combined with high localized plantar pressure, appear to be the most significant factors contributing to these ulcers. In this study, patient-specific finite element models of the second ray of the foot were developed to study the influence of TCI design on peak plantar pressure (PPP) under the metatarsal heads. A typical full contact insert was modified based on the results of finite element analyses, by inserting 4 mm diameter cylindrical plugs of softer material in the regions of high pressure. Validation of the numerical model was addressed by comparing the numerical results obtained by the finite element method with measured pressure distribution in the region of the metatarsal heads for a shoe and TCI condition. Two subjects, one with a history of forefoot pain and one with diabetes and peripheral neuropathy, were tested in the laboratory while wearing therapeutic shoes and customized inserts. The study showed that customized inserts with softer plugs distributed throughout the regions of high plantar pressure reduced the PPP over that of the TCI alone. This supports the outcome as predicted by the numerical model, without causing edge effects as reported by other investigators using different plug designs, and provides a greater degree of flexibility for customizing orthotic devices than current practice allows. PMID:18266017

  14. Do spike insoles enhance postural stability and plantar-surface cutaneous sensitivity in the elderly?

    PubMed

    Palluel, Estelle; Nougier, Vincent; Olivier, Isabelle

    2008-03-01

    Balance problems are often related to a loss of plantar-sensitivity in elderly people. The purpose of this study was to explore the contribution of plantar cutaneous inputs induced by a spike support surface to the control of stance. Nineteen elderly (mean age 69.0 years, range 62-80) and 19 young adults (mean age 25.9 years, range 21-32) were instructed to stand (standing session) or to walk (walking session) for 5 min with sandals equipped with spike insoles (spike condition). Both sessions also involved a no spike condition in which participants stood or walked for 5 min without these insoles (no spike condition). In all conditions, postural responses were assessed during unperturbed stance and were performed (1) immediately after putting the spike or the no spike insoles, and (2) 5 min after standing or walking with them. Sway parameters, such as centre of foot pressure mean location, surface area, mean speed, root mean square and median frequency on the antero-posterior and medio-lateral axes, were calculated. As postural performances are often related to plantar-surface sensitivity, cutaneous sensitivity threshold was also evaluated with Semmes-Weinstein monofilaments. Although no immediate effect of the spike insoles was found, results indicated that standing or walking for 5 min with sandals equipped with spike insoles led to a significant improvement of quiet standing in the elderly. Balance improvement was also observed in young adults. The results provided evidence that wearing sandals with spike insoles can contribute, at least temporarily, to the improvement of unperturbed stance in elderly people with relatively intact plantar cutaneous sensation. Further research is needed to assess the effects of longer and discontinuous stimulations with spike insoles on postural control.

  15. Controlling Posture and Vergence Eye Movements in Quiet Stance: Effects of Thin Plantar Inserts

    PubMed Central

    Foisy, A.; Gaertner, C.; Matheron, E.; Kapoula, Z.

    2015-01-01

    The purpose of this study was to assess properties of vergence and saccade eye movements as well as posture in quiet stance, and the effects of thin plantar inserts upon postural and oculomotor control. The performances of 36 young healthy subjects were recorded by a force platform and an eye tracker in three testing conditions: without plantar stimulation, with a 3 millimetre-thick plantar insert, either a Medial or a Lateral Arch Support (MAS / LAS). The results showed a decrease of the Surface and Variance of Speed and a more posterior position of the CoP with either stimulation compared with the control condition. The fractal analysis showed a decrease with MAS. Wavelet analysis in the time-frequency domain revealed an increase in the Cancelling Time of the low frequency band with MAS. These results suggest a better stability for a lower energy cost. Concerning eye movements, the inserts influenced only vergence (not saccades): MAS caused an increase of the phasic amplitude of divergence, and conversely a decrease of the tonic amplitude. In contrast, LAS caused an increase of the tonic amplitude of convergence. Thus, MAS renders divergence less visually driven, while LAS renders convergence more visually driven. We conclude that the CNS uses the podal signal for both postural and vergence control via specific mechanisms. Plantar inserts have an influence upon posture and vergence movements in a different way according to the part of the foot sole being stimulated. These results can be useful to clinicians interested in foot or eye. PMID:26637132

  16. Plantar pressure measurements and running-related injury: A systematic review of methods and possible associations.

    PubMed

    Mann, Robert; Malisoux, Laurent; Urhausen, Axel; Meijer, Kenneth; Theisen, Daniel

    2016-06-01

    Pressure-sensitive measuring devices have been identified as appropriate tools for measuring an array of parameters during running. It is unclear which biomechanical characteristics relate to running-related injury (RRI) and which data-processing techniques are most promising to detect this relationship. This systematic review aims to identify pertinent methodologies and characteristics measured using plantar pressure devices, and to summarise their associations with RRI. PubMed, Embase, CINAHL, ScienceDirect and Scopus were searched up until March 2015. Retrospective and prospective, biomechanical studies on running using any kind of pressure-sensitive device with RRI as an outcome were included. All studies involving regular or recreational runners were considered. The study quality was assessed and the measured parameters were summarised. One low quality, two moderate quality and five high quality studies were included. Five different subdivisions of plantar area were identified, as well as five instants and four phases of measurement during foot-ground contact. Overall many parameters were collated and subdivided as plantar pressure and force, plantar pressure and force location, contact area, timing and stride parameters. Differences between the injured and control group were found for mediolateral and anteroposterior displacement of force, contact area, velocity of force displacement, relative force-time integral, mediolateral force ratio, time to peak force and inter-stride correlative patterns. However, no consistent results were found between studies and no biomechanical risk patterns were apparent. Additionally, conflicting findings were reported for peak force in three studies. Based on these observations, we provide suggestions for improved methodology measurement of pertinent parameters for future studies. PMID:27264395

  17. Characteristics of Plantar Loads in Maximum Forward Lunge Tasks in Badminton

    PubMed Central

    Hu, Xiaoyue; Li, Jing Xian; Hong, Youlian; Wang, Lin

    2015-01-01

    Background Badminton players often perform powerful and long-distance lunges during such competitive matches. The objective of this study is to compare the plantar loads of three one-step maximum forward lunges in badminton. Methods Fifteen right-handed male badminton players participated in the study. Each participant performed five successful maximum lunges at three directions. For each direction, the participant wore three different shoe brands. Plantar loading, including peak pressure, maximum force, and contact area, was measured by using an insole pressure measurement system. Two-way ANOVA with repeated measures was employed to determine the effects of the different lunge directions and different shoes, as well as the interaction of these two variables, on the measurements. Results The maximum force (MF) on the lateral midfoot was lower when performing left-forward lunges than when performing front-forward lunges (p = 0.006, 95% CI = −2.88 to −0.04%BW). The MF and peak pressures (PP) on the great toe region were lower for the front-forward lunge than for the right-forward lunge (MF, p = 0.047, 95% CI = −3.62 to −0.02%BW; PP, p = 0.048, 95% CI = −37.63 to −0.16 KPa) and left-forward lunge (MF, p = 0.015, 95% CI = −4.39 to −0.38%BW; PP, p = 0.008, 95% CI = −47.76 to −5.91 KPa). Conclusions These findings indicate that compared with the front-forward lunge, left and right maximum forward lunges induce greater plantar loads on the great toe region of the dominant leg of badminton players. The differences in the plantar loads of the different lunge directions may be potential risks for injuries to the lower extremities of badminton players. PMID:26367741

  18. Tyrosinaemia type II with diffuse plantar keratoderma and self-mutilation.

    PubMed

    Madan, V; Gupta, U

    2006-01-01

    Tyrosinaemia type II (oculocutaneous tyrosinaemia or Richner-Hanhart syndrome) is a rare and potentially treatable genetic disorder. Corneal opacities or ulcers, circumscribed palmoplantar keratoderma and subnormal intelligence form the classical triad of this syndrome. A case with additional features of self-harm and diffuse plantar keratoderma is discussed. Emphasis is laid on the importance of early diagnosis and intervention in the form of dietary regulation to prevent the neurological signs and treat the oculocutaneous symptoms.

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

    PubMed

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

    2013-03-01

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

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

    PubMed

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

    2014-02-12

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

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

    PubMed Central

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

    2009-01-01

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

  2. Biomechanical assessment of plantar foot tissue in diabetic patients using an ultrasound indentation system.

    PubMed

    Zheng, Y P; Choi, Y K; Wong, K; Chan, S; Mak, A F

    2000-03-01

    The biomechanical properties of plantar tissues were investigated for four older neuropathic diabetic patients and four healthy younger subjects. Indentation tests were performed at four high-pressure areas with three postures in each subject. The tissue thickness and effective Young's modulus were measured by an ultrasound (US) indentation system. The system comprised a pen-size probe having a US transducer at the tip and a load cell connected in series with it. Results showed that the plantar soft tissues of the elderly diabetic patients were significantly stiffer and thinner when compared with the healthy young subjects. For the diabetic subjects tested, the Young's modulus at the 1st metatarsal head was significantly larger than those at the other three sites. This site-dependence was not observed in the healthy young subjects. The plantar tissue became significantly stiffer in the healthy young subjects as a result of posture changes. This posture-dependence of the Young's modulus was not established for the elderly diabetic group.

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

    PubMed Central

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

    2013-01-01

    OBJECTIVE : Evaluate the probable relationship among plantar arch, lumbar curvature, and low back pain. METHODS : Fifteen healthy women were assessed taking in account personal data and anthropometric measurements, photopodoscopic evaluation of the plantar arch, and biophotogrammetric postural analysis of the patient (both using the SAPO software), as well as evaluation of lumbar pain using a Visual Analog Scale (VAS). The average age of the participants was 30.45 (±6.25) years. RESULTS : Of the feet evaluated, there were six individuals with flat feet, five with high arch, and four with normal feet. All reported algic syndrome in the lumbar spine, with the highest VAS values for the volunteers with high arch. Correlation was observed between the plantar arch and the angle of the lumbar spine (r = -0.71, p = 0.004) Conclusion: High arch was correlated with more intense algic syndrome, while there was moderate positive correlation between flat foot and increased lumbar curvature, and between high arch and lumbar correction. Level of Evidence IV. Case Series. PMID:24453656

  4. A device for characterising the mechanical properties of the plantar soft tissue of the foot.

    PubMed

    Parker, D; Cooper, G; Pearson, S; Crofts, G; Howard, D; Busby, P; Nester, C

    2015-11-01

    The plantar soft tissue is a highly functional viscoelastic structure involved in transferring load to the human body during walking. A Soft Tissue Response Imaging Device was developed to apply a vertical compression to the plantar soft tissue whilst measuring the mechanical response via a combined load cell and ultrasound imaging arrangement. Accuracy of motion compared to input profiles; validation of the response measured for standard materials in compression; variability of force and displacement measures for consecutive compressive cycles; and implementation in vivo with five healthy participants. Static displacement displayed average error of 0.04 mm (range of 15 mm), and static load displayed average error of 0.15 N (range of 250 N). Validation tests showed acceptable agreement compared to a Houndsfield tensometer for both displacement (CMC > 0.99 RMSE > 0.18 mm) and load (CMC > 0.95 RMSE < 4.86 N). Device motion was highly repeatable for bench-top tests (ICC = 0.99) and participant trials (CMC = 1.00). Soft tissue response was found repeatable for intra (CMC > 0.98) and inter trials (CMC > 0.70). The device has been shown to be capable of implementing complex loading patterns similar to gait, and of capturing the compressive response of the plantar soft tissue for a range of loading conditions in vivo. PMID:26343227

  5. Sonoelastography of Plantar Fascia: Reproducibility and Pattern Description in Healthy Subjects and Symptomatic Subjects.

    PubMed

    Ríos-Díaz, José; Martínez-Payá, Jacinto J; del Baño-Aledo, María Elena; de Groot-Ferrando, Ana; Botía-Castillo, Paloma; Fernández-Rodríguez, David

    2015-10-01

    The purpose of the work reported here was to describe the sonoelastographic appearance of the plantar fascia of healthy volunteers and patients with fasciitis. Twenty-three healthy subjects and 21 patients with plantar fasciitis were examined using B-mode and real-time sonoelastography (RTSR) scanning. B-Mode examination included fascia thickness and echotexture. Echogenicity and echovariation of the color histogram were analyzed. Fasciae were classified into type 1, blue (more elastic); type 2, blue/green (intermediate); or type 3, green (less elastic). RTSE revealed 72.7% of fasciae as type 2, with no significant association with fasciitis (χ(2) = 3.6, df = 2, p = 0.17). Quantitative analysis of the color histogram revealed a significantly greater intensity of green (mean = 77.8, 95% confidence interval [CI] = 71.9-83.6) and blue (mean = 74.2, 95% CI = 69.7-78.8) in healthy subjects. Echovariation of the color red was 33.4% higher in the fasciitis group than in the healthy group (95% CI = 16.7-50.1). Sonoelastography with quantitative analysis of echovariation can be a useful tool for evaluation of plantar fascia pathology. PMID:26164287

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

    PubMed Central

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

    2013-01-01

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

  7. Comparison of plantar pressure distribution in adolescent runners at low vs. high running velocity.

    PubMed

    Fourchet, François; Kelly, Luke; Horobeanu, Cosmin; Loepelt, Heiko; Taiar, Redha; Millet, Grégoire P

    2012-04-01

    This study aimed to compare foot plantar pressure distribution while jogging and running in highly trained adolescent runners. Eleven participants performed two constant-velocity running trials either at jogging (11.2 ± 0.9 km/h) or running (17.8 ± 1.4 km/h) pace on a treadmill. Contact area (CA in cm(2)), maximum force (F(max) in N), peak pressure (PP in kPa), contact time (CT in ms), and relative load (force time integral in each individual region divided by the force time integral for the total plantar foot surface, in %) were measured in nine regions of the right foot using an in-shoe plantar pressure device. Under the whole foot, CA, F(max) and PP were lower in jogging than in running (-1.2% [p<0.05], -12.3% [p<0.001] and -15.1% [p<0.01] respectively) whereas CT was higher (+20.1%; p<0.001). Interestingly, we found an increase in relative load under the medial and central forefoot regions while jogging (+6.7% and +3.7%, respectively; [p<0.05]), while the relative load under the lesser toes (-8.4%; p<0.05) was reduced. In order to prevent overloading of the metatarsals in adolescent runners, excessive mileage at jogging pace should be avoided. PMID:22205042

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

    PubMed Central

    Woitge, Sandra; Finze, Susanne; Mittelmeier, Wolfram

    2013-01-01

    Background. The wearing of personal equipment can cause specific changes in muscle activity and posture. In the present study, we investigated the influence of differences in equipment related weight loading and load distribution on plantar pressure. In addition, we studied functional effects of wearing different equipment with a particular focus on relevant changes in foot shape. Methods. Static and dynamic pedobarography were performed on 31 male soldiers carrying increasing weights consisting of different items of equipment. Results. The pressure acting on the plantar surface of the foot increased with higher loading, both under static and dynamic conditions (p < 0.05). We observed an increase in the contact area (p < 0.05) and an influence of load distribution through different ways to carry the rifle. Conclusions. The wearing of heavier weights leads to an increase in plantar pressure and contact area. This may be caused by flattening of the transverse and longitudinal arches. The effects are more evident in subjects with flat feet deformities which seem to flatten at an earlier load condition with a greater amount compared to subjects with normal arches. Improving load distribution should be a main goal in the development of military equipment in order to prevent injuries or functional disorders of the lower extremity. PMID:23766714

  9. Comparison of plantar pressure distribution in adolescent runners at low vs. high running velocity.

    PubMed

    Fourchet, François; Kelly, Luke; Horobeanu, Cosmin; Loepelt, Heiko; Taiar, Redha; Millet, Grégoire P

    2012-04-01

    This study aimed to compare foot plantar pressure distribution while jogging and running in highly trained adolescent runners. Eleven participants performed two constant-velocity running trials either at jogging (11.2 ± 0.9 km/h) or running (17.8 ± 1.4 km/h) pace on a treadmill. Contact area (CA in cm(2)), maximum force (F(max) in N), peak pressure (PP in kPa), contact time (CT in ms), and relative load (force time integral in each individual region divided by the force time integral for the total plantar foot surface, in %) were measured in nine regions of the right foot using an in-shoe plantar pressure device. Under the whole foot, CA, F(max) and PP were lower in jogging than in running (-1.2% [p<0.05], -12.3% [p<0.001] and -15.1% [p<0.01] respectively) whereas CT was higher (+20.1%; p<0.001). Interestingly, we found an increase in relative load under the medial and central forefoot regions while jogging (+6.7% and +3.7%, respectively; [p<0.05]), while the relative load under the lesser toes (-8.4%; p<0.05) was reduced. In order to prevent overloading of the metatarsals in adolescent runners, excessive mileage at jogging pace should be avoided.

  10. Sonoelastography of Plantar Fascia: Reproducibility and Pattern Description in Healthy Subjects and Symptomatic Subjects.

    PubMed

    Ríos-Díaz, José; Martínez-Payá, Jacinto J; del Baño-Aledo, María Elena; de Groot-Ferrando, Ana; Botía-Castillo, Paloma; Fernández-Rodríguez, David

    2015-10-01

    The purpose of the work reported here was to describe the sonoelastographic appearance of the plantar fascia of healthy volunteers and patients with fasciitis. Twenty-three healthy subjects and 21 patients with plantar fasciitis were examined using B-mode and real-time sonoelastography (RTSR) scanning. B-Mode examination included fascia thickness and echotexture. Echogenicity and echovariation of the color histogram were analyzed. Fasciae were classified into type 1, blue (more elastic); type 2, blue/green (intermediate); or type 3, green (less elastic). RTSE revealed 72.7% of fasciae as type 2, with no significant association with fasciitis (χ(2) = 3.6, df = 2, p = 0.17). Quantitative analysis of the color histogram revealed a significantly greater intensity of green (mean = 77.8, 95% confidence interval [CI] = 71.9-83.6) and blue (mean = 74.2, 95% CI = 69.7-78.8) in healthy subjects. Echovariation of the color red was 33.4% higher in the fasciitis group than in the healthy group (95% CI = 16.7-50.1). Sonoelastography with quantitative analysis of echovariation can be a useful tool for evaluation of plantar fascia pathology.

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

    PubMed

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

    2010-05-01

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

  12. The effect of landing surface on the plantar kinetics of chinese paratroopers using half-squat landing.

    PubMed

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

    2013-01-01

    The objective of the study was to determine the effect of landing surface on plantar kinetics during a half-squat landing. Twenty male elite paratroopers with formal parachute landing training and over 2 years of parachute jumping experience were recruited. The subjects wore parachuting boots in which pressure sensing insoles were placed. Each subject was instructed to jump off a platform with a height of 60 cm, and land on either a hard or soft surface in a half-squat posture. Outcome measures were maximal plantar pressure, time to maximal plantar pressure (T-MPP), and pressure-time integral (PTI) upon landing on 10 plantar regions. Compared to a soft surface, hard surface produced higher maximal plantar pressure in the 1(st) to 4(th) metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5(th) metatarsal region. Shorter T- MPP was found during hard surface landing in the 1(st) and 2(nd) metatarsal and medial rear foot. Landing on a hard surface landing resulted in a lower PTI than a soft surface in the 1(st)phalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the1(st) to 4(th)metatarsal region for hard surface landing, and the 1(st)phalangeal and 5(th)metatarsal region for soft surface landing. Key PointsUnderstanding plantar kinetics during the half-squat landing used by Chinese paratroopers can assist in the design of protective footwear.Compared to landing on a soft surface, a hard surface produced higher maximal plantar pressure in the 1(st) to 4(th) metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5(th) metatarsal region.A shorter time to maximal plantar pressure was found during a hard surface landing in the 1(st) and 2(nd) metatarsals and medial rear foot.Landing on a hard surface resulted in a lower pressure-time integral than landing on a soft surface in the 1(st) phalangeal region.For Chinese paratroopers, specific foot prosthesis should be designed to protect

  13. Biochemical response to chronic shortening in unloaded soleus muscles

    NASA Technical Reports Server (NTRS)

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

    1985-01-01

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

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

    SciTech Connect

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

    2009-03-01

    The Savannah River Site (SRS) will remove sludge as part of waste tank closure operations. Typically the bulk sludge is removed by mixing it with supernate to produce a slurry, and transporting the slurry to a downstream tank for processing. Experience shows that a residual heel may remain in the tank that cannot be removed by this conventional technique. In the past, SRS used oxalic acid solutions to disperse or dissolve the sludge heel to complete the waste removal. To better understand the actual conditions of oxalic acid cleaning of waste from carbon steel tanks, the authors developed and conducted an experimental program to determine its effectiveness in dissolving sludge, the hydrogen generation rate, the generation rate of other gases, the carbon steel corrosion rate, the impact of mixing on chemical cleaning, the impact of temperature, and the types of precipitates formed during the neutralization process. The test samples included actual SRS sludge and simulated SRS sludge. The authors performed the simulated waste tests at 25, 50, and 75 C by adding 8 wt % oxalic acid to the sludge over seven days. They conducted the actual waste tests at 50 and 75 C by adding 8 wt % oxalic acid to the sludge as a single batch. Following the testing, SRS conducted chemical cleaning with oxalic acid in two waste tanks. In Tank 5F, the oxalic acid (8 wt %) addition occurred over seven days, followed by inhibited water to ensure the tank contained enough liquid to operate the mixer pumps. The tank temperature during oxalic acid addition and dissolution was approximately 45 C. The authors analyzed samples from the chemical cleaning process and compared it with test data. The conclusions from the work are: (1) Oxalic acid addition proved effective in dissolving sludge heels in the simulant demonstration, the actual waste demonstration, and in SRS Tank 5F. (2) The oxalic acid dissolved {approx} 100% of the uranium, {approx} 100% of the iron, and {approx} 40% of the manganese

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

    SciTech Connect

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

    2000-05-17

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

  16. Effects of internal stress concentrations in plantar soft-tissue--A preliminary three-dimensional finite element analysis.

    PubMed

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

    2010-05-01

    It has been hypothesized that diabetic foot ulceration might be internally initiated. This study established a three-dimensional and nonlinear finite element model of a human foot complex with comprehensive skeletal and soft-tissue components. The model was validated by experimental data of subject-specific barefoot plantar pressure measurements. The feasibility of the model to predict the 3D, internal, plantar soft-tissue deformation and stress was evaluated. The preliminary results indicate that large von Mises stress occurs where plantar soft-tissue contacts with geometrically irregular bony structures, thus internal stress distribution within the plantar soft-tissue was dramatically influenced by bony prominences due to stress concentration. At the forefoot part, an average stress magnification factor of 3.01 was quantified. The lateral sesamoid bone associated to the 1st MTH showed the largest effect of stress concentration. The modeling approach presented provides a possible way to explore the complexity of the mechanical environment inside the plantar soft-tissue.

  17. Greater Reduction of Balance as a Result of Increased Plantar Fascia Elasticity at Ovulation during the Menstrual Cycle.

    PubMed

    Petrofsky, Jerrold; Lee, Haneul

    2015-01-01

    One of the sexual hormones, estrogen, increases elasticity of human connective tissue such as the anterior cruciate ligament during the menstrual cycle in women. In the present investigation, the plantar fascia was investigated to see if there is a difference in elasticity with the menstrual cycle. Fifteen young healthy females in the age range of 18-35 years old with a regular menstrual cycle were tested twice throughout one full menstrual cycle; once during the early follicular phases and once at ovulation. Foot length, while standing on both feet and one foot were used to assess plantar fascia elasticity, ultrasound measured plantar fascia thickness while lying and standing, and posture sway and tremor using a balance platform during 8 different balance tests were assessed to see the impact of elasticity changes. Foot length increased significantly at ovulation compared to menstruation when standing on two feet (p = 0.03) and standing on one foot (p < 0.001). There was also a significant increase in plantar fascia in thinning per kilogram weight applied to the foot at ovulation compared to menstruation (p = 0.014). Associated with this increase in elasticity at ovulation, there was a reduction in balance in the most difficult balance tasks and an increase in tremor during ovulation (p < 0.05). Plantar fascia elasticity change during the menstrual cycle might have effects on posture sway and tremor, which could have a potential risk of falling. Therefore, healthy professionals working with young female adults should recognize these physiological effects.

  18. A Holter-type, microprocessor-based, rehabilitation instrument for acquisition and storage of plantar pressure data.

    PubMed

    Abu-Faraj, Z O; Harris, G F; Abler, J H; Wertsch, J J

    1997-04-01

    A Holter-type, microprocessor-based, portable, in-shoe, plantar pressure data acquisition system has been developed. The system allows continuous recording of pressure data between the sole of the foot and the shoe during the performance of daily living activities. Fourteen conductive polymer sensors acquire the plantar pressure history, which is then stored in the system memory. Pressures are sampled at a rate of 40 Hz from each of the 14 sensors for up to 8 hrs. The extended recording and processing capacity of the system developed in this study allows quantitative analysis of cumulative plantar pressure and temporal gait data necessary for characterization of event-related alterations in plantar pressures. The alterations that could be examined with the system include rehabilitative, therapeutic, surgical, and nonsurgical treatment. The system is fully portable and does not disrupt the natural gait pattern of the subject during ambulation. Peak plantar pressures, pressure-time integrals, and contact durations are determined for each of the insole sensors.

  19. A Vibrotactile and Plantar Force Measurement-Based Biofeedback System: Paving the Way towards Wearable Balance-Improving Devices

    PubMed Central

    Ma, Christina Zong-Hao; Wan, Anson Hong-Ping; Wong, Duo Wai-Chi; Zheng, Yong-Ping; Lee, Winson Chiu-Chun

    2015-01-01

    Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1) no socks, system turned-off; (2) wearing five layers of socks, system turned-off; (3) wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP) movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p < 0.05), and increased the COP parameters (p < 0.017), indicating increased postural sway. After turning on the biofeedback system, the COP parameters decreased significantly (p < 0.017). The positive results of this study should inspire future development of wearable plantar force-based biofeedback systems for improving balance in people with sensory deficits. PMID:26694399

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

    PubMed Central

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

    2014-01-01

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

  1. Inversion and eversion strengths in the weightbearing ankle of young women. Effects of plantar flexion and basketball shoe height.

    PubMed

    Ottaviani, R A; Ashton-Miller, J A; Wojtys, E M

    2001-01-01

    Maximum isometric ankle inversion and eversion muscle strengths were measured under full unipedal weightbearing in 20 healthy young adult women. When the women wore a low-top shoe, the mean (standard deviation) maximum external eversion moments resisted with the foot in 0 degrees and 32 degrees of ankle plantar flexion were 24.1 (7.6) and 24.1 (8.1) N x m, respectively, while the corresponding values for maximum inversion moments resisted were 14.7 (6.8) and 17.4 (6.4) N x m, respectively. Both shoe height and ankle plantar flexion affected the overall inversion moment resisted by 17% (P = 0.03) at 0 degrees of ankle plantar flexion to 11.9% (P = 0.003) at 32 degrees of ankle plantar flexion. However, neither shoe height nor ankle plantar flexion significantly affected the maximum eversion moment resisted. Although eversion muscle strength of the young women averaged 39% less than the corresponding value found in young men, the sex difference was not significant when ankle strengths were normalized by body size (body weight x height). Thus, when data from healthy young men and women were averaged, eversion and inversion strengths averaged 1.6% and 2.7%, respectively, of body weight x height.

  2. [Chronic arsenic water pollution in the Republic of Argentina].

    PubMed

    Enrique Biagini, R

    1975-01-01

    Arsenical pollution of water supplies is a chronic problem of great medical, social and sanitary importance in Argentina. The well-known cutaneous manifestations of chronic arsenical toxicity, palmar and plantar keratoses, melanoderma and multiple epitheliomas are described. The interest which this disease has evoked in the last few years is emphasized when new arsenical areas are discovered with clinical cases of chronic arsenical intoxication. Furthermore it is shown that the high content of arsenic in drinking water may be the determining factor in the incidence of visceral neoplasms. Contrary to classic beliefs, the chronic toxic effects from arsenic may be present in young children but the palmar and plantar keratoses may be absent. The histochemical localization of the arsenic in the skin and its relation to thyroid function and the production of leukoplakia and laryngeal cancer are noted. When one analyses all the recent reports it is evident that patients with chronic arsenical intoxication must now be thoroughly studied bearing in mind the multiple localization of this carcinogenic agent.

  3. Effect on the parameters of the high-heel shoe and transfer time of ground reaction force during level walking

    PubMed Central

    Hyun, Seung-Hyun; Kim, Young-Pyo; Ryew, Che-Cheong

    2016-01-01

    This study aimed to analyze an effect on the parameters of high-heel shoe and transfer time of ground reaction force during level walking and subjects participated were composed of adult female subjects (n=13) of 20s with height of high heel (0 cm, 9 cm, respectively). Instrument used for the study was 1 set force plate (AMTI-OR9-7) and sampling rate for data collection of analysis parameters was set-up at 1,000 Hz. The revelation of required coefficient of friction (RCOF) maximum showed significant difference with more rapid than that of 1st peak vertical force (1 PVF). Transfer time of body weight showed significant difference with more delay at 9 cm than that of 0 cm. RCOF required more frictional force required because PVF showed significant difference with larger value on 9 cm than that of 3 cm at 1 PVF. Both center of pressure (COP) x and COPy showed rather less displacement on 9 cm than that of 0 cm. In addition, level walking by high heel shoe did not control efficiently the ground reaction force due to restricted control capacity of coefficient of frictional force and therefore could suggest an inducement of muscle fatigue, heightening a possibility of sliding and falling due to decrease of frictional force. PMID:27807524

  4. Effects of heel height and shoe shape on the compressive load between foot and base: a graphic analysis of principle.

    PubMed

    Broch, Nana Lise; Wyller, Thomas; Steen, Harald

    2004-01-01

    Even in the ever-changing and increasingly technical realm of medicine, common sense approaches are needed. We can still learn from our predecessors by using their practical and simple methods. In this article a graphic approach in the sagittal plane is used to explain the relationship between the heel height of a shoe and load under the foot. By using an elementary theoretical model based on schematic sketches, an analysis of principle can be performed to calculate the change in the distribution of mechanical stress in the planta with change in foot orientation. The model shows that when standing posture remains unaltered, load under the forefoot increases and load under the heel decreases with elevated heel height and the corresponding changes in shoe shape. These results can be confirmed by pedobarographic and gait-analysis measurements, but the graphic method can be used without application of advanced instrumentation. The rationale behind the model is to use common terms and simple means to facilitate a more fundamental understanding of complex mechanical orthopedic problems. The method is meant to be a helpful supplement to clinical judgment in the many situations in which advanced instrumentation is not available.

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

    PubMed

    Schönrich, Günther; Raftery, Martin J

    2015-01-01

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

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

    PubMed

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

    2008-10-01

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

  7. Reconstruction of Heel With Propeller Flap in Postfasciotomy and Popliteal Artery Revascularization State.

    PubMed

    Kang, Jin Seok; Choi, Hwan Jun; Tak, Min Sung

    2016-06-01

    Free flaps are still the gold standard for large defects of the lower limb, but propeller perforator flaps have become a simpler and faster alternative to free flaps because of some advantages such as reliable vascular pedicle, wide mobilization and rotation, great freedom in design, low donor site morbidity, and easy harvest with no requirement for anastomosis. But when the vessels show insufficient findings in preoperative evaluation using a Doppler probe or the vessel is injured, the surgeon should avoid performing free flap surgery to prevent flap failure and should select a propeller perforator flap as an alternative method on the condition that more than one perforator is intact. In this study, we report reconstruction of soft tissue defects of the heel with a pedicled propeller flap in postfasciotomy and popliteal artery revascularization state by making an incision on the central portion above the Achilles tendon, which can be covered by the posterior tibial artery perforator or the peroneal artery perforator based flaps. In conclusion, we showed that although the popliteal artery was injured, the soft tissue defect can be reconstructed using a perforator propeller flap if intact distal flow in the anastomosis site was confirmed.

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

    PubMed Central

    Schönrich, Günther; Raftery, Martin J.

    2015-01-01

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

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

    SciTech Connect

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

    2010-12-10

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

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

    SciTech Connect

    Hay, M; King, W; Martino, C

    2009-12-18

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

  11. [Bleeding, the Achilles' heel in patients treated with anticoagulants. Approach in patients with atrial fibrillation].

    PubMed

    Morais, João

    2012-04-01

    Bleeding is always the Achilles' heel of all antithrombotic therapy, being unthinkable to use this type of therapy ignoring the complications that it may arise. The bleeding risk raises very particular problems, namely how to predict it and how to manage it. The withdrawal of antithrombotic drugs and transfusion are two important practical problems, involving clinical decisions that are generally very difficult. The new oral anticoagulants pose new problems. If on the one hand its bleeding risk appears to be less, specially in what concerns intracranial bleeding and potentially life-threatening bleeding, on the other hand the lack of an antidote or the lack of a quick and effective laboratory test to evaluate its efficacy, are arguments used by the critics. The risk of bleeding is conditioned by several factors, among them old age. The elderly patient is, by definition, the patient that can bleed more but also the one that, due to its ischemic risk, can reap more benefit. In this paper some of the tools used to predict the risk of bleeding and its clinical impact are also presented.

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

    PubMed

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

    2013-01-01

    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

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

    PubMed Central

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

    2011-01-01

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

  14. The Effect of Different Foot Orthosis Inverted Angles on Plantar Pressure in Children with Flexible Flatfeet

    PubMed Central

    Lee, Hyunkeun; Ahn, Soyoung; Song, Youngshin; Park, Insik

    2016-01-01

    Although orthotic modification using the inverted technique is available for the treatment of flatfoot, empirical evidence for the biomechanical effects of inverted-angle foot orthoses (FOs) is lacking. The aim of this study was to evaluate the effects of different FO inversion angles on plantar pressure during gait in children with flatfoot. Twenty-one children with flexible flatfeet (mean age 9.9 years) were enrolled in this study. The plantar pressures were measured for the rearfoot; medial and lateral midfoot; and medial, central, and lateral forefoot as participants walked on a treadmill while wearing shoes only and shoes with the following 3 orthotic conditions: (i) orthosis with no inverted angle, (ii) orthosis with a 15° inverted angle, and (iii) orthosis with a 30° inverted angle. A one-way repeated measures analysis of variance (ANOVA) with the Bonferroni-adjusted post-hoc test was used to compare the mean values of each orthotic condition. Compared with the shoe only condition, the peak pressure decreased significantly under the medial forefoot and rearfoot with all FOs (p <0.05). However, no significant differences in the peak pressure under the medial forefoot and rearfoot were observed between the FOs. The peak pressure under the medial midfoot increased significantly with all FOs, and a maximal increase in the peak pressure was obtained with a 30° inverted angle orthosis. Furthermore, the contact area under the medial midfoot and rearfoot increased significantly with all FOs, compared with the shoe only condition (p <0.05). Again, no significant differences were observed between the FOs. For plantar pressure redistribution, a FO with a low inverted angle could be effective, accommodative, and convenient for children with flatfoot. PMID:27458719

  15. Applied felted foam for plantar pressure relief is an efficient therapy in neuropathic diabetic foot ulcers.

    PubMed

    Zimny, S; Meyer, M F; Schatz, H; Pfohl, M

    2002-10-01

    The application of felted foam is a promising method for plantar pressure reduction in the ulcer region of neuropathic diabetic foot ulcers, but the knowledge of its impact on the wound healing and healing times in foot ulcers compared to conventional methods of pressure relief is sparse. The aim of this study was to assess the effects on the wound healing of felted foam dressings for plantar pressure reduction in the therapy of neuropathic foot ulcers. This prospective cohort study evaluates healing times and wound healing in 61 diabetic patients with neuropathic foot ulcerations. Ulcer healing was assessed by planimetric measurement of the wound area at beginning of the study and after 10 weeks and at least until wound healing. The patients were consecutively enrolled in the study, 27 patients were randomized to the felted foam therapy, and 34 patients were randomized to conventional therapy. In the felted foam group, the initial average wound area was 110.8 +/- 14.4 mm 2 (mean +/- SE), and 2.1 +/- 0.5 mm 2 after ten weeks (p < 0.0001), with an average healing time of 79.6 (95%-CI 75-84) days. In the conventional therapy group, the initial average wound area was 119.2 +/- 13.8 mm 2, and 3.4 +/- 0.7 mm 2 after ten weeks (p < 0.0001). The average healing times was 83.2 (95%-CI 77-90) days. Both with respect to the wound healing process and the healing times, the felted foam technique appears to be as effective as conventional plantar ulcer treatment. We conclude that the felted foam technique is an useful alternative in the therapy of the neuropathic diabetic foot syndrome, especially in patients who are not able to avoid weight-bearing reliably.

  16. Inhibition of cyclooxygenase attenuates the blood pressure response to plantar flexion exercise in peripheral arterial disease

    PubMed Central

    Drew, Rachel C.; Ross, Amanda J.; Blaha, Cheryl A.; Cauffman, Aimee E.; Kaufman, Marc P.; Sinoway, Lawrence I.

    2015-01-01

    Prostanoids are produced during skeletal muscle contraction and subsequently stimulate muscle afferent nerves, thereby contributing to the exercise pressor reflex. Humans with peripheral arterial disease (PAD) have an augmented exercise pressor reflex, but the metabolite(s) responsible for this augmented response is not known. We tested the hypothesis that intravenous injection of ketorolac, which blocks the activity of cyclooxygenase, would attenuate the rise in mean arterial blood pressure (MAP) and heart rate (HR) evoked by plantar flexion exercise. Seven PAD patients underwent 4 min of single-leg dynamic plantar flexion (30 contractions/min) in the supine posture (workload: 0.5–2.0 kg). MAP and HR were measured on a beat-by-beat basis; changes from baseline in response to exercise were determined. Ketorolac did not affect MAP or HR at rest. During the first 20 s of exercise with the most symptomatic leg, ΔMAP was significantly attenuated by ketorolac (2 ± 2 mmHg) compared with control (8 ± 2 mmHg, P = 0.005), but ΔHR was similar (6 ± 2 vs. 5 ± 1 beats/min). Importantly, patients rated the exercise bout as “very light” to “fairly light,” and average pain ratings were 1 of 10. Ketorolac had no effect on perceived exertion or pain ratings. Ketorolac also had no effect on MAP or HR in seven age- and sex-matched healthy subjects who performed a similar but longer plantar flexion protocol (workload: 0.5–7.0 kg). These data suggest that prostanoids contribute to the augmented exercise pressor reflex in patients with PAD. PMID:26055794

  17. Plantar measurements to determine success of surgical correction of Stage IIb adult acquired flatfoot deformity.

    PubMed

    Matheis, Erika A; Spratley, E Meade; Hayes, Curtis W; Adelaar, Robert S; Wayne, Jennifer S

    2014-01-01

    Adult acquired flatfoot deformity is a degenerative disease causing medial arch dysfunction. Surgical correction has typically involved tendon reconstruction with calcaneal osteotomy; however, the postoperative changes have not been fully characterized. The present study assessed the success of surgical correction of Stage IIb adult acquired flatfoot deformity through changes in plantar pressures and patient-generated outcome scores. With Institutional Review Board approval, 6 participants were evaluated before and after surgery using pedobarography, the Foot and Ankle Outcome Score, and the Medical Outcomes Study 36-item short-form questionnaire. The plantar pressures were recorded using a TekScan HRMat(®) during walking and in a 1- and 2-foot stance. The resulting contour maps were segmented into 9 regions, with the peak pressure, normalized force, and arch index calculated. Surgical effects were analyzed using paired t tests. Postoperatively, the Foot and Ankle Outcome Score and Medical Outcomes Study 36-item short-form questionnaire scores increased significantly from 180 ± 78 to 360 ± 136 (p < .03) and 47 ± 18 to 71 ± 19 (p = .06), respectively. During the 2-foot stance, the normalized force had increased significantly in the lateral midfoot (p < .03), although no significant differences were found in peak pressures. No significant differences were observed in the 1-foot stance. During walking, the normalized force increased significantly in the lateral mid- and forefoot (p < .05). The peak pressure increased significantly in the lateral forefoot (p < .01). The arch index values demonstrated no significant changes. The increased questionnaire scores indicated that surgical correction improved the self-perceived health of the participants. Lateral shifts in the peak pressure and normalized force suggest that forefoot and midfoot loading is altered postoperatively, consistent with the goal of offloading the dysfunctional arch. Thus, the present study has

  18. The effect of knee joint angle on plantar flexor power in young and old men.

    PubMed

    Dalton, Brian H; Allen, Matti D; Power, Geoffrey A; Vandervoort, Anthony A; Rice, Charles L

    2014-04-01

    Human adult aging is associated with a loss of strength, contractile velocity and hence, power. The principal plantar flexors, consisting of the bi-articular gastrocnemeii and the mono-articular soleus, appear to be affected differently by the aging process. However, the age-related effect of knee joint angle on the torque-angular velocity relationship and power production of this functionally important muscle group is unknown. The purpose was to determine whether flexing the knee, thereby reducing the gastrocnemius contribution to plantar flexion, would exacerbate the age-related decrements in plantar flexion power, or shift the torque-angular velocity relationship differently in older compared with young men. Neuromuscular properties were recorded from 10 young (~25 y) and 10 old (~78 y) men with the knee extended (170°) and flexed (90°), in a randomized order. Participants performed maximal voluntary isometric contractions (MVCs), followed by maximal velocity-dependent shortening contractions at pre-set loads, ranging from 15 to 75% MVC. The young men were ~20-25% stronger, ~12% faster and ~30% more powerful than the old for both knee angles (P<0.05). In both age groups, isometric MVC torque was ~17% greater in the extended than flexed knee position, with no differences in voluntary activation (>95%). The young men produced 7-12% faster angular velocities in the extended knee position for loads ≤30% MVC, but no differences at higher loads; whereas there were no detectable differences in angular velocity between knee positions in the old across all relative loads. For both knee angles, young men produced peak power at 43.3±9.0% MVC, whereas the old men produced peak power at 54.8±7.9% MVC. These data indicate that the young, who have faster contracting muscles compared with the old, can rely more on velocity than torque for generating maximal power.

  19. Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training.

    PubMed

    Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett

    2015-01-01

    Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0-100, 100-200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance. PMID:26029114

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

    PubMed

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

    2011-08-11

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

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    2014-02-01

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

  3. Influence of the surface area approximation on plantar arch index calculus

    NASA Astrophysics Data System (ADS)

    Toth-Taşcǎu, Mirela; Stoia, Dan Ioan; Vigaru, Cosmina; Pasca, Oana

    2012-09-01

    The general purpose of this study was to establish some correction coefficients used in plantar index calculus. In order to compute the correction coefficients, the total area of scanned footprints was estimated using two methods. The footprints were acquired on white plan paper by means of graphite powder, and scanned at five different resolutions. One of the methods of area computing refers to counting squares of an applied grid on the image, while the other method uses a computer software to determine footprint limits and area.

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

    PubMed

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

    2014-07-01

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

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

    PubMed

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

    2013-12-01

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

  6. OPTIMAL POSITION OF THE HEEL FOLLOWING RECONSTRUCTION OF THE STAGE II ADULT ACQUIRED FLATFOOT DEFORMITY

    PubMed Central

    Conti, Matthew S.; Ellis, Scott J.; Chan, Jeremy Y.; Do, Huong T.; Deland, Jonathan T.

    2016-01-01

    Background While previous work has demonstrated a linear relationship between the amount of medializing calcaneal osteotomy (MCO) and the change in radiographic hindfoot alignment following reconstruction, an ideal postoperative hindfoot alignment has yet to be reported. The aim of this study was to identify an optimal postoperative hindfoot alignment by correlating radiographic alignment with patient outcomes. Methods Fifty-five feet in 55 patients underwent flatfoot reconstruction for stage II AAFD by two fellowship-trained foot and ankle orthopedic surgeons. Hindfoot alignment was determined as previously described by Saltzman and El-Khoury. Changes in pre- and postoperative scores in each FAOS subscale were calculated for patients in postoperative hindfoot valgus (≥0 mm valgus, n=18), mild varus (>0 to 5 mm varus, n=17), and moderate varus (>5 mm varus, n=20). Analysis of variance and post-hoc Tukey’s tests were used to compare the change in FAOS scores between these three groups. Results At 22 months or more postoperatively, patients corrected to mild hindfoot varus showed a significantly greater improvement in the FAOS pain subscale compared to patients in valgus (p=0.04) and symptoms subscale compared to patients in moderate varus (p=0.03). Although mild hindfoot varus did not differ significantly from moderate varus or valgus in the other subscales, mild hindfoot varus did not perform worse than these alignments in any FAOS subscale. No statistically significant correlations between intraoperative MCO slide distances and FAOS subscales were found. Conclusions Our study indicates that correction of hindfoot alignment to between 0 and 5 mm of varus on the hindfoot alignment view (clinically a straight heel) following stage II flatfoot reconstruction was associated with the greatest improvement in clinical outcomes following hindfoot reconstruction in stage II AAFD. PMID:25948692

  7. On Heels and Toes: How Ants Climb with Adhesive Pads and Tarsal Friction Hair Arrays.

    PubMed

    Endlein, Thomas; Federle, Walter

    2015-01-01

    Ants are able to climb effortlessly on vertical and inverted smooth surfaces. When climbing, their feet touch the substrate not only with their pretarsal adhesive pads but also with dense arrays of fine hairs on the ventral side of the 3rd and 4th tarsal segments. To understand what role these different attachment structures play during locomotion, we analysed leg kinematics and recorded single-leg ground reaction forces in Weaver ants (Oecophylla smaragdina) climbing vertically on a smooth glass substrate. We found that the ants engaged different attachment structures depending on whether their feet were above or below their Centre of Mass (CoM). Legs above the CoM pulled and engaged the arolia ('toes'), whereas legs below the CoM pushed with the 3rd and 4th tarsomeres ('heels') in surface contact. Legs above the CoM carried a significantly larger proportion of the body weight than legs below the CoM. Force measurements on individual ant tarsi showed that friction increased with normal load as a result of the bending and increasing side contact of the tarsal hairs. On a rough sandpaper substrate, the tarsal hairs generated higher friction forces in the pushing than in the pulling direction, whereas the reverse effect was found on the smooth substrate. When the tarsal hairs were pushed, buckling was observed for forces exceeding the shear forces found in climbing ants. Adhesion forces were small but not negligible, and higher on the smooth substrate. Our results indicate that the dense tarsal hair arrays produce friction forces when pressed against the substrate, and help the ants to push outwards during horizontal and vertical walking.

  8. On Heels and Toes: How Ants Climb with Adhesive Pads and Tarsal Friction Hair Arrays.

    PubMed

    Endlein, Thomas; Federle, Walter

    2015-01-01

    Ants are able to climb effortlessly on vertical and inverted smooth surfaces. When climbing, their feet touch the substrate not only with their pretarsal adhesive pads but also with dense arrays of fine hairs on the ventral side of the 3rd and 4th tarsal segments. To understand what role these different attachment structures play during locomotion, we analysed leg kinematics and recorded single-leg ground reaction forces in Weaver ants (Oecophylla smaragdina) climbing vertically on a smooth glass substrate. We found that the ants engaged different attachment structures depending on whether their feet were above or below their Centre of Mass (CoM). Legs above the CoM pulled and engaged the arolia ('toes'), whereas legs below the CoM pushed with the 3rd and 4th tarsomeres ('heels') in surface contact. Legs above the CoM carried a significantly larger proportion of the body weight than legs below the CoM. Force measurements on individual ant tarsi showed that friction increased with normal load as a result of the bending and increasing side contact of the tarsal hairs. On a rough sandpaper substrate, the tarsal hairs generated higher friction forces in the pushing than in the pulling direction, whereas the reverse effect was found on the smooth substrate. When the tarsal hairs were pushed, buckling was observed for forces exceeding the shear forces found in climbing ants. Adhesion forces were small but not negligible, and higher on the smooth substrate. Our results indicate that the dense tarsal hair arrays produce friction forces when pressed against the substrate, and help the ants to push outwards during horizontal and vertical walking. PMID:26559941

  9. An Ethylene-Protected Achilles’ Heel of Etiolated Seedlings for Arthropod Deterrence

    PubMed Central

    Boex-Fontvieille, Edouard; Rustgi, Sachin; von Wettstein, Diter; Pollmann, Stephan; Reinbothe, Steffen; Reinbothe, Christiane

    2016-01-01

    A small family of Kunitz protease inhibitors exists in Arabidopsis thaliana, a member of which (encoded by At1g72290) accomplishes highly specific roles during plant development. Arabidopsis Kunitz-protease inhibitor 1 (Kunitz-PI;1), as we dubbed this protein here, is operative as cysteine PI. Activity measurements revealed that despite the presence of the conserved Kunitz-motif the bacterially expressed Kunitz-PI;1 was unable to inhibit serine proteases such as trypsin and chymotrypsin, but very efficiently inhibited the cysteine protease RESPONSIVE TO DESICCATION 21. Western blotting and cytolocalization studies using mono-specific antibodies recalled Kunitz-PI;1 protein expression in flowers, young siliques and etiolated seedlings. In dark-grown seedlings, maximum Kunitz-PI;1 promoter activity was detected in the apical hook region and apical parts of the hypocotyls. Immunolocalization confirmed Kunitz-PI;1 expression in these organs and tissues. No transmitting tract (NTT) and HECATE 1 (HEC1), two transcription factors previously implicated in the formation of the female reproductive tract in flowers of Arabidopsis, were identified to regulate Kunitz-PI;1 expression in the dark and during greening, with NTT acting negatively and HEC1 acting positively. Laboratory feeding experiments with isopod crustaceans such as Porcellio scaber (woodlouse) and Armadillidium vulgare (pillbug) pinpointed the apical hook as ethylene-protected Achilles’ heel of etiolated seedlings. Because exogenous application of the ethylene precursor 1-aminocyclopropane-1-carboxylic acid (ACC) and mechanical stress (wounding) strongly up-regulated HEC1-dependent Kunitz-PI;1 gene expression, our results identify a new circuit controlling herbivore deterrence of etiolated plants in which Kunitz-PI;1 is involved.

  10. An Ethylene-Protected Achilles’ Heel of Etiolated Seedlings for Arthropod Deterrence

    PubMed Central

    Boex-Fontvieille, Edouard; Rustgi, Sachin; von Wettstein, Diter; Pollmann, Stephan; Reinbothe, Steffen; Reinbothe, Christiane

    2016-01-01

    A small family of Kunitz protease inhibitors exists in Arabidopsis thaliana, a member of which (encoded by At1g72290) accomplishes highly specific roles during plant development. Arabidopsis Kunitz-protease inhibitor 1 (Kunitz-PI;1), as we dubbed this protein here, is operative as cysteine PI. Activity measurements revealed that despite the presence of the conserved Kunitz-motif the bacterially expressed Kunitz-PI;1 was unable to inhibit serine proteases such as trypsin and chymotrypsin, but very efficiently inhibited the cysteine protease RESPONSIVE TO DESICCATION 21. Western blotting and cytolocalization studies using mono-specific antibodies recalled Kunitz-PI;1 protein expression in flowers, young siliques and etiolated seedlings. In dark-grown seedlings, maximum Kunitz-PI;1 promoter activity was detected in the apical hook region and apical parts of the hypocotyls. Immunolocalization confirmed Kunitz-PI;1 expression in these organs and tissues. No transmitting tract (NTT) and HECATE 1 (HEC1), two transcription factors previously implicated in the formation of the female reproductive tract in flowers of Arabidopsis, were identified to regulate Kunitz-PI;1 expression in the dark and during greening, with NTT acting negatively and HEC1 acting positively. Laboratory feeding experiments with isopod crustaceans such as Porcellio scaber (woodlouse) and Armadillidium vulgare (pillbug) pinpointed the apical hook as ethylene-protected Achilles’ heel of etiolated seedlings. Because exogenous application of the ethylene precursor 1-aminocyclopropane-1-carboxylic acid (ACC) and mechanical stress (wounding) strongly up-regulated HEC1-dependent Kunitz-PI;1 gene expression, our results identify a new circuit controlling herbivore deterrence of etiolated plants in which Kunitz-PI;1 is involved. PMID:27625656

  11. An Ethylene-Protected Achilles' Heel of Etiolated Seedlings for Arthropod Deterrence.

    PubMed

    Boex-Fontvieille, Edouard; Rustgi, Sachin; von Wettstein, Diter; Pollmann, Stephan; Reinbothe, Steffen; Reinbothe, Christiane

    2016-01-01

    A small family of Kunitz protease inhibitors exists in Arabidopsis thaliana, a member of which (encoded by At1g72290) accomplishes highly specific roles during plant development. Arabidopsis Kunitz-protease inhibitor 1 (Kunitz-PI;1), as we dubbed this protein here, is operative as cysteine PI. Activity measurements revealed that despite the presence of the conserved Kunitz-motif the bacterially expressed Kunitz-PI;1 was unable to inhibit serine proteases such as trypsin and chymotrypsin, but very efficiently inhibited the cysteine protease RESPONSIVE TO DESICCATION 21. Western blotting and cytolocalization studies using mono-specific antibodies recalled Kunitz-PI;1 protein expression in flowers, young siliques and etiolated seedlings. In dark-grown seedlings, maximum Kunitz-PI;1 promoter activity was detected in the apical hook region and apical parts of the hypocotyls. Immunolocalization confirmed Kunitz-PI;1 expression in these organs and tissues. No transmitting tract (NTT) and HECATE 1 (HEC1), two transcription factors previously implicated in the formation of the female reproductive tract in flowers of Arabidopsis, were identified to regulate Kunitz-PI;1 expression in the dark and during greening, with NTT acting negatively and HEC1 acting positively. Laboratory feeding experiments with isopod crustaceans such as Porcellio scaber (woodlouse) and Armadillidium vulgare (pillbug) pinpointed the apical hook as ethylene-protected Achilles' heel of etiolated seedlings. Because exogenous application of the ethylene precursor 1-aminocyclopropane-1-carboxylic acid (ACC) and mechanical stress (wounding) strongly up-regulated HEC1-dependent Kunitz-PI;1 gene expression, our results identify a new circuit controlling herbivore deterrence of etiolated plants in which Kunitz-PI;1 is involved. PMID:27625656

  12. Effects of surface characteristics on the plantar shape of feet and subjects' perceived sensations.

    PubMed

    Witana, Channa P; Goonetilleke, Ravindra S; Xiong, Shuping; Au, Emily Y L

    2009-03-01

    Orthotics and other types of shoe inserts are primarily designed to reduce injury and improve comfort. The interaction between the plantar surface of the foot and the load-bearing surface contributes to foot and surface deformations and hence to perceived comfort, discomfort or pain. The plantar shapes of 16 participants' feet were captured when standing on three support surfaces that had different cushioning properties in the mid-foot region. Foot shape deformations were quantified using 3D laser scans. A questionnaire was used to evaluate the participant's perceptions of perceived shape and perceived feeling. The results showed that the structure in the mid-foot could change shape, independent of the rear-foot and forefoot regions. Participants were capable of identifying the shape changes with distinct preferences towards certain shapes. The cushioning properties of the mid-foot materials also have a direct influence on perceived feelings. This research has strong implications for the design and material selection of orthotics, insoles and footwear.

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

    PubMed

    Zequera, M; Stephan, S; Paul, J

    2007-01-01

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

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

    PubMed

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

    2014-07-01

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

  15. Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity

    PubMed Central

    Bisi-Balogun, Adebisi; Cassel, Michael; Mayer, Frank

    2016-01-01

    This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC. PMID:27089369

  16. Increased calf and plantar muscle fibrotic contents in obese subjects may cause ankle instability

    PubMed Central

    Zhu, Junwei; Zhang, Lei; Chen, Yong; Zhao, Jianning

    2016-01-01

    Obesity is strongly associated with musculoskeletal disorders of the lower limb, including ankle instability and resulting gait problems. In the present study, we aimed to examine, using paired comparisons of subjects, whether moderate duration of obesity in patients with mild to moderate elevations of body mass index (BMI), changes the fibrous contents of muscles that support the ankle mortices, namely calf and plantar muscles. We attempted to examine these parameters because this shall provide direct evidence of whether obesity directly impacts myoarchitecture and support of the adjoining joints. MRI image segmentation and pixel correlations by grey level co-occurrence matrix (GLCM) and entropy were used to analyse the changes. The differences in the means between groups (both GLCM and entropy) were significant from control lean populations (P<0.0001, ANOVA) for the parameters examined for both the calf and the plantar muscles. Reduction in weight should thus be a first-line approach in preventing these changes that may significantly affect quality of life due to gait disturbances. PMID:27380952

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

    PubMed Central

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

    2007-01-01

    The purpose of this study was to determine if three minutes of petrissage and tapotement forms of massage would influence plantar flexors’ flexibility, and muscle power. Nineteen participants were randomly subjected to three conditions (control and two massages) before performing two power tests. Prior to the intervention, subjects completed ankle joint flexibility assessments. The conditions were; (1) control, where subjects lay prone and had a therapist’s hands resting, (2) vigorous petrissage, and (3) tapotement applied at a rate of 4Hz; all on the triceps surae. Following completion of the intervention, subjects immediately completed a post- ankle joint flexibility test, followed by a drop-jump and concentric calf raise. The power measures were; concentric peak force, rate of force development, and drop-jump height / contact time. The data showed a significant increase (p < 0.05) in ankle joint angle on the right leg and a corresponding tendency on the left. No significant change was seen with the power measures. Results suggest that massage can increase plantar flexors’ flexibility without a change in power and thus may be an alternative to static stretching during an athletic warm-up. Key pointsThree minutes of petrissage and tapotement forms of massage increased ankle flexibility.Massage did not adversely affect jump power measures.Massage may be an effective alternative to static stretching as a component of a pre-event warm-up. PMID:24149484

  18. Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity.

    PubMed

    Bisi-Balogun, Adebisi; Cassel, Michael; Mayer, Frank

    2016-04-13

    This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC.

  19. Human ankle plantar flexor muscle-tendon mechanics and energetics during maximum acceleration sprinting.

    PubMed

    Lai, Adrian; Schache, Anthony G; Brown, Nicholas A T; Pandy, Marcus G

    2016-08-01

    Tendon elastic strain energy is the dominant contributor to muscle-tendon work during steady-state running. Does this behaviour also occur for sprint accelerations? We used experimental data and computational modelling to quantify muscle fascicle work and tendon elastic strain energy for the human ankle plantar flexors (specifically soleus and medial gastrocnemius) for multiple foot contacts of a maximal sprint as well as for running at a steady-state speed. Positive work done by the soleus and medial gastrocnemius muscle fascicles decreased incrementally throughout the maximal sprint and both muscles performed more work for the first foot contact of the maximal sprint (FC1) compared with steady-state running at 5 m s(-1) (SS5). However, the differences in tendon strain energy for both muscles were negligible throughout the maximal sprint and when comparing FC1 to SS5. Consequently, the contribution of muscle fascicle work to stored tendon elastic strain energy was greater for FC1 compared with subsequent foot contacts of the maximal sprint and compared with SS5. We conclude that tendon elastic strain energy in the ankle plantar flexors is just as vital at the start of a maximal sprint as it is at the end, and as it is for running at a constant speed. PMID:27581481

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

    PubMed

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

    2014-07-01

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

  1. Effects of the application of Low-Dye taping on the pain and stability of patients with plantar fasciitis.

    PubMed

    Park, Chan; Lee, Sangyong; Lim, Dong-Young; Yi, Char-Woo; Kim, Jang Hwan; Jeon, Chunbae

    2015-08-01

    [Purpose] This study examined how the application of Low-Dye (LD) taping affected the pain and stability of patients with plantar fasciitis. [Subjects] The subjects were 30 patients with plantar fasciitis who were divided into two groups: a Low-Dye taping group (LTG, n=15) and a conservative treatment group (CTG, n=15). [Methods] The treatments were performed three times a week for six weeks in both groups. A visual analog scale (VAS) was used to evaluate the pain and stability of patients with plantar fasciitis, and the transfer area of the center of gravity (TAOCOG) was measured to evaluate stability using a BioRescue device. [Results] In the within-group comparison of the VAS, the LTG and CTG values significantly decreased. In the post-test between-group comparison, the VAS pain decreased more significantly in LTG than in CTG. In the within-group comparison of the TAOCOG, the LTG value significantly increased. In the post-test between-group comparison, the TAOCOG value increased more significantly than in LTG than in CTG. [Conclusion] Utilizing Low-Dye taping for patients with plantar fasciitis appears to be an effective intervention method for reducing pain and enhancing stability.

  2. Comparative Clustering of Plantar Pressure Distributions in Diabetics with Polyneuropathy May Be Applied to Reveal Inappropriate Biomechanical Stress

    PubMed Central

    Niemann, Uli; Spiliopoulou, Myra; Szczepanski, Thorsten; Samland, Fred; Grützner, Jens; Senk, Dominik; Ming, Antao; Kellersmann, Juliane; Malanowski, Jan; Klose, Silke; Mertens, Peter R.

    2016-01-01

    In diabetic patients, excessive peak plantar pressure has been identified as major risk factor for ulceration. Analyzing plantar pressure distributions potentially improves the identification of patients with a high risk for foot ulceration development. The goal of this study was to classify regional plantar pressure distributions. By means of a sensor-equipped insole, pressure recordings of healthy controls (n = 18) and diabetics with severe polyneuropathy (n = 25) were captured across eight foot regions. The study involved a controlled experimental protocol with multiple sessions, where a session contained several cycles of pressure exposure. Clustering was used to identify subgroups of study participants that are characterized by similar pressure distributions. For both analyzed groups, the number of clusters to best describe the pressure profiles was four. When both groups were combined, analysis again led to four distinct clusters. While three clusters did not separate between healthy and diabetic volunteers the fourth cluster was only represented by diabetics. Here the pressure distribution pattern is characterized by a focal point of pressure application on the forefoot and low pressure on the lateral region. Our data suggest that pressure clustering is a feasible means to identify inappropriate biomechanical plantar stress. PMID:27529421

  3. Effects of the application of Low-Dye taping on the pain and stability of patients with plantar fasciitis

    PubMed Central

    Park, Chan; Lee, Sangyong; Lim, Dong-young; Yi, Char-Woo; Kim, Jang Hwan; Jeon, Chunbae

    2015-01-01

    [Purpose] This study examined how the application of Low-Dye (LD) taping affected the pain and stability of patients with plantar fasciitis. [Subjects] The subjects were 30 patients with plantar fasciitis who were divided into two groups: a Low-Dye taping group (LTG, n=15) and a conservative treatment group (CTG, n=15). [Methods] The treatments were performed three times a week for six weeks in both groups. A visual analog scale (VAS) was used to evaluate the pain and stability of patients with plantar fasciitis, and the transfer area of the center of gravity (TAOCOG) was measured to evaluate stability using a BioRescue device. [Results] In the within-group comparison of the VAS, the LTG and CTG values significantly decreased. In the post-test between-group comparison, the VAS pain decreased more significantly in LTG than in CTG. In the within-group comparison of the TAOCOG, the LTG value significantly increased. In the post-test between-group comparison, the TAOCOG value increased more significantly than in LTG than in CTG. [Conclusion] Utilizing Low-Dye taping for patients with plantar fasciitis appears to be an effective intervention method for reducing pain and enhancing stability. PMID:26355306

  4. Effects of the application of Low-Dye taping on the pain and stability of patients with plantar fasciitis.

    PubMed

    Park, Chan; Lee, Sangyong; Lim, Dong-Young; Yi, Char-Woo; Kim, Jang Hwan; Jeon, Chunbae

    2015-08-01

    [Purpose] This study examined how the application of Low-Dye (LD) taping affected the pain and stability of patients with plantar fasciitis. [Subjects] The subjects were 30 patients with plantar fasciitis who were divided into two groups: a Low-Dye taping group (LTG, n=15) and a conservative treatment group (CTG, n=15). [Methods] The treatments were performed three times a week for six weeks in both groups. A visual analog scale (VAS) was used to evaluate the pain and stability of patients with plantar fasciitis, and the transfer area of the center of gravity (TAOCOG) was measured to evaluate stability using a BioRescue device. [Results] In the within-group comparison of the VAS, the LTG and CTG values significantly decreased. In the post-test between-group comparison, the VAS pain decreased more significantly in LTG than in CTG. In the within-group comparison of the TAOCOG, the LTG value significantly increased. In the post-test between-group comparison, the TAOCOG value increased more significantly than in LTG than in CTG. [Conclusion] Utilizing Low-Dye taping for patients with plantar fasciitis appears to be an effective intervention method for reducing pain and enhancing stability. PMID:26355306

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

    PubMed

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

    2015-07-01

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

  6. Tendon elastic strain energy in the human ankle plantar-flexors and its role with increased running speed.

    PubMed

    Lai, Adrian; Schache, Anthony G; Lin, Yi-Chung; Pandy, Marcus G

    2014-09-01

    The human ankle plantar-flexors, the soleus and gastrocnemius, utilize tendon elastic strain energy to reduce muscle fiber work and optimize contractile conditions during running. However, studies to date have considered only slow to moderate running speeds up to 5 m s(-1). Little is known about how the human ankle plantar-flexors utilize tendon elastic strain energy as running speed is advanced towards maximum sprinting. We used data obtained from gait experiments in conjunction with musculoskeletal modeling and optimization techniques to calculate muscle-tendon unit (MTU) work, tendon elastic strain energy and muscle fiber work for the ankle plantar-flexors as participants ran at five discrete steady-state speeds ranging from jogging (~2 m s(-1)) to sprinting (≥8 m s(-1)). As running speed progressed from jogging to sprinting, the contribution of tendon elastic strain energy to the positive work generated by the MTU increased from 53% to 74% for the soleus and from 62% to 75% for the gastrocnemius. This increase was facilitated by greater muscle activation and the relatively isometric behavior of the soleus and gastrocnemius muscle fibers. Both of these characteristics enhanced tendon stretch and recoil, which contributed to the bulk of the change in MTU length. Our results suggest that as steady-state running speed is advanced towards maximum sprinting, the human ankle plantar-flexors continue to prioritize the storage and recovery of tendon elastic strain energy over muscle fiber work.

  7. Ultrasonographic diagnosis of porcupine quill foreign bodies in the plantar flexor tendon sheath region in a heifer.

    PubMed

    Mulon, Pierre-Yves; Achard, Damien; Babkine, Marie

    2010-08-01

    A 17-month-old Holstein heifer was presented for persistent enlargement above the right hind fetlock of 1-month's duration. Diffuse plantar soft tissue swelling was present on the radiographs and ultrasonography revealed the presence of multiple porcupine quill extremities embedded in the subcutaneous tissue within the flexor tendon sheath wall. Surgical removal was performed. PMID:21037892

  8. Ankle dorsi- and plantar-flexion torques measured by dynamometry in healthy subjects from 5 to 80 years

    PubMed Central

    2013-01-01

    Background Ankle strength is often impaired in some of the most common neuromuscular disorders. Consequently, strength generated around this joint is important to assess, because it has a great impact on balance and gait. The objectives of this study were to establish normative data and predictive equations for both ankle dorsi- and plantar-flexion strength from a population of healthy subjects (children and adults), to assess the reliability of the measurements and to study the feasibility of using a novel dynamometer on a group of patients with a neuromuscular disorder. Methods Measurements of maximal isometric torque for dorsi- and plantar-flexion were performed on 345 healthy subjects from 5 to 80 years of age. The feasibility of the method was tested on nine patients diagnosed with type 2A limb girdle muscular dystrophy. Results The results documented normal strength values depending on gender and age on ankle dorsi- and plantar-flexion. The reliability of the technique was good with no evaluator effect and a small learning effect. The dynamometer was found suitable in the group of patients, even very weak. Conclusions The device developed was both reliable and accurate in assessing both ankle dorsi-flexion and plantar-flexion torque measurements from weak patients and children to strong healthy adults. Norms and predictive equations are provided for these two muscle functions. PMID:23522186

  9. Effects of running-induced fatigue on plantar pressure distribution in novice runners with different foot types.

    PubMed

    Anbarian, Mehrdad; Esmaeili, Hamed

    2016-07-01

    This study aimed to assess the effects of running-induced fatigue on plantar pressure parameters in novice runners with low and high medial longitudinal arch. Plantar pressure data from 42 novice runners (21 with high, and 21 with low arch) were collected before and after running-induced fatigue protocol during running at 3.3m/s along the Footscan(®) platform. Peak plantar pressure, peak force and force-time integral (impulse) were measured in ten anatomical zones. Relative time for foot roll-over phases and medio-lateral force ratio were calculated before and after the fatigue protocol. After the fatigue protocol, increases in the peak pressure under the first-third metatarsal zones and reduction under the fourth-fifth metatarsal regions were observed in the low arch individuals. In the high arch group, increases in peak pressure under the fourth-fifth metatarsal zones after the running-induced fatigue was observed. It could be concluded that running-induced fatigue had different effects on plantar pressure distribution pattern among novice runners with low and high medial longitudinal foot arch. These findings could provide some information related to several running injuries among individuals with different foot types. PMID:27477708

  10. The relationship between trans-femoral prosthesis alignment and the center trajectory of plantar pressure in the frontal plane

    PubMed Central

    Nomura, Tomohiro; Watanabe, Kota; Nosaka, Toshiya; Matsubara, Hiroyuki; Akiyama, Masaharu; Inui, Kimiharu

    2016-01-01

    [Purpose] It is difficult to identify by visual observation whether alignment abnormalities in trans-femoral prostheses in the frontal plane are attributable to the adduction angle or the abnormal alignment of the positions of the medial and lateral sides of the socket in relation to the foot. Therefore, we focused on the trajectory of the center of plantar pressure during walking, and we proposed a method for differentiating these two alignment abnormalities. [Subjects and Methods] We recruited 4 trans-femoral unilateral amputees. Bench alignment was achieved initially. We compared the amplitude of the trajectory of the center of plantar pressure when walking under 2 conditions: 1) when changing the adduction angle and 2) when changing the positional relationship between the socket and the foot. [Results] It was not possible to distinguish between the 2 types of malalignment on the prosthesis side. There was a significant difference when changing the positional relationship on the contralateral side. Thereby, the plantar pressure of the contralateral side could be used to distinguish between the 2 types of malalignment. [Conclusion] The results of this study suggested that trans-femoral prosthesis malalignment could be evaluated through the plantar pressure of the contralateral side in amputees. PMID:27065546

  11. Arterial pseudoaneurysm of the ankle after plantar flexion-inversion injury. A rare complication and its non-invasive diagnosis.

    PubMed

    Sarungi, M; Milassin, P; Császár, J; Sándor, L

    1994-01-01

    We report a case of arterial pseudoaneurysm over the lateral side of the ankle caused by plantar flexion-inversion injury and discuss the aetiology of this rarely seen complication. In the English orthopaedic literature, our case is the first of the very few previously reported cases with a similar aetiology which was examined and confirmed by colour Doppler ultrasound.

  12. Effects of 4 Weeks of Explosive-type Strength Training for the Plantar Flexors on the Rate of Torque Development and Postural Stability in Elderly Individuals.

    PubMed

    Kobayashi, Y; Ueyasu, Y; Yamashita, Y; Akagi, R

    2016-06-01

    This study aimed to investigate the effect of a 4-week explosive-type strength training program for the plantar flexors on the rate of torque development and postural stability. The participants were 56 elderly men and women divided into training (17 men and 15 women) and control (14 men and 10 women) groups. The participants in the training group underwent explosive-type strength training of the plantar flexors 2 days per week for 4 weeks. Training consisted of 3 sets of 10 repetitions of explosive plantar flexion lasting less than 1 s. The following parameters were determined: muscle volume of the plantar flexors estimated by the muscle thickness and lower leg length, maximal voluntary contraction torque and rate of torque development of plantar flexion, and one-leg standing ability. The training increased the maximal voluntary contraction torque and rate of torque development, but corresponding increases in muscle volume and one-leg standing ability were not found. These results suggest that, for elderly individuals, the 4-week explosive-type strength training of the plantar flexors is effective for increasing the maximal voluntary contraction torque and rate of torque development of plantar flexion but is not effective for improving postural stability.

  13. Effects of 4 Weeks of Explosive-type Strength Training for the Plantar Flexors on the Rate of Torque Development and Postural Stability in Elderly Individuals.

    PubMed

    Kobayashi, Y; Ueyasu, Y; Yamashita, Y; Akagi, R

    2016-06-01

    This study aimed to investigate the effect of a 4-week explosive-type strength training program for the plantar flexors on the rate of torque development and postural stability. The participants were 56 elderly men and women divided into training (17 men and 15 women) and control (14 men and 10 women) groups. The participants in the training group underwent explosive-type strength training of the plantar flexors 2 days per week for 4 weeks. Training consisted of 3 sets of 10 repetitions of explosive plantar flexion lasting less than 1 s. The following parameters were determined: muscle volume of the plantar flexors estimated by the muscle thickness and lower leg length, maximal voluntary contraction torque and rate of torque development of plantar flexion, and one-leg standing ability. The training increased the maximal voluntary contraction torque and rate of torque development, but corresponding increases in muscle volume and one-leg standing ability were not found. These results suggest that, for elderly individuals, the 4-week explosive-type strength training of the plantar flexors is effective for increasing the maximal voluntary contraction torque and rate of torque development of plantar flexion but is not effective for improving postural stability. PMID:26990722

  14. [Therapeutic superiority of regional retrograde venous antibiotic pressure infusion versus systemic venous infusions in diabetic patients with infected neuropathic plantar ulcers].

    PubMed

    Seidel, C; Bühler-Singer, S; Tacke, J; Hornstein, O P

    1994-02-01

    Since systemic treatment of neuropathic plantar ulcers in diabetics (DNPU) has so far been rather ineffective, recent reports of successful management of DNPU by short-term retrograde transvenous leg perfusion (RVP) by South American angiologists encouraged us to apply this treatment method in diabetics suffering from chronic DNPU. Hence, in a prospective comparative clinical trial started in 1989 we have treated 45 male diabetics suffering from DNPU with the same daily doses of netilmycin, administered either in systemic venous infusions (SVI: n = 21, three times/day) or in RVP (n = 24, once/day). After 10 consecutive days of treatment, ulcers had closed in 8 of the 24 patients treated with RVP, as against 3 of the 21 treated with SVI. Diminution of the ulcer area by > 30% including full debridement was achieved in 10/24 of the RVP cases (SVI: 4/21). During 6 months of follow-up, amputation of toes or forefoot was necessary in only 1 patient in the RVP group, but in 4 in the SVI group. Partial restitution of osteolytic damage was observed in some cases after RVP. Our results show that regional netilmycin therapy given by the RVP procedure is clearly superior to equal netilmycin doses administered by SVI for the treatment of DNPU. RVP can be recommended in DNPU, particularly when the ulcers are complicated by infections.

  15. Three Case Reports of Successful Vibration Therapy of the Plantar Fascia for Spasticity Due to Cerebral Palsy-Like Syndrome, Fetal-Type Minamata Disease.

    PubMed

    Usuki, Fusako; Tohyama, Satsuki

    2016-04-01

    Fetal-type Minamata disease is caused by the exposure to high concentrations of methylmercury in the fetal period and shows cerebral palsy-like clinical features. Relief of spasticity is a major task of rehabilitation to improve their activities of daily living. Here we report the effect of long-term vibration therapy on bilateral lower-limb spasticity in 3 patients with fetal-type Minamata disease. We used a simple, inexpensive, and noninvasive approach with hand-held vibration massagers, which were applied to the plantar fascia at 90 Hz for 15 minutes. The effect was observed soon after the first treatment and resulted in better performance of the repetitive facilitation. Vibration therapy for 1 year improved Modified Ashworth Scale for the ankle flexors in 2 cases. The labored gait improved and gait speed increased in another case. Continued vibration therapy for another 1 year further improved Modified Ashworth Scale score and range of motion of ankle dorsiflexion in 1 case. This case showed the decreased amplitude of soleus H-reflex after the 15-minute vibration therapy, suggesting that α-motor neuron excitability was suppressed. Vibration therapy using a hand-held vibration massager may offer safe and effective treatment for lower-limb spasticity in patients with chronic neurological disorders.

  16. Three Case Reports of Successful Vibration Therapy of the Plantar Fascia for Spasticity Due to Cerebral Palsy-Like Syndrome, Fetal-Type Minamata Disease

    PubMed Central

    Usuki, Fusako; Tohyama, Satsuki

    2016-01-01

    Abstract Fetal-type Minamata disease is caused by the exposure to high concentrations of methylmercury in the fetal period and shows cerebral palsy-like clinical features. Relief of spasticity is a major task of rehabilitation to improve their activities of daily living. Here we report the effect of long-term vibration therapy on bilateral lower-limb spasticity in 3 patients with fetal-type Minamata disease. We used a simple, inexpensive, and noninvasive approach with hand-held vibration massagers, which were applied to the plantar fascia at 90 Hz for 15 minutes. The effect was observed soon after the first treatment and resulted in better performance of the repetitive facilitation. Vibration therapy for 1 year improved Modified Ashworth Scale for the ankle flexors in 2 cases. The labored gait improved and gait speed increased in another case. Continued vibration therapy for another 1 year further improved Modified Ashworth Scale score and range of motion of ankle dorsiflexion in 1 case. This case showed the decreased amplitude of soleus H-reflex after the 15-minute vibration therapy, suggesting that α-motor neuron excitability was suppressed. Vibration therapy using a hand-held vibration massager may offer safe and effective treatment for lower-limb spasticity in patients with chronic neurological disorders. PMID:27082608

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

    PubMed Central

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

    2006-01-01

    Background Metatarsalgia is related to repetitive high-pressure loading under the metatarsal head (MH) that causes pain. The high pressure under the MH can be reduced by adequately applying metatarsal pads (MPs). Plantar pressure measurements may provide a method to objectively evaluate pressure loading under the MH. However, it is still unclear if the decrease in plantar pressure under the MH after MP treatment is associated with subjective improvement. This study aims to explore the correlations between subjective pain improvement and outcome rating, and the plantar pressure parameters in metatarsalgia patients treated using MPs. Methods Thirteen patients (a total of 18 feet) with secondary metatarsalgia were included in this study. Teardrop-shaped MPs made of polyurethane foam were applied just proximal to the second MH by an experienced physiatrist. Insole plantar pressure was measured under the second MH before and after MP application. Visual analog scale (VAS) scores of pain were obtained from all subjects before and after 2 weeks of MP treatment. The subjects rated using four-point subjective outcome scales. The Wilcoxon signed-rank test was used to analyze the difference between the plantar pressure parameters and VAS scores before and after treatment. The Kruskal-Wallis test was applied to compare the plantar pressure parameters in each outcome group. Pearson's correlation was applied to analyze the correlation between the changes in plantar pressure parameters and VAS scores. Statistical significance was set as p < 0.05. Results MP application decreased the maximal peak pressure (MPP) and pressure-time integral (PTI) under the second MH and also statistically improved subjective pain scores. However, neither the pre-treatment values of the MPP and PTI shift in the position of the MPP after treatment, nor the age, gender and body mass index (BMI) of the subjects were statistically correlated with subjective improvement. Declines in the PTI and MPP values

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

    PubMed Central

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

    2011-01-01

    OBJECTIVE Therapeutic footwear for diabetic foot patients aims to reduce the risk of ulceration by relieving mechanical pressure on the foot. However, footwear efficacy is generally not assessed in clinical practice. The purpose of this study was to assess the value of in-shoe plantar pressure analysis to evaluate and optimize the pressure-reducing effects of diabetic therapeutic footwear. RESEARCH DESIGN AND METHODS Dynamic in-shoe plantar pressure distribution was measured in 23 neuropathic diabetic foot patients wearing fully customized footwear. Regions of interest (with peak pressure >200 kPa) were selected and targeted for pressure optimization by modifying the shoe or insole. After each of a maximum of three rounds of modifications, the effect on in-shoe plantar pressure was measured. Successful optimization was achieved with a peak pressure reduction of >25% (criterion A) or below an absolute level of 200 kPa (criterion B). RESULTS In 35 defined regions, mean peak pressure was significantly reduced from 303 (SD 77) to 208 (46) kPa after an average 1.6 rounds of footwear modifications (P < 0.001). This result constitutes a 30.2% pressure relief (range 18–50% across regions). All regions were successfully optimized: 16 according to criterion A, 7 to criterion B, and 12 to criterion A and B. Footwear optimization lasted on average 53 min. CONCLUSIONS These findings suggest that in-shoe plantar pressure analysis is an effective and efficient tool to evaluate and guide footwear modifications that significantly reduce pressure in the neuropathic diabetic foot. This result provides an objective approach to instantly improve footwear quality, which should reduce the risk for pressure-related plantar foot ulcers. PMID:21610125

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

    PubMed

    Pradels, Antoine; Pradon, Didier; Hlavačková, Petra; Diot, Bruno; Vuillerme, Nicolas

    2013-01-01

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

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

    PubMed Central

    Pradels, Antoine; Pradon, Didier; Hlavačková, Petra; Diot, Bruno; Vuillerme, Nicolas

    2013-01-01

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

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

    SciTech Connect

    PAGE JS; COOKE GA; PESTOVICH JA; HUBER HJ

    2011-12-01

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

  2. Synergistic Co-activation Increases the Extent of Mechanical Interaction between Rat Ankle Plantar-Flexors

    PubMed Central

    Tijs, Chris; van Dieën, Jaap H.; Baan, Guus C.; Maas, Huub

    2016-01-01

    Force transmission between rat ankle plantar-flexors has been found for physiological muscle lengths and relative positions, but only with all muscles maximally activated. The aims of this study were to assess intermuscular mechanical interactions between ankle plantar-flexors during (i) fully passive conditions, (ii) excitation of soleus (SO), (iii) excitation of lateral gastrocnemius (LG), and (iv) during co-activation of SO, and LG (SO&LG). We assessed effects of proximal lengthening of LG and plantaris (PL) muscles (i.e., simulating knee extension) on forces exerted at the distal SO tendon (FSO) and on the force difference between the proximal and distal LG+PL tendons (ΔFLG+PL) of the rat. LG+PL lengthening increased FSO to a larger extent (p = 0.017) during LG excitation (0.0026 N/mm) than during fully passive conditions (0.0009 N/mm). Changes in FSO in response to LG+PL lengthening were lower (p = 0.002) during SO only excitation (0.0056 N/mm) than during SO&LG excitation (0.0101 N/mm). LG+PL lengthening changed ΔFLG+PL to a larger extent (p = 0.007) during SO excitation (0.0211 N/mm) than during fully passive conditions (0.0157 N/mm). In contrast, changes in ΔFLG+PL in response to LG+PL lengthening during LG excitation (0.0331 N/mm) were similar (p = 0.161) to that during SO&LG excitation (0.0370 N/mm). In all conditions, changes of FSO were lower than those of ΔFLG+PL. This indicates that muscle forces were transmitted not only between LG+PL and SO, but also between LG+PL and other surrounding structures. In addition, epimuscular myofascial force transmission between rat ankle plantar-flexors was enhanced by muscle activation. However, the magnitude of this interaction was limited. PMID:27708589

  3. Plantar Wart

    MedlinePlus

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

  4. An automatic incision device for obtaining blood samples from the heels of preterm infants causes less damage than a conventional manual lancet

    PubMed Central

    Vertanen, H; Fellman, V; Brommels, M; Viinikka, L

    2001-01-01

    OBJECTIVES—To evaluate in a randomised blind study the effect on puncture site lesions of two different incision devices used to obtain blood samples from preterm infants by repeated heel sticks. 
SETTING—The neonatal intensive care unit at the Hospital for Children and Adolescents and Laboratory, Helsinki University Central Hospital. 
PATIENTS—A total of 100 preterm infants (birth weight below 2500 g) not previously subjected to heel stick sampling. 
INTERVENTIONS—The infants were randomly allocated to blood sampling from the heel with either a conventional manual lancet or an automatic incision device. The same type of lancet was used for any given baby throughout the study (2-21 days).
MAIN OUTCOME MEASURES—The damage caused by sampling was evaluated using four criteria: bruising of the heel, inflammation of the heel, bruising of either the ankle or the leg, and skin healing at the puncture site. The evaluation was based on photographs presenting typical categories of each outcome. 
RESULTS—To obtain a sufficient volume of blood, on average 2.6 times more punctures were needed when the conventional manual lancet was used than when the automatic incision device was used. Heels punctured with the lancet had more bruising (100% v 84%) and more signs of inflammation (79% v 53%), and there was more bruising of the ankle or leg (92% v 53%) than when the automatic incision device was used. Skin healed equally rapidly in the two groups.
CONCLUSION—The use of an automatic incision device for collecting repeated skin puncture samples from preterm infants is less traumatic than the use of a conventional manual lancet.

 PMID:11124927

  5. Effect of footwear on minimum foot clearance, heel slippage and spatiotemporal measures of gait in older women.

    PubMed

    Davis, Annette M; Galna, Brook; Murphy, Anna T; Williams, Cylie M; Haines, Terry P

    2016-02-01

    Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls. PMID:27004631

  6. Cell shedding from human plantar skin in vitro: evidence of its dependence on endogenous proteolysis.

    PubMed

    Lundström, A; Egelrud, T

    1988-10-01

    Cell shedding from plantar stratum corneum was studied in vitro. Cells were shed only from the surface that had faced outwards in vivo. A quantitative measure of the cell release was obtained by determining the amount of protein that could be extracted from released and sedimented cells with 1 M sodium hydroxide. The cell release was optimal at pH 7-9 but was significant also at pH 6. The rate of cell release increased with increasing temperature, but was decreased abruptly at temperatures above 50 degrees C. The cell dissociation could be inhibited by aprotinin (Trasylol) and soybean trypsin inhibitor. Thus, it is evident that the unipolar cell dissociation in this system is mediated by an enzymatically catalyzed process, most likely with the involvement of a serine protease with an alkaline pH-optimum. The in vitro cell release shows properties indicating that it may be mediated by mechanisms also active in vivo.

  7. An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

    PubMed

    Inaba, A S; Zukin, D D; Perro, M

    1992-02-01

    The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated.

  8. An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

    PubMed

    Inaba, A S; Zukin, D D; Perro, M

    1992-02-01

    The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated. PMID:1603689

  9. Effects of plantar flexor muscle fatigue induced by electromyostimulation on postural coordination.

    PubMed

    Ponce, Antoine; Fouque, Florent; Cahouët, Violaine; Martin, Alain

    2007-02-27

    The aim of the present study was to investigate the influence of a modification of an intrinsic capacity (plantar flexor strength) on the implementation of in-phase and anti-phase mode of coordination. Analysis of hip and ankle relative phases during fore-aft tracking task was done before and after an electromyostimulation fatigue protocol on the soleus muscles. Results showed participants used exclusively in-phase and anti-phase modes of coordination, with a sudden switch from one to the other with target frequency increase. Regarding tracking tasks, fatigue induces a decrease of performance for lower frequencies, and a significant decrease of switch frequency (-0.08 Hz) for each subject. In conclusion, changes in mode of coordination implementation suggest that the in-phase mode implementation is highly linked to the strength production capacity at the ankle joint. PMID:17280784

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

    PubMed

    Gamborg Nielsen, P

    1984-01-01

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

  11. Energy metabolism in human calf muscle performing isometric plantar flexion superimposed by 20-Hz vibration.

    PubMed

    Zange, Jochen; Haller, Timo; Müller, Klaus; Liphardt, Anna-Maria; Mester, Joachim

    2009-01-01

    Vibration training is commonly expected to induce an active muscle contraction via a complex reflex mechanism. In calf muscles of 20 untrained subjects, the additional energy consumption in response to vibration superimposed on an isometric contraction was examined by (31)P magnetic resonance spectroscopy and by near infrared spectroscopy. Subjects performed 3 min of isometric plantar flexion exercise at 40% MVC under four conditions: with (VIB) and without (CON) superimposed 20 Hz vibration at +/-2 mm amplitude, both combined with or without arterial occlusion (AO). After contraction under all conditions, the decreases in oxygenated haemoglobin were not significantly different. After VIB + AO consumption of ATP was increased by 60% over CON + AO, visible by significant decreases in [PCr] and intracellular pH (P < 0.05). The additional energy consumption by vibration was not detectable under natural perfusion. Probably without AO the additional energy consumption by vibration was compensated by oxidative phosphorylation enabled by additional perfusion.

  12. Plantar Purpura as the Initial Presentation of Viridians Streptococcal Shock Syndrome Secondary to Streptococcus gordonii Bacteremia

    PubMed Central

    Liao, Chen-Yi; Su, Kuan-Jen; Lin, Cheng-Hui; Huang, Shu-Fang; Chin, Hsien-Kuo; Chang, Chin-Wen; Kuo, Wu-Hsien; Ben, Ren-Jy; Yeh, Yen-Cheng

    2016-01-01

    Viridians streptococcal shock syndrome is a subtype of toxic shock syndrome. Frequently, the diagnosis is missed initially because the clinical features are nonspecific. However, it is a rapidly progressive disease, manifested by hypotension, rash, palmar desquamation, and acute respiratory distress syndrome within a short period. The disease course is generally fulminant and rarely presents initially as a purpura over the plantar region. We present a case of a 54-year-old female hospital worker diagnosed with viridians streptococcal shock syndrome caused by Streptococcus gordonii. Despite aggressive antibiotic treatment, fluid hydration, and use of inotropes and extracorporeal membrane oxygenation, the patient succumbed to the disease. Early diagnosis of the potentially fatal disease followed by a prompt antibiotic regimen and appropriate use of steroids are cornerstones in the management of this disease to reduce the risk of high morbidity and mortality. PMID:27366188

  13. Ambulatory assessment of 3D ground reaction force using plantar pressure distribution.

    PubMed

    Rouhani, H; Favre, J; Crevoisier, X; Aminian, K

    2010-07-01

    This study aimed to use the plantar pressure insole for estimating the three-dimensional ground reaction force (GRF) as well as the frictional torque (T(F)) during walking. Eleven subjects, six healthy and five patients with ankle disease participated in the study while wearing pressure insoles during several walking trials on a force-plate. The plantar pressure distribution was analyzed and 10 principal components of 24 regional pressure values with the stance time percentage (STP) were considered for GRF and T(F) estimation. Both linear and non-linear approximators were used for estimating the GRF and T(F) based on two learning strategies using intra-subject and inter-subjects data. The RMS error and the correlation coefficient between the approximators and the actual patterns obtained from force-plate were calculated. Our results showed better performance for non-linear approximation especially when the STP was considered as input. The least errors were observed for vertical force (4%) and anterior-posterior force (7.3%), while the medial-lateral force (11.3%) and frictional torque (14.7%) had higher errors. The result obtained for the patients showed higher error; nevertheless, when the data of the same patient were used for learning, the results were improved and in general slight differences with healthy subjects were observed. In conclusion, this study showed that ambulatory pressure insole with data normalization, an optimal choice of inputs and a well-trained nonlinear mapping function can estimate efficiently the three-dimensional ground reaction force and frictional torque in consecutive gait cycle without requiring a force-plate.

  14. The effects of passive stretching plus vibration on strength and activation of the plantar flexors.

    PubMed

    Miller, Jonathan D; Herda, Trent J; Trevino, Michael A; Mosier, Eric M

    2016-09-01

    This study examined the effects of passive stretching only (PS+CON) and passive stretching with the addition of continuous vibration (VIB) during post-passive stretching tests (PS+VIB) on peak torque (PT), percent voluntary inactivation (%VI), single stimulus twitch torque (TTSINGLE), and doublet stimuli twitch torque (TTDOUBLET) of the plantar flexors at a short (20° plantar flexion (PF)) and long muscle length (15° dorsiflexion (DF)). Fourteen healthy men (age = 22 ± 3 years) performed isometric maximal voluntary contractions at PF and DF, and passive range of motion (PROM) assessments before and after 8 × 30-s passive stretches without (PS+CON) or with VIB (PS+VIB) administered continuously throughout post-passive stretching tests. The passive properties of the muscle tendon unit were assessed pre- and post-passive stretching via PROM, passive torque (PASSTQ), and musculotendinous stiffness (MTS) measurements. PT, TTSINGLE, and TTDOUBLET decreased, whereas, %VI increased following passive stretching at PF and DF (P < 0.05) with no significant differences between PS+CON and PS+VIB. PASSTQ and MTS decreased while PROM increased post-passive stretching during both trials (P < 0.05). The stretching-induced force/torque deficit and increases in %VI were evident following passive stretching at short and long muscle lengths. Although not statistically significant, effect size calculations suggested large and moderate differences in the absolute changes in PT (Cohen's d = 1.14) and %VI (Cohen's d = 0.54) from pre- to post-passive stretching between treatments, with PS+VIB having greater decreases of PT and higher %VI than PS+CON. The decrement in PT following passive stretching may be primarily neural in origin. PMID:27512816

  15. Plantar Fibroma and Plantar Fibromatosis

    MedlinePlus

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

  16. Clarification of functional differences between the hallux and lesser toes during the single leg stance: immediate effects of conditioning contraction of the toe plantar flexion muscles

    PubMed Central

    Saeki, Junya; Tojima, Michio; Torii, Suguru

    2015-01-01

    [Purpose] The purpose of this study was to determine the functional differences of the plantar flexion muscles of the hallux and lesser toes during the single leg stance by comparing postural sway in different conditioning contraction interventions. [Subjects] Thirty-four healthy, young males and females participated in this study. [Methods] The front-back and right-left direction components of maximal displacement and postural sway velocity during the single leg stance were measured in various conditioning contraction interventions for the plantar flexion muscles of the hallux or lessor toes. [Results] The main findings of this study were as follows: 1) the front-back direction component of maximal displacement was reduced by conditioning contraction of the plantar flexion muscles of the hallux, and 2) the front-back direction component of the postural sway velocity was reduced by conditioning contraction of the plantar flexion muscles of the lesser toes during the single leg stance. [Conclusion] The plantar flexion muscles of the lesser toes control the postural sway velocity. Furthermore, the plantar flexion muscles of the hallux appear to control the amplitude of postural sway. PMID:26504272

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

    PubMed Central

    Abdel-aziem, Amr Almaz; Mohammad, Walaa Sayed

    2012-01-01

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

  18. Chronic Bronchitis

    MedlinePlus

    ... chronic. Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease). The inflamed bronchial tubes produce a lot of mucus. This leads to coughing and difficulty breathing. Cigarette smoking is the most ... diagnose chronic bronchitis, your doctor will look at your signs ...

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

    NASA Astrophysics Data System (ADS)

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

    2016-01-01

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

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

    PubMed Central

    Bingol, Ugur A.; Cinar, Can; Arslan, Hakan; Altındas, Muzaffer

    2015-01-01

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

  1. Ammonium lactate 12% lotion versus a liposome-based moisturizing lotion for plantar xerosis. A double-blind comparison study.

    PubMed

    Uy, J J; Joyce, A M; Nelson, J P; West, B; Montague, J R

    1999-10-01

    Two emollients, ammonium lactate 12% lotion and a liposome-based moisturizing lotion, were compared in a double-blind test for efficacy in the treatment of plantar xerosis. A total of 43 out of 57 participants (75%) with bilateral plantar xerosis followed instructions completely and applied the lotions (one to each foot) twice daily for 4 weeks. Each participant was evaluated once a week for 6 weeks (the final 2 weeks for evaluation of post-treatment regression) to determine xerotic grade (degree of dryness) and treatment effectiveness. With both lotions, significant improvement began during the second week of treatment and continued into the fourth week. There were no significant differences between the two lotions in the 6-week patterns of either xerotic grade or treatment effectiveness.

  2. Experience with extracorporeal shock wave therapy (ESWT) in the United States

    NASA Astrophysics Data System (ADS)

    Furia, John P.

    2005-04-01

    The purpose of this presentation is to summarize the literature and to report on single treatment, high-energy ESWT for the treatment of chronic plantar fasciitis and lateral epicondylitis. Fifty-three patients (60 heels) were treated with 3800 shock waves. Sixteen patients (19 heels) were active, 21 (22 heels), were moderately active, and 16 (19 heels) were sedentary. Twelve weeks post treatment, mean visual analog scores (VAS) for the entire group improved from 9.2 to 2.4 (p<0.05), RAND-Physical Functioning score improved from 40.4 to 91.5 (p<0.05), and RAND-Pain score improved from 33.3 to 90 (p<0.05). Fifty heels (83.3%) were assigned an excellent or good result. Thirty-six patients with chronic lateral epicondylitis were treated with 3200 shock waves. There were 9 workers compensation and 27 non-workers compensation patients. Twelve weeks post treatment, the mean VAS for the entire group improved from 8.0 to 2.5 (p<0.05), and the mean RAND-Physical Functioning score improved from 65.6 to 88.0 (p<0.05). Twenty-eight elbows (77.8%) were assigned an excellent or good result. In both trials, outcome was similar for each subgroup. There were no significant complications in either trial. Using the therapeutic parameters applied, ESWT is a safe and effective treatment for chronic plantar fasciitis and lateral epicondylitis.

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

    PubMed Central

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

    2003-01-01

    Objectives: To examine changes in the pattern of force transfer between the foot and the floor associated with chronically sprained ankles by measuring the peak forces and their timing under several regions of the feet during level walking. Methods: Twelve young male subjects (mean (SD) age 21 (2) years) with recurrent ankle sprains were studied. Seven of them had unilateral and bilateral chronic instability and laxity, and five had bilateral instability. Twelve healthy men (without orthopaedic or medical disease) served as a control group. Subjects walked at their own pace along a 7 m walkway, which included a Mini-EMED pressure distribution measuring system. The variables measured were relative peak force (fraction of body weight) and relative timing (fraction of stance time). These variables were measured under six regions of interest in each foot print: heel, midfoot, medial, central, and lateral forefoot, and toes. Results: (a) A significant delay to the time of peak force under the central and lateral forefoot and toes in subjects with chronic ankle instability. (b) A significant decrease in the relative forces under the heel and toes and an increase in the relative forces under the midfoot and lateral forefoot in subjects with chronic ankle instability. (c) In the patients with unilateral instability, there were no significant differences in any of the variables between the injured and non-injured foot. Conclusions: In patients with chronic ankle instability, there is a slowing down of weight transfer from heel strike to toe off, a reduced impact at the beginning and end of the stance phase, and a lateral shift of body weight. PMID:14665586

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

    PubMed Central

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

    2014-01-01

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

  5. Contributions of knee swing initiation and ankle plantar flexion to the walking mechanics of amputees using a powered prosthesis.

    PubMed

    Ingraham, Kimberly A; Fey, Nicholas P; Simon, Ann M; Hargrove, Levi J

    2014-01-01

    Recently developed powered prostheses are capable of producing near-physiological joint torque at the knee and/or ankle joints. Based on previous studies of biological joint impedance and the mechanics of able-bodied gait, an impedance-based controller has been developed for a powered knee and ankle prosthesis that integrates knee swing initiation and powered plantar flexion in late stance with increasing ankle stiffness throughout stance. In this study, five prosthesis configuration conditions were tested to investigate the individual contributions of each sub-strategy to the overall walking mechanics of four unilateral transfemoral amputees as they completed a clinical 10-m walk test using a powered knee and ankle prosthesis. The baseline condition featured constant ankle stiffness and no swing initiation or powered plantar flexion. The four remaining conditions featured knee swing initiation alone (SI) or in combination with powered plantar flexion (SI+PF), increasing ankle stiffness (SI+IK), or both (SI+PF+IK). Self-selected walking speed did not significantly change between conditions, although subjects tended to walk the slowest in the baseline condition compared to conditions with swing initiation. The addition of powered plantar flexion resulted in significantly higher ankle power generation in late stance irrespective of ankle stiffness. The inclusion of swing initiation resulted in a significantly more flexed knee at toe off and a significantly higher average extensor knee torque following toe off. Identifying individual contributions of intrinsic control strategies to prosthesis biomechanics could help inform the refinement of impedance-based prosthesis controllers and simplify future designs of prostheses and lower-limb assistive devices alike.

  6. Why person affected by leprosy did not look after their plantar ulcer? Experience from Pakokku zone, Myanmar.

    PubMed

    Win, Le Le; Shwe, San; Maw, Win; Ishida, Yutaka; Myint, Kyaw; Mar, Kyi Kyi; Min, Thandar; Oo, Phyo Min; Khine, Aye Win

    2010-09-01

    A cross-sectional study was carried out to identify methods of caring plantar ulcers in leprosy patients and the underlying causes of poor plantar ulcer care during January and February 2008. This was conducted in Pakokku zone as it was one of the "9 selected townships of the Disabilities survey, i.e., Basic Health Staff project 2003/4", which was funded by Japan International Cooperation Agency. After getting consent, all available leprosy cases, i.e., 101 cases with foot disability grade 2 were interviewed with the pre-tested questionnaire. Among 101 cases, 13 cases who took care of their ulcer poorly and 20 who did none of the recommended measures were recruited for in-depth interview (IDI). The subjects were largely old people, males and people with no marriage partner. The majority had earned money by doing sedentary job. Prolongation of ulcers was observed in 78 cases. Most had been suffering from ulcers for years. When asking face-to-face interview, all the recommended care measures were not reported. Among these recommended measures, a large number of respondents reported about soaking measure. However, these reported measures were contradicted to the preventive methods which they disclosed in IDI. Plantar ulcer care seemed to be an individualised practice. The individual ways of performing were related to their view of ulcer, the environment, and occupation, and custom, communication with family and health staff. The findings identified the actual practice of plantar ulcer care in study areas. It is suggested that the current performance of planar ulcer care is inadequate and more attention should be given to achieve the target set by the programme as a recommendation. PMID:20857653

  7. The practical application of multimedia technology to facilitate the education and treatment of patients with plantar fasciitis: a pilot study.

    PubMed

    Beischer, Andrew Donald; Clarke, Andrew; de Steiger, Richard Noel; Donnan, Leo; Ibuki, Aileen; Unglik, Rebecca

    2008-02-01

    This study was designed to evaluate the efficacy of a multimedia patient education module when incorporated into the standard treatment protocol for patients diagnosed with plantar fasciitis. A thorough, standardized surgeon-patient education discourse took place following diagnosis. At the conclusion of the consultation, patients viewed the multimedia module. Questionnaires designed to assess understanding and satisfaction with information delivery were completed by patients following the consultation and again after viewing the module. Forty-one patients participated in the study. After viewing the module, patients achieved an average of 87% correct responses on the knowledge questionnaire, a significant improvement (P < .0001) over the 64% achieved following the surgeon-patient discourse. Ease of understanding of the information delivered by the module was rated significantly better (P < .0001) than the surgeon-patient discourse. Ninety-eight percent of patients indicated they felt well informed about plantar fasciitis following viewing the module compared with 68% following the surgeon-patient discourse. Sixty-three percent of patients indicated that the module best answered their questions, 7% preferred the surgeon, and 30% rated both equally. Multimedia plantar fasciitis educational material improved patient understanding of the standard treatment protocol and satisfaction with the information delivery in an orthopedic private practice.

  8. School-based screening of plantar pressures during level walking with a backpack among overweight and obese schoolchildren.

    PubMed

    Pau, Massimiliano; Leban, Bruno; Corona, Federica; Gioi, Sara; Nussbaum, Maury A

    2016-05-01

    Among children, postural modifications due to backpack carriage have direct consequences on how forces are exchanged between body and ground and thus on plantar pressure distribution. However, it is unknown whether such alterations are influenced by the foot structure and functionality typical of obesity. In this study, we tested 65 overweight/obese primary schoolchildren using a pressure platform while walking with and without the backpack. Contact areas, arch index, peak and mean plantar pressures in the forefoot, midfoot and rearfoot were compared with those from an additional 65 age- and gender-matched group of normal-weight children. Backpack carriage modified pressure distribution similarly in both groups, with the exception of mean midfoot pressure, which increased significantly among normal-weight children but not in the overweight/obese group. Notably, the pressure values associated with mass excess and backpack carriage still raise some concerns regarding potential long-term adverse consequences on foot structure and functionality of overweight/obese children. Practitioner summary: Backpack carriage by overweight/obese schoolchildren altered plantar pressures similar to what was observed in their normal-weight peers. Yet, high pressures were found among the overweight/obese children. This raises concerns regarding potential long-term adverse consequences on foot structure and functionality, and supports establishing more specific limits for the carried load. PMID:26226045

  9. Effect of plantar subcutaneous administration of bergamot essential oil and linalool on formalin-induced nociceptive behavior in mice.

    PubMed

    Katsuyama, Soh; Otowa, Akira; Kamio, Satomi; Sato, Kazuma; Yagi, Tomomi; Kishikawa, Yukinaga; Komatsu, Takaaki; Bagetta, Giacinto; Sakurada, Tsukasa; Nakamura, Hitoshi

    2015-01-01

    This study investigated the effect of bergamot essential oil (BEO) or linalool, a major volatile component of BEO, on the nociceptive response to formalin. Plantar subcutaneous injection of BEO or linalool into the ipsilateral hindpaw reduced both the first and late phases of the formalin-induced licking and biting responses in mice. Plantar subcutaneous injection of BEO or linalool into the contralateral hindpaw did not yield an antinociceptive effect, suggesting that the antinociceptive effect of BEO or linalool in the formalin test occurred peripherally. Intraperitoneal and plantar subcutaneous injection pretreatment with naloxone hydrochloride, an opioid receptor antagonist, significantly attenuated both BEO- and linalool-induced antinociception. Pretreatment with naloxone methiodide, a peripherally acting opioid receptor antagonists, also significantly antagonized the antinociceptive effects of BEO and linalool. Our results provide evidence for the involvement of peripheral opioids in antinociception induced by BEO and linalool. These results suggest that activation of peripheral opioid receptors may play an important role in reducing formalin-induced nociception.

  10. Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial.

    PubMed

    Kiritsi, Olga; Tsitas, Konstantinos; Malliaropoulos, Nikolaos; Mikroulis, Grogorios

    2010-03-01

    The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on plantar fasciitis documented by the ultrasonographic appearance of the aponeurosis and by patients' pain scores. Thirty individuals with diagnosis of unilateral plantar fasciitis were enrolled in a randomized, double-blind, placebo-controlled trial, but 25 participants completed the therapeutic protocol. The contralateral asymptomatic fascia was used as control. After enrolment, symptomatic individuals were randomly assigned to receive LLLT, or identical placebo, for 6 weeks. Ultrasonography was performed at baseline and after completion of therapy. The subjective subcalcaneal pain was recorded at baseline and after treatment on a visual analogue scale (VAS). After LLLT, plantar fascia thickness in both groups showed significant change over the experimental period and there was a difference (before treatment and after treatment) in plantar fascia thickness between the two groups. However, plantar fascia thickness was insignificant (mean 3.627 +/- 0.977 mm) when compared with that in the placebo group (mean 4.380 +/- 1.0042 mm). Pain estimation on the visual analogue scale had improved significantly in all test situations (after night rest, daily activities) after LLLT when compared with that of the placebo group. (P=0.006 and P=0.01, respectively). Additionally, when the difference in pain scores was compared between the two groups, the change was statistically significant (after night rest P=0.000; daily activities P=0.001). In summary, while ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis, 904 nm gallium-arsenide (GaAs) infrared laser may contribute to healing and pain reduction in plantar fasciitis.

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

    PubMed

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

    2012-01-01

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

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

    PubMed

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

    2012-01-01

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

  13. Prevention of Recurrent Foot Ulcers With Plantar Pressure–Based In-Shoe Orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial

    PubMed Central

    Ulbrecht, Jan S.; Hurley, Timothy; Mauger, David T.

    2014-01-01

    OBJECTIVE To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. RESEARCH DESIGN AND METHODS Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. RESULTS There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3–8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. CONCLUSIONS We conclude that shape- and barefoot plantar pressure–based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. PMID:24760263

  14. Plantar tactile perturbations enhance transfer of split-belt locomotor adaptation

    PubMed Central

    Mukherjee, Mukul; Eikema, Diderik Jan A.; Chien, Jung Hung; Myers, Sara A.; Scott-Pandorf, Melissa; Bloomberg, Jacob J.; Stergiou, Nicholas

    2015-01-01

    Patterns of human locomotion are highly adaptive and flexible, and depend on the environmental context. Locomotor adaptation requires the use of multisensory information to perceive altered environmental dynamics and generate an appropriate movement pattern. In this study, we investigated the use of multisensory information during locomotor learning. Proprioceptive perturbations were induced by vibrating tactors, placed bilaterally over the plantar surfaces. Under these altered sensory conditions, participants were asked to perform a split-belt locomotor task representative of motor learning. Twenty healthy young participants were separated into two groups: no-tactors (NT) and tactors (TC). All participants performed an overground walking trial, followed by treadmill walking including 18 minutes of split-belt adaptation and an overground trial to determine transfer effects. Interlimb coordination was quantified by symmetry indices and analyzed using mixed repeated measures ANOVAs. Both groups adapted to the locomotor task, indicated by significant reductions in gait symmetry during the split-belt task. No significant group differences in spatiotemporal and kinetic parameters were observed on the treadmill. However, significant groups differences were observed overground. Step and swing time asymmetries learned on the split belt treadmill, were retained and decayed more slowly overground in the TC group whereas in NT, asymmetries were rapidly lost. These results suggest that tactile stimulation contributed to increased lower limb proprioceptive gain. High proprioceptive gain allows for more persistent overground after-effects, at the cost of reduced adaptability. Such persistence may be utilized in populations displaying pathologic asymmetric gait by retraining a more symmetric pattern. PMID:26169104

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

    PubMed

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

    2013-03-01

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

  16. Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

    PubMed Central

    Cashley, David G.; Cochrane, Lynda

    2015-01-01

    Objective The purpose of this retrospective case series is to describe treatment outcomes for patients with plantar digital neuralgia (PDN) (Morton’s neuroma) who were treated using foot manipulation. Methods Charts were reviewed retrospectively for patients with a diagnosis of PDN and who received a minimum of 6 treatments consisting of manipulation alone. Visual analogue pain scales (VAS) and pressure threshold meter readings (PTM) were extracted as outcome measures. Results Thirty-eight cases met inclusion criteria. Mean pretreatment duration of pain was 28 months. Mean pretreatment VAS was 69.5/100 mm. Mean pretreatment PTM was 2.54 Kp. By the sixth treatment, 30 (79%) of the 38 patients scored a VAS of 0 mm and a further 4 (10%) were below 10 mm. Contralateral limb PTM showed a mean pre-treatment score of 5.5 Kp, which rose slightly to 5.85 Kp. This compared to a pre-treatment score of 2.54 Kp rising to 5.86 Kp in the affected limb. This represents a 126% increase in the affected side compared to 6.5% in the unaffected limb. Statistical analysis demonstrated a significant linear trend between decreasing VAS and manipulation (P < .001). Conclusion The patients with PDN who were included in this case series improved with conservative care that included only foot manipulation. PMID:26257593

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

    PubMed

    Pataky, Todd Colin

    2015-01-01

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

  18. Enhanced physiological tremor deteriorates plantar flexor torque steadiness after bed rest.

    PubMed

    Mulder, Edwin R; Horstman, Astrid M; Gerrits, Karin; Massa, Mark; Kleine, Bert U; de Haan, Arnold; Belavý, Daniel L; Felsenberg, Dieter; Zwarts, Machiel; Stegeman, Dick F

    2011-04-01

    This study evaluated the effectiveness of resistance training to preserve submaximal plantar flexor (PF) torque steadiness following 60 days of bed rest (BR). Twenty-two healthy male subjects underwent either BR only (CTR, n=8), or BR plus resistance training (RT, n=14). The magnitude of torque fluctuations during steady submaximal isometric PF contractions (20%, 40%, 60% and 80% of maximum) were assessed before and after BR. Across contraction intensities, torque fluctuations (coefficient of variation, CV) increased more (P<0.05) after BR for CTR (from 0.31±0.10 to 0.92±0.63; P<0.001), than for RT (from 0.30±0.09 to 0.54±0.27; P<0.01). A shift in the spectral content of torque fluctuations towards increased rhythmic activity between 6.5 and 20Hz was observed in CTR only (P<0.05). H-reflex amplitude (H(max)/M(max) ratio) declined across groups from 0.57±0.18 before BR to 0.44±0.14 following BR (P<0.01) without correlation to CV. The present study showed that increased torque fluctuation after BR resulted from enhanced physiological tremor. Resistance training prevented the spectral shift in isometric PF torque fluctuation and offset ∼50% of the decline in performance associated with long-term BR.

  19. Accuracy of plantar electrodes compared with hand and foot electrodes in fat-free-mass measurement.

    PubMed

    Jaffrin, Michel Y; Bousbiat, Sana

    2014-01-01

    This paper investigates the measurement of fat-free mass (FFM) by bioimpedance using foot-to-foot impedancemeters (FFI) with plantar electrodes measuring the foot-to-foot resistance R34 and hand-to-foot medical impedancemeters. FFM measurements were compared with corresponding data using Dual X-ray absorptiometry (DXA). Equations giving FFM were established using linear multiple regression on DXA data in a first group of 170 subjects. For validation, these equations were used on a second group of 86 subjects, and FFM were compared with DXA data; no significant difference was observed. The same protocol was repeated, but using electrodes on the right hand and foot in standing position to measure the hand to-foot resistance R13. Mean differences with DXA were higher for R13 than for R34. Effect of electrode size and feet position on resistance was also investigated. R34 decreased when electrode area increased or if feet were moved forward. It decreased if feet were moved backward. A proper configuration of contact electrodes can improve measurement accuracy and reproducibility of FFI.

  20. Plantar tactile perturbations enhance transfer of split-belt locomotor adaptation.

    PubMed

    Mukherjee, Mukul; Eikema, Diderik Jan A; Chien, Jung Hung; Myers, Sara A; Scott-Pandorf, Melissa; Bloomberg, Jacob J; Stergiou, Nicholas

    2015-10-01

    Patterns of human locomotion are highly adaptive and flexible and depend on the environmental context. Locomotor adaptation requires the use of multisensory information to perceive altered environmental dynamics and generate an appropriate movement pattern. In this study, we investigated the use of multisensory information during locomotor learning. Proprioceptive perturbations were induced by vibrating tactors, placed bilaterally over the plantar surfaces. Under these altered sensory conditions, participants were asked to perform a split-belt locomotor task representative of motor learning. Twenty healthy young participants were separated into two groups: no-tactors (NT) and tactors (TC). All participants performed an overground walking trial, followed by treadmill walking including 18 min of split-belt adaptation and an overground trial to determine transfer effects. Interlimb coordination was quantified by symmetry indices and analyzed using mixed repeated-measures ANOVAs. Both groups adapted to the locomotor task, indicated by significant reductions in gait symmetry during the split-belt task. No significant group differences in spatiotemporal and kinetic parameters were observed on the treadmill. However, significant group differences were observed overground. Step and swing time asymmetries learned on the split-belt treadmill were retained and decayed more slowly overground in the TC group whereas in NT, asymmetries were rapidly lost. These results suggest that tactile stimulation contributed to increased lower limb proprioceptive gain. High proprioceptive gain allows for more persistent overground after effects, at the cost of reduced adaptability. Such persistence may be utilized in populations displaying pathologic asymmetric gait by retraining a more symmetric pattern.

  1. Hybrid diffuse optical techniques for continuous hemodynamic measurement in gastrocnemius during plantar flexion exercise.

    PubMed

    Henry, Brad; Zhao, Mingjun; Shang, Yu; Uhl, Timothy; Thomas, D Travis; Xenos, Eleftherios S; Saha, Sibu P; Yu, Guoqiang

    2015-12-01

    Occlusion calibrations and gating techniques have been recently applied by our laboratory for continuous and absolute diffuse optical measurements of forearm muscle hemodynamics during handgrip exercises. The translation of these techniques from the forearm to the lower limb is the goal of this study as various diseases preferentially affect muscles in the lower extremity. This study adapted a hybrid near-infrared spectroscopy and diffuse correlation spectroscopy system with a gating algorithm to continuously quantify hemodynamic responses of medial gastrocnemius during plantar flexion exercises in 10 healthy subjects. The outcomes from optical measurement include oxy-, deoxy-, and total hemoglobin concentrations, blood oxygen saturation, and relative changes in blood flow (rBF) and oxygen consumption rate (rV̇O2). We calibrated rBF and rV̇O2 profiles with absolute baseline values of BF and V̇O2 obtained by venous and arterial occlusions, respectively. Results from this investigation were comparable to values from similar studies. Additionally, significant correlation was observed between resting local muscle BF measured by the optical technique and whole limb BF measured concurrently by a strain gauge venous plethysmography. The extensive hemodynamic and metabolic profiles during exercise will allow for future comparison studies to investigate the diagnostic value of hybrid technologies in muscles affected by disease. PMID:26720871

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

    PubMed

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

    2014-11-01

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

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

    PubMed Central

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

    2014-01-01

    Thermography is a useful tool since it provides information that may help in the diagnostic of several diseases in a noninvasive and fast way. Particularly, thermography has been applied in the study of the diabetic foot. However, most of these studies report only qualitative information making it difficult to measure significant parameters such as temperature variations. These variations are important in the analysis of the diabetic foot since they could bring knowledge, for instance, regarding ulceration risks. The early detection of ulceration risks is considered an important research topic in the medicine field, as its objective is to avoid major complications that might lead to a limb amputation. The absence of symptoms in the early phase of the ulceration is conceived as the main disadvantage to provide an opportune diagnostic in subjects with neuropathy. Since the relation between temperature and ulceration risks is well established in the literature, a methodology that obtains quantitative temperature differences in the plantar area of the diabetic foot to detect ulceration risks is proposed in this work. Such methodology is based on the angiosome concept and image processing. PMID:24688595

  4. Palmar-plantar hyperhidrosis occurring in a kindred with nail-patella syndrome.

    PubMed

    Pechman, K J; Bergfeld, W F

    1980-12-01

    Nail-patella syndrome (NPS) is an autosomal dominant genetic defect, which may be associated with, or closely linked to, the locus controlling palmar and plantar hyperhidrosis (HH). A clinical review of a family with NPS involving six generations was performed. Data were accumulated by personal examination and analysis of medical and family records for the trials characterizing NPS as well as the coincidence of HH. A family pedigree of each entity was constructed and the pedigree for HH was compared to the NPS pedigree. Thirty-three of sixty-eight members of the extended family were affected with NPS and nine members had HH. The NPS pedigree supported the previously known autosomal dominant mode of inheritance. The incidence of HH indicated a direct inheritance and occurred only in members affected with NPS. The pedigree provides evidence for concluding that HH occurred as a spontaneous mutation transmitted as an autosomal dominant trait closely linked to NPS or that HH represents a previous unrecognized associated disorder. PMID:7204680

  5. Hybrid diffuse optical techniques for continuous hemodynamic measurement in gastrocnemius during plantar flexion exercise

    NASA Astrophysics Data System (ADS)

    Henry, Brad; Zhao, Mingjun; Shang, Yu; Uhl, Timothy; Thomas, D. Travis; Xenos, Eleftherios S.; Saha, Sibu P.; Yu, Guoqiang

    2015-12-01

    Occlusion calibrations and gating techniques have been recently applied by our laboratory for continuous and absolute diffuse optical measurements of forearm muscle hemodynamics during handgrip exercises. The translation of these techniques from the forearm to the lower limb is the goal of this study as various diseases preferentially affect muscles in the lower extremity. This study adapted a hybrid near-infrared spectroscopy and diffuse correlation spectroscopy system with a gating algorithm to continuously quantify hemodynamic responses of medial gastrocnemius during plantar flexion exercises in 10 healthy subjects. The outcomes from optical measurement include oxy-, deoxy-, and total hemoglobin concentrations, blood oxygen saturation, and relative changes in blood flow (rBF) and oxygen consumption rate (rV˙O2). We calibrated rBF and rV˙O2 profiles with absolute baseline values of BF and V˙O2 obtained by venous and arterial occlusions, respectively. Results from this investigation were comparable to values from similar studies. Additionally, significant correlation was observed between resting local muscle BF measured by the optical technique and whole limb BF measured concurrently by a strain gauge venous plethysmography. The extensive hemodynamic and metabolic profiles during exercise will allow for future comparison studies to investigate the diagnostic value of hybrid technologies in muscles affected by disease.

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

    PubMed

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

    2014-06-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  9. [Preliminary report on a method for establishing the relation between the surface of a plantar load and the total projective surface of the foot: index of plantar load (IPL)].

    PubMed

    Della Capanna, G P

    1983-07-30

    The creation of a Plantar Load Index (PLI) is proposed, with a view to studying the plantar surface of the foot from a morphofunctional standpoint. This Index would provide information on the centesimal relationship between the surface load values and the total projective values of the foot, expressed in cm2. The measurements in question are homogeneous in nature and may, therefore, be easily related to one another. To obtain these values, the two surfaces are visualized, photographed together in a single photogram and analyzed by means of the computerized visual system (Zeiss Videoplan). Visualization is obtained by means of a thermochromatic variation plate which is placed on the stand of a reflexion podoscope and which is sensitive to the heat of the plantar skin and the suitably emitted infra-red rays. The heat of the skin in contact with the plate shows the load surface. The intra-red rays suitably emitted from above onto the plate and onto the back of the foot produce the general chromatic variation of the plate, also showing the perimetrical outline of the foot. The picture to be photographed will, then, be as follows: a continuous black edge formed from the outside by the colouring of the plate produced by the infra-red rays (the perimeter of the foot); more black, extending inwards, in varying degrees, when the skin is not touching the plate (the archer and furrows in the skin); coloured areas inside of the perimeter, showing the load surface.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6626330

  10. Simplified versus geometrically accurate models of forefoot anatomy to predict plantar pressures: A finite element study.

    PubMed

    Telfer, Scott; Erdemir, Ahmet; Woodburn, James; Cavanagh, Peter R

    2016-01-25

    Integration of patient-specific biomechanical measurements into the design of therapeutic footwear has been shown to improve clinical outcomes in patients with diabetic foot disease. The addition of numerical simulations intended to optimise intervention design may help to build on these advances, however at present the time and labour required to generate and run personalised models of foot anatomy restrict their routine clinical utility. In this study we developed second-generation personalised simple finite element (FE) models of the forefoot with varying geometric fidelities. Plantar pressure predictions from barefoot, shod, and shod with insole simulations using simplified models were compared to those obtained from CT-based FE models incorporating more detailed representations of bone and tissue geometry. A simplified model including representations of metatarsals based on simple geometric shapes, embedded within a contoured soft tissue block with outer geometry acquired from a 3D surface scan was found to provide pressure predictions closest to the more complex model, with mean differences of 13.3kPa (SD 13.4), 12.52kPa (SD 11.9) and 9.6kPa (SD 9.3) for barefoot, shod, and insole conditions respectively. The simplified model design could be produced in <1h compared to >3h in the case of the more detailed model, and solved on average 24% faster. FE models of the forefoot based on simplified geometric representations of the metatarsal bones and soft tissue surface geometry from 3D surface scans may potentially provide a simulation approach with improved clinical utility, however further validity testing around a range of therapeutic footwear types is required.

  11. Treatment of Palmar Plantar Erythrodysesthesia (PPE) with Topical Sildenafil: A Pilot Study

    PubMed Central

    Meadows, Kellen L.; Rushing, Christel; Honeycutt, Wanda; Latta, Kenneth; Howard, Leigh; Arrowood, Christy A.; Niedzwiecki, Donna; Hurwitz, Herbert I.

    2016-01-01

    Purpose Palmar-plantar erythrodysethesia (PPE) is a common chemotherapy and anti-VEGF multi-kinase inhibitor class-related toxicity that often results in debilitating skin changes and often limits the use of active anti-cancer regimens. Mechanistic and anecdotal clinical evidence suggested that topical application of sildenafil cream may help reduce the severity of PPE. Therefore, we conducted a randomized, double-blind, placebo-controlled pilot study to evaluate the feasibility, safety and efficacy of topical sildenafil cream for the treatment of PPE. Methods Eligible subjects were required to have grade 1–3 PPE associated with either capecitabine or sunitinib. Subjects were randomized to receive 1% topical sildenafil cream to the left extremities or right extremities and placebo cream on the opposite extremity. 0.5 mL of cream was applied to each affected hand/foot two times per day. The primary endpoint was improvement in PPE grading at any point on study. Clinical assessments were evaluated by NCI-CTC 4.0 grading and patient self-reported pain. Results Ten subjects were enrolled; 9 were evaluable for safety and efficacy. Five of nine subjects reported some improvement in foot pain and 3 of 8 subjects for hand pain improvement. One of these subjects noted specific improvement in tactile function. No treatment-related toxicities were observed. Conclusions In this limited, single center study, topical cream containing 1% sildenafil is feasible to administer, is well-tolerated, and may mitigate PPE-related symptoms due to anti-cancer therapeutic agents. Further validation is necessary. PMID:25341548

  12. Plantar tactile perturbations enhance transfer of split-belt locomotor adaptation.

    PubMed

    Mukherjee, Mukul; Eikema, Diderik Jan A; Chien, Jung Hung; Myers, Sara A; Scott-Pandorf, Melissa; Bloomberg, Jacob J; Stergiou, Nicholas

    2015-10-01

    Patterns of human locomotion are highly adaptive and flexible and depend on the environmental context. Locomotor adaptation requires the use of multisensory information to perceive altered environmental dynamics and generate an appropriate movement pattern. In this study, we investigated the use of multisensory information during locomotor learning. Proprioceptive perturbations were induced by vibrating tactors, placed bilaterally over the plantar surfaces. Under these altered sensory conditions, participants were asked to perform a split-belt locomotor task representative of motor learning. Twenty healthy young participants were separated into two groups: no-tactors (NT) and tactors (TC). All participants performed an overground walking trial, followed by treadmill walking including 18 min of split-belt adaptation and an overground trial to determine transfer effects. Interlimb coordination was quantified by symmetry indices and analyzed using mixed repeated-measures ANOVAs. Both groups adapted to the locomotor task, indicated by significant reductions in gait symmetry during the split-belt task. No significant group differences in spatiotemporal and kinetic parameters were observed on the treadmill. However, significant group differences were observed overground. Step and swing time asymmetries learned on the split-belt treadmill were retained and decayed more slowly overground in the TC group whereas in NT, asymmetries were rapidly lost. These results suggest that tactile stimulation contributed to increased lower limb proprioceptive gain. High proprioceptive gain allows for more persistent overground after effects, at the cost of reduced adaptability. Such persistence may be utilized in populations displaying pathologic asymmetric gait by retraining a more symmetric pattern. PMID:26169104

  13. In vivo maximal fascicle-shortening velocity during plantar flexion in humans.

    PubMed

    Hauraix, Hugo; Nordez, Antoine; Guilhem, Gaël; Rabita, Giuseppe; Dorel, Sylvain

    2015-12-01

    Interindividual variability in performance of fast movements is commonly explained by a difference in maximal muscle-shortening velocity due to differences in the proportion of fast-twitch fibers. To provide a better understanding of the capacity to generate fast motion, this study aimed to 1) measure for the first time in vivo the maximal fascicle-shortening velocity of human muscle; 2) evaluate the relationship between angular velocity and fascicle-shortening velocity from low to maximal angular velocities; and 3) investigate the influence of musculo-articular features (moment arm, tendinous tissues stiffness, and muscle architecture) on maximal angular velocity. Ultrafast ultrasound images of the gastrocnemius medialis were obtained from 31 participants during maximal isokinetic and light-loaded plantar flexions. A strong linear relationship between fascicle-shortening velocity and angular velocity was reported for all subjects (mean R(2) = 0.97). The maximal shortening velocity (V(Fmax)) obtained during the no-load condition (NLc) ranged between 18.8 and 43.3 cm/s. V(Fmax) values were very close to those of the maximal shortening velocity (V(max)), which was extrapolated from the F-V curve (the Hill model). Angular velocity reached during the NLc was significantly correlated with this V(Fmax) (r = 0.57; P < 0.001). This finding was in agreement with assumptions about the role of muscle fiber type, whereas interindividual comparisons clearly support the fact that other parameters may also contribute to performance during fast movements. Nevertheless, none of the biomechanical features considered in the present study were found to be directly related to the highest angular velocity, highlighting the complexity of the upstream mechanics that lead to maximal-velocity muscle contraction.

  14. Foot-type analysis and plantar pressure differences between obese and nonobese adolescents during upright standing.

    PubMed

    Cimolin, Veronica; Capodaglio, Paolo; Cau, Nicola; Galli, Manuela; Pau, Massimiliano; Patrizi, Alessandra; Tringali, Gabriella; Sartorio, Alessandro

    2016-03-01

    This study aimed to characterize the effect of obesity on foot-type and plantar pressure distribution in adolescents. Ten obese adolescents (obese group; BMI: 35.45±4.73 kg/m) and eight normal-weighted adolescents (control group; BMI: 18.67±2.46 kg/m) were recruited. Both groups were evaluated while standing using the Pedar-X in-shoe system. Foot-ground contact was characterized using contact area, peak of force and pressure calculated for the subareas of the foot. The analysis showed that obese participants had significantly higher area of contact in forefoot and midfoot (only in medial area) regions in comparison with the control group, whereas no statistically significant differences were observed for the rearfoot region. As far as the maximum pressure and force was concerned, similar results were obtained for both groups. Obese participants showed higher values for all the regions, with the exception of medial rearfoot area, for which the values were similar between the two groups. The analysis of foot-type distribution displayed that in the obese group high percentage of participants presented flat foot (70%) respect to cavus foot (20%) and normal foot (10%); on the contrary, in the control group, foot-types were markedly different, with 25% of participants with flat foot, 25% with cavus foot and 50% with normal foot. These results are important from a clinical perspective to develop and enhance the rehabilitative options in these patients and to avoid a worsening of their foot abnormalities. Untreated flat foot can in fact be disabling and over time can result in significant difficulties for the patient.

  15. Tradeoffs between impact loading rate, vertical impulse and effective mass for walkers and heel strike runners wearing footwear of varying stiffness.

    PubMed

    Addison, Brian J; Lieberman, Daniel E

    2015-05-01

    Humans experience repetitive impact forces beneath the heel during walking and heel strike running that cause impact peaks characterized by high rates and magnitudes of loading. Impact peaks are caused by the exchange of momentum between the ground and a portion of the body that comes to a full stop (the effective mass) during the period of the impact peak. A number of factors can influence this exchange of momentum, including footwear stiffness. This study presents and tests an impulse-momentum model of impact mechanics which predicts that effective mass and vertical impulse is greater in walkers and heel strike runners wearing less stiff footwear. The model also predicts a tradeoff between impact loading rate and effective mass, and between impact loading rate and vertical impulse among individuals wearing footwear of varying stiffness. We tested this model using 19 human subjects walking and running in minimal footwear and in two experimental footpads. Subjects walked and ran on an instrumented treadmill and 3D kinematic data were collected. As predicted, both vertical impulse (walking: F(2,54)=52.0, p=2.6E-13; running: F(2,54)=25.2, p=1.8E-8) and effective mass (walking: F(2,54)=12.1, p=4.6E-5; running: F(2,54)=15.5, p=4.7E-6) increase in less stiff footwear. In addition, there is a significant inverse relationship between impact loading rate and vertical impulse (walking: r=-0.88, p<0.0001; running: r=-0.78, p<0.0001) and between impact loading rate and effective mass (walking: r=-0.88, p<0.0001; running: r=-0.82, p<0.0001). The tradeoff relationships documented here raise questions about how and in what ways the stiffness of footwear heels influence injury risk during human walking and running.

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

    PubMed

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

    2013-04-26

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

  17. Tradeoffs between impact loading rate, vertical impulse and effective mass for walkers and heel strike runners wearing footwear of varying stiffness.

    PubMed

    Addison, Brian J; Lieberman, Daniel E

    2015-05-01

    Humans experience repetitive impact forces beneath the heel during walking and heel strike running that cause impact peaks characterized by high rates and magnitudes of loading. Impact peaks are caused by the exchange of momentum between the ground and a portion of the body that comes to a full stop (the effective mass) during the period of the impact peak. A number of factors can influence this exchange of momentum, including footwear stiffness. This study presents and tests an impulse-momentum model of impact mechanics which predicts that effective mass and vertical impulse is greater in walkers and heel strike runners wearing less stiff footwear. The model also predicts a tradeoff between impact loading rate and effective mass, and between impact loading rate and vertical impulse among individuals wearing footwear of varying stiffness. We tested this model using 19 human subjects walking and running in minimal footwear and in two experimental footpads. Subjects walked and ran on an instrumented treadmill and 3D kinematic data were collected. As predicted, both vertical impulse (walking: F(2,54)=52.0, p=2.6E-13; running: F(2,54)=25.2, p=1.8E-8) and effective mass (walking: F(2,54)=12.1, p=4.6E-5; running: F(2,54)=15.5, p=4.7E-6) increase in less stiff footwear. In addition, there is a significant inverse relationship between impact loading rate and vertical impulse (walking: r=-0.88, p<0.0001; running: r=-0.78, p<0.0001) and between impact loading rate and effective mass (walking: r=-0.88, p<0.0001; running: r=-0.82, p<0.0001). The tradeoff relationships documented here raise questions about how and in what ways the stiffness of footwear heels influence injury risk during human walking and running. PMID:25814181

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

    NASA Astrophysics Data System (ADS)

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

    2001-10-01

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

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

    PubMed

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

    2015-02-26

    Therapeutic footwear with specially-made insoles is often used in people with diabetes and rheumatoid arthritis to relieve ulcer risks and pain due to high pressures from areas beneath bony prominences of the foot, in particular to the metatarsal heads (MTHs). In a three-dimensional finite element study of the foot and footwear with sensitivity analysis, effects of geometrical variations of a therapeutic insole, in terms of insole thicknesses and metatarsal pad (MP) placements, on local peak plantar pressure under MTHs and stress/strain states within various forefoot tissues, were determined. A validated musculoskeletal finite element model of the human foot was employed. Analyses were performed in a simulated muscle-demanding instant in gait. For many design combinations, increasing insole thicknesses consistently r