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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. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis

    PubMed Central

    2009-01-01

    Background Chronic plantar heel pain (CPHP) is a generalised term used to describe a range of undifferentiated conditions affecting the plantar heel. Plantar fasciitis is reported as the most common cause and the terms are frequently used interchangeably in the literature. Diagnostic imaging has been used by many researchers and practitioners to investigate the involvement of specific anatomical structures in CPHP. These observations help to explain the underlying pathology of the disorder, and are of benefit in forming an accurate diagnosis and targeted treatment plan. The purpose of this systematic review was to investigate the diagnostic imaging features associated with CPHP, and evaluate study findings by meta-analysis where appropriate. Methods Bibliographic databases including Medline, Embase, CINAHL, SportDiscus and The Cochrane Library were searched electronically on March 25, 2009. Eligible articles were required to report imaging findings in participants with CPHP unrelated to inflammatory arthritis, and to compare these findings with a control group. Methodological quality was evaluated by use of the Quality Index as described by Downs and Black. Meta-analysis of study data was conducted where appropriate. Results Plantar fascia thickness as measured by ultrasonography was the most widely reported imaging feature. Meta-analysis revealed that the plantar fascia of CPHP participants was 2.16 mm thicker than control participants (95% CI = 1.60 to 2.71 mm, P < 0.001) and that CPHP participants were more likely to have plantar fascia thickness values greater than 4.0 mm (OR = 105.11, 95% CI = 3.09 to 3577.28, P = 0.01). CPHP participants were also more likely to show radiographic evidence of subcalcaneal spur than control participants (OR = 8.52, 95% CI = 4.08 to 17.77, P < 0.001). Conclusion This systematic review has identified 23 studies investigating the diagnostic imaging appearance of the plantar fascia and inferior calcaneum in people with CPHP

  3. 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

  4. 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.

  5. 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.

  6. Getting to the heel of the problem: plantar fascia lesions.

    PubMed

    Jeswani, T; Morlese, J; McNally, E G

    2009-09-01

    Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease.

  7. 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.

  8. 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.

  9. A review of plantar heel pain of neural origin: differential diagnosis and management.

    PubMed

    Alshami, Ali M; Souvlis, Tina; Coppieters, Michel W

    2008-05-01

    Plantar heel pain is a symptom commonly encountered by clinicians. Several conditions such as plantar fasciitis, calcaneal fracture, rupture of the plantar fascia and atrophy of the heel fat pad may lead to plantar heel pain. Injury to the tibial nerve and its branches in the tarsal tunnel and in the foot is also a common cause. Entrapment of these nerves may play a role in both the early phases of plantar heel pain and recalcitrant cases. Although the contribution of nerve entrapment to plantar heel pain has been well documented in the literature, its pathophysiology, diagnosis and management are still controversial. Therefore, the purpose of this article was to critically review the available literature on plantar heel pain of neural origin. Possible sites of nerve entrapment, effectiveness of diagnostic clinical tests and electrodiagnostic tests, differential diagnoses for plantar heel pain, and conservative and surgical treatment will be discussed.

  10. The effect of heel elevation on strain within the plantar aponeurosis: in vitro study.

    PubMed

    Kogler, G F; Veer, F B; Verhulst, S J; Solomonidis, S E; Paul, J P

    2001-05-01

    Mild, temporary reduction of symptoms from plantar fasciitis have been reported with the use of high heeled shoes (i.e. cowboy boots, ladies pumps). However, little is known on how heel elevation may contribute to a decrease in the pain and inflammation. The aim of this study was to quantify strain in the plantar aponeurosis in cadaveric feet with the use of various heel elevation configurations. An in vitro method that simulated "static" stance was used to determine the loading characteristics of the plantar aponeurosis (n = 12). Heel elevation was evaluated with blocks placed beneath the heel and with a contoured platform that simulated the arch profile of a shoe at three different heel heights (2.0, 4.0, 6.0 cm) with a level plane serving as the control. Strain in the plantar aponeurosis decreased with elevations of the heel that simulated the arch profile of a shoe at load levels (337, 450 N) (P < 0.05). Elevations of the heel with blocks did not significantly affect strain in the plantar aponeurosis (P < 0.05). Contrasting results of some specimen limbs compared with the overall means suggests that the influence of heel elevation on loading of the plantar aponeurosis may be dependent on individual variation and foot structure differences. Therefore, clinicians should be cautious in recommending heel elevation as a treatment for plantar fasciitis since some subjects may not achieve the desired decrease in plantar aponeurosis strain.

  11. Heel pain-plantar fasciitis and Achilles enthesopathy.

    PubMed

    Williams, Seth K; Brage, Michael

    2004-01-01

    Plantar fasciitis and Achilles enthesopathy are two of the most common causes of posterior heel pain. In the vast majority of cases, nonsurgical treatment methods are effective. In recalcitrant cases, surgery has been shown to be generally effective. There are a variety of described techniques for both conditions. Endoscopic treatment of plantar fasciitis leads to slightly enhanced recovery times compared with the traditional open release, but in the long term the results seem to be equivalent. Open debridement of the retrocalcaneal bursa, calcaneal osteophyte, and diseased tendon is the underlying principle behind surgical treatment of Achilles enthesopathy. This can be performed through a variety of approaches, and augmentation with suture anchors, tendon transfers, or allograft may be necessary when more than 50% of the tendon is excised.

  12. 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.

  13. The relationship of pes planus and calcaneal spur to plantar heel pain.

    PubMed

    Prichasuk, S; Subhadrabandhu, T

    1994-09-01

    A prospective study of pes planus by using calcaneal pitch and calcaneal spur was carried out in 82 patients with plantar heel pain and in 400 normal subjects. The mean normal calcaneal pitch was 20.54 degrees. The mean calcaneal pitch in patients with plantar heel pain was 15.99 degrees, which was significantly lower than in normal subjects. The incidence of calcaneal spur in normal subjects and in patients with plantar heel pain was 15.5% percent (62 of 400) and 65.9% (54 of 82), respectively. Again, this was a highly significant difference. Excessive weight gain, aging, and gender may be important factors effecting the lowering of the pitch and the increasing of spur formation. These factors could lead to the development of plantar heel pain.

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

    NASA Astrophysics Data System (ADS)

    Cong, Yan; Lee, Winson; Zhang, Ming

    2011-12-01

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

  15. The effect of different depths of medial heel skive on plantar pressures

    PubMed Central

    2012-01-01

    Background Foot orthoses are often used to treat lower limb injuries associated with excessive pronation. There are many orthotic modifications available for this purpose, with one being the medial heel skive. However, empirical evidence for the mechanical effects of the medial heel skive modification is limited. This study aimed to evaluate the effect that different depths of medial heel skive have on plantar pressures. Methods Thirty healthy adults (mean age 24 years, range 18–46) with a flat-arched or pronated foot posture and no current foot pain or deformity participated in this study. Using the in-shoe pedar-X® system, plantar pressure data were collected for the rearfoot, midfoot and forefoot while participants walked along an 8 metre walkway wearing a standardised shoe. Experimental conditions included a customised foot orthosis with the following 4 orthotic modifications: (i) no medial heel skive, (ii) a 2 mm medial heel skive, (iii) a 4 mm medial heel skive and (iv) a 6 mm medial heel skive. Results Compared to the foot orthosis with no medial heel skive, statistically significant increases in peak pressure were observed at the medial rearfoot – there was a 15% increase (p = 0.001) with the 4 mm skive and a 29% increase (p < 0.001) with the 6 mm skive. No significant change was observed with the 2 mm medial heel skive. With respect to the midfoot and forefoot, there were no significant differences between the orthoses. Conclusions This study found that a medial heel skive of 4 mm or 6 mm increases peak pressure under the medial rearfoot in asymptomatic adults with a flat-arched or pronated foot posture. Plantar pressures at the midfoot and forefoot were not altered by a medial heel skive of 2, 4 or 6 mm. These findings provide some evidence for the effects of the medial heel skive orthotic modification. PMID:22889267

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

    PubMed Central

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

    2014-01-01

    Background Plantar heel pain is a common disorder of the foot for which patients seek medical treatment. The purpose of this study is to explore the relationship between duration of symptoms in plantar fasciitis patients and demographic factors, the intensity and location of pain, extent of previous treatment and self reported pain and function. Methods The charts of patients presenting with plantar heel pain between June 2008 and October 2010 were reviewed retrospectively and 182 patients with a primary diagnosis of plantar fasciitis were identified. Patients with symptoms less than 6 months were identified as acute and patients with symptoms greater than or equal to six months were defined as having chronic symptoms. Comparisons based on duration of symptoms were performed for age, gender, BMI, comorbidities, pain location and intensity, and a functional score measured by the Foot and Ankle Ability Measure (FAAM). Results The two groups were similar in age, BMI, gender, and comorbidities. Pain severity, as measured by a VAS, was not statistically significant between the two groups (6.6 and 6.2). The acute and chronic groups of patients reported similar levels of function on both the activity of daily living (62 and 65) and sports (47 and 45) subscales of the FAAM. Patients in the chronic group were more likely to have seen more providers and tried more treatment options for this condition. Conclusion As plantar fasciitis symptoms extend beyond 6 months, patients do not experience increasing pain intensity or functional limitation. No specific risk factors have been identified to indicate a risk of developing chronic symptoms. PMID:22995253

  17. 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

  18. Effects of duration of wearing high-heeled shoes on plantar pressure.

    PubMed

    Yin, Chun-Ming; Pan, Xiao-Hua; Sun, Yu-Xin; Chen, Zhi-Bin

    2016-10-01

    In the present study we investigated the effects of different durations of using high-heeled shoes on plantar pressure and gait. A questionnaire survey and dynamic plantar pressure measurements were performed in 20 control females and 117 females who had worn high-heeled shoes for a long time. According to the duration of using high-heeled shoes (as specified in the questionnaire), subjects were divided into a control group and five groups with different durations of use (i.e. <2years, 2-5years, 6-10years, 11-20years and >20years). Parameters, including peak pressure, impulse and pressure duration, in different plantar regions were measured with the Footscan pressure plate. The 2-5years group had smaller midfoot contact areas for both feet and higher subtalar joint mobility, while the 6-10years group had larger midfoot contact areas for both feet and prolonged foot flat phase during gait. The peak pressure and impulse under the second and fourth metatarsus were increased with the prolonged wearing of high-heeled shoes, and the pressure and impulse under the midfoot were substantially reduced in the 2-5years group. The findings suggest that long-term use of high-heeled shoes can induce changes in arch morphology: the longitudinal arch tends to be elevated within 2-5years; the longitudinal arch tends to be flattened within 6-10years; and the forefoot latitudinal arch tends to collapse in more than 20years.

  19. Diagnosis and treatment of heel pain in chronic inflammatory arthritis using ultrasound.

    PubMed

    Cunnane, G; Brophy, D P; Gibney, R G; FitzGerald, O

    1996-06-01

    The authors examined the role of ultrasound (US) in diagnosis and management of heel pain in chronic inflammatory arthritis. Nineteen patients underwent US examination. Eight patients (2 with previously unsuccessful nonguided injections), had 11 US-guided corticosteroid injections for treatment of retrocalcaneal bursitis (n = 6), plantar fasciitis (n = 3), and posterior tibial tenosynovitis (n = 2). US-demonstrated Achilles tendon rupture (n = 2), Achilles tendinitis (n = 8), posterior tibial tenosynovitis (n = 6), peroneus longus tenosynovitis (n = 2), retrocalcaneal bursitis (n = 13), and plantar fasciitis (n = 4). Loss of smooth bone contour (n = 13) correlated with bone erosions on plain radiographs in all but one case. Ten of 11 guided injections resulted in full resolution of heel pain. The diverse causes of heel pain are highlighted, and the ability of US to provide information with management implications is confirmed. US-guided corticosteroid injection is beneficial, especially after failure of nonguided injection.

  20. 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

  1. Shock wave therapy for chronic proximal plantar fasciitis.

    PubMed

    Ogden, J A; Alvarez, R; Levitt, R; Cross, G L; Marlow, M

    2001-06-01

    Three hundred two patients with chronic heel pain caused by proximal plantar fasciitis were enrolled in a study to assess the treatment effects consequent to administration of electrohydraulicall-generated extracorporeal shock waves. Symptoms had been present from 6 months to 18 years. Each treated patient satisfied numerous inclusion and exclusion criteria before he or she was accepted into this study, which was approved by the Food and Drug Administration as a randomized, double-blind evaluation of the efficacy of shock wave therapy for this disorder. Overall, at the predetermined evaluation period 3 months after one treatment, 56% more of the treated patients had a successful result by all four of the evaluation criteria when compared with the patients treated with a placebo. This difference was significant and corroborated the fact that this difference in the results was specifically attributable to the shock wave treatment, rather than any natural improvement caused by the natural history of the condition. The current study showed that the directed application of electrohydraulic-generated shock waves to the insertion of the plantar fascia onto the calcaneus is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome that has been present for at least 6 months and has been refractory to other commonly used nonoperative therapies. This technology, when delivered using the OssaTron (High Medical Technology, Kreuz-lingen, Switzerland), has been approved by the Food and Drug Administration specifically for the treatment of chronic proximal plantar fasciitis. The results suggest that this therapeutic modality should be considered before any surgical options, and even may be preferable to cortisone injection, which has a recognized risk of rupture of the plantar fascia and recurrence of symptoms.

  2. Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases.

    PubMed

    Jarde, Olivier; Diebold, Patrice; Havet, Eric; Boulu, Gilles; Vernois, Joël

    2003-06-01

    The authors studied 38 cases of degenerative lesions of the plantar fascia which were treated surgically between 1989 and 1999. MRI showed chronic fasciitis in eight cases and an old rupture of the plantar fascia in 30 cases. Surgical treatment, which was performed in all cases after failure of conservative treatment of several months duration, combined excision of the fascia with resection of the heel spur. Histological examination found inflammation in all cases (fasciitis or rupture), calcification of the aponeurosis in four cases, cartilaginous metaplasia in four and fibromatosis in four. Patients were assessed a minimum of one year and a maximum of seven years after operation. The postoperative results were assessed using three criteria: resolution of pain, results on the static foot and patients' functional activity. Overall there were 24 very good and good results, nine fair and five poor. MRI performed at the time of follow-up revealed good healing of the plantar fascia in 16 cases, defects in two cases, inflammation in seven cases and defects associated with inflammation in 13 cases. Surgical treatment may be considered in cases where conservative treatment of talalgia has failed. Symptoms originating from degenerative damage to the plantar fascia, such as rupture or fasciitis, may benefit from fasciectomy. Short-term results show resolution of pain in 75% of cases, and a slight sagging of the plantar arch. Pre-operative MRI study is useful to determine the exact location of the lesions.

  3. 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

  4. The influence of high-heeled shoes on strain and tension force of the anterior talofibular ligament and plantar fascia during balanced standing and walking.

    PubMed

    Yu, Jia; Wong, Duo Wai-Chi; Zhang, Hongtao; Luo, Zong-Ping; Zhang, Ming

    2016-10-01

    High-heeled shoes have the capability to alter the strain and tension of ligamentous structures between the foot and ankle, which may result in ankle instability. However, high-heeled shoes can also reduce the strain on plantar fascia, which may be beneficial for the treatment of plantar fasciitis. In this study, the influence of heel height on strain and tension force applied to the anterior talofibular ligament (ATL) and plantar fascia were investigated. A three-dimensional finite element model of coupled foot-ankle-shoe complex was constructed. Four heel heights were studied in balanced standing: 0 in. (0cm), 1 in. (2.54cm), 2 in. (5.08cm), and 3 in. (7.62cm). A walking analysis was performed using 2-in. (5.08cm) high-heeled shoes. During balanced standing, the tension force on the ATL increased from 14.8N to 97.0N, with a six-fold increase in strain from 0 in. to 3 in. (0-7.62cm). The tension force and the average strain on the plantar fascia decreased from 151.0N (strain: 0.74%) to 59.6N (strain: 0.28%) when the heel height increased from 0 in. to 2 in. (0-5.08cm). When heel height reached 3 in. (7.62cm), the force and average strain increased to 278.3N (strain: 1.33%). The walking simulation showed that the fascia stretched out while the ATL loading decreased during push off. The simulation outcome demonstrated the influence of heel height on ATL alteration and plantar fascia strain, which implies risks for ankle injury and suggests guidance for the treatment of plantar fasciitis.

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

    PubMed

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

    2015-06-01

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

  6. A review of 105 consecutive uniport endoscopic plantar fascial release procedures for the treatment of chronic plantar fasciitis.

    PubMed

    Morton, Troy N; Zimmerman, Jeffrey P; Lee, Michael; Schaber, John D

    2013-01-01

    Plantar fasciitis is a common cause of heel pain in the U.S. Army soldier, resulting in a significant loss of man hours. Given the heavy operations tempo of the U.S. military, successful treatment options need to be considered and used as quickly as possible. Plantar fasciitis can be successfully treated in up to 90% of patients using conservative measures. Operative intervention might need to be considered for those in whom conservative measures have failed. The present report is a review of 105 consecutive uniport endoscopic plantar fascial release procedures performed by the principal investigator during a 9-year period. The following data were collected and analyzed: gender, age, weight, height, body mass index, medical treatment facility, procedure laterality, preoperative pain levels, postoperative pain levels at 3 months, first ambulatory day in the controlled ankle motion boot, return to activity as tolerated, and complications. Three major points were of interest: evidence of improvement in chronic plantar fasciitis when treated with uniport endoscopic procedures; the patient attributes associated with self-reported pain levels 90 days postoperatively; and the patient attributes associated with the average time until patients were able to return to activities as tolerated in a controlled ankle motion boot. It was noted that 44.5% of those with a body mass index of 29.80 kg/m(2) or greater reported a postoperative pain level of 0; and 96.3% of those with a body mass index of 25.53 kg/m(2) or less reported postoperative pain levels of 0. The analyzed data were used to characterize the clinical outcomes of the procedure, identify changes in outcome with surgeon experience, and identify whether certain patient subgroups have better outcomes, allowing surgeons to identify which patient might be the best candidates for an endoscopic release procedure.

  7. Plantar fasciitis

    MedlinePlus

    ... Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 58. Ferri FF. Plantar fasciitis. ... FF ed. Ferri's Clinical Advisor 2016 . Philadelphia, PA: Elsevier; 2016:970. Kadakia AR. Heel pain and plantar ...

  8. 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.

  9. 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.

  10. Plantar fascia release and calcaneal spur excision for sub-calcaneal heel pain.

    PubMed

    Torudom, Yingyong

    2009-06-01

    Aim of this study was to evaluate the results of open plantar fascia release and calcaneal spur excision in patients with plantar fasciitis. The author studied retrospectively the results in 16 patients who had been treated with open plantar fascia release and calcaneal spur excision from 2002 to 2008. Two patients were men and fourteen were women. Their mean age was 43.3 years (39 to 52). Based on visual analog scale the results were pain free in 12 feet and some pain in four. There are two patients with superficial skin infection which can be manage with local wound care and oral antibiotic. We conclude that open plantar fascia release and calcaneal spur excision can relieve pain in patients who resist conservative treatment.

  11. Amniotic Tissues for the Treatment of Chronic Plantar Fasciosis and Achilles Tendinosis

    PubMed Central

    Werber, Bruce

    2015-01-01

    Introduction. Allogeneic amniotic tissue and fluid may be used to treat chronic plantar fasciosis and Achilles tendinosis. This innovative approach involves delivering a unique allograft of live human cells in a nonimmunogenic structural tissue matrix to treat chronic tendon injury. These tissues convey very positive regenerative attributes; procurement is performed with maternal consent during elective caesarian birth. Materials and Methods. In the present investigation all patients were unresponsive to multiple standard therapies for a minimum of 6 months and were treated with one implantation of PalinGen SportFLOW around the plantar fascia and/or around the Achilles paratenon. The patients were given a standard protocol for postimplant active rehabilitation. Results. The analogue pretreatment pain score (VAS) of 8. By the fourth week after treatment, all patients had significantly reduced self-reported pain. Twelve weeks following the procedure the average pain level had reduced to only 2. No adverse reactions were reported in any of the patients. Conclusion. All patients in this study experienced heel or Achilles pain, unresponsive to standard therapy protocols. After treatment all patients noted significant pain reduction, indicating that granulized amniotic membrane and amniotic fluid can be successfully used to treat both chronic plantar fasciosis and Achilles tendinosis. PMID:26491722

  12. Diagnosis and management of plantar fasciitis.

    PubMed

    Thompson, John V; Saini, Sundeep S; Reb, Christopher W; Daniel, Joseph N

    2014-12-01

    Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary.

  13. [Heel pain].

    PubMed

    Cizmár, I; Svizenská, I; Pilný, J; Repko, M; Ira, D

    2005-01-01

    Heel pain is quite frequent clinical symptom in our population. Successful therapy derives from the problem aetiology. The most frequent source of pain is the mechanical basis, both on dorsal and plantar side of calcaneum. Therapy includes a variety of procedures, from routine measures to surgical intervention.

  14. 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

  15. Plantar fibromatosis.

    PubMed

    Zgonis, Thomas; Jolly, Gary Peter; Polyzois, Vasilios; Kanuck, David M; Stamatis, Emmanouil D

    2005-01-01

    Plantar fibromatosis is defined as a benign fibrous disorder involving the plantar aponeurosis. Although its incidence is well described on the hands, it is less commonly seen on the feet, and its etiology is unknown. A differential diagnosis for the heel pain along the medial arch could be a benign thickening of the plantar fascia associated with plantar fibromatosis. Its high recurrence after surgical excision and problematic scarring and wound presents a significant challenge to the reconstructive foot and ankle surgeon. This article reviews the history, clinical presentation, pathologic findings, and surgical approaches to the treatment of plantar fibromatosis.

  16. Plantar fasciitis: a degenerative process (fasciosis) without inflammation.

    PubMed

    Lemont, Harvey; Ammirati, Krista M; Usen, Nsima

    2003-01-01

    The authors review histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis. Findings include myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. Histologic findings are presented to support the thesis that "plantar fasciitis" is a degenerative fasciosis without inflammation, not a fasciitis. These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture.

  17. 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.

  18. Chronic multifocal Mycobacterium fortuitum osteomyelitis following penetrating plantar trauma.

    PubMed

    Cruz, Andrea T; Antekeier, Shannon B

    2012-08-01

    We present the case of a 10-year-old girl with Mycobacterium fortuitum osteomyelitis following a plantar puncture wound with vegetative material. Nontuberculous mycobacterial (NTM) skin and soft tissue infections are well described in immunocompromised populations. However, NTM infection can also be seen in healthy hosts following direct inoculation. Magnetic resonance imaging examination demonstrated multifocal midfoot and metatarsal osteomyelitis. Surgical exploration revealed caseation necrosis and a chronic draining sinus tract. Combined surgical debridement and medical therapy resulted in clinical cure. A high index of suspicion and adequate collection and handling of surgical specimens facilitate the diagnosis and treatment of NTM skin and soft tissue infections.

  19. 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

  20. Plantar fasciitis: evidence-based review of diagnosis and therapy.

    PubMed

    Cole, Charles; Seto, Craig; Gazewood, John

    2005-12-01

    Plantar fasciitis causes heel pain in active as well as sedentary adults of all ages. The condition is more likely to occur in persons who are obese or in those who are on their feet most of the day. A diagnosis of plantar fasciitis is based on the patient's history and physical findings. The accuracy of radiologic studies in diagnosing plantar heel pain is unknown. Most interventions used to manage plantar fasciitis have not been studied adequately; however, shoe inserts, stretching exercises, steroid injection, and custom-made night splints may be beneficial. Extracorporeal shock wave therapy may effectively treat runners with chronic heel pain but is ineffective in other patients. Limited evidence suggests that casting or surgery may be beneficial when conservative measures fail.

  1. Diagnosing heel pain in adults.

    PubMed

    Aldridge, Tracy

    2004-07-15

    Heel pain is a common condition in adults that may cause significant discomfort and disability. A variety of soft tissue, osseous, and systemic disorders can cause heel pain. Narrowing the differential diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain. The most common cause of heel pain in adults is plantar fasciitis. Patients with plantar fasciitis report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting. Tenderness at the calcaneal tuberosity usually is apparent on examination and is increased with passive dorsiflexion of the toes. Tendonitis also may cause heel pain. Achilles tendonitis is associated with posterior heel pain. Bursae adjacent to the Achilles tendon insertion may become inflamed and cause pain. Calcaneal stress fractures are more likely to occur in athletes who participate in sports that require running and jumping. Patients with plantar heel pain accompanied by tingling, burning, or numbness may have tarsal tunnel syndrome. Heel pad atrophy may present with diffuse plantar heel pain, especially in patients who are older and obese. Less common causes of heel pain, which should be considered when symptoms are prolonged or unexplained, include osteomyelitis, bony abnormalities (such as calcaneal stress fracture), or tumor. Heel pain rarely is a presenting symptom in patients with systemic illnesses, but the latter may be a factor in persons with bilateral heel pain, pain in other joints, or known inflammatory arthritis conditions.

  2. 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

  3. 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)

  4. Diagnosis of heel pain.

    PubMed

    Tu, Priscilla; Bytomski, Jeffrey R

    2011-10-15

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

  5. 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.

  6. Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur) using very low doses – a study protocol

    PubMed Central

    Niewald, Marcus; Seegenschmiedt, M Heinrich; Micke, Oliver; Gräber, Stefan

    2008-01-01

    Background A lot of retrospective data concerning the effect of radiotherapy on the painful heel spur (plantar fasciitis) is available in the literature. Nevertheless, a randomized proof of this effect is still missing. Thus, the GCGBD (German cooperative group on radiotherapy for benign diseases) of the DEGRO (German Society for Radiation Oncology) decided to start a randomized multicenter trial in order to find out if the effect of a conventional total dose is superior compared to that of a very low dose. Methods/Design In a prospective, controlled and randomized phase III trial two radiotherapy schedules are to be compared: standard arm: total dose 6.0 Gy in single fractions of 1.0 Gy applied twice a week experimental arm: total dose 0.6 Gy in single fractions of 0.1 Gy applied twice a week (acting as a placebo) Patients aged over 40 years who have been diagnosed clinically and radiologically to be suffering from a painful heel spur for at least six months can be included. Former trauma, surgery or radiotherapy to the heel are not allowed nor are patients with a severe psychiatric disease or women during pregnancy and breastfeeding. According to the statistical power calculation 100 patients have to be enrolled into each arm. After having obtaining a written informed consent a patient is randomized by the statistician to one of the arms mentioned above. After radiotherapy, the patients are seen first every six weeks, then regularly up to 48 months after therapy, they additionally receive a questionnaire every six weeks after the follow-up examinations. The effect is measured using several target variables (scores): Calcaneodynia-score according to Rowe et al., SF-12 score, and visual analogue scale of pain. The most important endpoint is the pain relief three months after therapy. Patients with an inadequate result are offered a second radiotherapy series applying the standard dose (equally in both arms). This trial protocol has been approved by the expert panel

  7. 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.

  8. 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

  9. [Characterization of chronic plantar ulcers in former leprosy patients].

    PubMed

    Grauwin, M Y; Gentile, B; Chevallard, A; Cartel, J L

    1994-01-01

    Between 1988 and 1992, 21 biopsies for pathological examination were taken from 20 Senegalese leprosy patients suffering from chronic plantar ulcers (CPU) suspected of malignant transformation. The diagnosis of squamous cell carcinoma was effectively made in 13 cases and that of pseudoepitheliomatous hyperplasia in the remaining 8 cases. The mean period of time between the onset of CPU and that of malignant transformation was 10 years (range: 1 to 15 years); the mean annual frequency of the malignant transformation was 2 per 1,000 CPU. In countries where pathological examination is not available, below knee amputation could be considered whenever main clinical signs of malignant transformation are present. In countries where pathological examination is available, the therapeutic decision may differ according to the diagnosis: below knee amputation supplemented with block dissection of inguinal lymph nodes whenever possible in cases of carcinoma; below knee amputation depending on the function status of the foot and on the volume of tumor in case of pseudo-epitheliomatous hyperplasia.

  10. [Tumoral proliferations in chronic plantar ulcers: how to treat?].

    PubMed

    Grauwin, M Y; Mane, I; Cartel, J L

    1996-01-01

    Between 1983 and 1994, 66 Senegalese leprosy patients were seen for cauliflower growths developed in chronic plantar ulcer (CPU), (2 patients had each 2 tumors). 68 biopsies for pathological examination were taken: the diagnosis of squamous cell carcinoma was effectively made in 39 cases (38 patients) and that of pseudo-epitheliomatous hyperplasia in the remaining 29 cases (28 patients). The mean annual frequency of cauliflower growths was 0.45 per 100 CPU. Among these tumors, the percentage of carcinoma was 57%. Of the 38 patients with a carcinoma, 5 refused amputation and all of them died. The 33 others were amputated and of these 8 died as a direct result of their carcinoma (24%). In the case of the 28 patients with hyperplasia, amputation was carried out on 18 patients and local excision on 10. In the months following the operation 8 recurrences were observed in 10 of the patients on whom excision had been carried out. These recurrences were treated by amputation. This gives a total of 93% of amputations in the cases of hyperplasia. These facts lead as to conclude that at least in countries where pathological examination is not available below knee amputation is the most reasonable action to take in the proliferative tumors developed on a CPU.

  11. 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.

  12. 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 ...

  13. 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.

  14. [Heel pain and calcaneal spurs].

    PubMed

    Lu, H; Gu, G; Zhu, S

    1996-05-01

    The authors of this paper have reviewed 137 X-ray films of the involved feet and followed up 30 patients all of them suffering from heel pain treated in the authors' hospital during 1980-1985, in order to find out the relationship between the length, shape and the direction of the spurs with the heel pain. We have found: (1) There are no clear relationship between heel pain and the length, shape and the direction of the calcaneal spur. (2) The plantar soft tissue of the painful foot was thickened, indicating the heel pain was due to inflammation in the plantar soft tissue. (3) Heel pain is related to the patient's age and sex. (4) The spurs still exist and grow even bigger after the syndrome disappears.

  15. 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.

  16. 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.

  17. Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances.

    PubMed

    Yu, J S

    2000-09-01

    Magnetic resonance (MR) imaging has emerged as an important noninvasive diagnostic imaging technique for assessment of foot pathology. This modality, owing to its multiplanar imaging capability and inherent superiority in contrast, has been shown to be more accurate and sensitive for detection of plantar fascia pathology than any other imaging method. One of the most important and recognizable causes of heel pain is plantar fasciitis. With the exception of plantar fasciitis, there has been little emphasis on imaging other conditions that affect this important structure. The objective of this review is to demonstrate, from a perspective of MR imaging, the many different pathologic conditions that affect the plantar fascia. Included in this review will be a discussion of normal anatomy as well as entities such as acute plantar fasciitis, chronic plantar fasciitis, traumatic rupture, normal post-surgical changes, pathologic post-fasciotomy conditions, infection, and fibromatosis.

  18. Retrospective analysis of calcaneal spur removal and complete fascial release for the treatment of chronic heel pain.

    PubMed

    Gormley, J; Kuwada, G T

    1992-01-01

    Doctors Gormley and Kuwada investigate the pathology of chronic heel pain secondary to soft tissue and osseous inflammatory conditions. Pertinent literature review regarding success following fascial release as well as bone spur removal is provided. Ninety-four patients are reported having sustained spur removal with fascia resection according to the authors' technique. They report a 95% success rate postoperatively.

  19. Plantar fasciitis: evaluation and treatment.

    PubMed

    Neufeld, Steven K; Cerrato, Rebecca

    2008-06-01

    Plantar fasciitis is the most common cause of plantar heel pain. Its characteristic features are pain and tenderness, predominately on the medial aspect of the calcaneus near the sole of the heel. Considering a complete differential diagnosis of plantar heel pain is important; a comprehensive history and physical examination guide accurate diagnosis. Many nonsurgical treatment modalities have been used in managing the disorder, including rest, massage, nonsteroidal anti-inflammatory drugs, night splints, heel cups/pads, custom and off-the-shelf orthoses, injections, casts, and physical therapy measures such as shock wave therapy. Most reported treatment outcomes rely on anecdotal experience or combinations of multiple modalities. Nevertheless, nonsurgical management of plantar fasciitis is successful in approximately 90% of patients. Surgical treatment is considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months.

  20. Painful heel: MR imaging findings.

    PubMed

    Narváez, J A; Narváez, J; Ortega, R; Aguilera, C; Sánchez, A; Andía, E

    2000-01-01

    Heel pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. These disorders are classified on the basis of anatomic origin and predominant location of heel pain to foster a better understanding of this complaint. The disorders include plantar fascial lesions (fasciitis, rupture, fibromatosis, xanthoma), tendinous lesions (tendinitis, tenosynovitis), osseous lesions (fractures, bone bruises, osteomyelitis, tumors), bursal lesions (retrocalcaneal bursitis, retroachilleal bursitis), tarsal tunnel syndrome, and heel plantar fat pad abnormalities. With its superior soft-tissue contrast resolution and multiplanar capability, magnetic resonance (MR) imaging can help determine the cause of heel pain and help assess the extent and severity of the disease in ambiguous or clinically equivocal cases. Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases. The majority of patients with heel pain can be successfully treated conservatively, but in cases requiring surgery (eg, plantar fascia rupture in competitive athletes, deeply infiltrating plantar fibromatosis, masses causing tarsal tunnel syndrome), MR imaging is especially useful in planning surgical treatment by showing the exact location and extent of the lesion.

  1. Spontaneous rupture of the plantar fascia.

    PubMed

    Ahstrom, J P

    1988-01-01

    In this study, rupture of the plantar fascia was seen in five feet, of which four had had plantar fasciitis. At the time of the injury, which is an acceleration type of motion, there is severe pain in the heel followed by the development of ecchymosis in the sole and toward the heel of the foot. With conservative symptomatic care, the acute symptoms as well as the plantar fasciitis symptoms subside, generally allowing full activity in 3 to 4 weeks.

  2. 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

  3. 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)

  4. 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.

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

    PubMed Central

    Sudoł-Szopińska, Iwona; Zaniewicz-Kaniewska, Katarzyna; Kwiatkowska, Brygida

    2014-01-01

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

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

    PubMed

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

    2009-11-03

    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.

  7. Heel Spur and Acupuncture: Does it Work?

    PubMed

    Sahin, A E; Cayir, Y; Imerci, A; Uzkeser, H; Akcay, F

    2015-11-11

    Heel spur is also known as a result of plantar calcaneal bone spur which is a common complaint associated with pain at heel. Heel spur is more common in females. Anti-inflammatory drugs, local steroid injections, physical therapy, low-dose radiotherapy and shock wave therapy are the commonly used treatment choices. There is no evidence that acupuncture is an effective method for heel spur in the literature. However, we know that acupuncture can be used for many orthopaedic diseases like frozen shoulder, tennis elbow, sciatic pain, joint sprains, several forms of bursitis and arthritis. In this case, we aimed to demonstrate whether acupuncture is effective in a patient with heel spur. To the best of our knowledge, this is the first case in which only acupuncture is used alone for treatment of heel spur up-to-date in the literature.

  8. 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.

  9. Plantar fasciitis: current diagnostic modalities and treatments.

    PubMed

    Healey, Kevin; Chen, Katherine

    2010-07-01

    Plantar fasciitis is a common cause of heel pain. The diagnosis is made clinically and validated with different diagnostic modalities ranging from ultrasound to magnetic resonance imaging. Treatments vary from stretching exercises to different surgical options. No single treatment is guaranteed to alleviate the heel pain.

  10. 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.

  11. Pathologic conditions of the plantar fascia.

    PubMed

    La Porta, Guido A; La Fata, Paul C

    2005-01-01

    Plantar heel pain in adults is commonly seen in the office of the podiatric foot and ankle specialist. These symptoms may have developed acutely or over a period of time. Often the plantar fascia is the source of the pain, which is caused by a traumatic event or a biomechanical flaw. It is imperative that the podiatric physician understands the multiple causes of plantar foot pain and is able to differentiate the multiple causes of heel pain to confirm a specific diagnosis and formulate a proper treatment plan. A thorough history and physical examination are necessary to obtain this information, and diagnostic procedures are sometimes needed.

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  13. Targeting the Plantar Fascia for Corticosteroid Injection.

    PubMed

    Salvi, Andrea Emilio

    2015-01-01

    Plantar fasciitis is often a difficult condition to treat. It is related to repetitive strain of the fascia at its attachment to the heel bone. This condition quite often appears with the concomitant presence of a plantar calcaneal heel spur. Corticosteroid injection is a popular treatment choice for plantar fasciitis, and accurate localization of the injected medication is essential for successful resolution of symptoms after the injection. In the present brief technical communication, a method for targeting the attachment of the plantar fascia to the medial tubercle of the tuberosity of the calcaneus is described. The targeting method uses the lateral radiograph of the foot to aid in localization of the proximal attachment of the plantar fascia to the calcaneus.

  14. 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

  15. 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

  16. 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.

  17. Plantar fascia rupture associated with corticosteroid injection.

    PubMed

    Sellman, J R

    1994-07-01

    A series of 37 patients, all with a presumptive diagnosis of plantar fascia rupture, is presented. All had had prior heel pain diagnosed as plantar fasciitis, and all had been treated with corticosteroid injection into the calcaneal origin of the fascia. One third described a sudden tearing episode in the heel, while the rest had a gradual change in symptoms. Most of the patients had relief of the original heel pain, which had been replaced by a variety of new foot problems, including dorsal and lateral midfoot pain, swelling, foot weakness, metatarsal pain, and metatarsal fracture. In all 37 patients, there was a palpable diminution in the tension of the plantar fascia on the involved side, and footprints often showed a flattening of the involved arch. Magnetic resonance imaging done on one patient showed attenuation of the plantar fascia. From these observations and data, the author concluded that plantar fascia rupture had occurred. Treatment following rupture included supportive shoes, orthoses, and time. The majority had resolution of their new symptoms, but this often took 6 to 12 months to occur. In the remainder, there were persisting symptoms. Corticosteroid injections, although helpful in the treatment of plantar fasciitis, appear to predispose to plantar fascia rupture.

  18. The integration of acetic acid iontophoresis, orthotic therapy and physical rehabilitation for chronic plantar fasciitis: a case study

    PubMed Central

    Costa, Ivano A; Dyson, Anita

    2007-01-01

    A 15-year-old female soccer player presented with chronic plantar fasciitis. She was treated with acetic acid iontophoresis and a combination of rehabilitation protocols, ultrasound, athletic taping, custom orthotics and soft tissue therapies with symptom resolution and return to full activities within a period of 6 weeks. She reported no significant return of symptoms post follow-up at 2 months. Acetic acid iontophoresis has shown promising results and further studies should be considered to determine clinical effectiveness. The combination of acetic acid iontophoresis with conservative treatments may promote recovery within a shorter duration compared to the use of one-method treatment approaches. PMID:17885679

  19. 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.

  20. 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.

  1. Resection of a plantar calcaneal spur using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser.

    PubMed

    Smith, W K; Noriega, J A; Smith, W K

    2001-03-01

    Many procedures have been described for the resection of plantar calcaneal spurs as treatment of heel spur syndrome and chronic plantar fasciitis. Most of these techniques involve a medial incision of between 2 and 6 cm for adequate exposure of the calcaneal spur. This article describes a new technique for resecting a calcaneal spur with a smaller medial incision using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This laser permits adequate resection of a plantar calcaneal spur as well as coagulation of the bone and surrounding tissues. This minimally invasive procedure has been used with good results over the past year by the senior author (W.K.S.) for the resection of calcaneal spurs.

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

    PubMed

    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.

  3. Subcalcaneal bursitis with plantar fasciitis treated by arthroscopy.

    PubMed

    Yamakado, Kotaro

    2013-05-01

    We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging.

  4. Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

    PubMed Central

    Yamakado, Kotaro

    2013-01-01

    We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging. PMID:23875139

  5. [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.

  6. Autologous whole blood versus corticosteroid local injection in treatment of plantar fasciitis: A randomized, controlled multicenter clinical trial.

    PubMed

    Karimzadeh, Afshin; Raeissadat, Seyed Ahmad; Erfani Fam, Saleh; Sedighipour, Leyla; Babaei-Ghazani, Arash

    2017-03-01

    Plantar fasciitis is the most common cause of heel pain. Local injection modalities are among treatment options in patients with resistant pain. The aim of the present study was to evaluate the effect of local autologous whole blood compared with corticosteroid local injection in treatment of plantar fasciitis. In this randomized controlled multicenter study, 36 patients with chronic plantar fasciitis were recruited. Patients were allocated randomly into three treatment groups: local autologous blood, local corticosteroid injection, and control groups receiving no injection. Patients were assessed with visual analog scale (VAS), pressure pain threshold (PPT), and plantar fasciitis pain/disability scale (PFPS) before treatment, as well as 4 and 12 weeks post therapy. Variables of pain and function improved significantly in both corticosteroid and autologous blood groups compared to control group. At 4 weeks following treatment, patients in corticosteroid group had significantly lower levels of pain than patients in autologous blood and control groups (higher PPT level, lower PFPS, and VAS). After 12 weeks of treatment, both corticosteroid and autologous blood groups had lower average levels of pain than control group. The corticosteroid group showed an early sharp and then more gradual improvement in pain scores, but autologous blood group had a steady gradual drop in pain. Autologous whole blood and corticosteroid local injection can both be considered as effective methods in the treatment of chronic plantar fasciitis. These treatments decrease pain and significantly improve function compared to no treatment.

  7. Calcaneal Plantar Flexion During the Stance Phase of Gait.

    PubMed

    Stamm, Stacy E; Chiu, Loren Z F

    2016-04-01

    When the rear- and forefoot are constrained, calcaneal plantar flexion may occur, deforming the longitudinal arch. Previous research has reported calcaneal motion relative to the tibia or forefoot; these joint rotations may not accurately describe rotation of the calcaneus alone. This investigation: (1) characterized the calcaneus and leg segment and ankle joint rotations during stance in gait, and (2) described the range of calcaneal plantar flexion in different structural arch types. Men (n = 14) and women (n = 16) performed gait in a motion analysis laboratory. From heel strike to heel off, the leg rotated forward while the calcaneus plantar flexed. Before foot flat, calcaneal plantar flexion was greater than forward leg rotation, resulting in ankle plantar flexion. After foot flat, forward leg rotation was greater than calcaneal plantar flexion, resulting in ankle dorsiflexion. Structural arch type was classified using the longitudinal arch angle. The range of calcaneal plantar flexion from foot flat to heel off was small in low (-2° to -8°), moderate in high (-3° to -12°), and large in normal (-2° to -20°) structural arches. Calcaneal plantar flexion in gait during midstance may reflect functional arch characteristics, which vary depending on structural arch type.

  8. 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

  9. MRI of the plantar structures of the foot after falanga torture.

    PubMed

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

    2000-01-01

    Falanga is an ancient form of punishment or torture but is still commonly reported by our refugees. The late result of caning the heel and ball of the foot is a chronic painful condition with few clinical signs. The aim of the present study was to assess, by MRI, possible morphologic characteristics of the heel and ball of the foot, related to falanga and pain in correlation to clinical findings. Magnetic resonance imaging of the foot was obtained in 12 victims exposed to falanga torture and 9 healthy volunteers. Sagittal T1-weighted spin-echo images (TR 616-840 ms, TE 20 ms), T2-weighted spin-echo images (TR 1900 ms, TE 90 ms), and short tau inversion recovery (STIR) images (TR 1200 ms, TE 15 ms, TI 100 ms) were performed. The central portion of the plantar aponeurosis was generally significantly thicker in victims exposed to falanga torture as compared with that of controls (P < 0.05). In all except one of the victims, MRI demonstrated two layers of the thickened plantar aponeurosis: a deeper portion with normal homogeneous low signal intensity (SI) appearance, and a superficial layer with characteristic areas of mixed SI on both T1- and T2-weighted images. There were no signs of chronic muscular compartment syndromes, and the thickness of the plantar pad did not differ between the two groups. Magnetic resonance imaging may demonstrate morphologic characteristics of the plantar aponeurosis which may confirm falanga torture. Further imaging with more specific sequences is warranted to demonstrate the supposed injuries in the compartmental fat tissue chambers and the vascularity of the ball pad of the foot.

  10. 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.

  11. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes.

    PubMed

    Yalcin, E; Keskin Akca, A; Selcuk, B; Kurtaran, A; Akyuz, M

    2012-02-01

    Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients' complaints about heel spurs.

  12. Long-term follow-up of heel spur surgery. A 10-year retrospective study.

    PubMed

    Vohra, P K; Giorgini, R J; Sobel, E; Japour, C J; Villalba, M A; Rostkowski, T

    1999-02-01

    A comparative retrospective study of 48 open heel spur surgeries and 20 endoscopic plantar fasciotomies was conducted involving 59 patients over a 10-year period. There was a significant reduction in heel pain at the time of follow-up (average, 3 years) for both groups. Overall, 85% of procedures were associated with patient satisfaction with the results, and patients said that they would recommend heel spur surgery for relief of severe heel pain in 94% of cases. Factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity, are discussed.

  13. The effects of increasing heel height on forefoot peak pressure.

    PubMed

    Mandato, M G; Nester, E

    1999-02-01

    The purpose of this study was to determine the effect of increasing heel height on peak forefoot pressure. Thirty-five women were examined while wearing sneakers and shoes with 2-inch and 3-inch heels. An in-shoe pressure-measurement system was used to document the magnitude and location of plantar peak pressures. Pressure under the forefoot was found to increase significantly with increasing heel height. As the heel height increased, the peak pressure shifted toward the first metatarsal and the hallux. The reproducibility of data obtained with the in-shoe pressure-measurement system was tested in five subjects; the data were found to be reproducible to within approximately 3% of measured pressures.

  14. Measurement of plantar pressure distribution during gait for diagnosis of functional lateral ankle instability.

    PubMed

    Becker, HP; Rosenbaum, D; Claes, L; Gerngro, H

    1997-04-01

    INTRODUCTION:: Chronic functional instability of the lateral ankle may be difficult to distinguish from mechanical instability when radiological stress tests reveal only small ligamentous defects. For decision making whether to surgically reconstruct the ligaments or not, it can be helpful to use additional information on joint and foot function. Therefore, the aim of a prospective study of patients with longstanding chronic ankle instability was to demonstrate that the dynamic measurement of plantar pressure distribution can identify patients with functional ankle instability. [Table: see text] MATERIALS AND METHODS:: Sixty five patients (mean age 24 (4.6 years)) were included. After clinical examination and radiological stress views, plantar pressure patterns were measured during gait using a capacitive platform, the EMED-SF 2-system. Five trials of each foot were documented and the maximum impulses in eight points of the foot (central heel, lateral and medial heel, midfoot, 1st, 2nd, 5th metatarsal head and hallux) were calculated intraindividually and compared with a group of 100 healthy subjects. The medio-lateral loading factor (MLF) as the quotient of the medial and lateral relative impulses indicated the tendency to walk on the lateral edge of the foot. RESULTS:: Based on clinical criteria alone, two comparable groups of patients were separated, 35 with functional instability and 30 with mechanical instability. After collective analyses of the results, the patients with functional instability showed a significantly increased lateral loading of the unstable foot (p=0 0 1), whereas the mechanically unstable group tended to walk more on the medial side of the unstable foot (Table 1). DISCUSSION:: Dynamic measurement of plantar pressure can identify a group of patients walking on the lateral side of the unstable foot when compared with the stable foot. This finding is explained by a deficit of peroneal strength during stance phase based on a proprioceptive

  15. 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.

  16. Estimating the material properties of heel pad sub-layers using inverse Finite Element Analysis.

    PubMed

    Ahanchian, Nafiseh; Nester, Christopher J; Howard, David; Ren, Lei; Parker, Daniel

    2017-02-01

    Detailed information about the biomechanical behaviour of plantar heel pad tissue contributes to our understanding of load transfer when the foot impacts the ground. The objective of this work was to obtain the hyperelastic and viscoelastic material properties of heel pad sub-layers (skin, micro-chamber and macro-chamber layers) in-vivo. An anatomically detailed 3D Finite Element model of the human heel was used to derive the sub-layer material properties. A combined ultrasound imaging and motorised platform system was used to compress heel pad and to create input data for the Finite Element model. The force-strain responses of the heel pad and its sub-layers under slow compression (5mm/s) and rapid loading-hold-unloading cycles (225mm/s), were measured and hyperelastic and viscoelastic properties of the three heel pad sub-layers were estimated by the model. The loaded (under ∼315N) thickness of the heel pad was measured from MR images and used for hyperelastic model validation. The capability of the model to predict peak plantar pressure was used for further validation. Experimental responses of the heel pad under different dynamic loading scenarios (loading-hold-unloading cycles at 141mm/s and sinusoidal loading with maximum velocity of 300mm/s) were used to validate the viscoelastic model. Good agreement was achieved between the predicted and experimental results for both hyperelastic (<6.4% unloaded thickness, 4.4% maximum peak plantar pressure) and viscoelastic (Root Mean Square errors for loading and unloading periods <14.7%, 5.8% maximum force) simulations. This paper provides the first definition of material properties for heel pad sub-layers by using in-vivo experimental force-strain data and an anatomically detailed 3D Finite Element model of the heel.

  17. 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.

  18. The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications.

    PubMed

    Heneghan, M A; Pavlov, H

    1984-01-01

    Haglund syndrome, a common cause of pain in the posterior heel, consists of a painful swelling of the local soft tissues (the so-called pump bump) and prominence of the calcaneal bursal projection. The condition is caused by compression of the distal Achilles tendon and surrounding soft tissue between the os calcis and the posterior shoe counter. Osseous plantar projections appear to be a critical etiologic factor in Haglund syndrome. With an experimental model, it has been demonstrated that osseous projections on the plantar surface of the calcaneus adversely influence the bone-soft tissue relation of the posterior heel. Shoe heel elevation has been shown to be clinically effective in alleviating symptoms. It is demonstrated with an experimental model that elevation of the shoe heel decreases the pitch angle. This diminishes the prominence of the bursal projection and allows the foot to slip forward, displacing the posterior calcaneus away from the shoe counter.

  19. 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)

  20. 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

  1. 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

  2. Black heel, talon noir or calcaneal petechiae?

    PubMed

    Urbina, Francisco; León, Lorena; Sudy, Emilio

    2008-08-01

    We describe a series of six patients with superficial cutaneous haemorrhages of the feet, including a classical case of black heel (talon noir) and other similar cases with diverse clinical presentations that do not match the typical description of that process. The main differences lay in production mechanism, morphology and location. The causes of these 'atypical' lesions were: burns with hot sand, friction against the rough edge of a swimming pool, wearing new shoes, jogging, or pricking a blister with a needle. Clinically, they consisted of isolated or multiple, small, large or linear, brown or black lesions located in areas that did not include the convex part of the heel, in which talon noir usually appears; on the contrary, the lesions affected the back third of the soles, the toes, periungual fold and plantar arch. As the presence of blood in the horny layer was a common final factor in all these cases, a better name for this process would be 'post-traumatic cutaneous intracorneal blood' to describe black heel and its diverse clinical presentations.

  3. Bursitis of the heel

    MedlinePlus

    ... It may be caused by too much walking, running, or jumping. This condition is very often linked ... include: Pain in the heel, especially with walking, running, or when the area is touched Pain may ...

  4. 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…

  5. 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.

  6. Human papillomaviruses genotyping in plantar warts.

    PubMed

    de Planell-Mas, Elena; Martínez-Garriga, Blanca; Zalacain, Antonio Jesús; Vinuesa, Teresa; Viñas, Miguel

    2017-05-01

    Plantar warts are caused by human papillomaviruses (HPVs) and have been associated with several HPV genotypes. However, there are few studies focused exclusively on plantar warts. In this work, we aim to identify the HPV genotypes of plantar warts and explore their relation to demographic and clinical characteristics of patients. A total of 72 patients diagnosed with plantar warts were recruited at the Laser unit at Podiatric Hospital, University of Barcelona, Spain. Inner hyperkeratosis laminar sections of warts were collected and DNA of samples were extracted. Amplification of a conserved region of the HPV L1 gene was performed with the SK-Polymerase chain reaction method. DNA amplicons were sequenced and HPV types identified. The most prevalent genotypes detected among the 105 analyzed plantar warts were HPV-57 (37.1%), HPV-27 (23.8%), HPV-1a (20.9%), HPV-2 (15.2%), and HPV-65 (2.8%). The majority of patients (78%) presented one single plantar wart, whereas multiple warts were detected in 22.2% of patients. One patient with multiple warts presented HPV types from two different genera, suggesting the spread of warts by self-inoculation as well as by de novo infection. No significant differences between the number of warts in toes, midfoot and heel were found. The most prevalent HPV types detected in all areas belonged to the alpha genus. This work provides new insight on plantar warts and their associated HPV genotypes, and evidences the usefulness and reliability of both the sample collection procedure and the PCR method used for HPV detection and typing. J. Med. Virol. 89:902-907, 2017. © 2016 Wiley Periodicals, Inc.

  7. Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis.

    PubMed

    Broholm, Rikke; Pingel, Jessica; Simonsen, Lene; Bülow, Jens; Johannsen, Finn

    2017-02-27

    Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularisation in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). 20 patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5) and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis. This article is protected by copyright. All rights reserved.

  8. Biomechanical consequences of plantar fascial release or rupture during gait. Part II: alterations in forefoot loading.

    PubMed

    Sharkey, N A; Donahue, S W; Ferris, L

    1999-02-01

    With a model using feet from cadavers, we tested the hypothesis that plantar fascial release or rupture alters the loading environment of the forefoot during the latter half of the stance phase of gait. The model simulated the position and loading environment of the foot at two instants: early in terminal stance immediately after heel-off and late in terminal stance just preceding contralateral heel strike. Eight feet were loaded at both positions by simulated plantar flexor contraction, and the distribution of plantar pressure was measured before and after progressive release of the plantar fascia. Strain in the diaphysis of the second metatarsal was also measured, from which the bending moments and axial force imposed on the metatarsal were calculated. Cutting the medial half of the central plantar fascial band significantly increased peak pressure under the metatarsal heads but had little effect on pressures in other regions of the forefoot or on second metatarsal strain and loading. Dividing the entire central band or completely releasing the plantar fascia from the calcaneus had a much greater effect and caused significant shifts in plantar pressure and force from the toes to beneath the metatarsal heads. These shifts were accompanied by significantly increased strain and bending in the second metatarsal. Complete fasciotomy increased the magnitude of strain in the dorsal aspect of the second metatarsal by more than 80%, suggesting that plantar fascial release or rupture accelerates the accumulation of fatigue damage in these bones. Altered forefoot loading may be a potential complication of plantar fasciotomy.

  9. 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.

  10. Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

    PubMed Central

    Malone, Terry R.

    2004-01-01

    Objective: Plantar fasciitis is a prevalent problem, with limited consensus among clinicians regarding the most effective treatment. The purpose of this literature review is to provide a systematic approach to the treatment of plantar fasciitis based on the windlass mechanism model. Data Sources: We searched MEDLINE, SPORT Discus, and CINAHL from 1966 to 2003 using the key words plantar fasciitis, windlass mechanism, pronation, heel pain, and heel spur. Data Synthesis: We offer a biomechanical application for the evaluation and treatment of plantar fasciitis based on a review of the literature for the windlass mechanism model. This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between the conditions and their treatments. Conclusions/Recommendations: Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition. Principles from this approach might also provide a basis for future research investigating the efficacy of plantar fascia treatment. PMID:16558682

  11. 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.

  12. Anatomic relationship of heel spur to surrounding soft tissues: greater variability than previously reported.

    PubMed

    Li, J; Muehleman, C

    2007-11-01

    The stimulating factor for the development of heel spur (calcaneal exostosis) is controversial. In a sample of elderly cadaveric specimens, using radiographic, gross morphological, and histological investigation, we demonstrate that heel spurs are generally not found in the trajectory of traction from the plantar aponeurosis enthesis or plantar muscles. Rather, they are variably associated with soft tissues including loose connective tissue, fibrocartilage, muscle, and aponeurosis. Furthermore, the bony trabeculae of the spur are not aligned in the direction of soft tissue traction, but rather in the direction of stress on the calcaneus during walking and standing. These results substantiate the view that the heel spur may be a skeletal response to stress and may serve to protect the bone against the development of microfractures.

  13. 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.

  14. Calcaneus (Heel Bone) Fractures

    MedlinePlus

    ... Calcaneus (Heel Bone) Fractures cont. Page ( 5 ) • Early motion. Many doctors encourage motion of the foot and ankle early in the ... therapy. Specific exercises can improve the range of motion in your foot and ankle, and strengthen supporting ...

  15. 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.

  16. [Plantar fasciitis and extracorporeal shock wave therapy--essence, diagnosis and treatment methods].

    PubMed

    Peled, Eli; Portal-Banker, Tali; Norman, Doron; Melamed, Eyal

    2011-02-01

    Heel pain is a very common foot complaint, usually caused by inflammation at the origin of the plantar fascia in the heel, termed plantar fasciitis (PF). The diagnosis is based on patient history and physical examination. Treatment of PF is mainly conservative. In recent years, extracorporeal shock wave therapy (ESWT) for a variety of orthopedic pathologies has become more acceptable and is increasing in popularity. Treating PF with ESWT is effective and should be considered before steroid injections and definitely prior to surgical intervention.

  17. [Calcaneus fractures as a complication of the percutaneous treatment of plantar fasciitis. Case report].

    PubMed

    Apóstol-González, S; Herrera, J; Herrera, I

    2014-01-01

    Plantar fasciitis, a self-limiting pathologic entity, is a common cause of heel pain in adult patients. Surgical treatment is indicated when the patient does not improve after receiving conservative treatment for 4-6 months with proper surveillance. The complications of percutaneous techniques include: infection, persistent pain, and neurologic injuries, among others. We report the case of a patient with calcaneus fracture following percutaneous plantar fasciotomy and resection of a calcaneal spur. We conducted a review and discussion of the literature.

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

    PubMed

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

    2009-12-01

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

  19. Pattern of outsole shoe heel wear in infantry recruits

    PubMed Central

    2012-01-01

    Background Excessive shoe heel abrasion is of concern to patients, parents and shoe manufacturers, but little scientific information is available. The purpose of this study was to describe the phenomenon in a group of infantry recruits performing similar physical activity, and search for biomechanical factors that might be related. Methods Seventy-six subjects (median age 19) enrolled. Pre-training parameters measured included height, weight, tibial length, foot arch height and foot progression angle. Digital plantar pressure maps were taken to calculate arch indexes. Shoe heel abrasion was assessed manually after 14 weeks of training with different-sized clock transparencies and a calliper. Results Outsole abrasion was posterolateral, averaging 12 degrees on each shoe. The average heel volume that was eroded was almost 5 cm3. The angle of maximum wear was related to right foot progression angle (r = 0.27, p = 0.02). Recruits with lateral ankle sprains had higher angles of maximal abrasion (17° versus 10°, p = 0.26) and recruits with lateral heel abrasion had more lateral ankle sprains (14% versus 3%, p = 0.12). Conclusion While shoe heel wear affects many people, very little has been done to measure it. In this study in healthy subjects, we found the main abrasion to be posterolateral. This seems to be related to foot progression angle. It was not related to hindfoot valgus/varus or other factors related to subtalar joint motion. These findings do not warrant modification of subtalar joint motion in order to limit shoe heel abrasion. PMID:23098624

  20. 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.

  1. Slip-Related Changes in Plantar Pressure Distribution, and Parameters for Early Detection of Slip Events

    PubMed Central

    Choi, Seungyoung; Cho, Hyungpil; Kang, Boram; Lee, Dong Hun; Kim, Mi Jung

    2015-01-01

    Objective To investigate differences in plantar pressure distribution between a normal gait and unpredictable slip events to predict the initiation of the slipping process. Methods Eleven male participants were enrolled. Subjects walked onto a wooden tile, and two layers of oily vinyl sheet were placed on the expected spot of the 4th step to induce a slip. An insole pressure-measuring system was used to monitor plantar pressure distribution. This system measured plantar pressure in four regions (the toes, metatarsal head, arch, and heel) for three events: the step during normal gait; the recovered step, when the subject recovered from a slip; and the uncorrected, harmful slipped step. Four variables were analyzed: peak pressure (PP), contact time (CT), the pressure-time integral (PTI), and the instant of peak pressure (IPP). Results The plantar pressure pattern in the heel was unique, as compared with other parts of the sole. In the heel, PP, CT, and PTI values were high in slipped and recovered steps compared with normal steps. The IPP differed markedly among the three steps. The IPPs in the heel for the three events were, in descending order (from latest to earliest), slipped, recovered, and normal steps, whereas in the other regions the order was normal, recovered, and slipped steps. Finally, the metatarsal head-to-heel IPP ratios for the normal, recovered, and slipped steps were 6.1±2.9, 3.1±3.0, and 2.2±2.5, respectively. Conclusion A distinctive plantar pressure pattern in the heel might be useful for early detection of a slip event to prevent slip-related injuries. PMID:26798603

  2. 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.

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

    PubMed Central

    Stupar, Maja; Tibbles, Anthony

    2008-01-01

    Plantar fasciitis is diagnosed based on a pathognomonic clinical presentation and physical examination including plantar heel pain with the initial few steps after a period of inactivity. People living with HIV/AIDS, who are taking anti-retroviral medications, often have an associated redistribution of body fat (lipodystrophy). Lipoatrophy of the extremities may involve the heel fat-pad in this population and result in the signs and symptoms of plantar fasciitis. Two cases of plantar heel pain in HIV-associated lipodystrophy are presented to discuss the possible clinical association between the two conditions. Although conservative therapies have limited evidence, they are commonly used and have been seen, clinically, to result in a resolution of symptoms. In the presented cases, the individuals benefited from soft tissue therapy, modalities, activity modification and education on proper footwear. Clinicians should be aware that the association between these two conditions may be a significant cause of morbidity in a population of patients with HIV. PMID:18516231

  4. Plantar fasciitis/calcaneal spur among security forces personnel.

    PubMed

    Sadat-Ali, M

    1998-01-01

    A prospective single survey was conducted among Security Forces personnel at the Mobile Hospital, Ministry of Interior, Makkah Al-Mukarramah, Saudi Arabia. One hundred three patients presented to the orthopedic clinic with painful heel. A control group of patients from the other clinics without painful heel was also screened. The average age was 38.81 years and 38.1 years in the patient and the control group, respectively. The mean Quetelet index of body mass in the patient group was 30.36 kg/m2 and in the control group it was 26.71 kg/m2. There was a statistically significant difference of p < 0.05 between the two groups for Quetelet index of body mass. The right side was affected in 37 patients, the left side was involved in 45 patients, and 21 patients had pain bilaterally. Seventy-one patients had spur on the calcaneum. The prevalence of painful heel attributable to plantar fasciitis/calcaneum spur was 1.18%. This study suggests that obesity is a cause and initiator of heel pain and plantar fasciitis/calcaneal spur and that improper footwear aggravates the condition.

  5. 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.

  6. Distally Based Abductor Hallucis Adipomuscular Flap for Forefoot Plantar Reconstruction.

    PubMed

    Lee, Sanglim; Kim, Min Bom; Lee, Young Ho; Baek, Jeong Kook; Baek, Goo Hyun

    2015-09-01

    Soft tissue and bone defects of the lower leg, ankle, and heel region often require coverage by local or distant flaps. The authors successfully used the distally based adipomuscular abductor hallucis flap for the treatment of 7 patients with soft tissue defect on the plantar forefoot after diabetic ulcer (n = 2), excision of melanoma at the medial forefoot (n = 3), and posttraumatic defects of the plantar forefoot (n = 2). The size of the defects ranged from 6 to 36 cm. All defects were covered successfully without major complications. The distally based adipomuscular flap from the abductor hallucis muscle provides a reliable coverage for small and moderate defects of the plantar and medial forefoot. This flap is often preferable to the use of free flaps because the surgery is rapidly performed and does not require microsurgical expertise.

  7. Reconstruction of lateral forefoot using reversed medial plantar flap with free anterolateral thigh flap.

    PubMed

    Fujioka, Masaki; Hayashida, Kenji; Senju, Chikako

    2014-01-01

    Skin defects of the heel have frequently been reconstructed using the medial plantar flap; however, forefoot coverage has remained a challenge, because the alternatives for flap coverage have been very limited. We describe a case of malignant melanoma on the lateral forefoot that was radically removed and reconstructed successfully with a distally based medial plantar flap, together with a free anterolateral thigh flap. The advantages of this flap include that it does not reduce the vascular supply to the foot owing to reconstruction of the medial plantar vascular systems, reduces the risk of flap congestion, minimizes donor site morbidity, and enables the transport of structurally similar tissues to the plantar forefoot. We believe this technique is a reasonable reconstructive option for large lateral plantar forefoot defects.

  8. Complications of plantar fascia rupture associated with corticosteroid injection.

    PubMed

    Acevedo, J I; Beskin, J L

    1998-02-01

    From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

  9. Heel Pain in the Athlete

    PubMed Central

    Hunt, Kenneth John; Anderson, Robert B.

    2009-01-01

    Context: Heel pain, a relatively common problem in the athlete, can present a diagnostic and therapeutic dilemma. The purpose of this article is to review treatment techniques for common causes of heel pain in the athlete. Evidence Acquisition: Articles in the English literature through August 2008 were selected and reviewed in the context of the management of heel pain in the athlete. Clinical and surgical photographs are presented as an illustration of preferred techniques and pertinent pathologic findings. Results: Although nonoperative treatment remains the mainstay for most painful heel pathologies, a number of surgical interventions have shown encouraging results in carefully selected patients. Conclusions: The management of heel pain in the athlete requires diagnostic skill, appropriate imaging evaluation, and a careful, initially conservative approach to treatment. Surgical treatment can be successful in carefully selected patients. PMID:23015903

  10. The efficacy of a pneumatic compression device in the treatment of plantar fasciitis.

    PubMed

    Kavros, Steven J

    2005-11-01

    Plantar fasciitis is a common foot disorder that affects more than two million Americans each year. Conservative management of plantar fasciitis is the first line of treatment by the medical specialist who frequently encounters this common foot complaint. In this study, 50 patients with plantar fasciitis of 4 weeks duration but less than 12 weeks were randomized into two groups. One group of 25 patients used the AirHeel (Aircast, Inc.) and the second group of 25 used the 1st Step prefabricated foot insert (Wrymark, Inc). Standardized weight-bearing radiographs were obtained in order to categorize the foot type: normal arch, pes planus, or pes cavus. Patients were initially evaluated and at 12 weeks they returned for a subsequent visit. The contact area of the foot with the AirHeel and 1st Step insert were similar, an increase of 27% and 26%, respectively, over the contact area barefoot. There was a noted difference in force reduction with the two devices. The AirHeel reduced the midstance force by 20.19%, as compared to the 1st Step insert which showed a 1.03% increase in midstance force. Patients with a higher initial pain score seemed to respond better initially to the AirHeel (p = 0.015) than the 1st Step insert (p = 0.035). This study demonstrates the benefits of offloading the foot at midstance with two devices to relieve the discomfort associated with plantar fasciitis. The Aircast AirHeel is a new modality for dynamic, functional treatment of proximal plantar fasciitis.

  11. Development of inexpensive prosthetic feet for high-heeled shoes using simple shoe insole model.

    PubMed

    Meier, Margrit R; Tucker, Kerice A; Hansen, Andrew H

    2014-01-01

    The large majority of prosthetic feet are aimed at low-heeled shoes, with a few models allowing a heel height of up to 5 cm. However, a survey by the American Podiatric Medical Association indicates that most women wear heels over 5 cm; thus, current prosthetic feet limit most female prosthesis users in their choice. Some prosthetic foot components are heel-height adjustable; however, their plantar surface shapes do not change to match the insole shapes of the shoes with different heel heights. The aims of the study were therefore (1) to develop a model that allows prediction of insole shape for various heel height shoes in combination with different shoe sizes and (2) to develop and field-test low-cost prototypes of prosthetic feet whose insole shapes were based on the new model. An equation was developed to calculate insole shapes independent of shoe size. Field testing of prototype prosthetic feet fabricated based on the equation was successful and demonstrated the utility of the equation.

  12. Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location☆,☆☆,★

    PubMed Central

    Ledoux, William R.; Shofer, Jane B.; Cowley, Matthew S.; Ahroni, Jessie H.; Cohen, Victoria; Boyko, Edward J.

    2014-01-01

    Aims We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Methods Diabetic subjects (n = 591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure–time integral (PTI) was assessed using Cox regression. Results During follow-up (2.4 years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194 kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Conclusions Location must be considered when assessing the relationship between PPP and plantar ulceration. PMID:24012295

  13. Material properties of the heel fat pad across strain rates.

    PubMed

    Grigoriadis, Grigoris; Newell, Nicolas; Carpanen, Diagarajen; Christou, Alexandros; Bull, Anthony M J; Masouros, Spyros D

    2017-01-01

    The complex structural and material behaviour of the human heel fat pad determines the transmission of plantar loading to the lower limb across a wide range of loading scenarios; from locomotion to injurious incidents. The aim of this study was to quantify the hyper-viscoelastic material properties of the human heel fat pad across strains and strain rates. An inverse finite element (FE) optimisation algorithm was developed and used, in conjunction with quasi-static and dynamic tests performed to five cadaveric heel specimens, to derive specimen-specific and mean hyper-viscoelastic material models able to predict accurately the response of the tissue at compressive loading of strain rates up to 150s(-1). The mean behaviour was expressed by the quasi-linear viscoelastic (QLV) material formulation, combining the Yeoh material model (C10=0.1MPa, C30=7MPa, K=2GPa) and Prony׳s terms (A1=0.06, A2=0.77, A3=0.02 for τ1=1ms, τ2=10ms, τ3=10s). These new data help to understand better the functional anatomy and pathophysiology of the foot and ankle, develop biomimetic materials for tissue reconstruction, design of shoe, insole, and foot and ankle orthoses, and improve the predictive ability of computational models of the foot and ankle used to simulate daily activities or predict injuries at high rate injurious incidents such as road traffic accidents and underbody blast.

  14. Vibration therapy of the plantar fascia improves spasticity of the lower limbs of a patient with fetal-type Minamata disease in the chronic stage.

    PubMed

    Usuki, Fusako; Tohyama, Satsuki

    2011-10-11

    The authors present a novel treatment for spasticity using a hand-held vibration massager. A fetal-type Minamata disease patient showing spasticity of lower limbs had direct application of vibratory stimuli to the right plantar fascia and to the left hamstring. After the treatment for 1 year, the Modified Ashworth Scale (MAS) of the lower limbs was improved from three (right > left) to two (right < left). After then, direct application of the same method with the left plantar fascia improved the MAS of the left lower limb to two (right = left). The increased deep tendon reflexes had diminished and markedly positive Babinski's sign had also decreased to slightly positive on both sides. This method is so simple that patients can treat themselves at home. The authors think that direct application of vibratory stimuli to the plantar fascia is valuable to patients with neurologic disorders, particularly those who cannot receive more invasive treatments.

  15. 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.

  16. 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.

  17. Plantar pressures during level walking compared with other ambulatory activities.

    PubMed

    Lundeen, S; Lundquist, K; Cornwall, M W; McPoil, T G

    1994-06-01

    This study was designed to determine the magnitude of plantar pressures during level walking in comparison to other activities. These activities included climbing up stairs, going down stairs, a simple pivot while walking, and a crossover pivot while walking in normal individuals. Twelve volunteers, six men and six women, mean age 28 years, served as subjects. Data were collected on the dominant foot with an EMED-SF pressure sensor platform as each subject walked barefoot and did each of the five activities. Maximum plantar pressure (MPP) and pressure-time integral (PTI) was found in the metatarsal and heel regions. The results of repeated-measures analysis of variance tests showed that the five experimental conditions were statistically different for both MPP and PTI in the metatarsal and heel regions. Post hoc analysis indicated that MPP and PTI were decreased during the going down stairs condition in the heel and increased during the crossover pivot while walking and pivot while walking conditions for the metatarsal region.

  18. 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

  19. 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, ...

  20. Use of pulsed radio frequency energy in the effective treatment of recalcitrant plantar fasciitis: Six case histories.

    PubMed

    Michel, R

    2012-03-01

    Plantar fasciitis (or Heel Pain Syndrome) is a common foot disorder. Whereas most patients with this condition have satisfactory outcomes with conventional treatment, the condition can become recalcitrant. For these patients, the use of Pulsed Radio Frequency Energy (PRFE) appears to be a safe, noninvasive, and effective treatment option. While PRFE has been used to provide pain relief for other clinical conditions, little clinical information is available regarding its effectiveness for the treatment of plantar fasciitis. Reported here are outcomes for six cases of recalcitrant plantar fasciitis (duration 6 months or longer) that were unresponsive to conventional treatment alone, for which complete or near complete pain relief was achieved following adjunctive PRFE therapy.

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

    PubMed

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

    2012-03-01

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

  2. Plantar pressures in individuals with normal and pronated feet according to static squat depths.

    PubMed

    Koh, Da Hyun; Lee, Jong Dae; Kim, Kyoung

    2015-09-01

    [Purpose] The purpose of the present study was to investigate differences in plantar pressure between individuals with normal and pronated feet according to 3 static squat depths. [Subjects and Methods] Study subjects were 10 young adults with normal and pronated feet. Plantar pressures were measured in the standing position and static squat positions at 45° (semi-squat) and 90° (half-squat) knee flexion using the F-Mat. Subjects' plantar pressures were analyzed by dividing the foot into 4 areas: forefoot medial, forefoot lateral, midfoot, and heel. [Results] In the half-squat position, the pronated foot group showed a higher foot pressure in the forefoot medial than was seen in the normal group, whereas the normal group exhibited a higher foot pressure in the heel than was seen in the pronated foot group. [Conclusion] An increase in squat depth led to the transfer of plantar pressure to the heel in normal feet and to the forefoot medial in pronated feet.

  3. Plantar pressures in individuals with normal and pronated feet according to static squat depths

    PubMed Central

    Koh, Da Hyun; Lee, Jong Dae; Kim, Kyoung

    2015-01-01

    [Purpose] The purpose of the present study was to investigate differences in plantar pressure between individuals with normal and pronated feet according to 3 static squat depths. [Subjects and Methods] Study subjects were 10 young adults with normal and pronated feet. Plantar pressures were measured in the standing position and static squat positions at 45° (semi-squat) and 90° (half-squat) knee flexion using the F-Mat. Subjects’ plantar pressures were analyzed by dividing the foot into 4 areas: forefoot medial, forefoot lateral, midfoot, and heel. [Results] In the half-squat position, the pronated foot group showed a higher foot pressure in the forefoot medial than was seen in the normal group, whereas the normal group exhibited a higher foot pressure in the heel than was seen in the pronated foot group. [Conclusion] An increase in squat depth led to the transfer of plantar pressure to the heel in normal feet and to the forefoot medial in pronated feet. PMID:26504304

  4. Basketball lay-up - foot loading characteristics and the number of trials necessary to obtain stable plantar pressure variables.

    PubMed

    Chua, YaoHui K; Quek, Raymond K K; Kong, Pui W

    2017-03-01

    This study aimed (1) to profile the plantar loading characteristics when performing the basketball lay-up in a realistic setting and (2) to determine the number of trials necessary to establish a stable mean for plantar loading variables during the lay-up. Thirteen university male basketball players [age: 23.0 (1.4) years, height: 1.75 (0.05) m, mass: 68.4 (8.6) kg] performed ten successful basketball lay-ups from a stationary position. Plantar loading variables were recorded using the Novel Pedar-X in-shoe system. Loading variables including peak force, peak pressure, and pressure-time integral were extracted from eight foot regions. Performance stability of plantar loading variables during the take-off and landing steps were assessed using the sequential averaging technique and intra-class correlation coefficient (ICC). High plantar loadings were experienced at the heel during the take-off steps, and both the heel and forefoot regions upon landing. The sequential estimation technique revealed a five-eight trial range to achieve a stable mean across all plantar loading variables, whereas ICC analysis was insensitive to inter-trial differences of repeated lay-up performances. Future studies and performance evaluation protocols on plantar loading during basketball lay-ups should include at least eight trials to ensure that the measurements obtained are sufficiently stable.

  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. High Heels Increase Women's Attractiveness.

    PubMed

    Guéguen, Nicolas

    2015-11-01

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

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

    PubMed

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

    2014-06-01

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

  8. Spatial resolution in plantar pressure measurement revisited.

    PubMed

    Pataky, Todd C

    2012-08-09

    Plantar pressures are typically measured using sensors of finite area, so the accuracy with which one can measure true maximum pressure is dependent on sensor size. Measurement accuracy has been modeled previously for one patient's metatarsals (Lord, 1997), but has not been modeled either for general subjects or for other parts of the foot. The purposes of this study were (i) to determine whether Lord's (1997) model is also valid for heel and hallux pressures, and (ii) to examine how sensor size relates to measurement accuracy in the context of four factors common to many measurement settings: pressure pulse size, foot positioning, pressure change quantification, and gross pressure redistribution. Lord's (1997) model was first generalized and was then validated using 10 healthy walking subjects, with relatively low RMSE values on the order of 20 kPa. Next, postural data were used to show that gross pressure redistributions can be accurately quantified (p<0.002), even with rather gross sensor sizes of 30 mm. Finally, numerical analyses revealed that the relation between sensor size and measurement accuracy is highly complex, with deep dependency on the measurement context. In particular, the critical sensor widths required to achieve 90% accuracy ranged from 1.7 mm to 17.4 mm amongst the presently investigated scenarios. Since measurement accuracy varies so extensively with so many factors, the current results cannot yield specific recommendations regarding spatial resolution. It is concluded simply that no particular spatial resolution can yield a constant measurement accuracy across common plantar pressure measurement tasks.

  9. [Plantar fibromatosis (Ledderhose's disease)].

    PubMed

    Koudela, K; Koudela, K; Kunešová, M; Koudelová, J

    2010-08-01

    The authors describe the concomitant presence of plantar fibromatosis and Dupuytren's disease in a 33-year-old man. A lesion located under the sesamoid bones of the first metatarsophalangeal joint on the right showed an aggressive tendency (rapid growth, pain, impossibility to put weight on the medial side of the foot). Another lesion located proximal to the first one was smaller and painless. Neither plain radiography nor computed tomography showed any structural changes of the skeleton. Contrast-enhancement on magnetic resonance imaging revealed two lesions on the sole of the foot. Since a concurrence of plantar fibromatosis and malignant tumour could not be ruled out, an excision of both lesions and the adjacent plantar aponeurosis was made for biopsy examination. The operative procedure was carried out from two incisions.The intra-operative findings included proliferative growth and bleeding in the lesion located under the first metatarsophalangeal joint, and delimited growth without noticeable bleeding in the other lesion. Based on histological examination, the diagnosis of plantar fibromatosis was made for both lesions.The differential diagnosis and therapy of plantar fibromatosis is discussed.

  10. Comparison of plantar loads during running on different overground surfaces.

    PubMed

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

    2012-04-01

    The objective of this study is to compare plantar loads during running on different overground surfaces. Fifteen heel-to-toe runners participated in the study. Plantar load data were collected and analyzed using an insole sensor system during running on concrete, synthetic rubber, and grass surfaces at a running speed of 3.8 m/s. Compared with running on concrete surface, running on natural grass showed a lower magnitude of maximum plantar pressure at the total foot (451.8 kPa vs. 401.7 kPa, p = 0.016), lateral midfoot (175.3 kPa vs. 148.0 kPa, p = 0.004), central forefoot (366.3 kPa vs. 336.8 kPa, p = 0.003), and lateral forefoot (290.2 kPa vs. 257.9 kPa, p = 0.004). Moreover, running on natural grass showed a longer relative contact time compared with running on a concrete surface at the central forefoot (81.9% vs. 78.8%, p = 0.017) and lateral forefoot (75.2% vs. 73.1%, p = 0.007). No significant difference was observed in other multiple comparisons. Different surfaces affected the plantar loads while running. The differences may help us to understand potential injury mechanisms.

  11. 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

  12. Testing and comparing of film-type sensor materials in measurement of plantar pressure distribution.

    PubMed

    Rajala, Satu; Salpavaara, Timo; Tuukkanen, Sampo

    2016-08-01

    Simple in-shoe sensors based on film-type sensor materials were developed in this study. Three sensor materials were tested: polyvinylidenefluoride (PVDF), cellulose nanofibrils (CNF) and ElectroMechanical Film (EMFi). Plantar pressure distributions of a subject were measured with the developed in-shoe sensors; each consisting of three sensor channels (lateral and medial metatarsal heads and heel). In addition, piezoelectric sensor sensitivities and crosstalk between the sensor channels were determined. Differences between the tested film-type materials and measured plantar pressure distribution signals were studied.

  13. Image intensifier-guided injection of corticosteroid and local anesthetic agent for the treatment of recalcitrant plantar fasciitis.

    PubMed

    Atkins, Kate L; Chin, Kuen Foo; Noorani, Ali M; Nairn, David S

    2010-08-01

    Plantar fasciitis is the most common cause of plantar heel pain. The condition is potentially self-limiting and can respond to conservative treatment, but patients may opt for surgery if the treatments fail. Surgical intervention is associated with potential complications. This study set out to explore the efficacy of the specific nonsurgical intervention offered to treatment-resistant cases in a local clinical setting. The technique involves image intensifier-guided injection of corticosteroid and local anesthetic agents under general anesthesia. Nineteen patients with recalcitrant plantar fasciitis of over 12 months' duration received injections. A simple follow-up questionnaire was given to patients after the procedure that focused on their subjective opinion of any change in their pain. They were also asked if the injection had solved their problems with heel pain. The improvements that the patients reported were found to be statistically significant (P = .012).

  14. Rupture of the plantar fascia.

    PubMed

    Pai, V S

    1996-01-01

    Rupture of the plantar fascia in athletes engaged in sports that require running and jumping has been reported. However, spontaneous degenerative rupture of the plantar fascia is not well documented in the literature. This paper reports a patient with degenerative rupture of the plantar fascia.

  15. 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.

  16. 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

  17. Endoscopic plantar fasciotomy versus injection of platelet-rich plasma for resistant plantar fasciopathy

    PubMed Central

    Othman, Ahmed Mohamed Ahmed; Hegazy, Islam Hassan Ali

    2015-01-01

    Background Resistant plantar fasciopathy is a common orthopedic problem. Aim Comparing two different methods of treatment. Methods Fifty patients with chronic resistant plantar fasciopathy were divided into two groups. The first included 23 patients treated by endoscopic release of plantar fascia (EPF) and the second included 27 patients treated by injection of platelet-rich plasma (PRP). Results In the EPF group, the average VAS improved from 8.28 to 2.35. The average AOFAS improved from 65 to 94. In the PRP group, average VAS improved from 8.22 to 2.9 and the average AOFAS improved from 66 to 92. Conclusion Both methods gave comparable results at late follow-up. PMID:27047220

  18. Ultrasound evaluation of a spontaneous plantar fascia rupture.

    PubMed

    Louwers, Michael J; Sabb, Brian; Pangilinan, Percival H

    2010-11-01

    Plantar fascia rupture is an occasional complication in patients with chronic plantar fasciitis or in patients with plantar fasciitis treated with steroid injection. Very few cases of spontaneous plantar fascia rupture have been reported in the literature (Herrick and Herrick, Am J Sports Med 1983;11:95; Lun et al, Clin J Sports Med 1999;9:48-9; Rolf et al, J Foot Ankle Surg 1997;36:112-4; Saxena and Fullem, Am J Sports Med 2004;32:662-5). Spontaneous medial plantar fascia rupture in a 37-yr-old man with no preceding symptoms or steroid injections was confirmed with diagnostic ultrasound, which revealed severe fasciitis at the calcaneal insertion with partial tearing. After conservative treatment, the patient returned to full activities. We discuss the anatomy, risk factors, examination findings, and treatment for this condition, as well as the unique benefits that ultrasound offers over magnetic resonance imaging. It is important to consider plantar fascia rupture in patients with hindfoot pain and medioplantar ecchymosis, particularly if an injury occurred during acceleration maneuvers. Ultrasound in these cases can be used to diagnose a plantar fascia tear quickly, accurately, and cost-effectively.

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

    PubMed

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

    2009-12-01

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

  20. 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

  1. Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics.

    PubMed

    Elias, David A; Carne, Andrew; Bethapudi, Sarath; Engebretsen, Lars; Budgett, Richard; O'Connor, Philip

    2013-12-01

    Plantar fascia and distal Achilles injuries are common in elite athletes. Acute athletic injuries of the plantar fascia include acute plantar fasciopathy and partial or complete tears. Underlying most acute injuries is a background of underlying chronic plantar fasciopathy. Injuries may affect the central or less commonly lateral portions of the fascia and acute tears are generally proximal. Athletic Achilles injuries may occur at the mid tendon or the distal insertion, and there may be an underlying chronic tendinopathy. Acute or chronic paratendinopathy may occur as a separate entity or combined with Achilles injury. In this article, the spectrum of athletic injuries of the plantar fascia and Achilles is described, illustrated by imaging findings from the London 2012 Olympic games.

  2. Percutaneous Ultrasonic Fasciotomy for Refractory Plantar Fasciopathy After Failure of a Partial Endoscopic Release Procedure.

    PubMed

    Pourcho, Adam M; Hall, Mederic M

    2015-11-01

    Plantar fasciopathy is a painful, degenerative condition of the plantar fascia that affects 2 million people annually and has an estimated 10% lifetime prevalence. When both nonoperative and operative management fails, patients have limited therapeutic options. We present a case of an active 47-year-old male runner who was successfully treated with songraphically guided percutaneous ultrasonic fasciotomy after undergoing a prolonged course of nonoperative management and an endoscopic plantar fascia release procedure. Percutaneous ultrasonic fasciotomy may be considered in patients with chronic, refractory plantar fasciopathy, including those for whom a prior operative release procedure has failed.

  3. Deformation and stress distribution of the human foot after plantar ligaments release: a cadaveric study and finite element analysis.

    PubMed

    Liang, Jun; Yang, Yunfeng; Yu, Guangrong; Niu, Wenxin; Wang, Yubin

    2011-03-01

    The majority of foot deformities are related to arch collapse or instability, especially the longitudinal arch. Although the relationship between the plantar fascia and arch height has been previously investigated, the stress distribution remains unclear. The aim of this study was to explore the role of the plantar ligaments in foot arch biomechanics. We constructed a geometrical detailed three-dimensional (3-D) finite element (FE) model of the human foot and ankle from computer tomography images. The model comprised the majority of joints in the foot as well as bone segments, major ligaments, and plantar soft tissue. Release of the plantar fascia and other ligaments was simulated to evaluate the corresponding biomechanical effects on load distribution of the bony and ligamentous structures. These intrinsic ligaments of the foot arch were sectioned to simulate different pathologic situations of injury to the plantar ligaments, and to explore bone segment displacement and stress distribution. The validity of the 3-D FE model was verified by comparing results with experimentally measured data via the displacement and von Mise stress of each bone segment. Plantar fascia release decreased arch height, but did not cause total collapse of the foot arch. The longitudinal foot arch was lost when all the four major plantar ligaments were sectioned simultaneously. Plantar fascia release was compromised by increased strain applied to the plantar ligaments and intensified stress in the midfoot and metatarsal bones. Load redistribution among the centralized metatarsal bones and focal stress relief at the calcaneal insertion were predicted. The 3-D FE model indicated that plantar fascia release may provide relief of focal stress and associated heel pain. However, these operative procedures may pose a risk to arch stability and clinically may produce dorsolateral midfoot pain. The initial strategy for treating plantar fasciitis should be non-operative.

  4. Modified pressure distribution patterns in walking following reduction of plantar sensation.

    PubMed

    Eils, Eric; Nolte, Stefan; Tewes, Markus; Thorwesten, Lothar; Völker, Klaus; Rosenbaum, Dieter

    2002-10-01

    The aim of the present study was to investigate the influence of reduced plantar sensation on pressure distribution patterns during gait of 40 healthy subjects (25.3+/-3.3 yr, 70.8+/-10.6 kg and 176.5+/-7.8 cm) with no history of sensory disorders. Plantar sensation in the subjects was reduced by using an ice immersion approach, and reduced sensitivity was tested with Semmes-Weinstein monofilaments. All subjects performed six trials of barefoot walking over a pressure distribution platform under normal as well as iced conditions. Plantar cutaneous sensation was significantly reduced after the cooling procedure (p<0.0001). Pressure distribution analysis showed substantially modified plantar pressure distribution patterns during the roll-over process (ROP) under iced conditions. Analysis of peak pressures revealed significant reductions under the toes and under the heel (p<0.001). The contact time and the relative impulse for the whole foot did not change significantly between the two conditions. For the different areas, a significant load shift from the heel and toes towards the central and lateral forefoot and the lateral midfoot was observed. The results indicate the strong influence of reduced afferent information of the sole of the foot on the ROP in walking.

  5. Pedal-plantar loop technique for a challenging below-the-knee chronic total occlusion: a novel approach to percutaneous revascularization in critical lower limb ischemia.

    PubMed

    Fusaro, Massimiliano; Dalla Paola, Luca; Biondi-Zoccai, Giuseppe

    2007-02-01

    Arterial revascularization by means of percutaneous transluminal angioplasty (PTA) is a mainstay in the management of patients with peripheral artery disease and critical limb ischemia (CLI). However, when employing standard approaches, percutaneous transluminal angioplasty (PTA) of below-the-knee arteries may fail in up to 20% of cases. In the present article, we report on a novel interventional strategy, the pedal-plantar loop technique, which we successfully employed in a patient with critical lower limb ischemia. This technique may sensibly increase success rates of PTA in very challenging total occlusions of below-the-knee arteries (e.g., those lacking a proximal occlusion stump). Technical points pertinent to this case are clearly illustrated, including the need to accurately choose guidewires and balloons of appropriate length, and the extensive use of the subintimal angioplasty technique.

  6. Differential effects of plantar desensitization on locomotion dynamics.

    PubMed

    Manor, Brad; Wolenski, Peter; Guevaro, Alvaro; Li, Li

    2009-10-01

    Reduced plantar sensation secondary to chronic diffuse polyneuropathy (PN) is believed to reduce locomotor stability, especially when walking at non-preferred speeds. However, the contribution of plantar sensation to the maintenance of locomotor stability is not entirely clear. The purpose of this study was to examine the effects of acute loss of plantar sensation on the stability-related kinematic properties of walking at different speeds. Lower-extremity joint kinematics were acquired as healthy young adults walked on a treadmill at their preferred walking speed (PWS) and three predetermined speeds (0.8, 1.0, and 1.2m/s) under both normal and desensitized conditions. Desensitization of the foot soles was induced by ice-exposure, and plantar pressure sensation was assessed by a 5.07 monofilament. The average magnitude of stride duration variability (SDvar) and lower-extremity joint angle variability (JTvar), as well as short- and long-term "finite-time" Lyapunov exponents (lambda(ST)(*), lambda(LT)(*)) associated with lower-extremity joint angles were computed. Ice-induced plantar desensitization led to increased lambda(ST)(*) ( approximately 40%) and lambda(LT)(*) (approximately 8%) values but did not affect SDvar or JTvar. Higher treadmill speed led to greater lambda(ST)(*) and lambda(LT)(*) values, but the speed effects were not influenced by plantar desensitization.While acute loss of plantar sensation does not appear to influence the magnitude of spatial or temporal variability, it did attenuate the state-space trajectory divergence caused by stride-to-stride variability (i.e., lambda(ST)( *) and lambda(LT)(*)). However, as opposed to walking at PWS, otherwise healthy locomotor systems do not appear to place increased reliance on plantar sensation when walking at non-preferred treadmill speeds.

  7. Significance of heel pad confinement for the shock absorption at heel strike.

    PubMed

    Jørgensen, U; Ekstrand, J

    1988-12-01

    Shock absorption (SA) is a simple way to reduce the body load and can be used in the prevention and treatment of injuries. The heel pad is the most important shock absorber in the shoe heel complex. The purpose of this study was to investigate whether the SA at heel strike can be increased by heel support in people and shoes with high or low SA. The impact forces at heel strike were measured on an AMTI (R) force platform. Fourteen legs were tested in seven persons (nine with normal and five with low heel pad SA) in gait analysis and in human drop tests. The tests were performed barefooted, and in a soccer and a running shoe (selected by shoe drop test), with and without the distal 2 cm of the heel counter. The heel pad confinement produced by the heel counter (the heel counter effect) increased the SA in both shoe types significantly in both impact situations. The mean increase in SA was 8.8% (range 5.8%-15.5%). The heel counter effect was in all situations significantly higher in persons with low heel pad shock absorbency (LHPSA) than in those with normal heel pads. The barefoot impact peak force per kg body weight was significantly higher (6% mean) on the side with LHPSA. The running shoe provided the significantly greatest SA compared with the soccer shoe. It is concluded that the shock absorbency at heel strike can be increased significantly by heel support, with highest effect in persons with LHPSA, both in shoes with high and low SA.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed

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

    2015-01-21

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

  9. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging.

    PubMed

    Draghi, Ferdinando; Gitto, Salvatore; Bortolotto, Chandra; Draghi, Anna Guja; Ori Belometti, Gioia

    2017-02-01

    Plantar fascia (PF) disorders commonly cause heel pain and disability in the general population. Imaging is often required to confirm diagnosis. This review article aims to provide simple and systematic guidelines for imaging assessment of PF disease, focussing on key findings detectable on plain radiography, ultrasound and magnetic resonance imaging (MRI). Sonographic characteristics of plantar fasciitis include PF thickening, loss of fibrillar structure, perifascial collections, calcifications and hyperaemia on Doppler imaging. Thickening and signal changes in the PF as well as oedema of adjacent soft tissues and bone marrow can be assessed on MRI. Radiographic findings of plantar fasciitis include PF thickening, cortical irregularities and abnormalities in the fat pad located deep below the PF. Plantar fibromatosis appears as well-demarcated, nodular thickenings that are iso-hypoechoic on ultrasound and show low-signal intensity on MRI. PF tears present with partial or complete fibre interruption on both ultrasound and MRI. Imaging description of further PF disorders, including xanthoma, diabetic fascial disease, foreign-body reactions and plantar infections, is detailed in the main text. Ultrasound and MRI should be considered as first- and second-line modalities for assessment of PF disorders, respectively. Indirect findings of PF disease can be ruled out on plain radiography. Teaching Points • PF disorders commonly cause heel pain and disability in the general population.• Imaging is often required to confirm diagnosis or reveal concomitant injuries.• Ultrasound and MRI respectively represent the first- and second-line modalities for diagnosis.• Indirect findings of PF disease can be ruled out on plain radiography.

  10. [Prevention of pressure ulcers in heels].

    PubMed

    Verdú Soriano, José; López Casanaova, Pablo; Fuentes Pagés, Gemma; Torra i Bou, Joan-Enric

    2004-09-01

    Heels are, for all assistance levels, one of the most frequent locations for the development of pressure ulcers (PU). In this study we deal to investigate in order to determine in patients at risk in an Internal Medicine Unit, the PU incidence on heels, after applying a specific prevention protocol. This protocol particularly designed for pressure ulcers on heels included a combined application of special hydrocellular dressings specially shaped for heels (Allevyn Heel), hyper-oxygenated fatty acids (Mepentol) and special surfaces for pressure management (Aerocare); afterwards, we attempted a comparison of our results with those from previous similar studies. We designed a prospective study which lasted from May 1-2002 until June 30-2003, with a sample of 100 patients without PU included in the study when admitted to the unit. The cumulated incidence established for PU in heels is a 4% which means an incidence rate of 2.06 PU in heels per 1000 persons/day. After observing the results we may affirm that applying the protocol is, under a clinical point of view, as effective as other measures used in previous studies. If we focus on the cost-benefit, the protocol studied represents an option with an excellent cost-efficiency relationship.

  11. Computer-assisted assessment of lateral column movement following plantar fascial release: a cadaveric study.

    PubMed

    Anderson, D J; Fallat, L M; Savoy-Moore, T

    2001-01-01

    In patients who fail conservative treatment, releasing the plantar fascia relieves heel pain but destabilizes the lateral column of the foot. After surgery, pain can present in the area of the sinus tarsi, extensor digitorum brevis muscle, between the fourth and fifth metatarsals, and at the calcaneocuboid joint. The precise mechanism and involved structures for this painful compensation remains unclear. The authors hypothesized that the lateral plantar fascial band, bifurcate and cervical ligaments, lateral talocalcaneal ligament, and interosseous talocalcaneal ligament become excessively strained after this surgery. Using eight cadaver lower extremity limbs amputated 7 cm above the ankle joint, structural changes in the foot in response to staged release of the plantar fascia were measured. All ligament, tendon, and osseous structures were exposed along the plantar, medial, and lateral aspects of the foot and ankle. Using a servohydraulic system, compressive loads in increasing increments (50 lbs) were applied along the tibial axis. Tissue and bony structure displacement in the foot was measured using images electronically captured from two fixed cameras and a digital camera following each load change. All measurements were made in pixels and converted to millimeters in a spreadsheet program. Except for plantar fascial measurements, data were expressed as percentage of initial baseline. As expected, increasing compressive loads changed all measurements [repeated measures ANOVA, p<.04]. When releasing the plantar fascia, the inferior sinus tarsi space widened (intact, 85.4+/-10.8%; 1/4 release, 87.7+/-13.0; 1/2 release, 88.3+/-9.2; 3/4 release, 91.2+/-8.8; p<.04). Lateral length increased and medial height decreased, while medial length and lateral height were unchanged as the fascia was sequentially released. Significant movement of the inferior sinus tarsi strained the bifurcate and cervical ligaments, the lateral talocalcaneal ligament, and interosseous

  12. 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

  13. 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

  14. 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.

  15. Heel pain and Achilles tendonitis -- aftercare

    MedlinePlus

    ... walking or standing on your foot References Achilles Tendinitis. In: Safran MR, Zachazewski J, Stone DA, eds. ... Related MedlinePlus Health Topics Heel Injuries and Disorders Tendinitis Browse the Encyclopedia A.D.A.M., Inc. ...

  16. Role of gastrocnemius-soleus muscle in forefoot force transmission at heel rise - A 3D finite element analysis.

    PubMed

    Chen, Wen-Ming; Park, Jaeyoung; Park, Seung-Bum; Shim, Victor Phyau-Wui; Lee, Taeyong

    2012-06-26

    The functions of the gastrocnemius-soleus (G-S) complex and other plantar flexor muscles are to stabilize and control major bony joints, as well as to provide primary coordination of the foot during the stance phase of gait. Geometric positioning of the foot and transferring of plantar loads can be adversely affected when muscular control is abnormal (e.g., equinus contracture). Although manipulation of the G-S muscle complex by surgical intervention (e.g., tendo-Achilles lengthening) is believed to be effective in restoring normal plantar load transfer in the foot, there is lack of quantitative data supporting that notion. Thus, the objective of this study is to formulate a three-dimensional musculoskeletal finite element model of the foot to quantify the precise role of the G-S complex in terms of biomechanical response of the foot. The model established corresponds to a muscle-demanding posture during heel rise, with simulated activation of major extrinsic plantar flexors. In the baseline (reference) case, required muscle forces were determined from what would be necessary to generate the targeted resultant ground reaction forces. The predicted plantar load transfer through the forefoot plantar surface, as indicated by plantar pressure distribution, was verified by comparison with experimental observations. This baseline model served as a reference for subsequent parametric analysis, where muscle forces applied by the G-S complex were decreased in a step-wise manner. Adaptive changes of the foot mechanism, in terms of internal joint configurations and plantar stress distributions, in response to altered muscular loads were analyzed. Movements of the ankle and metatarsophalangeal joints, as well as forefoot plantar pressure peaks and pressure distribution under the metatarsal heads (MTHs), were all found to be extremely sensitive to reduction in the muscle load in the G-S complex. A 40% reduction in G-S muscle stabilization can result in dorsal-directed rotations

  17. Miniscalpel-Needle versus Steroid Injection for Plantar Fasciitis: A Randomized Controlled Trial with a 12-Month Follow-Up

    PubMed Central

    Li, Shuming; Shen, Tong; Liang, Yongshan; Zhang, Ying; Bai, Bo

    2014-01-01

    Plantar fasciitis is the most common cause of heel pain in adults. A novel alternative medical instrument, the miniscalpel-needle (MSN), which is based on an acupuncture needle, has been recently developed in China. The objective of this study was to evaluate the effectiveness of the MSN release treatment versus that of traditional steroid injection for plantar fasciitis. Patients with plantar fasciitis were randomly assigned to 2 groups and followed up for 12 months, with 29 receiving MSN treatment and 25 receiving steroid injection treatment. The results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Our data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection. PMID:25114704

  18. Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers.

    PubMed

    Theodorou, D J; Theodorou, S J; Kakitsubata, Y; Lektrakul, N; Gold, G E; Roger, B; Resnick, D

    2000-10-01

    Understanding of the normal anatomy of the plantar aponeurosis (PA) and familiarity with pathologic conditions are required for an accurate evaluation of the patient with subcalcaneal heel pain. In this study, we evaluated the diagnostic capabilities of magnetic resonance (MR) imaging in the assessment of the PA with close anatomic correlation. Herein, we describe the MR imaging features of plantar fasciitis and fascial rupture in 26 patients. High-spatial-resolution MR imaging was performed in four cadaveric feet, and a prescribed imaging plane was used for depiction of the peroneal component of the PA. MR imaging delineated the anatomy of the PA and perifascial soft tissues. The peroneal component was best visualized in prescribed sagittal oblique images. Perifascial edema was the most common finding of plantar fasciitis, and it was remarkable in those cases with acute fascial rupture. MR imaging reliably delineated the anatomy of the PA and may allow precise localization and definition of the extent of involvement in disease processes.

  19. 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.

  20. Reliability of plantar pressure platforms.

    PubMed

    Hafer, Jocelyn F; Lenhoff, Mark W; Song, Jinsup; Jordan, Joanne M; Hannan, Marian T; Hillstrom, Howard J

    2013-07-01

    Plantar pressure measurement is common practice in many research and clinical protocols. While the accuracy of some plantar pressure measuring devices and methods for ensuring consistency in data collection on plantar pressure measuring devices have been reported, the reliability of different devices when testing the same individuals is not known. This study calculated intra-mat, intra-manufacturer, and inter-manufacturer reliability of plantar pressure parameters as well as the number of plantar pressure trials needed to reach a stable estimate of the mean for an individual. Twenty-two healthy adults completed ten walking trials across each of two Novel emed-x(®) and two Tekscan MatScan(®) plantar pressure measuring devices in a single visit. Intraclass correlation (ICC) was used to describe the agreement between values measured by different devices. All intra-platform reliability correlations were greater than 0.70. All inter-emed-x(®) reliability correlations were greater than 0.70. Inter-MatScan(®) reliability correlations were greater than 0.70 in 31 and 52 of 56 parameters when looking at a 10-trial average and a 5-trial average, respectively. Inter-manufacturer reliability including all four devices was greater than 0.70 for 52 and 56 of 56 parameters when looking at a 10-trial average and a 5-trial average, respectively. All parameters reached a value within 90% of an unbiased estimate of the mean within five trials. Overall, reliability results are encouraging for investigators and clinicians who may have plantar pressure data sets that include data collected on different devices.

  1. 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

  2. Effects of indoor slippers on plantar pressure and lower limb EMG activity in older women.

    PubMed

    Yick, K L; Tse, L T; Lo, W T; Ng, S P; Yip, J

    2016-09-01

    Open-toe mule slippers are popular footwear worn at home especially by older women. However, their biomechanical effects are still poorly understood. The objective of this study is to therefore evaluate the physical properties of two typical types of open-toe mule slippers and the changes in plantar pressure and lower limb muscle activity of older women when wearing these slippers. Five walking trials have been carried out by ten healthy women. The results indicate that compared to barefoot, wearing slippers results in significant increases in the contact area of the mid-foot regions which lead to plantar pressure redistribution from metatarsal heads 2-3 and the lateral heel to the midfoot regions. However, there is no significant difference in the selected muscle activity across all conditions. The findings enhance our understanding of slipper features associated with changes in biomechanical measures thereby providing the basis of slipper designs for better foot protection and comfort.

  3. 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.

  4. Topical cidofovir for plantar warts.

    PubMed

    Padilla España, Laura; Del Boz, Javier; Fernández Morano, Teresa; Arenas Villafranca, Javier; de Troya Martín, Magdalena

    2014-01-01

    Plantar warts are a common reason for dermatological consultations and their treatment can occasionally be a challenge. Plantar warts are benign lesions produced by the human papillomavirus (HPV) that often fail to respond to habitual treatment. Cidofovir is a potent antiviral drug that acts competitively, inhibiting viral DNA polymerase. Our aim was to assess the efficacy and safety of cidofovir cream for the treatment of viral plantar warts. We undertook a retrospective observational study of patients with plantar warts who received treatment with topical cidofovir between July 2008 and July 2011 at the Dermatology Service of the Hospital Costa del Sol, Marbella, Spain. Data about the rate of treatment response, the adverse effects, and recurrences, as well as the characteristics of the patient cohort, were recorded. We identified 35 patients who had received some previous treatment. The usual concentration was 3% (in 33 of 35 cases), applied twice a day (in 31 of 35 cases). A greater or lesser response was noted in 28 cases. There were two recurrences. Topical cidofovir seems to be a useful alternative for the therapeutic management of recalcitrant plantar common warts that fail to respond to usual treatment.

  5. 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.

  6. 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…

  7. Autologous blood injection and botulinum toxin for resistant plantar fasciitis accompanied by spasticity.

    PubMed

    Logan, Lynne Romeiser; Klamar, Karl; Leon, Jerry; Fedoriw, Wladislaw

    2006-08-01

    An originally ambulatory 18-yr-old woman with spastic left hemiplegic cerebral palsy developed left plantar fasciitis with a gradual loss of function requiring use of a wheelchair. Her symptoms were resistant to physical therapy. Two hundred units of botulinum toxin A was diluted in 4 mL of saline and injected into the gastrocnemius. Three milliliters of autologous blood was injected into the plantar fascia. She reported decreased pain at 3 days postinjection. At 10 days, she had no pain on walking. Dorsiflexion increased and Ashworth and Tardieu improved. A stretching program was taught and a better-fitting night splint was obtained. At 21 days, she exhibited no pain and increased dorsiflexion. Autologous blood injection combined with botulinum toxin A may be an alternative treatment for resistant plantar fasciitis accompanied by spasticity. Our hypothesis is that chronic plantar fasciitis is a degenerative condition and thus is relieved when a mild inflammatory process is created that leads to healing.

  8. Studying Maximum Plantar Stress per Insole Design Using Foot CT-Scan Images of Hyperelastic Soft Tissues

    PubMed Central

    Sarikhani, Ali; Motalebizadeh, Abbas; Kamali Doost Azad, Babak

    2016-01-01

    The insole shape and the resulting plantar stress distribution have a pivotal impact on overall health. In this paper, by Finite Element Method, maximum stress value and stress distribution of plantar were studied for different insoles designs, which are the flat surface and the custom-molded (conformal) surface. Moreover, insole thickness, heel's height, and different materials were used to minimize the maximum stress and achieve the most uniform stress distribution. The foot shape and its details used in this paper were imported from online CT-Scan images. Results show that the custom-molded insole reduced maximum stress 40% more than the flat surface insole. Upon increase of thickness in both insole types, stress distribution becomes more uniform and maximum stress value decreases up to 10%; however, increase of thickness becomes ineffective above a threshold of 1 cm. By increasing heel height (degree of insole), maximum stress moves from heel to toes and becomes more uniform. Therefore, this scenario is very helpful for control of stress in 0.2° to 0.4° degrees for custom-molded insole and over 1° for flat insole. By changing the material of the insole, the value of maximum stress remains nearly constant. The custom-molded (conformal) insole which has 0.5 to 1 cm thickness and 0.2° to 0.4° degrees is found to be the most compatible form for foot. PMID:27843284

  9. Analysis of heel pad tissues mechanics at the heel strike in bare and shod conditions.

    PubMed

    Fontanella, C G; Forestiero, A; Carniel, E L; Natali, A N

    2013-04-01

    A combined experimental and numerical approach is used to investigate the interaction phenomena occurring between foot and footwear during the heel strike phase of the gait. Two force platforms are utilised to evaluate the ground reaction forces of a subject in bare and shod walking. The reaction forces obtained from the experimental tests are assumed as loading conditions for the numerical analyses using three dimensional models of the heel region and of the running shoe. The heel pad region, as fat and skin tissues, is described by visco-hyperelastic and fibre-reinforced hyperelastic formulations respectively and bone region by a linear orthotropic formulation. Different elastomeric foams are considered with regard to the outsole, the midsole and the insole layers. The mechanical properties are described by a hyperfoam formulation. The evaluation of the mechanical behaviour of the heel pad tissues at the heel strike in bare and shod conditions is performed considering different combinations of materials for midsole and insole layers. Results allow for the definition of the influence of different material characteristics on the mechanical response of the heel pad region, in particular showing the compressive stress differentiation in the bare and shod conditions.

  10. Biomechanical consequences of plantar fascial release or rupture during gait: part I--disruptions in longitudinal arch conformation.

    PubMed

    Sharkey, N A; Ferris, L; Donahue, S W

    1998-12-01

    To examine whether conformational changes induced by plantar fascial division may progress during gait, we loaded the feet of seven cadavers using an apparatus that simulates the actions of the extrinsic plantarflexors. We measured the effects of plantar fasciotomy at two instants in the terminal-stance phase of gait. Radiographic measurements of height of the arch, base length of the arch, and talo first-metatarsal angle were used to assess contributions to arch support made by the plantar fascia, tibialis posterior, peroneus longus and brevis, and digital flexor muscles. Complete fasciotomy caused significant collapse of the arch in the sagittal plane. Early in terminal stance, at the instant after heel-off, mean height of the arch decreased from 47 to 45 mm. Late in terminal stance, at the instant preceding contralateral heel strike, mean height of the arch decreased from 46 to 43. Effects of division of the central band, though significant, were mild. Medial base length of the arch increased from 163 to 167 mm in the absence of tibialis posterior contraction at late terminal stance. Arch-supporting abilities of the other extrinsic muscles were insignificant.

  11. 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.

  12. Parameter identification of hyperelastic material properties of the heel pad based on an analytical contact mechanics model of a spherical indentation.

    PubMed

    Suzuki, Ryo; Ito, Kohta; Lee, Taeyong; Ogihara, Naomichi

    2017-01-01

    Accurate identification of the material properties of the plantar soft tissue is important for computer-aided analysis of foot pathologies and design of therapeutic footwear interventions based on subject-specific models of the foot. However, parameter identification of the hyperelastic material properties of plantar soft tissues usually requires an inverse finite element analysis due to the lack of a practical contact model of the indentation test. In the present study, we derive an analytical contact model of a spherical indentation test in order to directly estimate the material properties of the plantar soft tissue. Force-displacement curves of the heel pads are obtained through an indentation experiment. The experimental data are fit to the analytical stress-strain solution of the spherical indentation in order to obtain the parameters. A spherical indentation approach successfully predicted the non-linear material properties of the heel pad without iterative finite element calculation. The force-displacement curve obtained in the present study was found to be situated lower than those identified in previous studies. The proposed framework for identifying the hyperelastic material parameters may facilitate the development of subject-specific FE modeling of the foot for possible clinical and ergonomic applications.

  13. 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

  14. Plantar fibromatosis--topical review.

    PubMed

    Veith, Nils T; Tschernig, Thomas; Histing, Tina; Madry, Henning

    2013-12-01

    Morbus Ledderhose is a rare hyperproliferative disease of the plantar fascia, leading to the formation of nodules. Its origin is unknown. No causal therapy is available, and treatment remains symptomatic. Various therapeutic strategies to alleviate symptoms are available and are adapted to the severity of the disease. In early stages, conservative therapy including nonpharmacological, physical, and pharmacological treatments is applied. If the disease progresses, irradiation of the plantar surface, injections of steroids, shock wave therapy, and partial or complete fasciectomy as an ultimate therapy may be indicated. Novel experimental treatment options including application of fibrinolytic agents are currently being tested, but no controlled, randomized long-term studies are available. This review aims to provide a systematic overview of current established procedures and outlines novel experimental strategies for the treatment of morbus Ledderhose, including future avenues to treat this rare disease.

  15. Ultrasound-guided injection for plantar fasciitis: A brief review

    PubMed Central

    Nair, AS; Sahoo, RK

    2016-01-01

    Plantar fasciitis (PF) is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US) imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation. PMID:27833490

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

    PubMed

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

    2014-09-01

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

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

    PubMed Central

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

    2015-01-01

    Background Clubfoot has been evaluated in many ways, including the most common classifications of clubfoot, described by Caterrall and Piraniis based on six clinical signs. The purpose of this study was to gain better understanding of the heel pad in relation to the term “empty heel”, and to propose modification of clubfoot severity scoring system based on “empty heel”. Methods A combination of prospective study of 79 clubfoot patients treated with Ponseti method and literature review of heel pad anatomy and biomechanics. The setting was a university teaching hospital. The ethical research committee approved study protocol and informed consent of patients' parent obtained. The selection criteria included patients' diagnosed congenital idiopathic clubfoot, age < 2years, no history of previous treatment and tenotomy indicated. An evaluation of patient was assessed by orthopaedic surgeons trained on Ponseti method and has above 5 years experience. Data analysis performed on the age, sex, Pirani scores at onset of treatment, tenotomy, and 6 month after initial full correction. Results One hundred and thirty-two clubfeet in 79 patients (56 males, 23 females) completed Ponseti protocol. The median age at presentation was 5.2 months (range 0.1–23.7 months). The mean right foot abduction after correction 57.30(S.D. 9.20), and for the left foot, was 56.30 (S.D. 9.40). The mean right foot dorsiflexion was −13.70 (S.D. 18.40) before correction while after correction, it was 20.00 (S.D. 4.50) and for the left, the mean was −8.50 (S.D. 9.60) before correction and 21.00 (S.D. 4.30) after correction. Eighteen (22.8%) patients (10 bilateral, 9 unilateral) had clubfeet with empty heel score above zero point at initial full correction (p<0.001). Clinic anatomy shows the heel pad is a solid complex structure existing in normal, moderate and severe atrophied form. Heel pad is attached tightly to calcaneus without a cavity for the calcaneus to drop. Conclusions Heel pad

  18. [High energy shock wave treatment of the painful heel spur].

    PubMed

    Perlick, L; Boxberg, W; Giebel, G

    1998-12-01

    Extracorporal shock wave application (ESWA) has been used in the treatment of stones located in kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of the ESWA on the treatment of soft tissue disorders. The aim of this study was to explore the effect of high energy extracorporal shock waves in patients with painful calcaneus spurs. 83 patients who underwent medicophysical treatment without benefit were treated with 3000 impulses of 0.30 mj/mm2. Follow-ups after 12 weeks and 12 months showed that 51 of 83 patients became pain-free and 20 patients improved from the treatment. The results are showing the benefit of the high energy extracorporal shock wave application in the treatment of chronic plantar fasciitis.

  19. Integrated kinematics-kinetics-plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics.

    PubMed

    Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Guiotto, Annamaria; Avogaro, Angelo; Cobelli, Claudio

    2012-05-01

    The fundamental cause of lower-extremity complications in diabetes is chronic hyperglycemia leading to diabetic foot ulcer pathology. While the relationship between abnormal plantar pressure distribution and plantar ulcers has been widely investigated, little is known about the role of shear stress. Moreover, the mutual relationship among plantar pressure, shear stress, and abnormal kinematics in the etiology of diabetic foot has not been established. This lack of knowledge is determined by the lack of commercially available instruments which allow such a complex analysis. This study aims to develop a method for the simultaneous assessment of kinematics, kinetics, and plantar pressure on foot subareas of diabetic subjects by means of combining three commercial systems. Data were collected during gait on 24 patients (12 controls and 12 diabetic neuropathics) with a motion capture system synchronized with two force plates and two baropodometric systems. A four segment three-dimensional foot kinematics model was adopted for the subsegment angles estimation together with a three segment model for the plantar sub-area definition during gait. The neuropathic group exhibited significantly excessive plantar pressure, ground reaction forces on each direction, and a reduced loading surface on the midfoot subsegment (p<0.04). Furthermore the same subsegment displayed excessive dorsiflexion, external rotation, and eversion (p<0.05). Initial results showed that this methodology may enable a more appropriate characterization of patients at risk of foot ulcerations, and help planning prevention programs.

  20. 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.

  1. 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

  2. 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

  3. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations.

    PubMed

    Kirkpatrick, Joshua; Yassaie, Omid; Mirjalili, Seyed Ali

    2017-03-29

    The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.

  4. 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.

  5. 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.

  6. Post-traumatic unilateral plantar hyperhidrosis.

    PubMed

    Eren, Y; Yavasoglu, N G; Comoglu, S S

    2016-02-01

    Localized unilateral hyperhidrosis is rare and poorly understood, sometimes stemming from trauma. Feet, quite vulnerable to trauma are affected by disease-mediated plantar hyperhidrosis, usually bilaterally. This report describes partial hyperhidrosis developing post-traumatically on the left plantar region of a 52-year-old male.

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

    PubMed

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

    2011-01-01

    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 1(st) metatarsal (p=0.042), 3(rd) metatarsal (p<0.001), 5(th) metatarsal (<0.001), 2(nd) (p=0.018) and 5(th) 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.

  8. 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

  9. Registration of plantar pressure images.

    PubMed

    Oliveira, Francisco P M; Tavares, João Manuel R S

    2012-01-01

    In this work, five computational methodologies to register plantar pressure images are compared: (1) the first methodology is based on matching the external contours of the feet; (2) the second uses the phase correlation technique; (3) the third addresses the direct maximization of cross-correlation using the Fourier transform; (4) the fourth minimizes the sum of squared differences using the Fourier transform; and (5) the fifth methodology iteratively optimizes an intensity (dis)similarity measure based on Powell's method. The accuracy and robustness of the five methodologies were assessed by using images from three common plantar pressure acquisition devices: a Footscan system, an EMED system, and a light reflection system. Using the residual error as a measure of accuracy, all methodologies revealed to be very accurate even in the presence of noise. The most accurate was the methodology based on the iterative optimization, when the mean squared error was minimized. It achieved a residual error inferior to 0.01 mm and 0.6 mm for non-noisy and noisy images, respectively. On the other hand, the methodology based on image contour matching was the fastest, but its accuracy was the lowest.

  10. The "Heel Hook"-A Climbing-Specific Technique to Injure the Leg.

    PubMed

    Schöffl, Volker; Lutter, Christoph; Popp, Dominik

    2016-06-01

    Acute injuries in rock climbing either come from a fall onto the lower leg or from performing a hard move and injuring the upper extremity. Further evaluations of lower leg injuries in rock climbing athletes have been performed recently finding sport characteristics such as peroneal tendon dislocations or chronic deformations of the feet. One injury mechanism described in case reports is the so-called heel hook position, which is used more frequently today compared with the beginngs of rock climbing. In addition, the number of these injuries is expected to rise with the increase in popularity of climbing and bouldering. Therefore, it is important to further analyze this pathology. We investigated 17 patients with injuries of the lower extremities after performing a heel hook.

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

    PubMed

    Cronin, Neil J

    2014-04-01

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

  12. 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.

  13. The influence of sex, body mass and body mass index on plantar soft-tissue stiffness in healthy people in their 60s.

    PubMed

    Teoh, Jee Chin; Lee, Dong Yeon; Lee, Taeyong

    2016-09-06

    Foot abnormality has become a public health concern. Early detection of pathological soft tissue is therefore an important preventive measure, especially in older people who generally have a higher risk of foot pathology. However, the interpretation of plantar tissue stiffness data - whether to normalize the data or to separate the data on the basis of sex- remains questionable. The objective of this study was to assess the influence of sex and physical attributes such as body mass (BM) and body mass index (BMI) on plantar soft-tissue stiffness, and to evaluate whether it is necessary to isolate the differences in sex, BM and BMI in the data analysis. One hundred healthy subjects in their 60s were recruited for the experiment. Localized force response was obtained underneath the second metatarsal head (MTH) pad at three different dorsiflexion angles of 0°, 20°, 40° and the hallux and heel at 0°. No significant relationship was found between the independent variables and plantar stiffness. From the experimental results, it can be deduced that BM and BMI are weakly associated with plantar tissue stiffness, and that there is no significant difference in stiffness between male and female participants. No difference was found between left and right foot measurements. This suggests that normalizing of plantar tissue stiffness by BM and BMI is not necessary in healthy people in their 60s. The data can be pooled and treated equally regardless of sex.

  14. Do somatosensory conditions from the foot and ankle affect postural responses to plantar-flexor muscles fatigue during bipedal quiet stance?

    PubMed

    Hlavackova, Petra; Vuillerme, Nicolas

    2012-05-01

    The present study investigated the effects of somatosensory conditions at the foot and ankle on postural responses to plantar-flexor muscle fatigue during bipedal quiet stance. Twenty-two young healthy adults were asked to stand upright as still as possible with their eyes closed in three somatosensory conditions (normal, altered and improved) both prior to and after exercises inducing plantar-flexor muscle fatigue. In the normal condition, the postural task was executed on a firm support surface constituted by the force platform. In the altered condition, a 2-cm thick foam support surface was placed under the subjects' feet. In the improved condition, increased cutaneous feedback at the foot and ankle was provided by strips of athletic tape applied across both their ankle joints. Muscle fatigue was induced in the plantar-flexor muscles of both legs through the execution of a repeated standing heel raise exercise. Centre of foot pressure displacements were recorded using a force platform. Results showed that plantar-flexor muscle fatigue yielded increased centre of foot pressure displacements under normal foot and ankle sensory conditions. Furthermore, this effect was exacerbated under altered foot and ankle sensory conditions and mitigated under improved foot and ankle sensory conditions. Altogether, the present findings suggested an increased reliance on somatosensory information from the foot and ankle for controlling upright posture in the presence of plantar-flexor muscle fatigue.

  15. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF).

    PubMed

    Jerosch, Jörg; Schunck, Jochem; Liebsch, Dietrich; Filler, Tim

    2004-09-01

    The purpose of the present study is to present the surgical technique for, and review our indications and results after, endoscopic fascial release in patients with plantar fasciitis. In five thiel-embalmed human specimens, a biportal technique for endoscopic release of the plantar fascia was established. The aim was here to evaluate the relation between the plantar fascia and the heel spur and to perform a release that would not exceed 50-70% of the diameter of the calcaneoplantar fascia. The endoscopic technique was performed within the last 5 years in ten male and seven female patients. All patients with the clinical entity of plantar fasciitis underwent conservative treatment for at least 6 months. The average age at surgery was 35 years (24-56 years). In the first five patients, surgery was performed under c-arm control. In all patients the operation could be finished endoscopically. The endoscopic portals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 min (average 41 min) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average 18.5 months). Out of 17 patients, 13 improved clinically, and they would choose the treatment option again. In the Ogilvie-Harris score, seven patients showed good and six excellent results. In two patients, the initial results were not satisfactory, because of a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing, without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimal invasive approach it seems to be important to be careful in increasing the weight bearing in early rehabilitation. The technique of the endoscopic plantar fascia release (E FRPF) can be performed in a standardised and reproducible procedure. The follow-up examination showed good midterm results, but a loss of stability of the plantar arch

  16. 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.

  17. Reverse sural flap for ankle and heel soft tissues reconstruction

    PubMed Central

    Ciofu, RN; Zamfirescu, DG; Popescu, SA; Lascar, I

    2017-01-01

    Introduction: The potential of the medial calf integument, as donor site for a free flap based on musculocutaneous branches of the medial sural artery, was first identified by Taylor and Daniel, following cadaver investigation. In 1981, Pontén described the fasciocutaneous sural flap as a reconstructive option for soft tissue loss of the lower extremity, particularly around the knee. Two years later, Donski and Fogdestram presented the distally based fasciocutaneous flap from the sural region followed by Montegut and Allen who considered the sural artery perforator flap as a viable alternative for the gastrocnemius myocutaneous flap. The sural flap proved a considerable versatility at the level of the lower leg (from the knee to the ankle and heel) as well as for other anatomical regions. The most common usage of the flap is for the distal-third defects of the leg. Materials and method: A group of 10 patients with soft tissue losses at the ankle or heal due to a various etiopathogeny represented by cancer excision, trauma, unstable scars, chronic osteomyelitis, in which a microsurgical free transfer had no indication or was not wanted, was presented. Our group reported a 30% complication rate in a high-risk patient population, including patients with diabetes mellitus, peripheral vascular disease, and venous insufficiency. Results: All the defects were covered successfully, without major complications. Usually, only a minor margin of the tip of the flap was lost, which was easily solved with a guided secondary healing. Most flaps showed a slight venous congestion, which cleared in a few days. The functional result was very good in all the patients, while the aesthetic appearance was acceptable even in female patients. Discussion: An ideal indication of a reverse sural flap may be a defect over an intact but partially exposed Achilles tendon. Conclusions: The sural reverse flap is useful in the ankle and foot soft tissues reconstruction whenever we have reasons not

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

    PubMed Central

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

    2011-01-01

    Diabetes and its associated complications have become a major concern locally, nationally and internationally. One such complication is lower extremity amputation, commonly preceded by chronic ulceration. The cause of this tissue breakdown is multi-faceted, but includes an increase in pressure, particularly plantar pressure. As such, the choice of dressing to be applied to a plantar wound should ideally not increase this pressure further. A commonly used and possibly more bulky dressing is the foam dressing. This pilot study investigates the plantar pressures associated with three common foam dressings (Allevyn®, Lyofoam® and Mepilex®) compared with a control dressing (Melolin®). Twelve healthy males and 19 females [SD] age 36.6 [10.4] were measured using the F-scan plantar pressure measurement system. Substantial variations in individual pressure changes occurred across the foot. No significant differences were identified, once a Bonferroni correction was applied. In healthy adults, it could be concluded that foam dressings do not have any effect on the plantar pressures of the foot. However, the need remains for a robust trial on a pathological population. PMID:22396822

  19. Foot Plantar Pressure Measurement System: A Review

    PubMed Central

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

    2012-01-01

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

  20. A 4-week instructed minimalist running transition and gait-retraining changes plantar pressure and force.

    PubMed

    Warne, J P; Kilduff, S M; Gregan, B C; Nevill, A M; Moran, K A; Warrington, G D

    2014-12-01

    The purpose of this study is to compare changes in plantar pressure and force using conventional running shoes (CRS) and minimalist footwear (MFW) pre and post a 4-week MFW familiarization period. Ten female runners (age: 21 ± 2 years; stature: 165.8 ± 4.5 cm; mass: 55.9 ± 3.2 kg) completed two 11 km/h treadmill runs, 24 hours apart, in both CRS and MFW (pretest). Plantar data were measured using sensory insoles for foot strike patterns, stride frequency, mean maximum force ( M ⁢ F ¯ ), mean maximum pressure ( M ⁢ P ¯ ) and eight mean maximum regional pressures. Subjects then completed a 4-week familiarization period consisting of running in MFW and simple gait-retraining, before repeating the tests (posttest). During the pretests, 30% of subjects adopted a forefoot strike in MFW, following familiarization this increased to 80%; no change occurred in CRS. A significant decrease in M ⁢ F ¯ in both MFW and CRS (P = 0.024) was observed from pre-post, and a significant decrease in heel pressures in MFW. M ⁢ P ¯ was higher in MFW throughout testing (P < 0.001).A 4-week familiarization to MFW resulted in a significant reduction in M ⁢ F ¯ in both the CRS and MFW conditions, as well as a reduction in heel pressures. Higher M ⁢ P ¯ was observed throughout testing in the MFW condition.

  1. 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.

  2. A composite medial plantar flap for the repair of an achilles' tendon defect: a case report.

    PubMed

    Dumont, C E; Kessler, J

    2001-12-01

    The surgical management of infected necrosis of the Achilles' tendon and overlying skin is very demanding, and reconstruction with vascularized tendon and skin flaps is considered the benchmark procedure. The authors report a 65-year-old man who sustained a chronic wound after operative repair of a chronic rupture of the Achilles' tendon. A pedicled medial plantar flap including the surrounding vascularized plantar aponeurosis was elevated. The plantar aponeurosis was split and used to bridge the 4-cm-long tendon defect. The flap donor site was covered with a thin skin graft. The flap survived completely without recurrence of the infection. At the 7-month follow-up, the reconstructed Achilles' tendon showed a good functional result and a normal range of dorsi- and plantar flexion of the foot. This technique is of great interest in comparison with free flaps because it does not require vascular anastomosis in a septic environment or a secondary debulking operation, yet it still provides both vascularized tendon and skin graft.

  3. Effect of rocker shoes on plantar pressure pattern in healthy female runners.

    PubMed

    Sobhani, Sobhan; van den Heuvel, Edwin; Bredeweg, Steef; Kluitenberg, Bas; Postema, Klaas; Hijmans, Juha M; Dekker, Rienk

    2014-03-01

    Rocker profile shoes (rocker shoes) are one of the treatment options of metatarsalgia and forefoot stress fractures. The efficacy of rocker shoes in unloading the forefoot pressure has been shown in walking. In running, however, the effect of rocker shoes on forefoot pressure is unknown. Eighteen healthy female runners participated in this study. In-shoe plantar pressures were recorded during running with the standard running shoes and rocker shoes. Shoe comfort was assessed after each shoe measurement. Peak pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven foot areas. The effects of shoes on the different outcome variables were statistically analyzed using a linear mixed model. Running with the rocker shoes caused a significant reduction (p<0.001) in all pressure parameters in the central and lateral forefoot. FTI and MMP were also reduced by 11% and 12% in the medial forefoot while running with rocker shoes. Running with rocker shoes resulted in a significant increase in all pressure parameters at the heel region (p<0.001). Running with rocker shoes received a significant (p<0.01) lower comfort rate than running with standard running shoes. Rocker shoes might be beneficial for runners who are recovering from metatarsalgia or stress fractures of the forefoot region, as it reduces plantar pressure in the forefoot region.

  4. Effects of footwear on plantar foot sensitivity: a study with Formula 1 shoes.

    PubMed

    Schlee, Günther; Sterzing, Thorsten; Milani, Thomas L

    2009-05-01

    The aim of this study was to investigate the influence of Formula 1 footwear on the ability of the plantar foot to detect vibration stimuli. Twenty-five male subjects participated in the study. Five foot/shoe conditions were analysed (barefoot and four shoe conditions). Vibration thresholds were measured at three anatomical locations of the plantar foot (heel, first metatarsal head and hallux) at two frequencies (30 and 200 Hz). The results show a frequency-dependent influence of footwear on foot sensitivity. The comparison between barefoot and shod conditions showed lower thresholds (P < 0.01) for the barefoot condition at 30 Hz, whereas lower thresholds (P < 0.01) were found for all shoe conditions at 200 Hz compared to barefoot. Lower thresholds (P < 0.01) were measured at 200 Hz in comparison to 30 Hz in all experimental conditions. The shoe outsole material seems to facilitate the transmission of high-frequent vibration stimuli to the skin, resulting in better vibration sensitivity at 200 Hz when wearing Formula 1 shoes compared to barefoot.

  5. Plantar Pressure Changes and Correlating Risk Factors in Chinese Patients with Type 2 Diabetes: Preliminary 2-year Results of a Prospective Study

    PubMed Central

    Qiu, Xuan; Tian, De-Hu; Han, Chang-Ling; Chen, Wei; Wang, Zhan-Jian; Mu, Zhen-Yun; Liu, Kuan-Zhi

    2015-01-01

    Background: Plantar pressure serves as a key factor for predicting ulceration in the feet of diabetes patients. We designed this study to analyze plantar pressure changes and correlating risk factors in Chinese patients with type 2 diabetes. Methods: We recruited 65 patients with type 2 diabetes. They were invited to participate in the second wave 2 years later. The patients completed identical examinations at the baseline point and 2 years later. We obtained maximum force, maximum pressure, impulse, pressure-time integral, and loading rate values from 10 foot regions. We collected data on six history-based variables, six anthropometric variables, and four metabolic variables of the patients. Results: Over the course of the study, significant plantar pressure increases in some forefoot portions were identified (P < 0.05), especially in the second to forth metatarsal heads. Decreases in heel impulse and pressure-time integral levels were also found (P < 0.05). Plantar pressure parameters increased with body mass index (BMI) levels. Hemoglobin A1c (HbA1c) changes were positively correlated with maximum force (β = 0.364, P = 0.001) and maximum pressure (β = 0.366, P = 0.002) changes in the first metatarsal head. Cholesterol changes were positively correlated with impulse changes in the lateral portion of the heel (β = 0.179, P = 0.072) and pressure-time integral changes in the second metatarsal head (β = 0.236, P = 0.020). Ankle-brachial index (ABI) changes were positively correlated with maximum force changes in the first metatarsal head (β = 0.137, P = 0.048). Neuropathy symptom score (NSS) and common peroneal nerve sensory nerve conduction velocity (SCV) changes were positively correlated with some plantar pressure changes. In addition, plantar pressure changes had a correlation with the appearance of infections, blisters (β = 0.244, P = 0.014), and calluses over the course of the study. Conclusions: We should pay attention to the BMI, HbA1c, cholesterol, ABI

  6. 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

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

    PubMed

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

    2010-09-01

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

  8. Contribution of plantar pressure to the prevention and quantification of the muscle-skeletal injury risk in hiking trails--a pilot study.

    PubMed

    Gabriel, Ronaldo; Monteiro, Marco; Moreira, Helena; Maia, Miguel

    2008-01-01

    Hiking trails have been growing in popularity in the health and well-being promotion. Consequently, the foot became an object of study in order to understand the discomfort and pain in the lower limb. The aims of the work were: 1) to detect tendencies for behaviour of maximum values of plantar pressure (MaxP) during the walk on different slopes, 2) to contribute to the methodology of the difficulty level of hiking trails. Equations show strong tendencies (R2 > 0.8) of behaviour of MaxP in the lateral zones of the heel, 4th and 5th metatarsus as well as in the plantar zone of the hallux. The analysis of the difficulty level of the hiking trails branches deserves a separate presentation, including the technical difficulty analysis (with a compulsory emphasis on the biomechanics) and information on the caloric consumption and on the slopes of each branch.

  9. Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures.

    PubMed

    Aydogan, Umur; Roush, Evan P; Moore, Blake E; Andrews, Seth H; Lewis, Gregory S

    2016-06-09

    Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p <.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p <.05). This article is protected by copyright. All rights reserved.

  10. [Plantar fibromatosis: therapy by total plantarfasciectomy].

    PubMed

    Beckmann, J; Kalteis, T; Baer, W; Grifka, J; Lerch, K

    2004-01-01

    Morbus Ledderhose is a rare fibromatous disease of the plantar fascia. Clinical features include palpable solitary or multiple nodules and cords, mainly affecting the medial part of the plantar fascia. When clinical symptoms occur, conservative options include stretching, orthotics, nonsteroidal antirheumatic drugs, local cortisone-injections and physiotherapy. Operative treatment is indicated in case of persistent pain or if conservative measures fail. The standard procedure includes a partial fasciectomy of the plantar aponeurosis. There is a high recurrence rate with an increased risk of complications and more aggressive ingrowth into anatomical structures after partial resection. Therefore we recommend a complete fasciectomy not only in recurrent disease, but also as the primary procedure of choice.

  11. Plantar fibromatosis: an immunohistochemical and ultrastructural study.

    PubMed

    de Palma, L; Santucci, A; Gigante, A; Di Giulio, A; Carloni, S

    1999-04-01

    The analogies between plantar fibromatosis and Dupuytren's disease (palmar fibromatosis) are well known. The latter is clinically more frequent and has been the object of extensive immunohistochemical and ultrastructural studies, with a view to investigating its pathogenesis. By contrast, such data on plantar fibromatosis are quite scarce. A histochemical, immunohistochemical, and ultrastructural study was performed on nodule tissue from six patients who were subjected to total fasciectomy for plantar fibromatosis. The study of myofibroblasts revealed features suggestive of their fibroblastic origin and evidenced a cytoskeleton and an extracellular filamentous system that could enable myofibroblasts to generate and exert the intracellular forces that contribute to the contraction of the aponeurosis. These aspects are similar to those observed in Dupuytren's disease and seem to lend support to the theory that the two diseases are expressions of the same disorder.

  12. Rupture of the plantar fascia in athletes.

    PubMed

    Leach, R; Jones, R; Silva, T

    1978-06-01

    Symptoms resembling those of plantar fasciitis were seen in six athletes who were thought to have a partial rupture of the plantar fascia. Treatment, which included the use of crutches, anti-inflammatory agents, strapping of the arch, and ice packs, was successful in all but one patient who had a painful mass in the area of the previous rupture. After surgical excision of the painful mass and release of the fascia, he recovered. Five of the six athletes had been previously treated with repeated local injections of steroid.

  13. Plantar fascia rupture: diagnosis and treatment.

    PubMed

    Rolf, C; Guntner, P; Ericsäter, J; Turan, I

    1997-01-01

    Two patients with spontaneous medial plantar fascia rupture due to a definite injury with no prior symptoms, were referred to our institution. Clinically, there was a tender lump in the sole, and magnetic resonance imaging confirmed the diagnosis. Nonoperative treatment was sufficient in curing the acute total rupture. Endoscopic release was used on the partially ruptured plantar fascia, but it is probably more optimal in the acute phase. The literature provides no comparative data on operative or nonoperative treatment efficacy for this rare condition.

  14. 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.

  15. 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

  16. Incidence of plantar fascia ruptures following corticosteroid injection.

    PubMed

    Kim, Chul; Cashdollar, Michael R; Mendicino, Robert W; Catanzariti, Alan R; Fuge, LaDonna

    2010-12-01

    Plantar fasciitis is commonly treated with corticosteroid injections to decrease pain and inflammation. Therapeutic benefits often vary in terms of efficacy and duration. Rupture of the plantar fascia has been reported as a possible complication following corticosteroid injection. A retrospective chart review of 120 patients who received corticosteroid injection for plantar fasciitis was performed at the authors' institution to determine the incidence of plantar fascia rupture. The plantar fascia rupture was diagnosed clinically and confirmed with magnetic resonance imaging. Various factors were analyzed, including the number of injections, interval between injections, body mass index (BMI), and activity level. Four patients (2.4%) consequently experienced plantar fascia rupture following an average of 2.67 injections. The average BMI of these patients was 38.6 kg/m². The authors conclude that corticosteroid injection therapy appears to be a safe and effective form of nonoperative treatment with minimal complications and a relatively low incident of plantar fascia rupture.

  17. 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.

  18. Aspects of treatment for posterior heel pain in young athletes

    PubMed Central

    Elengard, Thomas; Karlsson, Jón; Silbernagel, Karin Grävare

    2010-01-01

    Posterior heel pain occurs in young athletes involved in running and jumping. Due to the pain, the child often limits his/her physical activity level, with a possible negative effect on health and well-being. Although numerous research studies have examined the cause and treatment of heel and Achilles tendon pain in adults, there are no randomized clinical trials on treatment in children and adolescents. Therefore, there is limited evidence for how to treat young athletes with this type of complaint. The purpose of this review was to analyze critically and summarize the literature in regards to the cause and treatment of posterior heel pain in young athletes. The various diagnoses and clinical presentations relating to posterior heel and Achilles tendon pain are discussed. The theory and mechanism behind various recommended treatment strategies are also reviewed in the context of use in the young athlete. In summary, it is important to perform a thorough evaluation of each young athlete with heel pain to determine the appropriate diagnosis and to treat the deficits found and allow for a gradual progression to training. However, the recommendations at this time are based on clinical experience and a few retrospective studies, so further well designed prospective studies with validated outcome measures are urgently needed for the young athlete. PMID:24198561

  19. Efficacy of EZStep in the management of plantar fasciitis: a prospective, randomized study.

    PubMed

    Al-Bluwi, Mohammed T; Sadat-Ali, Mir; Al-Habdan, Ibrahim M; Azam, Mohammed Q

    2011-08-01

    Plantar fasciitis is one of the most common causes of heel pain. Despite extensive efforts foot surgeons continue to debate the best modality of treatment. Analgesics, shoe inserts, stretching exercises, steroid injection, night splints, and extracorporeal shock wave therapy have proved effective in one group but fail in others. This study evaluated the efficacy of EZStep, a new foot brace for the management of plantar fasciitis. A total of 198 patients were randomized in 2 groups; group 1 (study group) received nonsteroidal anti-inflammatory drugs (NSAIDs; 4-6 weeks) and EZStep whereas group 2 (control group) received either NSAID and physiotherapy alone (2A) or NSAID, physiotherapy, and local steroid injection (2B). None of the patients received over-the-counter insoles or strapping of plantar arch to avoid any bias in randomization. Evaluations included measurement of weight and height, visual analog scale (VAS) for pain, and Short-Form McGill Pain Questionnaire (SFMPQ). After 8 weeks, patients were reevaluated, and assessment for the VAS and SFMPQ with treatment outcome was performed. Patients with VAS scores ≤3 were considered as excellent, ≥4 as good, and ≥7 as poor. The posttreatment evaluation showed that VAS scores were in the range from 2.97 ± 1.06 to 7.64 ± 2.9 (2A), P = .001, 95% confidence interval (CI) <-4.104; for 2B P = .001, CI <-2.44, and SFMPQ was 21.7 ± 4.5 and 69.2 ± 5.8 (group 2A; P = .001, 95% CI <-46.44). Compared with group 2B the SFMPQ was 66.5 ± 4.3 (P = .001, 95% CI <-30.720). In group 1 as per VAS, 86 (73.5%) were evaluated as excellent, 15 (12.8%) as good, and 16 (13.6%) as poor. Our study shows that the regular use of EZStep with short course of NSAIDs (4-6 weeks) was effective in ameliorating symptoms in more than 85% of patients suffering from plantar fasciitis.

  20. 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

  1. 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.

  2. Square, Random Fasciocutaneous Plantar Flaps for Treating Noninfected Diabetic Plantar Ulcers: A Patient Series.

    PubMed

    Caravaggi, Carlo Maria Ferdinando; Sganzaroli, Adriana Barbara; Bona, Fosca; Galenda, Paolo; Ferraresi, Roberto; Gherardi, Piero; Reho, Andrea

    2016-01-01

    In patients with diabetes, the off-loading cast has not been widely used to treat plantar ulcers because of its poor acceptance by patients and the high risk of side effects. We evaluated the safety and efficacy of an alternative surgical treatment: a square, fasciocutaneous random plantar flap to cover plantar ulcers. From December 2012 to February 2013, we enrolled 23 consecutive diabetic patients with deep neuropathic or neuroischemic plantar ulcers. Of these 23 patients, 9 underwent percutaneous transluminal angioplasty, 10 had the metatarsal removed, 3 underwent dorsiflexory, distal metatarsal osteotomies, 2 underwent first metatarsophalangeal joint resection and ray stabilization with Kirschner wires, and 1 each underwent midfoot exostectomy, sesamoidectomy, and partial calcanectomy. A square random fasciocutaneous plantar flap was created for all 23 patients. Two patients were excluded from the analysis for weightbearing on the involved foot within 24 hours of surgery. The healing rate was 100% for the remaining 21 patients, with healing by first intention in 15 (mean ± standard deviation time to healing 30 ± 13 days), by second intention in 5 (86 ± 40 days), and by surgical revision in 1. The overall mean healing time was 44 ± 31 days. During a mean follow-up of 724 ± 275 days, no ulcer recurred; however, 1 transfer ulcer appeared on an adjacent metatarsal head. The use of a square random fasciocutaneous plantar flap is a safe and effective surgical option for treating neuropathic plantar ulcers, offering a high healing rate, a short healing time, and a low rate of recurrence.

  3. Heel strike detection using split force-plate treadmill.

    PubMed

    Rouhani, Hossein; Abe, Masaki O; Nakazawa, Kimitaka; Popovic, Milos R; Masani, Kei

    2015-03-01

    A common source of error when detecting heel-strike moments utilizing split force-plate treadmills is unwillingly stepping on contra-lateral force-plate. In this study, we quantified this error when heel-strike was detected based on such erroneous data and compared three methods to investigate how well the heel-strikes and stride-intervals were detected with erroneous data. Eleven subjects walked on a split force-plate treadmill for more than 20min. We used 20N and 50% body-weight thresholds to detect the heel-strike moments (HS20N and HS50%, respectively). Besides, we used linear approximation to estimate the unaffected force profile from affected force-plate data, and subsequently to detect the heel-strike moments (HSest). We used heel-strike moments detected by a foot-switch as a reference to compare accuracy of HS20N, HS50% and HSest. HS20N and HSest detected heel-strike moments accurately for unaffected force-plate data (median(max) errors for all subjects: 9(23) and 9(37) ms) but HS50% showed significantly larger errors (52(74) ms). Unlike HS50% and HSest, HS20N was considerably affected by the affected force-plate data (23(68) ms). The error in stride-interval measurement was relatively small using any methods for unaffected force-plate data (3(7), 6(8), and 6(12) ms), while stride-interval errors were large for some subjects when using HS20N for affected data (6(175) ms). We concluded that unwillingly stepping on contra-lateral force-plate occurred a few percent and up to 37.7% of all strides (median: 12.9%). Our proposed method (HSest) robustly showed small errors for heel-strike detection and stride-interval calculation consistently among subjects, while HS50% and HS20N showed large errors depending on subjects.

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

    PubMed

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

    2015-04-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 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...

  6. 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... 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...

  7. 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...

  8. 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...

  9. 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... 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...

  10. Biomechanical simulation of high-heeled shoe donning and walking.

    PubMed

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

    2013-08-09

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

  11. Transarterial Coil Embolization of a Symptomatic Posttraumatic Plantar Pseudoaneurysm

    PubMed Central

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

    2015-01-01

    Posttraumatic pseudoaneurysms of the lateral plantar artery are rare. We report the case of a 31-year-old woman with a painful pseudoaneurysm of the lateral plantar artery resulting from a deep plantar cut injury. The pseudoaneurysm was successfully treated by performing a transarterial “frontdoor-backdoor” coil embolization technique, which is a minimally invasive alternative to conventional ligature of the artery. PMID:25874151

  12. 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.

  13. 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.

  14. 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.

  15. Reduction of digital plantar pressure by debridement and silicone orthosis.

    PubMed

    Slater, R A; Hershkowitz, I; Ramot, Y; Buchs, A; Rapoport, M J

    2006-12-01

    The lesser digits are frequent sites of elevated plantar pressure and ulceration in the diabetic foot. We sought to determine whether debridement of callus and the wearing of a custom molded digital orthosis could significantly reduce digital plantar pressure. Fourteen patients with distal digital callus were studied. For each patient, the toe with the highest plantar pressure was selected. A computerized pressure mat was used to record the plantar pressure before and after debridement with and without a moldable silicone digital orthosis. Mean peak plantar digital pressures before treatment were 2.80+/-0.7 kg/cm2 for the entire group. The digital orthosis alone reduced plantar pressure to a mean of 1.95+/-0.65 kg/cm2 p < 0.05. Treatment by debridement similarly reduced pressure to 1.99+/-0.76 kg/cm2 p < 0.05. The most effective reduction of pressure for all patients, as well as the most statistically significant, occurred when both treatments were given, with mean peak plantar pressure falling to 1.28+/-0.61 kg/cm2 p < 0.01. Debridement and custom molded digital orthoses alleviate distal digital plantar pressure. Since elevated plantar pressure increases the risk of neuropathic ulceration, these treatments should be considered in the prophylactic care of appropriate patients.

  16. [Lower limb stump reconstruction with a functional calcaneo-plantar unit free flap. A series of 16 cases].

    PubMed

    Malikov, S; Dubert, T; Koupatadze, D; Nabokov, V; Polosov, R

    1999-04-01

    The main objective of surgery, once amputation is inevitable, is to preserve a functional stump. This report describes the immediate reconstruction of 16 leg stumps in children by transfer of a functional calcaneo-plantar unit. Of these, 3 were thigh and 13 were lower leg reconstructions. Amputation was performed for tumor in 4 cases, and was due to accidents in the remaining twelve. The main technical features of flap preparation are preservation of the calcaneum branch and attachment of the heel skin to the greater tuberosity of the calcaneum. One case resulted in failure due to vascular thrombosis. The other 15 cases resulted in bone consolidation after an average of 45 days, sensitive protection by 70 days, and very good trophic and protective results. The provision of good distal pressure area encourages overall development of the child. There was no morbidity at the donor site, and because there is no major muscle mass in the distal fragment, the overall risk is very low compared to that of total proximal leg replantation. The transfer of functional calcaneo-plantar tissue as a single unit is the best strategy for one-step restoration of good distal support area for the stump. All surgeons liable to perform leg amputations should be aware of this technical approach.

  17. A dynamic model of the windlass mechanism of the foot: evidence for early stance phase preloading of the plantar aponeurosis.

    PubMed

    Caravaggi, Paolo; Pataky, Todd; Goulermas, John Y; Savage, Russel; Crompton, Robin

    2009-08-01

    In the present study we have estimated the temporal elongation of the plantar aponeurosis (PA) during normal walking using a subject-specific multi-segment rigid-body model of the foot. As previous studies have suggested that muscular forces at the ankle can pre-load the PA prior to heel-strike, the main purpose of the current study was to test, through modelling, whether there is any tension present in the PA during early stance phase. Reflective markers were attached to bony landmarks to track the kinematics of the calcaneus, metatarsus and toes during barefoot walking. Ultrasonography measurements were performed on three subjects to determine both the location of the origin of the PA on the plantar aspect of the calcaneus, and the radii of the metatarsal heads. Starting with the foot in a neutral, unloaded position, inverse kinematics allowed calculation of the tension in the five slips of the PA during the whole duration of the stance phase. The results show that the PA experienced tension significantly above rest during early stance phase in all subjects (P<0.01), thus providing support for the PA-preloading hypothesis. The amount of preloading and the maximum elongation of the slips of the PA decreased from medial to lateral. The mean maximum tension exerted by the PA was 1.5 BW (body weight) over the three subjects.

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

    PubMed

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

    2013-11-01

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

  19. [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.

  20. 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.

  1. Effect of socks structures on plantar dynamic pressure distribution.

    PubMed

    Soltanzadeh, Zeynab; Shaikhzadeh Najar, Saeed; Haghpanahi, M; Mohajeri-Tehrani, M R

    2016-11-01

    A major purpose of investigating the plantar pressure in patients with pain or those at risk for skin injury is to reduce the pressure below metatarsal heads, specially first and second metatarsal heads. The aim of this article is to evaluate the effects of the socks structures on the changes in plantar dynamic pressure. In this study, seven socks types with different structures for the sole area were produced. The Gaitview(®) AFA-50 system, a force plate, was used to measure the plantar dynamic pressure of 10 participants. The barefoot plantar dynamic pressure distribution was compared with the plantar dynamic pressure distribution with socks by two independent samples test on various zones of the foot and on different genders using SPSS software. Mann-Whitney tests were used to determine specific significant differences. The obtained results showed that the main trend was to redistribute the plantar dynamic pressure from the higher plantar pressure zones (toe and first through forth metatarsal bone regions) were decreased and as a result the plantar pressure toward the relatively lower pressure zones (fifth metatarsal bone and midfoot regions). In comparison with the barefoot condition, the cross miss structure reduced the mean pressure in the critical region of the foot (first metatarsal) for male and female subjects ( p < 0.05) and also the mock rib structure reduced the mean pressure for female subjects ( p < 0.05). In general, the results suggested wearing the socks because the socks make the plantar pressure redistributed from high to low plantar pressure zones. The results of this research indicated that wearing socks with cross miss and mock rib structures will reduce the mean plantar pressure values in forefoot area in comparison with the barefoot condition.

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

    PubMed Central

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

    2013-01-01

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

  3. 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

  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. Changes in Achilles tendon mechanical properties following eccentric heel drop exercise are specific to the free tendon.

    PubMed

    Obst, S J; Newsham-West, R; Barrett, R S

    2016-04-01

    Mechanical loading of the Achilles tendon during isolated eccentric contractions could induce immediate and region-dependent changes in mechanical properties. Three-dimensional ultrasound was used to examine the immediate effect of isolated eccentric exercise on the mechanical properties of the distal (free tendon) and proximal (gastrocnemii) regions of the Achilles tendon. Participants (n = 14) underwent two testing sessions in which tendon measurements were made at rest and during a 30% and 70% isometric plantar flexion contractions immediately before and after either: (a) 3 × 15 eccentric heel drops or (b) 10-min rest. There was a significant time-by-session interaction for free tendon length and strain for all loading conditions (P < 0.05). Pairwise comparisons revealed a significant increase in free tendon length and strain at all contraction intensities after eccentric exercise (P < 0.05). There was no significant time-by-session interaction for the gastrocnemii (medial or lateral) aponeurosis or tendon for any of the measured parameters. Immediate changes in Achilles tendon mechanical properties were specific to the free tendon and consistent with changes due to mechanical creep. These findings suggest that the mechanical properties of the free tendon may be more vulnerable to change with exercise compared with the gastrocnemii aponeurosis or tendon.

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

    PubMed

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

    2013-12-01

    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 thick

  7. 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

  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. 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.

  10. Material properties of the plantar aponeurosis.

    PubMed

    Kitaoka, H B; Luo, Z P; Growney, E S; Berglund, L J; An, K N

    1994-10-01

    Material properties of the plantar aponeurosis were determined by a two-dimensional video tracking method to simultaneously measure the aponeurosis deformation. Failure loads averaged 1189 +/- 244 N and were higher in men. Average stiffness of the intact fascia was 203.7 +/- 50.5 N/mm at a loading rate of 11.12 N/sec and it did not vary significantly for the loading rates of 11.12 to 1112 N/sec. The high tensile loads required for failure were consistent with clinical and biomechanical studies and indicated the importance of the aponeurosis in foot function and arch stability.

  11. Ultrasound-Assisted Endoscopic Partial Plantar Fascia Release

    PubMed Central

    Ohuchi, Hiroshi; Ichikawa, Ken; Shinga, Kotaro; Hattori, Soichi; Yamada, Shin; Takahashi, Kazuhisa

    2013-01-01

    Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure. PMID:24265989

  12. 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.

  13. The nature of functional variability in plantar pressure during a range of controlled walking speeds

    PubMed Central

    Pataky, Todd C.; Crompton, Robin H.; Savage, Russell; Bates, Karl T.

    2016-01-01

    During walking, variability in step parameters allows the body to adapt to changes in substrate or unexpected perturbations that may occur as the feet interface with the environment. Despite a rich literature describing biomechanical variability in step parameters, there are as yet no studies that consider variability at the body–environment interface. Here, we used pedobarographic statistical parametric mapping (pSPM) and two standard measures of variability, mean square error (m.s.e.) and the coefficient of variation (CV), to assess the magnitude and spatial variability in plantar pressure across a range of controlled walking speeds. Results by reduced major axis, and pSPM regression, revealed no consistent linear relationship between m.s.e. and speed or m.s.e. and Froude number. A positive linear relationship, however, was found between CV and walking speed and CV and Froude number. The spatial distribution of variability was highly disparate when assessed by m.s.e. and CV: relatively high variability was consistently confined to the medial and lateral forefoot when measured by m.s.e., while the forefoot and heel show high variability when measured by CV. In absolute terms, variability by CV was universally low (less than 2.5%). From these results, we determined that variability as assessed by m.s.e. is independent of speed, but dependent on speed when assessed by CV. PMID:27853618

  14. 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.

  15. 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.

  16. Music modulates behaviour of premature infants following heel lance.

    PubMed

    Butt, M L; Kisilevsky, B S

    2000-03-01

    The physiological and behavioural effects of music during recovery from heel lance were examined in 14 preterm infants at 29 to 36 weeks post-conceptual age (PCA). Infants were tested on 2 occasions: during a music condition and during a no-music control condition. Each condition was videotaped during 3 periods: baseline, heel lance, and recovery. Infants were divided into 2 age groups for data analyses: less than and greater than 31 weeks PCA. Mixed model ANOVAs showed that heel lance elicited a stress response (i.e., increased heart rate, decreased oxygen saturation, increased state-of-arousal, and increased facial actions indicative of pain) in both age groups. The stress response was greater in the older group. During recovery, the older group had a more rapid return of heart rate, behavioural state, and facial expressions of pain to baseline levels in the presence of compared to the absence of music. It was concluded that music is an effective NICU intervention following a stress-provoking stimulus in infants older than 31 weeks PCA.

  17. Constitutive formulation and analysis of heel pad tissues mechanics.

    PubMed

    Natali, A N; Fontanella, C G; Carniel, E L

    2010-06-01

    This paper presents a visco-hyperelastic constitutive model developed to describe the biomechanical response of heel pad tissues. The model takes into account the typical features of the mechanical response such as large displacement, strain phenomena, and non-linear elasticity together with time-dependent effects. The constitutive model was formulated, starting from the analysis of the complex structural and micro-structural configuration of the tissues, to evaluate the relationship between tissue histology and mechanical properties. To define the constitutive model, experimental data from mechanical tests were analyzed. To obtain information about the mechanical response of the tissue so that the constitutive parameters could be established, data from both in vitro and in vivo tests were investigated. Specifically, the first evaluation of the constitutive parameters was performed by a coupled deterministic and stochastic optimization method, accounting for data from in vitro tests. The comparison of constitutive model results and experimental data confirmed the model's capability to describe the compression behaviour of the heel pad tissues, regarding both constant strain rate and stress relaxation tests. Based on the data from additional experimental tests, some of the constitutive parameters were modified in order to interpret the in vivo mechanical response of the heel pad tissues. This approach made it possible to interpret the actual mechanical function of the tissues.

  18. Functional evaluation of the 10-year outcome after modified Evans repair for chronic ankle instability.

    PubMed

    Rosenbaum, D; Becker, H P; Sterk, J; Gerngross, H; Claes, L

    1997-12-01

    The Evans tenodesis is an operative treatment for chronic ankle instability with good short-term results. The disadvantage of impaired hind foot kinematics and restricted motion has been described, and only few reports of long-term results can be found. No techniques have been used to assess the outcome objectively. We wanted to determine whether a modified Evans procedure led to a satisfactory clinical and functional outcome. Nineteen patients were available at a 10-year follow-up. The clinical examination included a detailed questionnaire and stress radiographs. Foot function was evaluated with plantar pressure distribution measurements during walking and peroneal reaction time measurements elicited on a rapidly tilting platform (recorded with surface electromyography). High subjective patient satisfaction was contrasted with a high rate of residual instability, pain, and swelling. The radiographs showed an increased number of exostoses. The gait analysis revealed reduced peak pressures under the lateral heel and increased values under the longitudinal arch. The reaction times of the peroneal muscles were shorter on the operated side (significant: peroneus longus). The persistent clinical problems as well as the functional changes indicate that the disturbed ankle joint kinematics permanently alter foot function and may subsequently support the development of arthrosis. Therefore, the Evans procedure should only be applied if anatomical reconstruction of the lateral ankle ligaments is not feasible.

  19. Creation of the Driver Fixed Heel Point (FHP) CAD Accommodation Model for Military Ground Vehicle Design

    DTIC Science & Technology

    2016-08-04

    NOTES N/A 14. ABSTRACT The objective of this effort is to create a parametric Computer- Aided Design (CAD) accommodation model for the Fixed Heel...Heel Point (FHP), accommodation model, occupant work space, central 90% of the Soldier population, encumbrance, posture and position, computer aided ...Arbor, MI ABSTRACT The objective of this effort is to create a parametric Computer- Aided Design (CAD) accommodation model for the Fixed Heel

  20. Medial and Lateral Plantar Artery Angiosome Rotational Flaps for Transmetatarsal and Lisfranc Amputation in Patients With Compromised Plantar Tissue.

    PubMed

    Boffeli, Troy J; Waverly, Brett J

    2016-01-01

    Traditional incision techniques for midfoot amputation might not provide immediate soft tissue coverage of the underlying metatarsal and tarsal bones in the presence of a large plantar soft tissue defect. Patients undergoing transmetatarsal and Lisfranc amputation frequently have compromised plantar tissue in association with neuropathic ulcers, forefoot gangrene, and infection, necessitating wide resection as a part of the amputation procedure. Open amputation will routinely be performed under these circumstances, although secondary healing could be compromised owing to residual bone exposure. Alternatively, the surgeon might elect to perform a more proximal lower extremity amputation, which will allow better soft tissue coverage but compromises function of the lower extremity. A third option for this challenging situation is to modify the plantar flap incision design to incorporate a medial or lateral plantar artery angiosome-based rotational flap, which will provide immediate coverage of the forefoot and midfoot soft tissue defects without excessive shortening of the bone structure. A plantar medial soft tissue defect is treated with the lateral plantar artery angiosome flap, and a plantar lateral defect is treated with the medial plantar artery angiosome flap. Medial and lateral flaps can be combined to cover a central plantar wound defect. Incorporating large rotational flaps requires knowledge of the applicable angiosome anatomy and specific modifications to incision planning and dissection techniques to ensure adequate soft tissue coverage and preservation of the blood supply to the flap. A series of 4 cases with an average follow-up duration of 5.75 years is presented to demonstrate our patient selection criteria, flap design principles, dissection pearls, and surgical staging protocol.

  1. Fiber optic plantar pressure/shear sensor

    NASA Astrophysics Data System (ADS)

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

    2011-04-01

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

  2. Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding.

    PubMed

    Jackson, Lorraine; Binning, Jodi; Potter, Julia

    2004-01-01

    We sought to determine whether one of two prefabricated insole designs could better manage high forefoot plantar pressures in patients with rheumatoid arthritis. Ten subjects with rheumatoid arthritis who experienced pain with shod weightbearing were studied by using a plantar pressure measurement system. Two insole designs and a shoe-only control condition were randomly tested in repeated trials. Dome- and bar-shaped metatarsal pads made of latex foam were incorporated into full-length insoles made of urethane. Significant reductions in mean peak plantar pressures over the central metatarsals were noted when using the insole and dome pad design (12% [33 kPa]) and the insole and bar pad design (21% [58 kPa]) compared with the shoe-only condition. A prefabricated insole design incorporating a bar metatarsal pad is recommended to manage high forefoot plantar pressures in patients with rheumatoid arthritis.

  3. A comparison of shoe insole materials in plantar pressure relief.

    PubMed

    Leber, C; Evanski, P M

    1986-12-01

    A clinical study was performed to evaluate the effectiveness of seven shoe insole materials and their ability to relieve areas of high plantar pressure. The following materials were tested: Latex foam, Plastazote, Dynafoam, Ortho felt, PPTR, Spenco, and Molo. Twenty-six patients with areas of high plantar pressure were tested using each of these materials. The Harris and Beath footprinting technique was used to measure plantar pressure. It was found that the average pressure of a clinically painful plantar area was 398.15kN/m2. All insole materials tested decreased this pressure, with averages ranging from 186.33kN/m2 to 286.35kN/m2. PPT, Plastazote and Spenco were the most effective products tested.

  4. [Magnetic resonance imaging in lesions of the plantar aponeurosis].

    PubMed

    Roger, B; Christel, P; Poux, D; Saillant, G; Cabanis, E A

    1987-12-01

    Exploration of sporting injures to plantar aponeurosis (PA) has up to now been based mainly on clinical examination, from which the diagnosis was established. Imaging technics such as standard radiography and ultrasound scanning have limitations allowing diagnosis to be made usually only by elimination, the lesion being very rarely visualized directly. Ten patients with hyperalgic lesion of plantar arch and functional impotence were explored by MR imaging, and in all cases this examination provided superior data confirmed at operation. The examination is painless and little invasive and can be carried out during the acute phase. The plantar aponeurosis is visualized directly between the muscle mass of the plantar arch and the fatty cushion. All three spatial planes can be investigated, most interesting data being obtained from the sagittal (in the PA axis) and frontal (comparative) planes.

  5. Acitretin for the treatment of recalcitrant plantar warts.

    PubMed

    Joshipura, Deep; Goldminz, Ari; Greb, Jacqueline; Gottlieb, Alice

    2017-03-15

    Plantar warts caused by human papilloma virus (HPV)may be challenging to treat when conventionalmodalities fail. We report a case of severely recalcitrantplantar warts, successfully treated with oral acitretinand topical 40% urea cream.

  6. 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

  7. Plantar Pressure Detection with Fiber Bragg Gratings Sensing System.

    PubMed

    Liang, Tsair-Chun; Lin, Jhe-Jhun; Guo, Lan-Yuen

    2016-10-22

    In this paper, a novel fiber-optic sensing system based on fiber Bragg gratings (FBGs) to measure foot plantar pressure is proposed. This study first explores the Pedar-X insole foot pressure types of the adult-size chart and then defines six measurement areas to effectively identify four foot types: neutral foot, cavus foot, supinated foot and flat foot. The plantar pressure signals are detected by only six FBGs, which are embedded in silicone rubber. The performance of the fiber optic sensing is examined and compared with a digital pressure plate of i-Step P1000 with 1024 barometric sensors. In the experiment, there are 11 participants with different foot types to participate in the test. The Pearson correlation coefficient, which is determined from the measured results of the homemade fiber-optic plantar pressure system and i-Step P1000 plantar pressure plate, reaches up to 0.671 (p < 0.01). According to the measured results from the plantar pressure data, the proposed fiber optic sensing system can successfully identify the four different foot types. Measurements of this study have demonstrated the feasibility of the proposed system so that it can be an alternative for plantar pressure detection systems.

  8. Discrete sensors distribution for accurate plantar pressure analyses.

    PubMed

    Claverie, Laetitia; Ille, Anne; Moretto, Pierre

    2016-12-01

    The aim of this study was to determine the distribution of discrete sensors under the footprint for accurate plantar pressure analyses. For this purpose, two different sensor layouts have been tested and compared, to determine which was the most accurate to monitor plantar pressure with wireless devices in research and/or clinical practice. Ten healthy volunteers participated in the study (age range: 23-58 years). The barycenter of pressures (BoP) determined from the plantar pressure system (W-inshoe®) was compared to the center of pressures (CoP) determined from a force platform (AMTI) in the medial-lateral (ML) and anterior-posterior (AP) directions. Then, the vertical ground reaction force (vGRF) obtained from both W-inshoe® and force platform was compared for both layouts for each subject. The BoP and vGRF determined from the plantar pressure system data showed good correlation (SCC) with those determined from the force platform data, notably for the second sensor organization (ML SCC= 0.95; AP SCC=0.99; vGRF SCC=0.91). The study demonstrates that an adjusted placement of removable sensors is key to accurate plantar pressure analyses. These results are promising for a plantar pressure recording outside clinical or laboratory settings, for long time monitoring, real time feedback or for whatever activity requiring a low-cost system.

  9. [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.

  10. Plantar Pressure Detection with Fiber Bragg Gratings Sensing System

    PubMed Central

    Liang, Tsair-Chun; Lin, Jhe-Jhun; Guo, Lan-Yuen

    2016-01-01

    In this paper, a novel fiber-optic sensing system based on fiber Bragg gratings (FBGs) to measure foot plantar pressure is proposed. This study first explores the Pedar-X insole foot pressure types of the adult-size chart and then defines six measurement areas to effectively identify four foot types: neutral foot, cavus foot, supinated foot and flat foot. The plantar pressure signals are detected by only six FBGs, which are embedded in silicone rubber. The performance of the fiber optic sensing is examined and compared with a digital pressure plate of i-Step P1000 with 1024 barometric sensors. In the experiment, there are 11 participants with different foot types to participate in the test. The Pearson correlation coefficient, which is determined from the measured results of the homemade fiber-optic plantar pressure system and i-Step P1000 plantar pressure plate, reaches up to 0.671 (p < 0.01). According to the measured results from the plantar pressure data, the proposed fiber optic sensing system can successfully identify the four different foot types. Measurements of this study have demonstrated the feasibility of the proposed system so that it can be an alternative for plantar pressure detection systems. PMID:27782089

  11. Assessment of plantar pressure and balance in patients with diabetes

    PubMed Central

    Anjos, Daniela M.C.; Gomes, Luciana P.O.; Sampaio, Luciana M.M.; Correa, João C.F.

    2010-01-01

    Introduction Patients with diabetes for more than 10 years may have an increase in peak plantar pressure, considerable postural oscillation, balance deficit, alterations in gait pattern and an increased risk of falls. The aim of the present study was to assess the correlation between plantar pressure distribution and balance in patients with diabetes using a pressure platform (Footwork). Material and methods The study was carried out at the Human Movement Clinic of the Centro Universitário de Belo Horizonte (Brazil). The sample was made up of 18 right-handed individuals with type 2 diabetes – 14 females and 4 males – with an average age of 58.72 ±9.54 and an average of 18.56 ±6.61 years since diagnosis. Result Data analysis revealed that greater peak plantar pressure on the right hindfoot led to greater radial displacement (Rd) (r = 0.2022) and greater displacement velocity (r = 0.2240). Greater peak plantar pressure on the left hindfoot also led to greater displacement velocity (P) (r = 0.5728) and radial displacement (RD) (r = 0.1972). A positive correlation was found between time elapsed since diagnosis and peak midfoot pressure (r = 0.3752) on the right and left side as well as between BMI and plantar pressure on all regions of the foot. Conclusions The data reveal a correlation between postural oscillation and peak plantar pressure on the hindfoot. PMID:22371719

  12. Abductor Hallucis: Anatomical Variation and Its Clinical Implications in the Reconstruction of Chronic Nonhealing Ulcers and Defects of Foot

    PubMed Central

    Chittoria, Ravi Kumar; Pratap, Harsha; Yekappa, Suma Hottigoudar

    2015-01-01

    Abductor hallucis (AH) is an intrinsic muscle of sole of the foot. It is commonly used in the coverage of ankle and heel defects and chronic nonhealing ulcers of the foot; its use is reported to have a favorable long-term outcome. The muscle's apt bulk and size, its simple surgical isolation, absence of donor-site defect, unvaried anatomy, and long neurovascular pedicle are some of the advantages that make it a promising muscle flap. During routine cadaver dissection in the Department of Anatomy of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, we identified an anatomical variation in AH in both feet of a 45-year-old embalmed male Indian cadaver. The variant muscle had innumerable proximal attachments, a majority of them arising atypically in the form of tough tendinous slips from the medial intermuscular septum at the junction of central and tibial components of plantar aponeurosis, the medial surface of first metatarsal and the intermuscular septum separating AH from the flexor hallucis brevis. The tendon: muscle ratio was 1.76, higher than the normal reported ratio of 0.56±0.07. This article highlights the variation noted and its implication for clinicians. On Internet search, we did not come across the variations described in our article. Findings of the anatomical variation reported in this article could benefit surgeons who decide to use AH flaps in the future. PMID:26634184

  13. 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.

  14. 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

  15. 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

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

    ERIC Educational Resources Information Center

    Liu, Yuanlong; Wang, Yong Tai

    2004-01-01

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

  17. Synovitis of the Tarsal Canal: An Uncommon Cause of Lateral Heel Pain After Triple Arthrodesis.

    PubMed

    Lui, Tun Hing

    Lateral heel pain after triple arthrodesis can have numerous causes, including nonunion of the fusion site, hindfoot malalignment, degenerative arthritis in adjacent joints, and deep infection. We present a case of lateral heel pain after triple arthrodesis due to synovitis of the tarsal canal that was successfully treated with anterior subtalar arthroscopy.

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

    PubMed Central

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

    2014-01-01

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

  19. Force Depression in Plantar Flexors Exists Equally in Plantar Flexed and Dorsiflexed Regions

    PubMed Central

    Fukutani, Atsuki; Misaki, Jun; Isaka, Tadao

    2017-01-01

    Isometric muscle force attained during isometric contractions decreases after active shortening compared to that attained during purely isometric contractions. This phenomenon is called residual force depression. The aim of this study was to examine whether residual force depression occurs in human plantar flexors in both plantar flexed and dorsiflexed region. In addition, the magnitude of fascicle shortening was evaluated because not only muscle force but also fascicle shortening during active shortening are considered to affect force depression. Eleven male subjects were recruited. All muscle contractions were evoked by muscle belly-electrical stimulation. In the reference trials, isometric plantar flexion (PF) was performed at 0° and 15° of PF. In the residual force depression trials, the following two contractions were conducted: (1) muscles were activated isometrically at 15° of dorsiflexion, then actively shortened to 0° of PF (long condition) and (2) muscles were activated isometrically at 0° of PF, then actively shortened to 15° of PF (short condition). Isometric joint torque obtained 4.9 s after the onset of contraction was compared between the reference and residual force depression trials at the same joint angle to calculate the magnitude of residual force depression. At the same time point, fascicle length and pennation angle were obtained from ultrasonographic images to examine whether the muscle architecture affected residual force depression. As a result, residual force depression was confirmed in both the long and short length conditions (long: 87.1 ± 9.1%, short: 92.1 ± 7.8%) while the magnitude was not different (p = 0.182). The fascicle length and pennation angle were not different between the reference and residual force depression trials (p = 0.291–0.906). These results indicate that residual force depression occurs in the physiological range of motion in the human plantar flexors, and this phenomenon is not related to muscle

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

    PubMed

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

    2011-05-01

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

  1. Free sensate medial plantar flap for contralateral plantar forefoot reconstruction with flap reinnervation using end-to-side neurorrhaphy: a case report and literature review.

    PubMed

    Lykoudis, Efstathios G; Seretis, Konstantinos; Lykissas, Marios G

    2013-03-01

    Reconstruction of weight-bearing plantar defects remains a challenge due to the unique characteristics of the plantar skin and thus the limited available options. The medial plantar flap, either pedicled or free, represents an ideal option, but its use as sensate flap for forefoot defects has been scarcely reported. We present a case of plantar forefoot reconstruction with a free sensate medial plantar flap, with end-to-side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve of the recipient. Last follow-up, at 2 years post-op, verified a very good functional and aesthetic outcome, indicating that the suggested approach may prove the treatment of choice in selected cases of plantar forefoot reconstruction.

  2. 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.

  3. Different plantar interface effects on dynamics of the lower limb.

    PubMed

    Hao, Z H; Zhou, J B; Jin, D W; Zhou, D W; Li, X D

    2005-01-01

    The moments acting on the lower limb joints influence the life of the arthrosis. These loads may depend on the footwear and action style. The footwear factor was studied with three-dimensional gait measure system. Five young women in their 20s, wear 7 cm high-heeled shoes and sneakers, and walked in 10 m gait laboratory walkway. Inversed dynamics was used to analysis the torques at the ankle, knee and hip. Results showed that peak adduction moments at the knee and ankle increased and flexion/extension moments at hip increased with high-heel shoes compared with the sneakers. The high-heeled shoes result in greater load in lower limb joints especial to the knee and hip.

  4. Multi-criterion optimization for heel-toe running.

    PubMed

    Wang, Nenzi

    2005-08-01

    This paper presents an optimization procedure for multi-criterion analysis essential in many biomechanical studies. The optimization is illustrated with a heel-toe running analysis wherein the rate of load and the passive load on support leg are minimized concurrently. The goal of multi-criterion optimization is achieved by incorporating the criterion of Pareto optimality in the genetic algorithm. The proposed procedure can replace the popular weighted-sum approach for problems with multiple objectives. The selection of a final design from the Pareto optimum points (non-dominated designs) can be determined, based on the min-max objective deviation criterion. Nevertheless, a different decision can be made in the final selection without incurring recalculations. The scheme is readily adoptable for parallel computing, which deserves further study to reduce the execution time in a complex biomechanical analysis.

  5. 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.

  6. Are mitochondria the Achilles' heel of the Kingdom Fungi?

    PubMed

    Chatre, Laurent; Ricchetti, Miria

    2014-08-01

    A founding event in the origin of eukaryotes is the acquisition of an extraordinary organelle, the mitochondrion, which contains its own genome. Being linked to energy metabolism, oxidative stress, cell signalling, and cell death, the mitochondrion to a certain extent controls life and death in eukaryotic cells. The large metabolic diversity and living strategies of the Kingdom Fungi make their mitochondria of particular evolutionary interest. The review focuses first on the characteristics of mitochondria in the Kingdom Fungi, then on their implications in the organism survival, pathogenicity and resistance, and finally on proposing unconventional strategies to investigate the biology of fungal mitochondria, unveiling the possibility that mitochondria play as the Achilles' heel of this kingdom.

  7. Effect of the 6-minute walk test on plantar loading and capability to produce ankle plantar flexion forces.

    PubMed

    Vie, Bruno; Griffon, Patricia; Bijoux, Audrey; Cadiere, Julie; Weber, Jean Paul; Jammes, Yves

    2016-09-01

    The six-minute walk test (6MWT) is used to evaluate the ambulatory capacity of patients suffering from respiratory disorders, obesity or neuromuscular diseases. Our primary aim was to evaluate the effects of the 6MWT on the postural sway and the ankle plantar flexion forces in healthy subjects. We measured the ankle plantar flexion forces and the plantar contact area before and after a 6MWT in normal weight and overweight subjects with no history of respiratory, cardiac, and neuromuscular disorders. A post-6MWT sensation of bodily fatigue was evaluated by Multidimensional Fatigue Inventory (MFI) and Pichot fatigue scales. A computerized pedobarographic platform was used to collect the mean plantar contact area, the changes of the center of pressure (CoP) surface and its medial and lateral deviations. In a limited number of subjects, the reproducibility of all the measurements was explored. In both groups, the 6MWT elicited a sensation of bodily fatigue. It also significantly reduced the ankle plantar flexion forces, and increased both the mean plantar contact area and the CoP surface, the changes being not apparent after 10min. The post-6MWT lateral CoP deviations were accentuated in normal weight subjects, while an increase in medial CoP deviations occurred in overweight ones. The 6MWT-induced changes in the plantar flexion force and pedobarographic variables were reproducible. Because this study clearly showed some post-6MWT alterations of the subjects' posture sway of our subjects, we questioned the possible mechanisms occurring that could explain the altered muscle force and the transient destabilization of posture after the 6MWT.

  8. Quantitative heel ultrasound variables in powerlifters and controls

    PubMed Central

    Jawed, S; Horton, B; Masud, T

    2001-01-01

    Objective—To compare by cross sectional study the quantitative heel ultrasound (QUS) variables broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in male powerlifters and controls. Methods—Twenty four powerlifters and 21 sedentary male controls were recruited to the study. All the powerlifters were members of the British Drug Free Powerlifting Association and actively competing at the time of the study. A questionnaire was completed by all those entered into the study. This included a history of smoking and an estimation of daily intake of alcohol and calcium. For the powerlifters, the number of years spent training and time spent training each week was also recorded. The QUS variables of all powerlifters and controls were measured using a Cubaclinical II (McCue) ultrasound scanner. Results—The powerlifters had been training for a mean (SEM) of 10.6 (1.6) years and they trained for 6.5 (0.4) hours a week. The powerlifters were non-significantly older and had a significantly higher body mass index (BMI) than the controls. Calcium intake and consumption of alcohol and tobacco were similar in the two groups. The mean BUA in the powerlifters was a significant 9.5% (95% confidence interval 0.7 to 18.3%) higher than the controls (105 v 96 dB/MHZ) and 15.6% (95% confidence interval 6.8 to 24.4%) higher after adjustment using analysis of covariance for age, BMI, and alcohol and tobacco consumption (108 v 93 dB/MHZ). The mean VOS was similar in the two groups, but after adjustment it was significantly higher in the powerlifters (1671 v 1651 m/s, p<0.01). Conclusions—The study shows the ability of heel ultrasound to discriminate between QUS variables in powerlifters and controls. The results indicate that the QUS variables BUA and VOS are significantly higher for powerlifters than for controls. PMID:11477028

  9. Differences in calcium accumulation between human plantar and palmar aponeuroses.

    PubMed

    Azuma, Cho; Tohno, Yoshiyuki; Morimoto, Mamoru; Tohno, Setsuko; Minami, Takeshi; Takano, Yasuo; Utsumi, Masako; Moriwake, Yumi; Nishiwaki, Fumio; Yamada, Masa-oki

    2002-01-01

    To elucidate the characteristics of calcium accumulation of human plantar and palmar aponeuroses, the authors determined the calcium content of human plantar and palmar aponeuroses by atomic absorption flame emission spectrophotometry. The subjects consisted of 9 men and 14 women, ranging in age from 61 to 93 yr. In the plantar aponeurosis, the calcium content was significantly higher in the anterior and posterior parts than in the middle part. It is known that pressure distribution under the sole of a foot is higher in the anterior and posterior parts than in the middle part. The present study suggests that the accumulation of calcium in the plantar aponeurosis is related with the pressure distribution under the sole of a foot. The calcium content increased progressively with aging in the anterior part of the plantar aponeurosis, but not in the middle and posterior parts. Regarding the palmar aponeurosis, the calcium content was significantly higher in the anterior and posterior parts in comparison with the middle part. It was found that the calcium content increased progressively with aging in the posterior part of the palmar aponeurosis, whereas it did not increase significantly with aging in the anterior and middle parts. Regarding the relationship between the calcium content of the aponeuroses and the bone mineral density, a significant correlation was found between the calcium content in the anterior part of the palmar aponeurosis and the bone mineral density of the scaphoid bone.

  10. 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.

  11. 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.

  12. Role of the plantar fascia in digital stabilization. A case report.

    PubMed

    Pontious, J; Flanigan, K P; Hillstrom, H J

    1996-01-01

    The plantar aponeurosis is a ligamentous structure that extends from the calcaneus to the proximal phalanges. Under tension, it functions to support the longitudinal arch, supinate the rearfoot, and stabilize the digits against the ground. The anatomy and biomechanics of the plantar fascia and plantar aponeurosis, particularly their role in digital stabilization, are reviewed. A case is presented showing a patient who developed hammer toes as a postoperative complication after having a portion of the plantar aponeurosis removed.

  13. Skin Conductance at Baseline and Post-Heel Lance Reflects Sympathetic Activation in Neonatal Opiate Withdrawal

    PubMed Central

    Oji-Mmuo, Christiana N.; Michael, Eric J.; McLatchy, Jacqueline; Lewis, Mary M.; Becker, Julie E.; Doheny, Kim Kopenhaver

    2015-01-01

    Aim Skin conductance (SC) provides an objective measure of autonomic system regulation through sympathetic-mediated filling of sweat glands. This study aimed to test the utility of SC to detect sympathetic activation in neonatal abstinence syndrome (NAS). Methods 14 term (mean, SE: 38.8 ± 0.35 weeks gestational age) neonates with chronic prenatal opiate exposure were enrolled. SC (peaks/sec and mean of peaks) were measured at baseline, during heel lance/squeeze (HLS) and recovery from HLS at 24-48 (mean 38) hours of life prior to treatment for NAS. Blinded coders with established reliability assessed neonates using the Modified Finnegan Neonatal Scoring System (MFNSS). Non-parametric tests were used to determine group differences, phase differences from baseline to HLS and HLS to recovery, and associations between MFNSS and SC measures. Results Neonates that would later require morphine treatment for NAS (n = 6) had higher baseline SC mean of peaks than those that did not require treatment (n = 8) (P<0.05). Moreover, there were unique phase differences between groups and SC positively correlated with MFNSS (P< 0.05). Conclusion SC provides early identification of NAS severity. However, a larger sample is needed to determine sensitivity and specificity of SC for early identification of NAS and treatment effectiveness. PMID:26613197

  14. 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

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

    PubMed

    Ko, Dong Yeol; Lee, Han Suk

    2013-10-01

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

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

    PubMed Central

    Ko, Dong Yeol; Lee, Han Suk

    2013-01-01

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

  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. Heel pain due to psoriatic arthritis in a 50 year old recreational male athlete: case report

    PubMed Central

    Yedon, Dominique Forand; Howitt, Scott

    2011-01-01

    Heel pain is a common presentation in a sports injury practice, with a list of common differentials including achilles tendinopathy and retrocalcaneal bursitis. However, seronegative arthritis can also cause enthesopathies that produce heel pain and should be considered in a differential diagnosis list. In this case, a 50 year old recreationally active male presented with non-traumatic insidious heel pain and without history of any skin conditions or any other symptoms of seronegative spondyloarthritis. Clinical suspicion led to laboratory testing and radiographs/bone scan which yielded the diagnosis of psoriatic arthritis. PMID:22131565

  19. Management of Plantar Hyperhidrosis with Endoscopic Lumbar Sympathectomy.

    PubMed

    Rieger, Roman

    2016-11-01

    Primary plantar hyperhidrosis is defined as excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle and reduction of health-related quality of life. Conservative therapy measures usually fail to provide sufficient relieve of symptoms and do not allow long-lasting elimination of hyperhidrosis. Endoscopic lumbar sympathectomy appears to be a safe and effective procedure for eliminating excessive sweating of the feet and improves quality of life of patients with severe plantar hyperhidrosis.

  20. Effects of bridging plus exercises with heel lift on lower extremity muscles

    PubMed Central

    Yoo, Won-gyu

    2016-01-01

    [Purpose] This study investigated the effects of the bridging plus exercise with heel lift on lower extremity muscles. [Subjects and Methods] Nine healthy males participated. The subjects performed bridging exercises under two conditions. Surface electromyography was used to measure the electrical activities of the medial hamstring (MH) and the gluteus maximus (GM) muscles. [Results] Activation of the MH muscle during bridging with heel lift decreased, and activation of the GM muscle during bridging with heel lift increased compared to those with the bridging exercise. [Conclusion] This result showed that bridging plus exercises with heel lift could be an effective exercise for patients with compensatory mechanisms during bridging exercises, such as weak GM with hamstring tightness. PMID:27313376

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2012-10-01

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

  3. A retrospective descriptive study of nursing home residents with heel eschar or blisters.

    PubMed

    Shannon, Mary M

    2013-01-01

    Pressure ulcers on heels are a serious problem in nursing home patients and can lead to complications. Current clinical guidelines recommend leaving dry heel eschar intact, but the evidence for this recommendation is largely based on expert opinion and not always followed. To examine outcomes of heel pressure ulcers in nursing home patients, a retrospective study was conducted by reviewing the charts of patients in 15 different nursing homes who had a heel eschar or a heel blister during a period of 50 months. In all facilities, standard protocol of care consisted of offloading the area and keeping eschar and blisters dry and debriding only if the eschar or blister became loose. A total of 263 heel wounds were identified. Of those, 179 (68%) had eschar and 84 (32%) were blisters. Almost half of all patients (41%) were lost to follow-up. All but one (amputation related to pain from ischemia) of the remaining wounds (n = 154) healed. Ninety-four of the 95 wounds with eschar and 57 of 57 wounds with blisters healed after an average of 11 (SD 9.44) weeks for wounds with eschar and 6 (SD 4.75) weeks for blister-covered wounds. These results suggest practitioners can follow current clinical guidelines for the management of these wounds until further research comparing different protocols of care has been conducted.

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

    PubMed

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

    2012-01-01

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

  5. Effects of body mass index on plantar pressure and balance

    PubMed Central

    Yoon, Se-Won; Park, Woong-Sik; Lee, Jeong-Woo

    2016-01-01

    [Purpose] To suggest physiotherapy programs and to determine foot stability based on the results of plantar pressure and spontaneity balance in the normal group and in the obesity group according to the body mass index (BMI). [Subjects and Methods] The plantar pressure and balance of 20 females college students in their 20s were measured according to their BMI. BMI was measured by using BMS 330. The peak plantar pressure was measured in a static position in the forefoot and hind-foot areas. To study balance, the spontaneity balance of each foot was measured on both stable and unstable surfaces. [Results] In terms of plantar pressure, no significant change was observed in the forefoot and hind-foot peak pressure. In terms of spontaneity balance, no significant difference in foot position interaction was observed on both stable and unstable surfaces, while a significant difference was observed in the foot position between the groups. [Conclusion] The index of hind-foot spontaneity balance was low, particularly in the obesity group. This meant significant hind-foot swaying. The forefoot body weight support percentage increased to reinforce the reduced spontaneity balance index. PMID:27942127

  6. 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…

  7. Effects of body mass index on plantar pressure and balance.

    PubMed

    Yoon, Se-Won; Park, Woong-Sik; Lee, Jeong-Woo

    2016-11-01

    [Purpose] To suggest physiotherapy programs and to determine foot stability based on the results of plantar pressure and spontaneity balance in the normal group and in the obesity group according to the body mass index (BMI). [Subjects and Methods] The plantar pressure and balance of 20 females college students in their 20s were measured according to their BMI. BMI was measured by using BMS 330. The peak plantar pressure was measured in a static position in the forefoot and hind-foot areas. To study balance, the spontaneity balance of each foot was measured on both stable and unstable surfaces. [Results] In terms of plantar pressure, no significant change was observed in the forefoot and hind-foot peak pressure. In terms of spontaneity balance, no significant difference in foot position interaction was observed on both stable and unstable surfaces, while a significant difference was observed in the foot position between the groups. [Conclusion] The index of hind-foot spontaneity balance was low, particularly in the obesity group. This meant significant hind-foot swaying. The forefoot body weight support percentage increased to reinforce the reduced spontaneity balance index.

  8. Calculation of plantar pressure time integral, an alternative approach.

    PubMed

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

    2011-07-01

    In plantar pressure measurement, both peak pressure and pressure time integral are used as variables to assess plantar loading. However, pressure time integral shows a high concordance with peak pressure. Many researchers and clinicians use Novel software (Novel GmbH Inc., Munich, Germany) that calculates this variable as the summation of the products of peak pressure and duration per time sample, which is not a genuine integral of pressure over time. Therefore, an alternative calculation method was introduced. The aim of this study was to explore the relevance of this alternative method, in different populations. Plantar pressure variables were measured in 76 people with diabetic polyneuropathy, 33 diabetic controls without polyneuropathy and 19 healthy subjects. Peak pressure and pressure time integral were obtained using Novel software. The quotient of the genuine force time integral over contact area was obtained as the alternative pressure time integral calculation. This new alternative method correlated less with peak pressure than the pressure time integral as calculated by Novel. The two methods differed significantly and these differences varied between the foot sole areas and between groups. The largest differences were found under the metatarsal heads in the group with diabetic polyneuropathy. From a theoretical perspective, the alternative approach provides a more valid calculation of the pressure time integral. In addition, this study showed that the alternative calculation is of added value, along peak pressure calculation, to interpret adapted plantar pressures patterns in particular in patients at risk for foot ulceration.

  9. Floodplains as an Achilles' heel of Amazonian forest resilience.

    PubMed

    Flores, Bernardo M; Holmgren, Milena; Xu, Chi; van Nes, Egbert H; Jakovac, Catarina C; Mesquita, Rita C G; Scheffer, Marten

    2017-04-10

    The massive forests of central Amazonia are often considered relatively resilient against climatic variation, but this view is challenged by the wildfires invoked by recent droughts. The impact of such fires that spread from pervasive sources of ignition may reveal where forests are less likely to persist in a drier future. Here we combine field observations with remotely sensed information for the whole Amazon to show that the annually inundated lowland forests that run through the heart of the system may be trapped relatively easily into a fire-dominated savanna state. This lower forest resilience on floodplains is suggested by patterns of tree cover distribution across the basin, and supported by our field and remote sensing studies showing that floodplain fires have a stronger and longer-lasting impact on forest structure as well as soil fertility. Although floodplains cover only 14% of the Amazon basin, their fires can have substantial cascading effects because forests and peatlands may release large amounts of carbon, and wildfires can spread to adjacent uplands. Floodplains are thus an Achilles' heel of the Amazon system when it comes to the risk of large-scale climate-driven transitions.

  10. Casting methods and plantar pressure: effects of custom-made foot orthoses on dynamic plantar pressure distribution.

    PubMed

    Guldemond, Nick A; Leffers, Pieter; Sanders, Antal P; Emmen, Hans; Schaper, Nicolaas C; Walenkamp, Geert H I M

    2006-01-01

    Foot orthoses are widely used to treat various foot problems. A literature search revealed no publications on differences in plantar pressure distribution resulting from casting methods for foot orthoses. Four casting methods were used for construction of orthoses. Two foam box techniques were used: accommodative full weightbearing method (A) and functional semiweightbearing method (B). Also, two suspension plaster casting techniques were used: accommodative casting (C) and functional subtalar joint neutral position (Root) method (D). Their effects on contact area, plantar pressure, and walking convenience were evaluated. All orthoses increased the total contact area (mean, 17.4%) compared with shoes without orthoses. Differences in contact areas between orthoses for total plantar surface were statistically significant. Peak pressures for the total plantar surface were lower with orthoses than without orthoses (mean, 22.8%). Among orthoses, only the difference between orthoses A and B was statistically significant. Differences between orthoses for the forefoot were small and not statistically significant. The gait lines of the shoe without an insole and of the accommodative orthoses are more medially located than those of functional orthoses. Walking convenience in the shoe was better rated than that with orthoses. There were no differences in perception of walking convenience between orthoses A, B, and C. Orthosis D had the lowest convenience rating. The four casting methods resulted in differences between orthoses with respect to contact areas and walking convenience but only slight differences in peak pressures.

  11. A mathematical method for quantifying in vivo mechanical behaviour of heel pad under dynamic load.

    PubMed

    Naemi, Roozbeh; Chatzistergos, Panagiotis E; Chockalingam, Nachiappan

    2016-03-01

    Mechanical behaviour of the heel pad, as a shock attenuating interface during a foot strike, determines the loading on the musculoskeletal system during walking. The mathematical models that describe the force deformation relationship of the heel pad structure can determine the mechanical behaviour of heel pad under load. Hence, the purpose of this study was to propose a method of quantifying the heel pad stress-strain relationship using force-deformation data from an indentation test. The energy input and energy returned densities were calculated by numerically integrating the area below the stress-strain curve during loading and unloading, respectively. Elastic energy and energy absorbed densities were calculated as the sum of and the difference between energy input and energy returned densities, respectively. By fitting the energy function, derived from a nonlinear viscoelastic model, to the energy density-strain data, the elastic and viscous model parameters were quantified. The viscous and elastic exponent model parameters were significantly correlated with maximum strain, indicating the need to perform indentation tests at realistic maximum strains relevant to walking. The proposed method showed to be able to differentiate between the elastic and viscous components of the heel pad response to loading and to allow quantifying the corresponding stress-strain model parameters.

  12. Continuous phenobarbital treatment leads to recurrent plantar fibromatosis.

    PubMed

    Strzelczyk, Adam; Vogt, Heinrich; Hamer, Hajo M; Krämer, Günter

    2008-11-01

    Despite contrary recommendations by expert opinion and international guidelines phenobarbital remains the most widely prescribed anticonvulsant worldwide. Although associated connective tissue disorders were described in a timely way after its introduction, the association between plantar fibromatosis--also called Ledderhose syndrome--and phenobarbital seems not to be well known in general. Our case series uniquely demonstrates that continuous phenobarbital treatment leads to recurrent plantar fibromatosis and may result in long-term disability and numerous unnecessary operations. In general, the association between connective tissue disorders and phenobarbital most prominently appears in adult patients of northern European descent. However, our case series and data from the literature suggest that patient groups less susceptible to connective tissue disorders may as well develop Ledderhose syndrome or other associated syndromes as Dupuytren's contractures, frozen shoulder, Peyronie's disease or complex regional pain syndrome in the course of phenobarbital treatment.

  13. [Anatomical quantification of the tibial part of the plantar aponeurosis].

    PubMed

    Hiramoto, Y

    1983-03-01

    The metrical analysis of the anatomical characteristics is important because of its objectiveness. As it is concerned with the organs belonging to the locomotor system, the metrical method of the bones has already been systematized by Martin (1928), whereas the same kind of method for use on other organs remains undeveloped. The author aims to establish the metrical method of the plantar aponeurosis. The method for measuring the tibial part of the aponeurosis developed in this paper is sufficiently applicable for obtaining its principal anatomical characteristics. The results show that the tibial portion of the plantar aponeurosis becomes statistically significantly wider and thinner in its anterior part, and that the thickness of the tibial portion of the aponeurosis in the anterior part is larger on the right side than on the left side.

  14. Plantar fascia rupture in a professional soccer player.

    PubMed

    Suzue, Naoto; Iwame, Toshiyuki; Kato, Kenji; Takao, Shoichiro; Tateishi, Tomohiko; Takeda, Yoshitsugu; Hamada, Daisuke; Goto, Tomohiro; Takata, Yoichiro; Matsuura, Tetsuya; Sairyo, Koichi

    2014-01-01

    We report the case of a 29-year-old male professional soccer player who presented with symptoms of plantar fasciitis. His symptoms occurred with no remarkable triggers and gradually worsened despite conservative treatments including taping, use of insoles, and physical therapy. Local corticosteroid injection was given twice as a further intervention, but his plantar fascia partially ruptured 49 days after the second injection. He was treated conservatively with platelet-rich plasma, and magnetic resonance imaging showed regenerative change of the ruptured fascia. Five months after the rupture, he returned to his original level of training. If professional athletes find it difficult to refrain from athletic activity, as in the present case, the risk of rupture due to corticosteroid injection should not be overlooked.

  15. [Surgical treatment of rupture of the plantar fascia].

    PubMed

    Christel, P; Rigal, S; Poux, D; Roger, B; Witvoët, J

    1993-01-01

    Among the various lesions of the hindfoot in athletes, plantar fascia ruptures are not well documented and their surgical treatment is not often reported in the literature. The purpose of the current work was to more precisely define therapeutic indications and to evaluate the results of the surgical treatment based on the excision-release of the plantar fascia. Between 1986 and 1991, 19 patients (5 females, 14 males, average age 32 years) were operated on by one surgeon. All patients were either recreational or competitive athletes. The plantar fascia rupture occurred 18 times during sports activity. Surgical treatment was indicated when pain persisted despite a well conducted conservative treatment. In 17 cases, MRI allowed to plan the operative strategy by showing the fascia lesion. The patients were operated after an average of 8 months following the initial injury (6-16 months). One patient was lost for follow-up, 2 had a follow-up below 6 months, thus 16 patients were available for analysis. The clinical outcome was evaluated through persistence of pain, return to sports, and functional activity. With a 16-month average follow-up (6-51 months) it was observed that pain constantly disappeared and that 11 patients over 16 returned to the same level of sports activity after 6 months with a time-stable result. After failure of a well conducted conservative treatment, surgical treatment of plantar fascia rupture must be proposed. Surgical technique is based not only on fascia release but also on the excision of the pathological scar tissue in order to avoid the restoration of the continuity of the fascia with the calcaneus.

  16. Effects of shoe heel height on the end-point and joint kinematics of the locomotor system when crossing obstacles of different heights.

    PubMed

    Chien, Hui-Lien; Lu, Tung-Wu

    2017-03-01

    High-heeled shoes increase the risk of falling during walking, especially in the presence of obstacles. The study aimed to compare the end-point (foot/shoe) trajectories and joint angles of the lower extremities in 12 healthy females crossing obstacles of different heights while barefoot and when wearing narrow-heeled shoes (heel heights: 3.9, 6.3 and 7.3 cm). During obstacle-crossing, young females in narrow-heeled shoes maintained the same leading toe-clearance as when barefoot, irrespective of the heel height, primarily through increased plantarflexion of the leading swing ankle. However, the shoe heel-clearance was significantly reduced when compared with barefoot, presumably related to the difficulty in precisely sensing the position of the shoe-heel tip. With an increasing obstacle height, the toe-clearance, heel-clearance and shoe heel-clearance were reduced linearly, indicating an increasing risk of tripping over the obstacle. The results will be helpful for the design and development of strategies to reduce the risk of falling when wearing narrow-heeled shoes. Practitioner Summary: Knowledge of the influence of narrow-heeled shoes and obstacles on lower limb joint and end-point kinematics helps in shoe design to address fall risks. Compared to barefoot, narrow-heeled shoes reduced shoe heel-clearances, which were further reduced linearly with increasing obstacle height, indicating an increasing risk of tripping over the obstacle.

  17. Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis

    PubMed Central

    Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

    2016-01-01

    We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.  PMID:28083457

  18. Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis.

    PubMed

    Assad, Salman; Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

    2016-12-05

    We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.

  19. The medial gastrocnemius muscle attenuates force fluctuations during plantar flexion.

    PubMed

    Shinohara, Minoru; Yoshitake, Yasuhide; Kouzaki, Motoki; Fukunaga, Tetsuo

    2006-02-01

    Force fluctuations during steady contractions of multiple agonist muscles may be influenced by the relative contribution of force by each muscle. The purpose of the study was to compare force fluctuations during steady contractions performed with the plantar flexor muscles in different knee positions. Nine men (25.8+/-5.1 years) performed steady contractions of the plantar flexor muscles in the knee-flexed and knee-extended (greater involvement of the gastrocnemii muscles) positions. The maximal voluntary contraction (MVC) force was 32% greater in the knee-extended position compared with the knee-flexed position. The target forces were 2.5-10% MVC force in the respective position. The amplitude of electromyogram in the medial gastrocnemius muscle was greater in the knee-extended position (10.50+/-9.80%) compared with the knee-flexed position (1.26+/-1.15%, P<0.01). The amplitude of electromyogram in the soleus muscle was not influenced by the knee position. The amplitude of electromyogram in the lateral gastrocnemius and tibialis anterior muscles was marginal and unaltered with knee position. At the same force (in Newtons), the standard deviation of force was lower in the knee-extended position compared with the knee-flexed position. These results indicate that force fluctuations during plantar flexion are attenuated with greater involvement of the medial gastrocnemius muscle.

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

    PubMed

    Yoo, Won-Gyu

    2014-10-01

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

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

    PubMed Central

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

    2014-01-01

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

  2. First Tarsometatarsal Arthrodesis: An Anatomic Evaluation of Dorsomedial Versus Plantar Plating.

    PubMed

    Simons, Paul; Fröber, Rosemarie; Loracher, Clemens; Knobe, Matthias; Gras, Florian; Hofmann, Gunther O; Klos, Kajetan

    2015-01-01

    Fusion of the first tarsometatarsal joint is a widely used procedure for the correction of hallux valgus deformity. Although dorsomedial H-shaped plating systems are being increasingly used, fusion can also be achieved by plantar plating. The goal of the present study was to compare these 2 operative techniques based on the anatomic considerations and show the potential pitfalls of both procedures. Six pairs of deep-frozen human lower legs were used in the present cadaveric study. In a randomized manner, either dorsomedial arthrodesis or plantar plating through a medial incision was performed. With regard to arterial injury, the plantar technique resulted in fewer lesions (plantar, 4 injuries [66.7%] to the terminal branches of the first digital branch of the medial plantar artery; dorsomedial, 3 injuries [50%] to the main trunks of the plantar metatarsal arteries and the first dorsal metatarsal artery). With respect to injury to the veins, the plantar procedure affected significantly fewer high-caliber subcutaneous trunk veins. The nerves coursing through the operative field, such as the saphenous and superficial fibular nerves, were compromised more often by the dorsal approach. Neither the plantar plating nor the dorsomedial plating technique was associated with injury to the insertion of the tibialis anterior muscle. Both studied techniques are safe, well-established procedures. Arthrodesis with plantar plating, however, offers additional advantages and is a reliable tool in the foot and ankle surgeon's repertoire.

  3. Impaired plantar sensitivity among the obese is associated with increased postural sway.

    PubMed

    Wu, Xuefang; Madigan, Michael L

    2014-11-07

    Impaired foot plantar sensitivity has been hypothesized among individuals who are obese, and may contribute to their impaired balanced during quiet standing. The objective of this study was to investigate the effects of obesity on plantar sensitivity, and explore the relationship between plantar sensitivity and balance during quiet standing. Thirty-nine young adults from the university population participated in the study including 19 obese and 20 non-obese adults. Plantar sensitivity was measured as the force threshold at which an increasing force applied to the plantar surface of the foot was first perceived, and the force threshold at which a decreasing force was last perceived. Measurements were obtained while standing, and at two locations on the plantar surface of the dominant foot. Postural sway during quiet standing was then measured under three different sensory conditions. Results indicated less sensitive plantar sensitivity and increased postural sway among the obese, and statistically significant correlations between plantar sensitivity and postural sway that were characterized as weak to moderate in strength. As such, impaired plantar sensitivity among individuals who are obese may be a mechanism by which obesity degrades standing balance among these individuals.

  4. 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.

  5. [The use of magnetic resonance imaging in the diagnosis of plantar fibromatosis: a case report].

    PubMed

    Halefoğlu, Ahmet Mesrur

    2005-01-01

    Plantar fibromatosis is a benign but infiltrative neoplasm, presenting as a slow-growing nodular thickening most often within the central band of the plantar aponeurosis. In this case report, we presented a 43-year-old male patient who had a tender nodule in the sole of the right foot for two years. On magnetic resonance images, the location and signal intensity characteristics of the lesion were suggestive of plantar fibromatosis, which was histologically confirmed following an incisional biopsy. Magnetic resonance imaging is a noninvasive method for confirmation of the clinical diagnosis of plantar fibromatosis and also has an important role in planning surgical treatment by delineating the extent of the lesion.

  6. Fibromatosis of the plantar fascia: diagnosis and indications for surgical treatment.

    PubMed

    Dürr, H R; Krödel, A; Trouillier, H; Lienemann, A; Refior, H J

    1999-01-01

    Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection.

  7. Simultaneous Knee Extensor Muscle Action Induces an Increase in Voluntary Force Generation of Plantar Flexor Muscles.

    PubMed

    Suzuki, Takahito; Shioda, Kohei; Kinugasa, Ryuta; Fukashiro, Senshi

    2017-02-01

    Suzuki, T, Shioda, K, Kinugasa, R, and Fukashiro, S. Simultaneous knee extensor muscle action induces an increase in voluntary force generation of plantar flexor muscles. J Strength Cond Res 31(2): 365-371, 2017-Maximum activation of the plantar flexor muscles is required for various sporting activities that involve simultaneous plantar flexion and knee extension. During a multi-joint movement, activation of the plantar flexor muscles is affected by the activity of the knee extensor muscles. We hypothesized that coactivation of the plantar flexor muscles and knee extensor muscles would result in a higher plantar flexion torque. To test this hypothesis, 8 male volunteers performed maximum voluntary isometric action of the plantar flexor muscles with and without isometric action of the knee extensor muscles. Surface electromyographic data were collected from 8 muscles of the right lower limb. Voluntary activation of the triceps surae muscles, evaluated using the interpolated twitch technique, significantly increased by 6.4 percentage points with intentional knee extensor action (p = 0.0491). This finding is in line with a significant increase in the average rectified value of the electromyographic activity of the vastus lateralis, fibularis longus, and soleus muscles (p = 0.013, 0.010, and 0.045, respectively). The resultant plantar flexion torque also significantly increased by 11.5% of the predetermined maximum (p = 0.031). These results suggest that higher plantar flexor activation coupled with knee extensor activation facilitates force generation during a multi-joint task.

  8. 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

  9. Influence of knee flexion angle and age on triceps surae muscle fatigue during heel raises.

    PubMed

    Hébert-Losier, Kim; Schneiders, Anthony G; García, José A; Sullivan, S John; Simoneau, Guy G

    2012-11-01

    The triceps surae (TS) muscle-tendon unit is 1 of the most commonly injured in elite and recreational athletes, with a high prevalence in middle-aged adults. The performance of maximal numbers of unilateral heel raises is used to assess, train, and rehabilitate TS endurance and conventionally prescribed in 0° knee flexion (KF) for the gastrocnemius and 45° for the soleus (SOL). However, the extent of muscle selectivity conferred through the change in the knee angle is lacking for heel raises performed to volitional fatigue. This study investigated the influence of knee angle on TS muscle fatigue during heel raises and determined whether fatigue differed between middle-aged and younger-aged adults. Forty-eight healthy individuals aged 18-25 and 35-45 years performed maximal numbers of unilateral heel raises in 0° and 45° KF. Median frequencies and linear regression slopes were calculated from the SOL, gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) surface electromyographic signals. Stepwise mixed-effect regressions were used for analysis. The subjects completed an average of 45 and 48 heel raises in 0° and 45° KF, respectively. The results indicated that the 3 muscles fatigued during testing as all median frequencies decreased, and regression slopes were negative. Consistent with muscle physiology and fiber typing, fatigue was greater in the GM and GL than in the SOL (p < 0.001). However, knee angle did not influence TS muscle fatigue parameters (p = 0.814), with similar SOL, GM, and GL fatigue in 0° and 45° KF. These findings are in contrast with the traditionally described clinical use of heel raises in select knee angles for the gastrocnemius and the SOL. Furthermore, no difference in TS fatigue between the 2 age groups was able to be determined, despite the reported higher prevalence of injury in middle-aged individuals.

  10. 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'.

  11. 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

  12. Distribution and correlates of plantar hyperkeratotic lesions in older people

    PubMed Central

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

    2009-01-01

    Background Plantar hyperkeratotic lesions are common in older people and are associated with pain, mobility impairment and functional limitations. However, little has been documented in relation to the frequency or distribution of these lesions. The aim of this study was to document the occurrence of plantar hyperkeratotic lesions and the patterns in which they occur in a random sample of older people. Methods A medical history questionnaire was administered to a random sample of 301 people living independently in the community (117 men, 184 women) aged between 70 and 95 years (mean 77.2, SD 4.9), who also underwent a clinical assessment of foot problems, including the documentation of plantar lesion locations, toe deformities and the presence and severity of hallux valgus. Results Of the 301 participants, 180 (60%) had at least one plantar hyperkeratotic lesion. Those with plantar lesions were more likely to be female (χ2 = 18.75, p < 0.01; OR = 2.86), have moderate to severe hallux valgus (χ2 = 6.15, p < 0.02; OR = 2.95), a larger dorsiflexion range of motion at the ankle (39.4 ± 9.3 vs 36.3 ± 8.4°; t = 2.68, df = 286, p < 0.01), and spent more time on their feet at home (5.1 ± 1.0 vs 4.8 ± 1.3 hours, t = -2.46, df = 299, p = 0.01). No associations were found between the presence of plantar lesions and body mass index, obesity, foot posture, dominant foot or forefoot pain. A total of 53 different lesions patterns were observed, with the most common lesion pattern being "roll-off" hyperkeratosis on the medial aspect of the 1st metatarsophalangeal joint (MPJ), accounting for 12% of all lesion patterns. "Roll-off" lesions under the 1st MPJ and interphalangeal joint were significantly associated with moderate to severe hallux valgus (p < 0.05), whereas lesions under the central MPJs were significantly associated with deformity of the corresponding lesser toe (p < 0.05). Factor analysis indicated that 62% of lesion patterns could be grouped under three broad

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

    SciTech Connect

    KRUMHANSL, JAMES L.

    2002-07-01

    The long-range objective of this study was to develop chemically assisted technologies for removing heels from tanks. In FY 01, the first two steps toward this objective were taken: (1) catalogue the occurrence and nature of tank heels and assess which materials are available for study and (2) develop methods for synthesizing non-radioactive surrogate heel materials for use in testing potential removal technologies. The chief finding of Task 1 was the existence of ''heels'', depending on the definition used. Hard materials that would be almost impossible to remove by sluicing are all but absent from the records of both Savannah River and Hanford. Historical usage suggests that the term ''heel'' may also apply to chunky, granular, or semi-solid pasty accumulations. These materials are documented and may also be difficult to remove by conventional sluicing technologies. Such heels may be comprised of normal sludge components, dominantly iron and aluminum hydroxides, or they may result from added materials which were not part of the normal fuel reprocessing operations: Portland cement, diatomaceous earth, sand and soil and spent zeolite ion exchange ''resins''. The occurrence and chemistry of the most notable ''heel'', that of the zeolite mass in Tank 19F at Savannah River, is reviewed in some detail. Secondly, no clear correlation was found between high tank temperatures and difficulties encountered in removing materials from a tank at a later date; nor did the sludges from these tanks give any indication of being particularly solid. Experimental studies to develop synthetic heel materials were caned out using a number of different approaches. For normal sludge materials settling, even when assisted by a centrifuge, it proved ineffective. The same result was obtained from drying sludge samples. Even exposing sludges to a molten salt melt at 233 C, only produced a fine powder, rather than a resilient ceramic which resisted disaggregation. A cohesive material, however

  14. Collar height and heel counter-stiffness for ankle stability and athletic performance in basketball.

    PubMed

    Liu, Hui; Wu, Zitian; Lam, Wing-Kai

    2017-01-25

    This study examined the effects of collar height and heel counter-stiffness of basketball shoes on ankle stability during sidestep cutting and athletic performance. 15 university basketball players wore customized shoes with different collar heights (high and low) and heel counter-stiffness (regular, stiffer and stiffest) for this study. Ankle stability was evaluated in sidestep cutting while athletic performance evaluated in jumping and agility tasks. All variables were analysed using two-way repeated ANOVA. Results showed shorter time to peak ankle inversion for both high collar and stiff heel counter conditions (P < 0.05), while smaller initial ankle inversion angle, peak inversion velocity and total range of inversion for wearing high collar shoes (P < 0.05). No shoe differences were found for performance variables. These findings imply that the collar height might play a larger role in lateral stability than heel counter-stiffness, while both collar height and counter-stiffness have no effect on athletic performance.

  15. 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.

  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. The influence of whole body vibration on the plantarflexors during heel raise exercise.

    PubMed

    Robbins, D; Goss-Sampson, M

    2013-06-01

    Whole body vibration (WBV) during exercise offers potential to augment the effects of basic exercises. However, to date there is limited information on the basic physiological and biomechanical effects of WBV on skeletal muscles. The aim of this study was to determine the effects of WBV (40Hz, 1.9mm synchronous vertical displacement) on the myoelectrical activity of selected plantarflexors during heel raise exercise. 3D motion capture of the ankle, synchronised with sEMG of the lateral gastrocnemius and soleus, was obtained during repetitive heel raises carried out at 0.5Hz on 10 healthy male subjects (age 27±5 years, height 1.78±0.04m, weight 75.75±11.9kg). During both vibration and non vibration the soleus activation peaked earlier than that of the lateral gastrocnemius. The results indicate that WBV has no effect on the timing of exercise completion or the amplitude of the lateral gastrocnemius activity, however significant increases in amplitudes of the soleus muscle activity (77.5-90.4% MVC P<0.05). WBV had no significant effect on median frequencies of either muscle. The results indicate that the greatest effect of WBV during heel raise activity is in the soleus muscles during the early phases of heel raise.

  18. 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 S; 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.

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Long-term use of high-heeled shoes alters the neuromechanics of human walking.

    PubMed

    Cronin, Neil J; Barrett, Rod S; Carty, Christopher P

    2012-03-01

    Human movement requires an ongoing, finely tuned interaction between muscular and tendinous tissues, so changes in the properties of either tissue could have important functional consequences. One condition that alters the functional demands placed on lower limb muscle-tendon units is the use of high-heeled shoes (HH), which force the foot into a plantarflexed position. Long-term HH use has been found to shorten medial gastrocnemius muscle fascicles and increase Achilles tendon stiffness, but the consequences of these changes for locomotor muscle-tendon function are unknown. This study examined the effects of habitual HH use on the neuromechanical behavior of triceps surae muscles during walking. The study population consisted of 9 habitual high heel wearers who had worn shoes with a minimum heel height of 5 cm at least 40 h/wk for a minimum of 2 yr, and 10 control participants who habitually wore heels for less than 10 h/wk. Participants walked at a self-selected speed over level ground while ground reaction forces, ankle and knee joint kinematics, lower limb muscle activity, and gastrocnemius fascicle length data were acquired. In long-term HH wearers, walking in HH resulted in substantial increases in muscle fascicle strains and muscle activation during the stance phase compared with barefoot walking. The results suggest that long-term high heel use may compromise muscle efficiency in walking and are consistent with reports that HH wearers often experience discomfort and muscle fatigue. Long-term HH use may also increase the risk of strain injuries.

  5. 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

  6. The deep band of the plantar aponeurosis of the human foot.

    PubMed

    Cralley, J C; Schuberth, J M; Fitch, K L

    1982-01-01

    The deep band of the plantar aponeurosis is a variable structure formed by fibers from both the medial and lateral portions of the plantar aponeurosis. This band courses directly to the plantar ligament of the fourth metatarsophalangeal joint. Proximally it is superficial. Distally it passes deep to the tendons of the flexor digitorum longus to attach at the metatarsophalangeal joint. The second plantar and third and fourth dorsal interosseous muscles as well as the transverse head of adductor hallucis have attachments to the deep aponeurotic band. This band becomes taut when the proximal phalanx of the fourth toe is extended. No recent references to this structure could be found. The function of the deep band of the plantar aponeurosis is unknown, although the anatomical arrangement may make it important in stabilizing the fourth ray of the foot during locomotion.

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2015-12-01

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

  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. 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.

  11. Resurfacing weight bearing areas of the heel. The role of the dorsalis pedis innervated free tissue transfer.

    PubMed

    Duncan, M J; Zuker, R M; Manktelow, R T

    1985-01-01

    Five cases of chronic ulceration following skin graft resurfacing of the weight bearing surface of the heel are presented. All were managed with debridement and coverage with a free innervated dorsalis pedis tissue transfer. The technical refinements that have contributed to the reliability of the flap include careful distal identification of the first dorsal metatarsal artery (FDMA) and division of the dorsalis pedis artery (DPA) under direct vision below the takeoff of the FDMA. Donor site morbidity has been minimized by taking care to preserve the extensor paratenon as a bed for the subsequent skin graft and by immobilization of the donor foot with plaster and bed rest for 10 days. Four of the patients were followed for 2, 4, 4, and 6 years; one was lost to follow-up. All were active with protective sensation in their flaps. No instances of flap breakdown and no significant donor site morbidity were noted. The dorsalis pedis innervated free tissue transfer is recommended as a reliable procedure for resurfacing weight bearing areas of the foot when simpler methods have failed.

  12. 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

  13. 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

  14. Influence of knee flexion angle and age on triceps surae muscle activity during heel raises.

    PubMed

    Hébert-Losier, Kim; Schneiders, Anthony G; García, José A; Sullivan, S John; Simoneau, Guy G

    2012-11-01

    Triceps surae and Achilles tendon injuries are frequent in sports medicine, particularly in middle-aged adults. Muscle imbalances and weakness are suggested to be involved in the etiology of these conditions, with heel-raise testing often used to assess and treat triceps surae (TS) injuries. Although heel raises are recommended with the knee straight for gastrocnemius and bent for soleus (SOL), the extent of muscle selectivity in these positions is not clear. This study aimed to determine the influence of knee angle and age on TS muscle activity during heel raises. Forty-eight healthy men and women were recruited from a younger-aged (18-25 years) and middle-aged (35-45 years) population. All the subjects performed unilateral heel raises in 0° and 45° knee flexion (KF). Soleus, gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) surface electromyography signals were processed to compute root-mean-square amplitudes, and data were analyzed using mixed-effects models and stepwise regression. The mean TS activity during heel raises was 23% of maximum voluntary isometric contraction when performed in 0° KF and 21% when in 45°. Amplitudes were significantly different between TS muscles (p < 0.001) and KF angles (p < 0.001), with a significant interaction (p < 0.001). However, the age of the population did not influence the results (p = 0.193). The findings demonstrate that SOL activity was 4% greater when tested in 45° compared with 0° KF and 5% lower in the GM and GL. The results are consistent with the recommended use of heel raises in select knee positions for assessing, training, and rehabilitating the SOL and gastrocnemius muscles; however, the 4-5% documented change in activity might not be enough to significantly influence clinical outcome measures or muscle-specific benefits. Contrary to expectations, TS activity did not distinguish between middle-aged and younger-aged adults, despite the higher injury prevalence in middle age.

  15. Relative sensitivity of depth discrimination for ankle inversion and plantar flexion movements.

    PubMed

    Black, Georgia; Waddington, Gordon; Adams, Roger

    2014-02-01

    25 participants (20 women, 5 men) were tested for sensitivity in discrimination between sets of six movements centered on 8 degrees, 11 degrees, and 14 degrees, and separated by 0.3 degrees. Both inversion and plantar flexion movements were tested. Discrimination of the extent of inversion movement was observed to decline linearly with increasing depth; however, for plantar flexion, the discrimination function for movement extent was found to be non-linear. The relatively better discrimination of plantar flexion movements than inversion movements at around 11 degrees from horizontal is interpreted as an effect arising from differential amounts of practice through use, because this position is associated with the plantar flexion movement made in normal walking. The fact that plantar flexion movements are discriminated better than inversion at one region but not others argues against accounts of superior proprioceptive sensitivity for plantar flexion compared to inversion that are based on general properties of plantar flexion such as the number of muscle fibres on stretch.

  16. Mechanical power of ankle plantar flexion and subjective pain by monophasic electrical stimulation.

    PubMed

    Suzuki, Tatsuto; Watanabe, Takashi; Saura, Ryuichi; Uchiyama, Hironobu

    2011-01-01

    The aim of this study was to investigate the mechanical power of the ankle plantar flexion. The investigated power of the ankle plantar flexion would help to improve effectively the FES walking system using the ankle plantar flexion for patients and aged people in slow walking. The subjective pain by electrical stimulation sometimes becomes the burden to use the FES system. We also investigated the relationship between the mechanical power in ankle plantar flexion by electrical stimulation and the subjective pain. We developed the device to measure the ankle movement by electrical stimulation against load resistance torque. The device consisted of pads to support a single lower leg, a rotational footplate with a large pulley and a vertical weight to generate the load resistance torque, and a monophasic electrical stimulator via surface electrodes. Our results showed the proportional relationship between the mechanical power of the ankle plantar flexion and the subjective pain by electrical stimulation. To generate the same level in the ankle plantar flexor power 2.75 W under the maximum voluntary exertion, the subjective pain by electrical stimulation exceeded 70, which means the feeling of crying at the Face Pain Scale. This result would help the better design of the FES walking system using the ankle plantar flexion for patients and aged people.

  17. High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease)

    PubMed Central

    2012-01-01

    Background Plantar fibromatosis is a benign disease creating nodules on the medial plantar side of affected patients. While surgical removal is regarded as the therapeutic mainstay, recurrence rates and impairment of daily activities remains substantial. High-energy focussed extracorporeal shockwave therapy has been suggested to be potentially effective in plantar fibromatosis in terms of pain reduction. Hypothesis High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis. Findings A total number of six patients (5 males, 58±4 years) were included with plantar fibromatosis (Ledderhose’s disease) associated with pain. Three patients were operated on previously, one had concomitant Dupuytren’s contracture. High-energy focussed ESWT was applied using a Storz Duolith SD1 (2000 impulses, 3 Hz, 1.24 mJ/mm2) in two sessions with 7 days between. Pain was 6±2 at baseline, 2±1 after 14 days and 1±1 after 3 months. Softening of the nodules was noted by all patients. No adverse effects were noted. Conclusions High-energy focussed extracorporeal shockwave energy reduces pain in painful plantar fibromatosis (Morbus Ledderhose). Further large-scale prospective trials are warranted to elucidate the value of high-energy focussed extracorporeal shockwave therapy (ESWT) in plantar fibromatosis in terms of recurrence and efficacy. PMID:23031080

  18. Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review.

    PubMed

    Huffer, Dean; Hing, Wayne; Newton, Richard; Clair, Mike

    2017-03-01

    The aim was to critically evaluate the literature investigating strength training interventions in the treatment of plantar fasciitis and improving intrinsic foot musculature strength. A search of PubMed, CINHAL, Web of Science, SPORTSDiscus, EBSCO Academic Search Complete and PEDRO using the search terms plantar fasciitis, strength, strengthening, resistance training, intrinsic flexor foot, resistance training. Seven articles met the eligibility criteria. Methodological quality was assessed using the modified Downs and Black checklist. All articles showed moderate to high quality, however external validity was low. A comparison of the interventions highlights significant differences in strength training approaches to treating plantar fasciitis and improving intrinsic strength. It was not possible to identify the extent to which strengthening interventions for intrinsic musculature may benefit symptomatic or at risk populations to plantar fasciitis. There is limited external validity that foot exercises, toe flexion against resistance and minimalist running shoes may contribute to improved intrinsic foot musculature function. Despite no plantar fascia thickness changes being observed through high-load plantar fascia resistance training there are indications that it may aid in a reduction of pain and improvements in function. Further research should use standardised outcome measures to assess intrinsic foot musculature strength and plantar fasciitis symptoms.

  19. Achilles tendon and plantar fascia in recently diagnosed type II diabetes: role of body mass index.

    PubMed

    Abate, Michele; Schiavone, Cosima; Di Carlo, Luigi; Salini, Vincenzo

    2012-07-01

    Previous research has shown that plantar fascia and Achilles tendon thickness is increased in diabetes. The aims of present study were to assess whether tendon changes can occur in the early stages of the disease and to evaluate the extent of the influence of body mass index (BMI). The study population included 51 recent-onset type II diabetic subjects, who were free from diabetic complications, divided according to BMI into three groups (normal weight, overweight, and obese). Eighteen non-diabetic, normal-weight subjects served as controls. Plantar fascia and Achilles tendon thickness was measured by means of sonography. The groups were well balanced for age and sex. In all the diabetic subjects, plantar fascia and Achilles tendon thickness was increased compared to the controls (p < 0.001, p = 0.01, p = 0.003, respectively). A significant relationship was found between plantar fascia thickness and BMI values (r = 0.749, p < 0.0001), while the correlation between BMI and Achilles tendon was weaker (r = 0.399, p = 0.004). This study shows that plantar fascia and Achilles tendon thickness is increased in the early stages of type II diabetes and that BMI is related more to plantar fascia than Achilles tendon thickness. Further longitudinal studies are needed to evaluate whether these early changes can overload the metatarsal heads and increase the stress transmitted to plantar soft tissues, thus representing an additional risk factor for foot ulcer development.

  20. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.

    PubMed

    Sato, Tomoya; Ichioka, Shigeru

    2016-01-01

    Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot.

  1. Plantar flexor moment arm and muscle volume predict torque-generating capacity in young men.

    PubMed

    Baxter, Josh R; Piazza, Stephen J

    2014-03-01

    Muscle volume is known to correlate with maximal joint torque in humans, but the role of muscle moment arm in determining maximal torque is less clear. Moderate correlations have been reported between maximal isometric knee extensor torque and knee extensor moment arm, but no such observations have been made for the ankle joint. It has been suggested that smaller muscle moment arms may enhance force generation at high rates of joint rotation, but this has not yet been observed for ankle muscles in vivo. The purpose of the present study was to correlate plantar flexor moment arm and plantar flexor muscle volume with maximal plantar flexor torque measured at different rates of plantar flexion. Magnetic resonance imaging was used to quantify the plantar flexor moment arm and muscle volume of the posterior compartment in 20 healthy young men. Maximal plantar flexor torque was measured isometrically and at three plantar flexion speeds using an isokinetic dynamometer. Plantar flexor torque was significantly correlated with muscle volume (0.222 < R(2) < 0.322) and with muscle moment arm at each speed (0.323 < R(2) < 0.494). While muscle volume was strongly correlated with body mass and stature, moment arm was not. The slope of the torque-moment arm regression line decreased as the rate of joint rotation increased, indicating that subjects with small moment arms experienced smaller reductions in torque at high speeds. The findings of this study suggest that plantar flexor moment arm is a determinant of joint strength that is at least as important as muscle size.

  2. 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

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

    PubMed

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

    2011-02-01

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

  4. The most temperature-adapted corals have an Achilles' Heel.

    PubMed

    Purkis, S J; Renegar, D A; Riegl, B M

    2011-02-01

    The corals of the Persian/Arabian Gulf are better adapted to temperature fluctuations than elsewhere in the Indo-Pacific. The Gulf is an extreme marine environment displaying the highest known summer water temperatures for any reef area. The small and shallow sea can be considered a good analogue to future conditions for the rest of the world's oceans under global warming. The fact that corals can persist in such a demanding environment indicates that they have been able to acclimatize and selectively adapt to elevated temperature. The implication being that colonies elsewhere may be able to follow suit. This in turn provides hope that corals may, given sufficient time, similarly adapt to survive even in an impoverished form, under conditions of acidification-driven lowering of CaCO₃ saturation state, a further consequence of raised atmospheric CO₂. This paper demonstrates, however, that the uniquely adapted corals of the Gulf may, within the next three centuries, be threatened by a chronic habitat shortage brought about by the dissolution of the lithified seabed on which they rely for colonisation. This will occur due to modifications in the chemical composition of the Gulf waters due to climate change.

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

    PubMed

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

    2015-01-01

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

  6. Impact of the difference in the plantar flexor strength of the ankle joint in the affected side among hemiplegic patients on the plantar pressure and walking asymmetry.

    PubMed

    You, Young Youl; Chung, Sin Ho; Lee, Hyung Jin

    2016-11-01

    [Purpose] This study was to examine the changes in the gait lines and plantar pressures in static and dynamic circumstances, according to the differences in the strengths of the plantar flexors in the ankle joints on the affected sides of hemiplegic patients, and to determine their impacts on walking symmetry. [Subjects and Methods] A total of thirty hospitalized stroke patients suffering from hemiplegia were selected in this study. The subjects had ankylosing patterns in the ankle joints of the affected sides. Fifteen of the patients had plantar flexor manual muscle testing scores between poor and fair, while fifteen of the patients had zero and trace. [Results] The contact pattern of the plantar surface with the ground is a reliable method for walking analysis, which is an important index for understanding the ankle mechanism and the relationship between the plantar surface and the ground. [Conclusion] The functional improvement of patients with stroke could be supported through a verification of the analysis methods of the therapy strategy and walking pattern.

  7. Impact of the difference in the plantar flexor strength of the ankle joint in the affected side among hemiplegic patients on the plantar pressure and walking asymmetry

    PubMed Central

    You, Young Youl; Chung, Sin Ho; Lee, Hyung Jin

    2016-01-01

    [Purpose] This study was to examine the changes in the gait lines and plantar pressures in static and dynamic circumstances, according to the differences in the strengths of the plantar flexors in the ankle joints on the affected sides of hemiplegic patients, and to determine their impacts on walking symmetry. [Subjects and Methods] A total of thirty hospitalized stroke patients suffering from hemiplegia were selected in this study. The subjects had ankylosing patterns in the ankle joints of the affected sides. Fifteen of the patients had plantar flexor manual muscle testing scores between poor and fair, while fifteen of the patients had zero and trace. [Results] The contact pattern of the plantar surface with the ground is a reliable method for walking analysis, which is an important index for understanding the ankle mechanism and the relationship between the plantar surface and the ground. [Conclusion] The functional improvement of patients with stroke could be supported through a verification of the analysis methods of the therapy strategy and walking pattern. PMID:27942112

  8. A New Distal Arthrogryposis Syndrome Characterized by Plantar Flexion Contractures

    PubMed Central

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

    2011-01-01

    The distal arthrogryposis (DA) syndromes are a distinct group of disorders characterized by contractures of two or more different body areas. More than a decade ago, we revised the classification of DAs and distinguished several new syndromes. This revision has facilitated the identification of five genes (i.e., TNNI2, TNNT3, MYH3, MYH8, and TPM2) that encode components of the contractile apparatus of fast-twitch myofibers and cause DA syndromes. We now report the phenotypic features of a novel DA disorder characterized primarily by plantar flexion contractures in a large five-generation Utah family. Contractures of hips, elbows, wrists, and fingers were much milder though they varied in severity among affected individuals. All affected individuals had normal neurological examinations; electromyography and creatinine kinase levels were normal on selected individuals. We have tentatively labeled this condition distal arthrogryposis type 10 (DA10). PMID:17103435

  9. Differences in impulse distribution in patients with plantar fasciitis.

    PubMed

    Bedi, H S; Love, B R

    1998-03-01

    The impulse distribution based upon vertical foot-floor reaction forces and time under the fore-, mid-, and hindfoot was determined using Tekscan's F-Scan system. This was compared in 40 barefoot patients with long-standing plantar fasciitis with an equal number of normal subjects. The patient group tended to load the hind- and midfoot to a lesser extent than the control group. Consequently, a greater proportionate load was borne by the forefoot. This result was highly significant for both the midfoot (P < 0.001) and forefoot (P = 0.002) comparisons. An objective biomechanical method such as this may be useful as a diagnostic aid, to identify individuals predisposed to this condition, and for evaluating the efficacy of various treatment modalities.

  10. Mycobacterial pseudotumor of the plantar fascia: how common is it?

    PubMed

    Sideras, Panagiotis A; Heiba, Sherif; Machac, Josef; Hechtman, Jaclyn; Vatti, Sridhar

    2013-01-01

    Mycobacterial spindle cell pseudotumor (MSCP) is an extremely rare complication of mycobacterial infections. It has been reported to occur in various sites such as skin, lymph nodes, bone marrow, lungs, and spleen. This tumor-like lesion can be confused clinically as well as radiographically with dermatofibroma, nodular fasciitis, xanthogranuloma, and Kaposi's sarcoma. While this lesion is rare and has been previously reported to occur only in superficial skin, we emphasize its consideration and inclusion in the differential diagnoses when a deep soft tissue mass is complicated by symptoms of deep tissue infection secondary to abscess formation in immunocompromised hosts. Here, we present the clinical and radiologic findings of a case of MSCP involving the deep plantar sheaths.

  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. Extraction of mechanical properties of foot plantar tissues using ultrasound indentation associated with genetic algorithm.

    PubMed

    Ling, Hang-Yin; Choi, Pong-Chi; Zheng, Yong-ping; Lau, Kin-Tak

    2007-08-01

    This paper demonstrates the use of ultrasound indentation technique for estimating the mechanical properties of foot plantar tissues in virtue of the reconstruction of the force response using genetic algorithm (GA) from an indentation test based on a quasi-linear viscoelastic (QLV) model. The indentation test on the plantar tissues covering the right first metatarsal head of a normal subject was carried out to verify the feasibility of the GA for the extraction of the tissue properties. The QLV properties of the plantar tissues were determined by the GA with a fixed Poisson's ratio. Such results were then compared with those obtained using a classical optimization method. Moreover, the GA was further employed to simultaneously determine the QLV properties as well as the Poisson's ratio of the plantar tissues. The correlations between the QLV properties and the Poisson's ratio are discussed.

  13. Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine

    PubMed Central

    Tognetti, Linda; Fimiani, Michele; Rubegni, Pietro

    2015-01-01

    We report the case of a 37-year-old woman (phototype II) who presented at our outpatient clinic with a two-month history of hyperpigmented plantar macules. Medical history revealed that the patient had taken capecitabine in the past three months as adjuvant chemotherapy for recurrent breast cancer. Dermoscopic examination of the plantar macules showed parallel ridge pattern with pigmentation in the furrows without obliteration of eccrine gland apertures. Besides in acral melanoma, parallel ridge pattern can also be observed in benign plantar lesions, such as congenital or acquired acral nevi, subcorneal hemorrhage, dye-related pigmentation and drug-induced hyperpigmentation, especially in patients with phototypes III–VI. The few reported cases of capecitabine-induced hyperpigmentation have been associated with hand and foot syndrome in patients with phototypes IV–V and palmar as well as plantar involvement. PMID:26114058

  14. Atypical presentation of plantar fasciitis secondary to soft-tissue mass infiltration.

    PubMed

    Ng, A; Beegle, T; Rockett, A K

    2001-02-01

    This article describes a patient with plantar fascial pain who presented to the office of one of the authors. Physical examination and the patient's description of the history of symptoms revealed classic signs and symptoms of plantar fasciitis. The patient was treated with numerous conservative modalities, including ultrasound, nonsteroidal anti-inflammatory medications, trigger-point injections, over-the-counter orthoses, and stretching exercises. When the pain was not relieved by these conservative measures, magnetic resonance imaging of the area was performed. Visualization of the insertional area of the plantar fascia revealed a mass inferior to, as well as infiltrated into, the plantar fascia. Surgical excision of the lesion resulted in complete elimination of the patient's pain.

  15. Correction of Crossover Toe Deformity by Arthroscopically Assisted Plantar Plate Tenodesis.

    PubMed

    Lui, Tun Hing

    2016-12-01

    Plantar plate deficiency is the major pathology causing metatarsophalangeal joint instability. As the joint subluxates dorsally, the lumbrical is tethered at the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Plantar plate repair or reconstruction is a logical surgical treatment option. This can be performed through a dorsal or plantar approach. The purpose of this technical note is to report a minimally invasive technique of crossover toe deformity correction by suturing the plantar plate to the extensor tendon. It is indicated for symptomatic crossover toe deformity that is not responsive to nonsurgical treatment. It is contraindicated if the metatarsophalangeal joint is degenerated, destructed, or dislocated, or there is interdigital neuroma at the sides of the deformed toe, or the deformity is caused by bony deformities of the metatarsal head or the proximal phalanx.

  16. Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States.

    PubMed

    Fraser, John J; Glaviano, Neal R; Hertel, Jay

    2017-02-01

    Study Design Retrospective observational study. Background Plantar fasciitis is responsible for 1 million ambulatory patient care visits annually in the United States. Few studies have investigated practice patterns in the treatment of patients with plantar fasciitis. Objective To assess physical therapist utilization and employment of manual therapy and supervised rehabilitation in the treatment of patients with plantar fasciitis. Methods A retrospective review of the PearlDiver patient record database was used to evaluate physical therapist utilization and use of manual therapy and supervised rehabilitation in patients with plantar fasciitis between 2007 and 2011. An International Classification of Diseases code (728.71) was used to identify plantar fasciitis, and Current Procedural Terminology codes were used to identify evaluations (97001), manual therapy (97140), and rehabilitation services (97110, 97530, 97112). Results A total of 819 963 unique patients diagnosed with plantar fasciitis accounted for 5 739 737 visits from 2007 to 2011, comprising 2.7% of all patients in the database. Only 7.1% (95% confidence interval: 7.0%, 7.1%) of patients received a physical therapist evaluation. Of the 57 800 patients evaluated by a physical therapist (59.8% female), 50 382 (87.2% ± 0.4%) received manual therapy, with significant increases in utilization per annum. A large proportion (89.5% ± 0.4%) received rehabilitation following physical therapist evaluation. Conclusion Despite plantar fasciitis being a frequently occurring musculoskeletal condition, a small proportion of patients with plantar fasciitis were seen by physical therapists. Most patients who were evaluated by a physical therapist received manual therapy and a course of supervised rehabilitation as part of their plan of care. Level of Evidence Treatment, level 2a. J Orthop Sports Phys Ther 2017;47(2):49-55. doi:10.2519/jospt.2017.6999.

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

    PubMed Central

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

    2015-01-01

    [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. PMID:25729207

  18. 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

  19. How effective is acupuncture for reducing pain due to plantar fasciitis?

    PubMed Central

    Thiagarajah, Anandan Gerard

    2017-01-01

    INTRODUCTION Plantar fasciitis is a commonly seen outpatient condition that has numerous treatment modalities of varying degrees of efficacy. This systematic review aimed to determine the effectiveness of acupuncture in reducing pain caused by plantar fasciitis. METHODS Online literature searches were performed on the PubMed and Cochrane Library databases for studies on the use of acupuncture for pain caused by plantar fasciitis. Studies designed as randomised controlled trials and that compared acupuncture with standard treatments or had real versus sham acupuncture arms were selected. The Delphi list was used to assess the methodological quality of the studies retrieved. RESULTS Three studies that compared acupuncture with standard treatment and one study on real versus sham acupuncture were found. These showed that acupuncture significantly reduced pain levels in patients with plantar fasciitis, as measured on the visual analogue scale and the Plantar Fasciitis Pain/Disability Scale. These benefits were noted between four and eight weeks of treatment, with no further significant reduction in pain beyond this duration. Side effects were found to be minimal. CONCLUSION Although acupuncture may reduce plantar fasciitis pain in the short term, there is insufficient evidence for a definitive conclusion regarding its effectiveness in the longer term. Further research is required to strengthen the acceptance of acupuncture among healthcare providers. PMID:27526703

  20. Functional characteristics of the foot and plantar aponeurosis under tibiotalar loading.

    PubMed

    Sarrafian, S K

    1987-08-01

    Structurally the foot is equivalent to a twisted plate. The hindpart is located in the sagittal plane and the forepart in the transverse plane. The transition induced by the twist creates the transverse and the longitudinal arches. Under vertical loading of the foot plate by the tibiotalar column, compressive forces are created on the dorsum and tensile forces on the plantar aspect of the foot plate. The plantar aponeurosis acting as a tie-rod when under tension relieves the tensile forces from the plantar aspect of the foot plate. The increased tension in the plantar aponeurosis in the weightbearing position of the foot occurs with anterior flexion of the leg or with hyperextension of the toes. In the plantigrade position when vertical loading and external rotation are simultaneously applied by the tibiotalar column on the foot, the hindfoot and the midfoot are supinated, and the forefoot is pronated. The medial longitudinal arch is higher, the foot is shorter, and the plantar aponeurosis is relaxed. The foot is then more flexible. With vertical loading and simultaneous internal rotation, the hindfoot and the midfoot are pronated, and the forefoot is supinated. The medial longitudinal arch is lower, the foot is longer, and the plantar aponeurosis is tense. The foot is then more rigid and a better lever arm. Demonstrations are presented both in living and in anatomic dissections.

  1. 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.

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

    PubMed

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

    2016-06-01

    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 pointsFatigue does not increase foot pressuresEvery runner has a dominant foot where pressures are higher and that he/she favoursFoot pressures do not increase over the distance of a marathon run.

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

    PubMed

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

    2014-04-01

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

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

    PubMed

    Gaudreault, Nathaly; Gravel, Denis; Nadeau, Sylvie

    2009-06-01

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

  5. Can subjective comfort be used as a measure of plantar pressure in football boots?

    PubMed

    Okholm Kryger, Katrine; Jarratt, Vicky; Mitchell, Séan; Forrester, Steph

    2017-05-01

    Comfort has been shown to be the most desired football boot feature by players. Previous studies have shown discomfort to be related to increased plantar pressures for running shoes which, in some foot regions, has been suggested to be a causative factor in overuse injuries. This study examined the correlation between subjective comfort data and objective plantar pressure for football boots during football-specific drills. Eight male university football players were tested. Plantar pressure data were collected during four football-specific movements for each of three different football boots. The global and local peak pressures based on a nine-sectioned foot map were compared to subjective comfort measures recorded using a visual analogue scale for global discomfort and a discomfort foot map for local discomfort. A weak (rs = -0.126) yet significant (P < 0.05) correlation was shown between the peak plantar pressure experienced and the visual analogue scale rated comfort. The model only significantly predicted (P > 0.001) the outcome for two (medial and lateral forefoot) of the nine foot regions. Subjective comfort data is therefore not a reliable measure of increased plantar pressures for any foot region. The use of plantar pressure measures is therefore needed to optimise injury prevention when designing studded footwear.

  6. 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)

  7. 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.

  8. Association of force steadiness of plantar flexor muscles and postural sway during quiet standing by young adults.

    PubMed

    Oshita, Kazushige; Yano, Sumio

    2012-08-01

    This study was conducted to assess the relations of force fluctuations during isometric plantar-flexion and postural sway during quiet standing. Twelve healthy men (M age = 21 yr., SD = 1) performed unilateral plantar flexion measured by a strain gauge force transducer. Participants performed force-matching tasks; sustained plantar flexion for 20 sec. at levels corresponding to 10% and 20% of maximum voluntary contraction with the visual feedback. Also, participants were asked to stand quietly with their eyes open, and then the center of mass displacement and velocity in the anteroposterior were measured. In analysis, postural sway was associated with force fluctuation at only 10% of maximum voluntary contraction. The statistically significant correlation between variables was found only at corresponding contraction intensities for plantar-flexor muscles. From this one may infer neural strategies in plantar-flexor muscles during quiet standing may be characteristics similar to those controlling the plantar-flexion force in young adults.

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

    PubMed

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

    2013-03-01

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

  10. 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

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

    PubMed

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

    2005-12-01

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

  12. The comparison of manual lymph drainage and ultrasound therapy on the leg swelling caused by wearing high heels.

    PubMed

    Lee, Dong-Yeop; Han, Ji-Su; Jang, Eun-Ji; Seo, Dong-Kwon; Hong, Ji-Heon; Lee, Sang-Sook; Lee, Dong-Geol; Yu Lee, Jae-Ho

    2014-01-01

    One of the major symptoms when women are wearing high heels for a long time is leg swelling. The purpose of this study was to compare the effect of manual lymph drainage with ultrasound therapy. The forty-five healthy women of twenties were participated in this study and divided randomly into three groups; manual lymph drainage group (n=15), ultrasound therapy group (n=15) and control group (n=15). Swelling was measured before wearing the high heels (10 cm-height), after one-hour of wearing the high heels, wearing the high heels of one-hour after the intervention of 15 minutes. Also swelling was calculated by using a tape measure, volumeter and body composition analyzer. Statistical analysis of the comparison between the three groups was performed by one-way ANOVA. Also comparison to the mean value in swelling according to the time was performed by repeated measure ANOVA. As the result of this study, a significant changes have emerged within each of manual lymph drainage, ultrasound therapy and control group (p< 0.05). However, there were no significant differences between each group (p> 0.05). But the mean value of manual lymph drainage group showed the tendency of fast recovering before causing swelling. Therefore, we consider that the clinical treatment of manual lymph drainage and ongoing studies will be made since manual lymph drainage is very effective in releasing the leg swelling caused by wearing high heels and standing for a long time at work.

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

    PubMed

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

    2004-10-01

    The rocker sole and solid-ankle cushion-heel (SACH) heels are the most commonly prescribed external shoe modification. Only a limited number of scientific evidence exists to support these interventions in clinical practice. The objective of this study was to determine the effects of rocker soles and SACH heels on kinematics during gait. In this study, we investigated the gait parameters during level walking, stair climbing and stair descending in healthy volunteers and assessed the effects of the modified shoes on the motion of the forefoot and hindfoot compared with the traditional shoes. Eleven normal subjects participated in this study. A six-camera motion analysis system was used to capture motion trajectories. The three-dimensional (3D) coordinates of the markers were used to calculate the angles of flexion-extension, valgus-varus, and internal-external rotation at the hindfoot and forefoot joints in a gait cycle by the custom software for foot kinematic analysis. The results showed that the rocker soles offer several advantages from the viewpoint of gait kinematics. The forefoot joint excursion in sagittal plane while wearing rocker shoes was significantly less than that while wearing traditional shoes during level walking, stair climbing and stair descending. It means that they could mimic the action of the forefoot joint, aid in roll off, and simulate forefoot dorsiflexion. Since the bony structures mechanically link the forefoot joint and hindfoot joint to a triplanar axis of motion, they could be used whenever there is minimal or no motion at the forefoot joint or hindfoot joint, because of, for example, fusion, fracture, cast immobilization, orthosis design, pain, or arthritis.

  14. 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

  15. The effect of melody on the physiological responses of heel sticks pain in neonates

    PubMed Central

    Marofi, Maryam; Nikobakht, Farzaneh; Badiee, Zohreh; Golchin, Mehri

    2015-01-01

    Background: During health care in the neonatal intensive care unit (NICU), infants undergo extremely painful procedures, which may cause problems, if not controlled, such as changes in the pattern of respiratory rate, heart rate, and blood oxygen saturation. The present study aimed to find the effect of melody on the physiological responses of neonates’ heel stick pain. Materials and Methods: This quasi-experimental study was conducted in Alzahra Hospital (Isfahan, Iran) for 5 months. Fifty infants were selected through convenient sampling method and were randomly assigned in equal numbers to two groups (n = 25). In the melody group (intervention), a selected melody was played for the infants at a distance of 1 m from them, with a sound intensity of 65 dB, from 3 minutes before, during, and after the heel stick procedure, respectively, and their physiological responses were observed with a monitoring system and recorded at the afore-mentioned time periods. Physiological responses were also recorded in the control group (no intervention) 3 min before, during, and after the heel stick procedure, respectively. Results: Means of respiratory and pulse rates in the melody and control groups showed a significant difference at different time points. But the mean blood oxygen saturation in the melody group showed no significant difference at different time points, although the difference was significant in the control group. Conclusions: The results showed that melody could maintain more balance in some physiological responses of infants, such as the respiratory rate and pulse rate during the Guthrie test. Therefore, melody is recommended to be used to prevent the destructive effects of pain in infants during painful procedures. PMID:26120343

  16. 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.

  17. In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners.

    PubMed

    Tessutti, Vitor; Trombini-Souza, Francis; Ribeiro, Ana Paula; Nunes, Ana Luiza; Sacco, Isabel de Camargo Neves

    2010-01-01

    The type of surface used for running can influence the load that the locomotor apparatus will absorb and the load distribution could be related to the incidence of chronic injuries. As there is no consensus on how the locomotor apparatus adapts to loads originating from running surfaces with different compliance, the objective of this study was to investigate how loads are distributed over the plantar surface while running on natural grass and on a rigid surface--asphalt. Forty-four adult runners with 4+/-3 years of running experience were evaluated while running at 12 km/h for 40 m wearing standardised running shoes and Pedar insoles (Novel). Peak pressure, contact time and contact area were measured in six regions: lateral, central and medial rearfoot, midfoot, lateral and medial forefoot. The surfaces and regions were compared by three ANOVAS (2 x 6). Asphalt and natural grass were statistically different in all variables. Higher peak pressures were observed on asphalt at the central (p<0.001) [grass: 303.8(66.7)kPa; asphalt: 342.3(76.3)kPa] and lateral rearfoot (p<0.001) [grass: 312.7(75.8)kPa; asphalt: 350.9(98.3)kPa] and lateral forefoot (p<0.001) [grass: 221.5(42.9)kPa; asphalt: 245.3(55.5)kPa]. For natural grass, contact time and contact area were significantly greater at the central rearfoot (p<0.001). These results suggest that natural grass may be a surface that provokes lighter loads on the rearfoot and forefoot in recreational runners.

  18. 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

  19. Is there an association between the use of heeled footwear and schizophrenia?

    PubMed

    Flensmark, Jarl

    2004-01-01

    Existing etiological and pathogenetical theories of schizophrenia have only been able to find support in some epidemiological, clinical, and pathophysiological facts. A selective literature review and synthesis is used to present a hypothesis that finds support in all facts and is contradicted by none. Heeled footwear began to be used more than a 1000 years ago, and led to the occurrence of the first cases of schizophrenia. Industrialization of shoe production increased schizophrenia prevalence. Mechanization of the production started in Massachusetts, spread from there to England and Germany, and then to the rest of Western Europe. A remarkable increase in schizophrenia prevalence followed the same pattern. In Baden in Germany the increasing stream of young patients more or less hastily progrediating to a severe state of cognitive impairment made it possible for Kraepelin to delineate dementia praecox as a nosological entity. The patients continued to use heeled shoes after they were admitted to the hospitals and the disease progrediated. High rates of schizophrenia are found among first-generation immigrants from regions with a warmer climate to regions with a colder climate, where the use of shoes is more common. Still higher rates among second-generation immigrants are caused by the use of shoes during the onset of walking at an age of about 11-12 months. Other findings point to the importance of this in the later development of schizophrenia. A child born in January-March begins to walk in December-March, when it's cold outside and the chances of going barefoot are smaller. They are also smaller in urban settings. During walking synchronised stimuli from mechanoreceptors in the lower extremities increase activity in cerebello-thalamo-cortico-cerebellar loops through their action on NMDA-receptors. Using heeled shoes leads to weaker stimulation of the loops. Reduced cortical activity changes dopaminergic function which involves the basal ganglia

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

    PubMed Central

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

    1996-01-01

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

  1. 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.

  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. 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.

  4. Appropriateness of plantar pressure measurement devices: a comparative technical assessment.

    PubMed

    Giacomozzi, Claudia

    2010-05-01

    Accurate plantar pressure measurements are mandatory in both clinical and research contexts. Differences in accuracy, precision and reliability of the available devices have prevented so far the onset of standardization processes or the definition of reliable reference datasets. In order to comparatively assess the appropriateness of the most used pressure measurement devices (PMD) on-the-market, in 2006 the Institute the author is working for approved a two-year scientific project aimed to design, validate and implement dedicated testing methods for both in-factory and on-the field assessment. A first testing phase was also performed which finished in December 2008. Five commercial PMDs using different technologies-resistive, elastomer-based capacitive, air-based capacitive-were assessed and compared with respect to absolute pressure measurements, hysteresis, creep and COP estimation. The static and dynamic pressure tests showed very high accuracy of capacitive, elastomer-based technology (RMSE<0.5%), and quite a good performance of capacitive, air-based technology (RMSE<5%). High accuracy was also found for the resistive technology by TEKSCAN (RMSE<2.5%), even though a complex ad hoc calibration was necessary.

  5. Operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis.

    PubMed

    Conflitti, Joseph M; Tarquinio, Thom A

    2004-07-01

    A retrospective review was conducted of 23 patients (26 feet) to assess operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis. Nonsurgical treatment was implemented in all patients with no relief of symptoms (average 20.8 months) prior to surgery. Using a visual analog pain scale (0-10), the average preoperative pain was 9.2 (range, 8-10). Prior to surgery, 65.2% of patients had severe limitations of activity, and 34.8% of patients had moderate limitations of activity. An average 25.3-month follow-up (range, 8-51) was performed by telephone interview. Average postoperative pain decreased to 1.7 using the same visual analog scale. Thirteen patients (57%) had no functional limitations postoperatively and nine patients (39%) had minimal functional limitations postoperatively. One patient (4%) had moderate functional limitations postoperatively. Twenty patients (87%) were completely satisfied with the surgery, two patients (9%) were satisfied with reservations, and one patient (4%) was unsatisfied with the surgery. The average period before return to work or daily activities was 1.5 months. Two patients had minor complications of partial wound dehiscence that healed uneventfully and mild dorsal midfoot pain which required temporary use of a boot walker. While the majority of patients with plantar fasciitis can be managed with nonoperative treatment, those patients with recalcitrant plantar fasciitis can be effectively treated with partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle.

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

    PubMed

    Kogler, G F; Solomonidis, S E; Paul, J P

    1996-07-01

    OBJECTIVE: The purpose of this investigation was to quantify the longitudinal arch support properties of several types of foot orthosis. DESIGN: An in vitro method that simulated 'static stance' was used to determine arch support capabilities, with plantar aponeurosis strain implemented as the performance measure. BACKGROUND: A longitudinal arch support mechanism of an orthosis resists depression of the foot's arches by transferring a portion of the load to the medial structures of the foot. Since the plantar aponeurosis is in tension when the foot is loaded, a quantifiable decrease in strain should occur with an adequate orthotic arch control mechanism. METHODS: A differential variable reluctance transducer was surgically implanted in the plantar aponeurosis of cadaveric donor limb feet (n = 7). Each specimen was mounted in an electromechanical test machine which applied a load of up to 900 N axially to the tibia. The test schedule was divided into seven test conditions: specimen barefoot; specimen with shoe and specimen with shoe and five different orthoses. RESULTS: The University of California Biomechanics Laboratory Shoe Insert and two other foot orthoses significantly decreased the strain in the plantar aponeurosis compared to the barefoot control and were considered effective arch supports (P < 0.05). The functional foot orthosis, stock orthosis, and test shoe did not effectively reduce plantar aponeurosis strain. Significant variations of time required to achieve the specified load levels were recorded among the test conditions, indicating the relative cushioning properties of the shoe/orthosis systems. CONCLUSIONS: The patterns of plantar aponeurosis strain observed in cadaveric tests suggest that certain types of orthoses are more effective than others in the support of the foot's longitudinal arches. It is suggested that to support the longitudinal arches of the foot effectively the medial surface contours of the orthosis must stabilize the apical bony

  7. Heel Pain

    MedlinePlus

    ... the muscles and ligaments of the foot, by stretching of the long band of tissue that connects ... inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching ...

  8. Cracked Heels

    MedlinePlus

    ... foot and ankle surgeons. All Fellows of the College are board certified by the American Board of Foot and Ankle Surgery. Copyright © 2017 American College of Foot and Ankle Surgeons (ACFAS), All Rights ...

  9. Influence of shoe midsole hardness on plantar pressure distribution in four basketball-related movements.

    PubMed

    Lam, Wing-Kai; Ng, Wei Xuan; Kong, Pui Wah

    2017-01-01

    This study examined how shoe midsole hardness influenced plantar pressure in basketball-related movements. Twenty male university basketball players wore customized shoes with hard and soft midsoles (60 and 50 Shore C) to perform four movements: running, maximal forward sprinting, maximal 45° cutting and lay-up. Plantar loading was recorded using an in-shoe pressure measuring system, with peak pressure (PP) and pressure time integral (PTI) extracted from 10 plantar regions. Compared with hard shoes, subjects exhibited lower PP in one or more plantar regions when wearing the soft shoes across all tested movements (Ps < 0.05). Lower PTI was also observed in the hallux for 45° cutting, and the toes and forefoot regions during the first step of lay-up in the soft shoe condition (Ps < 0.05). In conclusion, using a softer midsole in the forefoot region may be a plausible remedy to reduce the high plantar loading experienced by basketball players.

  10. 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.

  11. 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.

  12. Effect of repeated doses of sucrose during heel stick procedure in preterm neonates.

    PubMed

    Johnston, C C; Stremler, R; Horton, L; Friedman, A

    1999-03-01

    The purpose of this randomized clinical trial was to test the efficacy of repeated versus single dose sucrose to decrease pain from routine heel stick procedures in preterm neonates. Infants (n = 48) in the first week of life with a mean gestational age of 31 weeks received 0.05 ml of 24% sucrose solution or sterile water by mouth (1) 2 min prior to actual lancing of the heel; (2) just prior to lancing, and (3) 2 min after lancing. The single-dose group received sucrose for the first dose and water for the second and third dose; the repeated-dose group received sucrose three times, and the placebo group received only water. The Premature Infant Pain Profile (PIPP) scores were obtained for five 30-second blocks from lancing. Both sucrose groups had lower PIPP scores (single sucrose pain scores, 6.8-8.2, p = 0.07; repeated sucrose pain scores, 5.3-6. 2, p < 0.01) than water (pain scores 7.9-9.1), and in the last block, the repeated dose had lower scores than the single dose (6.2 vs. 8. 2, p < 0.05).

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

    PubMed

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

    2012-01-01

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

  14. Constitutive modeling of time-dependent response of human plantar aponeurosis.

    PubMed

    Pavan, P G; Pachera, P; Stecco, C; Natali, A N

    2014-01-01

    The attention is focused on the viscoelastic behavior of human plantar aponeurosis tissue. At this purpose, stress relaxation tests were developed on samples taken from the plantar aponeurosis of frozen adult donors with age ranging from 67 to 78 years, imposing three levels of strain in the physiological range (4%, 6%, and 8%) and observing stress decay for 240 s. A viscohyperelastic fiber-reinforced constitutive model with transverse isotropy was assumed to describe the time-dependent behavior of the aponeurotic tissue. This model is consistent with the structural conformation of the tissue where collagen fibers are mainly aligned with the proximal-distal direction. Constitutive model fitting to experimental data was made by implementing a stochastic-deterministic procedure. The stress relaxation was found close to 40%, independently of the level of strain applied. The agreement between experimental data and numerical results confirms the suitability of the constitutive model to describe the viscoelastic behaviour of the plantar aponeurosis.

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

    PubMed

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

    2014-01-01

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

  16. Calcaneal osteomyelitis following steroid injection for plantar fasciitis: a case report.

    PubMed

    Wronka, Konrad Sebastian; Sinha, Amit

    2012-08-01

    This study reports a case of a 57-year-old woman diabetic patient who presented to the authors' institution with signs and symptoms typical of plantar fasciitis. Her condition did not resolve with nonsteroidal anti-inflammatory drug therapy, podiatry, and physiotherapy input and she was given a steroid injection for treatment of plantar fasciitis. She was admitted to the hospital 17 days following injection with signs of acute infection. Diagnostic workup revealed an acute calcaneal osteomyelitis. Infection did not respond to conservative treatment and the patient required a partial calcanectomy. This case highlights the significant risk of steroid injection in plantar fasciitis, especially in diabetic patient. The authors urge surgeons to consider this when obtaining consent for injection and they advise very close follow-up of such patients.

  17. A penetrating nail-prick injury of the lateral plantar artery leading to pseudo-aneurysm formation and rupture.

    PubMed

    Şişli, Emrah; Hasde, Ali İhsan; Mavi, Mustafa; Dursun, Suat

    2014-08-23

    Pseudo-aneurysm in the plantar region is so rare that there are only sporadic case reports in the literature. The aetiology is usually either iatrogenic or stepping on a piece of glass. In comparison to the medial plantar artery, the lateral plantar artery is the most common arterial structure injured in the plantar region due to its more superficial course and it being less protected by the surrounding structures. With variable presentation and different time intervals from injury to diagnosis, the mechanism and penetration depth of the injury is thought to have a major impact on the formation of a pseudo-aneurysm. The aims of this article were to present a case of a lateral plantar artery injury after stepping on a construction nail, leading to pseudo-aneurysm formation and rupture, and to review the literature with regard to the clinical characteristics of these rare and overlooked cases.

  18. 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.

  19. 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

  20. 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.

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

    PubMed Central

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

    2008-01-01

    Background Skin-to-skin contact, or kangaroo mother care (KMC) has been shown to be efficacious in diminishing pain response to heel lance in full term and moderately preterm neonates. The purpose of this study was to determine if KMC would also be efficacious in very preterm neonates. Methods Preterm neonates (n = 61) between 28 0/7 and 31 6/7 weeks gestational age in three Level III NICU's in Canada comprised the sample. A single-blind randomized crossover design was employed. In the experimental condition, the infant was held in KMC for 15 minutes prior to and throughout heel lance procedure. In the control condition, the infant was in prone position swaddled in a blanket in the incubator. The primary outcome was the Premature Infant Pain Profile (PIPP), which is comprised of three facial actions, maximum heart rate, minimum oxygen saturation levels from baseline in 30-second blocks from heel lance. The secondary outcome was time to recover, defined as heart rate return to baseline. Continuous video, heart rate and oxygen saturation monitoring were recorded with event markers during the procedure and were subsequently analyzed. Repeated measures analysis-of-variance was employed to generate results. Results PIPP scores at 90 seconds post lance were significantly lower in the KMC condition (8.871 (95%CI 7.852–9.889) versus 10.677 (95%CI 9.563–11.792) p < .001) and non-significant mean differences ranging from 1.2 to1.8. favoring KMC condition at 30, 60 and 120 seconds. Time to recovery was significantly shorter, by a minute(123 seconds (95%CI 103–142) versus 193 seconds (95%CI 158–227). Facial actions were highly significantly lower across all points in time reaching a two-fold difference by 120 seconds post-lance and heart rate was significantly lower across the first 90 seconds in the KMC condition. Conclusion Very preterm neonates appear to have endogenous mechanisms elicited through skin-to-skin maternal contact that decrease pain response, but not as

  2. Management of pain from heel lance with lidocaine-prilocaine (EMLA) cream: is it safe and efficacious in preterm infants?

    PubMed

    Stevens, B; Johnston, C; Taddio, A; Jack, A; Narciso, J; Stremler, R; Koren, G; Aranda, J

    1999-08-01

    Hospitalized preterm infants undergo multiple painful heel lances. A two-phase, randomized, controlled trial was undertaken to determine the safety and efficacy of lidocaine-prilocaine 5% cream (EMLA, Astra Pharmaceuticals, L.P, Westborough, MA) for relieving pain from heel lance. One hundred twenty infants were randomly assigned to receive 0.5 g of EMLA or placebo cream for 30 minutes (Phase 1) or 60 minutes (Phase 2) before a routine heel lance. Efficacy was assessed using the Premature Infant Pain Profile (PIPP). Safety was determined by methemoglobin concentration 8 hours after EMLA application and by clinical signs of methemoglobinemia. No significant differences existed on PIPP scores between EMLA and placebo groups in Phase 1 (p < .480) or Phase 2 (p < .831). No infant had any clinical signs of methemoglobinemia. The mean methemoglobin concentration was 1.19% (.47). Approximately 10% of infants had minor skin reactions, and approximately 20% of EMLA-treated infants had blanching at the application site. The authors conclude that EMLA is safe but not efficacious for relieving pain from heel lance in preterm infants.

  3. Partial Heel Pad Avulsion with Open Calcaneal Tuberosity Fracture with Tendo-achilles Rupture: A Case Report

    PubMed Central

    Ahmed, Shameem; Ifthekar, Syed; Ahmed Khan, R Pathan Rameez; Ranjan, Rahul

    2016-01-01

    Introduction: The management of heel pad avulsion injuries has been challenging because of the precarious blood supply. The difficulties get compounded when it is associated with tendo-achilles rupture and calcaneal fracture. Here, it is a description of a case with the above features managed with a unique technique. Case Report: A 63-year-old woman presented to casualty with injury to right ankle after a road traffic accident. On clinical and radiological examination, there was avulsion of heel pad with calcaneal tuberosity fracture and tendo-achilles rupture. It was managed with debridement of the wound, repair of tendo-achilles, and fixation of calcaneal tuberosity and heel pad. The functional outcome was assessed in terms of the ability of the patient to return to painless barefoot weight bearing. The uniqueness of this method is the combined use of suture material (Ethibond) and stainless steel (cannulated cancellous screws [CCS]), by tying the Ethibond from tendo-achilles to the head of CCS rather than bone. When the CCS were tightened, two things were achieved; one being the reduction of the fracture and the second to bring a good apposition of tendo-achilles with the calcaneum. As this method worked on tension band principle and Ethibond was used instead of stainless steel wire, if no objections, this technique can be called as “soft tension band technique.” Conclusion: This case report illustrates a method of preserving heel pad when it is viable along with definitive treatment of associated soft tissue and bony injuries by a simple technique. This method has described the fixation of open fracture of calcaneal tuberosity with tendo-achilles rupture with heel pad avulsion in one sitting with excellent clinical results. PMID:27299125

  4. Does shoe heel design influence ground reaction forces and knee moments during maximum lunges in elite and intermediate badminton players?

    PubMed Central

    Cheung, Jason Tak-Man; Ryu, Jiseon

    2017-01-01

    Background Lunge is one frequently executed movement in badminton and involves a unique sagittal footstrike angle of more than 40 degrees at initial ground contact compared with other manoeuvres. This study examined if the shoe heel curvature design of a badminton shoe would influence shoe-ground kinematics, ground reaction forces, and knee moments during lunge. Methods Eleven elite and fifteen intermediate players performed five left-forward maximum lunge trials with Rounded Heel Shoe (RHS), Flattened Heel Shoe (FHS), and Standard Heel Shoes (SHS). Shoe-ground kinematics, ground reaction forces, and knee moments were measured by using synchronized force platform and motion analysis system. A 2 (Group) x 3 (Shoe) ANOVA with repeated measures was performed to determine the effects of different shoes and different playing levels, as well as the interaction of two factors on all variables. Results Shoe effect indicated that players demonstrated lower maximum vertical loading rate in RHS than the other two shoes (P < 0.05). Group effect revealed that elite players exhibited larger footstrike angle, faster approaching speed, lower peak horizontal force and horizontal loading rates but higher vertical loading rates and larger peak knee flexion and extension moments (P < 0.05). Analysis of Interactions of Group x Shoe for maximum and mean vertical loading rates (P < 0.05) indicated that elite players exhibited lower left maximum and mean vertical loading rates in RHS compared to FHS (P < 0.01), while the intermediate group did not show any Shoe effect on vertical loading rates. Conclusions These findings indicate that shoe heel curvature would play some role in altering ground reaction force impact during badminton lunge. The differences in impact loads and knee moments between elite and intermediate players may be useful in optimizing footwear design and training strategy to minimize the potential risks for impact related injuries in badminton. PMID:28334016

  5. Chronic spinal infusion of loperamide alleviates postsurgical pain in rats.

    PubMed

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

    2014-04-01

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

  6. 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.

  7. 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.

  8. 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…

  9. 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

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

    PubMed

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

    2014-01-01

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

  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. A quantitative index for classification of plantar thermal changes in the diabetic foot

    NASA Astrophysics Data System (ADS)

    Hernandez-Contreras, D.; Peregrina-Barreto, H.; Rangel-Magdaleno, J.; Gonzalez-Bernal, J. A.; Altamirano-Robles, L.

    2017-03-01

    One of the main complications caused by diabetes mellitus is the development of diabetic foot, which in turn, can lead to ulcerations. Because ulceration risks are linked to an increase in plantar temperatures, recent approaches analyze thermal changes. These approaches try to identify spatial patterns of temperature that could be characteristic of a diabetic group. However, this is a difficult task since thermal patterns have wide variations resulting on complex classification. Moreover, the measurement of contralateral plantar temperatures is important to determine whether there is an abnormal difference but, this only provides information when thermal changes are asymmetric and in absence of ulceration or amputation. Therefore, in this work is proposed a quantitative index for measuring the thermal change in the plantar region of participants diagnosed diabetes mellitus regards to a reliable reference (control) or regards to the contralateral foot (as usual). Also, a classification of the thermal changes based on a quantitative index is proposed. Such classification demonstrate the wide diversity of spatial distributions in the diabetic foot but also demonstrate that it is possible to identify common characteristics. An automatic process, based on the analysis of plantar angiosomes and image processing, is presented to quantify these thermal changes and to provide valuable information to the medical expert.

  13. Controlling Posture and Vergence Eye Movements in Quiet Stance: Effects of Thin Plantar Inserts.

    PubMed

    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.

  14. 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.

  15. Plantar Pressure Distribution among Older Persons with Different Types of Foot and Its Correlation with Functional Reach Distance

    PubMed Central

    2016-01-01

    Background. Changes in biomechanical structures of human foot are common in the older person, which may lead to alteration of foot type and plantar pressure distribution. We aimed to examine how foot type affects the plantar pressure distribution and to determine the relationship between plantar pressure distribution and functional reach distance in older persons. Methods. Fifty community-dwelling older persons (age: 69.98 ± 5.84) were categorized into three groups based on the Foot Posture Index. The plantar pressure (max⁡P) and contact area were analyzed using Footscan® RSScan platform. The Kruskal-Wallis test was used to compare the plantar pressure between foot types and Spearman's correlation coefficient was used to correlate plantar pressure with the functional reach distance. Results. There were significant differences of max⁡P in the forefoot area across all foot types. The post hoc analysis found significantly lower max⁡P in the pronated foot compared to the supinated foot. A high linear rank correlation was found between functional reach distance and max⁡P of the rearfoot region of the supinated foot. Conclusions. These findings suggested that types of the foot affect the plantar maximal pressure in older persons with functional reach distance showing some associations. PMID:27980874

  16. Blood pressure and calf muscle oxygen extraction during plantar flexion exercise in peripheral artery disease.

    PubMed

    Luck, J Carter; Miller, Amanda J; Aziz, Faisal; Radtka, John F; Proctor, David N; Leuenberger, Urs A; Sinoway, Lawrence I; Muller, Matthew D

    2017-04-06

    Peripheral artery disease (PAD) is an atherosclerotic vascular disease that affects 200 million worldwide. While PAD primarily affects large arteries, it is also associated with microvascular dysfunction, an exaggerated blood pressure (BP) response to exercise, and high cardiovascular mortality. We hypothesized that fatiguing plantar flexion exercise that evokes claudication elicits a greater reduction in skeletal muscle oxygenation (SmO2) and a higher rise in BP in PAD compared to age-matched healthy subjects, but low-intensity steady state plantar flexion elicits similar responses between groups. In the first experiment, eight PAD patients and eight healthy controls performed fatiguing plantar flexion exercise (from 0.5 to 7 kg for up to 14 min). In the second experiment, seven PAD patients and seven healthy controls performed low-intensity plantar flexion exercise (2.0 kg for 14 min). BP, heart rate (HR), and SmO2 from near-infrared spectroscopy (NIRS) were measured continuously. SmO2 is the ratio of oxygenated hemoglobin to total hemoglobin, expressed as a percent. At fatigue, PAD patients had a greater increase in mean arterial BP (18 ± 2 versus vs. 10 ± 2 mmHg, P = 0.029) and HR (14 ± 2 versus 6 ± 2 beats/min, P = 0.033) and a greater reduction in SmO2 (-54 ± 10 versus -12 ± 4 %, P = 0.001). However, both groups had similar physiological responses to low-intensity, non-painful plantar flexion exercise. These data suggest that PAD patients have altered oxygen uptake and/or utilization during fatiguing exercise coincident with an augmented BP response.

  17. The effect of transcutaneous electrical nerve stimulation on postural sway on fatigued dorsi-plantar flexor.

    PubMed

    Yu, JaeHo; Lee, SoYeon; Kim, HyongJo; Seo, DongKwon; Hong, JiHeon; Lee, DongYeop

    2014-01-01

    The application of transcutaneous electrical nerve stimulation (TENS) enhances muscle weakness and static balance by muscle fatigue. It was said that TENS affects decrease of the postural sway. On the other hand, the applications of TENS to separate dorsi-plantar flexor and the comparison with and without visual input have not been studied. Thus, the aim of this study was to compare the effects of TENS on fatigued dorsi-plantar flexor with and without visual input. 13 healthy adult males and 12 females were recruited and agreed to participate as the subject (mean age 20.5 ± 1.4, total 25) in this study after a preliminary research. This experiment was a single group repeated measurements design in three days. The first day, after exercise-induced fatigue, the standing position was maintained for 30 minutes and then the postural sway was measured on eyes open(EO) and eyes closed(EC). The second, TENS was applied to dorsi flexor in standing position for 30 minutes after conducting exercise-induced fatigue. On the last day, plantar flexor applied by TENS was measured to the postural sway on EO and EC after same exercise-induced fatigue. The visual input was not statistically difference between the groups. However, when compared of dorsi-plantar flexor after applied to TENS without visual input, the postural sway of plantar flexor was lower than the dorsi flexor (p< 0.05). As the result, the application of TENS in GCM clinically decreases the postural sway with visual input it helps to stable posture control and prevent to falling down.

  18. 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

  19. Oral baclofen increases maximal voluntary neuromuscular activation of ankle plantar flexors in children with spasticity due to cerebral palsy.

    PubMed

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

    2008-06-01

    Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. We tested voluntary ability to activate ankle plantar flexor muscles using the ratio of the surface electromyographic signal during isometric maximal voluntary contraction to the M-wave during supramaximal electrical stimulation of the tibial nerve and tested muscle strength using maximal isometric plantar flexion torque. Mean maximal voluntary neuromuscular activation increased from 1.13 +/- 1.02 to 1.60 +/- 1.30 ( P < .05) after treatment, corresponding to an increase in 9 of 10 subjects. Mean maximal plantar flexion torque did not change. We conjecture that antispasticity agents could facilitate strength training by increasing the ability to voluntarily activate muscle.

  20. The relation between bone mineral density in the heel and pixel intensity in the mandibular jaw bone among elderly women

    PubMed Central

    Hedström, L; Baigi, A; Bergh, H

    2010-01-01

    Objectives The purpose of this study was to investigate the correlation between pixel intensity (PI) in digital radiographs of the lower jaw and bone mineral density (BMD) in the heels of post-menopausal women (as measured with DXL, a combination of dual energy X-ray absorptiometry and lasers). Methods Two intraoral periapical digital radiographs were taken in the right and left mandible premolar region, and the digital images were analysed by a computer program (Dimaxis) regarding PI. As the radiographs were taken, the BMD of the patient's left heel was measured via a portable Calscan device. The patient answered a questionnaire concerning risk factors. The correlation between variables was analysed using statistical tests. Results A significant correlation was found between the PI in the left (P = 0.001) and right (P = 0.004) mandible and the BMD of the left heel for the whole group. A pronounced correlation was found to exist for women > 70 years old. Based on a cut-off value of the PI, to differentiate between healthy individuals and those who required further analysis for osteoporosis, the following values were obtained: sensitivity 0.74, specificity 0.50, positive predictive value 0.77 and negative predictive value 0.46. Conclusion A positive correlation was found between PI in digital radiographs of the mandible and the BMD of the heel. The low predictive value does not allow any definite conclusions to be drawn from the present study. A reasonable recommendation could be for future studies to employ a larger study population to explore the effect on this value. PMID:20841458

  1. The oscillatory behavior of the CoM facilitates mechanical energy balance between push-off and heel strike.

    PubMed

    Kim, Seyoung; Park, Sukyung

    2012-01-10

    Humans use equal push-off and heel strike work during the double support phase to minimize the mechanical work done on the center of mass (CoM) during the gait. Recently, a step-to-step transition was reported to occur over a period of time greater than that of the double support phase, which brings into question whether the energetic optimality is sensitive to the definition of the step-to-step transition. To answer this question, the ground reaction forces (GRFs) of seven normal human subjects walking at four different speeds (1.1-2.4 m/s) were measured, and the push-off and heel strike work for three differently defined step-to-step transitions were computed based on the force, work, and velocity. To examine the optimality of the work and the impulse data, a hybrid theoretical-empirical analysis is presented using a dynamic walking model that allows finite time for step-to-step transitions and incorporates the effects of gravity within this period. The changes in the work and impulse were examined parametrically across a range of speeds. The results showed that the push-off work on the CoM was well balanced by the heel strike work for all three definitions of the step-to-step transition. The impulse data were well matched by the optimal impulse predictions (R(2)>0.7) that minimized the mechanical work done on the CoM during the gait. The results suggest that the balance of push-off and heel strike energy is a consistent property arising from the overall gait dynamics, which implies an inherited oscillatory behavior of the CoM, possibly by spring-like leg mechanics.

  2. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2007-11-01

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

  5. 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.

  6. Chronic pancreatitis

    MedlinePlus

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... hospital for: Pain medicines Fluids given through a vein (IV) Stopping food or fluid by mouth to ...

  7. 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.

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

    PubMed Central

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

    2013-01-01

    Cancer immunotherapy has emerged as a mainstream therapy option in the battle against cancer. Pre-clinical data demonstrates the ability of immunotherapy to harness the immune system to fight disseminated malignancy. Clinical translation has failed to recapitulate the promising results of pre-clinical studies although there have been some successes. In this review we explore some of the short-comings of cancer immunotherapy that have limited successful clinical translation. We will give special consideration to what we consider the most formidable hurdle to successful cancer immunotherapy: tumor-induced immune suppression and immune escape. We will discuss the need for antigen-specific immune responses for successful immunotherapy but also consider the need for antigen specificity as an Achilles heel of immunotherapy given tumor heterogeneity, immune editing, and antigen loss. Finally, we will discuss how combinatorial strategies may overcome some of the pitfalls of antigen specificity and highlight recent studies from our lab which suggest that the induction of antigen non-specific immune responses may also produce robust anti-tumor effects and bypass the need for antigen specificity. PMID:23898464

  12. Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy

    PubMed Central

    Souza, Bruno Gonçalves Schröder e; de Souza Júnior, Gilberto Zaquine; Rodrigues, Raíssa Mansilla Cabrera; Dias, Diogo Stelito Rezende; de Oliveira, Valdeci Manoel

    2015-01-01

    Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted. PMID:26783478

  13. Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy.

    PubMed

    Souza, Bruno Gonçalves Schröder E; de Souza Júnior, Gilberto Zaquine; Rodrigues, Raíssa Mansilla Cabrera; Dias, Diogo Stelito Rezende; de Oliveira, Valdeci Manoel

    2015-01-01

    Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.

  14. Subthreshold electrical stimulation reduces motor unit discharge variability and decreases the force fluctuations of plantar flexion.

    PubMed

    Kouzaki, Motoki; Kimura, Tetsuya; Yoshitake, Yasuhide; Hayashi, Tatsuya; Moritani, Toshio

    2012-04-04

    The purpose of this study was to examine the influence of subthreshold electrical stimulation on the force fluctuations and motor-unit discharge variability during low-level, steady contraction of the plantar flexor muscles. Seven subjects performed a force-matching task of isometric plantar flexion at 5% of maximal voluntary contraction with and without random electrical stimulation applied to the tibial nerve. During the task, the motor unit action potential was continuously recorded with fine-wire electrodes, and the inter-spike intervals of a single motor unit were calculated. The coefficient of variation (CV) of the force fluctuations and the inter-spike intervals of the motor unit discharge were significantly decreased by the intervention of subthreshold electrical stimulation, although there were no changes in the mean values. These results suggest that subthreshold stimulation reduced the motor-unit discharge variability, which in turn, increased the steadiness of the force.

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

    PubMed

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

    2009-07-01

    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 degrees 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 approximately 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 approximately 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.

  16. Arteriographic pattern of plantar ulcers in lepromatous leprosy--study of 20 cases.

    PubMed

    Debi, B P; Mohanty, H C; Tripathy, N; Tompe, D B; Sarangi, B K

    1980-07-01

    Sixty arteriograms were done in twenty cases of lepromatous leprosy with thirty five plantar ulcers of six months to two years duration. Tortuosity, narrowing and obliteration of vascular lumen was mostly observed. Obliteration of vascular lumen was seen in twenty five percent of cases. Arteriographic findings were directly proportional with age of patient and duration of ulcer. Hyperemia and neovascularisation were seen in active and infected ulcers. Advanced vascular changes were associated with osteolytic changes of the bone along with neurological deficit.

  17. Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer.

    PubMed

    Örneholm, Hedvig; Apelqvist, Jan; Larsson, Jan; Eneroth, Magnus

    2017-04-01

    Diabetic foot ulcer is a serious complication in patients with diabetes. In most outcome studies of this condition, there is a combination of various types of ulcer and ulcer locations. Plantar ulcers are usually localized to the forefoot, and constitute a quarter of all diabetic foot ulcers. There are a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and there are no uniform definitions of recurrent and other new ulcers. The aim of this study was to evaluate the outcome of a large cohort of consecutively treated patients with diabetes mellitus and a healed planter forefoot ulcer (n=617) with regard to development, characteristics, and outcome of recurrent and other new ulcers. Patients were followed consecutively and prospectively with a two-year follow-up, according to a pre-set protocol. Out of 617 patients, 250 (41%) did not develop any new ulcer, 262 (42%) developed a new ulcer, 87 (14%) died and 18 (3%) were lost at two years following healing of a plantar forefoot ulcer. Thirty-four per cent developed other new ulcers (112 on the same foot and 99 on the contralateral foot), whereas 51 patients (8%) developed a recurrent ulcer (at the same site and foot). Of the patients who died within two years, 30 patients had developed other new ulcers. The risk of a recurrent ulcer in patients with diabetes and a healed plantar forefoot ulcer was only eight per cent within two years, whereas other new ulcers, on the same foot or on the contralateral foot, was seen in 4 out of 10 patients indicating the need for further preventive measures and surveillance in these patients. We suggest a concise definition for new ulcer to be used in future research. This article is protected by copyright. All rights reserved.

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

    PubMed Central

    2013-01-01

    Background Plantar calluses are a common cause of foot pain, which can have a detrimental impact on the mobility and independence of older people. Scalpel debridement is often the first treatment used for this condition. Our aim was to evaluate the effectiveness of scalpel debridement of painful plantar calluses in older people. Methods This study was a parallel-group, participant- and assessor-blinded randomized trial. Eighty participants aged 65 years and older with painful forefoot plantar calluses were recruited. Participants were randomly allocated to one of two groups: either real or sham scalpel debridement. Participants were followed for six weeks after their initial intervention appointment. The primary outcomes measured were the difference between groups in pain (measured on a 100-mm visual analogue scale) immediately post-intervention, and at one, three and six weeks post-intervention. Results Both the real debridement and sham debridement groups experienced a reduction in pain when compared with baseline. Small, systematic between-group differences in pain scores were found at each time point (between 2 and 7 mm favoring real scalpel debridement); however, none of these were statistically significant and none reached a level that could be considered clinically worthwhile. Scalpel debridement caused no adverse events. Conclusions The benefits of real scalpel debridement for reducing pain associated with forefoot plantar calluses in older people are small and not statistically significant compared with sham scalpel debridement. When used alone, scalpel debridement has a limited effect in the short term, although it is relatively inexpensive and causes few complications. However, these findings do not preclude the possibility of cumulative benefits over a longer time period or additive effects when combined with other interventions. Trial registration Australian Clinical Trials Registry (ACTRN012606000176561). PMID:23915078

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

    PubMed Central

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

    2014-01-01

    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

  20. Morphological Pattern Classification System for Plantar Thermography of Patients with Diabetes

    PubMed Central

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

    2013-01-01

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

  1. 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

  2. Injury reduction effectiveness of selecting running shoes based on plantar shape.

    PubMed

    Knapik, Joseph J; Swedler, David I; Grier, Tyson L; Hauret, Keith G; Bullock, Steven H; Williams, Kelly W; Darakjy, Salima S; Lester, Mark E; Tobler, Steven K; Jones, Bruce H

    2009-05-01

    Popular running magazines and running shoe companies suggest that imprints of the bottom of the feet (plantar shape) can be used as an indication of the height of the medial longitudinal foot arch and that this can be used to select individually appropriate types of running shoes. This study examined whether or not this selection technique influenced injury risk during United States Army Basic Combat Training (BCT). After foot examinations, BCT recruits in an experimental group (E: n = 1,079 men and 451 women) selected motion control, stability, or cushioned shoes for plantar shapes judged to represent low, medium, or high foot arches, respectively. A control group (C: n = 1,068 men and 464 women) received a stability shoe regardless of plantar shape. Injuries during BCT were determined from outpatient medical records. Other previously known injury risk factors (e.g., age, fitness, and smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference in injury risk between the E and C groups among men (risk ratio (E/C) = 1.01; 95% confidence interval = 0.88-1.16; p = 0.87) or women (risk ratio (E/C) = 1.07; 95% confidence interval = 0.91-1.25; p = 0.44). In practical application, this prospective study demonstrated that selecting shoes based on plantar shape had little influence on injury risk in BCT. Thus, if the goal is injury prevention, this selection technique is not necessary in BCT.

  3. High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.

    PubMed

    Örneholm, Hedvig; Apelqvist, Jan; Larsson, Jan; Eneroth, Magnus

    2015-01-01

    Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing.

  4. Low-frequency force steadiness practice in plantar flexor muscle reduces postural sway during quiet standing.

    PubMed

    Oshita, Kazushige; Yano, Sumio

    2011-01-01

    The purpose of this study was to assess the effect of low-frequency force steadiness practice in the plantar flexor muscles on postural sway during quiet standing. Healthy young 21 men (21±1 yrs) were randomly assigned to a practice group (n=14) and a nonexercising control group (n=7). Practice groups were divided by frequency of practice: 7 participants practiced once a week, and the other 7 twice a week, for 4 weeks. Steadiness practice required practice group to 5 sets of 60-s contraction at levels corresponding to 10% and 20% maximal voluntary contraction (MVC) in the plantar flexor muscles. The 4-week-long practice period reduced the force fluctuations (assessed as the standard deviation (SD) of the outputted force during steady isometric plantar flexion) and postural sway (assessed as SD of the center of mass velocity during quiet standing). However, these practice effects were not significantly affected by the practice frequencies (1 vs. 2 sessions per week) examined in this study. Further, a linear regression analysis revealed the association between prepractice postural sway and the relative change in postural sway by the practice (r=-0.904) in the practice group. These results suggest that the steadiness practice in plantar flexor muscles improves postural stability during quiet standing, even though the practice is low-frequency (once a week) and low-intensity (within 20% MVC). These practice effects are dependent on prepractice postural stability. Further, the present results have provided the functional significance of force fluctuation in lower limb muscles.

  5. 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.

  6. Evidence that filaggrin is a component of cornified cell envelopes in human plantar epidermis.

    PubMed Central

    Simon, M; Haftek, M; Sebbag, M; Montézin, M; Girbal-Neuhauser, E; Schmitt, D; Serre, G

    1996-01-01

    Cornified cell envelope (CE) is generated during the late stages of epidermal differentiation and is made up of proteins covalently linked together by transglutaminases. To determine whether filaggrin is a component of this structure in humans, we analysed highly purified CE from plantar stratum corneum. An immunoelectron microscopy analysis showed specific binding of four different anti-(pro)filaggrin monoclonal antibodies to the surface of the CE, proved previously to be free of non-covalently linked proteins. Moreover, the anti-filaggrin activity of one of the antibodies was absorbed by preincubation with the plantar CE, as determined by ELISA. Convincingly, fragments of CE produced by proteolytic digestion of the structures were stained by this antibody on immunoblots. These data provide direct evidence that filaggrin is a component of CE purified from human plantar stratum corneum. Cross-linking between CE and the filaggrin-containing fibrous matrix may enhance the structural cohesion of the corneocytes and thus the resistance of the stratum corneum. PMID:8694761

  7. Evaluating the quality of Internet-derived information on plantar fasciitis.

    PubMed

    Moshirfar, Ali; Campbell, John T; Khasraghi, Fardin A; Wenz, James F

    2004-04-01

    Patients seeking medical advice increasingly turn to the World Wide Web. To test the hypothesis that Internet-provided medical information often is inaccurate and biased, we selected a common musculoskeletal condition. Three common Internet search engines were used to search "plantar fasciitis" and "plantar fascitis." Combining the first 50 web addresses from each search engine for both phrases and eliminating duplicate sites resulted in a database of 152 websites. Each website then was analyzed for authorship, sponsoring agency, and presence of financial incentive. The informational value score of each site then was graded using a 10-point scale evaluating the following parameters: basic definition of plantar fasciitis, causes and risk factors, clinical symptoms, diagnostic tests, differential diagnosis, conservative and surgical treatment options, and complications. The overall mean information value score for all 152 sites was 3.8 points; 36% of the sites showed financial bias. The highest mean scores among all authorship and sponsorship categories belonged to orthopaedic surgeons and academic institutions with mean scores of 7.1 and 6.1 points, respectively. Sites without obvious financial bias had significantly higher information value scores than sites with financial interests. Healthcare professionals should consider these findings when advising patients.

  8. 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

  9. 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

  10. The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties.

    PubMed

    Samukawa, Mina; Hattori, Masaki; Sugama, Naoko; Takeda, Naoki

    2011-12-01

    Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p < 0.0001). A significant distal displacement of the MTJ was observed until the second stretching set (p < 0.001) with no significant changes thereafter. Pennation angle, and fascicle length were unaffected by the dynamic stretching. Dynamic stretching was shown to be effective in increasing ankle joint flexibility. Outcomes that could have indicated changes in muscle tissue (such as the pennation angle and fascicle length) were unaltered. However, a significant displacement of the MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues.

  11. Reliability of Baropodometry on the Evaluation of Plantar Load Distribution: A Transversal Study

    PubMed Central

    Baumfeld, Daniel; da Rocha, Romário Lopes; Macedo, Benjamim; Raduan, Fernando; Zambelli, Roberto; Alves Silva, Thiago Alexandre

    2017-01-01

    Introduction. Baropodometry is used to measure the load distribution on feet during rest and walking. The aim of this study was to evaluate changes in plantar foot pressures distribution due to period of working and due to stretching exercises of the posterior muscular chain. Methods. In this transversal study, all participants were submitted to baropodometric evaluation at two different times: before and after the working period and before and after stretching the muscles of the posterior chain. Results. We analyzed a total of 54 feet of 27 participants. After the working period, there was an average increase in the forefoot pressure of 0.16 Kgf/cm2 and an average decrease in the hindfoot pressure of 0.17 Kgf/cm2. After stretching the posterior muscular chain, the average increase in the forefoot pressure was 0.56 Kgf/cm2 and the hindfoot average pressure decrease was 0.56 Kgf/cm2. These changes were not statistically significant. Discussion. It was reported that the strength of the Achilles tendon generates greater forefoot load transferred from the hindfoot. In our study, no significant variation in the distribution of plantar pressure was observed. It can be inferred that baropodometry was a reliable instrument to determine the plantar pressure, regardless of the tension of the posterior chain muscles. PMID:28349064

  12. 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.

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

    PubMed

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

    2014-01-01

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

  14. Effectiveness of local tenoxicam versus corticosteroid injection for plantar fasciitis treatment.

    PubMed

    Guner, Savas; Onder, Haci; Guner, Sukriye Ilkay; Ceylan, Mehmet Fethi; Gökalp, Mehmet Ata; Keskin, Siddik

    2013-10-01

    Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (P>.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.

  15. Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

    PubMed Central

    Lee, Su-Jin; Kang, Jung-Ho; Kim, Ja-Young; Kim, Jin-Hong; Jung, Kwang-Ik

    2013-01-01

    Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT. PMID:23869336

  16. The effect of landing surface on the plantar kinetics of chinese paratroopers using half-squat landing.