Sciatic nerve block causing heel ulcer after total knee replacement in 36 patients.

PubMed

Todkar, Manoj

2005-12-01

Femoral and sciatic nerve blocks are often used for postoperative analgesia following total knee replacement surgery. In this report, we focus on cases of heel ulcers which occurred following the implementation of peripheral nerve block in concert with knee replacement surgery. In some instances, heel ulcers have resulted in delayed rehabilitation and prolonged hospital stays in this group of patients, which makes this phenomenon a potential burden on the healthcare system. Pressure points in the foot should be protected after the implementation of nerve blocks to prevent pressure sores. An awareness of this unusual complication related to knee replacement surgery is necessary to prevent its occurrence and avoid delays in patient rehabilitation and recovery.

Returning to Army Leadership

DTIC Science & Technology

2011-03-15

ABSTRACT AUTHOR: Colonel John M. Riley TITLE: Returning To Army Leadership FORMAT: Strategy Research Project DATE: 15 March 2011...the market on the heels of the renewed fervor for stories of leadership, character, and values spurred perhaps by cinematic works of the past ten...the Army, March 8, 2007). 6 U.S. Department of the Army, Army Leadership: Competent, Confident, and Agile, Field Manual 6-22 (Washington, DC

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Niewald, Marcus, E-mail: marcus.niewald@uks.eu; Seegenschmiedt, M. Heinrich; Micke, Oliver

2012-11-15

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

Plantar fasciitis.

PubMed

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

2012-11-01

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

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. Analysis of these studies found that people with CPHP are likely to have a thickened plantar fascia with associated fluid collection, and that thickness values >4.0 mm are diagnostic of plantar fasciitis. Additionally, subcalcaneal spur formation is strongly associated with pain beneath the heel. PMID:19912628

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. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Bursitis of the heel

MedlinePlus

... by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Bursitis Read more Heel Injuries and Disorders Read ...

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

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

PubMed

Hanna-Bull, Debbie

2016-01-01

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

[Percutaneous surgery for plantar fasciitis due to a calcaneal spur].

PubMed

Apóstol-González, Saúl; Herrera, Jesús

2009-01-01

Determine the efficacy of percutaneous surgical treatment for talalgia due to a calcaneal spur. This is an observational, descriptive, clinical series analyzing the outcomes of 10 patients with a diagnosis of talalgia due to plantar fasciitis with a calcaneal spur treated with percutaneous foot surgery. The end result was assessed with a visual analog scale (VAS) to measure pain, the patients' opinion and their return to activities of daily living. Central tendency and scatter measurements were calculated. The inferential analysis was done with the non-parametric chi square (chi2) test. Most patients were females (90%) and mean age was 40.5 years. Follow-up was 12 months. One patient had bleeding of the approached area. Pain was reduced from 8 to 1.5 in the VAS. Nine patients returned to their activities. Two patients had occasional mild pain upon prolonged bipedestation. Ninety percent of results were satisfactory. Percutaneous foot surgery in talalgias caused by plantar fasciitis due to a calcaneal spur is a simple and effective method. It reduces the operative time and allows for an early return of patients to their activities of daily living.

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.

Hindfoot containment orthosis for management of bone and soft-tissue defects of the heel.

PubMed

Johnson, Jeffrey E; Rudzki, Jonas R; Janisse, Erick; Janisse, Dennis J; Valdez, Ray R; Hanel, Douglas P; Gould, John S

2005-03-01

Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel. Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required. Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one. The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.

SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population

DTIC Science & Technology

2011-10-01

ULCER HX # DAYS TO 1ST PU SINCE INJURY # PUs SINCE INJURY AVG. LENGTH TO HEAL PU SURGERY NEEDED FOR PUs SURGERY TYPE TROCHANTER SACRUMISCHIUM HEELS OTHER PRESSURE ULCER LOCATIO OTHER MENTAL STATUS EDUC LEVEL: HGB HBA1C 8

[Treatment of calcaneal avulsion fractures with twinfix suture anchors fixation].

PubMed

Zhao, Bin-xiu; Wang, Kun-zheng; Wang, Chun-sheng; Xie, Yue; Dai, Zhi-tang; Liu, Gang; Liu, Wei-dong

2011-06-01

For the calcaneal avulsion fracture, the current method is more commonly used screws or Kirschner wire to fix fracture fragment. This article intended to explore the feasibility and clinical efficacy for the treatment of avulsion fractures with TwinFix suture anchors. From July 2007 to November 2010, 21 patients were reviewed, including 15 males and 6 females, ranging in age from 49 to 65 years,with a mean of 58.7 years. Twelve patients had nodules in the right heel and 9 patients had nodules in the left heel. All the patients had closed fractures. The typical preoperative symptoms of the patients included pain in the upper heel and weak in heel lift. Body examination results: palpable sense of bone rubbing in the back of the heel, and swelling in the heel. Surgery treatment with TwinFix suture anchors performed as follows : to fix TwinFix suture anchors into the calcaneal body, then to drill the fracture block, to make the double strand suture through the fracture holes, to knot the suture eachother to fix the block, and to use stitch to fix the remaining suture in the Achilles tendon in order to improve the block fixation. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional recovery was used to evaluate the Achilles tendon. Total average score was (95.5 +/- 3.12) points, including pain items of(38.5 +/- 2.18) points,the average score of functional items of (49.5 +/- 3.09) points,and power lines of 10 points in all patients. Twenty-one patients got an excellent result, 16 good and 5 poor. The methods of treatment for the calcaneal avulsion fractures with TwinFix suture anchors is a simple operation, and have excellent clinical effect, which is worthy of promotion.

Double Crush of L5 Spinal Nerve Root due to L4/5 Lateral Recess Stenosis and Bony Spur Formation of Lumbosacral Transitional Vertebra Pseudoarticulation: A Case Report and Review

PubMed Central

Iwasaki, Motoyuki; Akiyama, Masahiko; Koyanagi, Izumi; Niiya, Yoshimasa; Ihara, Tatsuo; Houkin, Kiyohiro

2017-01-01

We present a case of double-crushed L5 nerve root symptoms caused by inside and outside of the spinal canal with spur formation of the lumbosacral transitional vertebra (LSTV). A 78-year-old man presented with 7-year history of moderate paresis of his toe and left leg pain when walking. Magnetic resonance imaging (MRI) revealed spinal stenosis at the L3/4 and 4/5 spinal levels and he underwent wide fenestration of both levels. Leg pain disappeared and 6-min walk distance (6MWD) improved after surgery, however, the numbness in his toes increased and 6MWD decreased 9 months after surgery. Repeated MR and 3D multiplanar reconstructed computed tomography (CT) images showed extraforaminal impingement of the L5 root by bony spur of the left LSTV. He underwent second decompression surgery of the L5/S via the left sided Wiltse approach, resulting in the improvement of his symptoms. The impingement of L5 spinal nerve root between the transverse process of the fifth lumbar vertebra and the sacral ala is a rare entity of the pathology called “far-out syndrome (FOS)”. Especially, the bony spur formation secondary to the anomalous articulation of the LSTV (LSPA) has not been reported. These articulations could be due to severe disc degeneration, following closer distance and contact between the transverse process and the sacral ala. To our knowledge, this is the first report describing a case with this pathology and may be considered in cases of failed back surgery syndromes (FBSS) of the L5 root symptoms. PMID:29018654

Prior leg massage decreases pain responses to heel stick in preterm babies.

PubMed

Jain, Sunil; Kumar, Praveen; McMillan, Douglas D

2006-09-01

Leg massage could inhibit the transmission of pain by 'closing the gate' or by activating the endogenous opioid pathway to decrease nociceptive transmission of pain associated with heel stick. The aim of this study is to determine the effects of massage therapy prior to heel stick on responses assessed by the Neonatal Infant Pain Scale (NIPS) (primary outcome), heart rate, respiratory rate and oxygen saturation (secondary outcomes) in infants who required a heel stick for blood sampling. This randomised, double-blind, crossover trial with infants from 1 to 7 days post birth excluded those with prior surgery, septicaemia, current assisted ventilation or an analgesic within 48 h. After informed consent, 13 infants received a 2-min massage of the ipsilateral leg prior to heel stick on the first study sampling and no massage on the next sampling 2-7 days later and 10 infants had the reverse order. The bedside nurse, blinded to the intervention, measured NIPS, heart rate, respiratory rate, and oxygen saturation prior to massage, after massage, and 5 min after heel stick. Serum cortisol was measured with the blood sampling. In 23 infants (birthweight 795-2507 g), there were no adverse physiologic effects of massage. After heel stick, NIPS (P < 0.001) and heart rate (P = 0.03) were increased in the no-massage group compared with the massage group. Respiratory rate, oxygen saturation and serum cortisol were not significantly different. Gentle massage of the leg prior to heel stick is safe and decreases pain responses in preterm infants.

Prospective randomized clinical trial of aggressive rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique.

PubMed

De la Fuente, Carlos; Peña y Lillo, Roberto; Carreño, Gabriel; Marambio, Hugo

2016-03-01

Rupture of the Achilles tendon is a common injury during working years. Aggressive rehabilitation may provide better outcomes, but also a greater chance of re-rupture. To determine if aggressive rehabilitation has better clinical outcomes for Achilles tendon function, Triceps surae function, one-leg heel rise capacity and lower complication rate during twelve weeks after percutaneous Achilles tendon repair compared to conventional rehabilitation. Randomized controlled trial. Thirty-nine patients were prospectively randomized. The aggressive group (n=20, 41.4 ± 8.3 years) received rehabilitation from the first day after surgery. The conventional group (n=19, 41.7 ± 10.7 years) rested for 28 days, before rehabilitation started. The statistical parameters were the Achilles tendon rupture score (ATRS), verbal pain scale, time to return to work, pain medication consumption, Achilles tendon strength, dorsiflexion range of motion (RoM), injured-leg calf circumference, calf circumference difference, one-leg heel rise repetition and difference, re-rupture rate, strength deficit rate, and other complication rates. Mixed-ANOVA and Bonferroni's post hoc test were performed for multiple comparisons. Student's t-test was performed for parameters measured on the 12th week. The aggressive group with respect to the conventional group had a higher ATRS; lower verbal pain score; lower pain medication consumption; early return to work; higher Achilles tendon strength; higher one-leg heel rise repetitions; and lower one-leg heel rise difference. The re-rupture rate was 5% and 5%, the strength deficit rate was 42% and 5%, and other complications rate was 11% and 15% in the conventional and aggressive group, respectively. Patients with Dresden repair and aggressive rehabilitation have better clinical outcomes, Achilles tendon function and one-leg heel rise capacity without increasing the postoperative complications rate after 12 weeks compared to rehabilitation with immobilization and non-weight-bearing during the first 28 days after surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis.

PubMed

Yin, Mengchen; Chen, Ni; Huang, Quan; Marla, Anastasia Sulindro; Ma, Junming; Ye, Jie; Mo, Wen

2017-12-01

To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. Randomized, controlled, prospective study. Outpatient of local medical center settings. Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm 2 , respectively (a rate of 8 impulses per second), were applied. The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e [.011+42.807×heel spur+.109×edema+5.395×VAS score] ) -1 .The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The Youden index was .4243, .3003, and .7189, respectively. The Hosmer-Lemeshow test showed a good fitting of the predictive model, with an overall accuracy of 89.6%. This study establishes a new and accurate predictive model for the efficacy of ESWT in managing patients with chronic plantar fasciitis. The use of these parameters, in the form of a predictive model for ESWT efficacy, has the potential to improve decision-making in the application of ESWT. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2014-01-01

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

Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

PubMed

Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

2010-12-01

Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

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

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. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Case Report: Late Reconstruction of the Land Mine-Injured Heel With an Osteomyocutaneous Composite Fibular Flap.

PubMed

Tuzun, Harun Yasin; Kurklu, Mustafa; Kulahci, Yalcin; Turkkan, Selim; Arsenishvili, Arsen

The heel comprises the epidermis, minimal subcutaneous tissue, a dense septum, and the calcaneus. Injury to any of these structures can impair the ability to walk. The soft tissue or calcaneal bone can be injured by trauma. Injuries incurred in war are usually high-energy traumas caused by weapons such as rifles, rockets, and land mines. Such injuries can be life threatening and involve the loss of tissue, including skin, soft tissue, bone, and neurovascular tissue. Two main treatment protocols are used for such injuries with large tissue defects: amputation and reconstruction. We describe a reconstruction with an osteomyocutaneous fibular flap for a heel injury. At the 2-year follow-up point, the patient had 30% loss of ankle range of motion. The visual analog scale score had dramatically decreased from 8 to 1, and the patient was satisfied with the result. In conclusion, patients with significant problems such as infection, pain, and anatomic deterioration of the calcaneus can be successfully treated using an osteomyocutaneous fibular flap in a single surgery. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Novel approach to repair of acute achilles tendon rupture: early recovery without postoperative fixation or orthosis.

PubMed

Yotsumoto, Tadahiko; Miyamoto, Wataru; Uchio, Yuji

2010-02-01

Immobilization or orthosis is required after conventional Achilles tendon surgery. Hypothesis This new Achilles tendon repair approach enables early rehabilitation without any postoperative immobilization or orthosis. Case series; Level of evidence, 4. Twenty consecutive patients (14 men and 6 women; mean age, 43.4 years; range, 16-70 years) who had acute subcutaneous Achilles tendon rupture were treated by the new method, with an average follow-up of 2.9 years (range, 2-4.8 years). Among them, 15 injuries were sports-related and 5 were work-related. The authors applied a side-locking loop technique of their own design for the core suture, using braided polyblend suture thread, with peripheral cross-stitches added. The patients started active and passive ankle mobilization from the next day, partial weightbearing walking from 1 week, full-load walking from 4 weeks, and double-legged heel raises from 6 weeks after surgery. The range of motion recovery equal to the intact side averaged 3.2 weeks. Double-legged heel raises and 20 continuous single-legged heel raise exercises were possible at an average of 6.3 weeks and 9.9 weeks, respectively. T2-weighted magnetic resonance signal intensity recovered to equal that of the intact portion of the same tendon at 12 weeks. The patients resumed sports activities or heavy labor at an average of 14.4 weeks. The Achilles tendon rupture score averaged 98.3 at 24 weeks. There were no complications. This new Achilles tendon repair approach enables early mobilization exercise without costly specialized orthosis or immobilization and allows an early return to normal life and sports activities, reducing the physical and economic burden on patients.

Factors influencing wound healing of critical ischaemic foot after bypass surgery: is the angiosome important in selecting bypass target artery?

PubMed

Azuma, N; Uchida, H; Kokubo, T; Koya, A; Akasaka, N; Sasajima, T

2012-03-01

The aim of the study is to determine factors affecting ischaemic wound healing and role of the angiosome concept in bypass surgery. Single-centre, retrospective clinical study. A total of 249 consecutive critical ischaemic limbs with tissue loss in 228 patients who underwent distal bypasses from 2003 to 2009 were reviewed. A total of 81% of patients were diabetic, and 49% of patients had dialysis-dependent renal disease (end-stage renal disease, ESRD). Distal targets of bypasses were the crural artery (57%) and the pedal artery (43%). The complete healing of ischaemic wounds was achieved in 211 limbs (84.7%). ESRD (odds ratio (OR) 0.127, p < 0.001), diabetes (OR 0.216, p = 0.030), Rutherford category 6 (R6) with heel ulcer/gangrene (OR 0.134, p < 0.001), R6 except heel (OR 0.336, p = 0.025) and low albuminaemia (OR 0.387, p = 0.049) were negative predictors of wound healing. Regarding the angiosome, the healing rate in the indirect revascularisation (IR) group was slower than in the direct revascularisation (DR) group, especially in patients with ESRD (p < 0.001). However, the healing rates of the DR and IR groups were similar after minimising background differences with propensity score methods (p = 0.185). In the field of bypass surgery, the angiosome concept seems unimportant, at least in non-ESRD cases. The location and extent of ischaemic wounds as well as co-morbidities may be more relevant than the angiosome in terms of wound healing. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Computer-assisted stereotactic neurological surgery: pre-planning and on-site real-time operating control and simulation system

NASA Astrophysics Data System (ADS)

Zamorano, Lucia J.; Jiang, Charlie Z. W.

1993-09-01

In this decade the concept and development of computer assisted stereotactic neurological surgery has improved dramatically. First, the computer network replaced the tape as the data transportation media. Second, newer systems include multi-modality image correlation and frameless stereotactics as an integral part of their functionality, and offer extensive assistance to the neurosurgeon from the preplanning stages to and throughout the operation itself. These are very important changes, and have spurred the development of many interesting techniques. Successful systems include the ISG and NSPS-3.0.

Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study.

PubMed

Tornese, Davide; Mattei, Enrico; Lucchesi, Giampaolo; Bandi, Marco; Ricci, Gabriele; Melegati, Gianluca

2008-09-01

To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. Random assignment to two groups of treatment with two and eight months follow-up. The data were collected in outpatients. Forty-five subjects with a history of at least six months of heel pain were studied. Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 +/- 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 +/- 12.3 years). Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up. Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 +/-18.7; group B 53.5 +/- 20; P>0.05). In both groups there was a significant (P<0.05) increase in the Mayo Clinical Scoring System score at two months (group A 83.9 +/- 13.7; group B 80 +/- 15,8) and eight months (group A 90 +/- 10.5; group B 90.2 +/-8.7) follow-up. No significant differences were obtained comparing the Mayo Clinical Scoring System scores of the two groups at two and eight months follow-up. There was no difference between the two techniques of using extracorporeal shock wave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.

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.

Chevron osteotomy for the treatment of hallux valgus.

PubMed

Horne, G; Tanzer, T; Ford, M

1984-03-01

Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.

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)

Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

PubMed Central

Liu, Yiyang; Zhang, Chun; Guo, Qiaofeng; Huang, Wenhua; Wong, Kelvin Kian Loong; Chang, Shimin

2017-01-01

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs. PMID:28345420

Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion.

PubMed

Shen, Lifeng; Liu, Yiyang; Zhang, Chun; Guo, Qiaofeng; Huang, Wenhua; Wong, Kelvin Kian Loong; Chang, Shimin

2017-06-01

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

[Cohort study of the incidence of heel pressure sores in patients with leg casts at the Rizzoli Orthopedic Hospital and of the associated risk factors].

PubMed

Forni, Cristiana; Zoli, Marina; Loro, Loretta; Tremosini, Morena; Mini, Sandra; Pirini, Valter; Turrini, Roberta; Durante, Stefano; Nicolini, Annamaria; Riccioni, Francesca; Girolami, Roberto

2009-01-01

Pressure sores, especially at the heel, are a side effect of the cast. To assess the incidence of late skin complications (heel pressure sores) of a cast and determine risk factors. All consecutive patients treated with a leg cast over a 16 months observation time were recruited. Risk factors were identified by the nurse that placed the cast and skin lesions classified with the NPUAP scale when the cast was removed. In the 216 enrolled patients 17.6% (38) developed a pressure sore: 16/124 in orthopedic wards; 22/92 in oncology wards. The multivariate analysis identified the following risk factors: administration of cytotoxic drugs (p = 0.033; OR = 2.61; having a cancer did not increase the risk); skin redness before cast application (p = 0.001; OR = 4.44) and having reported symptoms after the application (p = 0.000; OR = 7.86). Pressure sores were mainly stage 1 and only 6/216 (2.4%) > or = stage II. The type of plaster cast, the material, the number of days it was worn and having had a surgery are not significant risk factors. Pressure sores related to leg plaster casts are a frequent complication in at risk sub-groups. The acknowledgement and identification of specific risk factors may allow to identify and evaluate preventive interventions to improve the care of these patients.

PTT functional recovery in early stage II PTTD after tendon balancing and calcaneal lengthening osteotomy.

PubMed

Brilhault, Jean; Noël, Vincent

2012-10-01

The decision to offer surgery for Stage II posterior tibial tendon deficiency (PTTD) is a difficult one since orthotic treatment has been documented to be a viable alternative to surgery at this stage. Taking this into consideration we limited our treatment to bony realignment by a lengthening calcaneus Evans osteotomy and tendon balancing. The goal of the study was to clinically evaluate PTT functional recovery with this procedure. The patient population included 17 feet in 13 patients. Inclusion was limited to early Stage II PTTD flatfeet with grossly intact but deficient PTT. Deficiency was assessed by the lack of hindfoot inversion during single heel rise test. The surgical procedure included an Evans calcaneal opening wedge osteotomy with triceps surae and peroneus brevis tendon lengthening. PTT function at follow up was evaluated by an independent examiner. Evaluation was performed at an average of 4 (range, 2 to 6.3) years. One case presented postoperative subtalar pain that required subtalar fusion. Every foot could perform a single heel rise with 13 feet having active inversion of the hindfoot during elevation. The results of this study provide evidence of PTT functional recovery without augmentation in early Stage II. It challenges our understanding of early Stage II PTTD as well as the surgical guidelines recommending PTT augmentation at this specific stage.

Determinants of footwear difficulties in people with plantar heel pain.

PubMed

Sullivan, Justin; Pappas, Evangelos; Adams, Roger; Crosbie, Jack; Burns, Joshua

2015-01-01

Plantar heel pain is a common foot disorder aggravated by weight-bearing activity. Despite considerable focus on therapeutic interventions such as orthoses, there has been limited investigation of footwear-related issues in people with plantar heel pain. The aim of this study was to investigate whether people with plantar heel pain experience footwear-related difficulties compared to asymptomatic individuals, as well as identifying factors associated with footwear comfort, fit and choice. The footwear domain of the Foot Health Status Questionnaire (FHSQ) was assessed in 192 people with plantar heel pain and 69 asymptomatic controls. The plantar heel pain group was also assessed on a variety of measures including: foot posture, foot strength and flexibility, pedobarography and pain level. A univariate analysis of covariance, with age as the covariate, was used to compare the heel pain and control groups on the FHSQ footwear domain score. A multiple regression model was then constructed to investigate factors associated with footwear scores among participants with plantar heel pain. When compared to asymptomatic participants, people with plantar heel pain reported lower FHSQ footwear domain scores (mean difference -24.4; p < 0.001; 95 % CI: -32.0 to -17.0). In the participants with heel pain, footwear scores were associated with maximum force beneath the postero-lateral heel during barefoot walking, toe flexor strength and gender. People with plantar heel pain experience difficulty with footwear comfort, fit and choice. Reduced heel loading during barefoot walking, toe flexor weakness and female gender are all independently associated with reports of footwear difficulties in people with heel pain. Increased focus, in both clinical and research settings, is needed to address footwear-related issues in people with plantar heel pain.

The Effect of Offloading Heels on Sacral Pressure.

PubMed

Al-Majid, Sadeeka; Vuncanon, Barbara; Carlson, Nika; Rakovski, Cyril

2017-09-01

Offloading a patient's heels during supine surgical procedures is a common practice to prevent heel pressure injuries. This practice may increase sacral pressure and jeopardize sacral skin integrity, but prophylactic dressings may help protect sacral skin. The purpose of this study was to examine the effects of offloading the heels and of multilayered silicone foam dressings on sacral pressure. We measured the sacral pressure of 50 healthy volunteers using a pressure-mapping system under four conditions: heels not offloaded and sacral dressing applied, heels offloaded and dressing applied, heels not offloaded and no dressing, and heels offloaded and no dressing. We used linear mixed-effects modeling to compare the effects of these conditions on sacral pressure. Offloading the heels significantly increased sacral pressure (P < .001), whereas the dressing had no effect on sacral pressure (P = .49). Offloading a patient's heels may increase the risk of sacral pressure injuries. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

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

Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking.

PubMed

Hong, Wei-Hsien; Lee, Yung-Hui; Chen, Hsieh-Ching; Pei, Yu-Cheng; Wu, Ching-Yi

2005-12-01

The possible negative effects of high-heeled shoes on subjective comfort perception and objective biomechanical assessment have been noted. Although shoe inserts have been widely applied in footwear to increase comfort and to reduce the frequency of movement-related injury, no study has attempted to identify insert effectiveness in high heels. The purpose of this study was to determine the effects of heel height and shoe inserts on comfort and biomechanics as represented by plantar pressure and ground reaction force (GRF). Twenty young female adults performed the test conditions formed by the cross-matching of shoe inserts (shoe without insert and shoe with total contact insert [TCI]) and heel height (a flat, a low heel [3.8 cm] and a high heel [7.6 cm]). Two-way analyses of variance for repeated measures design were used to test condition effects on comfort rating, plantar pressure, and GRF during gait. To determine the biomechanical variables that can predict comfort, a multiple linear regression with stepwise method was done. The results showed that discomfort increased with heel height. In high heels, the plantar pressure in the heel and midfoot shifted to the medial forefoot, and the vertical and anteroposterior GRF increased. Use of the TCI reduced the peak pressure in the medial forefoot. Interestingly, the effectiveness of the TCI was greater in the higher heels than in the lower heels and in flat heels. The peak pressure in the medial forefoot, impact force, and the first peak vertical GRF could explain 75.6% of the variance of comfort in high-heeled gait. These findings suggest that higher heels result in decreased comfort, which can be reflected by both the subjective rating scale and biomechanical variables. Use of a TCI altered the biomechanics and therefore improved the comfort in high-heeled shoes.

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.

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

PubMed Central

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

2015-01-01

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

Characteristics of Intratendinous Microcirculation Shortly After an Achilles Rupture and Subsequent Treatment Outcomes.

PubMed

Chang, Yi-Ping; Shih, Kao-Shang; Chiang, Hongsen; Ma, Hsiao-Li; Lin, Leou-Chyr; Peng, Wei-Chen; Wen, Che-Sheng; Wang, Hsing-Kuo

2017-01-01

Early microcirculatory responses after experimental tenotomy are critical to the healing of tendons and their ultimate tensile strength. The effects of changes in microcirculation on the outcomes of tendon healing, however, have not been determined. To assess microcirculation values in injured Achilles tendons in the first 3 months after surgical repair and to correlate the inter-limb microcirculatory changes with functional outcomes at 3 and 6 months after surgery. Case-control study. A university sports physiotherapy laboratory. Thirteen subjects (median age: 45 years; range: 34.8-51.9 years) with a repaired Achilles tendon were recruited. Surgical repair. Measurements were obtained at 1, 2, 3, and 6 months after surgery. Bilateral measurements of tendon microcirculation (total hemoglobin [THb] and oxygen saturation [StO 2 ]) were recorded at the first 3 time points, whereas outcome measures of a Taiwan Chinese version of the Victorian Institute of Sport Assessment Scale-Achilles questionnaire, one-leg hopping distance, the star excursion balance test, and the heel raise index were conducted at the third and fourth time points. Correlations between the inter-limb microcirculatory changes, eg, between the measurements at 2 months and 1 month (2-1) after surgery, at 3 months and 2 months (3-2) after surgery, and at 3 months and 1 month (3-1) after surgery, and the outcome measures were investigated. Compared with the noninjured tendons, the repaired Achilles demonstrated greater THb (at 1, 2, and 3 months; P = .017, .008, and .012 respectively) and StO 2 (at 3 months; P = .017). Furthermore, the THb2-1 and THb3-2, StO 2 2-1, and StO 2 3-2 showed correlations with the heel raise index, differences in the star excursion balance test and one-leg hopping distance between the noninjured leg and injured leg, and Taiwan Chinese version of the Victorian Institute of Sport Assessment Scale-Achilles questionnaire scores (rho -0.921 to 0.855). Changes in the inter-limb microcirculation shortly after Achilles repair were correlated with subsequent symptoms and functional symmetry. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

The athlete's foot: the grey zone behind the ankle.

PubMed

van Giffen, Nicolien; Seil, Romain; Pape, Diederich; Nührenbörger, Christian

2009-01-01

Posterior ankle and heel pain is common among athletes. The most common injury in this region is that of the Achilles tendon. However, besides the Achilles tendon, pain can originate from a retrocalcaneal bursitis, posterior impingement syndrome, os trigonum syndrome, or flexor hallucis longus tenosynovitis. These pathologies often caused by overuse, but can also occur after trauma. With careful examination, and the help of MRI imaging, the distinction can be made among these pathologies and the more common Achilles tendon problems. Like most overuse injuries, the majority of cases of retrocalcaneal bursitis, posterior impingement, flexor hallucis longus tenosynovitis respond to conservative treatment. However, when this fails, open or arthroscopic surgery can be proposed. Arthroscopy is less aggressive than open surgery, with the added advantage of less patient morbidity, less post-operative pain, and early functional rehabilitation. It is becoming the surgery of choice, especially among athletes.

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

PubMed

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

2011-03-01

Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar(®) system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain. Copyright © 2010 Elsevier B.V. All rights reserved.

Walking variations in healthy women wearing high-heeled shoes: Shoe size and heel height effects.

PubMed

Di Sipio, Enrica; Piccinini, Giulia; Pecchioli, Cristiano; Germanotta, Marco; Iacovelli, Chiara; Simbolotti, Chiara; Cruciani, Arianna; Padua, Luca

2018-05-03

The use of high heels is widespread in modern society in professional and social contests. Literature showed that wearing high heels can produce injurious effects on several structures from the toes to the pelvis. No studies considered shoe length as an impacting factor on walking with high heels. The aim of this study is to evaluate walking parameters in young healthy women wearing high heels, considering not only the heel height but also the foot/shoe size. We evaluate spatio-temporal, kinematic and kinetic data, collected using a 8-camera motion capture system, in a sample of 21 healthy women in three different walking conditions: 1) barefoot, 2) wearing 12 cm high heel shoes independently from shoe size, and 3) wearing shoes with heel height based on shoe size, keeping the ankles' plantar flexion angle constant. The main outcome measures were: spatio-temporal parameters, gait harmony measurement, range of motion, flexion and extension maximal values, power and moment of lower limb joints. Comparing the three walking conditions, the Mixed Anova test, showed significant differences between both high heeled conditions (variable and constant height) and barefoot in spatio-temporal, kinematic and kinetic parameters. Regardless of the shoe size, both heeled conditions presented a similar gait pattern and were responsible for negative effects on walking parameters. Considering our results and the relevance of the heel height, further studies are needed to identify a threshold, over which it is possible to observe that wearing high heels could cause harmful effects, independently from the foot/shoe size. Copyright © 2018 Elsevier B.V. All rights reserved.

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 heeling...

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

PubMed

Yung-Hui, Lee; Wei-Hsien, Hong

2005-05-01

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

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

PubMed

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

2014-01-01

The ability to measure the functional behaviour of the plantar heel pad is clinically relevant in dystrophic or pathological heel conditions and may help to inform the design and development of interventions that attempt to restore normal function. In this study we present a novel technique which utilises orthotic heel inserts with an embedded ultrasound (US) transducer to allow the functional, dynamic behaviour of the heel pad to be measured in-shoe during gait. The aim of this study was to demonstrate feasibility of the technique, determine the reproducibility of measurements, and to compare the effects of two orthotic inserts: (i) a flat orthotic heel raise and (ii) a contoured heel cup insert on the behaviour of the heel pad during gait. Dynamic compression of the heel pads of 16 healthy participants was recorded during treadmill walking and combined with plantar pressure measurements to allow stiffness and energy disappation ratio (EDR) to be estimated. Inter-session reliability of the US measurements was found to be excellent (ICC2,1=0.94-0.95), as was inter-rater reliability (ICC2,1=0.89). Use of the heel cup insert significantly reduced the maximum compression of the heel pad (p<0.0001) as well as the overall stiffness of the pad (p<0.001). There was no change in EDR (p=0.949). In-shoe embedded US is a reliable method to establish person-specific functional geometry of plantar soft tissues. Use of a contoured heel cup reduces the compression of the mid portion of the heel pad. Copyright © 2013 Elsevier B.V. All rights reserved.

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

PubMed

Zhang, Xianyi; Li, Bo

2014-04-01

The aim of this study was to investigate how the height and material of in-shoe heel lifts affect plantar pressure and center of pressure (COP) trajectory in the medial-lateral direction during walking. Seventeen healthy young male adults were asked to walk along an 8m walkway while wearing a high-cut flat shoe and 5 different heel lifts. Peak pressure (PP), pressure-time integral (PTI) and contact area (CA) were measured by Pedar insole system for three foot regions: forefoot, midfoot and heel. Range and velocity of medial-lateral (ML) COP during forefoot contact phase (FFCP) and foot flat phase (FFP) were collected using Footscan pressure plate. Forefoot pressure and ML-COP parameters increased as the heel was elevated. Statistically significant attenuation of heel peak plantar pressure was provided by all heel lifts except for the hard lift. Post hoc tests suggest that material had a greater influence on the range and velocity of ML-COP during FFCP than heel height, while during FFP, heel height seemed to affect these parameters more. The findings from this study suggest that thick heel lifts should be used with caution, and that a heel lift made of materials with good support and elastic properties might be more appropriate to improve footwear comfort and medial-lateral motion control. Copyright © 2013 Elsevier B.V. All rights reserved.

Effect of Gender on Mechanical Properties of the Plantar Fascia and Heel Fat Pad.

PubMed

Taş, Serkan

2017-10-01

The purpose of the study was to investigate the plantar fascia and heel fat pad stiffness and thickness parameters in females and compare these values with those of males. This study was carried out in 60 healthy sedentary participants (30 female, 30 male) between the ages of 19 and 50 years. Shear wave velocity (SWV) and thickness of the plantar fascia and heel fat pad were measured with an ultrasonography device. Males had a higher plantar fascia ( P = .037) and heel fat pad ( P = .001) thickness compared with females, but SWV of the plantar fascia ( P = .673), heel fat pad microchamber layer ( P = .240), and heel fat pad macrochamber layer ( P = .636) were similar in both groups. Body mass had a strong correlation with the plantar fascia ( r = 0.64, P < .001) and heel fat pad thickness ( r = 0.68, P < .001). Height had a moderate correlation with the plantar fascia ( r = 0.44, P < .001) and heel fat pad thickness ( r = 0.42, P = .001). Plantar fascia and heel fat pad stiffness were similar in both genders; however, females had a lower plantar fascia and heel fat pad thickness compared with males. Correlation analysis results suggest that higher plantar fascia and heel fat pad thickness in males may be related to higher body mass and height. Level III, Retrospective comparative study.

46 CFR 171.055 - Intact stability requirements for a monohull sailing vessel or a monohull auxiliary sailing vessel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and operation from— (1) 0 to at least 70 degrees of heel for service on protected or partially protected waters; and (2) 0 to at least 90 degrees of heel for service on exposed waters. (d) Each vessel... defined by the equation— HZ=HZA cos2 (T) where— HZ=heeling arm. HZA=heeling arm at 0 degrees of heel. T...

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.

Successful heel pressure ulcer prevention program in a long-term care setting.

PubMed

Lyman, Vicky

2009-01-01

Heel pressure ulcers (PUs) are common in long-term healthcare settings. Early identification of risk and the use of preventive measures are central to reducing the morbidity, mortality, and high medical costs associated with heel PUs. A Quality Improvement Process was initated based on a tailored protocol, in-service education program, and a heel protective device was approved by the US Food and Drug Administration. The Braden Scale was used to evaluate PU risk in 550 patients in a long-term healthcare facility. Patients with a Braden Scale score of 18 or less and with 1 of 7 high-risk comorbidities were considered at high risk for PUs, and this prompted a more aggressive prevention program that included a protocol for reducing the risk of heel ulceration. The number of hospital-acquired heel PUs during the 6-month preintervention period was 39. Following the intervention, there were 2 occurrences, representing a 95% reduction in heel ulcers between the 2 periods. After the cost of 2 heel protectors for 550 at-risk patients was subtracted from the estimated cost of treating the 37 heel ulcers prevented, the estimated cost savings was calculated to be between $12,400 and $1,048,400.

Body load in heel-strike running: the effect of a firm heel counter.

PubMed

Jørgensen, U

1990-01-01

The effect of a firm heel counter in the shoe was studied in 11 athletes during submaximal heel-strike running on a treadmill under standardized conditions. The runners were tested in identical shoes with and without the distal 2 cm of the firm heel counter. Body load was expressed by absolute and relative VO2, surface EMG on the right leg, and g-force registration from an accelerometer below the right tibial tuberosity. The heel counter caused a 2.4% significant decrease in VO2, a reduction in musculoskeletal transients, and a decrease in the activity of the triceps surae and quadriceps muscles at heel strike. The changes found are expressions of kinematic adaptations in the body to increased or decreased load and provide functional evidence for the loading factor in the pathophysiology of overuse injuries.

Effects of high-heeled shoes and asymmetrical load carrying on lower-extremity kinematics during walking in young women.

PubMed

Lee, Soul; Li, Jing Xian

2014-01-01

Asymmetrical load carrying and wearing high-heeled shoes are very common. Biomechanics studies on the combined effects of high-heeled shoe wearing and asymmetrical load carrying are lacking. We sought to identify changes in lower-extremity joint kinematics associated with the effect of shoes and asymmetrical load carrying during walking. Fifteen healthy young women (mean ± SD: age, 24.67 ± 3.54 years; body weight, 54.96 ± 6.67 kg; and height, 162.2 ± 3.91 cm) who habitually wore high-heeled shoes participated in the study. They were asked to walk under nine combined conditions of three heights of shoe heels (0, 3, and 9 cm) and three carried loads (0%, 5%, and 10% of body weight). Temporospatial parameters and maximal joint angles in the sagittal and frontal planes of the hip, knee, and ankle on both limbs were studied. It was found that high-heeled shoe wearing and asymmetrical load carrying altered temporospatial parameters and joint kinematics. With increased heel height and load weight, cadence decreased and stride length increased. The knee flexion angle increased with an increase in heel height, and the load served only to exacerbate the changes. Changes in the hip angle were mostly caused by asymmetrical load carrying, whereas angle changes in the ankle were mostly caused by an increase in heel height. This study demonstrated that when high-heeled shoe wearing and asymmetrical load carrying are combined, changes at each joint are much greater than with high-heeled shoe wearing or load carrying alone.

Selection on spur shape in Impatiens capensis.

PubMed

Young, Helen J

2008-06-01

Rapid speciation within some plant families has been attributed to the evolution of floral spurs and to the effect of spur length on plant reproductive success. The flowers of Impatiens capensis (jewelweed) possess a long, curved spur in which nectar is produced and stored. Spur length and curvature varies among plants within one population. Here I document that spur shape is variable in natural populations, variation within plants is less than variation among plants, and spur shape is correlated with components of female and male reproductive success. The apparent natural selection is weakly directional in 1 of 2 years, with greatest seed production and pollen removal occurring in flowers with the greatest spur curvature. Bee pollinator visit length is longest at flowers with highly curved spurs, and they leave less nectar in these spurs than in flowers with straighter spurs. Spur angle evolution may be limited, at least in part, by opposing selection by nectar-robbers who prefer to visit flowers with greater spur curvature. Other factors that might contribute to the maintenance of spur angle variation are temporal variation in the strength of selection and potential genetic correlations of spur shape with other traits under selection.

46 CFR 172.195 - Survival conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... The final waterline, in the final condition of sinkage, heel, and trim, must be below the lower edge...) Heel angle. The maximum angle of heel must not exceed 30 degrees. (c) Range of stability. Through an... lines may not be considered for reducing the angle of heel. Spaces joined by ducts of large cross...

46 CFR 173.095 - Towline pull criterion.

Code of Federal Regulations, 2011 CFR

2011-10-01

...=heeling arm. θ=angle of heel. N, P, D, K, s, h, and Δ are as defined in paragraph (b) of this section. (e... watertight automatically. (f) For the purpose of this section, at each angle of heel, a vessel's righting arm... moment is zero; or (2) The vessel does not trim as it heels. ...

46 CFR 172.195 - Survival conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... The final waterline, in the final condition of sinkage, heel, and trim, must be below the lower edge...) Heel angle. The maximum angle of heel must not exceed 30 degrees. (c) Range of stability. Through an... lines may not be considered for reducing the angle of heel. Spaces joined by ducts of large cross...

Development of a finite element model of female foot for high-heeled shoe design.

PubMed

Yu, Jia; Cheung, Jason Tak-Man; Fan, Yubo; Zhang, Yan; Leung, Aaron Kam-Lun; Zhang, Ming

2008-01-01

Wearing high-heeled shoes may produce deleterious effects on the musculoskeletal system while elevation of the shoe heel with arch insole insert is used as a treatment strategy for plantar fasciitis. Due to limitations of the experimental approaches, direct measurements of internal stress/strain of the foot are impossible or invasive. This study aims at developing a finite element model for evaluating the biomechanical effects of high-heeled support on the ankle-foot complex. A 3D anatomically detailed FE model of the female foot and ankle together with a high-heeled support was developed and used to investigate the plantar contact pressure and internal loading responses of the bony and soft tissue structures of the foot with varying heel heights during simulated balanced standing. In the balanced standing position with high-heeled support, a pronounced increase in von Mises stress at the first metatarsophalangeal (MTP) joint was predicted. The strain on plantar fascia decreased compared to the flat horizontal support and valgus deformity of the hallux was not significant. The increased stress in forefoot especially at the first MTP segment during prolonged high-heeled standing may contribute to progressive hallux valgus (HV) deformity. However, the reduced tensile strain in the plantar fascia with heel elevation may help relieve plantar fasciitis related pain and inflammation.

Depression, Anxiety, and Stress in People With and Without Plantar Heel Pain.

PubMed

Cotchett, Matthew; Munteanu, Shannon E; Landorf, Karl B

2016-08-01

Depression, anxiety, and stress are prevalent in patients with musculoskeletal pain, but the impact of these emotional states has not been evaluated in people with plantar heel pain. The aim of this study was to evaluate the association between depression, anxiety, and stress with plantar heel pain. Forty-five participants with plantar heel pain were matched by sex and age (±2 years) to 45 participants without plantar heel pain. Levels of depression, anxiety, and stress were measured using the Depression, Anxiety and Stress Scale (short version) in participants with and without plantar heel pain. Logistic regression was conducted to determine if levels of depression, anxiety, or stress were associated with having plantar heel pain. Univariate analysis indicated that participants with plantar heel pain had greater levels of depression (mean difference = 4.4, 95% CI 2.3 to 6.5), anxiety (mean difference = 2.6, 95% CI 0.9 to 4.3), and stress (mean difference = 4.8, 95% CI 1.9 to 7.8). After adjusting for age, sex, BMI, and education, for every 1 unit increase in depression, anxiety, or stress (in the DASS subscales), the odds ratios for having plantar heel pain were increased by 1.3 (95% CI 1.1 to 1.6), 1.3 (95% CI 1.1 to 1.5), and 1.2 (95% CI 1.1 to 1.3), respectively. Symptoms of depression, anxiety, and stress were independently associated with plantar heel pain. Larger prospective studies are necessary to evaluate the temporal association between these emotional states and plantar heel pain. Level III, cross sectional, observational. © The Author(s) 2016.

Movement behavior of high-heeled walking: how does the nervous system control the ankle joint during an unstable walking condition?

PubMed

Alkjær, Tine; Raffalt, Peter; Petersen, Nicolas C; Simonsen, Erik B

2012-01-01

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

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. Copyright © 2011 Elsevier B.V. All rights reserved.

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

PubMed Central

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

2012-01-01

The human locomotor system is flexible and enables humans to move without falling even under less than optimal conditions. Walking with high-heeled shoes constitutes an unstable condition and here we ask how the nervous system controls the ankle joint in this situation? We investigated the movement behavior of high-heeled and barefooted walking in eleven female subjects. The movement variability was quantified by calculation of approximate entropy (ApEn) in the ankle joint angle and the standard deviation (SD) of the stride time intervals. Electromyography (EMG) of the soleus (SO) and tibialis anterior (TA) muscles and the soleus Hoffmann (H-) reflex were measured at 4.0 km/h on a motor driven treadmill to reveal the underlying motor strategies in each walking condition. The ApEn of the ankle joint angle was significantly higher (p<0.01) during high-heeled (0.38±0.08) than during barefooted walking (0.28±0.07). During high-heeled walking, coactivation between the SO and TA muscles increased towards heel strike and the H-reflex was significantly increased in terminal swing by 40% (p<0.01). These observations show that high-heeled walking is characterized by a more complex and less predictable pattern than barefooted walking. Increased coactivation about the ankle joint together with increased excitability of the SO H-reflex in terminal swing phase indicates that the motor strategy was changed during high-heeled walking. Although, the participants were young, healthy and accustomed to high-heeled walking the results demonstrate that that walking on high-heels needs to be controlled differently from barefooted walking. We suggest that the higher variability reflects an adjusted neural strategy of the nervous system to control the ankle joint during high-heeled walking. PMID:22615997

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

PubMed

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

2013-07-01

High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. Knowledge of the motion of the body's center of mass (COM) with respect to the center of pressure (COP) during high-heeled gait may offer insights into the balance control strategies and provide a basis for approaches that minimize the risk of falling and associated adverse effects. The study aimed to investigate the influence of the base and height of the heels on the COM motion in terms of COM-COP inclination angles (IA) and the rate of change of IA (RCIA). Fifteen females who regularly wear high heels walked barefoot and with narrow-heeled shoes with three heel heights (3.9cm, 6.3cm and 7.3cm) while kinematic and ground reaction force data were measured and used to calculate the COM and COP, as well as the temporal-distance parameters. The reduced base of the heels was found to be the primary factor for the reduced normalized walking speed and the reduced frontal IA throughout the gait cycle. This was achieved mainly through the control of the RCIA during double-leg stance (DLS). The heel heights affected mainly the peak RCIA during DLS, which were not big enough to affect the IA. These results suggest young adults adopt a conservative strategy for balance control during narrow-heeled gait. The results will serve as baseline data for future evaluation of patients and/or older adults during narrow-heeled gait with the aim of reducing the risk of falling. Copyright © 2012 Elsevier B.V. All rights reserved.

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

PubMed

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

2012-03-01

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

Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy.

PubMed

Al-Ashhab, Mohamed Ebrahim; Elbegawy, Hossam El-Dein A; Hasan, Hala Ali Abed

Plantar fasciopathy is a common cause of heel pain. Endoscopic plantar fasciotomy has the advantage of less surgical trauma and rapid recovery. The aim of the present prospective study was to delineate the results of endoscopic plantar fascia release through 2 medial portals. The present study included 2 groups. The first group included 27 feet in 25 patients that had undergone endoscopic plantar fascia release followed up for 19.7 (range 12 to 33) months. The second group, the control group, included 20 feet in 16 patients treated conservatively and followed up for 16.4 (range 12 to 24) months. The results of endoscopic plantar fascia release were superior to the conservative methods. The surgically treated group experienced significantly less pain, activity limitations, and gait abnormality. The presence of a calcaneal spur had no effect on the final postoperative score. In conclusion, endoscopic plantar fascia release through 2 medial portals is an effective procedure for treatment of resistant plantar fasciopathy that fails to respond to conservative management options. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

46 CFR 42.20-12 - Conditions of equilibrium.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., heel, and trim, is below the lower edge of any opening through which progressive flooding can take... angle of heel. The angle of heel due to unsymmetrical flooding does not exceed 15 degrees. If no part of the deck is immersed, an angle of heel of up to 17 degrees may be accepted. (d) Metacentric height...

46 CFR 42.20-12 - Conditions of equilibrium.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., heel, and trim, is below the lower edge of any opening through which progressive flooding can take... angle of heel. The angle of heel due to unsymmetrical flooding does not exceed 15 degrees. If no part of the deck is immersed, an angle of heel of up to 17 degrees may be accepted. (d) Metacentric height...

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

Code of Federal Regulations, 2014 CFR

2014-10-01

... lateral resistance of the underwater hull to the center of wind pressure on “A”. (c) When calculating “A... 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...

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

Code of Federal Regulations, 2012 CFR

2012-10-01

... lateral resistance of the underwater hull to the center of wind pressure on “A”. (c) When calculating “A... 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...

46 CFR 171.050 - Passenger heel requirements for a mechanically propelled or a non-self propelled vessel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Passenger heel requirements for a mechanically propelled... Intact Stability § 171.050 Passenger heel requirements for a mechanically propelled or a non-self... be carried on the vessel. T = 14 degrees or the angle of heel at which the deck edge is first...

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

PubMed

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

2006-01-01

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

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.

THE EFFECT OF STEP RATE MANIPULATION ON FOOT STRIKE PATTERN OF LONG DISTANCE RUNNERS.

PubMed

Allen, Darrell J; Heisler, Hollie; Mooney, Jennifer; Kring, Richard

2016-02-01

Running gait retraining to change foot strike pattern in runners from a heel strike pattern to a non heel- strike pattern has been shown to reduce impact forces and may help to reduce running related injuries. Step rate manipulation above preferred is known to help decrease step length, foot inclination angle, and vertical mass excursion, but has not yet been evaluated as a method to change foot strike pattern. The purpose of this study was to investigate the effect of step rate manipulation on foot strike pattern in shod recreational runners who run with a heel strike pattern. A secondary purpose was to describe the effect of step rate manipulation at specific percentages above preferred on foot inclination angle at initial contact. Forty volunteer runners, who were self-reported heel strikers and had a weekly running mileage of at least 10 miles, were recruited. Runners were confirmed to be heel strikers during the warm up period on the treadmill. The subject's step rate was determined at their preferred running pace. A metronome was used to increase step rate above the preferred step rate by 5%, 10% and 15%. 2D video motion analysis was utilized to determine foot strike pattern and to measure foot inclination angle at initial contact for each step rate condition. There was a statistically significant change in foot strike pattern from a heel strike pattern to a mid-foot or forefoot strike pattern at both 10% and 15% step rates above preferred. Seven of the 40 subjects (17.5%) changed from a heel- strike pattern to a non- heel strike pattern at +10% and 12 of the 40 subjects (30%) changed to a non-heel strike pattern at +15%. Mean foot inclination angle at initial contact showed a statistically significant change (reduction) as step rate increased. Step rate manipulation of 10% or greater may be enough to change foot strike pattern from a heel strike to a mid-foot or forefoot strike pattern in a small percentage of recreational runners who run in traditional running shoes. If changing the foot strike pattern is the main goal, other gait re-training methods may be needed to make a change from a heel strike to a non-heel strike pattern. Step rate manipulation shows a progressive reduction of foot inclination angle at 5%, 10%, and 15% above preferred step rate which reduces the severity of the heel strike at initial contact. Step rate manipulation of at least +10% above preferred may be an effective running gait retraining method for clinicians to decrease the severity of heel strike and possibly assist a runner to change to a non-heel strike pattern. 3.

Preventing pressure ulcers on the heel: a Canadian cost study.

PubMed

Torra I Bou, Joan-Enric; Rueda López, Justo; Camañes, Gemma; Herrero Narváez, Elias; Blanco Blanco, Joan; Ballesté Torralba, Jordi; Martinez-Esparza, Elvira Hernández; García, Lorena San Miguel; Soriano, José Verdú

2009-01-01

An adaptation of a clinical study of 130 patients at risk of developing a pressure ulcer on the heels was performed using Canadian costs. The aim of the study was to compare the cost effectiveness of a specially shaped hydrocellular dressing (Allevyn Heel) versus that of a protective heel bandage (Soffban and gauze) in pressure ulcer prevention over an 8-week period.

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

PubMed

Williams, Cylie M; Haines, Terry P

2014-01-23

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

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

PubMed Central

2014-01-01

Background Many women are warned against the dangers of wearing high heel footwear however there is limited empirical evidence demonstrating an association between wearing high heel with injury. Gait laboratory testing has found a higher heel height placed the foot in a position that increases the risk of ankle sprain. Women have also been surveyed about wearing high heels and approximately half of those reported inconvenience and pain after wearing a high heel shoe. This study aims to explore emergency department presentations of injuries and the estimated costs that have been directly attributed to wearing high heeled footwear within Victoria, Australia during 2006–2010. Methods The Victorian Emergency Minimum Dataset (VEMD) was searched for all injuries attributed to wearing high heel footwear presenting to emergency departments in Victoria Australia, between the years of 2006–2010. The VEMD produced a report detailing sex, age at presentation, month of presentation, time of day of presentation, day of presentation, location that injury occurred and type of injury for presentation. Monash Health in Victoria Australia, provided emergency department estimates for injury types to calculate an estimated cost of an acute injury related to wearing high heel footwear. Results There were 240 injuries presenting to Victorian emergency departments directly attributed to wearing high heeled footwear. The majority of people injured were women (n = 236) and all were less than 55 years of age. More injuries presented on a Sunday (n = 83) and more in the 8 am-12 pm time bracket (n = 64). There were also more injuries presenting in the months of November, December and January (n = 80). The most commonly injured body part was the ankle (n = 123). The emergency department estimate of the cost of these injuries over this time-frame was almost $72,000 (mean of $316.72 per presentation). Conclusions People who wear high heel footwear on weekends appear to be at higher risk for injury that leads to emergency department presentation. However, there was not a large cost associated with emergency department presentations attributable to wearing high heel footwear over a 5 year period. PMID:24456691

EFFECT OF HEEL LIFTS ON PATELLOFEMORAL JOINT STRESS DURING RUNNING.

PubMed

Mestelle, Zachary; Kernozek, Thomas; Adkins, Kelly S; Miller, Jessica; Gheidi, Naghmeh

2017-10-01

Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress. Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. A repeated-measures research design. Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running. When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p<0.001) despite all runners utilizing a heel strike pattern. Dorsiflexion at initial contact was reduced 28% (p=0.016) when heel lifts were donned. No differences in step length and cadence (p>0.05) were shown between conditions. Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is to reduce patellofemoral joint stress. 3b.

EFFECT OF HEEL LIFTS ON PATELLOFEMORAL JOINT STRESS DURING RUNNING

PubMed Central

Mestelle, Zachary; Kernozek, Thomas; Adkins, Kelly S.; Miller, Jessica; Gheidi, Naghmeh

2017-01-01

Background Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress. Purpose Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. Study Design A repeated-measures research design Methods Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running. Results When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p<0.001) despite all runners utilizing a heel strike pattern. Dorsiflexion at initial contact was reduced 28% (p=0.016) when heel lifts were donned. No differences in step length and cadence (p>0.05) were shown between conditions. Conclusions Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is to reduce patellofemoral joint stress. Level of Evidence 3b PMID:29181248

Internal strain estimation for quantification of human heel pad elastic modulus: A phantom study.

PubMed

Holst, Karen; Liebgott, Hervé; Wilhjelm, Jens E; Nikolov, Svetoslav; Torp-Pedersen, Søren T; Delachartre, Philippe; Jensen, Jørgen A

2013-02-01

Shock absorption is the most important function of the human heel pad. However, changes in heel pad elasticity, as seen in e.g. long-distance runners, diabetes patients, and victims of Falanga torture are affecting this function, often in a painful manner. Assessment of heel pad elasticity is usually based on one or a few strain measurements obtained by an external load-deformation system. The aim of this study was to develop a technique for quantitative measurements of heel pad elastic modulus based on several internal strain measures from within the heel pad by use of ultrasound images. Nine heel phantoms were manufactured featuring a combination of three heel pad stiffnesses and three heel pad thicknesses to model the normal human variation. Each phantom was tested in an indentation system comprising a 7MHz linear array ultrasound transducer, working as the indentor, and a connected load cell. Load-compression data and ultrasound B-mode images were simultaneously acquired in 19 compression steps of 0.1mm each. The internal tissue displacement was for each step calculated by a phase-based cross-correlation technique and internal strain maps were derived from these displacement maps. Elastic moduli were found from the resulting stress-strain curves. The elastic moduli made it possible to distinguish eight of nine phantoms from each other according to the manufactured stiffness and showed very little dependence of the thickness. Mean elastic moduli for the three soft, the three medium, and the three hard phantoms were 89kPa, 153kPa, and 168kPa, respectively. The combination of ultrasound images and force measurements provided an effective way of assessing the elastic properties of the heel pad due to the internal strain estimation. Copyright © 2012 Elsevier B.V. All rights reserved.

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

PubMed

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

1993-01-01

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

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. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

Reconstruction of Heel With Propeller Flap in Postfasciotomy and Popliteal Artery Revascularization State.

PubMed

Kang, Jin Seok; Choi, Hwan Jun; Tak, Min Sung

2016-06-01

Free flaps are still the gold standard for large defects of the lower limb, but propeller perforator flaps have become a simpler and faster alternative to free flaps because of some advantages such as reliable vascular pedicle, wide mobilization and rotation, great freedom in design, low donor site morbidity, and easy harvest with no requirement for anastomosis. But when the vessels show insufficient findings in preoperative evaluation using a Doppler probe or the vessel is injured, the surgeon should avoid performing free flap surgery to prevent flap failure and should select a propeller perforator flap as an alternative method on the condition that more than one perforator is intact. In this study, we report reconstruction of soft tissue defects of the heel with a pedicled propeller flap in postfasciotomy and popliteal artery revascularization state by making an incision on the central portion above the Achilles tendon, which can be covered by the posterior tibial artery perforator or the peroneal artery perforator based flaps. In conclusion, we showed that although the popliteal artery was injured, the soft tissue defect can be reconstructed using a perforator propeller flap if intact distal flow in the anastomosis site was confirmed. © The Author(s) 2015.

Numerical investigation and identification of susceptible sites of atherosclerotic lesion formation in a complete coronary artery bypass model.

PubMed

Zhang, Jun-Mei; Chua, Leok Poh; Ghista, Dhanjoo N; Yu, Simon Ching Man; Tan, Yong Seng

2008-07-01

As hemodynamics is widely believed to correlate with anastomotic stenosis in coronary bypass surgery, this paper investigates the flow characteristics and distributions of the hemodynamic parameters (HPs) in a coronary bypass model (which includes both proximal and distal anastomoses), under physiological flow conditions. Disturbed flows (flow separation/reattachment, vertical and secondary flows) as well as regions of high oscillatory shear index (OSI) with low wall shear stress (WSS), i.e., high-OSI-and-low-WSS and low-OSI-and-high-WSS were found in the proximal and distal anastomoses, especially at the toe and heel regions of distal anastomosis, which indicate highly suspected sites for the onset of the atherosclerotic lesions. The flow patterns found in the graft and distal anastomoses of our model at deceleration phases are different from those of the isolated distal anastomosis model. In addition, a huge significant difference in segmental averages of HPs was found between the distal and proximal anastomoses. These findings further suggest that intimal hyperplasia would be more prone to form in the distal anastomosis than in the proximal anastomosis, particularly along the suture line at the toe and heel of distal anastomosis.

46 CFR 174.207 - Damaged stability criteria.

Code of Federal Regulations, 2011 CFR

2011-10-01

... sinkage, heel, and trim, must be below the lower edge of an opening through which progressive flooding may... of this subpart; or (v) Side scuttle of the non-opening type. (2) Angle of heel. The angle of heel...

46 CFR 174.145 - Intact stability requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... less than 40 degrees. (d) The maximum righting arm shall occur at a heel of at least 25 degrees. (e..., at each angle of heel, a vessel's righting arm may be calculated considering either— (1) The vessel... heels. ...

46 CFR 174.145 - Intact stability requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... less than 40 degrees. (d) The maximum righting arm shall occur at a heel of at least 25 degrees. (e..., at each angle of heel, a vessel's righting arm may be calculated considering either— (1) The vessel... heels. ...

Effect of Kangaroo mother care in reducing pain due to heel prick among preterm neonates: a crossover trial.

PubMed

Chidambaram, Ambika Gnanam; Manjula, S; Adhisivam, B; Bhat, B Vishnu

2014-03-01

Preterm neonates undergo several painful procedures in NICU including heel prick for blood sugar monitoring. Nonpharmacological interventions have been tried to decrease this procedural pain. There are only few studies on Kangaroo mother care (KMC) in reducing pain among preterm neonates. This crossover trial was conducted at a tertiary care teaching hospital in south India. Premature Infant Pain Profile (PIPP) related to heel prick was assessed in 50 preterm neonates undergoing KMC and compared with 50 preterm babies without KMC. PIPP scores at 15 minutes and 30 minutes after heel prick were significantly less in KMC group compared to control group. Mean PIPP difference between baseline and 30 minutes after heel prick was also significantly low in KMC group compared to control group. KMC is effective in reducing pain due to heel prick among preterm babies.

Treatment of Unicameral Bone Cysts of the Calcaneus: A Systematic Review.

PubMed

Levy, David M; Gross, Christopher E; Garras, David N

2015-01-01

The calcaneus is the most common tarsal affected by unicameral bone cysts (UBCs); however, the treatment of calcaneal UBCs remains controversial. The purpose of the present systematic review was to evaluate the treatment modalities for calcaneal UBCs. A systematic review was performed using clinical studies of calcaneal UBCs with a minimum of 1 year of follow-up and level I to IV evidence. Ten studies with 171 patients (181 cysts) were selected. Heel pain and radiographic cyst consolidation were the primary outcomes. A series of Z tests were used to compare the outcomes in the nonoperative and operative groups, cannulated screw and bone augmentation groups, and autografting and allografting groups. All patients treated with open curettage and bone augmentation had significant improvements in heel pain (p < .001). Only 1.1% ± 1.0% of the cysts treated conservatively had healed on radiographs compared with 93.0% ± 13.0% of the cysts after surgery (p < .001). A greater percentage of patients treated with bone augmentation had preoperative heel pain and resolution of that pain than did patients treated with cannulated screws (p < .001). Autografting had a significantly greater percentage of radiographic cyst consolidation than did allografting (97.4% ± 11.1% versus 85.1% ± 15.8%, p < .001, Z = 3.5). Objective outcomes data on calcaneal UBCs are relatively sparse. The results of the present review suggest that open curettage with autograft bone augmentation is the most effective procedure. We would encourage future comparative clinical studies to elucidate differences in UBC treatment modalities. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of shoe heel height and total-contact insert on muscle loading and foot stability while walking.

PubMed

Hong, Wei-Hsien; Lee, Yung-Hui; Lin, Yen-Hui; Tang, Simon F T; Chen, Hsieh-Ching

2013-02-01

Women wearing high-heeled shoes often complain of foot instability and low-back pain. Previous studies have demonstrated that using total-contact inserts (TCIs) in running shoes reduces impact on leg muscles and alters rearfoot motion. This study investigated how shoe heel height and use of TCIs in high-heeled shoes affect the wearer's rearfoot complex, muscle loading, and subjective comfort. Fifteen inexperienced high heel wearers walked under 6 test conditions formed by the cross-matching of shoe insert (with and without TCI) and heel height (1.0, 5.1, and 7.6 cm) at a speed of 1.3 m/s. The measures of interest were rearfoot kinematics; muscle activities by electromyography (EMG) of the tibialis anterior (TA), medial gastrocnemius (MG), quadriceps (QUA), hamstrings (HAM), and erector spinae (ES); and subjective comfort rating by visual analogue scale for each test condition. The statistical results showed that elevated heel height significantly increased plantar flexion (P < .001) and inversion (P < .01) at heel strike, prolonged TA-MG co-contraction (P < .001) and QUA activation period (P < .001), and increased root mean square (RMS) EMG in all measured muscles (TA, MG, QUA, ES: P < .001; HAM: P < .01). The use of TCIs reduced the rearfoot inversion angle (P < .01) and RMS EMG in both QUA and ES muscles (P < .01) and increased comfort rating (P < .001). These findings suggest that wearing high-heeled shoes adversely affects muscle control and reduces loads in QUA and ES muscles. The use of a TCI may improve comfort rating and foot stability.

Effect of Vibration on Pain Response to Heel Lance: A Pilot Randomized Control Trial.

PubMed

McGinnis, Kate; Murray, Eileen; Cherven, Brooke; McCracken, Courtney; Travers, Curtis

2016-12-01

Applied mechanical vibration in pediatric and adult populations has been shown to be an effective analgesic for acute and chronic pain, including needle pain. Studies among the neonatal population are lacking. According to the Gate Control Theory, it is expected that applied mechanical vibration will have a summative effect with standard nonpharmacologic pain control strategies, reducing behavioral and physiologic pain responses to heel lancing. To determine the safety and efficacy of mechanical vibration for relief of heel lance pain among neonates. In this parallel design randomized controlled trial, eligible enrolled term or term-corrected neonates (n = 56) in a level IV neonatal intensive care unit were randomized to receive either sucrose and swaddling or sucrose, swaddling, and vibration for heel lance analgesia. Vibration was applied using a handheld battery-powered vibrator (Norco MiniVibrator, Hz = 92) to the lateral aspect of the lower leg along the sural dermatome throughout the heel lance procedure. Neonatal Pain, Agitation, and Sedation Scale (N-PASS) scores, heart rate, and oxygen saturations were collected at defined intervals surrounding heel lancing. Infants in the vibration group (n = 30) had significantly lower N-PASS scores and more stable heart rates during heel stick (P = .006, P = .037) and 2 minutes after heel lance (P = .002, P = .016) than those in the nonvibration group. There were no adverse behavioral or physiologic responses to applied vibration in the sample. Applied mechanical vibration is a safe and effective method for managing heel lance pain. This pilot study suggests that mechanical vibration warrants further exploration as a nonpharmacologic pain management tool among the neonatal population.

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

PubMed Central

Jung, Jaemin; Lee, Sang-yeol

2014-01-01

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

A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma.

PubMed

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

2017-04-01

Pathological conditions such as diabetic foot and plantar heel pain are associated with changes in the mechanical properties of plantar soft tissue. However, the causes and implications of these changes are not yet fully understood. This is mainly because accurate assessment of the mechanical properties of plantar soft tissue in the clinic remains extremely challenging. To develop a clinically viable non-invasive method of assessing the mechanical properties of the heel pad. Furthermore the effect of non-linear mechanical behaviour of the heel pad on its ability to uniformly distribute foot-ground contact loads in light of the effect of overloading is also investigated. An automated custom device for ultrasound indentation was developed along with custom algorithms for the automated subject-specific modeling of heel pad. Non-time-dependent and time-dependent material properties were inverse engineered from results from quasi-static indentation and stress relaxation test respectively. The validity of the calculated coefficients was assessed for five healthy participants. The implications of altered mechanical properties on the heel pad's ability to uniformly distribute plantar loading were also investigated in a parametric analysis. The subject-specific heel pad models with coefficients calculated based on quasi-static indentation and stress relaxation were able to accurately simulate dynamic indentation. Average error in the predicted forces for maximum deformation was only 6.6±4.0%. When the inverse engineered coefficients were used to simulate the first instance of heel strike the error in terms of peak plantar pressure was 27%. The parametric analysis indicated that the heel pad's ability to uniformly distribute plantar loads is influenced both by its overall deformability and by its stress-strain behaviour. When overall deformability stays constant, changes in stress/strain behaviour leading to a more "linear" mechanical behaviour appear to improve the heel pad's ability to uniformly distribute plantar loading. The developed technique can accurately assess the visco-hyperelastic behaviour of heel pad. It was observed that specific change in stress-strain behaviour can enhance/weaken the heel pad's ability to uniformly distribute plantar loading that will increase/decrease the risk for overloading and trauma. Copyright © 2017 Elsevier Ltd. All rights reserved.

Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery.

PubMed

Bain, Gregory; Gupta, Prince; Phadnis, Joideep; Singhi, Prahalad K

2016-02-01

The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision. It allows the surgeon to introduce open surgical techniques into the depths of the wound in a controlled manner. Because of the dead space created, there is a risk of hematoma formation. Many of the concepts used in open surgery are now being used for endoscopic surgery, and vice versa. The barriers and differences among endoscopic, arthroscopic, and open procedures are being broken down. We report another endoscopic technique, which is part of the ongoing evolution of musculoskeletal surgery.

Cobedding of twin premature infants: calming effects on pain responses.

PubMed

Badiee, Zohreh; Nassiri, Zohreh; Armanian, Amirmohammad

2014-08-01

The purpose of this trial was to determine whether cobedding of preterm twins has analgesic effects during heel lancing or not. One hundred premature twins (50 sets) born between 26 weeks' and 34 weeks' gestation undergoing heel blood sampling were randomly assigned into two groups: the cobedding group (receiving care in the same incubator) and the standard care group (receiving care in separate incubators). Pain was assessed using the premature infant pain profile score. Duration of crying was measured after heel blood sampling, and salivary cortisol was measured prior to and after heel blood sampling. Infants in the standard care group cried for a longer time during heel lancing than those in the cobedding group (42.6 ± 19.8 seconds vs. 36.4 ± 21.7 seconds, p = 0.03). The mean premature infant pain profile score after heel lancing was significantly higher in the standard care group (9.8 ± 2.6 vs. 8.06 ± 2.8, p = 0.002). The mean salivary cortisol after heel lancing was also significantly higher in the standard care group (24.3 ± 7.4 nmol/L vs. 20.8 ± 7.4 nmol/L, p = 0.02). No significant adverse effects were seen with cobedding. Cobedding is a comforting measure for twin premature infants during heel lancing, which can be performed without any significant adverse effects. Copyright © 2014. Published by Elsevier B.V.

Can an off-the-rack orthotic stiletto alter pressure and comfort scores in the forefoot, arch and heel?

PubMed

Penny, Jeannette Østergaard; Speedtsberg, Merete Brink; Kallemose, Thomas; Bencke, Jesper

2018-03-16

The study sought to investigate whether an orthotic stiletto could modulate the pressure and comfort under the forefoot, arch and heel that stiletto wearers experience. Twenty-two women participated. We measured the peak pressure and pressure-time integral for orthotic stilettos with built-in metatarsal pad, heel cup and arch support; standard stilettos without inlays; and trainers. Comfort was recorded during 3 × 3 working days. The orthotic stiletto exhibited lower metatarsal head1 (MTH) and MTH2+3 and heel pressures than the standard stiletto (p < .01), and a long second metatarsal increased MTH2+3 pressure (p < .01). The comfort in the forefoot and heel was higher in the orthotic stiletto than in the standard one (p < .01), and comfort in the forefoot was correlated to the pressure-time integral of MTH2+3 (p = .03) and not peak pressure. Off-the-rack orthotic stilettos can notably reduce plantar pressures and improve forefoot and heel comfort during everyday use. Practitioner Summary: Off-the-rack orthotic stilettos with built-in metatarsal pad, arch support and heel caps can lower the pressure under the heel and forefoot in comparison with a standard stiletto and can improve comfort during everyday use. Having a long second metatarsal is a risk factor for increased forefoot pressure.

The role of beaded activated carbon's pore size distribution on heel formation during cyclic adsorption/desorption of organic vapors.

PubMed

Jahandar Lashaki, Masoud; Atkinson, John D; Hashisho, Zaher; Phillips, John H; Anderson, James E; Nichols, Mark

2016-09-05

The effect of activated carbon's pore size distribution (PSD) on heel formation during adsorption of organic vapors was investigated. Five commercially available beaded activated carbons (BAC) with varying PSDs (30-88% microporous) were investigated. Virgin samples had similar elemental compositions but different PSDs, which allowed for isolating the contribution of carbon's microporosity to heel formation. Heel formation was linearly correlated (R(2)=0.91) with BAC micropore volume; heel for the BAC with the lowest micropore volume was 20% lower than the BAC with the highest micropore volume. Meanwhile, first cycle adsorption capacities and breakthrough times correlated linearly (R(2)=0.87 and 0.93, respectively) with BAC total pore volume. Micropore volume reduction for all BACs confirmed that heel accumulation takes place in the highest energy pores. Overall, these results show that a greater portion of adsorbed species are converted into heel on highly microporous adsorbents due to higher share of high energy adsorption sites in their structure. This differs from mesoporous adsorbents (low microporosity) in which large pores contribute to adsorption but not to heel formation, resulting in longer adsorbent lifetime. Thus, activated carbon with high adsorption capacity and high mesopore fraction is particularly desirable for organic vapor application involving extended adsorption/regeneration cycling. Copyright © 2016 Elsevier B.V. All rights reserved.

Does Foot Anthropometry Predict Metabolic Cost During Running?

PubMed

van Werkhoven, Herman; Piazza, Stephen J

2017-10-01

Several recent investigations have linked running economy to heel length, with shorter heels being associated with less metabolic energy consumption. It has been hypothesized that shorter heels require larger plantar flexor muscle forces, thus increasing tendon energy storage and reducing metabolic cost. The goal of this study was to investigate this possible mechanism for metabolic cost reduction. Fifteen male subjects ran at 16 km⋅h -1 on a treadmill and subsequently on a force-plate instrumented runway. Measurements of oxygen consumption, kinematics, and ground reaction forces were collected. Correlational analyses were performed between oxygen consumption and anthropometric and kinetic variables associated with the ankle and foot. Correlations were also computed between kinetic variables (peak joint moment and peak tendon force) and heel length. Estimated peak Achilles tendon force normalized to body weight was found to be strongly correlated with heel length normalized to body height (r = -.751, p = .003). Neither heel length nor any other measured or calculated variable were correlated with oxygen consumption, however. Subjects with shorter heels experienced larger Achilles tendon forces, but these forces were not associated with reduced metabolic cost. No other anthropometric and kinetic variables considered explained the variance in metabolic cost across individuals.

Influence of a Viscoelastic Insole on Foot, Knee and Back Pain among Members of the United States Army Band

DTIC Science & Technology

2010-07-13

band members by providing them shoes with some favorable properties such as outsoles with built in compression pads in the heel and forefoot as well...compared to a no insole condition49 and that peak pressure generated at the forefoot and heel have been reduced by 24 percent and 37 percent...Attenuation of spinal transients at heel strike using viscoelastic heel insoles: an in vivo study. Preventive Medicine. 2004;39:351-354. 30

Heel Ultrasound Can Assess Maintenance of Bone Mass in Women with Breast Cancer

PubMed Central

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

2016-01-01

Postmenopausal women with early-stage breast cancer are at increased risk for bone loss and fractures. Bisphosphonates can prevent bone loss, but little data are available on changes in bone mass assessed by heel quantitative ultrasound (QUS). Our objectives were to determine if (1) heel QUS would provide a reliable and accessible method for evaluation of changes in bone mass in women with breast cancer as compared to the current standard of bone mass measurement, dual-energy x-ray absorptiometry (DXA), and (2) oral risedronate could affect these changes. Eighty-six newly postmenopausal (up to 8 years) women with nonmetastatic breast cancer were randomized to risedronate, 35 mg once weekly or placebo. Outcomes were changes in heel QUS bone mass measurements and conventional dual-energy x-ray absorptiometry (DXA) derived bone mineral density (BMD). Over 2 years, bone mass assessed by heel QUS remained stable in women on risedronate, while women on placebo had a 5.2% decrease (p ≤ 0.05) in heel QUS bone mass. Both total hip BMD and femoral neck BMD assessed by DXA decreased by 1.6% (p ≤ 0.05) in the placebo group and remained stable with risedronate. Spine BMD remained stable in both groups. Heel QUS was moderately associated with BMD measured by DXA at the total hip (r = 0.50), femoral neck (r = 0.40), and spine (r = 0.46) at baseline (all p ≤ 0.001). In conclusion, risedronate helps to maintain skeletal integrity as assessed by heel QUS for women with early-stage breast cancer. Heel QUS is associated with DXA-derived BMD at other major axial sites and may be used to follow skeletal health and bone mass changes in these women. PMID:22425507

Adolescent runners: the effect of training shoes on running kinematics.

PubMed

Mullen, Scott; Toby, E Bruce

2013-06-01

The modern running shoe typically features a large cushioned heel intended to dissipate the energy at heel strike to the knees and hips. The purpose of this study was to evaluate the effect that shoes have upon the running biomechanics among competitive adolescent runners. We wish to answer the question of whether running style is altered in these athletes because of footwear. Twelve competitive adolescent athletes were recruited from local track teams. Each ran on a treadmill in large heel trainers, track flats, and barefoot. Four different speeds were used to test each athlete. The biomechanics were assessed with a motion capture system. Stride length, heel height during posterior swing phase, and foot/ground contact were recorded. Shoe type markedly altered the running biomechanics. The foot/ground contact point showed differences in terms of footwear (P<0.0001) and speed (P=0.000215). When wearing trainers, the athletes landed on their heels 69.79% of the time at all speeds (P<0.001). The heel was the first point of contact <35% of the time in the flat condition and <30% in the barefoot condition. Running biomechanics are significantly altered by shoe type in competitive adolescents. Heavily heeled cushioned trainers promote a heel strike pattern, whereas track flats and barefoot promote a forefoot or midfoot strike pattern. Training in heavily cushioned trainers by the competitive runner has not been clearly shown to be detrimental to performance, but it does change the gait pattern. It is not known whether the altered biomechanics of the heavily heeled cushioned trainer may be detrimental to the adolescent runner who is still developing a running style.

Heel blood flow during loading and off-loading in bedridden older adults with low and normal ankle-brachial pressure index: a quasi-experimental study.

PubMed

Masaki, Nami; Sugama, Junko; Okuwa, Mayumi; Inagaki, Misako; Matsuo, Junko; Nakatani, Tosio; Sanada, Hiromi

2013-07-01

The purpose of this study was to evaluate the differences in heel blood flow during loading and off-loading in bedridden adults older than 65 years. The patients were divided into three groups based on ankle-brachial pressure index (ABI) and transcutaneous oxygen tension (tcPO₂): (1) patients with an ABI ≥ 0.8 (Group A); (2) patients with an ABI < 0.8 and heel tcPO₂ ≥ 10 mmHg (Group B); and (3) patients with an ABI < 0.8 and heel tcPO₂ < 10 mmHg (Group C). Heel blood flow was monitored using tcPO₂ sensors. Data were collected with the heel (1) suspended above the bed surface (preload), (2) on the bed surface for 30 min (loading), and (3) again suspended above the bed surface for 60 min (off-loading). Heel blood flow during off-loading was assessed using three parameters: oxygen recovery index (ORI), total tcPO₂ for the first 10 min, and change in tcPO₂ after 60 min of off-loading. ORI in Group C (n = 8) was significantly shorter than in Groups A (n = 22) and B (n = 15). Total tcPO₂ for the first 10 min of off-loading in Group C was significantly less than that in Groups A and B. Change in tcPO₂ after 60 min of off-loading in Group C was less than in Group A. Based on these findings, additional preventive care against heel blood flow decrease in older adults with an ABI < 0.8 and heel tcPO₂ < 10 mmHg might be necessary after loading.

Shoe heel abrasion and its possible biomechanical cause: a transversal study with infantry recruits.

PubMed

Baumfeld, Daniel; Raduan, Fernando C; Macedo, Benjamim; Silva, Thiago Alexandre Alves; Baumfeld, Tiago; Favato, Danilo Fabrino; de Andrade, Marco Antonio Percope; Nery, Caio

2015-11-19

Excessive shoe heel abrasion is of concern to patients and shoe manufacturers, but little scientific information is available about this feature and its possible causes. The purpose of this study was to relate this phenomenon with biomechanical factors that could predispose to shoe heel abrasion. Ninety-seven recruits (median age 25) were enrolled in this study. Shoe abrasion was assessed manually with a metric plastic tape on the posterior part of the heel that comes in contact with the ground. The number of sprains, foot alignment, and calf muscle shortening (Silfverskiold test) was also assessed in order to relate it with shoe heel abrasion. After using our exclusion criteria, 86 recruits and 172 were considered for this study. The most common abrasion site was the lateral portion of the heel surface (50 %). Forty-four percent of the participants had neutral hind-foot alignment and 39 % had valgus alignment. Twenty-six (30 %) patients have had previous ankle or foot sprains. Neutral foot was related with less calf muscle shortening. On the other hand, valgus hind-foot alignment was more associated with Achilles shortening (p < 0.05). Patients with neutral alignment were associated with more uniform shoe heel abrasion and varus feet were associated with more central and lateral abrasion (p < 0.05). The pattern of shoe heel abrasion was not statistically related with calf muscle shortening nor with number of sprains. This study was able to correlate shoe heel abrasion with biomechanical causes (neutral alignment-uniform abrasion/varus alignment-central and lateral abrasion). More effort has to be done to continue evaluating outsole abrasion with its possible biomechanical cause in order to predict and treat possible associated injuries.

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. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

The dawn of the third renaissance in surgery.

PubMed

Hackam, David J

2015-08-01

In this presidential address, I will share my belief that our proud and noble field stands at the dawn of a great renaissance. I further believe that this is the third such renaissance that has occurred in surgery. As described herein, the first renaissance in surgery occurred during the 1600s, which involved a transformation in operative care unlike anything that had been seen since Roman times. This first renaissance was triggered by tumultuous world events but was spurred on by the invention of the printing press. The second renaissance occurred during the 1980s and was triggered by the invention of the computer, which is of equal significance to the printing press 240 years earlier. I believe that this third renaissance shares with the earlier renaissances its transformative nature and its reaction to turmoil, both in the medical and nonmedical worlds. This is a renaissance driven by science, by creativity, and by innovation—resources that are never in short supply within our great profession. Copyright © 2015. Published by Elsevier Inc.

Conservation implications of spur length variation in long-spur columbines (Aquilegia longissima)

Treesearch

Christopher J. Stubben; Brook G. Milligan

2007-01-01

Populations of long-spur columbine (Aquilegia longissima) with spurs 10-16 cm long are known only from a few populations in Texas, a historical collection near Baboquivari Peak, Arizona, and scattered populations in Coahuila, Chihuahua, and Nuevo Leon, Mexico. Populations of yellow columbine with spurs 7-10 cm long are also found in Arizona, Texas,...

North Carolina wound nurses examine heel pressure ulcers.

PubMed

Clegg, Amy; Kring, Daria; Plemmons, Judy; Richbourg, Leanne

2009-01-01

Heels are the second most common location for pressure ulcers, and their prevalence is increasing. The purpose of this multisite research project was to describe physical characteristics and medical history of patients experiencing heel pressure ulcers (PUs). The settings for this study were different healthcare settings (acute care, long-term care, and homecare) in North Carolina and Virginia, where member WOC nurses perform consultative services for patients with heel ulcers. Patients older than 18 years with a heel PU were included in the study. A data collection tool was developed by the authors. Participating members of the NC WOC Nurses Group identified 84 participants. Descriptive statistics were used to summarize the data by using proportions, means, standard deviations, and ranges. Over half of the population had a palpable pedal pulse. Full-thickness PUs were found in 45% of the sample while 19% had suspected deep tissue loss. Subjects tended to be elderly and have low nutritional markers, high body mass index, multiple comorbid conditions such as diabetes mellitus, systemic infection, end-stage renal disease and peripheral arterial disease, as well as low Braden Scale scores. The study revealed important factors specific to heel PUs including advanced age, malnutrition, high body mass index, and multiple comorbid conditions. Further research is needed to further refine our knowledge of our factors associated with an increase likelihood of heel PUs. Our findings also point out the need for a tool specific for the evaluation of heel PU risk.

Chronic Achilles tendinopathy: a prospective randomized study comparing the therapeutic effect of eccentric training, the AirHeel brace, and a combination of both.

PubMed

Petersen, Wolf; Welp, Robert; Rosenbaum, Dieter

2007-10-01

Previous studies have shown that eccentric training has a positive effect on chronic Achilles tendinopathy. A new strategy for the treatment of chronic Achilles tendinopathy is the AirHeel brace. AirHeel brace treatment improves the clinical outcome of patients with chronic Achilles tendinopathy. The combination of the AirHeel brace and an eccentric training program has a synergistic effect. Randomized controlled clinical trial; Level of evidence, 1. One hundred patients were randomly assigned to 1 of 3 treatment groups: (1) eccentric training, (2) AirHeel brace, and (3) combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 54 weeks after the beginning of the treatment protocol with ultrasonography, visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and Short Form-36 (SF-36). The VAS score for pain, AOFAS score, and SF-36 improved significantly in all 3 groups at all 3 follow-up examinations. At the 3 time points (6 weeks, 12 weeks, and 54 weeks) of follow-up, there was no significant difference between all 3 treatment groups. In all 3 groups, there was no significant difference in tendon thickness after treatment. The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is no synergistic effect when both treatment strategies are combined. The AirHeel brace is an alternative treatment option for chronic Achilles tendinopathy.

Manual therapy for plantar heel pain.

PubMed

Pollack, Yosefa; Shashua, Anat; Kalichman, Leonid

2018-03-01

Manual therapy employed in the treatment of plantar heel pain includes joint or soft tissue mobilizations. Efficacy of these methods is still under debate. To determine whether manual therapy, consisting of deep massage, myofascial release or joint mobilization is effective in treating plantar heel pain. A critical review of all available studies with an emphasis on randomized controlled trials (RCTs) was performed. PubMed, PEDro, and Google Scholar databases were searched for keywords relating to plantar heel pain, joint, and soft tissue mobilizations. There were no search limitations or language restrictions. The reference lists of all retrieved articles were searched. The PEDro score was used to assess the quality of the reviewed papers. A total of six relevant RCTs were found: two examined the effectiveness of joint mobilization on plantar heel pain and four the effectiveness of soft tissue techniques. Five studies showed a positive short-term effect after manual therapy treatment, mostly soft tissue mobilizations, with or without stretching exercises for patients with plantar heel pain, compared to other treatments. One study observed that adding joint mobilization to the treatment of plantar heel pain was not effective. The quality of all studies was moderate to high. According to reviewed moderate and high-quality RCTs, soft tissue mobilization is an effective modality for treating plantar heel pain. Outcomes of joint mobilizations are controversial. Further studies are needed to evaluate the short and long-term effect of different soft tissue mobilization techniques. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evolution of spur-length diversity in Aquilegia petals is achieved solely through cell-shape anisotropy.

PubMed

Puzey, Joshua R; Gerbode, Sharon J; Hodges, Scott A; Kramer, Elena M; Mahadevan, L

2012-04-22

The role of petal spurs and specialized pollinator interactions has been studied since Darwin. Aquilegia petal spurs exhibit striking size and shape diversity, correlated with specialized pollinators ranging from bees to hawkmoths in a textbook example of adaptive radiation. Despite the evolutionary significance of spur length, remarkably little is known about Aquilegia spur morphogenesis and its evolution. Using experimental measurements, both at tissue and cellular levels, combined with numerical modelling, we have investigated the relative roles of cell divisions and cell shape in determining the morphology of the Aquilegia petal spur. Contrary to decades-old hypotheses implicating a discrete meristematic zone as the driver of spur growth, we find that Aquilegia petal spurs develop via anisotropic cell expansion. Furthermore, changes in cell anisotropy account for 99 per cent of the spur-length variation in the genus, suggesting that the true evolutionary innovation underlying the rapid radiation of Aquilegia was the mechanism of tuning cell shape.

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…

Pollinator shifts and the evolution of spur length in the moth-pollinated orchid Platanthera bifolia.

PubMed

Boberg, Elin; Alexandersson, Ronny; Jonsson, Magdalena; Maad, Johanne; Ågren, Jon; Nilsson, L Anders

2014-01-01

Plant-pollinator interactions are thought to have shaped much of floral evolution. Yet the relative importance of pollinator shifts and coevolutionary interactions for among-population variation in floral traits in animal-pollinated species is poorly known. This study examined the adaptive significance of spur length in the moth-pollinated orchid Platanthera bifolia. Geographical variation in the length of the floral spur of P. bifolia was documented in relation to variation in the pollinator fauna across Scandinavia, and a reciprocal translocation experiment was conducted in south-east Sweden between a long-spurred woodland population and a short-spurred grassland population. Spur length and pollinator fauna varied among regions and habitats, and spur length was positively correlated with the proboscis length of local pollinators. In the reciprocal translocation experiment, long-spurred woodland plants had higher pollination success than short-spurred grassland plants at the woodland site, while no significant difference was observed at the grassland site. The results are consistent with the hypothesis that optimal floral phenotype varies with the morphology of the local pollinators, and that the evolution of spur length in P. bifolia has been largely driven by pollinator shifts.

Pollinator shifts and the evolution of spur length in the moth-pollinated orchid Platanthera bifolia

PubMed Central

Boberg, Elin; Alexandersson, Ronny; Jonsson, Magdalena; Maad, Johanne; Ågren, Jon; Nilsson, L. Anders

2014-01-01

Background and Aims Plant–pollinator interactions are thought to have shaped much of floral evolution. Yet the relative importance of pollinator shifts and coevolutionary interactions for among-population variation in floral traits in animal-pollinated species is poorly known. This study examined the adaptive significance of spur length in the moth-pollinated orchid Platanthera bifolia. Methods Geographical variation in the length of the floral spur of P. bifolia was documented in relation to variation in the pollinator fauna across Scandinavia, and a reciprocal translocation experiment was conducted in south-east Sweden between a long-spurred woodland population and a short-spurred grassland population. Key Results Spur length and pollinator fauna varied among regions and habitats, and spur length was positively correlated with the proboscis length of local pollinators. In the reciprocal translocation experiment, long-spurred woodland plants had higher pollination success than short-spurred grassland plants at the woodland site, while no significant difference was observed at the grassland site. Conclusions The results are consistent with the hypothesis that optimal floral phenotype varies with the morphology of the local pollinators, and that the evolution of spur length in P. bifolia has been largely driven by pollinator shifts. PMID:24169591

40 CFR 82.4 - Prohibitions for class I controlled substances.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (except for transhipments, heels or used controlled substances) import, at any time in any control period... period. Every kilogram of excess production or importation (other than transhipments, heels or used... person may import (except for transhipments or heels), at any time in any control period, (except for...

40 CFR 82.4 - Prohibitions for class I controlled substances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (except for transhipments, heels or used controlled substances) import, at any time in any control period... period. Every kilogram of excess production or importation (other than transhipments, heels or used... person may import (except for transhipments or heels), at any time in any control period, (except for...

46 CFR 172.245 - Survival conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... stage of flooding: (a) Final waterline. The final waterline, in the final condition of sinkage, heel... nonopening type; (7) Retractable inflatable seal; or (8) Guillotine door. (b) Heel angle. The maximum angle of heel must not exceed 15 degrees, except that this angle may be increased to 17 degrees if no deck...

46 CFR 172.245 - Survival conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... stage of flooding: (a) Final waterline. The final waterline, in the final condition of sinkage, heel... nonopening type; (7) Retractable inflatable seal; or (8) Guillotine door. (b) Heel angle. The maximum angle of heel must not exceed 15 degrees, except that this angle may be increased to 17 degrees if no deck...

A Comparison of 2 Current-Issue Army Boots.

DTIC Science & Technology

2000-01-01

at 3.5 mph, mean (SD) 32 21 .Maximum heel- strike vertical force (N) while walking at 3.5 mph, mean (SD) 33 22 Maximum heel- strike braking force...while running at 6.5 mph, mean (SD) 38 34 Maximum force on the hip (N) while running at 6.5 mph, mean (SD) 38 35 Maximum vertical heel- strike force (N...during 6.5 mph running, mean (SD) 39 36. Maximum heel- strike braking force (N) while running at 6.5 mph, mean (SD) 39 37. Maximum vertical push

An evaluation of a silicone adhesive shaped heel dressing.

PubMed

Hampton, Sylvie

Tissue breakdown is complex and involves many factors. Pressure ulcer development in the heels is subject to extrinsic factors such as pressure, shear, friction and moisture. The heels are the most common sites for friction and shear damage, which can lead to blistering, skin erosion and tissue breakdown (Grey et al, 2006). To address the issues of wounds that are painful on dressing removal and friable skin, Smith & Nephew has introduced a soft silicone adhesive dressing to its Allevyn dressing range. Silicone does not adhere to wounded areas and can be removed gently without trauma to the periwound area. This paper discusses the findings of a 20-patient multi-site evaluation examining the performance and acceptability of Allevyn Gentle Border Heel dressing in the management of heel wounds.

Foot-strike pattern and performance in a marathon.

PubMed

Kasmer, Mark E; Liu, Xue-Cheng; Roberts, Kyle G; Valadao, Jason M

2013-05-01

To determine prevalence of heel strike in a midsize city marathon, if there is an association between foot-strike classification and race performance, and if there is an association between foot-strike classification and gender. Foot-strike classification (forefoot, midfoot, heel, or split strike), gender, and rank (position in race) were recorded at the 8.1-km mark for 2112 runners at the 2011 Milwaukee Lakefront Marathon. 1991 runners were classified by foot-strike pattern, revealing a heel-strike prevalence of 93.67% (n = 1865). A significant difference between foot-strike classification and performance was found using a Kruskal-Wallis test (P < .0001), with more elite performers being less likely to heel strike. No significant difference between foot-strike classification and gender was found using a Fisher exact test. In addition, subgroup analysis of the 126 non-heel strikers found no significant difference between shoe wear and performance using a Kruskal-Wallis test. The high prevalence of heel striking observed in this study reflects the foot-strike pattern of most mid-distance to long-distance runners and, more important, may predict their injury profile based on the biomechanics of a heel-strike running pattern. This knowledge can help clinicians appropriately diagnose, manage, and train modifications of injured runners.

Role of EVA viscoelastic properties in the protective performance of a sport shoe: computational studies.

PubMed

Even-Tzur, Nurit; Weisz, Ety; Hirsch-Falk, Yifat; Gefen, Amit

2006-01-01

Modern sport shoes are designed to attenuate mechanical stress waves, mainly through deformation of the viscoelastic midsole which is typically made of ethylene vinyl acetate (EVA) foam. Shock absorption is obtained by flow of air through interconnected air cells in the EVA during shoe deformation under body-weight. However, when the shoe is overused and air cells collapse or thickness of the EVA is reduced, shock absorption capacity may be affected, and this may contribute to running injuries. Using lumped system and finite element models, we studied heel pad stresses and strains during heel-strike in running, considering the viscoelastic constitutive behavior of both the heel pad and EVA midsole. In particular, we simulated wear cases of the EVA, manifested in the modeling by reduced foam thickness, increased elastic stiffness, and shorter stress relaxation with respect to new shoe conditions. Simulations showed that heel pad stresses and strains were sensitive to viscous damping of the EVA. Wear of the EVA consistently increased heel pad stresses, and reduced EVA thickness was the most influential factor, e.g., for a 50% reduction in thickness, peak heel pad stress increased by 19%. We conclude that modeling of the heel-shoe interaction should consider the viscoelastic properties of the tissue and shoe components, and the age of the studied shoe.

Risk factors affecting chronic rupture of the plantar fascia.

PubMed

Lee, Ho Seong; Choi, Young Rak; Kim, Sang Woo; Lee, Jin Yong; Seo, Jeong Ho; Jeong, Jae Jung

2014-03-01

Prior to 1994, plantar fascia ruptures were considered as an acute injury that occurred primarily in athletes. However, plantar fascia ruptures have recently been reported in the setting of preexisting plantar fasciitis. We analyzed risk factors causing plantar fascia rupture in the presence of preexisting plantar fasciitis. We retrospectively reviewed 286 patients with plantar fasciitis who were referred from private clinics between March 2004 and February 2008. Patients were divided into those with or without a plantar fascia rupture. There were 35 patients in the rupture group and 251 in the nonrupture group. The clinical characteristics and risk factors for plantar fascia rupture were compared between the 2 groups. We compared age, gender, the affected site, visual analog scale pain score, previous treatment regimen, body mass index, degree of ankle dorsiflexion, the use of steroid injections, the extent of activity, calcaneal pitch angle, the presence of a calcaneal spur, and heel alignment between the 2 groups. Of the assessed risk factors, only steroid injection was associated with the occurrence of a plantar fascia rupture. Among the 35 patients with a rupture, 33 had received steroid injections. The odds ratio of steroid injection was 33. Steroid injections for plantar fasciitis should be cautiously administered because of the higher risk for plantar fascia rupture. Level III, retrospective comparative study.

Relationships between spur- and orchard-level fruit bearing in almond (Prunus dulcis).

PubMed

Tombesi, Sergio; Lampinen, Bruce D; Metcalf, Samuel; DeJong, Theodore M

2011-12-01

Almond is often considered to be a moderately alternate-bearing species but historical yield data typically do not exhibit clear patterns of alternate bearing at the orchard level, while research has indicated that spurs (the main fruit bearing unit in almond trees) rarely produce fruit in two subsequent years. The objective of the present work was to analyze the bearing behavior of almond trees at both the orchard level and the individual spur level over multiple years to explain this apparent paradox. The 10-year yield patterns of three almond cultivars grown at three different sites within California were analyzed for tendencies of alternate bearing at the orchard level. At the individual spur level, data on spur viability, and number of flowers and fruits per spur were collected on 2400 individually tagged spurs that were observed over 6 years to characterize bearing at that level. At the orchard level one cultivar (Nonpareil) did exhibit a tendency for alternate bearing at one site (Kern) but other cultivars and sites did not. The orchard and the individual trees in which the spur population study was conducted showed tendencies for alternate bearing but the spur population did not. Only a relatively small percentage of the total tagged spur population bore fruit in any given year and therefore while individual fruiting spurs exhibited a high level of non-bearing after fruiting the previous year the spurs that did produce fruit in any year generally did not constitute enough of the total spur population to exhibit alternate bearing at the whole population level. Our results suggest that annual bearing fluctuations in almond are probably mainly due to year-to-year variations of parameters affecting fruit set and that high rates of fruit set in a given year may involve a larger-than-normal percentage of a spur population in fruit bearing. This would limit the size of the spur population available for flowering in the subsequent year and could cause alternate year bearing. However, from historical records, this would appear to be the exception rather than a normal circumstance. Therefore, almond should not be considered to be a strictly alternate-bearing species.

The 2016 HIGh Heels: Health effects And psychosexual BenefITS (HIGH HABITS) study: systematic review of reviews and additional primary studies.

PubMed

Barnish, Max; Morgan, Heather May; Barnish, Jean

2017-08-01

High-heeled shoes (high heels) are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels. We searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted. A total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies) were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men's behaviour associated with high heel wear. With regard to second-party injury, evidence is limited to one descriptive study and eight case reports. Our evidence synthesis clearly shows that high heels bring psychosexual benefits to women but are detrimental to their health. In light of this dilemma, it is important that women's freedom of choice is respected and that any remaining issues of explicit or implicit compulsion are addressed.

[Heel pressure ulcers. Comparative study between heel protective bandage and hydrocellular dressing with special form for the heel].

PubMed

Torra i Bou, Joan-Enric; Rueda López, Justo; Camañes, Gemma; Herrero Narváez, Elias; Blanco Blanco, Joan; Martínez-Esparza, Elvira Hernández; Aneas Alcántara, Jesús; Verdú Soriano, José

2002-05-01

The heels, together with the sacra area, are one of the most frequent spots where pressure sores appear here in Spain. Any preventive measure against pressure sores on heels needs be oriented towards two main objectives: effective relief of pressure and its compatibility with localized care and skin inspection in order to detect lesions early on at least once a day. The authors planned a comparative, multi-centered, open, labeled and controlled study in which patients were assigned to two groups receiving these treatments: one received traditional preventive pressure sore treatment and a protective bandage on their heels while the other used a special Allevyn Heel hydrocellular dressing to protect their heels. The patients took part in this study over an eight week period. The response variable used to determine the effectiveness of the preventive measure in this study was the appearance of pressure sores. At the beginning, 130 patients were included in this study, 65 in each one of the treatment groups. In the bandage group, 50 patients finished this study while 61 in the dressing group finished this study. The appearance of pressure sores in the protective bandage group occurred in 44% of the patients, 22 out of 50, while in the dressing group, the occurrence rate was 3.3%, 2 out of 61 patients with a value of "ji" squared p < 0.001. The risk factor to develop a pressure sore brought us a value of relative risk of 13.42 (IC 95%: 3.31-54.3) in the group wearing the protective bandage compared to the group wearing the dressing. The results of this study allow us to accept as valid the alternate hypothesis that there exist significant statistical differences between both treatment methods in favor of the Allevyn Heel dressing instead of the protective heel bandage. The use of this dressing, even though it is more expensive a priori than the protective bandage, in terms of unit cost for the product, has proven to be more effective in preventing pressure sores, and cheaper than the protective bandage if we bear in mind these combination of variables: time of usage, application and removal.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

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

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 ismore » 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)« less

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

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

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 ismore » 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.« less

Cerebral Oxygenation and Pain of Heel Blood Sampling Using Manual and Automatic Lancets in Premature Infants.

PubMed

Hwang, Mi-Jung; Seol, Geun Hee

2015-01-01

Heel blood sampling is a common but painful procedure for neonates. Automatic lancets have been shown to be more effective, with reduced pain and tissue damage, than manual lancets, but the effects of lancet type on cortical activation have not yet been compared. The study aimed to compare the effects of manual and automatic lancets on cerebral oxygenation and pain of heel blood sampling in 24 premature infants with respiratory distress syndrome. Effectiveness was measured by assessing numbers of pricks and squeezes and duration of heel blood sampling. Pain responses were measured using the premature infant pain profile score, heart rate, and oxygen saturation (SpO2). Regional cerebral oxygen saturation (rScO2) was measured using near-infrared spectroscopy, and cerebral fractional tissue oxygen extraction was calculated from SpO2 and rScO. Measures of effectiveness were significantly better with automatic than with manual lancing, including fewer heel punctures (P = .009) and squeezes (P < .001) and shorter duration of heel blood sampling (P = .002). rScO2 was significantly higher (P = .013) and cerebral fractional tissue oxygen extraction after puncture significantly lower (P = .040) with automatic lancing. Premature infant pain profile scores during (P = .004) and after (P = .048) puncture were significantly lower in the automatic than in the manual lancet group. Automatic lancets for heel blood sampling in neonates with respiratory distress syndrome significantly reduced pain and enhanced cerebral oxygenation, suggesting that heel blood should be sampled routinely using an automatic lancet.

Effects of skin-to-skin contact on autonomic pain responses in preterm infants.

PubMed

Cong, Xiaomei; Cusson, Regina M; Walsh, Stephen; Hussain, Naveed; Ludington-Hoe, Susan M; Zhang, Di

2012-07-01

The purpose of this randomized crossover trial was to determine the effects on autonomic responses in preterm infants of longer Kangaroo Care (30 minutes, KC30) and shorter KC (15 minutes, KC15) before and throughout heel stick compared with incubator care (IC). Beat-to-beat heart rate (HR) and spectral power analysis of heart rate variability, low frequency power (LF), high frequency power (HF), and LF/HF ratio were measured in 26 infants. HR changes from Baseline to Heel Stick were significantly less in KC30 and KC15 than in IC, and more infants had HR decrease in IC than in 2 KC conditions. In IC, LF and HF significantly increased from Baseline to Heel Stick and dropped from Heel Stick to Recovery; in 2 KC conditions, no changes across study phases were found. During Heel Stick, LF and HF were significantly higher in IC than in KC30. In all 3 conditions, LF/HF ratio decreased from Baseline to Heel Stick and increased to Recovery; no differences were found between IC and two KC conditions. Both longer and shorter KC before and throughout heel stick can stabilize HR response in preterm infants, and longer KC significantly affected infants' sympathetic and parasympathetic responses during heel stick compared with incubator care. This study showed that KC has a significant effect on reducing autonomic pain responses in preterm infants. The findings support that KC is a safe and effective pain intervention in the neonatal intensive care unit. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2014-04-01

High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. This study investigated the effects of habitual wearing of high-heeled shoes on the body's center of mass (COM) motion relative to the center of pressure (COP) during gait. Fifteen female experienced wearers and 15 matched controls walked with high-heeled shoes (7.3cm) while kinematic and ground reaction force data were measured and used to calculate temporal-distance parameters, joint moments, COM-COP inclination angles (IA) and the rate of IA changes (RCIA). Compared with inexperienced wearers, experienced subjects showed significantly reduced frontal IA with increased ankle pronator moments during single-limb support (p<0.05). During double-limb support (DLS), they showed significantly increased magnitudes of the frontal RCIA at toe-off and contralateral heel-strike, and reduced DLS time (p<0.05) but unaltered mean RCIA over DLS. In the sagittal plane experienced wearers showed significantly increased mean RCIA (p<0.05) and significant differences in the RCIA at toe-off and contralateral heel-strike (p<0.05). Significantly increased hip flexor moments and knee extensor moments at toe-off (p<0.05) were needed for forward motion of the trailing limb. The current results identified the change in the balance control in females after long-term use of high-heeled shoes, providing a basis for future design of strategies to minimize the risk of falling during high-heeled gait. Copyright © 2014 Elsevier B.V. All rights reserved.

46 CFR 174.255 - Restricted service.

Code of Federal Regulations, 2014 CFR

2014-10-01

... wind heeling moment, either to the angle of the second intercept of those curves or to the angle of heel at which downflooding would occur, whichever angle is less. (iii) A residual righting energy of at... righting moment and wind heeling moment, either to the angle of the second intercept of those curves or to...

46 CFR 174.255 - Restricted service.

Code of Federal Regulations, 2013 CFR

2013-10-01

... wind heeling moment, either to the angle of the second intercept of those curves or to the angle of heel at which downflooding would occur, whichever angle is less. (iii) A residual righting energy of at... righting moment and wind heeling moment, either to the angle of the second intercept of those curves or to...

46 CFR 174.255 - Restricted service.

Code of Federal Regulations, 2012 CFR

2012-10-01

... wind heeling moment, either to the angle of the second intercept of those curves or to the angle of heel at which downflooding would occur, whichever angle is less. (iii) A residual righting energy of at... righting moment and wind heeling moment, either to the angle of the second intercept of those curves or to...

46 CFR 172.065 - Damage stability.

Code of Federal Regulations, 2011 CFR

2011-10-01

... of sinkage, heel, and trim, must be below the lower edge of an opening through which progressive... sliding watertight door; or (vi) Side scuttle of the non-opening type. (2) Heel angle. The maximum angle of heel must not exceed 25 degrees, except that this angle may be increased to 30 degrees if no deck...

46 CFR 172.065 - Damage stability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of sinkage, heel, and trim, must be below the lower edge of an opening through which progressive... sliding watertight door; or (vi) Side scuttle of the non-opening type. (2) Heel angle. The maximum angle of heel must not exceed 25 degrees, except that this angle may be increased to 30 degrees if no deck...

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

PubMed

Agosti, Jennifer K; Chandler, Lois A

2015-11-01

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

Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

PubMed Central

Revak, Andrew; Diers, Keith; Kernozek, Thomas W.; Gheidi, Naghmeh; Olbrantz, Christina

2017-01-01

Context: Achilles tendinopathies are common injuries during sport participation, although men are more prone to Achilles tendon injuries than women. Heel-raising and -lowering exercises are typically suggested for Achilles tendon rehabilitation. Objective: To compare the estimated Achilles tendon loading variables and the ankle range of motion (ROM) using a musculoskeletal model during commonly performed heel-raising and -lowering exercises. Design: Controlled laboratory study. Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-one healthy men (age = 21.59 ± 1.92 years, height = 178.22 ± 8.02 cm, mass = 75.81 ± 11.24 kg). Intervention(s): Each participant completed 4 exercises: seated heel raising and lowering, bilateral standing heel raising and lowering, bilateral heel raising and unilateral lowering, and unilateral heel raising and lowering. Main Outcome Measure(s): A repeated-measures multivariate analysis of variance (α = .05) was used to compare Achilles tendon stress, force, and strain and ankle ROM for each exercise. Kinematic data were recorded at 180 Hz with 15 motion-analysis cameras synchronized with kinetic data collected from a force platform sampled at 1800 Hz. These data were then entered in a musculoskeletal model to estimate force in the triceps surae. For each participant, we determined Achilles tendon stress by measuring cross-sectional images using ultrasound. Results: Peak Achilles tendon loading was lowest when performing the seated heel-raising and -lowering exercise and highest when performing the unilateral heel-raising and -lowering exercise. Loading was greater for the unilateral exercise or portions of the exercise that were performed unilaterally. Conclusions: Bilateral and seated exercises with less weight-bearing force resulted in less Achilles tendon loading. These exercises may serve as progressions during the rehabilitation process before full-body weight-bearing, unilateral exercises are allowed. Ankle ROM did not follow the same order as loading and may need additional monitoring or instruction during rehabilitation. PMID:28145739

CAN RUNNERS PERCEIVE CHANGES IN HEEL CUSHIONING AS THE SHOE AGES WITH INCREASED MILEAGE?

PubMed

Cornwall, Mark W; McPoil, Thomas G

2017-08-01

For those runners who utilize footwear and have a rearfoot strike pattern, the durability of the midsole heel region has been shown to deteriorate as shoe mileage increases. The purpose of this study was threefold: 1) to determine if the runner can self-report changes in heel cushioning properties of the midsole after an extended period of distance running, 2) to determine if force and plantar pressures measured in the heel region of the midsole using a capacitance sensor insole change after running 640 km, and 3) to determine if a durometer could be used clinically to objectively measure changes in the hardness of the material in the heel region of the midsole. Cross-sectional Study. Fifteen recreational runners voluntarily consented to participate and were provided with a new pair of running shoes. Each participant's running style was observed and classified as having a rearfoot strike pattern. Inclusion criteria included running at least 24 km per week, experience running on a treadmill, no history of lower extremity congenital or traumatic deformity, or acute injury six months prior to the start of the study. The ability of each participant to self-perceive changes in shoe cushioning, comfort and fit was assessed using the Footwear Comfort Assessment Tool (FCAT). In-shoe plantar pressures and vertical forces were assessed using a capacitance sensor insole while runners ran over a 42-meter indoor runway. A Shore A durometer was used to measure the hardness of the midsole in the heel region. All measures were completed at baseline (zero km) and after running 160, 320, 480, and 640 km. In addition to descriptive statistics, a repeated measures analysis of variance was used to determine if the FCAT, pressures, forces, or midsole hardness changed because of increased running mileage. While plantar pressures and vertical forces were significantly reduced in the midsole heel region, none of the runners self-reported a significant reduction in heel cushioning based on FCAT scores after running 640 km. The use of a durometer provided an objective measure of the changes in the heel region of the midsole that closely matched the reductions observed in pressure and force values. The results indicated that runners who have a rearfoot strike pattern will have a 16% to 33% reduction in the amount of cushioning in the heel region of the midsole after running 480 km. Although there were significant reductions in heel cushioning, the experienced recreational runners in this study were not able to self-perceive these changes after running 640 km. In addition, the use of a durometer provides a quick and accurate way to assess changes in the hardness of the heel region of the midsole as running mileage increases. 3, Controlled laboratory study.

SPURS: Salinity Processes in the Upper-Ocean Regional Study: THE NORTH ATLANTIC EXPERIMENT

NASA Technical Reports Server (NTRS)

Lindstrom, Eric; Bryan, Frank; Schmitt, Ray

2015-01-01

In this special issue of Oceanography, we explore the results of SPURS-1, the first part of the ocean process study Salinity Processes in the Upper-ocean Regional Study (SPURS). The experiment was conducted between August 2012 and October 2013 in the subtropical North Atlantic and was the first of two experiments (SPURS come in pairs!). SPURS-2 is planned for 20162017 in the tropical eastern Pacific Ocean.

[Comparison of efficacy of heel ulcer prevention between classic padded bandage and polyurethane heel in a medium-stay hospital: randomized controlled trial].

PubMed

Ferrer Solà, Marta; Espaulella Panicot, Joan; Altimires Roset, Jacint; Ylla-Català Borè, Elisenda; Moreno Susi, María

2013-01-01

The aim of the study is to determine the incidence of heel pressure ulcers (UPPT) and to compare the two systems for UPPT prevention: classic padded bandage and polyurethane heel. Prospective intervention study in a medium-long hospital stay of all people admitted that had no UPPT but had a risk of UPPT according to the Braden Scale or clinical judgment. The patients were randomized to prevention with classic padded bandage or polyurethane heel. The outcome variable was the incidence of UPPT for each study group, which was recorded every 15 days or when there were clinical changes. Of the 940 patients evaluated, 409 with a mean age of 80.5 years and 59.1% women,were included in the study. Of these, 78% had Barthel score ≤30; 28.6% dementia; delirium 37.6%; 27.6% diabetes; and 19.6% other UPP. The overall incidence was 2.9% UPPT; 2.49% in the classic padded bandage and 3.37% in the polyurethane heel group (p=0.82). No statistically significant differences were observed between the group with the classical dressing and the group with the polyurethane heel dressing. The use of multiple measures to prevent UPPT achieved a low incidence of these. Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.

Foot-strike pattern and performance in a marathon

PubMed Central

Kasmer, Mark E.; Liu, Xue-cheng; Roberts, Kyle G.; Valadao, Jason M.

2016-01-01

Purpose To: 1) determine prevalence of heel-strike in a mid-size city marathon, 2) determine if there is an association between foot-strike classification and race performance, and 3) determine if there is an association between foot-strike classification and gender. Methods Foot-strike classification (fore-foot strike, mid-foot strike, heel strike, or split-strike), gender, and rank (position in race) were recorded at the 8.1 kilometer (km) mark for 2,112 runners at the 2011 Milwaukee Lakefront Marathon. Results 1,991 runners were classified by foot-strike pattern, revealing a heel-strike prevalence of 93.67% (n=1,865). A significant difference between foot-strike classification and performance was found using a Kruskal-Wallis test (p < 0.0001), with more elite performers being less likely to heel-strike. No significant difference between foot-strike classification and gender was found using a Fisher’s exact test. Additionally, subgroup analysis of the 126 non-heel strikers found no significant difference between shoe wear and performance using a Kruskal-Wallis test. Conclusions The high prevalence of heel-striking observed in this study reflects the foot-strike pattern of the majority of mid- to long-distance runners and more importantly, may predict their injury profile based on the biomechanics of a heel strike running pattern. This knowledge can aid the clinician in the appropriate diagnosis, management, and training modifications of the injured runner. PMID:23006790

Effect of monophasic pulsed current on heel pain and functional activities caused by plantar fasciitis.

PubMed

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

2015-03-20

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. 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). 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. This trial showed that MPC is useful in treating inferior heel symptoms caused by PF.

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

46 CFR 172.150 - Survival conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... waterline, in the final condition of sinkage, heel, and trim, must be below the lower edge of openings such.... (5) Side scuttles of the non-opening type. (b) Heel angle. (1) Except as described in paragraph (b)(2) of this section, the maximum angle of heel must not exceed 15 degrees (17 degrees if no part of the...

46 CFR 172.110 - Survival conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... flooding: (c) A hopper barge must not heel or trim beyond the angle at which— (1) The deck edge is first... section. (d) A hopper barge must not heel beyond the angle at which the deck edge is first submerged by... section, each tank barge must not heel beyond the angle at which— (1) The deck edge is first submerged; or...

40 CFR 82.15 - Prohibitions for class II controlled substances.

Code of Federal Regulations, 2011 CFR

2011-07-01

... transhipments, heels or used class II controlled substances) for which EPA has apportioned baseline production... to Article 5 Parties under § 82.18(a); for HCFC-141b exemption needs; as a transhipment or heel; or... 5 Parties under § 82.18(a); as a transhipment or heel; or for exemptions permitted in paragraph (f...

46 CFR 172.150 - Survival conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... waterline, in the final condition of sinkage, heel, and trim, must be below the lower edge of openings such.... (5) Side scuttles of the non-opening type. (b) Heel angle. (1) Except as described in paragraph (b)(2) of this section, the maximum angle of heel must not exceed 15 degrees (17 degrees if no part of the...

46 CFR 173.020 - Intact stability standards: Counterballasted and non-counterballasted vessels.

Code of Federal Regulations, 2010 CFR

2010-10-01

... not heel beyond the limits specified in paragraph (d) of this section: (1) Beam to depth—3.40 to 4.75...) of this section, the following limits of heel apply with the vessel at its deepest operating draft: (1) Protected and partially protected waters and Great Lakes in summer—heel to main deck immersion or...

46 CFR 172.110 - Survival conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... flooding: (c) A hopper barge must not heel or trim beyond the angle at which— (1) The deck edge is first... section. (d) A hopper barge must not heel beyond the angle at which the deck edge is first submerged by... section, each tank barge must not heel beyond the angle at which— (1) The deck edge is first submerged; or...

46 CFR 173.020 - Intact stability standards: Counterballasted and non-counterballasted vessels.

Code of Federal Regulations, 2011 CFR

2011-10-01

... not heel beyond the limits specified in paragraph (d) of this section: (1) Beam to depth—3.40 to 4.75...) of this section, the following limits of heel apply with the vessel at its deepest operating draft: (1) Protected and partially protected waters and Great Lakes in summer—heel to main deck immersion or...

40 CFR 82.15 - Prohibitions for class II controlled substances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... transhipments, heels or used class II controlled substances) for which EPA has apportioned baseline production... to Article 5 Parties under § 82.18(a); for HCFC-141b exemption needs; as a transhipment or heel; or... 5 Parties under § 82.18(a); as a transhipment or heel; or for exemptions permitted in paragraph (f...

Evaluation of the High-Heel Roof-to-Wall Connection with Extended OSB Wall Sheathing

Treesearch

Andrew DeRenzis; Vladimir Kochkin; Xiping Wang

2013-01-01

A recently completed testing project conducted to evaluate optimized structural roof-to-wall attachment solutions demonstrated the effectiveness of wood structural panels in restraining high-heel trusses against rotation. This study was designed to further evaluate the performance of OSB wall sheathing panels extended over the high-heel truss in resisting combined...

Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury.

PubMed

Brorsson, Annelie; Willy, Richard W; Tranberg, Roy; Grävare Silbernagel, Karin

2017-11-01

It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term. To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and patient-reported outcomes at a mean of 6 years after ATR between 2 groups that, at 1-year follow-up, had less than 15% versus greater than 30% differences in heel-rise height. Cohort study; Level of evidence, 3. Seventeen patients with less than 15% (<15% group) and 17 patients with greater than 30% (>30% group) side-to-side difference in heel-rise height at 1 year after ATR were evaluated at a mean (SD) 6.1 (2.0) years after their ATR. Ankle kinematics and kinetics were sampled via standard motion capture procedures during walking, jogging, and jumping. Patient-reported outcome was evaluated with Achilles tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and Foot and Ankle Outcome Score (FAOS). Tendon length was evaluated by ultrasonography. The Limb Symmetry Index (LSI = [Injured Side ÷ Healthy Side] × 100) was calculated for side differences. The >30% group had significantly more deficits in ankle kinetics during all activities compared with patients in the <15% group at a mean of 6 years after ATR (LSI, 70%-149% and 84%-106%, respectively; P = .010-.024). The >30% group, compared with the <15% group, also had significantly lower values in heel-rise height (LSI, 72% and 95%, respectively; P < .001) and heel-rise work (LSI, 58% and 91%, respectively; P < .001) and significantly larger side-to-side difference in tendon length (114% and 106%, respectively; P = .012). Achilles tendon length correlated with ankle kinematic variables ( r = 0.38-0.44; P = .015-.027) whereas heel-rise work correlated with kinetic variables ( r = -0.57 to 0.56; P = .001-.047). LSI tendon length correlated negatively with LSI heel-rise height ( r = -0.41; P = .018). No differences were found between groups in patient-reported outcome ( P = .143-.852). Height obtained during the single-leg standing heel-rise test performed 1 year after ATR related to the long-term ability to regain normal ankle biomechanics. Minimizing tendon elongation and regaining heel-rise height may be important for the long-term recovery of ankle biomechanics, particularly during more demanding activities such as jumping.

Deficits in heel-rise height and achilles tendon elongation occur in patients recovering from an Achilles tendon rupture.

PubMed

Silbernagel, Karin Grävare; Steele, Robert; Manal, Kurt

2012-07-01

Whether an Achilles tendon rupture is treated surgically or not, complications such as muscle weakness, decrease in heel-rise height, and gait abnormalities persist after injury. The purpose of this study was to evaluate if side-to-side differences in maximal heel-rise height can be explained by differences in Achilles tendon length. Case series; level of evidence, 4. Eight patients (mean [SD] age of 46 [13] years) with acute Achilles tendon rupture and 10 healthy subjects (mean [SD] age of 28 [8] years) were included in the study. Heel-rise height, Achilles tendon length, and patient-reported outcome were measured 3, 6, and 12 months after injury. Achilles tendon length was evaluated using motion analysis and ultrasound imaging. The Achilles tendon length test-retest reliability (intraclass correlation coefficient = 0.97) was excellent. For the healthy subjects, there were no side-to-side differences in tendon length and heel-rise height. Patients with Achilles tendon ruptures had significant differences between the injured and uninjured side for both tendon length (mean [SD] difference, 2.6-3.1 [1.2-1.4] cm, P = .017-.028) and heel-rise height (mean [SD] difference, -4.1 to -6.1 [1.7-1.8] cm, P = .012-.028). There were significant negative correlations (r = -0.943, P = .002, and r = -0.738, P = .037) between the side-to-side difference in heel-rise height and Achilles tendon length at the 6- and 12-month evaluations, respectively. The side-to-side difference found in maximal heel-rise height can be explained by a difference in Achilles tendon length in patients recovering from an Achilles tendon rupture. Minimizing tendon elongation appears to be an important treatment goal when aiming for full return of function.

The prevalence of foot problems in older women: a cause for concern.

PubMed

Dawson, Jill; Thorogood, Margaret; Marks, Sally-Anne; Juszczak, Ed; Dodd, Chris; Lavis, Grahame; Fitzpatrick, Ray

2002-06-01

Painful feet are an extremely common problem amongst older women. Such problems increase the risk of falls and hamper mobility. The aetiology of painful and deformed feet is poorly understood. Data were obtained during a pilot case-control study about past high heel usage in women, in relation to osteoarthritis of the knee. A total of 127 women aged 50-70 were interviewed (31 cases, 96 controls); case-control sets were matched for age. The following information was obtained about footwear: (1) age when first wore shoes with heels 1, 2 and 3 inches high; (2) height of heels worn for work; (3) maximum height of heels worn regularly for work, going out socially and for dancing, in 10-year age bands. Information about work-related activities and lifetime occupational history was gathered using a Life-Grid. The interview included a foot inspection. Foot problems, particularly foot arthritis, affected considerably more cases than controls (45 per cent versus 16 per cent, p = 0.001) and was considered a confounder. Cases were therefore excluded from subsequent analyses. Amongst controls, the prevalence of any foot problems was very high (83 per cent). All women had regularly worn one inch heels and few (8 per cent) had never worn 2 inch heels. Foot problems were significantly associated with a history of wearing relatively lower heels. Few work activities were related to foot problems; regular lifting was associated with foot pain (p = 0.03). Most women in this age-group have been exposed to high-heeled shoes over many years, making aetiological research difficult in this area. Foot pain and deformities are widespread. The relationship between footwear, occupational activities and foot problems is a complex one that deserves considerably more research.

An unusual cause of intractable heel pain.

PubMed

Ghani, Samuel; Fazal, Muhammad Ali

2011-01-01

We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal cyst is rare. We were unable to identify a previous publication describing the presence of an epidermal cyst localized to the heel without a history of previous trauma. From our experience with the present case, we believe that clinicians should consider the possibility of an epidermal inclusion cyst and should have a low threshold for obtaining magnetic resonance imaging scans, in particular, before the initiation of invasive treatment, in the case of intractable heel pain. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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…

46 CFR 178.330 - Simplified stability proof test (SST).

Code of Federal Regulations, 2011 CFR

2011-10-01

... limits of heel: (1) On a flush deck vessel, not more than one-half of the freeboard may be immersed. (2... is less, may be immersed. (7) In no case may the angle of heel exceed 14 degrees. (e) The limits of heel must be measured at: (1) The point of minimum freeboard; or (2) At a point three-quarters of the...

46 CFR 171.080 - Damage stability standards for vessels with Type I or Type II subdivision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... to which the vessel heels after sustained damage, are swung out if necessary, fully loaded and ready...; and (C) Survival craft on the side of the vessel opposite that to which the vessel heels remain stowed... damage occurs. (3) The estimated maximum angle of heel before equalization must be approved by the...

9 CFR 11.2 - Prohibitions concerning exhibitors.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) that elevate or change the angle of such horses' hooves in excess of 1 inch at the heel. (9) Any weight... of the heel by 1 inch or more. The length of the toe shall be measured from the coronet band, at the center of the front pastern along the front of the hoof wall to the ground. The heel shall be measured...

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sewell, J.R.; Black, C.M.; Chapman, A.H.

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.

46 CFR 173.025 - Additional intact stability standards: Counterballasted vessels.

Code of Federal Regulations, 2014 CFR

2014-10-01

... of heel. T=angle of heel. EC01MR91.028 Where— GZ(1) is the righting arm curve at the displacement corresponding to the vessel without hooking load. GZ(2) is the righting arm curve at the displacement... of the hook load and the counterballast at the displacement with hook load. HA(2) is the heeling arm...

46 CFR 173.025 - Additional intact stability standards: Counterballasted vessels.

Code of Federal Regulations, 2012 CFR

2012-10-01

... of heel. T=angle of heel. EC01MR91.028 Where— GZ(1) is the righting arm curve at the displacement corresponding to the vessel without hooking load. GZ(2) is the righting arm curve at the displacement... of the hook load and the counterballast at the displacement with hook load. HA(2) is the heeling arm...

46 CFR 173.025 - Additional intact stability standards: Counterballasted vessels.

Code of Federal Regulations, 2011 CFR

2011-10-01

... of heel. T=angle of heel. EC01MR91.028 Where— GZ(1) is the righting arm curve at the displacement corresponding to the vessel without hooking load. GZ(2) is the righting arm curve at the displacement... of the hook load and the counterballast at the displacement with hook load. HA(2) is the heeling arm...

46 CFR 173.025 - Additional intact stability standards: Counterballasted vessels.

Code of Federal Regulations, 2013 CFR

2013-10-01

... of heel. T=angle of heel. EC01MR91.028 Where— GZ(1) is the righting arm curve at the displacement corresponding to the vessel without hooking load. GZ(2) is the righting arm curve at the displacement... of the hook load and the counterballast at the displacement with hook load. HA(2) is the heeling arm...

46 CFR 173.025 - Additional intact stability standards: Counterballasted vessels.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of heel. T=angle of heel. EC01MR91.028 Where— GZ(1) is the righting arm curve at the displacement corresponding to the vessel without hooking load. GZ(2) is the righting arm curve at the displacement... of the hook load and the counterballast at the displacement with hook load. HA(2) is the heeling arm...

Calcaneal Insufficiency Fracture Secondary to Celiac Disease-Induced Osteomalacia: A Rare Cause of Heel Pain.

PubMed

Kose, Ozkan; Kilicaslan, Omer Faruk; Ozyurek, Selahattin; Ince, Ahmet

2016-04-01

Plantar fasciitis is a common cause of plantar heel pain; however, a broad spectrum of disorders may also present with plantar heel pain. A detailed history, physical examination, laboratory testing, and imaging studies may be necessary to reach an accurate diagnosis. Herein, the clinical presentation of a 33-year-old woman with calcaneal insufficiency fracture secondary to celiac disease-induced osteomalacia is presented, and its diagnosis and treatment are discussed. Calcaneal insufficiency fractures should be kept in mind in a patient with celiac disease that presents with heel pain. Therapeutic, Level IV: Case study. © 2015 The Author(s).

The Effects of Fatigue and Local Carriage on Musculoskeletal Injury Mechanisms

DTIC Science & Technology

2012-09-01

the mean and SD of the pelvis, hip, knee , and ankle angles at heel contact and stance of walking. Table 5 shows the mean and SD of the hip, knee , and...22.9 (8.6) Hip flexion at heel contact (deg) 32.1 (4.3) 28.2 (10.4) 45.4 (5.2) 40.6 (10.9) Knee flexion at heel contact (deg) -2.5 (3.1...1.1 (4.5) 3.9 (3.2) 4.7 (4.9) Maximum knee flexion at stance (deg) 19.0 (2.8) 20.7 (4.4) 24.6 (4.5) 25.0 (5.3) Ankle dorsi-flexion at heel

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

PubMed

Gans, A

1985-08-01

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

The influence of a yacht's heeling stability on optimum sail design

NASA Astrophysics Data System (ADS)

Sneyd, A. D.; Sugimoto, T.

1997-01-01

This paper presents fundamental results concerning the optimum design of yacht sails and masts. The aerodynamics of a high aspect ratio sail in uniform flow is analysed using lifting line theory to maximise thrust for a given sail area. The novel feature of this work is that thrust is optimised subject to the constraint that the aerodynamic heeling moment generated by the sail is balanced by the righting moment due to hull buoyancy (and the weight of the keel). Initially, the heel angle is therefore unknown, and determined as part of the solution process. Under the assumption of small heel angle, the problem reduces to minimising a quadratic form in the Fourier coefficients for the circulation distribution along the mast, and a simple analytic solution can be derived. It is found that if the mast is too high, the upper section is unused, and as a consequence there is a theoretically ideal mast height for a yacht of given heeling stability. Under the constraints of given sail area and heeling equilibrium it is found that no advantage is to be gained by allowing reverse circulation near the top of the mast. Various implications for yacht performance are discussed.

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.

Heel anatomy for retrograde tibiotalocalcaneal roddings: a roentgenographic and anatomic analysis.

PubMed

Flock, T J; Ishikawa, S; Hecht, P J; Wapner, K L

1997-04-01

There is an increased interest in load-sharing devices for tibiotalocalcaneal arthrodesis. Although the neurovascular anatomy of the heel has been well described, the purpose of this study is to consider heel anatomy as it relates to plantar heel incisions and to well-defined fluoroscopic landmarks to prevent complications during these procedures. Twenty lateral radiographs of normal feet while standing were evaluated by two observers. The distance from the calcaneocuboid (CC) joint to a line parallel to the center of the intramedullary canal of the tibia was calculated. In the second part of the study, 14 dissections of the arterial and neural anatomy were performed. The distances from the CC joint to structures crossing the heel proximal to the CC joint were studied. In the 20 standing radiographs, the mean distance from the CC joint to the middle of the intramedullary canal of the tibia was 2.1 cm (standard deviation, 0.55 cm). In the dissections, the only artery or nerve found to cross the plantar surface proximal to the CC joint was the nerve to the abductor digiti quinti (NAbDQ). The mean distance from the CC joint to the NAbDQ was 3.1 cm (standard deviation, 1.36 cm). Assuming reaming to 12 mm, NAbDQ would be at risk 42% of the time. We recommend careful dissection of the heel during retrograde roddings to avoid damage to NAbDQ and subsequent neurogenic heel pain.

Do Prophylactic Foam Dressings Reduce Heel Pressure Injuries?

PubMed

Ramundo, Janet; Pike, Catlin; Pittman, Joyce

The purpose of this evidence-based report card is to examine the evidence and provide recommendations related to the effectiveness of prophylactic foam dressings in reducing heel pressure injuries. Do prophylactic foam dressings applied to the heel reduce heel pressure injuries for patients in the acute care setting? A search of the literature was performed by a trained university librarian that resulted in 56 articles that examined pressure injury, prevention, and prophylactic dressings. A systematic approach was used to review titles, abstracts, and text, yielding 13 studies that met inclusion criteria. Strength of the evidence was rated based on the methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine. Thirteen studies were identified that met inclusion criteria; 1 was a randomized controlled trial, 2 were systematic reviews, 3 quasi-experimental cohort studies, 1 quality improvement study, 1 case series, 1 scoping review, 1 consensus panel, and 3 bench studies. All of the studies identified suggest that the use of prophylactic foam dressings reduces the development of pressure injuries on the heel when used in conjunction with a pressure injury prevention program. The strength of the evidence for the identified studies was level 1 (4 level A, 4 level B, and 5 level C). The use of prophylactic multilayer foam dressings applied to the heels, in conjunction with an evidence-based pressure injury prevention program, is recommended for prevention of pressure injuries on the heel (SORT level 1).

Analysis of the Pressure Distribution Qualities of a Silicone Border Foam Dressing.

PubMed

Miller, Stephannie K; Sharma, Neal; Aberegg, Lauren C; Blasiole, Kimberly N; Fulton, Judith A

2015-01-01

To determine whether application of a silicone foam dressing is associated with decreased interface pressures when applied to the heel. Prospective, within-subjects design. The study was conducted in a community-based hospital using a convenience sample of 50 healthy volunteers with a mean age of 39.6 years and mean body mass index of 26.6; 70% were female. Application of the silicone border foam dressing was randomized between the left and right heels. Participants were asked to lie down in the supine position on a viscoelastic foam mattress. Interface pressure measurements were captured using a pressure mapping system; measurements were taken once with the dressing applied to the heel (intervention map) and once without (control map). Data were captured after a 4-minute time period allowing stabilization. Analysis was based on mean interface pressure; data points were collected for both heels in each of the 2 frames, yielding 4 observations per subject. Application of the dressing was associated with a significant decrease in average pressure measurements as compared to the heel with no dressing applied (P < .001). Application of the dressing did not impact pressure readings for the heel to which no dressing was applied (P = .53), and application of the dressing to either the left or right heel did not impact pressure readings (ie, the random effect was insignificant; P = .9). Application of a silicone border foam dressing is associated with significant reduction in interface pressure and may be considered as part of a pressure ulcer prevention program.

CAN RUNNERS PERCEIVE CHANGES IN HEEL CUSHIONING AS THE SHOE AGES WITH INCREASED MILEAGE?

PubMed Central

Cornwall, Mark W.

2017-01-01

Background For those runners who utilize footwear and have a rearfoot strike pattern, the durability of the midsole heel region has been shown to deteriorate as shoe mileage increases. Purpose The purpose of this study was threefold: 1) to determine if the runner can self-report changes in heel cushioning properties of the midsole after an extended period of distance running, 2) to determine if force and plantar pressures measured in the heel region of the midsole using a capacitance sensor insole change after running 640 km, and 3) to determine if a durometer could be used clinically to objectively measure changes in the hardness of the material in the heel region of the midsole. Study Design Cross-sectional Study Methods Fifteen recreational runners voluntarily consented to participate and were provided with a new pair of running shoes. Each participant's running style was observed and classified as having a rearfoot strike pattern. Inclusion criteria included running at least 24 km per week, experience running on a treadmill, no history of lower extremity congenital or traumatic deformity, or acute injury six months prior to the start of the study. The ability of each participant to self-perceive changes in shoe cushioning, comfort and fit was assessed using the Footwear Comfort Assessment Tool (FCAT). In-shoe plantar pressures and vertical forces were assessed using a capacitance sensor insole while runners ran over a 42-meter indoor runway. A Shore A durometer was used to measure the hardness of the midsole in the heel region. All measures were completed at baseline (zero km) and after running 160, 320, 480, and 640 km. In addition to descriptive statistics, a repeated measures analysis of variance was used to determine if the FCAT, pressures, forces, or midsole hardness changed because of increased running mileage. Result While plantar pressures and vertical forces were significantly reduced in the midsole heel region, none of the runners self-reported a significant reduction in heel cushioning based on FCAT scores after running 640 km. The use of a durometer provided an objective measure of the changes in the heel region of the midsole that closely matched the reductions observed in pressure and force values. Conclusion The results indicated that runners who have a rearfoot strike pattern will have a 16% to 33% reduction in the amount of cushioning in the heel region of the midsole after running 480 km. Although there were significant reductions in heel cushioning, the experienced recreational runners in this study were not able to self-perceive these changes after running 640 km. In addition, the use of a durometer provides a quick and accurate way to assess changes in the hardness of the heel region of the midsole as running mileage increases. Level of Evidence 3, Controlled laboratory study PMID:28900568

Transition to nonpenetrating trabecular surgery: sclerotrabeculectomy.

PubMed

Sourdille, Philippe; Santiago, Pierre Yves; Bresson-Dumont, Hélène

2002-12-01

A transition from trabeculectomy to nonpenetrating trabecular surgery (NPTS) is proposed under the name of sclerotrabeculectomy. The technique, which is aimed at facilitating the transition to NPTS, is a modification of both penetrating and nonpenetrating techniques. Sclerotrabeculectomy uses a more superficial sclerokeratectomy than NPTS to avoid the risk of perforation. A minitrabeculectomy with cross-linked hyaluronate implant insertion in the sclerokeratectomy site is performed, with several sutures placed in the superficial flap. The sclerokeratectomy site is filled with cohesive viscoelastic substance to avoid a flat or shallow anterior chamber. Using this technique, it is possible to move to NPTS by finding the pre-Descemet's plane in front of the scleral spur and removing the external trabeculum. In case of accidental microperforation of Descemet's plane, the operation is finished as a standard sclerotrabeculectomy with no risk to the patient's eye. A safe transition can thus be achieved. Initial clinical results demonstrate excellent lowering of intraocular pressure without significant complications.

Cyclodialysis: an update.

PubMed

González-Martín-Moro, Julio; Contreras-Martín, Inés; Muñoz-Negrete, Francisco José; Gómez-Sanz, Fernando; Zarallo-Gallardo, Jesús

2017-04-01

Cyclodialysis is the result of the separation of the longitudinal ciliary muscle fibers from the scleral spur, which creates an abnormal pathway for aqueous humor drainage that may lead to ocular hypotony. For many years cyclodialysis was considered a treatment option for glaucoma. However, today it usually occurs as a complication of blunt trauma or more rarely as a complication of anterior segment ocular surgery. Ocular hypotony can lead to cataract development, optic disk swelling, refractive changes, and several retinal complications, making accurate identification and timely intervention of the cleft mandatory. Traditionally gonioscopy was the only available technique to diagnose and localize the cleft. However, other tests such as optical coherence tomography, magnetic resonance imaging, transillumination, and specially ultrasound biomicroscopy are now available for the diagnosis of cyclodialysis. Multiple treatment options are also available for this condition. Although medical treatment can be effective to close small clefts, surgery is needed in most patients to restore ocular pressure.

Development of a Wearable Assist Robot for Walk Rehabilitation After Knee Arthroplasty Surgery

NASA Astrophysics Data System (ADS)

Terada, H.; Zhu, Y.; Horiguchi, K.; Nakamura, M.; Takahashi, R.

In Japan, it is popular that the disease knee joints will be replaced to artificial joints by surgery. And we have to assist so many patients for walk rehabilitation. So, the wearable assist robot has been developed. This robot includes the knee motion assist mechanism and the hip joint support mechanism. Especially, the knee motion assist mechanism consists of a non-circular gear and grooved cams. This mechanism rotates and slides simultaneously, which has two degree-of-freedom. Also, the hip joint support mechanism consists of a hip brace and a ball-joint. This mechanism can avoid motion constraints which are the internal or external rotation and the adduction or abduction. Then, the control algorithm, which considers an assisting timing for the walk rehabilitation, has been proposed. A sensing system of a walk state for this control system uses a heel contacts sensor and knee and hip joint rotation angle sensors. Also, the prototype robot has been tested. And it is confirmed that the assisting system is useful.

46 CFR 170.173 - Criterion for vessels of unusual proportion and form.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the maximum righting arm occurs at an angle of heel less than or equal to 30 degrees; or (2) Paragraph (b) of this section if the maximum righting arm occurs at an angle of heel greater than 30 degrees...); (2) A righting arm (GZ) of at least 0.66 feet (0.20 meters) at an angle of heel equal to or greater...

75 FR 67303 - Determinations of Attainment by the Applicable Attainment Date for the Hayden, Nogales, Paul Spur...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-02

... of Attainment by the Applicable Attainment Date for the Hayden, Nogales, Paul Spur/Douglas PM 10... proposes to determine that the Hayden, Nogales, and Paul Spur/Douglas nonattainment areas in Arizona... Hayden, Nogales and Paul Spur/Douglas nonattainment areas are not currently attaining the PM 10 standard...

SPURS-2: Multi-month and multi-scale observations of upper ocean salinity in a rain-dominated salinity minimum region.

NASA Astrophysics Data System (ADS)

Rainville, L.; Farrar, J. T.; Shcherbina, A.; Centurioni, L. R.

2017-12-01

The Salinity Processes in the Upper-ocean Regional Study (SPURS) is a program aimed at understanding the patterns and variability of sea surface salinity. Following the first SPURS program in an evaporation-dominated region (2012-2013), the SPURS-2 program targeted wide range of spatial and temporal scales associated with processes controlling salinity in the rain-dominated Eastern Pacific Fresh Pool. Autonomous instruments were delivered in August and September 2016 using research vessels conducted observations over one complete annual cycle. The SPURS-2 field program used coordinated observations from many different autonomous platforms, and a mix of Lagrangian and Eulerian approaches. Here we discuss the motivation, implementation, and the early of SPURS-2.

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

PubMed

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

2017-01-01

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.

The PdBI Arcsecond Whirlpool Survey (PAWS): The Role of Spiral Arms in Cloud and Star Formation

NASA Astrophysics Data System (ADS)

Schinnerer, Eva; Meidt, Sharon E.; Colombo, Dario; Chandar, Rupali; Dobbs, Clare L.; García-Burillo, Santiago; Hughes, Annie; Leroy, Adam K.; Pety, Jérôme; Querejeta, Miguel; Kramer, Carsten; Schuster, Karl F.

2017-02-01

The process that leads to the formation of the bright star-forming sites observed along prominent spiral arms remains elusive. We present results of a multi-wavelength study of a spiral arm segment in the nearby grand-design spiral galaxy M51 that belongs to a spiral density wave and exhibits nine gas spurs. The combined observations of the (ionized, atomic, molecular, dusty) interstellar medium with star formation tracers (H II regions, young <10 Myr stellar clusters) suggest (1) no variation in giant molecular cloud (GMC) properties between arm and gas spurs, (2) gas spurs and extinction feathers arising from the same structure with a close spatial relation between gas spurs and ongoing/recent star formation (despite higher gas surface densities in the spiral arm), (3) no trend in star formation age either along the arm or along a spur, (4) evidence for strong star formation feedback in gas spurs, (5) tentative evidence for star formation triggered by stellar feedback for one spur, and (6) GMC associations being not special entities but the result of blending of gas arm/spur cross sections in lower resolution observations. We conclude that there is no evidence for a coherent star formation onset mechanism that can be solely associated with the presence of the spiral density wave. This suggests that other (more localized) mechanisms are important to delay star formation such that it occurs in spurs. The evidence of star formation proceeding over several million years within individual spurs implies that the mechanism that leads to star formation acts or is sustained over a longer timescale.

Use of Piezosurgery for removal of retrovertebral body osteophytes in anterior cervical discectomy.

PubMed

Grauvogel, Juergen; Scheiwe, Christian; Kaminsky, Jan

2014-04-01

The relatively new technique of Piezosurgery is based on microvibrations, generated by the piezoelectrical effect, which results in selective bone cutting with preservation of adjacent soft tissue. To study the applicability of Piezosurgery in anterior cervical discectomy with fusion (ACDF) surgery. Prospective clinical study at the neurosurgical department of the University of Freiburg, Germany. Nine patients with cervical disc herniation and retrovertebral osteophytes who underwent ACDF surgery. Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, and preservation of adjacent neurovascular tissue. Pre- and postoperative clinical and radiological data were assessed. Piezosurgery was supportively used in ACDF in nine patients with either radiculopathy or myelopathy from disc herniation or ventral osteophytes. After discectomy, osteophytes were removed with Piezosurgery to decompress the spinal canal and the foramina. Angled inserts were used, allowing for cutting even retrovertebral osteophytes. In all nine cases, Piezosurgery cut bone selectively with no damage to nerve roots, dura, or posterior longitudinal ligament. None of the patients experienced any new neurological deficit after the operation. The handling of the instrument was safe and the cut precise. Osteophytic spurs, even retrovertebral ones that generally only can be approached via corpectomies, could be safely removed because of the angled inserts through the disc space. Currently, a slightly prolonged operation time was observed for Piezosurgery. Furthermore, the design of the handpiece could be further improved to facilitate the intraoperative handling in ACDF. Piezosurgery proved to be a useful and safe technique for selective bone cutting and removal of osteophytes with preservation of neuronal and soft tissue in ACDF. In particular, the angled inserts were effective in cutting bone spurs behind the adjacent vertebra which cannot be reached with conventional rotating burs. Copyright © 2014 Elsevier Inc. All rights reserved.

Gait perturbation response in chronic anterior cruciate ligament deficiency and repair.

PubMed

Ferber, Reed; Osternig, Louis R; Woollacott, Marjorie H; Wasielewski, Noah J; Lee, Ji Hang

2003-02-01

To determine how chronic anterior cruciate ligament deficient and surgically repaired subjects react to unexpected forward perturbations during gait as compared to healthy controls. Gait testing of 10 chronic anterior cruciate ligament deficient subjects prior to and three months following reconstructive surgery, and 10 uninjured controls. The ability of an anterior cruciate ligament injured individual to react and maintain equilibrium during gait perturbations is critical for the prevention of reinjury. No studies have investigated how these individuals respond to unexpected perturbations during normal gait. An unexpected forward perturbation was induced upon heel strike using a force plate capable of translational movement. Prior to surgery, the anterior cruciate ligament subjects exhibited a greater knee extensor moment in response to the perturbation compared to healthy controls. Following surgery, the anterior cruciate ligament injured subjects exhibited a static knee position and a sustained knee extensor moment throughout stance in response to the perturbation as compared to controls. These data suggest that chronic anterior cruciate ligament deficient subjects rely heavily on knee extensor musculature to prevent collapse in response to an unexpected perturbation. This same reactive response was more pronounced 3 months following surgery. The results suggest that, prior to and following surgery, chronic anterior cruciate ligament injured subjects respond differently than healthy controls to an unexpected perturbation during gait. Anterior cruciate ligament injured or repaired subjects do not reduce or avoid vigorous contraction of the quadriceps muscles when responding to gait perturbations.

An Inverse Kinematic Approach Using Groebner Basis Theory Applied to Gait Cycle Analysis

DTIC Science & Technology

2013-03-01

stance phase begins with initial contact, heel strike , and ends with toe off. The swing phase begins at toe off and ends with the heel striking the ground...and transition phase (10%). Recall, that the gait cycle begins when the heel strikes the ground of one foot and ends when that same foot strikes the...Validation of Knee Angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 12 Validation of Ankle Angle

Physiological, Biomechanical, and Maximal Performance Evaluation of Medium Rucksack Prototypes

DTIC Science & Technology

2013-07-01

injuries that limit the ROM about the shoulder, hip, knee , or ankle joint, were excluded from participation. Volunteers abstained from heavy and...time histories of running strides differ among individuals. Individuals who make initial contact with their heels ( heel - strike runners) show a...and a relatively large force. In the current data set, not all volunteers displayed the impact peak that is typical of heel - strike running. The

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

PubMed

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

2015-01-01

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

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.

The Effects of a Heel Wedge on Hip, Pelvis and Trunk Biomechanics During Squatting in Resistance Trained Individuals.

PubMed

Charlton, Jesse M; Hammond, Connor A; Cochrane, Christopher K; Hatfield, Gillian L; Hunt, Michael A

2017-06-01

Barbell back squats are a popular exercise for developing lower extremity strength and power. However, this exercise has potential injury risks, particularly to the lumbar spine, pelvis, and hip joint. Previous literature suggests heel wedges as a means of favorably adjusting trunk and pelvis kinematics with the intention of reducing such injury risks. Yet no direct biomechanical research exists to support these recommendations. Therefore, the purpose of this study was to examine the effects of heel wedges compared with barefoot on minimally loaded barbell back squats. Fourteen trained male participants performed a barbell back squat in bare feet or with their feet raised bilaterally with a 2.5-cm wooden block while 3-dimensional kinematics, kinetics, and electromyograms were collected. The heel wedge condition elicited significantly less forward trunk flexion angles at peak knee flexion, and peak external hip joint moments (p ≤ 0.05) compared with barefoot conditions. However, no significant differences were observed between conditions for trunk and pelvis angle differences at peak knee flexion (p > 0.05). Lastly, no peak or root mean square differences in muscle activity were elicited between conditions (p > 0.05). Our results lend support for the suggestions provided in literature aimed at using heel wedges as a means of reducing excessive forward trunk flexion. However, the maintenance of a neutral spine, another important safety factor, is not affected by the use of heel wedges. Therefore, heel wedges may be a viable modification for reduction of excessive forward trunk flexion but not for reduction in relative trunk-pelvis flexion during barbell back squats.

Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: a randomized controlled trial.

PubMed

Zhu, Jiemin; Hong-Gu, He; Zhou, Xiuzhu; Wei, Haixia; Gao, Yaru; Ye, Benlan; Liu, Zuguo; Chan, Sally Wai-Chi

2015-03-01

to test the effectiveness of breast feeding (BF), music therapy (MT), and combined breast feeding and music therapy (BF+MT) on pain relief in healthy-term neonates during heel lance. randomised controlled trial. in the postpartum unit of one university-affiliated hospital in China from August 2013 to February 2014. among 288 healthy-term neonates recruited, 250 completed the trial. All neonates were undergoing heel lancing for metabolic screening, were breast fed, and had not been fed for the previous 30 minutes. all participants were randomly assigned into four groups - BF, MT, BF+MT, and no intervention - with 72 neonates in each group. Neonates in the control group received routine care. Neonates in the other three intervention groups received corresponding interventions five minutes before the heel lancing and throughout the whole procedure. Neonatal Infant Pain Scale (NIPS), latency to first cry, and duration of first crying. mean changes in NIPS scores from baseline over time was dependent on the interventions given. Neonates in the BF and combined BF+MT groups had significantly longer latency to first cry, shorter duration of first crying, and lower pain mean score during and one minute after heel lance, compared to the other two groups. No significant difference in pain response was found between BF groups with or without music therapy. The MT group did not achieve a significantly reduced pain response in all outcome measures. BF could significantly reduce pain response in healthy-term neonates during heel lance. MT did not enhance the effect of pain relief of BF. healthy-term neonates should be breast fed to alleviate pain during heel lance. There is no need for the additional input of classical music on breast feeding in clinic to relieve procedural pain. Nurses should encourage breast feeding to relieve pain during heel lance. Copyright © 2014 Elsevier Ltd. All rights reserved.

Management of subcalcaneal pain and Achilles tendonitis with heel inserts

PubMed Central

Maclellan, G. E.; Vyvyan, Barbara

1981-01-01

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

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

PubMed

Riley, Peggy

2008-09-01

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

The PdBI Arcsecond Whirlpool Survey (PAWS): The Role of Spiral Arms in Cloud and Star Formation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schinnerer, Eva; Meidt, Sharon E.; Querejeta, Miguel

2017-02-10

The process that leads to the formation of the bright star-forming sites observed along prominent spiral arms remains elusive. We present results of a multi-wavelength study of a spiral arm segment in the nearby grand-design spiral galaxy M51 that belongs to a spiral density wave and exhibits nine gas spurs. The combined observations of the (ionized, atomic, molecular, dusty) interstellar medium with star formation tracers (H ii regions, young <10 Myr stellar clusters) suggest (1) no variation in giant molecular cloud (GMC) properties between arm and gas spurs, (2) gas spurs and extinction feathers arising from the same structure withmore » a close spatial relation between gas spurs and ongoing/recent star formation (despite higher gas surface densities in the spiral arm), (3) no trend in star formation age either along the arm or along a spur, (4) evidence for strong star formation feedback in gas spurs, (5) tentative evidence for star formation triggered by stellar feedback for one spur, and (6) GMC associations being not special entities but the result of blending of gas arm/spur cross sections in lower resolution observations. We conclude that there is no evidence for a coherent star formation onset mechanism that can be solely associated with the presence of the spiral density wave. This suggests that other (more localized) mechanisms are important to delay star formation such that it occurs in spurs. The evidence of star formation proceeding over several million years within individual spurs implies that the mechanism that leads to star formation acts or is sustained over a longer timescale.« less

Erosional development of bedrock spur and gully topography in the Valles Marineris, Mars

NASA Technical Reports Server (NTRS)

Patton, Peter C.

1990-01-01

Gully networks separated by resistant bedrock spurs are a common erosional feature along the escarpments that border the Valles Marineris. The resistant spur topography is best developed where the base of the slope is truncated by linear scarps interpreted as fault scarps. Regional variations in slope morphology imply that spur and gully topography undergoes a systematic progressive degradation through time associated with the erosional destruction of the basal fault scarps. The comparative morphometry of the divide networks indicates that the density of the spur networks and the number of first-order unbranched spurs decreases as the basal slope break becomes more sinuous. Abstraction of the spurs occurs through regolith storage in adjacent gullies at the slope base and the most degraded slope forms are entirely buried in talus. The basal fault scarps apparently control regolith transport by allowing debris to drain from the slope. As these basal scarps decay the slope base becomes increasingly sinuous and the slopes become transport limited. Dry mass-wasting may be the most important process acting on these slopes where a continually lowered base level is required to maintain the spur topography. In contrast to the Martian slopes, range front fault escarpments in the western U.S. show no systematic trend in spur network geometry as they are eroded. These weathering limited slopes are controlled by the more efficient removal of regolith through fluvial processes which rapidly create quasi-equilibrium drainage networks.

[An evaluation of eight cases of intraosseous lipoma].

PubMed

Sahin, Yilmaz; Dabak, Nevzat; Selçuk, M Bekir; Bariş, Y Sancar

2007-01-01

We retrospectively evaluated patients with intraosseous lipoma. The study included eight patients (5 males, 3 females; mean age 39 years; range 23 to 60 years) who were treated between 1997 and 2005 for intraosseous lipoma. Localizations of the lipomas were the calcaneus in six patients, proximal humerus in one patient, and proximal femur in one patient. The presenting complaints were heel pain in patients with calcaneal involvement, and shoulder pain associated with proximal humeral involvement. In one patient, detection of intraosseous lipoma in the left proximal femur was incidental during examination for right hip pain. According to the Milgram classification, five of the intraosseous lipomas were stage 1, while two calcaneal lesions and one femoral lesion were stage 2. Treatment consisted of excisional biopsy, curettage, and allografting under regional or general anesthesia. The diagnosis was confirmed histopathologically in all cases. The mean follow-up period was 28 months (range 9 to 110 months). Complaints of heel pain and shoulder pain resolved within four and five months, respectively. No infection or skin necrosis occurred at the wound site. No neurovascular complications developed during or after surgery. Radiological consolidation of the implanted bone allografts were complete by a mean of three months (range 2 to 4 months). No pathological fractures or recurrences were encountered. Treatment of intraosseous lipomas with curettage and grafting is effective in relieving pain and preventing possible pathological fractures.

Bicycle and motorcycle wheel spoke injury in children.

PubMed

Mak, C Y; Chang, J H T; Lui, T H; Ngai, W K

2015-04-01

To review bicycle and motorcycle wheel spoke injuries around the foot and ankle in 24 children. Medical records of 12 boys and 12 girls aged 2 to 11 (mean, 5.3) years who presented with an isolated posterior heel injury caused by wheel spokes of a motorcycle (n=9) or bicycle (n=15) were reviewed. All 9 motorcycle injury patients and 8 of 15 bicycle injury patients had lacerations. The remaining 7 bicycle injury patients had abrasions and developed skin necrosis and ulcerations, with 5 requiring debridement. The most common site of laceration was the posterolateral heel; 7 of these patients had deep soft tissue injury, and in 5 the Achilles tendon was partially cut or completely severed. The mean number of operations was 2.2 in the motorcycle group and 1.3 in the bicycle group. Seven patients with severe skin loss required skin grafting or flap surgery for wound coverage. The mean time from injury to definitive treatment was 8.2 days. The mean length of hospital stay was 18.4 days in the motorcycle group and 8.1 days in the bicycle group. Delayed definitive treatment was associated with more operations (r=0.499, p=0.013) and longer hospital stay (r=0.567, p=0.004). Wheel spoke injuries may result in severe soft tissue damage and bony trauma. Poor prognostic factors included high-energy injury, contamination and infection, and delayed treatment.

The nectar spur is not only a simple specialization for long-proboscid pollinators.

PubMed

Vlašánková, Anna; Padyšáková, Eliška; Bartoš, Michael; Mengual, Ximo; Janečková, Petra; Janeček, Štěpán

2017-09-01

Since the time of Darwin, biologists have considered the floral nectar spur to be an adaptation representing a high degree of plant specialization. Nevertheless, some researchers suggest that nature is more complex and that even morphologically specialized plants attract a wide spectrum of visitors. We observed visitors on Impatiens burtonii (Balsaminaceae) and measured the depth of the proboscis insertion into the spur, the distance of the nectar surface from the spur entrance and the visitor's effectiveness. The hoverfly Melanostoma sp., with the shortest proboscis, was most active early in the morning and fed on pollen and nectar near the spur entrance. The honeybee Apis mellifera and the hoverfly Rhingia mecyana were the most frequent visitors before and after noon, respectively. Although R. mecyana, the only visitor able to reach the end of the spur, was the most frequent, it did not deposit the largest number of pollen grains per visit. Nectar spurs may function as complex structures allowing pollination by both short- and long-proboscid visitors and separating their spatial and temporal niches. Spurred plants should be considered as more generalized and exposed to more diverse selection pressures than previously believed. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

Influence of anthropometric parameters on ultrasound measurements of Os calcis.

PubMed

Hans, D; Schott, A M; Arlot, M E; Sornay, E; Delmas, P D; Meunier, P J

1995-01-01

Few data have been published concerning the influence of height, weight and body mass index (BMI) on broadband ultrasound attenuation (BUA), speed of sound (SOS) and Lunar "stiffness" index, and always in small population samples. The first ain of the present cross-sectional study was to determine whether anthropometric factors have a significant influence on ultrasound measurements. The second objective was to establish whether these parameters have real effect on whether their influence is due only to measurement errors. We measured, in 271 healthy French women (mean age 77 +/- 11 years; range 31-97 years), the following parameters: age, height, weight, lean and fat body mass, heel width, foot length, knee height and external malleolus (HEM). Simple linear regression analyses between ultrasound and anthropometric parameters were performed. Age, height, and heel width were significant predictors of SOS; age, height, weight, foot length, heel width, HEM, fat mass and lean mass were significant predictors of BUA; age, height, weight, heel width, HEM, fat mass and lean mass were significant predictors of stiffness. In the multiple regression analysis, once the analysis had been adjusted for age, only heel width was a significant predictor for SOS (p = 0.0007), weight for BUA (p = 0.0001), and weight (p = 0.0001) and heel width (p = 0.004) for the stiffness index. Besides their statistical meaning, the regression coefficients have a more clinically relevant interpretation which is developed in the text. These results confirm the influence of anthropometric factors on the ultrasonic parameter values, because BUA and SOS were in part dependent on heel width and weight. The influence of the position of the transducer on the calcaneus should be taken into account to optimize the methods of measurement using ultrasound.

Impaired heel to toe progression during gait is related to reduced ankle range of motion in people with Multiple Sclerosis.

PubMed

Psarakis, Michael; Greene, David; Moresi, Mark; Baker, Michael; Stubbs, Peter; Brodie, Matthew; Lord, Stephen; Hoang, Phu

2017-11-01

Gait impairment in people with Multiple Sclerosis results from neurological impairment, muscle weakness and reduced range of motion. Restrictions in passive ankle range of motion can result in abnormal heel-to-toe progression (weight transfer) and inefficient gait patterns in people with Multiple Sclerosis. The purpose of this study was to determine the associations between gait impairment, heel-to-toe progression and ankle range of motion in people with Multiple Sclerosis. Twelve participants with Multiple Sclerosis and twelve healthy age-matched participants were assessed. Spatiotemporal parameters of gait and individual footprint data were used to investigate group differences. A pressure sensitive walkway was used to divide each footprint into three phases (contact, mid-stance, propulsive) and calculate the heel-to-toe progression during the stance phase of gait. Compared to healthy controls, people with Multiple Sclerosis spent relatively less time in contact phase (7.8% vs 25.1%) and more time in the mid stance phase of gait (57.3% vs 33.7%). Inter-limb differences were observed in people with Multiple Sclerosis between the affected and non-affected sides for contact (7.8% vs 15.3%) and mid stance (57.3% and 47.1%) phases. Differences in heel-to-toe progression remained significant after adjusting for walking speed and were correlated with walking distance and ankle range of motion. Impaired heel-to-toe progression was related to poor ankle range of motion in people with Multiple Sclerosis. Heel-to-toe progression provided a sensitive measure for assessing gait impairments that were not detectable using standard spatiotemporal gait parameters. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prevalence and severity of peripheral arterial disease among patient with heel pressure ulcer: a retrospective study of 42 patients.

PubMed

Tisserand, Guillaume; Zenati, Nora; Seinturier, Christophe; Blaise, Sophie; Pernod, Gilles

2017-09-01

Heel pressure ulcer is a major complication in elderly hospitalized patients. The association with peripheral arterial disease (PAD) which is also a frequent disease in this population is poorly known. The aim of this study was to assess the prevalence of PAD and critical limb ischemia (CLI) in patients with heel pressure ulcer. Patients referred to the vascular medicine department for heel pressure ulcer from October 2014 to June 2015 were included in the study. The assessment of peripheral arterial disease was made with the results of ankle brachial index and/or doppler ultra sound of lower limb arteries. Toe systolic pressure and transcutaneous pressure (TcPO2) were also recorded, and the diagnosis of critical limb ischemia was made according to the TASC 2 criteria. The population was composed with 42 patients (women 43%, men 57%). The mean age was 81±11 years. Heel pressures ulcers were diagnosed in the following situations: lower limb fracture (31%), acute medical illness (21%), multiple chronic conditions (28%) and critical care unit hospitalization (7%). A peripheral arterial disease was present in 31 patients (73%), and a critical limb ischemia in 7 patients. For 18 patients, PAD was not known in their past medical history, and this was the case of 5 patients among those with critical limb ischemia. A revascularization was performed in 12 patients, and 5 patients undergo a lower limb amputation. 12 patients were died at 3 months. PAD is frequent among patients with heel pressure ulcer, and is often unknown. The functional and vital prognostic are poor, and the results of our study emphasize the importance of screening PAD in the evaluation of heel pressure ulcer risk.

Impact reduction through long-term intervention in recreational runners: midfoot strike pattern versus low-drop/low-heel height footwear.

PubMed

Giandolini, Marlène; Horvais, Nicolas; Farges, Yohann; Samozino, Pierre; Morin, Jean-Benoît

2013-08-01

Impact reduction has become a factor of interest in the prevention of running-related injuries such as stress fractures. Currently, the midfoot strike pattern (MFS) is thought as a potential way to decrease impact. The purpose was to test the effects of two long-term interventions aiming to reduce impact during running via a transition to an MFS: a foot strike retraining versus a low-drop/low-heel height footwear. Thirty rearfoot strikers were randomly assigned to two experimental groups (SHOES and TRAIN). SHOES progressively wore low-drop/low-heel height shoes and TRAIN progressively adopted an MFS, over a 3-month period with three 30-min running sessions per week. Measurement sessions (pre-training, 1, 2 and 3 months) were performed during which subjects were equipped with three accelerometers on the shin, heel and metatarsals, and ran for 15 min on an instrumented treadmill. Synchronized acceleration and vertical ground reaction force signals were recorded. Peak heel acceleration was significantly lower as compared to pre-training for SHOES (-33.5 ± 12.8 % at 2 months and -25.3 ± 18.8 % at 3 months, p < 0.001), and so was shock propagation velocity (-12.1 ± 9.3 %, p < 0.001 at 2 months and -11.3 ± 4.6 %, p < 0.05 at 3 months). No change was observed for TRAIN. Important inter-individual variations were noted in both groups and reported pains were mainly located at the shin and calf. Although it induced reversible pains, low-drop/low-heel height footwear seemed to be more effective than foot strike retraining to attenuate heel impact in the long term.

Does topical amethocaine gel reduce pain from heel prick blood sampling in premature infants? A randomized double-blind cross-over controlled study

PubMed Central

Patel, Amita; Czerniawski, Barbara; Gray, Shari; Lui, Eric

2003-01-01

BACKGROUND: Heel prick blood sampling is the most common painful invasive procedure performed on neonates. Currently, there are no effective ways to provide pain relief from this painful procedure. OBJECTIVE: To assess the efficacy of the topical anesthetic amethocaine 4% gel (Ametop, Smith & Nephew Inc, St Laurent) in reducing the pain of heel prick blood sampling in neonates. METHODS: A randomized, double-blind, placebo controlled, crossover trial was conducted. Neonates between 33 to 37 weeks’ gestational age in their first seven days of life were eligible. Heel prick blood sampling was performed on each participant twice. Each infant was randomly assigned to receive either amethocaine 4% gel or placebo to the heel for the first prick, and then received the alternative agent for the second prick. Prick pain was assessed using both Premature Infant Pain Profile (PIPP) and Neonatal Infant Pain Scale (NIPS). Squeeze pain was assessed by NIPS. RESULTS: Ten babies were recruited. There were no significant differences in the average PIPP and NIPS scores between the treatment and placebo groups for both prick and squeeze pains from heel prick blood sampling. For prick pain, linear-regression showed significant correlation between the PIPP and NIPS scores. No adverse reactions were observed after application of either the active or placebo agents. CONCLUSION: Topical amethocaine 4% gel is not shown to reduce prick and squeeze pains significantly from heel prick blood sampling in neonates between 33 to 37 weeks’ gestational age. Further studies are needed to find ways to provide effective pain relief from this common procedure. PMID:20020001

[Estimation of spur dike-affected fish habitat area].

PubMed

Ray-Shyan, Wu; Yan-Ru, Chen; Yi-Liang, Ge

2012-04-01

Based on the HEC-RAS and River 2D modes, and taking 5% change rate of weighted usable area (WUA) as the threshold to define the spur dike- affected area of target fish species Acrossocheilus paradoxus in Fazi River in Taiwan, this paper studied the affected area of the fish habitat by spur dike, and, in combining with the references about the installations of spur dikes in Taiwan in recent 10 years, analyzed the relative importance of related affecting factors such as dike height, dike length (water block rate), average slope gradient of river way, single or double spur dike, and flow discharge. In spite of the length of the dike, the affected area in downstream was farther, and was about 2-6 times as large as that in upstream. The ratio of the affected area in downstream / upstream decreased with increasing slope gradient, but increased with increasing dike length and flow discharge. When the discharge was approximate to 10 years return periods, the ratio of the affected area would be close to a constant of 2. Building double spur dike would produce a better WUA than building single spur dike.

Design of a Quasi-Passive Parallel Leg Exoskeleton to Augment Load Carrying for Walking

DTIC Science & Technology

2005-08-01

cycle,’ which is time normalized. The following figure is a pictorial illustration of the gait cycle. The gait cycle begins with the heel strike ...Positive Power – Stabilization during heel strike . (H2) Negative Power – Body pendulums over the leg and stretches the quadriceps. (H3) Positive Power...Explanations: (K1) Negative Power – Knee braking/bending after heel strike . (K2) Positive Power – Knee straightening. (K3) Negligible Power

Development and validity of methods for the estimation of temporal gait parameters from heel-attached inertial sensors in younger and older adults.

PubMed

Misu, Shogo; Asai, Tsuyoshi; Ono, Rei; Sawa, Ryuichi; Tsutsumimoto, Kota; Ando, Hiroshi; Doi, Takehiko

2017-09-01

The heel is likely a suitable location to which inertial sensors are attached for the detection of gait events. However, there are few studies to detect gait events and determine temporal gait parameters using sensors attached to the heels. We developed two methods to determine temporal gait parameters: detecting heel-contact using acceleration and detecting toe-off using angular velocity data (acceleration-angular velocity method; A-V method), and detecting both heel-contact and toe-off using angular velocity data (angular velocity-angular velocity method; V-V method). The aim of this study was to examine the concurrent validity of the A-V and V-V methods against the standard method, and to compare their accuracy. Temporal gait parameters were measured in 10 younger and 10 older adults. The intra-class correlation coefficients were excellent in both methods compared with the standard method (0.80 to 1.00). The root mean square errors of stance and swing time in the A-V method were smaller than the V-V method in older adults, although there were no significant discrepancies in the other comparisons. Our study suggests that inertial sensors attached to the heels, using the A-V method in particular, provide a valid measurement of temporal gait parameters. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of material characteristics of shoe soles on muscle activation and energy aspects during running.

PubMed

Nigg, B M; Stefanyshyn, D; Cole, G; Stergiou, P; Miller, J

2003-04-01

The purposes of this study were (a) to determine group and individual differences in oxygen consumption during heel-toe running and (b) to quantify the differences in EMG activity for selected muscle groups of the lower extremities when running in shoes with different mechanical heel characteristics. Twenty male runners performed heel-toe running using two shoe conditions, one with a mainly elastic and a visco-elastic heel. Oxygen consumption was quantified during steady state runs of 6 min duration, running slightly above the aerobic threshold providing four pairs of oxygen consumption results for comparison. Muscle activity was quantified using bipolar surface EMG measurements from the tibialis anterior, medial gastrocnemius, vastus medialis and the hamstrings muscle groups. EMG data were sampled for 5 s every minute for the 6 min providing 30 trials. EMG data were compared for the different conditions using an ANOVA (alpha=0.05). The findings of this study showed that changes in the heel material characteristics of running shoes were associated with (a) subject specific changes in oxygen consumption and (b) subject and muscle specific changes in the intensities of muscle activation before heel strike in the lower extremities. It is suggested that further study of these phenomena will help understand many aspects of human locomotion, including work, performance, fatigue and possible injuries.

The influence of heel height on vertical ground reaction force during landing tasks in recreationally active and athletic collegiate females.

PubMed

Lindenberg, Kelly M; Carcia, Christopher R

2013-02-01

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

Heel pain

MedlinePlus

... overuse. However, it may be caused by an injury. Your heel may become tender or swollen from: Shoes with poor support or shock absorption Running on hard surfaces, like concrete Running too often ...

Suprachoroidal drainage with collagen sheet implant- a novel technique for non-penetrating glaucoma surgery.

PubMed

Szurman, Peter; Januschowski, Kai; Boden, Karl Thomas; Seuthe, Anna-Maria

2018-02-01

Our purpose was both to introduce the new technique of suprachoroidal drainage with collagen sheet implantation as a novel technique of non-penetrating glaucoma surgery and to present first results of a prospective pilot study. A superficial rectangular sclera flap of half-scleral thickness sized 4 × 4.5 mm is dissected anteriorly until clear cornea. Then, a second scleral flap is created underneath the first one sized 3.5x4mm and is cut down full-thickness to the choroid exposing the suprachoroidal space. The flap is then bluntly prepared until the scleral spur is reached. Sharp dissection above the sclera spur exposes Schlemm's canal, which is located directly anteriorly. Schlemm's canal is unroofed, juxtacanalicular meshwork is peeled and the deep flap is cut off at its base. An absorbable collagen sheet (Ologen®, Dahlhausen, Cologne, Germany) is placed into the suprachoroidal space at the level of the ciliary body, and the superficial sclera flap is sutured tightly to prevent leakage. We prospectively analyzed 65 eyes that underwent suprachoroidal drainage with collagen sheet implantation. Mean reduction of intraocular pressure after 3 months was 35.1% (from 21.0 ± 4.3 mmHg to 13.5 ± 3.4 mmHg)(p < 0.01) and after 12 months 35.6% (from 21.0 ± 4.3 mmHg to 13.5 ± 3.0  mmHg)(p < 0.01). The number of topical IOP-reducing medication decreased significantly from 3.5 ± 0.7 to 0.6 ± 0.9 and to 0.9 ± 1.1 after 3 and 12 months, respectively (p < 0.01). No serious complications occurred. Suprachoroidal drainage with collagen sheet implantation seems to be a safe and effective surgical technique for non-penetrating glaucoma surgery that yields the opportunity of a sufficient IOP reduction for eyes unsuitable for canaloplasty.

Apodization of spurs in radar receivers using multi-channel processing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Doerry, Armin W.; Bickel, Douglas L.

The various technologies presented herein relate to identification and mitigation of spurious energies or signals (aka "spurs") in radar imaging. Spurious energy in received radar data can be a consequence of non-ideal component and circuit behavior. Such behavior can result from I/Q imbalance, nonlinear component behavior, additive interference (e.g. cross-talk, etc.), etc. The manifestation of the spurious energy in a radar image (e.g., a range-Doppler map) can be influenced by appropriate pulse-to-pulse phase modulation. Comparing multiple images which have been processed using the same data but of different signal paths and modulations enables identification of undesired spurs, with subsequent croppingmore » or apodization of the undesired spurs from a radar image. Spurs can be identified by comparison with a threshold energy. Removal of an undesired spur enables enhanced identification of true targets in a radar image.« less

Detecting Gait Asymmetry with Wearable Accelerometers

DTIC Science & Technology

2015-03-18

swing time to stride duration is referred to as swing factor [24]. Some features used in the past relate to the gait subphases: the heel - strike , when the...used in the past include the peaks of the impulse of the heel - strike [28] and toe-off force and the integral of the force over the course of the...with high acceleration and high jerk. Heel - strike and toe-off times are determined by extending outward from the identified stance time into areas of

Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography

PubMed Central

Leung, Wilson K.C.; Chu, KL

2017-01-01

Background Mechanical loading is crucial for muscle and tendon tissue remodeling. Eccentric heel drop exercise has been proven to be effective in the management of Achilles tendinopathy, yet its induced change in the mechanical property (i.e., stiffness) of the Achilles tendon (AT), medial and lateral gastrocnemius muscles (MG and LG) was unknown. Given that shear wave elastography has emerged as a powerful tool in assessing soft tissue stiffness with promising intra- and inter-operator reliability, the objective of this study was hence to characterize the stiffness of the AT, MG and LG in response to an acute bout of eccentric heel drop exercise. Methods Forty-five healthy young adults (36 males and nine females) performed 10 sets of 15-repetition heel drop exercise on their dominant leg with fully-extended knee, during which the AT and gastrocnemius muscles, but not soleus, were highly stretched. Before and immediately after the heel drop exercise, elastic moduli of the AT, MG and LG were measured by shear wave elastography. Results After the heel drop exercise, the stiffness of AT increased significantly by 41.8 + 33.5% (P < 0.001), whereas the increases in the MG and LG stiffness were found to be more drastic by 75 + 47.7% (P < 0.001) and 71.7 + 51.8% (P < 0.001), respectively. Regarding the AT, MG and LG stiffness measurements, the inter-operator reliability was 0.940, 0.987 and 0.986, and the intra-operator reliability was 0.916 to 0.978, 0.801 to 0.961 and 0.889 to 0.985, respectively. Discussion The gastrocnemius muscles were shown to bear larger mechanical loads than the AT during an acute bout of eccentric heel drop exercise. The findings from this pilot study shed some light on how and to what extent the AT and gastrocnemius muscles mechanically responds to an isolated set of heel drop exercise. Taken together, appropriate eccentric load might potentially benefit mechanical adaptations of the AT and gastrocnemius muscles in the rehabilitation of patients with Achilles tendinopathy. PMID:28740756

Retrocalcaneal bursitis (image)

MedlinePlus

Retrocalcaneal bursitis is an inflammation of the bursa at the back of the heel bone. A bursa is a ... bursa to become irritated and inflamed. Symptoms of bursitis include pain in the heel, especially with walking, ...

Method and apparatus for spur-reduced digital sinusoid synthesis

NASA Technical Reports Server (NTRS)

Zimmerman, George A. (Inventor); Flanagan, Michael J. (Inventor)

1995-01-01

A technique for reducing the spurious signal content in digital sinusoid synthesis is presented. Spur reduction is accomplished through dithering both amplitude and phase values prior to word-length reduction. The analytical approach developed for analog quantization is used to produce new bounds on spur performance in these dithered systems. Amplitude dithering allows output word-length reduction without introducing additional spurs. Effects of periodic dither similar to that produced by a pseudo-noise (PN) generator are analyzed. This phase dithering method provides a spur reduction of 6(M + 1) dB per phase bit when the dither consists of M uniform variates. While the spur reduction is at the expense of an increase in system noise, the noise power can be made white, making the power spectral density small. This technique permits the use of a smaller number of phase bits addressing sinusoid look-up tables, resulting in an exponential decrease in system complexity. Amplitude dithering allows the use of less complicated multipliers and narrower data paths in purely digital applications, as well as the use of coarse-resolution, highly-linear digital-to-analog converters (DAC's) to obtain spur performance limited by the DAC linearity rather than its resolution.

46 CFR 174.255 - Restricted service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... heel at which downflooding would occur, whichever angle is less. (iii) A residual righting energy of at... the angle of heel at which downflooding would occur, whichever angle is less. (2) For this section...

46 CFR 174.255 - Restricted service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... heel at which downflooding would occur, whichever angle is less. (iii) A residual righting energy of at... the angle of heel at which downflooding would occur, whichever angle is less. (2) For this section...

Natural Fatigue Crack Initiation and Detection in High Quality Spur Gears

DTIC Science & Technology

2012-06-01

Natural Fatigue Crack Initiation and Detection in High Quality Spur Gears by David “Blake” Stringer, Ph.D., Kelsen E. LaBerge, Ph.D., Cory...0383 June 2012 Natural Fatigue Crack Initiation and Detection in High Quality Spur Gears David “Blake” Stringer and Ph.D., Kelsen E. LaBerge...Quality Spur Gears 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) David “Blake” Stringer, Ph.D., Kelsen E

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.

Investigation on wear characteristic of biopolymer gear

NASA Astrophysics Data System (ADS)

Ghazali, Wafiuddin Bin Md; Daing Idris, Daing Mohamad Nafiz Bin; Sofian, Azizul Helmi Bin; Basrawi, Mohamad Firdaus bin; Khalil Ibrahim, Thamir

2017-10-01

Polymer is widely used in many mechanical components such as gear. With the world going to a more green and sustainable environment, polymers which are bio based are being recognized as a replacement for conventional polymers based on fossil fuel. The use of biopolymer in mechanical components especially gear have not been fully explored yet. This research focuses on biopolymer for spur gear and whether the conventional method to investigate wear characteristic is applicable. The spur gears are produced by injection moulding and tested on several speeds using a custom test equipment. The wear formation such as tooth fracture, tooth deformation, debris and weight loss was observed on the biopolymer spur gear. It was noted that the biopolymer gear wear mechanism was similar with other type of polymer spur gears. It also undergoes stages of wear which are; running in, linear and rapid. It can be said that the wear mechanism of biopolymer spur gear is comparable to fossil fuel based polymer spur gear, thus it can be considered to replace polymer gears in suitable applications.

Moving characteristics of single file passengers considering the effect of ship trim and heeling

NASA Astrophysics Data System (ADS)

Sun, Jinlu; Lu, Shouxiang; Lo, Siuming; Ma, Jian; Xie, Qimiao

2018-01-01

Ship listing and motion affects the movement pattern of passengers on board, thus pedestrian traffic and evacuation dynamics would be significantly different from those on level ground. To quantify the influence of ship listing and motion on passenger evacuation, we designed a ship corridor simulator, with which we performed single-file pedestrian movement experiments considering the effect of trim and heeling. Results indicated that density is not the only factor that affects pedestrian speed under ship trim or heeling conditions, for that both individual walking speed and group walking speed would be greatly attenuated due to the influence of the trim angles. However, heeling angles show less impact on speed when compared with trim angles. In addition, the speed correlation coefficient between the adjacent experimental subjects would be higher with larger angles and lower speed. Moreover, both female and male experimental subjects need similar distance headway for walking in different trim or heeling conditions. Furthermore, experimental subjects with lower individual walking speed need longer time headway to keep enough distance headway. This work will provide fundamental guidance to the development of evacuation models and the design of evacuation facilities on board.

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. Copyright © 2015 Elsevier B.V. All rights reserved.

Comparison of Varying Heel to Toe Differences and Cushion to Barefoot Running in Novice Minimalist Runners

PubMed Central

MOODY, DANNY; HUNTER, IAIN; RIDGE, SARAH; MYRER, J. WILLIAM

2018-01-01

There are many different types of footwear available for runners in today’s market. Many of these shoes claim to help runners run more efficiently by altering an individual’s stride mechanics. Minimalist footwear claims to aid runners run more on their forefeet whereas more traditional footwear provides more cushioning specifically for a heel first landing. The purpose of this paper was to determine if runners, who were accustomed to running in traditional footwear would alter their running mechanics while running acutely in various types of minimalist footwear. Twelve subjects, accustomed to running in traditional 12 mm heel/toe differential footwear, ran in five footwear conditions on a treadmill at a controlled pace for two minutes after warming up in each condition for 5 minutes. While running in 12 mm heel/toe differential footwear compared to barefoot, subjects ran with a significantly longer ground time, a lower stride rate and greater vertical oscillation. There were not any differences in variables when running in the shod conditions despite the varying heel/toe differentials. Running barefoot proved to be different than running in traditional 12 mm drop cushioned footwear. PMID:29795721

Comparison of Varying Heel to Toe Differences and Cushion to Barefoot Running in Novice Minimalist Runners.

PubMed

Moody, Danny; Hunter, Iain; Ridge, Sarah; Myrer, J William

2018-01-01

There are many different types of footwear available for runners in today's market. Many of these shoes claim to help runners run more efficiently by altering an individual's stride mechanics. Minimalist footwear claims to aid runners run more on their forefeet whereas more traditional footwear provides more cushioning specifically for a heel first landing. The purpose of this paper was to determine if runners, who were accustomed to running in traditional footwear would alter their running mechanics while running acutely in various types of minimalist footwear. Twelve subjects, accustomed to running in traditional 12 mm heel/toe differential footwear, ran in five footwear conditions on a treadmill at a controlled pace for two minutes after warming up in each condition for 5 minutes. While running in 12 mm heel/toe differential footwear compared to barefoot, subjects ran with a significantly longer ground time, a lower stride rate and greater vertical oscillation. There were not any differences in variables when running in the shod conditions despite the varying heel/toe differentials. Running barefoot proved to be different than running in traditional 12 mm drop cushioned footwear.

The heel: anatomy, blood supply, and the pathophysiology of pressure ulcers.

PubMed

Cichowitz, Adam; Pan, Wei Ren; Ashton, Mark

2009-04-01

There remains much confusion regarding the pathophysiology of pressure ulcers. Data indicate that the prevalence of pressure ulcers is increasing. The heel is unique in structure and well adapted to the task of shock absorption. However, it is often subject to prolonged pressure, which predisposes it to tissue breakdown, with attempts at reconstruction prone to failure. Four dissections were carried out of the heel region, which included removing each heel pad en bloc for histology. Seventeen arterial injection studies, 12 venous studies, and a combined arterial and venous study of the foot were performed. The results were correlated with clinical cases and previous research. The heel was found to be richly vascularized by a subdermal plexus and periosteal plexus with vessels traveling between the 2 within fibrous septa that connect the reticular dermis and periosteum of the calcaneus. These septa effectively create isolated compartments containing relatively avascular fat. A layer of panniculus carnosus muscle was observed in the subcutaneous tissue. It is likely that the metabolically active panniculus carnosus muscle is involved early in the course of pressure ulcers. Extensive pressure damage can be concealed by intact skin. Friction and shear are additional factors important in skin breakdown.

Characterising the biophysical properties of normal and hyperkeratotic foot skin.

PubMed

Hashmi, Farina; Nester, Christopher; Wright, Ciaran; Newton, Veronica; Lam, Sharon

2015-01-01

Plantar foot skin exhibits unique biophysical properties that are distinct from skin on other areas of the body. This paper characterises, using non-invasive methods, the biophysical properties of foot skin in healthy and pathological states including xerosis, heel fissures, calluses and corns. Ninety three people participated. Skin hydration, elasticity, collagen and elastin fibre organisation and surface texture was measured from plantar calluses, corns, fissured heel skin and xerotic heel skin. Previously published criteria were applied to classify the severity of each skin lesion and differences in the biophysical properties compared between each classification. Calluses, corns, xerotic heel skin and heel fissures had significantly lower levels of hydration; less elasticity and greater surface texture than unaffected skin sites (p < 0.01). Some evidence was found for a positive correlation between hydration and elasticity data (r ≤ 0.65) at hyperkeratotic sites. Significant differences in skin properties (with the exception of texture) were noted between different classifications of skin lesion. This study provides benchmark data for healthy and different severities of pathological foot skin. These data have applications ranging from monitoring the quality of foot skin, to measuring the efficacy of therapeutic interventions.

46 CFR 174.320 - Damage survival.

Code of Federal Regulations, 2010 CFR

2010-10-01

... angle of heel in each stage of flooding must not exceed 30 degrees or the angle of downflooding whichever is less. (b) The final waterline, taking into account sinkage, heel, and trim, must be below the...

46 CFR 174.320 - Damage survival.

Code of Federal Regulations, 2011 CFR

2011-10-01

... angle of heel in each stage of flooding must not exceed 30 degrees or the angle of downflooding whichever is less. (b) The final waterline, taking into account sinkage, heel, and trim, must be below the...

33 CFR 157.21 - Subdivision and stability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... account sinkage, heel, and trim, must be below the lower edge of an opening through which progressive.... (b) In the final stage of flooding, the angle of heel due to unsymmetrical flooding must not exceed...

33 CFR 157.21 - Subdivision and stability.

Code of Federal Regulations, 2010 CFR

2010-07-01

... account sinkage, heel, and trim, must be below the lower edge of an opening through which progressive.... (b) In the final stage of flooding, the angle of heel due to unsymmetrical flooding must not exceed...

Injury Prevention Effectiveness of Modifications of Shoe Type on Injuries and Risk Factors Associated with Pain and Discomfort in the US Army Band, Fort Meyer, Virginia 2007-2008

DTIC Science & Technology

2009-06-30

shown to reduce mean USACHPPM Epidemiological Report No. 12-HF-05WC-07 3 peak pressure during heel strike and forefoot landing(15). For...such as outsoles that have built in compression pads in the heel and forefoot , and Cooltech®. Cooltech theoretically improves breathability by...in the heel and forefoot , and Cooltech® which presumably improves breathability by increasing ventilation through eyeleted vent holes on the sides

Accuracy of the Peak (TM) Two and Three-Dimensional Videography Analysis for a Rearfoot Model

DTIC Science & Technology

1993-01-01

of gait. "Pronation occurs in the stance phase of gait to I allow for shock absorption, ground terrain changes, and equilibrium.""I At heel strike , 80...5 percent of the body weight is directly over the calcaneus. The calcaneus is in slight inversion at heel strike . 16 5 There are four major forces...acting on the foot at heel strike or toe strike . The forces are compression, rotation, anterior shear, and medial shear. " Normal pronation is U required

Analysis of foot kinematics wearing high heels using the Oxford foot model.

PubMed

Wang, Meizi; Gu, Yaodong; Baker, Julien Steven

2018-04-29

Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20-25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55∘± 1.62∘ VS 26.6∘± 2.33∘ for the barefoot; P= 0.001), and less hallux plantarflexion during the initial stance phase (-4.86∘± 2.32∘ VS -8.68∘± 1.13∘; P< 0.001). There were also greater forefoot adduction (16.15∘± 1.37∘ VS 13.18∘± 0.79∘; P< 0.001), but no significant differences were found in forefoot abduction between the two conditions. The hind foot demonstrated a larger dorsiflexion in the horizontal plane (16.59∘± 1.69∘ VS 12.08∘± 0.9∘; P< 0.001), greater internal rotation (16.72∘± 0.48∘ VS 7.97∘± 0.55∘; P< 0.001), and decreased peak hind foot extension rotation (-5.49∘± 0.69∘ VS -10.73∘± 0.42∘; P= 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.

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

PubMed Central

Barnish, Maxwell S; Barnish, Jean

2016-01-01

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

Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse-driven performance improvement project.

PubMed

McElhinny, Mary Louise; Hooper, Christine

2008-01-01

A nurse-driven performance improvement project designed to reduce the incidence of hospital-acquired ulcers of the heel in an acute care setting was evaluated. This was a descriptive evaluative study using secondary data analysis. Data were collected in 2004, prior to implementation of the prevention project and compared to results obtained in 2006, after the project was implemented. Data were collected in a 172-bed, not-for-profit inpatient acute care facility in North Central California. All medical-surgical inpatients aged 18 years and older were included in the samples. Data were collected on 113 inpatients prior to implementation of the project in 2004. Data were also collected on a sample of 124 inpatients in 2006. The prevalence and incidence of heel pressure ulcers were obtained through skin surveys prior to implementation of the prevention program and following its implementation. Results from 2004 were compared to data collected in 2006 after introduction of the Braden Scale for Predicting Pressure Sore Risk. Heel pressure ulcers were staged using the National Pressure Ulcer Advisory Panel (NPUAP) staging system and recommendations provided by the Agency for Health Care Quality Research (AHRQ) clinical practice guidelines. The incidence of hospital-acquired heel pressure ulcers in 2004 was 13.5% (4 of 37 patients). After implementation of the program in 2006, the incidence of hospital-acquired heel pressure ulcers was 13.8% (5 of 36 patients). The intervention did not appear to receive adequate staff nurse support needed to make the project successful. Factors that influenced the lack of support may have included: (1) educational method used, (2) lack of organization approved, evidenced-based standardized protocols for prevention and treatment of heel ulcers, and (3) failure of facility management to convey the importance as well as their support for the project.

46 CFR 28.540 - Free surface.

Code of Federal Regulations, 2010 CFR

2010-10-01

... liquid that is not a consumable or containing fish or a fish product that can shift as the vessel heels... transfer of liquids as the vessel heels are installed in the piping. (c) The moment of transference method...

46 CFR 28.540 - Free surface.

Code of Federal Regulations, 2011 CFR

2011-10-01

... liquid that is not a consumable or containing fish or a fish product that can shift as the vessel heels... transfer of liquids as the vessel heels are installed in the piping. (c) The moment of transference method...

46 CFR 174.185 - Intact stability.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (b) and (d) of this section, at each angle of heel an OSV's righting arm may be calculated... vessel does not trim as it heels. (g) For the purpose of paragraphs (b) and (d) of this section, the...

49 CFR 213.135 - Switches.

Code of Federal Regulations, 2010 CFR

2010-10-01

... point to the stock rail. Broken or cracked switch point rails will be subject to the requirements of... of the stock rail. (d) The heel of each switch rail shall be secure and the bolts in each heel shall...

49 CFR 213.135 - Switches.

Code of Federal Regulations, 2011 CFR

2011-10-01

... point to the stock rail. Broken or cracked switch point rails will be subject to the requirements of... of the stock rail. (d) The heel of each switch rail shall be secure and the bolts in each heel shall...

Achilles tendinitis

MedlinePlus

... large muscles in the calf. These create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel. Heel pain is most often due to overuse of the ...

Optimizing footwear for older people at risk of falls.

PubMed

Menant, Jasmine C; Steele, Julie R; Menz, Hylton B; Munro, Bridget J; Lord, Stephen R

2008-01-01

Footwear influences balance and the subsequent risk of slips, trips, and falls by altering somatosensory feedback to the foot and ankle and modifying frictional conditions at the shoe/floor interface. Walking indoors barefoot or in socks and walking indoors or outdoors in high-heel shoes have been shown to increase the risk of falls in older people. Other footwear characteristics such as heel collar height, sole hardness, and tread and heel geometry also influence measures of balance and gait. Because many older people wear suboptimal shoes, maximizing safe shoe use may offer an effective fall prevention strategy. Based on findings of a systematic literature review, older people should wear shoes with low heels and firm slip-resistant soles both inside and outside the home. Future research should investigate the potential benefits of tread sole shoes for preventing slips and whether shoes with high collars or flared soles can enhance balance when challenging tasks are undertaken.

Flow near a model spur dike with a fixed scoured bed

USDA-ARS?s Scientific Manuscript database

Three-dimensional flow velocities were measured using an acoustic Doppler velocimeter at a closely spaced grid over a fixed scoured bed with a submerged spur dike. Three-dimensional flow velocities were measured at 3484 positions around the trapezoidal shaped submerged model spur dike over a fixed ...

Posterior symphyseal spurs--an unusual differential diagnosis in athletes with groin pain.

PubMed

Hopp, Sascha Jörg; Ojodu, Ishaq; Pohlemann, Tim; Kelm, Jens

2015-05-01

We set out to highlight the significance of posterior symphyseal spurs as an unusual diagnostic possibility in athletes with chronic groin pain and to demonstrate that operative resection was successful in quickly and safely returning the patients to sporting activities. Five competitive nonprofessional male athletes, three soccer players, and two marathon runners (median age: 30 [26/33] years), who presented to us with significant groin and central pubic pain with duration of at least 12 months, and who had failed conservative or surgical interventions (symphyseal plating), were evaluated. Physical examination as well as pelvic radiographs confirmed the diagnosis of posterior symphyseal spurs. Four out of five athletes underwent complete resection of the spur. Size of spurs was 2.2 (1.3/2.9) cm (median) with four of them posterosuperiorly and one posterocentrally located. All of them had uneventful postoperative recovery period and were still pain-free at the latest follow up after 26.6 months (24/30). Median time-to-return to competitive sports level was 10 weeks (8/13). None of the patients developed pubic instability due to symphyseal spur resection. The results of considerable postoperative improvement in our patients highlight the significance of posterior symphyseal spurs as a diagnostic possibility in athletes with chronic groin pain.

Global Modeling of Spur Formation in Spiral Galaxies

NASA Astrophysics Data System (ADS)

Shetty, Rahul; Ostriker, Eve C.

2006-08-01

We investigate the formation of substructure in spiral galaxies using global MHD simulations, including gas self-gravity. Local modeling by Kim & Ostriker previously showed that self-gravity and magnetic fields cause rapid growth of overdensities in spiral arms; differential compression of gas flowing through the arms then results in the formation of sheared structures in the interarms. These sheared structures resemble features described as spurs or feathers in optical and IR observations of many spiral galaxies. Global modeling extends previous local models by including the full effects of curvilinear coordinates, a realistic log-spiral perturbation, self-gravitational contribution from five radial wavelengths of the spiral shock, and variation of density and epicyclic frequency with radius. We show that with realistic Toomre Q-values self-gravity and galactic differential rotation produce filamentary gaseous structures with kiloparsec-scale separations, regardless of the strength-or even presence-of a stellar spiral potential. However, a sufficiently strong spiral potential is required to produce true spurs, consisting of interarm structures emerging from gas concentrations in the main spiral arms. In models where Q is initially constant, filaments due to interarm self-gravity grow mainly in the outer regions, whereas true arm spurs grow only in the inner regions. For models with Q~R, outer regions are intrinsically more stable, so background interarm filaments do not grow, but arm spurs can develop if the spiral potential is strong. Unlike independently growing background filaments, the orientation of arm spurs depends on galactic location. Inside corotation, spurs emanate outward, on the convex side of the arm; outside corotation, spurs grow inward, on the concave side of the arm. Based on orientation and the relation to arm clumps, it is possible to distinguish true spurs that originate as instabilities in the arms from independently growing background filaments. We measure spur spacings of ~3-5 times the Jeans length in the arm and arm clump masses of ~107 Msolar. Finally, we have also studied models without self-gravity, finding that magnetic fields suppress a purely hydrodynamic instability recently proposed by Wada & Koda as a means of growing interarm spurs and feathers. Our models also suggest that magnetic fields are important in preserving grand-design spiral structure when gas in the arms fragments via self-gravity into GMCs.

Trial of Music, Sucrose, and Combination Therapy for Pain Relief during Heel Prick Procedures in Neonates.

PubMed

Shah, Swapnil R; Kadage, Shahajahan; Sinn, John

2017-11-01

To compare the effectiveness of music, oral sucrose, and combination therapy for pain relief in neonates undergoing a heel prick procedure. This randomized, controlled, blinded crossover clinical trial included stable neonates >32 weeks of postmenstrual age. Each neonate crossed over to all 3 interventions in random order during consecutive heel pricks. A video camera on mute mode recorded facial expressions, starting 2 minutes before until 7 minutes after the heel prick. The videos were later analyzed using the Premature Infant Pain Profile-Revised (PIPP-R) scale once per minute by 2 independent assessors, blinded to the intervention. The PIPP-R scores were compared between treatment groups using Friedman test. For the 35 participants, the postmenstrual age was 35 weeks (SD, 2.3) with an average weight of 2210 g (SD, 710). The overall median PIPP-R scores following heel prick over 6 minutes were 4 (IQR 0-6), 3 (IQR 0-6), and 1 (IQR 0-3) for the music, sucrose, and combination therapy interventions, respectively. The PIPP-R scores were significantly lower at all time points after combination therapy compared with the groups given music or sucrose alone. There was no difference in PIPP-R scores between the music and sucrose groups. In relatively stable and mature neonates, the combination of music therapy with sucrose provided better pain relief during heel prick than when sucrose or music was used alone. Recorded music in isolation had a similar effect to the current gold standard of oral sucrose. www.anzctr.org.au ACTRN12615000271505. Copyright © 2017 Elsevier Inc. All rights reserved.

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)

Influence of Ligament Properties on Knee Mechanics in Walking

PubMed Central

Smith, Colin R.; Lenhart, Rachel L.; Kaiser, Jarred; Vignos, Mike; Thelen, Darryl G.

2016-01-01

Computational knee models provide a powerful platform to investigate the effects of injury and surgery on functional knee behavior. The objective of this study was to use a multibody knee model to investigate the influence of ligament properties on tibiofemoral kinematics and cartilage contact pressures in the stance phase of walking. The knee model included 14 ligament bundles and articular cartilage contact acting across the tibiofemoral and patellofemoral joints. The knee was incorporated into a lower extremity musculoskeletal model and used to simulate knee mechanics during the stance phase of normal walking. A Monte Carlo approach was employed to assess the influence ligament stiffness and reference strains on knee mechanics. The ACL, MCL and posterior capsule properties exhibited significant influence on anterior tibial translation at heel strike, with the ACL acting as the primary restraint to anterior translation in mid-stance. The MCL and LCL exhibited the greatest influence on tibial rotation from heel strike through mid-stance. Simulated tibial plateau contact location was dependent on the ACL, MCL and LCL properties, while pressure magnitudes were most dependent on the ACL. A decrease in ACL stiffness or reference strain significantly increased average contact pressure in mid-stance, with the pressure migrating posteriorly on the medial tibial plateau. These ligament-dependent shifts in tibiofemoral cartilage contact during walking are potentially relevant to consider when investigating the causes of early onset osteoarthritis following knee ligament injury and surgical treatment. PMID:26408997

[Essential bone cyst of the calcaneus in children. Report of three cases].

PubMed

Antón Rodrigálvarez, L M; Ortega Medina, L; Cabadas González, M I; Aguilar Rodríguez, L

1998-10-01

The purpose of this study was to analyze the properties of essential bone cyst of the calcaneus in childhood, as well as its evolution, and differences with regard to adults. The cases of children with a diagnosis of essential bone cyst of calcaneus in last sixteen years in the pediatric orthopedic unit of San Carlos Clinic have been reviewed. We evaluated the information regarding the clinical history and the radiological and histological date as well as the therapy result with esteroid intracavity therapy and curettage and bone grafting. The radiologic score was done following Södergard criteria and the posttreatment follow-up with Neer's score. The mean age of the patients was 10.3 years. Two of the patients had recurrent heel pain for more than six months. Treatment consisted in intracavitary esteroid in two cases and curettage and bone grafting in all three cases, in two of the cases because of failure of esteroid therapy and in the other because of an atypical X-ray image. In all cases the histological stady identified the existence of a characteristic membrane conective tissue. The postsurgery follow-up a period of half four years has been satisfactory. The essential bone cyst of the calcaneous is exceptional localization in children, frequently symptomatic and resistant to the esteroid intracavitaria contrary to what happens with the essential bone cyst of other localizations and with the essential bone cyst of the calcaneus in the adults. The recurrent heel pain and atipical X-ray image are surgery indications.

Anatomy and Aesthetics of the Labia Minora: The Ideal Vulva?

PubMed

Clerico, C; Lari, A; Mojallal, A; Boucher, F

2017-06-01

Female genital cosmetic surgery is becoming more and more widespread both in the field of plastic and gynaecological surgery. The increased demand for vulvar surgery is spurred by the belief that the vulva is abnormal in appearance. What is normal in terms of labial anatomy? Labia minora enlargement or hypertrophy remains a clinical diagnosis which is poorly defined as it could be considered a variation of the normal anatomy. Enlarged labia minora can cause functional, aesthetic and psychosocial problems. In reality, given the wide variety of vulvar morphology among people, it is a very subjective issue to define the "normal" vulva. The spread of nudity in the general media plays a major role in creating an artificial image and standards with regard to the ideal form. Physicians should be aware that the patient's self-perception of the normal or ideal vulva is highly influenced by the arguably distorted image related to our socio-psychological environment, as presented to us by the general media and internet. As physicians, we have to educate our patients on the variation of vulvar anatomy and the potential risks of these surgeries. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ankle fracture spur sign is pathognomonic for a variant ankle fracture.

PubMed

Hinds, Richard M; Garner, Matthew R; Lazaro, Lionel E; Warner, Stephen J; Loftus, Michael L; Birnbaum, Jacqueline F; Burket, Jayme C; Lorich, Dean G

2015-02-01

The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. Level III, retrospective comparative study. © The Author(s) 2014.

The coupling between hydrodynamic and purification efficiencies of ecological porous spur-dike in field drainage ditch

NASA Astrophysics Data System (ADS)

Rao, Lei; Wang, Pei-fang; Dai, Qing-song; Wang, Chao

2018-05-01

In this study, a series of ecological porous spur-dikes are arranged in an experiment channel to simulate a real field drainage ditch. The inside and outside flow fields of spur-dikes are determined by numerical simulations and experimental methods. An Ammonia-Nitrogen (NH3-N) degradation evaluation model is built to calculate the pollution removal rate by coupling with the inner flow field of the porous spur-dikes. The variations of the total pollutant removal rate in the channel are discussed in terms of different porosities and gap distances between spur-dikes and inlet flow velocities. It is indicated that a reasonable parameter matching of the porosity and the gap distance with the flow velocity of the ditch can bring about a satisfactory purification efficiency with a small delivery quantity of ecological porous materials.

Rectus femoris muscle atrophy and recovery caused by preoperative pretibial traction in femoral shaft fractures-comparison between traction period.

PubMed

Shim, D-G; Kwon, T-Y; Lee, K-B

2017-09-01

Skeletal traction is performed to temporarily stabilize fracture sites before surgery in patients with femoral fracture. To date, however, there is no study evaluating the difference in the degree of the recovery, of the muscle strength, as well as muscle atrophy following skeletal traction. The purpose of this study was to compare the degree of recovery of rectus femoris muscle strength after surgery in association with muscle atrophy by analyzing the duration of preoperative tibial traction, age and sex in patients with femoral fracture. Rectus femoris muscle atrophy will progress depending on the duration of preoperative tibial traction, age and sex in patients with femoral fracture. Thirty-one patients who underwent preoperative pretibial skeletal traction and intramedullary nailing were divided into two groups according to the traction period: group A (n=12) with a duration of traction of <7 days (mean: 4.08±1.78 days) and group B (n=19) ≥7 days (mean: 13.63±7.17 days). The degree of muscle atrophy and recovery were compared between the two groups, according to age and gender. The degree of muscle atrophy was measured by the difference in thickness of the rectus femoris between pre- and post-traction using ultrasound. The degree of muscle recovery was evaluated by the Q-setting and heel off time. Clinical outcome was evaluated by the non-union rate and Lysholm score. The degree of muscle atrophy was 0.99±0.14mm in group A and 2.22±0.11mm in group B (P<0.001). The Q-setting time was 4.83±0.94 days in group A and 6.56±1.38 days in group B (P=0.001). Heel off time was also shorter in group A at 2.58±0.90 days, taking 3.72±1.27 days in group B (P=0.012). The recovery rate in the rectus femoris was significantly higher in group A than in group B (P<0.001). There was no significant difference in non-union rate between group A and B (P=0.672) but the mean Lysholm score at the last follow-up was significantly higher in group A than in group B (P=0.006). However, no significant differences were detected in the mean thickness of the rectus femoris, Q-setting, and heel off time between the different age and gender groups (P<0.05). The prolonged duration of preoperative skeletal traction indicates not only that the resulting disuse atrophy would progress further but also that the muscle atrophy would be accelerated more rapidly for shorter periods of time, based on a cut-off value of 7 days. In addition, the rate of rectus femoris muscle recovery and clinical outcomes were lower in patients undergoing traction for longer periods of time. This indicates that it would be effective for increasing the rate of the recovery and minimizing the occurrence of post surgical complications if surgeons could perform surgery at the earliest possible opportunity following traction, within seven days after the onset of trauma. IV, retrospective cohort study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Intracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial.

PubMed

Dogramaci, Yunus; Kalaci, Aydiner; Emir, Anil; Yanat, Ahmet Nedim; Gökçe, Ahmet

2010-04-01

Plantar fasciitis (PF) is a common clinical condition that usually resolves with non-operative treatments. Extracorporeal shock wave therapy (ESWT) has been used in the treatment of chronic PF not responding to other conservative measures; however, ESWT devices are expensive and available for daily practice in only few centers (In developing countries). A pneumatic lithotripter is a cheap and readily available device which uses pneumatic shock application for the intracorporeal lithotripsy. The aim of this study was to investigate the clinical efficacy of intracorporeal pneumatic shock therapy (IPST) application for the treatment of chronic PF using a cheap and readily available pneumatic lithotripter. A randomized, double-blind, placebo-controlled study was conducted. A total of 50 patients with clinically and radiologically confirmed PF were randomly allocated to either an active- (treatment) (n = 25) or inactive (placebo) (n = 25) group. Under local anesthesia and posterior tibial nerve block, a rigid probe was directly introduced into the calcaneal spur under fluoroscopic control; a standard protocol of 1,000 shock was applied during a single session into the calcaneal spur. The main outcome measure was the patients' subjective assessment of pain by means of a Visual Analog Scale (VAS) and the Roles and Maudsley Score before the treatment and 6 months later. At the 6 months, the rate of successful outcomes (excellent + good results) in the treatment group (92%) were significantly higher comparing to the control group (24%) (P < 0.001). Heel pain measured 6 months after using the VAS were 2.04 +/- 1.67 in treatment group and 7.16 +/- 1.57 in control group as compared to 8.92 +/- 1.22 and 9.12 +/- 1.23 before the commencement of the treatment. No complications attributable to the procedure such as rupture of the planter fascia, hematoma, or infection were observed during the study. This pilot study showed that IPST is an effective and safe method of treatment of patients with chronic PF not responding to conservative measures. IPST application should be considered before surgical intervention when the extracorporeal shock devices are not available for daily practice. However, further evaluation of this novel treatment is necessary to understand the exact mechanism of action.

Properties of shoe insert materials related to shock wave transmission during gait.

PubMed

Forner, A; García, A C; Alcántara, E; Ramiro, J; Hoyos, J V; Vera, P

1995-12-01

The influence of the mechanical characteristics of certain insole materials in the generation and transmission of heel strike impacts while walking was studied. Three insole materials were selected according to their mechanical characteristics under heel strike impacts. The selection of materials has made it possible to distinguish the effect of rigidity and loss tangent in the transmission of heel strike impacts. A lower rigidity and a high loss tangent have been shown to reduce the transmission of impacts to the tibia. A low rigidity was seen to significantly increase the transmission of impacts from tibia to forehead.

A Comparison of 2 Current-Issue Army Boots, 5 Prototype Military Boots, and 5 Commercial Hiking Boots: Performance, Efficiency, Biomechanics, Comfort and Injury

DTIC Science & Technology

1999-11-01

Maximum force (N) on the ankle, knee and hip while walking at 3.5 mph 51 23. Maximum heel- strike force (N) while walking at 3.5 mph ^.ർ 24...to first force peak while running at 6.5 mph ’.""."..62 34. Variables relating to force low point between the heel- strike and push-off peak...was lower peak deceleration and lower peak pressure at the heel than at the forefoot . In the second phase of their research, Hamill and Bensel (7, 8

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

PubMed

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

2010-01-01

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

A combined treatment approach emphasizing impairment-based manual physical therapy for plantar heel pain: a case series.

PubMed

Young, Brian; Walker, Michael J; Strunce, Joseph; Boyles, Robert

2004-11-01

Case series. To describe an impairment-based physical therapy treatment approach for 4 patients with plantar heel pain. There is limited evidence from clinical trials on which to base treatment decision making for plantar heel pain. Four patients completed a course of physical therapy based on an impairment-based model. All patients received manual physical therapy and stretching. Two patients were also treated with custom orthoses, and 1 patient received an additional strengthening program. Outcome measures included a numeric pain rating scale (NPRS) and self-reported functional status. Symptom duration ranged from 6 to 52 weeks (mean duration+/-SD, 33+/-19 weeks). Treatment duration ranged from 8 to 49 days (mean duration+/-SD, 23+/-18 days), with number of treatment sessions ranging from 2 to 7 (mode, 3). All 4 patients reported a decrease in NPRS scores from an average (+/-SD) of 5.8+/-2.2 to 0 (out of 10) during previously painful activities. Additionally, all patients returned to prior activity levels. In this case series, patients with plantar heel pain treated with an impairment-based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and full return to activities. Further research is necessary to determine the effectiveness of impairment-based physical therapy interventions for patients with plantar heel pain/plantar fasciitis.

Does Heel Height Cause Imbalance during Sit-to-Stand Task: Surface EMG Perspective

PubMed Central

Naik, Ganesh R.; Al-Ani, Ahmed; Gobbo, Massimiliano; Nguyen, Hung T.

2017-01-01

The purpose of this study was to determine whether electromyography (EMG) muscle activities around the knee differ during sit-to-stand (STS) and returning task for females wearing shoes with different heel heights. Sixteen healthy young women (age = 25.2 ± 3.9 years, body mass index = 20.8 ± 2.7 kg/m2) participated in this study. Electromyography signals were recorded from the two muscles, vastus medialis (VM) and vastus lateralis (VL) that involve in the extension of knee. The participants wore shoes with five different heights, including 4, 6, 8, 10, and 12 cm. Surface electromyography (sEMG) data were acquired during STS and stand-to-sit-returning (STSR) tasks. The data was filtered using a fourth order Butterworth (band pass) filter of 20–450 Hz frequency range. For each heel height, we extracted median frequency (MDF) and root mean square (RMS) features to measure sEMG activities between VM and VL muscles. The experimental results (based on MDF and RMS-values) indicated that there is imbalance between vasti muscles for more elevated heels. The results are also quantified with statistical measures. The study findings suggest that there would be an increased likelihood of knee imbalance and fatigue with regular usage of high heel shoes (HHS) in women. PMID:28894422

Rare nodular malignant melanoma of the heel in the Caribbean: A case report.

PubMed

Warner, Wayne A; Sookdeo, Vandana Devika; Umakanthan, Srikanth; Sarran, Kevin; Pran, Lemuel; Fortuné, Maurice; Greaves, Wesley; Narinesingh, Sharda; Harnanan, Dave; Maharaj, Ravi

2017-01-01

Malignant melanoma of the heel is a rare melanoma subtype with incidence rates that reflect the complex relationship between sun exposure at certain geographic locations, individual melanin levels and overall melanoma risk. It is oftentimes characterized by poor prognosis because of delays in presentation resulting in longitudinal tumor invasion, lymph node involvement and metastasis. A 59-year-old woman was admitted to the Eric Williams Medical Sciences Complex, Trinidad and Tobago with a 5mm pruritic lesion on her left heel. At presentation, the lesion was asymmetric with border irregularities, color heterogeneity, with dynamics in elevation and overall size. She was subsequently diagnosed with malignant melanoma with left inguinal lymphadenopathy. A single stage wide local excision (WLE) of the left heel lesion with a split-thickness skin graft (STSG) and a left inguinal lymphadenectomy were performed. Dacarbazine (Bayer) was administered post operatively. Globally, the incidence of malignant melanoma is rapidly increasing, particularly, in countries like Trinidad and Tobago with a significant population of non-fair skinned individuals. There is need for strategic initiatives to increase patient adherence in these populations. The rarity of malignant heel melanomas heightens the need for increased patient awareness and greater clinical surveillance to ensure early diagnosis and treatment. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Osseous spurs at the fovea capitis femoris-a frequent finding in asymptomatic volunteers.

PubMed

Bensler, Susanne; Agten, Christoph A; Pfirrmann, Christian W A; Sutter, Reto

2018-01-01

To investigate the different morphologic types of the fovea capitis femoris and the spectrum of osseous spurs/osteophytes of the fovea in asymptomatic volunteers and patients with hip osteoarthritis. Sixty-five patients (mean age 63.6 years) with radiographically confirmed osteoarthritis of the hip and 59 asymptomatic healthy volunteers (mean age 33.9 years) underwent non-contrast MRI of the hip joint. Two radiologists independently evaluated all images. Fovea morphology (standard type, diamond type, flat type, triangular type) as well as the frequency, size and location of spurs/osteophytes of the fovea were assessed. Descriptive and inferential statistics were applied. The most frequent morphologic type of the fovea capitis femoris was the standard type for both asymptomatic volunteers (average 45%) and patients (average 49%). Osseous spurs were detected in 70% of the asymptomatic volunteers, and 97% of the patients had osteophytes. Spur size at all locations was significantly smaller in asymptomatic volunteers (range 1-2 mm) than osteophyte size in patients (range 1-4 mm) (p ≤ 0.035). In volunteers and patients, the spurs/osteophytes were most frequently located at the anterior border of the fovea capitis femoris. Smaller osseous spurs (<2 mm) at the border of the fovea capitis femoris are very common in asymptomatic volunteers and do not seem to be pathologic.

75 FR 72964 - Determinations of Attainment by the Applicable Attainment Date for the Hayden, Nogales, Paul Spur...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-29

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [R09-OAR-2010-0718; FRL-9233-1] Determinations of Attainment by the Applicable Attainment Date for the Hayden, Nogales, Paul Spur/Douglas PM10 Nonattainment... November 2, 2010 (75 FR 67220), direct final rule determining that the Hayden, Nogales, and Paul Spur...

Phenotype profiling and multivariate statistical analysis of Spur-pruning type Grapevine in National Clonal Germplasm Repository (NCGR, Davis)

USDA-ARS?s Scientific Manuscript database

Most Korean vineyards employed spur-pruning type modified-T trellis system. This produce system is suitable to spur-pruning type cultivars. But most European table grape is not adaptable to this produce system because their fruitfulness is sufficient to cane-pruning type system. Total 20 of fruit ch...

Error associated with a reduced order linear model of a spur gear pair

NASA Technical Reports Server (NTRS)

Kahraman, A.; Singh, R.

1991-01-01

The paper proposes a reduced-order analytical model of a spur gear pair which consists of two identical spur gears, two identical flexible shafts, and four identical rolling element bearings of a given radial stiffness. The error associated with the undamped eigensolution is estimated by a comparison with a benchmark finite element model.

46 CFR 153.235 - Exceptions to cargo piping location restrictions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... any heel or trim resulting from the damage specified in § 172.135 of this chapter; and (b) Enters the cargo tank above the liquid level for a full tank in any condition of heel or trim resulting from the...

46 CFR 28.515 - Submergence test as an alternative to stability calculations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... float in calm water after being submerged for 18 hours so that— (1) The vessel has an equilibrium heel... in paragraph (c) of this section, except that the equilibrium heel angle must not exceed 30° and the...

46 CFR 153.235 - Exceptions to cargo piping location restrictions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... any heel or trim resulting from the damage specified in § 172.135 of this chapter; and (b) Enters the cargo tank above the liquid level for a full tank in any condition of heel or trim resulting from the...

Experimental Investigation of Shrouding on Meshed Spur Gear Windage Power Loss

NASA Technical Reports Server (NTRS)

Delgado, Irebert R.; Hurrell, Michael J.

2017-01-01

Windage power loss in high-speed gearboxes results in efficiency losses and increased heating due to drag on the gear teeth. Test results for meshed spur gear windage power loss are presented at ambient oil inlet temperatures, both with and without shrouding. The rate of windage power loss is observed to increase above a gear surface speed of 10,000 feet per minute (51 meters per second), similar to results presented in the literature. Shrouding is observed to become more effective above 15,000 feet per minute (76 meters per second), decreasing power loss by 10 percent at 25,000 feet per minute (127 meters per second). The need for gearbox oil drain slots limits the effectiveness of shrouding in reducing windage power loss. Windage power loss is observed to decrease with increasing gearbox temperatures and to increase with oil flow. Windage power losses for unshrouded meshed spur gears are 7 times greater than losses determined from unshrouded single spur gear tests. A 6- to 12-times increase in windage power loss is observed in the shrouded meshed spur gear data compared with shrouded single spur gear data. Based on this preliminary study, additional research is suggested to determine the effect of oil drain slot configurations, axial and radial shroud clearances, and higher gear surface speeds on windage power loss. Additional work is also suggested to determine the sensitivity of windage power loss to oil temperature and oil flow. Windage power loss for meshed spur gears tested in both the shrouded and unshrouded configurations is shown to be more than double versus windage power loss for the same spur gears run individually in the same shroud configurations. Further study of the physical processes behind these results is needed to optimize gearbox shrouds for minimum windage power loss.

Experimental Investigation of Shrouding on Meshed Spur Gear Windage Power Loss

NASA Technical Reports Server (NTRS)

Delgado, Irebert; Hurrell, Michael

2017-01-01

Windage power loss in high-speed gearboxes result in efficiency losses and increased heating due to drag on the gear teeth. Meshed spur gear windage power loss test results are presented at ambient oil inlet temperatures both with and without shrouding. The rate of windage power loss is observed to increase above 10,000 ft.min., gear surface speed, similar to results presented in the literature. Shrouding is observed to become more effective above 15,000 ft.min., decreasing power loss by 10 at 25,000 ft.min. The need for gearbox oil drain slots limits the effectiveness of shrouding on reducing windage power loss. Also, windage power loss is observed to decrease with increasing gearbox temperatures and to increase with oil flow. Windage power losses for the unshrouded meshed spur gears are 7x more than losses determined from unshrouded single spur gear tests. A 6x to 12x increase in windage power is observed comparing shrouded single spur gear data with shrouded meshed spur gear data. Based on this preliminary study additional research is suggested to determine the effect of oil drain slot configurations, axial and radial shroud clearances, and higher gear surface speeds on windage power loss. Additional work is also suggested to determine the sensitivity of windage power loss to oil temperature and oil flow. Windage power loss of meshed spur gears tested in both the shrouded and unshrouded configurations is shown to be more than double versus the same spur gears run individually in the same shroud configurations. Further study of the physical processes behind these results is needed for optimizing gearbox shrouds for minimum windage power loss.

Effects of Arnica comp.-Heel® on reducing cardiovascular events in patients with stable coronary disease.

PubMed

Fioranelli, Massimo; Bianchi, Maria; Roccia, Maria G; Di Nardo, Veronica

2016-02-01

The purpose of the study was to evaluate the effectiveness of the treatment with one tablet a day of a low dose multicomponent medication (Arnica comp.-Heel® tablets) with anti-inflammatory properties in order to reduce the risk of cardiovascular events in patients with clinically stable coronary disease. The presence of inflammatory cells in atherosclerotic plaques of patients with stable coronary disease indicates the possibility to act by inhibiting the inflammatory phenomenon with Arnica comp.-Heel® tablets reducing the risk of instability of the plaque and, consequently, improving the clinical outcome in patients with stable coronary disease. Within this retrospective observational spontaneous clinical study 44 patients (31 males and 13 females) all presenting stable coronary artery disease were evaluated; 25 subjects were treated with only acetylsalicylic acid and/or clopidogrel in association with statins (standard therapeutic protocol) while for the other 18 subjects the standard therapeutic protocol was integrated with Arnica comp.-Heel® (one sublingual tablet/day). The primary outcome was to evaluate the incidence of acute coronary syndrome, out-of-hospital cardiac arrest, or non-cardioembolic ischemic stroke. The evaluation of the primary outcome showed that in the group of patients (18) who received the standard therapeutic protocol plus Arnica comp.-Heel® only one cardiovascular event was registered (5.6%) while in the group treated only with standard therapy 4 events were recorded in 25 patients (16%). The treatment with Arnica comp.-Heel® (one tablet/day) in combination with standard therapies for secondary prevention is effective in reducing the incidence of cardiovascular events in patients with stable coronary artery disease.

Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial.

PubMed

Santamaria, N; Gerdtz, M; Liu, W; Rakis, S; Sage, S; Ng, A W; Tudor, H; McCann, J; Vassiliou, T; Morrow, F; Smith, K; Knott, J; Liew, D

2015-08-01

Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.

Effects of altering heel wedge properties on gait with the Intrepid Dynamic Exoskeletal Orthosis.

PubMed

Ikeda, Andrea J; Fergason, John R; Wilken, Jason M

2018-06-01

The Intrepid Dynamic Exoskeletal Orthosis is a custom-made dynamic response carbon fiber device. A heel wedge, which sits in the shoe, is an integral part of the orthosis-heel wedge-shoe system. Because the device restricts ankle movement, the system must compensate to simulate plantarflexion and allow smooth forward progression during gait. To determine the influence of wedge height and durometer on the walking gait of individuals using the Intrepid Dynamic Exoskeletal Orthosis. Repeated measures. Twelve individuals walked over level ground with their Intrepid Dynamic Exoskeletal Orthosis and six different heel wedges of soft or firm durometer and 1, 2, or 3 cm height. Center of pressure velocity, joint moments, and roll-over shape were calculated for each wedge. Height and durometer significantly affected time to peak center of pressure velocity, time to peak internal dorsiflexion and knee extension moments, time to ankle moment zero crossing, and roll-over shape center of curvature anterior-posterior position. Wedge height had a significant influence on peak center of pressure velocity, peak dorsiflexion moment, time to peak knee extension moment, and roll-over shape radius and vertical center of curvature. Changes in wedge height and durometer systematically affected foot loading. Participants preferred wedges which produced ankle moment zero crossing timing, peak internal knee extension moment timing, and roll-over shape center of curvature anterior-posterior position close to that of able-bodied individuals. Clinical relevance Adjusting the heel wedge is a simple, straightforward way to adjust the orthosis-heel wedge-shoe system. Changing wedge height and durometer significantly alters loading of the foot and has great potential to improve an individual's gait.

Pain Threshold Tests in Patients With Heel Pain Syndrome.

PubMed

Saban, Bernice; Masharawi, Youssef

2016-07-01

Pressure pain threshold (PPT) is a useful tool for evaluating mechanical sensitivity in patients suffering from various musculoskeletal disorders. However, no previous study has investigated PPT in the heel of patients experiencing plantar heel pain syndrome (PHPS). The aim of this study was to compare PPT levels and topographic presentation of sensitivity in the heel of patients with PHPS and in healthy controls. The reliability of PPT testing in patients with PHPS was assessed for intra- and interrater recordings. The PPT levels of 40 feet in each group were then assessed on 5 predetermined sites in the heel using a standardized measurement protocol. Patient functional status (FS) as measured by the Foot & Ankle Computerized Adaptive Test was employed as an external reference. Multivariate analysis of covariance revealed no group differences for PPTs at all sites (P = .406). Age (P = .099) or BMI (P = .510) did not affect PPT values, although there was an effect on gender (P = .006). The analysis revealed significant differences between sites (P < .001) demonstrating a diverse topographic distribution. In the PHPS group, PPT levels at the anterior/medial, posterior/medial and central sites were significantly lower than at the posterior/lateral and anterior/lateral sites (P < .05). For the control group, PPT levels at the anterior/medial site were significantly lower than all other sites (P < .001). No significant differences were found between PPT of the PHPS patients and controls, therefore, PPT cannot be recommended as an assessment tool for these patients. The topographic distribution indicated low PPT levels at the anterior/medial area of the heel in patients with PHPS and controls. Level II, comparative study. © The Author(s) 2016.

Effects of high-heeled footwear on static and dynamic pelvis position and lumbar lordosis in experienced younger and middle-aged women.

PubMed

Schroeder, Jan; Hollander, Karsten

2018-01-01

There is still conflicting evidence about the effect of high-heeled footwear on posture, especially if methodological confounders are taken into account. The purpose of this study was to investigate the effect of high-heeled footwear on lumbopelvic parameters in experienced younger and middle-aged women while standing and walking. Thirty-seven experienced younger (n=19:18-25 years) and middle-aged (n=18:26-56 years) women were included in this randomized crossover study. Using a non-invasive back shape reconstruction device (rasterstereography), static (pelvic tilt and lumbar lordosis angle) and dynamic (pelvic rotation, median lumbar lordosis angle and range of motion) parameters representing pelvis position and lumbar curvature were measured. In order to analyse standing and walking on a treadmill (0.83m/s), the effects of high-heels (7-11cm) were compared to standard control shoes. There were no effects on the lumbar lordosis angle or range of motion under static or dynamic conditions (p>0.05, d≤0.06). But there was a small effect for a reduced pelvic tilt (p=0.003, d=0.24) and a moderate effect for an increased transversal pelvic rotation (p=0.001, d=0.63) due to high heel shoed standing or walking, respectively. There were no significant age-group or interaction effects (p>0.05). Altered pelvic parameters may be interpreted as compensatory adaptations to high-heeled footwear rather than lumbar lordosis adaptations in experienced wearers. The impact of these findings on back complaints should be revisited carefully, because muscular overuse as well as postural load relieving may contribute to chronic consequences. Further research is necessary to examine clinically relevant outcomes corresponding to postural alterations. Copyright © 2017 Elsevier B.V. All rights reserved.

The Shank-to-Vertical-Angle as a parameter to evaluate tuning of Ankle-Foot Orthoses.

PubMed

Kerkum, Yvette L; Houdijk, Han; Brehm, Merel-Anne; Buizer, Annemieke I; Kessels, Manon L C; Sterk, Arjan; van den Noort, Josien C; Harlaar, Jaap

2015-09-01

The effectiveness of an Ankle-Foot Orthosis footwear combination (AFO-FC) may be partly dependent on the alignment of the ground reaction force with respect to lower limb joint rotation centers, reflected by joint angles and moments. Adjusting (i.e. tuning) the AFO-FC's properties could affect this alignment, which may be guided by monitoring the Shank-to-Vertical-Angle. This study aimed to investigate whether the Shank-to-Vertical-Angle during walking responds to variations in heel height and footplate stiffness, and if this would reflect changes in joint angles and net moments in healthy adults. Ten subjects walked on an instrumented treadmill and performed six trials while walking with bilateral rigid Ankle-Foot Orthoses. The AFO-FC heel height was increased, aiming to impose a Shank-to-Vertical-Angle of 5°, 11° and 20°, and combined with a flexible or stiff footplate. For each trial, the Shank-to-Vertical-Angle, joint flexion-extension angles and net joint moments of the right leg at midstance were averaged over 25 gait cycles. The Shank-to-Vertical-Angle significantly increased with increasing heel height (p<0.001), resulting in an increase in knee flexion angle and internal knee extensor moment (p<0.001). The stiff footplate reduced the effect of heel height on the internal knee extensor moment (p=0.030), while the internal ankle plantar flexion moment increased (p=0.035). Effects of heel height and footplate stiffness on the hip joint were limited. Our results support the potential to use the Shank-to-Vertical-Angle as a parameter to evaluate AFO-FC tuning, as it is responsive to changes in heel height and reflects concomitant changes in the lower limb angles and moments. Copyright © 2015 Elsevier B.V. All rights reserved.

Displaceable Spur Gear Torque Controlled Driver and Method

NASA Technical Reports Server (NTRS)

Cook, Joseph S., Jr. (Inventor)

1996-01-01

Methods and apparatus are provided for a torque driver including a laterally displaceable gear support member to carry an output spur gear. A biasing assembly biases the output spur gear into engagement with a pinion to which is applied an input torque greater than a desired output torque limit for a threaded fastener such as a nut or screw. A coiled output linkage connects the output spur gear with a fastener adaptor which may be a socket for a nut. A gear tooth profile provides a separation force that overcomes the bias to limit torque at the desired torque limit. Multiple fasteners may be rotated simultaneously to a desired torque limit if additional output spur gears are provided. A gauged selector mechanism is provided to laterally displace multiple driven members for fasteners arranged in differing configurations. The torque limit is selectably adjustable and may be different for fasteners within the same fastener configuration.

Displaceable spur gear torque controlled driver and method

NASA Technical Reports Server (NTRS)

Cook, Joseph S., Jr. (Inventor)

1994-01-01

Methods and apparatus are provided for a torque driver including a laterally displaceable gear support member to carry an output spur gear. A biasing assembly biases the output spur gear into engagement with a pinion to which is applied an input torque greater than a desired output torque limit for a threaded fastener such as a nut or screw. A coiled output linkage connects the output spur gear with a fastener adaptor which may be a socket for a nut. A gear tooth profile provides a separation force that overcomes the bias to limit torque at the desired torque limit. Multiple fasteners may be rotated simultaneously to a desired torque limit if additional output spur gears are provided. A gauged selector mechanism is provided to laterally displace multiple driver members for fasteners arranged in differing configurations. The torque limit is selectably adjustable and may be different for fasteners within the same fastener configuration.

46 CFR 171.050 - Passenger heel requirements for a mechanically propelled or a non-self propelled vessel.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (metric) tons of persons other than required crew, including personal effects of those persons expected to be carried on the vessel. T = 14 degrees or the angle of heel at which the deck edge is first...

46 CFR 171.050 - Passenger heel requirements for a mechanically propelled or a non-self propelled vessel.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (metric) tons of persons other than required crew, including personal effects of those persons expected to be carried on the vessel. T = 14 degrees or the angle of heel at which the deck edge is first...

46 CFR 171.050 - Passenger heel requirements for a mechanically propelled or a non-self propelled vessel.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (metric) tons of persons other than required crew, including personal effects of those persons expected to be carried on the vessel. T = 14 degrees or the angle of heel at which the deck edge is first...

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2014-06-01

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

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

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

Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? A descriptive and explorative study.

PubMed

Muntlin Athlin, Åsa; Engström, Maria; Gunningberg, Lena; Bååth, Carina

2016-11-14

Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden. A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47-64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay. In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain. ISRCTN85296908 .

Armament Imbalances: Match and Mismatch in Plant-Pollinator Traits of Highly Specialized Long-Spurred Orchids

PubMed Central

Moré, Marcela; Amorim, Felipe W.; Benitez-Vieyra, Santiago; Medina, A. Martin; Sazima, Marlies; Cocucci, Andrea A.

2012-01-01

Background Some species of long-spurred orchids achieve pollination by a close association with long-tongued hawkmoths. Among them, several Habenaria species present specialized mechanisms, where pollination success depends on the attachment of pollinaria onto the heads of hawkmoths with very long proboscises. However, in the Neotropical region such moths are less abundant than their shorter-tongued relatives and are also prone to population fluctuations. Both factors may give rise to differences in pollinator-mediated selection on floral traits through time and space. Methodology/Principal Findings We characterized hawkmoth assemblages and estimated phenotypic selection gradients on orchid spur lengths in populations of three South American Habenaria species. We examined the match between hawkmoth proboscis and flower spur lengths to determine whether pollinators may act as selective agents on flower morphology. We found significant directional selection on spur length only in Habenaria gourlieana, where most pollinators had proboscises longer than the mean of orchid spur length. Conclusions/Significance Phenotypic selection is dependent on the mutual match between pollinator and flower morphologies. However, our findings indicate that pollinator-mediated selection may vary through time and space according to local variations in pollinator assemblages. PMID:22848645

Conservative management of pes valgus with plantar flexed talus, flexible.

PubMed

Bleck, E E; Berzins, U J

1977-01-01

The type of flat foot that we have called pes valgus with plantar flexed talus, flexible, was treated in children with the Helfet heel seat or the UCBL shoe insert. In follow-up examination of 71 cases for periods longer than one year, 79 per cent of the patients showed that the UCBL shoe insert and the Helfet heel seat improved the clinical and roentgenographic appearance of the foot. The Helfet heel seat is recommended in cases where the plantar flexion angle of the talus is 35 to 45 degrees and the UCBL shoe insert in those cases of plantar flexion of the talus greater than 45 degrees.

Kangaroo care and behavioral and physiologic pain responses in very-low-birth-weight twins: a case study.

PubMed

Cong, Xiaomei; Cusson, Regina M; Hussain, Naveed; Zhang, Di; Kelly, Sharon P

2012-09-01

The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition. Infant B had an incident of apnea and tachycardia by the end of the heel stick and a bradycardia episode during recovery in the IC condition. The twins had lower LF/HF ratios (better autonomic nervous system balance) during recovery in both longer and shorter KC conditions compared with the IC condition. Infant B had difficulty returning to LF/HF ratio baseline level after the painful procedure in the IC condition. These data suggest that both longer and shorter KC before and throughout painful procedures can be helpful in reducing behavioral and physiologic pain responses in preterm infants. Copyright © 2012 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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. Copyright © 2016 Elsevier B.V. All rights reserved.

Relationship between lower limb dynamics and knee joint pain.

PubMed

Radin, E L; Yang, K H; Riegger, C; Kish, V L; O'Connor, J J

1991-05-01

To test the hypothesis that appropriate and timely neuromuscular control of limb motions plays an important role in the preservation of joint health, we kinematically and kinetically examined the behavior of the legs of young adult subjects at heel strike during natural walking. We compared a group of 18 volunteers, who, we presumed, were preosteoarthrotic because of mild, intermittent, activity-related knee joint pain, with 14 age-matched asymptomatic normal subjects. The two groups of subjects exhibited similar gait patterns with equivalent cadences, walking speeds, terminal stance phase knee flexion, maximum (peak) swing angular velocity, and overall shape of the vertical ground reaction. However, our instrumentation detected statistically significant differences between the two groups within a few milliseconds of heel strike. In the knee pain group, the heel hit the floor with a stronger impact in this brief interval. Just before heel strike, there was a faster downward velocity of the ankle with a larger angular velocity of the shank. The follow-through of the leg immediately after heel strike was more violent with larger peak axial and angular accelerations of the leg echoed by a more rapid rise of the ground reaction force. This sequence of events represents repetitive impulsive loading, which consistently provoked osteoarthrosis in animal experiments. We refer to this micro-incoordination of neuromuscular control not visible to the naked eye as "microklutziness."

The role of beaded activated carbon's surface oxygen groups on irreversible adsorption of organic vapors.

PubMed

Jahandar Lashaki, Masoud; Atkinson, John D; Hashisho, Zaher; Phillips, John H; Anderson, James E; Nichols, Mark

2016-11-05

The objective of this study is to determine the contribution of surface oxygen groups to irreversible adsorption (aka heel formation) during cyclic adsorption/regeneration of organic vapors commonly found in industrial systems, including vehicle-painting operations. For this purpose, three chemically modified activated carbon samples, including two oxygen-deficient (hydrogen-treated and heat-treated) and one oxygen-rich sample (nitric acid-treated) were prepared. The samples were tested for 5 adsorption/regeneration cycles using a mixture of nine organic compounds. For the different samples, mass balance cumulative heel was 14 and 20% higher for oxygen functionalized and hydrogen-treated samples, respectively, relative to heat-treated sample. Thermal analysis results showed heel formation due to physisorption for the oxygen-deficient samples, and weakened physisorption combined with chemisorption for the oxygen-rich sample. Chemisorption was attributed to consumption of surface oxygen groups by adsorbed species, resulting in formation of high boiling point oxidation byproducts or bonding between the adsorbates and the surface groups. Pore size distributions indicated that different pore sizes contributed to heel formation - narrow micropores (<7Å) in the oxygen-deficient samples and midsize micropores (7-12Å) in the oxygen-rich sample. The results from this study help explain the heel formation mechanism and how it relates to chemically tailored adsorbent materials. Copyright © 2016 Elsevier B.V. All rights reserved.

A Comparison of Two Designs of Postoperative Shoe on Function, Satisfaction, and Back Pain After Hallux Valgus Surgery.

PubMed

Patel, Shelain; Garg, Parag; Fazal, M Ali; Shahid, Muhammad S; Park, Derek H; Ray, Pinak S

2018-06-01

The reverse camber shoe is commonly used after hallux valgus corrective surgery to offload the forefoot but is associated with back pain and poor compliance. Recent designs of postoperative shoes may obviate the need for a reverse camber. The purpose of this study was to compare the effects of a reverse camber shoe and a noncambered shoe with transitional rigidity after hallux valgus correction. A cohort of 80 feet was prospectively studied undergoing surgery at a single NHS trust. The first 40 feet received the reverse cambered Jura Medical Off-loader Heel shoe and the subsequent 40 feet received the noncambered DonJoy Podalux shoe. No demographic differences existed between the groups and data were collected at 2 weeks, 6 weeks, and 6 months. The Manchester-Oxford Foot Questionnaire (MOXFQ), a 5-question survey and dichotomous question about back pain was used to assess clinical outcome and radiographs were reviewed by 2 orthopaedic surgeons to monitor for loss of correction. Both groups experienced comparable improvements in MOXFQ and shoe satisfaction from 2 weeks compared with 6 weeks. Six patients experienced back pain in the reverse cambered shoe group and none in the noncambered shoe group. Five patients stopped using the reverse cambered shoe during the first 6 weeks after surgery and none stopped using their prescribed noncambered shoe. No loss of corrections were observed in either group. Both shoe designs gave equal foot specific functional and radiological outcomes, but the noncambered shoe with transitional rigidity was associated with less back pain and better compliance. Level II: Prospective comparative study.

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

Salinity Processes in the Upper Ocean Regional Study (SPURS)

NASA Image and Video Library

2012-09-04

Woods Hole Oceanographic Institution Senior Engineer Steve Faluotico works on the SPURS buoy prior to it being loaded onto the Institute's research vessel Knorr, Tuesday, Sept. 4, 2012, in Woods Hole, Mass. The SPURS buoy will be deployed in the Atlantic Ocean as part of the Salinity Processes in the Upper Ocean Regional Study (SPURS) which is set to sail on Sept. 6. The NASA-sponsored expedition will sail to the North Atlantic's saltiest spot to get a detailed, 3-D picture of how salt content fluctuates in the ocean's upper layers and how these variations are related to shifts in rainfall patterns around the planet. Photo Credit: (NASA/Bill Ingalls)

Design of Spur Gears for Improved Efficiency

NASA Technical Reports Server (NTRS)

Anderson, N. E.; Loewenthal, S. H.

1981-01-01

A method to calculate spur gear system loss for a wide range of gear geometries and operating conditions was used to determine design requirements for an efficient gearset. The effects of spur gear size, pitch, ratio, pitch line velocity and load on efficiency were determined. Peak efficiencies were found to be greater for large diameter and fine pitched gears and tare (no-load) losses were found to be significant.

Comparative floral spur anatomy and nectar secretion in four representatives of Ranunculaceae.

PubMed

Antoń, Sebastian; Kamińska, Magdalena

2015-11-01

Nectaries are common in Ranunculaceae. These secretory structures, however, have not been studied in detail despite their importance in plant-animal interactions, and data relating to the structure of nectary spurs, which are so characteristic of several genera of this family, remain scarce. In order to redress this imbalance, we sought, in the present paper, to analyze the anatomical and ultrastructural organization of the nectary spurs of four representatives of Ranunculaceae, i.e., Aconitum lycoctonum L., Aquilegia vulgaris L., Consolida regalis Gray, and Delphinium elatum L. Nectary spurs were examined using light, fluorescence, scanning electron, and transmission electron microscopy. The floral nectaries of A. lycoctonum and A. vulgaris are situated at the apices of the spurs, whereas in C. regalis and D. elatum, the nectary is located along the floor surface of the spurs. Nectar in C. regalis and D. elatum is exuded through micro-channels in the cuticle, whereas in A. lycoctonum and A. vulgaris, it is released by means of cell wall disruption, indicating that the method of nectar secretion here is holocrine. Structurally, the nectary of all four investigated species is quite similar, and its cells are typical of nectar-producing cells described in the literature. It is proposed that in A. lycoctonum and A. vulgaris, disruption of the cell wall and the release of the entire cell contents into the spur cavity contribute to the composition of the nectar that the latter contains, enriching it with cytoplasmic components. We conclude that the manner of nectar exudation may vary considerably between closely related plant species, regardless of their geographical origin and phylogeny.

The Effectiveness of Shrouding on Reducing Meshed Spur Gear Power Loss - Test Results

NASA Technical Reports Server (NTRS)

Delgado, I. R.; Hurrell, M. J.

2017-01-01

Gearbox efficiency is reduced at high rotational speeds due to windage drag and viscous effects on rotating, meshed gear components. A goal of NASA aeronautics rotorcraft research is aimed at propulsion technologies that improve efficiency while minimizing vehicle weight. Specifically, reducing power losses to rotorcraft gearboxes would allow gains in areas such as vehicle payload, range, mission type, and fuel consumption. To that end, a gear windage rig has been commissioned at NASA Glenn Research Center to measure windage drag on gears and to test methodologies to mitigate windage power losses. One method used in rotorcraft gearbox design attempts to reduce gear windage power loss by utilizing close clearance walls to enclose the gears in both the axial and radial directions. The close clearance shrouds result in reduced drag on the gear teeth, and reduced power loss. For meshed spur gears, the shrouding takes the form of metal side plates and circumferential metal sectors. Variably positioned axial and radial shrouds are incorporated in the NASA rig to study the effect of shroud clearance on gearbox power loss. A number of researchers have given experimental and analytical results for single spur gears, with and without shrouding. Shrouded meshed spur gear test results are sparse in the literature. Windage tests were run at NASA Glenn using meshed spur gears at four shroud configurations: unshrouded, shrouded (max. axial, max radial), and two intermediate shrouding conditions. Results are compared to available meshed spur gear power loss data analyses as well as single spur gear data/analyses. Recommendations are made for future work.

The Effectiveness of Shrouding on Reducing Meshed Spur Gear Power Loss Test Results

NASA Technical Reports Server (NTRS)

Delgado, I. R.; Hurrell, M. J.

2017-01-01

Gearbox efficiency is reduced at high rotational speeds due to windage drag and viscous effects on rotating, meshed gear components. A goal of NASA aeronautics rotorcraft research is aimed at propulsion technologies that improve efficiency while minimizing vehicle weight. Specifically, reducing power losses to rotorcraft gearboxes would allow gains in areas such as vehicle payload, range, mission type, and fuel consumption. To that end, a gear windage rig has been commissioned at NASA Glenn Research Center to measure windage drag on gears and to test methodologies to mitigate windage power losses. One method used in rotorcraft gearbox design attempts to reduce gear windage power loss by utilizing close clearance walls to enclose the gears in both the axial and radial directions. The close clearance shrouds result in reduced drag on the gear teeth and reduced power loss. For meshed spur gears, the shrouding takes the form of metal side plates and circumferential metal sectors. Variably positioned axial and radial shrouds are incorporated in the NASA rig to study the effect of shroud clearance on gearbox power loss. A number of researchers have given experimental and analytical results for single spur gears, with and without shrouding. Shrouded meshed spur gear test results are sparse in the literature. Windage tests were run at NASA Glenn using meshed spur gears at four shroud configurations: unshrouded, shrouded (max. axial, max. radial), and two intermediate shrouding conditions. Results are compared to available meshed spur gear power loss data analyses as well as single spur gear data analyses.

Quantitative morphology of a fringing reef tract from high-resolution laser bathymetry: Southern Molokai, Hawaii

USGS Publications Warehouse

Storlazzi, C.D.; Logan, J.B.; Field, M.E.

2003-01-01

High-resolution Scanning Hydrographic Operational Airborne Lidar Survey (SHOALS) laser-determined bathymetric data were used to define the morphology of spur-and-groove structures on the fringing reef off the south coast of Molokai, Hawaii. These data provide a basis for mapping and analyzing morphology of the reef with a level of precision and spatial coverage never before attained. An extensive fringing coral reef stretches along the central two-thirds of Molokai's south shore (???40 km); along the east and west ends there is only a thin veneer of living coral with no developed reef complex. In total, ???4800 measurements of spur-and-groove height and the distance between adjacent spur crests (wavelength) were obtained along four isobaths. Between the 5m and 15m isobaths, the mean spur height increased from 0.7 m to 1.6 m, whereas the mean wavelength increased from 71 m to 104 m. Reef flat width was found to exponentially decrease with increasing wave energy. Overall, mean spur-and-groove height and wavelength were shown to be inversely proportional to wave energy. In high-energy environments, spur-and-groove morphology remains relatively constant across all water depths. In low-energy environments, however, spur-and-groove structures display much greater variation; they are relatively small and narrow in shallow depths and develop into much larger and broader features in deeper water. Therefore, it appears that waves exert a primary control on both the small and large-scale morphology of the reef off south Molokai.

Comparative anatomy of the nectary spur in selected species of Aeridinae (Orchidaceae).

PubMed

Stpiczyńska, Małgorzata; Davies, Kevin L; Kamińska, Magdalena

2011-03-01

To date, the structure of the nectary spur of Aeridinae has not been studied in detail, and data relating to the nectaries of ornithophilous orchids remain scarce. The present paper compares the structural organization of the floral nectary in a range of Aeridinae species, including both entomophilous and ornithophilous taxa. Nectary spurs of Ascocentrum ampullaceum (Roxb.) Schltr. var. aurantiacum Pradhan, A. curvifolium (Lindl.) Schltr., A. garayi Christenson, Papilionanthe vandarum (Rchb.f.) Garay, Schoenorchis gemmata (Lindl.) J.J. Sm., Sedirea japonica (Rchb.f.) Garay & H.R. Sweet and Stereochilus dalatensis (Guillaumin) Garay were examined by means of light microscopy, scanning electron microscopy and transmission electron microscopy. The diverse anatomy of the nectary is described for a range of Aeridinae species. All species of Ascocentrum investigated displayed features characteristic of ornithophilous taxa. They have weakly zygomorphic, scentless, red or orange flowers, display diurnal anthesis, possess cryptic anther caps and produce nectar that is secluded in a relatively massive nectary spur. Unicellular, secretory hairs line the lumen at the middle part of the spur. Generally, however, with the exception of Papilionanthe vandarum, the nectary spurs of all entomophilous species studied here (Schoenorchis gemmata, Sedirea japonica, Stereochilus dalatensis) lack secretory trichomes. Moreover, collenchymatous secretory tissue, present only in the nectary spur of Asiatic Ascocentrum species, closely resembles that found in nectaries of certain Neotropical species that are hummingbird-pollinated and assigned to subtribes Maxillariinae Benth., Laeliinae Benth. and Oncidiinae Benth. This similarity in anatomical organization of the nectary, regardless of geographical distribution and phylogeny, indicates convergence.

Comparative anatomy of the nectary spur in selected species of Aeridinae (Orchidaceae)

PubMed Central

Stpiczyńska, Małgorzata; Davies, Kevin L.; Kamińska, Magdalena

2011-01-01

Background and Aims To date, the structure of the nectary spur of Aeridinae has not been studied in detail, and data relating to the nectaries of ornithophilous orchids remain scarce. The present paper compares the structural organization of the floral nectary in a range of Aeridinae species, including both entomophilous and ornithophilous taxa. Methods Nectary spurs of Ascocentrum ampullaceum (Roxb.) Schltr. var. aurantiacum Pradhan, A. curvifolium (Lindl.) Schltr., A. garayi Christenson, Papilionanthe vandarum (Rchb.f.) Garay, Schoenorchis gemmata (Lindl.) J.J. Sm., Sedirea japonica (Rchb.f.) Garay & H.R. Sweet and Stereochilus dalatensis (Guillaumin) Garay were examined by means of light microscopy, scanning electron microscopy and transmission electron microscopy. Key Results and Conclusions The diverse anatomy of the nectary is described for a range of Aeridinae species. All species of Ascocentrum investigated displayed features characteristic of ornithophilous taxa. They have weakly zygomorphic, scentless, red or orange flowers, display diurnal anthesis, possess cryptic anther caps and produce nectar that is secluded in a relatively massive nectary spur. Unicellular, secretory hairs line the lumen at the middle part of the spur. Generally, however, with the exception of Papilionanthe vandarum, the nectary spurs of all entomophilous species studied here (Schoenorchis gemmata, Sedirea japonica, Stereochilus dalatensis) lack secretory trichomes. Moreover, collenchymatous secretory tissue, present only in the nectary spur of Asiatic Ascocentrum species, closely resembles that found in nectaries of certain Neotropical species that are hummingbird-pollinated and assigned to subtribes Maxillariinae Benth., Laeliinae Benth. and Oncidiinae Benth. This similarity in anatomical organization of the nectary, regardless of geographical distribution and phylogeny, indicates convergence. PMID:21183455

Primary fusion in worker's compensation intraarticular calcaneus fracture. Prospective study of 169 consecutive cases.

PubMed

López-Oliva, Felipe; Sánchez-Lorente, Tomás; Fuentes-Sanz, Adela; Forriol, Francisco; Aldomar-Sanz, Yolanda

2012-12-01

To study the results of reconstruction and primary fusion in worker's compensation intraarticular calcaneus fractures. We carried out a prospective study of 169 acute intraarticular calcaneus fractures treated by reconstruction and primary fusion with the minimally invasive Vira® system, in severe calcaneus fractures. The evaluation was performed by clinical, radiological and biomechanical analysis. AOFAS score averaged 77.26 points at the end of follow up. Forty-two cases (24.9%) obtained excellent results, 108 (63.9%) good, 12 (7.1%) mild and 7 (4.1%) poor. The improvement in Börder's angle after surgery was significant (p = 0.05) and this did not vary during the follow up. Subtalar arthrodesis was achieved in all cases and only three cases needed bone grafting. Five major post-surgical complications were observed, and one deep infection in a case of open Gustilo Grade III fracture. In the kinetic study, the support time of the operated foot was lower than that of the contralateral foot (p<0.21). The axial force of the heel contact and the single limb support of the operated foot reduced the toe-off axial forces. In the foot with arthrodesis the posterior forces increased (p <0.01). The pressures were lower in the region of the heel and the mid-foot and in the external part of the forefoot, and increased in the big toe. Calcaneal workplace injuries are challenging to treat. Primary subtalar fusion with a minimally invasive method allows rapid recovery for these patients with a satisfactory clinical, functional and radiological outcome. Copyright © 2012 Elsevier Ltd. All rights reserved.

Partitioning of 13C-photosynthate from Spur Leaves during Fruit Growth of Three Japanese Pear (Pyrus pyrifolia) Cultivars Differing in Maturation Date

PubMed Central

ZHANG, CAIXI; TANABE, KENJI; TAMURA, FUMIO; ITAI, AKIHIRO; WANG, SHIPING

2005-01-01

• Background and Aims In fruit crops, fruit size at harvest is an important aspect of quality. With Japanese pears (Pyrus pyrifolia), later maturing cultivars usually have larger fruits than earlier maturing cultivars. It is considered that the supply of photosynthate during fruit development is a critical determinant of size. To assess the interaction of assimilate supply and early/late maturity of cultivars and its effect on final fruit size, the pattern of carbon assimilate partitioning from spur leaves (source) to fruit and other organs (sinks) during fruit growth was investigated using three genotypes differing in maturation date. • Methods Partitioning of photosynthate from spur leaves during fruit growth was investigated by exposure of spurs to 13CO2 and measurement of the change in 13C abundance in dry matter with time. Leaf number and leaf area per spur, fresh fruit weight, cell number and cell size of the mesocarp were measured and used to model the development of the spur leaf and fruit. • Key Results Compared with the earlier-maturing cultivars ‘Shinsui’ and ‘Kousui’, the larger-fruited, later-maturing cultivar ‘Shinsetsu’ had a greater total leaf area per spur, greater source strength (source weight × source specific activity), with more 13C assimilated per spur and allocated to fruit, smaller loss of 13C in respiration and export over the season, and longer duration of cell division and enlargement. Histology shows that cultivar differences in final fruit size were mainly attributable to the number of cells in the mesocarp. • Conclusions Assimilate availability during the period of cell division was crucial for early fruit growth and closely correlated with final fruit size. Early fruit growth of the earlier-maturing cultivars, but not the later-maturing ones, was severely restrained by assimilate supply rather than by sink limitation. PMID:15655106

A Case Report of Heel Pain Mimicking Plantar Fasciitis and Osteosarcoma: A Unique Presentation of a Nora's Lesion.

PubMed

Rushing, Calvin J; Rogers, Diana E; Spinner, Steven M; Gajzer, David C

Bizarre parosteal osteochondromatous proliferation, otherwise known as "Nora's lesion," is a rare benign neoplasm first described by Nora in 1983. The exact etiology of this neoplasm remains unknown, and its presentation in the lower extremity presents a diagnostic challenge, as both clinical and radiologic features cannot fully differentiate it from other neoplasms. We present the case of a 48-year-old female with plantar heel pain secondary to Nora's lesion mimicking plantar fasciitis and periosteal osteosarcoma. Following bone biopsy for histopathologic analysis, the patient's symptoms spontaneously resolved, and she returned to activity with complete resolution of symptoms 18 months post biopsy. Bizarre parosteal osteochondromatous proliferation as an etiology for plantar heel pain has not been previously described in the literature. Although rare, it should be considered in the differential diagnosis for patients presenting with plantar heel pain, especially after failed conservative treatment. Following diagnostic confirmation by histopathology, complete surgical excision is the treatment of choice. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Is There a Role for MRI in Plantar Heel Pain.

PubMed

Fazal, Muhammad Ali; Tsekes, Demetris; Baloch, Irshad

2018-06-01

There is an increasing trend to investigate plantar heel pain with magnetic resonance imaging (MRI) scan though plantar fasciitis is the most common cause. The purpose of our study was to evaluate the role of MRI in patients presenting with plantar heel pain. Case notes and MRI scans of 141 patients with a clinical diagnosis of plantar fasciitis were reviewed retrospectively. There were 98 females and 43 males patients. Fourteen patients had bilateral symptoms. Average age for male patients was 51 years (range = 26-78 years), and for female patients the average age was 52 years (range = 29-76 years). A total of 121 feet had MRI features suggestive of plantar fasciitis. MRI was normal in 32 feet. There was one case of stress fracture of calcaneus and another of a heel fibroma diagnosed on MRI scan. In our study, MRI scan was normal in 20.7% of the cases; 1.3% had a diagnosis other than plantar fasciitis but no sinister pathology. We therefore conclude that MRI scan is not routinely indicated and key is careful clinical assessment. Therapeutic, Level IV: Retrospective, Case series.

An automated approach for extracting Barrier Island morphology from digital elevation models

NASA Astrophysics Data System (ADS)

Wernette, Phillipe; Houser, Chris; Bishop, Michael P.

2016-06-01

The response and recovery of a barrier island to extreme storms depends on the elevation of the dune base and crest, both of which can vary considerably alongshore and through time. Quantifying the response to and recovery from storms requires that we can first identify and differentiate the dune(s) from the beach and back-barrier, which in turn depends on accurate identification and delineation of the dune toe, crest and heel. The purpose of this paper is to introduce a multi-scale automated approach for extracting beach, dune (dune toe, dune crest and dune heel), and barrier island morphology. The automated approach introduced here extracts the shoreline and back-barrier shoreline based on elevation thresholds, and extracts the dune toe, dune crest and dune heel based on the average relative relief (RR) across multiple spatial scales of analysis. The multi-scale automated RR approach to extracting dune toe, dune crest, and dune heel based upon relative relief is more objective than traditional approaches because every pixel is analyzed across multiple computational scales and the identification of features is based on the calculated RR values. The RR approach out-performed contemporary approaches and represents a fast objective means to define important beach and dune features for predicting barrier island response to storms. The RR method also does not require that the dune toe, crest, or heel are spatially continuous, which is important because dune morphology is likely naturally variable alongshore.

6. FLOOR 1; LOOKING WEST; SHOWS UNDERDRIFT SYSTEM, FOUR POSTS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. FLOOR 1; LOOKING WEST; SHOWS UNDERDRIFT SYSTEM, FOUR POSTS SUPPORT BRIDGE BEAM FOR FOOT BEARING OF UPRIGHT SHAFT, SPUR PINION STONE NUTS SLIDE DOWN STONE SPINDLE TO ENGAGE, CENTRIFUGAL GOVERNOR IS MOUNTED ON A SEPARATE SPINDLE DRIVEN BY A BELT FROM THE STONE SPINDLE; ALSO SHOWN ARE THE GREAT SPUR WHEEL AND A LAYSHAFT RUNNING OFF A CROWN WHEEL JUST ABOVE THE GREAT SPUR WHEEL - Gardiner Windmill, East Hampton, Suffolk County, NY

Comparison of an imaging heel quantitative ultrasound device (DTU-one) with densitometric and ultrasonic measurements.

PubMed

Diessel, E; Fuerst, T; Njeh, C F; Hans, D; Cheng, S; Genant, H K

2000-01-01

The purpose of this study was to evaluate a new imaging ultrasound scanner for the heel, the DTU-one (Osteometer MediTech, Denmark), by comparing quantitative ultrasound (QUS) results with bone mineral density (BMD) of the heel and femur from dual X-ray absorptiometry (DXA), and by comparing the DTU-one with another QUS device, the UBA 575+. The regions of interest in the DXA heel scan were matched with the regions evaluated by the two QUS devices. 134 healthy and 16 osteoporotic women aged 30-84 years old were enrolled in the study. In vivo short-term precision of the DTU-one for broadband ultrasound attenuation (BUA) and speed of sound (SOS) was 2.9% and 0.1%, respectively, and long-term precision was 3.8% and 0.2%, respectively. Highest correlations (r) between QUS and BMD measurements were achieved when comparing DTU-one results with BMD in matched regions of the DXA heel scan. Correlation coefficients (r) were 0.81 for BUA and SOS. Highest correlations with the UBA 575+ were 0.68 and 0.72, respectively. The comparison of BMD in different femoral sites with BUA and SOS (DTU-one) varied from 0.62 to 0.69 when including the entire study population. The correlation between BMD values within different sites of the femur tended to be higher (from r = 0.81 to 0.93). When comparing BUA with BUA and SOS with SOS on the two QUS devices, the absolute QUS values differed significantly. However, correlations were relatively high, with 0.76 for BUA and 0.82 for SOS. In conclusion, the results of the new quantitative ultrasound device, the DTU-one, are highly correlated (r = 0.8) with results obtained using the UBA 575+ and with BMD in the heel. The precision of the DTU-one is comparable to other QUS devices for BUA and is high for SOS.

Heelys and street gliders injuries: a new type of pediatric injury.

PubMed

Vioreanu, Mihai; Sheehan, Eoin; Glynn, Aaron; Casidy, Noelle; Stephens, Michael; McCormack, Damian

2007-06-01

Our goals were to highlight an increasing trend in orthopedic injuries in children as a result of "heeling" or "street gliding," to describe injuries sustained by children using Heelys (HSL, Carrollton, TX) and Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom), and to increase public awareness and prevent such injuries. We prospectively recorded the data of all roller shoes injuries referred to our department during the summer school holiday. Using a data-collection sheet, we recorded demographic data, type of injury, mechanism and place of injury, heeling or street-gliding experience, use of safety equipment, methods of treatment, and intention to continue heeling or street gliding after recovery from injury. Over a 10-week period, 67 children suffered orthopedic injuries while using Heelys or Street Gliders. There were 56 girls and 11 boys with a mean age of 9.6 years. Upper limbs were the most common location of injury. Distal radius fractures were the most prevalent, followed by supracondylar fractures, elbow dislocations, and hand fractures. The majority of children suffered the injury while heeling or street gliding outdoors. Interestingly, 20% of the injuries happened while trying Heelys or Street Gliders for the first time, and 36% of the injuries occurred while learning (using 1-5 times) how to use them. None of the children used any sort of protective gear at the time of the injury. The majority of the injured children expressed their intention to continue heeling or street gliding after complete recovery from their injury. Our study shows that the majority of children with injuries from heeling or street gliding are girls. We recommend close supervision of children using Heelys or Street Gliders during the steep learning curve and usage of protective gear at all times. These new types of injuries have a serious impact on child health and constitute a burden for the pediatric orthopedic service.

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

PubMed

Lam, Wing-Kai; Ryue, Jaejin; Lee, Ki-Kwang; Park, Sang-Kyoon; Cheung, Jason Tak-Man; Ryu, Jiseon

2017-01-01

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. 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. 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. 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.

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

PubMed Central

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

2008-01-01

Background Excessive pronation (or eversion) at ankle joint in heel-toe running correlated with lower extremity overuse injuries. Orthotics and inserts are often prescribed to limit the pronation range to tackle the problem. Previous studies revealed that the effect is product-specific. This study investigated the effect of medial arch-heel support in inserts on reducing ankle eversion in standing, walking and running. Methods Thirteen pronators and 13 normal subjects participated in standing, walking and running trials in each of the following conditions: (1) barefoot, and shod condition with insert with (2) no, (3) low, (4) medium, and (5) high medial arch-heel support. Motions were captured and processed by an eight-camera motion capture system. Maximum ankle eversion was calculated by incorporating the raw coordinates of 15 anatomical positions to a self-compiled Matlab program with kinematics equations. Analysis of variance with repeated measures with post-hoc Tukey pairwise comparisons was performed on the data among the five walking conditions and the five running conditions separately. Results Results showed that the inserts with medial arch-heel support were effective in dynamics trials but not static trials. In walking, they successfully reduced the maximum eversion by 2.1 degrees in normal subjects and by 2.5–3.0 degrees in pronators. In running, the insert with low medial arch support significantly reduced maximum eversion angle by 3.6 and 3.1 degrees in normal subjects and pronators respectively. Conclusion Medial arch-heel support in inserts is effective in reducing ankle eversion in walking and running, but not in standing. In walking, there is a trend to bring the over-pronated feet of the pronators back to the normal eversion range. In running, it shows an effect to restore normal eversion range in 84% of the pronators. PMID:18289375

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

PubMed Central

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

2010-01-01

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

Foot kinematics during a bilateral heel rise test in participants with stage II posterior tibial tendon dysfunction.

PubMed

Houck, Jeff R; Neville, Christopher; Tome, Josh; Flemister, A Samuel

2009-08-01

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

Effects of experimental leg length discrepancies on body posture and dental occlusion.

PubMed

Maeda, Nozomi; Sakaguchi, Kiwamu; Mehta, Noshir R; Abdallah, Emad F; Forgione, Albert G; Yokoyama, Atsuro

2011-07-01

The purpose of this study was to quantitatively evaluate the effects of experimental leg length discrepancies on body posture and dental occlusion. Thirty asymptomatic subjects (15 males and 15 females, ages 19-33, mean age 25.6 years) were included in this study and randomly assigned to one of two groups based on a table of random numbers. The only difference between group A and group B was the sequence of testing. Experimental leg length discrepancies were provided by using ten types of insoles with heights ranging from one to ten mm at one mm intervals, placed under both feet. The MatScan (Nitta Corp., Osaka, Japan) system was used to measure changes in body posture (center of foot pressure: COP) while subjects maintained the following three postural positions: 1. natural standing posture (control); 2. control with a heel lift under the right foot; or 3. control with a heel lift under the left foot. The T-Scan II system (Nitta Corp., Osaka, Japan) was used to analyze the results of changes in dental occlusion (center of occlusal force: COF) in the above-mentioned three postural positions. When subjects used a heel lift of six mm or more under the right foot, lateral weight distribution (LWD) shifted to the right side compared to the control (p<0.05). When a heel lift of four mm or more was used under the left foot, LWD shifted to the left side compared to the control (p<0.05). When subjects used a heel lift of eight mm or more under the right foot, occlusal force shifted to the right side compared to the control (p<0.05). When subjects used a heel lift of seven mm or more under the left foot, occlusal force shifted to the left side compared to the control (p<0.05). Based on these findings, it was concluded that leg length discrepancy affected body posture and dental occlusion.

Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without the AirHeel Brace. A randomized controlled trial. A: effects on pain and microcirculation.

PubMed

Knobloch, Karsten; Schreibmueller, Louisa; Longo, Umile Giuseppe; Vogt, Peter M

2008-01-01

To compare eccentric training and the combination of eccentric training with the AirHeel Brace for the management of tendinopathy of the main body of the Achilles tendon. We recruited 116 subjects with unilateral tendinopathy of the main body of the Achilles tendon, who were randomized in two groups. Group A performed a regimen of daily eccentric training associated with the AirHeel Brace (Donjoy Orthopedics, Vista, CA, USA). Group B performed the same eccentric training without the AirHeel Brace. Tendon microcirculatory mapping was performed using combined Laser-Doppler and spectrophotometry. Pre- and post-operative FAOS score and VAS score were used to evaluate the patients. The FAOS score and the VAS score showed significant improvements from pre-operative to post-operative values in both groups (A 5.1 +/- 2 vs. 2.9 +/- 2.4, 43% reduction and B: 5.4 +/- 2.1 vs. 3.6 +/- 2.4, 33% reduction, both p = 0.0001). There were no statistically significant differences in FAOS score and VAS score when comparing the two groups after the end of the intervention. In Group A, tendon oxygen saturation in the main body of the Achilles tendon showed significant increase from pre- to post-management values (68 +/- 12 vs.74 +/- 8%, p = 0.003). Post-capillary venous filling pressures showed significant reduction from pre- to post-intervention values. Eccentric training, associated or not with the AirHeel Brace, produces the same effect in patients with tendinopathy of the main body of the Achilles tendon. The combination of eccentric training with the AirHeel Brace can optimize tendon microcirculation, but these micro-circulator advantages do not translate into superior clinical performance when compared with eccentric training alone.

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

Use of polyurethane foam inside plaster casts to prevent the onset of heel sores in the population at risk. A controlled clinical study.

PubMed

Forni, Cristiana; Loro, Loretta; Tremosini, Morena; Mini, Sandra; Pignotti, Elettra; Bigoni, Ombretta; Guzzo, Giuseppe; Bellini, Laura; Trofa, Carmela; Di Cataldo, Anna M; Guzzi, Marilena

2011-03-01

The aim of this study was to test the effectiveness of polyurethane foam in contact with the heel inside a plaster cast to decrease the rate of pressure sores in the population at most risk. The rate of pressure sores caused by the plaster cast is reported to be 14-15% in the paediatric population, 33.3% in patients having undergone chemotherapy for bone tumours and 43% in orthopaedic patients who already have sore skin when the cast is applied (grade 1 lesion) to the heel. Controlled clinical trial. From November 2007-January 2009, all consecutive subjects requiring lower limb casts having undergone chemotherapy and/or presenting heel soreness received polyurethane foam in contact with the skin of the heel before applying the cast. The results were compared with those of patients with the same risk factors but were not administered the foam and were enrolled from May 2005-August 2006. In total, 156 patients were enrolled, 85 in the control group and 71 in the experimental group. In the experimental group, 2 of the 56 patients (3.6%) with sore skin developed a pressure sore compared with 21 of 49 (42.9%) in the control group without polyurethane foam (p < 0.0005). In the experimental group, one of the 24 patients (4.2%) patients undergoing chemotherapy developed a pressure sore compared with 18 of 54 (33.3%) in the control group (p = 0.005). Placing polyurethane foam in contact with the skin of the heel inside a plaster cast prevents the formation of pressure sores. This study provides evidence that using polyurethane foam to prevent sores even inside plaster casts in populations at most risk is a simple and cost-effective strategy and decreases the discomfort, pain and risks in these patients. © 2011 Blackwell Publishing Ltd.

The impact of automatic devices for capillary blood collection on efficiency and pain response in newborns: A randomized controlled trial.

PubMed

Sorrentino, G; Fumagalli, M; Milani, S; Cortinovis, I; Zorz, A; Cavallaro, G; Mosca, F; Plevani, L

2017-07-01

The heel stick is the method of choice in most neonatal units for capillary blood sampling, and it represents the most common event among all painful procedures performed on newborns. The type and design of heel stick device and the clinical procedure to collect a blood sample may have an impact on newborn pain response as well. To compare the pain response and efficiency of different automated devices for capillary blood collection in newborns. Randomized clinical trial. Postnatal ward of a tertiary-care university hospital in Italy. Newborn infants at gestational age ≥34 weeks undergoing the metabolic screening test after the 49th hour of life. A total of 762 neonates were recruited and randomized into 6 groups (127 babies in each group) assigned to 6 different capillary blood collection devices (Ames Minilet™ Lancet; Cardinal Health Gentleheel ® ; Natus Medical NeatNick™; BD Quikheel™ Lancet; Vitrex Steriheel ® Baby Lancet; Accriva Diagnostics Tenderfoot ® ). The following data were collected and assessed for each of the 6 groups evaluated: a) number of heel sticks, b) pain score according to the Neonatal Infant Pain Scale (NIPS) and c) need to squeeze the heel. The Ames Minilet™ Lancet device was found to perform by far the worst compared to the five device underexamination: it required the highest number of sticks (mean=3.91; 95% CI: 3.46-4.36), evoked the most intense pain (mean=3.98; 95% CI: 3.77-4.20), and most frequently necessitated squeezing the heel (92.9%; 95% CI: 86.9-96.3). The five devices under examination appeared to be similar in terms of the number of sticks required, but differed slightly in NIPS score and in need to squeeze the heel. The Accriva Diagnostics Tenderfoot ® device demonstrated the greatest efficiency for blood sampling and evoked the least pain. With this device, the metabolic screening test could be performed with a single skin incision in the large majority of infants (98.4%), heel squeezing was limited to only 6.3% of infants, and the NIPS score turns out to be lower than other devices in our study (1.22; 95% CI 1.05-1.39). Copyright © 2017 Elsevier Ltd. All rights reserved.

A pollinator shift explains floral divergence in an orchid species complex in South Africa

PubMed Central

Peter, Craig I.; Johnson, Steven D.

2014-01-01

Background and Aims Floral diversification driven by shifts between pollinators has been one of the key explanations for the radiation of angiosperms. According to the Grant–Stebbins model of pollinator-driven speciation, these shifts result in morphologically distinct ‘ecotypes’ which may eventually become recognizable as species. The current circumscription of the food-deceptive southern African orchid Eulophia parviflora encompasses a highly variable monophyletic species complex. In this study, two forms were identified within this complex that differ in distribution, floral morphology, scent chemistry and phenology, and a test was made of whether these differences represent adaptations for different pollinators. Methods and Results Multivariate analysis of floral and vegetative traits revealed that there are at least two discrete morphological forms in the species complex. Field observations revealed that each form is pollinated by a different insect species, and thus represent distinct ecotypes. The early-flowering coastal form which has long spurs and floral scent dominated by sesquiterpene compounds is pollinated exclusively by the long-tongued bee Amegilla fallax (Apidae, Anthophorinae), while the late-flowering inland form with short spurs and floral scent dominated by benzenoid compounds is pollinated exclusively by the beetle Cyrtothyrea marginalis (Cetoniinae; Scarabaeidae). Choice experiments in a Y-maze olfactometer showed that beetles are preferentially attracted to the scent of the short-spurred form. A spur-shortening experiment showed that long spurs are required for effective pollination of the bee-pollinated form. Although it was initially thought likely that divergence occurred across a geographical pollinator gradient, plants of the long-spurred form were effectively pollinated when transplanted to an inland locality outside the natural coastal range of this form. Thus, the underlying geographical basis for the evolution of ecotypes in the E. parviflora complex remains uncertain, although early flowering in the long-spurred form to exploit the emergence of naïve bees may restrict this form to coastal areas where there is no frost that would damage flower buds. Later flowering of the short-spurred form coincides closely with the emergence of the pollinating beetles following winter frosts. Conclusions This study identifies a shift between bee and beetle pollination as the main driver of floral divergence in an orchid species complex. Floral scent and spur length appear to be key traits in mediating this evolutionary transition. PMID:24107684

A pollinator shift explains floral divergence in an orchid species complex in South Africa.

PubMed

Peter, Craig I; Johnson, Steven D

2014-01-01

Floral diversification driven by shifts between pollinators has been one of the key explanations for the radiation of angiosperms. According to the Grant-Stebbins model of pollinator-driven speciation, these shifts result in morphologically distinct 'ecotypes' which may eventually become recognizable as species. The current circumscription of the food-deceptive southern African orchid Eulophia parviflora encompasses a highly variable monophyletic species complex. In this study, two forms were identified within this complex that differ in distribution, floral morphology, scent chemistry and phenology, and a test was made of whether these differences represent adaptations for different pollinators. Multivariate analysis of floral and vegetative traits revealed that there are at least two discrete morphological forms in the species complex. Field observations revealed that each form is pollinated by a different insect species, and thus represent distinct ecotypes. The early-flowering coastal form which has long spurs and floral scent dominated by sesquiterpene compounds is pollinated exclusively by the long-tongued bee Amegilla fallax (Apidae, Anthophorinae), while the late-flowering inland form with short spurs and floral scent dominated by benzenoid compounds is pollinated exclusively by the beetle Cyrtothyrea marginalis (Cetoniinae; Scarabaeidae). Choice experiments in a Y-maze olfactometer showed that beetles are preferentially attracted to the scent of the short-spurred form. A spur-shortening experiment showed that long spurs are required for effective pollination of the bee-pollinated form. Although it was initially thought likely that divergence occurred across a geographical pollinator gradient, plants of the long-spurred form were effectively pollinated when transplanted to an inland locality outside the natural coastal range of this form. Thus, the underlying geographical basis for the evolution of ecotypes in the E. parviflora complex remains uncertain, although early flowering in the long-spurred form to exploit the emergence of naïve bees may restrict this form to coastal areas where there is no frost that would damage flower buds. Later flowering of the short-spurred form coincides closely with the emergence of the pollinating beetles following winter frosts. This study identifies a shift between bee and beetle pollination as the main driver of floral divergence in an orchid species complex. Floral scent and spur length appear to be key traits in mediating this evolutionary transition.

Insertion of a solo LTR retrotransposon associates with spur mutations in 'Red Delicious' apple (Malus × domestica).

PubMed

Han, Mengxue; Sun, Qibao; Zhou, Junyong; Qiu, Huarong; Guo, Jing; Lu, Lijuan; Mu, Wenlei; Sun, Jun

2017-09-01

Insertion of a solo LTR, which possesses strong bidirectional, stem-specific promoter activities, is associated with the evolution of a dwarfing apple spur mutation. Spur mutations in apple scions revolutionized global apple production. Since long terminal repeat (LTR) retrotransposons are tightly related to natural mutations, inter-retrotransposon-amplified polymorphism technique and genome walking were used to find sequences in the apple genome based on these LTRs. In 'Red Delicious' spur mutants, a novel, 2190-bp insertion was identified as a spur-specific, solo LTR (sLTR) located at the 1038th nucleotide of another sLTR, which was 1536 bp in length. This insertion-within-an-insertion was localized within a preexisting Gypsy-50 retrotransposon at position 3,762,767 on chromosome 4. The analysis of transcriptional activity of the two sLTRs (the 2190- and 1536-bp inserts) indicated that the 2190-bp sLTR is a promoter, capable of bidirectional transcription. GUS expression in the 2190-bp-sense and 2190-bp-antisense transgenic lines was prominent in stems. In contrast, no promoter activity from either the sense or the antisense strand of the 1536-bp sLTR was detected. From ~150 kb of DNA on each side of the 2190 bp, sLTR insertion site, corresponding to 300 kb of the 'Golden Delicious' genome, 23 genes were predicted. Ten genes had predicted functions that could affect shoot development. This first report, of a sLTR insertion associated with the evolution of apple spur mutation, will facilitate apple breeding, cloning of spur-related genes, and discovery of mechanisms behind dwarf habit.

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.

The measurement of shock waves following heel strike while running.

PubMed

Dickinson, J A; Cook, S D; Leinhardt, T M

1985-01-01

A non-invasive method for demonstrating the shock wave which propagates through the skeletal system following heel strike is described. This wave was not seen in force plate studies where adequate shock absorption was provided by running shoes. In the present study six subjects ran across a force plate without shoes before and after they were fatigued on a treadmill to demonstrate possible changes in the heel strike transient. Most of the parameters measured were not altered by fatigue, and a relationship between the shock wave and height, but not the weight of the runner was demonstrated. The different mechanisms leading to this phenomenon, and its implication in the areas of osteoarthritic degeneration and running mechanics are discussed.

The SPURS Data Management System: Real-time Situational Awareness at Sea

NASA Astrophysics Data System (ADS)

Bingham, F.; Chao, Y.; Li, P.; Vu, Q. A.

2012-12-01

SPURS (Salinity Processes in the Upper ocean Regional Study) is a field program in the North Atlantic to study the subtropical surface salinity maximum. It is a heterogeneous array consisting of research ships, profiling floats, surface drifters, gliders, microstructure profilers and moorings, as well as satellite observations and models. The SPURS Data Management System aims to capture the status of the observing system in near-real time and allow SPURS science team members to deploy observational assets "on the fly". At the heart of this is a visualization system that tracks the positions of the various assets and displays them in a an interface using Google Earth. The interface was used by program participants on land and at sea to coordinate the deployment of instrumentation. Before the Fall AGU, SPURS will have completed the first part of its mission with a 6-week cruise to the study area. This poster presents some of the highlights of the field campaign, and details the lessons learned in doing real-time oceanography on the high seas.

Sensationalising the female pudenda: an examination of public communication of aesthetic genital surgery.

PubMed

Ashong, Ashong C; Batta, Herbert E

2012-12-26

We live in a society where beauty and sensations are important. Advances in medical technologies have brought on waves of new notions of beauty where commercial interests both in the media and the health industry spurred by fashion, advertising and celebrity promotion have tended to popularise body modifications and enhancements. In recent times, through offerings on cable television channels and glossy consumer magazines, medical procedures hitherto only in the precincts of medical schools, gyneacological clinics and medical journals have now pervaded the population. More seriously, on the Internet particularly, medical experts now offer services and graphic details of labiaplasty, clitoral hood reduction or enhancement, vaginal rejuvenation, etc. Here, we examine the public communication of the phenomenon of aesthetic genital surgery and interrogate thus; is it decent, honest, balanced and ethical? Relying on textual analysis, personal observation and literature review for data gathering, we observe that besides tending to commercialise and medicalise the female genitalia, a coalescence of medical, advertising and fashion interests as played out in the media sensationalises the benign science of plastic surgery and robs it of its truthfulness, genuineness, and purposefulness. The conclusion is that in Africa, where the effect of the development crises is telling, the hype surrounding cosmetic or aesthetic genital surgery is a damaging distraction particularly when the continent is waging a battle against female genital mutilation. The recommendations are that media and medical regulatory bodies should impress it upon media and medical industry operators that glaring commercial promotions of cosmetic genital surgery in the public media be checked, and that such communication should bear equal weight of facts related to risks, short comings, complications, and threats; in physical, social, and psychological terms.

Sensationalising the Female Pudenda: An Examination of Public Communication of Aesthetic Genital Surgery

PubMed Central

Ashong, Ashong C.; Batta, Herbert E.

2013-01-01

We live in a society where beauty and sensations are important. Advances in medical technologies have brought on waves of new notions of beauty where commercial interests both in the media and the health industry spurred by fashion, advertising and celebrity promotion have tended to popularise body modifications and enhancements. In recent times, through offerings on cable television channels and glossy consumer magazines, medical procedures hitherto only in the precincts of medical schools, gyneacological clinics and medical journals have now pervaded the population. More seriously, on the Internet particularly, medical experts now offer services and graphic details of labiaplasty, clitoral hood reduction or enhancement, vaginal rejuvenation, etc. Here, we examine the public communication of the phenomenon of aesthetic genital surgery and interrogate thus; is it decent, honest, balanced and ethical? Relying on textual analysis, personal observation and literature review for data gathering, we observe that besides tending to commercialise and medicalise the female genitalia, a coalescence of medical, advertising and fashion interests as played out in the media sensationalises the benign science of plastic surgery and robs it of its truthfulness, genuineness, and purposefulness. The conclusion is that in Africa, where the effect of the development crises is telling, the hype surrounding cosmetic or aesthetic genital surgery is a damaging distraction particularly when the continent is waging a battle against female genital mutilation. The recommendations are that media and medical regulatory bodies should impress it upon media and medical industry operators that glaring commercial promotions of cosmetic genital surgery in the public media be checked, and that such communication should bear equal weight of facts related to risks, short comings, complications, and threats; in physical, social, and psychological terms. PMID:23445703

Dynamic Analysis of Spur Gear Transmissions (DANST). PC Version 3.00 User Manual

NASA Technical Reports Server (NTRS)

Oswald, Fred B.; Lin, Hsiang Hsi; Delgado, Irebert R.

1996-01-01

DANST is a FORTRAN computer program for static and dynamic analysis of spur gear systems. The program can be used for parametric studies to predict the static transmission error, dynamic load, tooth bending stress and other properties of spur gears as they are influenced by operating speed, torque, stiffness, damping, inertia, and tooth profile. DANST performs geometric modeling and dynamic analysis for low- or high-contact-ratio spur gears. DANST can simulate gear systems with contact ratios ranging from one to three. It was designed to be easy to use and it is extensively documented in several previous reports and by comments in the source code. This report describes installing and using a new PC version of DANST, covers input data requirements and presents examples.

Higher body mass index is associated with plantar fasciopathy/'plantar fasciitis': systematic review and meta-analysis of various clinical and imaging risk factors.

PubMed

van Leeuwen, K D B; Rogers, J; Winzenberg, T; van Middelkoop, M

2016-08-01

What (risk) factors are associated with plantar fasciopathy (PF)? Systematic review with meta-analyses. Patients with PF. All factors described in prospective, case-control or cross-sectional observational studies. 51 included studies (1 prospective, 46 case-control and 4 cross-sectional studies) evaluated a total of 104 variables. Pooling was possible for 12 variables. Higher body mass index (BMI) (BMI>27, OR 3.7 (95% CI 2.93 to 5.62)) in patients with PF was the only significant clinical association, and its effect was the strongest in the non-athletic subgroup. In people with PF compared to controls, pooled imaging data demonstrated a significantly thicker, hypoechogenic plantar fascia with increased vascular signal and perifascial fluid collection. In addition, people with PF were more likely to have a thicker loaded and unloaded heel fat pat, and bone findings, including a subcalcaneal spur and increased Tc-99 uptake. No significant difference was found in the extension of the first metatarsophalangeal joint. We found a consistent clinical association between higher BMI and plantar fasciopathy. This association may differ between athletic and non-athletic subgroups. While consistent evidence supports a range of bone and soft tissue abnormalities, there is lack of evidence for the dogma of clinical and mechanical measures of foot and ankle function. Clinicians can use this information in shared decision-making. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Design of spur gears for improved efficiency

NASA Technical Reports Server (NTRS)

Anderson, N. E.; Loewenthal, S. H.

1981-01-01

A method to calculate spur gear system power loss for a wide range of gear geometries and operating conditions is used to determine design requirements for an efficient gearset. The effects of spur gear size, pitch, ratio, pitch-line-velocity and load on efficiency are shown. A design example is given to illustrate how the method is to be applied. In general, peak efficiencies were found to be greater for larger diameter and fine pitched gears and tare (no-load) losses were found to be significant.

Anterior open-bite orthodontic treatment in an adult patient: A clinical case report.

PubMed

Gracco, Antonio; Siviero, Laura; de Stefani, Alberto; Bruno, Giovanni; Stellini, Edoardo

2016-06-01

A 45-year-old woman presented with an anterior open-bite complaining chiefly of her unpleasant smile esthetics and masticatory and speech problems. Treatment included speech therapy initiated immediately after bonding. Lingual spurs were positioned on the mandibular incisors in order to help tongue rehabilitation. During the working phase, temporary anchorage devices (TADs) were used at the mandibular anterior segment to intrude the lower left premolars. A splint was used to ensure retention in the upper and lower arches; an enveloppe linguale nocturne (ELN) was provided. Non-surgical open-bite treatment could offer a valid alternative to orthognanthic surgery when cephalometric evaluation shows no vertical growth pattern; patient compliance is essential to prevent relapse. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.

Effects of different heel-raise-lower exercise interventions on the strength of plantarflexion, balance, and gait parameters in stroke survivors.

PubMed

Lee, Seung-Mi; Cynn, Heon-Seock; Yoon, Tae-Lim; Lee, Ji-Hyun

2017-09-01

The objective of this study was to investigate the effects of Heel-Raise-Lower Exercise (HRLE) interventions on the strength of plantarflexion, balance, and gait parameters in people with stroke. Specifically, this study compared the two different HRLEs to identify whether heels raise-lower with forefoot on a block (HRB) is more effective or ineffective to enhance strength and functional capacities than heels raise-lower on a level floor (HRL) exercise in people with stroke. Repetitive heel raise-lower is a common exercise for improving the strength and power of ankle plantarflexors. It is a simple movement, requires no equipment, and can be performed at home. Each group of 10 people with stroke was given either HRB training or HRL training. The subjects performed the exercise 100 times per day, 5 days per week for 6 weeks. The strength of plantarflexors, static/dynamic balance, and gait parameters were measured using the manual muscle test (MMT), a Biodex Balance System (BBS) SD, and the GAITRite system. After 6 weeks of treatment, there were significant increases in the plantarflexors strength in both groups: by 34% in the HRB group and by 21% in the HRL group. Static and dynamic balance and gait speed also increased significantly in both groups. However, cadence, the paretic side single limb support period (SLSP), paretic side step length, and paretic side stride length significantly increased only in the HRB group. The HRB improved significantly the plantar flexor strength of the paretic side, gait speed, and cadence compared to the HRL.

Gait parameter and event estimation using smartphones.

PubMed

Pepa, Lucia; Verdini, Federica; Spalazzi, Luca

2017-09-01

The use of smartphones can greatly help for gait parameters estimation during daily living, but its accuracy needs a deeper evaluation against a gold standard. The objective of the paper is a step-by-step assessment of smartphone performance in heel strike, step count, step period, and step length estimation. The influence of smartphone placement and orientation on estimation performance is evaluated as well. This work relies on a smartphone app developed to acquire, process, and store inertial sensor data and rotation matrices about device position. Smartphone alignment was evaluated by expressing the acceleration vector in three reference frames. Two smartphone placements were tested. Three methods for heel strike detection were considered. On the basis of estimated heel strikes, step count is performed, step period is obtained, and the inverted pendulum model is applied for step length estimation. Pearson correlation coefficient, absolute and relative errors, ANOVA, and Bland-Altman limits of agreement were used to compare smartphone estimation with stereophotogrammetry on eleven healthy subjects. High correlations were found between smartphone and stereophotogrammetric measures: up to 0.93 for step count, to 0.99 for heel strike, 0.96 for step period, and 0.92 for step length. Error ranges are comparable to those in the literature. Smartphone placement did not affect the performance. The major influence of acceleration reference frames and heel strike detection method was found in step count. This study provides detailed information about expected accuracy when smartphone is used as a gait monitoring tool. The obtained results encourage real life applications. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of modified short-leg walkers on ground reaction force characteristics.

PubMed

Keefer, Maria; King, Jon; Powell, Douglas; Krusenklaus, John H; Zhang, Songning

2008-11-01

Although short-leg walkers are often used in the treatment of lower extremity injuries (ankle and foot fractures and severe ankle sprains), little is known about the effect the short-leg walker on gait characteristics. The purpose was to examine how heel height modifications in different short-leg walkers and shoe side may affect ground reaction forces in walking. Force platforms were used to collect ground reaction force data on 10 healthy participants. Five trials were performed in each of six conditions: lab shoes, gait walker, gait walker with heel insert on shoe side, gait walker modified with insert on walker side, equalizer walker, and equalizer walker with heel insert on shoe side. Conditions were randomized and walking speed was standardized between conditions. A 2x6 (sidexcondition) repeated analysis of variance was used on selected ground reaction force variables (P<0.05). The application of a walker created peak vertical and anteroposterior ground reaction forces prior to the normal peaks associated with the loading response. Wearing a walker introduced an elevated minimum vertical ground reaction force in all conditions except the equalizer walker when compared to shoe on the shoe side. Peak propulsive anteroposterior ground reaction forces were smaller in all walker conditions compared to shoe on walker side. The application of heel insert in gait walker with heel insert (on shoe side) and gait walker modified (on walker side) does not diminish the minimum vertical ground reaction force as hypothesized. Wearing a walker decreases the peak propulsive anteroposterior ground reaction force on the walker side and induces asymmetrical loading.

Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: a pilot randomized clinical trial.

PubMed

Saban, Bernice; Deutscher, Daniel; Ziv, Tomer

2014-04-01

Plantar heel pain syndrome (PHPS) is a common foot disorder; however, there is limited clinical evidence on which to base treatment. Repeated clinical observations indicating heel pain during heel rise and minisquat on the affected leg, involving activation of posterior calf muscles, formed the basis of this study. To compare deep massage therapy to posterior calf muscles and neural mobilization with a self-stretch exercise program (DMS) to a common treatment protocol of ultrasound therapy to the painful heel area with the same self-stretch exercises (USS). Patients with PHPS were assigned to a program of 8 treatments over a period of 4-6 weeks in a single-blind randomized clinical trial. Functional status (FS) at admission and discharge from therapy as measured by the Foot & Ankle Computerized Adaptive Test was the main outcome measure. Sixty-nine patients were included in the trial (mean age 53, standard deviation (SD) 13, range 25-86, 57% women), 36 received DMS treatment and 33 with USS. The overall group-by-time interaction for the mixed-model analysis of variance (ANOVA) was found statistically significant (p=0.034), with a change of (mean (confidence interval, CI)) 15 (9-21) and 6 (1-11) FS points for the DMS and USS groups, respectively. Data indicated that both treatment protocols resulted in an overall short-term improvement, however, DMS treatment was significantly more effective in treating PHPS than USS treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Hardness and posting of foot orthoses modify plantar contact area, plantar pressure, and perceived comfort when cycling.

PubMed

Bousie, Jaquelin A; Blanch, Peter; McPoil, Thomas G; Vicenzino, Bill

2018-07-01

To evaluate the effects of hardness and posting of orthoses on plantar profile and perceived comfort and support during cycling. A repeated measures study with randomised order of orthoses, hardness, and posting conditions. Twenty-three cyclists cycled at a cadence of 90rpm and a perceived exertion rating of twelve. Contoured soft and hard orthoses with or without a medial forefoot or lateral forefoot post were evaluated. Plantar contact area, mean pressure and peak pressure were measured for nine plantar regions using the pedar ® -X system and represented as a percentage of the total (CA%, MP%, and PP% respectively). Perceived comfort and support was rated on a visual analogue scale. The softer orthosis significantly increased CA% (p=0.014) across the midfoot and heel with a decrease in the toe region and forefoot. MP% (p=0.034) and PP% (p=0.012) were significantly increased at the mid and lateral forefoot with reductions in MP% at the midfoot and in PP% at the hallux and toes. Forefoot posting significantly increased CA% (p=0.018) at the toes and forefoot and decreased it at the heel. PP% was significantly altered (p=0.013) based on posting position. Lateral forefoot posting significantly decreased heel comfort (p=0.036). When cycling, a soft, contoured orthosis increased contact across the midfoot and heel, modulating forefoot and midfoot plantar pressures but not altering comfort or support. Forefoot postings significantly modified contact areas and plantar pressures and reduced comfort at the heel. Copyright © 2017. Published by Elsevier Ltd.

Therapeutic touch is not therapeutic for procedural pain in very preterm neonates: a randomized trial.

PubMed

Johnston, Celeste; Campbell-Yeo, Marsha; Rich, Bonnie; Whitley, Julie; Filion, Francoise; Cogan, Jennifer; Walker, Claire-Dominique

2013-09-01

Preterm neonates below 30 weeks' gestational age undergo numerous painful procedures. Many management approaches are not appropriate for this population. Therapeutic Touch, an alternative approach based on the theory of energy medicine, has been shown to promote physiological stability in preterm neonates and reduce pain in some adult studies. The objective was to determine whether Therapeutic Touch is efficacious in decreasing pain in preterm neonates. Infants < 30 weeks' gestational age participated in a randomized control trial in 2 level III neonatal intensive care units. All evaluations, analyses, and heel lance procedure were conducted with only the therapist knowing the group assignment. Immediately before and after the heel lance procedure, the therapist performed nontactile Therapeutic Touch (n = 27) with infant behind curtains, leaving the curtained area for the heel lance, performed by another. In the sham condition (n = 28), the therapist stood by the incubator with hands by her side. The Premature Infant Pain Profile was used for pain response and time for heart rate to return to baseline for recovery. Heart rate variability and stress response were secondary outcomes. There were no group differences in any of the outcomes. Mean Premature Infant Pain Profile scores across 2 minutes of heel lance procedure in 30-second blocks ranged from 7.92 to 8.98 in the Therapeutic Touch group and 7.64 to 8.46 in the sham group. Therapeutic Touch given immediately before and after heel lance has no comforting effect in preterm neonates. Other effective strategies involving actual touch should be considered.

Effect of reconstruction of the anterior cruciate ligament on proprioception of the knee and the heel strike transient.

PubMed

Co, F H; Skinner, H B; Cannon, W D

1993-09-01

Abnormal proprioception of the knee joint has been documented after rupture of the anterior cruciate ligament (ACL) and may result in the loss of muscular reflexes. Excessive loading from the lack of muscular control may predispose the joint to osteoarthrosis. To investigate this problem, 10 patients were studied at an average of 31.6 months after ACL reconstruction. Three tests of joint proprioception and measurements of the vertical component of heel strike force during normal gait were used. A normal control group also was studied. For two of the proprioception tests (reproduction of passive motion and relative reproduction), there were no statistical differences among the uninjured (control) limbs, the normal contralateral limb of patients with a reconstructed ACL, and the extremity with a reconstructed ACL. In the third test (threshold of detection of motion), which previously has been shown to be adversely affected by ACL injury, the measurements for both extremities of patients with a reconstructed ACL were more accurate than those for the control group. The reconstructed extremity performed less accurately than the contralateral extremity (p < 0.05). The heel strike transient (vertical component of ground reaction force at heel strike) for uninjured and ACL-reconstructed limbs was not significantly different. In fact, the extremity with the reconstructed ACL had a lower transient than the uninjured extremity. Heel strike transients in patients with a reconstructed ACL were higher than those in the controls, but the differences were significant only when corrected for velocity of gait.(ABSTRACT TRUNCATED AT 250 WORDS)

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…

Energy-conserving impact algorithm for the heel-strike phase of gait.

PubMed

Kaplan, M L; Heegaard, J H

2000-06-01

Significant ground reaction forces exceeding body weight occur during the heel-strike phase of gait. The standard methods of analytical dynamics used to solve the impact problem do not accommodate well the heel-strike collision due to the persistent contact at the front foot and presence of contact at the back foot. These methods can cause a non-physical energy gain on the order of the total kinetic energy of the system at impact. Additionally, these standard techniques do not quantify the contact force, but the impulse over the impact. We present an energy-conserving impact algorithm based on the penalty method to solve for the ground reaction forces during gait. The rigid body assumptions are relaxed and the bodies are allowed to penetrate one another to a small degree. Associated with the deformation is a potential, from which the contact forces are derived. The empirical coefficient-of-restitution used in the standard approaches is replaced by two parameters to characterize the stiffness and the damping of the materials. We solve two simple heel-strike models to illustrate the shortcomings of a standard approach and the suitability of the proposed method for use with gait.

End effector with astronaut foot restraint

NASA Technical Reports Server (NTRS)

Monford, Leo G., Jr. (Inventor)

1991-01-01

The combination of a foot restraint platform designed primarily for use by an astronaut being rigidly and permanently attached to an end effector which is suitable for attachment to the manipulator arm of a remote manipulating system is described. The foot restraint platform is attached by a brace to the end effector at a location away from the grappling interface of the end effector. The platform comprises a support plate provided with a pair of stirrups for receiving the toe portion of an astronaut's boots when standing on the platform and a pair of heel retainers in the form of raised members which are fixed to the surface of the platform and located to provide abutment surfaces for abutting engagement with the heels of the astronaut's boots when his toes are in the stirrups. The heel retainers preclude a backward sliding movement of the feet on the platform and instead require a lifting of the heels in order to extract the feet. The brace for attaching the foot restraint platform to the end effector may include a pivot or swivel joint to permit various orientations of the platform with respect to the end effector.

Walking efficiency before and after total hip replacement.

PubMed

Brown, M; Hislop, H J; Waters, R L; Porell, D

1980-10-01

The energy cost of walking and gait characteristics of patients with hip disease were studied to determine changes in walking efficiency following total hip replacement. Twenty-nine patients, 24 with unilateral hip disease and 5 with bilateral hip disease, were tested preoperatively and at various times postoperatively. Oxygen uptake was measured by a modified Douglas bag procedure. The temporal and distance characteristics of gait were measured with contact closing heel switches. Results showed postoperative increases in velocity, cadence, and stride length in patients with unilateral disease and with bilateral disease with bilateral replacement. After surgery, energy cost tended toward more normal levels, but the subjects were not within normal limits for oxygen uptake per minute, oxygen uptake per distance walked, or percent of predicted maximum aerobic capacity. Comparison of energy expenditure data with temporal and distance factors of gait indicated that all subjects became more physiologically efficient after hip replacement.

Treatment of knee osteoarthritis.

PubMed

Ringdahl, Erika; Pandit, Sandesh

2011-06-01

Knee osteoarthritis is a common disabling condition that affects more than one-third of persons older than 65 years. Exercise, weight loss, physical therapy, intra-articular corticosteroid injections, and the use of nonsteroidal anti-inflammatory drugs and braces or heel wedges decrease pain and improve function. Acetaminophen, glucosamine, ginger, S-adenosylmethionine (SAM-e), capsaicin cream, topical nonsteroidal anti-inflammatory drugs, acupuncture, and tai chi may offer some benefit. Tramadol has a poor trade-off between risks and benefits and is not routinely recommended. Opioids are being used more often in patients with moderate to severe pain or diminished quality of life, but patients receiving these drugs must be carefully selected and monitored because of the inherent adverse effects. Intra-articular corticosteroid injections are effective, but evidence for injection of hyaluronic acid is mixed. Arthroscopic surgery has been shown to have no benefit in knee osteoarthritis. Total joint arthroplasty of the knee should be considered when conservative symptomatic management is ineffective.

Female high heel shoes: a study of comfort

NASA Astrophysics Data System (ADS)

Broega, A. C.; Righetto, M.; Ribeiro, R.

2017-10-01

Protection was the basic principle underlying the creation of footwear, once humankind felt the need to protect feet from direct contact with soil, heat, cold and sharp objects. However, this accessory soon acquired cultural, aesthetic, symbolic significance, and apparently it was not related to comfort. This work aims to analyze comfort in women footwear, especially high heels shoe. We intended to understand the emotional relationship of consumers with this type of accessory, as well as to understand to what extent women are willing to give up comfort in favor of aesthetics. For this purpose, a questionnaire was designed, aimed at the female audience in order to understand the relevance of women’s footwear, their daily relationship with shoes, the specificity of heels and the problems caused by it.

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

PubMed

Folman, Y; Wosk, J; Voloshin, A; Liberty, S

1986-01-01

The cyclic impacts induced by heel strike when walking were studied using both a high-resonance-frequency force plate and a low-mass skin-mounted accelerometer. The data were computer analyzed. The results showed that during normal human walking, the locomotor system is subjected to repetitive impact loads at heel strike, lasting about 5 ms and consisting of frequency spectra up to and above 100 Hz. The natural shock-absorbing structures in the musculoskeletal system have viscoelastic time-dependent mechanical behavior, which is relatively ineffective in withstanding sudden impulsive loads. Degenerative joint diseases may thus be seen as a late clinical result of fatigue failure of the natural shock absorbers, submitted to deleterious impacts over a period of time.

Michael J. Fox: Spurring Research on Parkinson's

MedlinePlus

... on. Feature: Parkinson's Disease Michael J. Fox: Spurring Research on Parkinson's Past Issues / Winter 2014 Table of ... founded the Michael J. Fox Foundation for Parkinson's Research in the year 2000. Photo courtesy of Shutterstock " ...

A novel accelerometry-based algorithm for the detection of step durations over short episodes of gait in healthy elderly.

PubMed

Micó-Amigo, M Encarna; Kingma, Idsart; Ainsworth, Erik; Walgaard, Stefan; Niessen, Martijn; van Lummel, Rob C; van Dieën, Jaap H

2016-04-19

The assessment of short episodes of gait is clinically relevant and easily implemented, especially given limited space and time requirements. BFS (body-fixed-sensors) are small, lightweight and easy to wear sensors, which allow the assessment of gait at relative low cost and with low interference. Thus, the assessment with BFS of short episodes of gait, extracted from dailylife physical activity or measured in a standardised and supervised setting, may add value in the study of gait quality of the elderly. The aim of this study was to evaluate the accuracy of a novel algorithm based on acceleration signals recorded at different human locations (lower back and heels) for the detection of step durations over short episodes of gait in healthy elderly subjects. Twenty healthy elderly subjects (73.7 ± 7.9 years old) walked twice a distance of 5 m, wearing a BFS on the lower back, and on the outside of each heel. Moreover, an optoelectronic three-dimensional (3D) motion tracking system was used to detect step durations. A novel algorithm is presented for the detection of step durations from low-back and heel acceleration signals separately. The accuracy of the algorithm was assessed by comparing absolute differences in step duration between the three methods: step detection from the optoelectronic 3D motion tracking system, step detection from the application of the novel algorithm to low-back accelerations, and step detection from the application of the novel algorithm to heel accelerations. The proposed algorithm successfully detected all the steps, without false positives and without false negatives. Absolute average differences in step duration within trials and across subjects were calculated for each comparison, between low-back accelerations and the optoelectronic system were on average 22.4 ± 7.6 ms (4.0 ± 1.3 % of average step duration), between heel accelerations and the optoelectronic system were on average 20.7 ± 11.8 ms (3.7 ± 1.9 %), and between low-back accelerations and heel accelerations were on average 27.8 ± 15.1 ms (4.9 ± 2.5 % of average step duration). This study showed that the presented novel algorithm detects step durations over short episodes of gait in healthy elderly subjects with acceptable accuracy from low-back and heel accelerations, which provides opportunities to extract a range of gait parameters from short episodes of gait.

Measuring surface salinity in the N. Atlantic subtropical gyre. The SPURS-MIDAS cruise, spring 2013

NASA Astrophysics Data System (ADS)

Font, Jordi; Ward, Brian; Emelianov, Mikhail; Morisset, Simon; Salvador, Joaquin; Busecke, Julius

2014-05-01

SPURS-MIDAS (March-April 2013) on board the Spanish R/V Sarmiento de Gamboa was a contribution to SPURS (Salinity Processes in the Upper ocean Regional Study) focused on the processes responsible for the formation and maintenance of the salinity maximum associated to the North Atlantic subtropical gyre. Scientists from Spain, Ireland, France and US sampled the mesoscale and submesoscale structures in the surface layer (fixed points and towed undulating CTD, underway near surface TSG) and deployed operational and experimental drifters and vertical profilers, plus additional ocean and atmospheric data collection. Validation of salinity maps obtained from the SMOS satellite was one of the objectives of the cruise. The cruise included a joint workplan and coordinated sampling with the US R/V Endeavor, with contribution from SPURS teams on land in real time data and analysis exchange. We present here an overview of the different kinds of measurements made during the cruise, as well as a first comparison between SMOS-derived sea surface salinity products and salinity maps obtained from near-surface sampling in the SPURS-MIDAS area and from surface drifters released during the cruise.

2001 News Releases | NREL

Science.gov Websites

Showcase Open Doors to Renewable Energy Information - (10/04/01) Pricing Programs Spur Growth of Renewable Technology Could Spur Growth in Photovoltaic Panels - (04/24/01) $6 Million in Awards to Advance Solar Cell

Design of spur-type streambank stabilization structures.

DOT National Transportation Integrated Search

1985-07-01

streambank stabilization structures has been conducted to establish design guidelines and other criteria for the use of spurs. The recommendations and findings are based on a thorough review of pertinent literature, analysis of several hundred field ...

Is percutaneous repair better than open repair in acute Achilles tendon rupture?

PubMed

Henríquez, Hugo; Muñoz, Roberto; Carcuro, Giovanni; Bastías, Christian

2012-04-01

Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair. We compared the two types of repairs in terms of (1) function (muscle strength, ankle ROM, calf and ankle perimeter, single heel rise tests, and work return), (2) cosmesis (length scar, cosmetic appearance), and (3) complications. We retrospectively reviewed 32 surgically treated patients with Achilles rupture: 17 with percutaneous repair and 15 with open repair. All patients followed a standardized rehabilitation protocol. The minimum followup was 6 months (mean, 18 months; range, 6-48 months). We observed similar values of plantar flexor strength, ROM, calf and ankle perimeter, and single heel raising test between the groups. Mean time to return to work was longer for patients who had open versus percutaneous repair (5.6 months versus 2.8 months). Mean scar length was greater in the open repair group (9.5 cm versus 2.9 cm). Cosmetic appearance was better in the percutaneous group. Two wound complications and one rerupture were found in the open repair group. One case of deep venous thrombosis occurred in the percutaneous repair group. All complications occurred before 6 months after surgery. We identified no patients with nerve injury. Percutaneous repair provides function similar to that achieved with open repair, with a better cosmetic appearance, a lower rate of wound complications, and no apparent increase in the risk of rerupture. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The effect of tibiotalar alignment on coronal plane mechanics following total ankle replacement.

PubMed

Grier, A Jordan; Schmitt, Abigail C; Adams, Samuel B; Queen, Robin M

2016-07-01

Gait mechanics following total ankle replacement (TAR) have reported improved ankle motion following surgery. However, no studies have addressed the impact of preoperative radiographic tibiotalar alignment on post-TAR gait mechanics. We therefore investigated whether preoperative tibiotalar alignment (varus, valgus, or neutral) resulted in significantly different coronal plane mechanics or ground reaction forces post-TAR. We conducted a non-randomized study of 93 consecutive end-stage ankle arthritis patients. Standard weight-bearing radiographs were obtained preoperatively to categorize patients as having neutral (±4°), varus (≥5° of varus), or valgus (≥5° of valgus) coronal plane tibiotalar alignment. All patients underwent a standard walking assessment including three-dimensional lower extremity kinetics and kinematics preoperatively, 12 and 24 months postoperatively. A significant group by time interaction was observed for the propulsive vertical ground reaction force (vGRF), coronal plane hip range of motion (ROM) and the peak hip abduction moment. The valgus group demonstrated an increase in the peak knee adduction angle and knee adduction angle at heel strike when compared to the other groups. Coronal plane ankle ROM, knee and hip angles at heel strike, and the peak hip angle exhibited significant increases across time. Peak ankle inversion moment, peak knee abduction moment and the weight acceptance vGRF also exhibited significant increases across time. Neutral ankle alignment was achieved for all patients by 2 years following TAR. Restoration of neutral ankle alignment at the time of TAR in patients with preoperative varus or valgus tibiotalar alignment resulted in biomechanics similar to those of patients with neutral preoperative tibiotalar alignment by 24-month follow-up. Copyright © 2016 Elsevier B.V. All rights reserved.

Comparing fixation used for calcaneal displacement osteotomies: a look at removal rates and cost.

PubMed

Lucas, Douglas E; Simpson, G Alex; Philbin, Terrence M

2015-02-01

The calcaneal displacement osteotomy is a procedure frequently used by foot and ankle surgeons for hindfoot angular deformity. Traditional techniques use compression screw fixation that can result in prominent hardware. While the results of the procedure are generally good, a common concern is the development of plantar heel pain related to prominent hardware. The primary purpose of this study is to retrospectively compare clinical outcomes of 2 fixation methods for the osteotomy. Secondarily a cost analysis will compare implant costs to hardware removal costs. Records were reviewed for patients who had undergone a calcaneal displacement osteotomy fixated with either lag screw or a locked lateral compression plate (LLCP). Neuropathy, previous ipsilateral calcaneus surgery, heel pad trauma, or incomplete radiographic follow-up were exclusionary. Thirty-two patients (19.4%) required hardware removal from the screw fixation group compared to 1 (1.6%) of the LLCP group, which is significant (P < .05). Time to radiographic healing was not significantly different (P = .87). The screw fixation group required more follow-up visits over a longer period of time (P < .05). Implant cost was remarkably different with screw fixation costing on average $247.12, compared to the LLCP costing $1175.59. Although the LLCP cost was significantly higher, cost savings were identified when the cost of removal and removal rates were included. This study demonstrates that this device provides adequate stabilization for healing in equivalent time to screw fixation. The LLCP required decreased rates of hardware removal with fewer postoperative visits over a shorter period of time. Significant savings were demonstrated in the LLCP group despite the higher implant cost. Therapeutic, Level III, Retrospective Comparative Study. © 2014 The Author(s).

A three-year prospective comparative gait study between patients with ankle arthrodesis and arthroplasty.

PubMed

Segal, Ava D; Cyr, Krista M; Stender, Christina J; Whittaker, Eric C; Hahn, Michael E; Orendurff, Michael S; Ledoux, William R; Sangeorzan, Bruce J

2018-05-01

End-stage ankle arthritis is a debilitating condition that often requires surgical intervention after failed conservative treatments. Ankle arthrodesis is a common surgical option, especially for younger and highly active patients; however, ankle arthroplasty has become increasingly popular as advancements in implant design improve device longevity. The longitudinal differences in biomechanical outcomes between these surgical treatments remain indistinct, likely due to the challenges associated with objective study of a heterogeneous population. Patients scheduled for arthroplasty (n = 27) and arthrodesis (n = 20) were recruited to participate in this three-year prospective study. Postoperative functional outcomes were compared at distinct annual time increments using measures of gait analysis, average daily step count and survey score. Both surgical groups presented reduced pain, improved survey scores, and increased walking speed at the first-year postoperative session, which were generally consistent across the three-year follow-up. Arthrodesis patients walked with decreased sagittal ankle RoM, increased sagittal hip RoM, increased step length, and increased transient force at heel strike, postoperatively. Arthroplasty patients increased ankle RoM and cadence, with no changes in hip RoM, step length or heel strike transient force. Most postoperative changes were detected at the first-year follow-up session and maintained across the three-year time period. Despite generally favorable outcomes associated with both surgeries, several underlying postoperative biomechanical differences were detected, which may have long-term functional consequences. Furthermore, neither technique was able to completely restore gait biomechanics to the levels of the contralateral unaffected limb, leaving potential for the development of improved surgical and rehabilitative treatments. Published by Elsevier Ltd.

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

PubMed

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

2011-11-01

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 this region. Finally, HFP was found to be thicker in males than in females. © 2011 The Authors. Journal of Anatomy © 2011 Anatomical Society of Great Britain and Ireland.

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 this region. Finally, HFP was found to be thicker in males than in females. PMID:21848602

A heel-strike real-time auditory feedback device to promote motor learning in children who have cerebral palsy: a pilot study to test device accuracy and feasibility to use a music and dance-based learning paradigm.

PubMed

Pitale, Jaswandi Tushar; Bolte, John H

2018-01-01

Cerebral palsy (CP) is a developmental disorder of movement and posture that occurs due to damage to the developing nervous system. As part of therapy, wearable sensors that trigger interactive feedback may provide multi-sensory guidance and motivation. A prototype of a heel-strike real-time feedback system has been developed which records the number of heel strikes during gait and indicates successful heel contact through real-time auditory feedback. The first aim of this feasibility study was to test the prototype accuracy.Since the end user for this device is a child, the device should be esthetically appealing and sufficiently motivating for children to perform repetitive challenging therapeutic movements. The second aim of this study was to collect feedback from the subjects with regard to the device usability and understand if the bell sound used as feedback used was motivating enough for children to continue using the prototype. This would help us in developing the next generation of the device. The prototype was tested with typically developing children and children who have CP. The accuracy in detecting heel strikes was calculated. As part of the study, the subjects were also asked questions to test the device compliance and acceptability of the musical beats with the pediatric population. The device accuracy in identifying heel strikes is 97.44% (95% CI 96.31, 98.88%). The subjects did not show any hesitation to put on the device and the sound feedback motivated them to move. Based on this pilot study, a minimum age limit of 5 years is appropriate and the intervention study should be conducted for no more than 30 min per week. The pilot study showed that a main study can be conducted to test auditory feedback as an intervention to promote motor learning in children who have cerebral palsy. No adverse event or safety issues were reported in the feasibility study.

The influence of heel height on sagittal plane knee kinematics during landing tasks in recreationally active and athletic collegiate females.

PubMed

Lindenberg, Kelly M; Carcia, Christopher R; Phelps, Amy L; Martin, Robroy L; Burrows, Anne M

2011-09-01

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

Pollinators of the Rocky Mountain columbine: temporal variation, functional groups and associations with floral traits

PubMed Central

Brunet, Johanne

2009-01-01

Background and Aims Pollinators together with other biotic and some abiotic factors can select for floral traits. However, variation in pollinator abundance over time and space can weaken such selection. In the present study, the variation in pollinator abundance over time and space was examined in populations of the Rocky Mountain columbine. The variation in three floral traits is described and correlations between pollinator type, functional pollinator groups or altitude and floral traits are examined. Methods Pollinator observations took place in six Aquilegia coerulea populations over 1–4 years and spur length, flower colour and sepal length were measured in 12 populations. Pollinator abundance, measured as visits per flower per hour, was compared among populations and years. Pollinators were grouped into two functional groups: pollen or nectar collectors. The following associations were examined: annual presence of hawkmoths and whiter flowers with longer spurs; the presence of Sphinx vashti and longer spurs; and higher altitudes and whiter flowers. The study looked at whether an increase in the proportion of hawkmoths in a population was associated with whiter and larger flowers with longer spurs. Key Results The abundance of different pollinator groups varied over time and space. Floral traits varied among populations. Higher altitude was correlated with bluer flowers. Whiter flowers were associated with the annual presence of hawkmoths. Populations visited by Sphinx vashti had longer spurs than populations visited only by Hyles lineata. Populations with greater percentage of nectar-collecting pollinators did not have whiter, larger flowers with longer spurs. Conclusions Despite the large variation in pollinator abundance over time and space, one species of bumble-bee or hawkmoth tended to predominate in each population each year. Future studies of Aquilegia coerulea should examine the specific influences of pollinators and the environment on flower colour and of hawkmoth species on spur length. PMID:19414518

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.

PubMed

Ohlsson, Arne; Shah, Prakeshkumar S

2015-06-25

Newborn infants have the ability to experience pain. Newborns treated in neonatal intensive care units are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests. Primary objectiveTo determine the efficacy and safety of paracetamol for the prevention or treatment of procedural/postoperative pain or pain associated with clinical conditions in neonates. Secondary objectiveTo review the effects of various doses and routes of administration (enteral, intravenous or rectal) of paracetamol for the prevention or treatment of pain in neonates. We designed the main comparisons according to intention of use, that is, paracetamol for prevention or treatment of pain. We included separate comparisons based on the painful intervention/procedure/condition (heel lance, insertion of nasogastric tube, insertion of intravenous catheter, lumbar puncture, assisted vaginal birth, postoperative pain, birth trauma, congenital anomalies such as myelomeningocoele and open cutaneous lesions) and the mode of administration of paracetamol. Within these comparisons, we planned to assess in subgroups (when possible) effects based on postmenstrual age (PMA) at the birth of randomly assigned infants (< 28 weeks, 28 weeks to 31 + 6 weeks, 32 weeks to 36 + 6 weeks and ≥ 37 weeks) or based on birth weight (or current weight) categories (≤ 1000 grams, 1001 to 1500 grams, 1501 to 2500 grams and ≥ 2501 grams) We used the standard search strategy of the Cochrane Neonatal Review Group including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (October 2014), MEDLINE (1966 to October 2014), EMBASE (1980 to October 2014) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to October 2014). We applied no language restrictions.We conducted electronic searches of abstracts from meetings of the Pediatric Academic Societies (2000 to 2014) and the Perinatal Society of Australia and New Zealand (2010 to 2014).We searched clinical trial registries for ongoing trials and the Web of Science for articles quoting identified randomised controlled trials. We searched the first 200 hits on Google Scholar(TM) to identify grey literature. We included randomised and quasi-randomised controlled trials of paracetamol for the prevention or treatment of pain in neonates (≤ 30 days of age). Two review authors independently extracted data from the full-text articles using a specifically designed form. We used this form to decide trial inclusion/exclusion, to extract data from eligible trials and to request additional published information from authors of the original reports. We entered and cross-checked data using RevMan 5.3.3 software. When noted, we resolved differences by mutual discussion and consensus. We included eight trials with low risk of bias, which assessed paracetamol use for the treatment of pain in 614 infants. Painful interventions studied included heel lance, assisted vaginal birth, eye examination for ascertainment of retinopathy of prematurity (ROP) and postoperative care following major surgery. Results of individual studies could not be combined in meta-analyses as the painful conditions, the use of paracetamol and comparison interventions and the outcome measures differed. Paracetamol compared with water, cherry elixir or EMLA cream did not significantly reduce pain following heel lance. The Premature Infant Pain Profile score (PIPP) within three minutes following lancing was higher in the paracetamol group than in the oral glucose group (mean difference (MD) 2.21, 95% confidence interval (CI) 0.72 to 3.70; one study, 38 infants). Paracetamol did not reduce "modified facies scores" after assisted vaginal birth (one study, 119 infants). In another study (n = 123), the Échelle de Douleur et d'Inconfort du Nouveau-Né score at two hours of age was significantly higher in the group that received paracetamol suppositories than in the placebo suppositories group (MD 1.00, 95% CI 0.60 to 1.40). In that study, when infants were subjected to a heel lance at two to three days of age, Bernese Pain Scale for Neonates scores were higher in the paracetamol group than in the placebo group, and infants spent a longer time crying (MD 19 seconds, 95% CI 14 to 24). For eye examinations, no significant reduction in PIPP scores in the first or last 45 seconds of eye examination was reported, nor at five minutes after the eye examination. In one study (n = 81), the PIPP score was significantly higher in the paracetamol group than in the 24% sucrose group (MD 3.90, 95% CI 2.92 to 4.88). For postoperative care following major thoracic or abdominal surgery, the total amount of morphine (µg/kg) administered over 48 hours was significantly less among infants randomly assigned to the paracetamol group than in those randomly assigned to the morphine group (MD -157 µg/kg, 95% CI -27 to -288). No adverse events were noted in any study. Paracetamol does not significantly reduce pain associated with heel lance or eye examinations. Paracetamol given after assisted vaginal birth may increase the response to later painful exposures. Paracetamol should not be used for painful procedures given its lack of efficacy and its potential for adverse effects. Paracetamol may reduce the total need for morphine following major surgery, and for this aspect of paracetamol use, further research is needed.

Achilles' death: anatomical considerations regarding the most famous trauma of the Trojan War.

PubMed

Anagnostopoulou, Sophia; Mavridis, Ioannis

2013-03-01

In Greek mythology, Achilles was a hero of the Trojan War, the central character and greatest warrior of Homer's Iliad. As Achilles died because of a small wound on his heel, the term "Achilles' heel" has come to mean a person's principal weakness. But is the human heel a really vulnerable part of our body? Could a non-poisonous arrow have caused Achilles' death? Should an arrow be necessarily poisonous in order to cause a lethal heel would? The purpose of this effort is to explain, from an anatomic point of view, how Achilles heel wounding could have led to his death. The Achilles tendon is the strongest, largest and thickest tendon in the human body and plays an important role in the biomechanics of the lower extremity. The blood supply of the tendon is from the peroneal and posterior tibial arteries. It is quite likely that the arrow which killed Achilles was poisoned. This supposition could be of course enough to cause his death. In case the arrow was not poisoned a rupture of the posterior tibial artery by the arrow could have caused a bleeding, but it seems unlikely for such a bleeding to be lethal. Moreover, a combination of these two theories could have also taken place, i.e. a poisoned arrow traumatizing the posterior tibial artery and hence causing rapid diffusion of the poison as well as bleeding. Furthermore, infectious and/or immunologic bases regarding Achilles' death could be considered. In our opinion, a poisoned arrow was probably the crucial factor leading to the famous inglorious death of this famous glorious Homeric hero.

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

PubMed

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

2015-01-01

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. 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. 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. 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. The Australian New Zealand Clinical Trials Registry ACTRN12612000463875.

Pneumatic bracing and total contact casting have equivocal effects on plantar pressure relief.

PubMed

Hartsell, H D; Fellner, C; Saltzman, C L

2001-06-01

The purpose was to examine and compare plantar pressures produced in healthy subjects while wearing a running shoe (RS), total contact cast (TCC) and 'customized' pneumatic pre-fabricated walking brace (PWB). A repeated measures design was used to compare the plantar pressures recorded for three footwear types (RS, TCC, PWB) in two body regions (forefoot, heel). Nine healthy subjects walked at a self-selected walking pace on a motorized treadmill while wearing the RS, TCC and PWB (ordered randomization). Following a five-minute acclimatization period on the treadmill with each footwear device, plantar pressures were recorded from 84 constant gait speed and step length steps using the Pedar system of in-shoe array of capacitive sensors embedded in an insert. Mean spatially averaged peak plantar pressures were recorded for the metatarsal heads and heel region for each footwear device worn by each subject. A two-way analysis of variance with repeated measures and post-hoc Tukey tests analysed the data with a significance level of p=.05. The main effects of footwear (p=.005) and body region (p=.000), and interaction effect (body region x footwear device) (p=.000) were significant. Unloading of the forefoot was 63.72% and 58.77% for the TCC and PWB, respectively, whereas loading under the heel was increased 37.09% and 34.11% for the same two devices, respectively. Patients who develop neuropathic plantar ulcers in the forefoot region, but not in the heel region, may benefit from a reduction in plantar pressures by using either the TCC or a 'customized' PWB. An alternative footwear device still needs to be found for those patients with heel ulceration.

Parkinsonian abnormality of foot strike: a phenomenon of ageing and/or one responsive to levodopa therapy?

PubMed Central

Hughes, J R; Bowes, S G; Leeman, A L; O'Neill, C J; Deshmukh, A A; Nicholson, P W; Dobbs, S M; Dobbs, R J

1990-01-01

1. Normally during walking, the heel strikes the ground before the forefoot. Abnormalities of foot strike in idiopathic Parkinson's disease may be amenable to therapy: objective measurements may reveal response which is not clinically apparent. Occult changes in foot strike leading to instability may parallel the normal, age-related loss of striatal dopamine. 2. The nature of foot strike was studied using pedobarography in 160 healthy volunteers, aged 15 to 91 years. Although 16% of strikes were made simultaneously by heel and forefoot, there were no instances of the forefoot preceding the heel. No significant effect of age on an index of normality of foot strikes was detected (P greater than 0.3). 3. The effect on foot strike of substituting placebo for a morning dose of a levodopa/carbidopa combination was studied in a double-blind, cross-over trial in 14 patients, aged 64 to 88 years, with no overt fluctuations in control of their idiopathic Parkinson's disease in relation to dosing. On placebo treatment there was a highly significant (P = 0.004) reduction in the number of more normal strikes, i.e. heel strikes plus simultaneous heel and forefoot strikes. The effect appeared unrelated to the corresponding difference between active and placebo treatments in plasma concentration of levodopa or a metabolite of long half-time, 3-O-methyldopa (3OMD). However, it correlated negatively (P less than 0.05) with the mean of the 3OMD concentrations. 4. It appears that some abnormalities of foot strike due to Parkinson's disease are reversible. Employing test conditions, designed to provoke abnormalities of foot strike, might be useful in screening for pre-clinical Parkinson's disease. PMID:2306409

Vertical Jump Height Estimation Algorithm Based on Takeoff and Landing Identification Via Foot-Worn Inertial Sensing.

PubMed

Wang, Jianren; Xu, Junkai; Shull, Peter B

2018-03-01

Vertical jump height is widely used for assessing motor development, functional ability, and motor capacity. Traditional methods for estimating vertical jump height rely on force plates or optical marker-based motion capture systems limiting assessment to people with access to specialized laboratories. Current wearable designs need to be attached to the skin or strapped to an appendage which can potentially be uncomfortable and inconvenient to use. This paper presents a novel algorithm for estimating vertical jump height based on foot-worn inertial sensors. Twenty healthy subjects performed countermovement jumping trials and maximum jump height was determined via inertial sensors located above the toe and under the heel and was compared with the gold standard maximum jump height estimation via optical marker-based motion capture. Average vertical jump height estimation errors from inertial sensing at the toe and heel were -2.2±2.1 cm and -0.4±3.8 cm, respectively. Vertical jump height estimation with the presented algorithm via inertial sensing showed excellent reliability at the toe (ICC(2,1)=0.98) and heel (ICC(2,1)=0.97). There was no significant bias in the inertial sensing at the toe, but proportional bias (b=1.22) and fixed bias (a=-10.23cm) were detected in inertial sensing at the heel. These results indicate that the presented algorithm could be applied to foot-worn inertial sensors to estimate maximum jump height enabling assessment outside of traditional laboratory settings, and to avoid bias errors, the toe may be a more suitable location for inertial sensor placement than the heel.

ICPP tank farm closure study. Volume 2: Engineering design files

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-02-01

Volume 2 contains the following topical sections: Tank farm heel flushing/pH adjustment; Grouting experiments for immobilization of tank farm heel; Savannah River high level waste tank 20 closure; Tank farm closure information; Clean closure of tank farm; Remediation issues; Remote demolition techniques; Decision concerning EIS for debris treatment facility; CERCLA/RCRA issues; Area of contamination determination; Containment building of debris treatment facility; Double containment issues; Characterization costs; Packaging and disposal options for the waste resulting from the total removal of the tank farm; Take-off calculations for the total removal of soils and structures at the tank farm; Vessel off-gas systems; Jet-groutedmore » polymer and subsurface walls; Exposure calculations for total removal of tank farm; Recommended instrumentation during retrieval operations; High level waste tank concrete encasement evaluation; Recommended heavy equipment and sizing equipment for total removal activities; Tank buoyancy constraints; Grout and concrete formulas for tank heel solidification; Tank heel pH requirements; Tank cooling water; Evaluation of conservatism of vehicle loading on vaults; Typical vault dimensions and approximately tank and vault void volumes; Radiological concerns for temporary vessel off-gas system; Flushing calculations for tank heels; Grout lift depth analysis; Decontamination solution for waste transfer piping; Grout lift determination for filling tank and vault voids; sprung structure vendor data; Grout flow properties through a 2--4 inch pipe; Tank farm load limitations; NRC low level waste grout; Project data sheet calculations; Dose rates for tank farm closure tasks; Exposure and shielding calculations for grout lines; TFF radionuclide release rates; Documentation of the clean closure of a system with listed waste discharge; and Documentation of the ORNL method of radionuclide concentrations in tanks.« less

Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial.

PubMed

Moghtaderi, Alireza; Khosrawi, Saeid; Dehghan, Farnaz

2014-01-01

Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone. The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session. Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group. The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

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. Copyright © 2011 Elsevier Ltd. All rights reserved.

12. VIEW OF SWITCHES AND SPURS FROM NEAR EAST END ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. VIEW OF SWITCHES AND SPURS FROM NEAR EAST END OF CEDAR MILL CREEK TRESTLE NEAR MERLO ROAD, FACING SOUTHEAST - Oregon Electric Railway Westside Corridor, Between Watson & 185th Avenues, Beaverton, Washington County, OR

Interlocking-based attachment during locomotion in the beetle Pachnoda marginata (Coleoptera, Scarabaeidae)

PubMed Central

Bußhardt, Philipp; Kunze, Daniel; Gorb, Stanislav N.

2014-01-01

The attachment function of tibial spurs and pretarsal claws in the beetle Pachnoda marginata (Coleoptera, Scarabaeidae) during locomotion was examined in this study. First, we measured the angle, at which the beetles detached from substrates with different roughness. At a surface roughness of 12 μm and higher, intact animals were able to cling to a completely tilted platform (180°). Second, we estimated the forces the beetles could exert in walking on smooth and rough cylinders of different diameters, on a plane and also between two plates. To elucidate the role of the individual structures, we ablated them consecutively. We found tibial spurs not to be in use in walking on flat substrates. On some of the curved substrates, ablation of tibial spurs caused an effect. A clear effect of tibial spurs was revealed in walking between two plates. Thus, these structures are probably used for generating propulsion in narrowed spaces. PMID:25385502

Surface fatigue life of CBN and vitreous ground carburized and hardened AISI 9310 spur gears

NASA Technical Reports Server (NTRS)

Townsend, Dennis P.; Patel, P. R.

1988-01-01

Spur gear surface endurance tests were conducted to investigate CBN ground AISI 9310 spur gears for use in aircraft applications, to determine their endurance characteristics and to compare the results with the endurance of standard vitreous ground AISI 9310 spur gears. Tests were conducted with VIM-VAR AISI 9310 carburized and hardened gears that were finish ground with either CBN or vitreous grinding methods. Test conditions were an inlet oil temeprature of 320 K (116 F), an outlet oil temperature of 350 K (170 F), a maximum Hertz stress of 1.71 GPa (248 ksi), and a speed of 10,000 rpm. The CBN ground gears exhibited a surface fatigue life that was slightly better than the vitreous ground gears. The subsurface residual stress of the CBN ground gears was approximately the same as that for the standard vitreous ground gears for the CBN grinding method used.

Task-specific recruitment of motor units for vibration damping.

PubMed

Wakeling, James M; Liphardt, Anna-Maria

2006-01-01

Vibrations occur within the soft tissues of the lower extremities due to the heel-strike impact during walking. Increases in muscle activity in the lower extremities result in increased damping to reduce this vibration. The myoelectric intensity spectra were compared using principal component analysis from the tibialis anterior and lateral gastrocnemius of 40 subjects walking with different shoe conditions. The soft insert condition resulted in a significant, simultaneous increase in muscle activity with a shift to higher myoelectric frequencies in the period 0-60 ms after heel-strike which is the period when the greater vibration damping occurred. These increases in myoelectric frequency match the spectral patterns which indicate increases in recruitment of faster motor units. It is concluded that fast motor units are recruited during the task of damping the soft-tissue resonance that occurs following heel-strike.

Maternal dietary intake and pregnancy outcome.

PubMed

Ferland, Suzanne; O'Brien, Huguette Turgeon

2003-02-01

To study the relationship between maternal diet and infant anthropometric measurements in 56 women, aged 28 +/- 5.1 years, with singleton pregnancies. The overall quality of the diet (three 24-hour recalls), including supplementation, was evaluated at 34 +/- 1.3 weeks using a total mean adequacy ratio (TMAR) of 12 nutrients. Specific interviewing techniques were used to minimize social desirability bias. Anthropometric measurements of both parents and maternal lifestyle practices were also obtained. Infant weight, crown-heel length and head circumference were measured 14.6 +/- 4.4 days after birth. Stepwise multiple regression analysis revealed that maternal diet quality (TMAR) was significantly related to infant weight (r = .039, P = .036) and crown-heel length (r = .071, P = .007). Other significant predictors included gestational age, maternal height, sex, smoking and physical activity. Maternal diet was positively associated with infant weight and crown-heel length.

miRNA and Degradome Sequencing Reveal miRNA and Their Target Genes That May Mediate Shoot Growth in Spur Type Mutant “Yanfu 6”

PubMed Central

Song, Chunhui; Zhang, Dong; Zheng, Liwei; Zhang, Jie; Zhang, Baojuan; Luo, Wenwen; Li, Youmei; Li, Guangfang; Ma, Juanjuan; Han, Mingyu

2017-01-01

The spur-type growth habit in apple trees is characterized by short internodes, increased number of fruiting spurs, and compact growth that promotes flowering and facilitates management practices, such as pruning. The molecular mechanisms responsible for regulating spur-type growth have not been elucidated. In the present study, miRNAs and the expression of their potential target genes were evaluated in shoot tips of “Nagafu 2” (CF) and spur-type bud mutation “Yanfu 6” (YF). A total of 700 mature miRNAs were identified, including 202 known apple miRNAs and 498 potential novel miRNA candidates. A comparison of miRNA expression in CF and YF revealed 135 differentially expressed genes, most of which were downregulated in YF. YF also had lower levels of GA, ZR, IAA, and ABA hormones, relative to CF. Exogenous applications of GA promoted YF shoot growth. Based on the obtained results, a regulatory network involving plant hormones, miRNA, and their potential target genes is proposed for the molecular mechanism regulating the growth of YF. miRNA164, miRNA166, miRNA171, and their potential targets, and associated plant hormones, appear to regulate shoot apical meristem (SAM) growth. miRNA159, miRNA167, miRNA396, and their potential targets, and associated plant hormones appear to regulate cell division and internode length. This study provides a foundation for further studies designed to elucidate the mechanism underlying spur-type apple architecture. PMID:28424721

How do patient demographics, time-related variables, reasons for cancellation, and clinical procedures affect frequency of same-day operating room surgery cancelation? A maximum likelihood method.

PubMed

Da'ar, Omar B; Al-Mutairi, Talal

2018-06-15

Cancelation of same-day surgery is a common global problem, wasting valuable hospitals' operating room (OR) times and imposing significant economic costs. There is limited evidence to support the association between frequency of same-day surgery cancelation and patient demographics, time-related variables, healthcare provider reasons for cancelation, and clinical procedures in Saudi Arabia. The aim of this study was to explore this relationship, providing an understanding of the local context. A retrospective cross-sectional study that retrieved medical records to examine the association between the frequency of same-day surgery cancelation and covariates including patient demographics, time-related variables, healthcare provider reason for cancelation, and clinical procedures. The data covered from January 2014 to December 2014 at King Fahad National Guard Hospital in Riyadh. We considered 440 patients that met the inclusion criteria for final analysis. The cancelation was regarded less frequent if a patient canceled once in the12 months and more frequent if a patient canceled two times or more in the same period. We used descriptive statistics to summarize data and employed a probit regression to estimate the association of frequency of same-day surgery cancelation and covariates via maximum likelihood method. King Abdullah International Medical Research Center granted the institutional approval. Our study suggests that while reasons of unavailability of OR time were associated with less frequent same-day surgery cancelation, scheduling issues were linked to more frequent cancelations, compared with reasons for patients being unwell on the day of surgery. Waiting time of more than six hours and morning sessions were associated with less frequent cancelations compared to shorter waiting time and afternoon sessions. Compared to general procedures, specialized clinical procedures were associated with cancelations that are more frequent. Further, female patients were more likely to have more cancelations. Finally, being married was associated with the less frequent cancelation of same-day surgery. Our findings provide evidence of determinants of the frequency of same-day surgery cancelations. This study draws several important implications for hospitals, especially on optimal utilization of resources and minimization of same-day surgery cancellations. The study also offers several recommendations that we believe will spur future research.

TARDEC FIXED HEEL POINT (FHP): DRIVER CAD ACCOMMODATION MODEL VERIFICATION REPORT

DTIC Science & Technology

2017-11-09

SUPPLEMENTARY NOTES N/A 14. ABSTRACT Easy-to-use Computer-Aided Design (CAD) tools, known as accommodation models, are needed by the ground vehicle... designers when developing the interior workspace for the occupant. The TARDEC Fixed Heel Point (FHP): Driver CAD Accommodation Model described in this...is intended to provide the composite boundaries representing the body of the defined target design population, including posture prediction

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.

Measurer’s Handbook: US Army and Marine Corps Anthropometric Surveys, 2010-2011

DTIC Science & Technology

2011-08-01

Circumference Ankle Circumference Heel Ankle Circumference Ball of Foot Circumference Bimalleolar Breadth Heel Breadth Lateral Malleolus Height...will be asked to put on a stocking from ankle to knee to compress the hair to prevent scan distortion. For all participants, sanitary protective...malleolus (outside ankle bone). Knee point, anterior - the most protruding point of the right kneecap of a seated participant. Medial malleolus - the

Effect of selected exercises on in-shoe plantar pressures in people with diabetes and peripheral neuropathy

PubMed Central

Shah, Kshamata M.; Mueller, Michael J.

2012-01-01

BACKGROUND In people with diabetes and peripheral neuropathy (DM+PN), injury risk is not clearly known for weight bearing (WB) vs. non-weight bearing (NWB) exercise. In-shoe peak plantar pressures (PPP) often are used as a surrogate indicator of injury to the insensitive foot. OBJECTIVE Compare PPPs in people with DM+PN during selected WB and NWB exercises. METHODS 15 subjects with DM+PN participated. PPPs were recorded for the forefoot, midfoot, and heel during level walking and compared to; WB exercises - treadmill walking, heel and toe raises, sit to stands, stair climbing, single leg standing; and NWB exercises - stationary bicycling, balance ball exercise and plantar flexion exercise. RESULTS Compared to level walking; mean forefoot PPP during treadmill walking was 13% higher, but this difference was eliminated when walking speed was used as a covariate. Mean PPPs were similar or substantially lower for other exercises, except for higher forefoot PPP with heel raise exercises. CONCLUSIONS Slow progression and regular monitoring of insensitive feet are recommended for all exercises, but especially for heel raises, and increases in walking speed. The remaining WB and NWB exercises pose no greater risk to the insensitive foot due to increases in PPP compared to level walking. PMID:22677098

Experimental and model-based analysis of differences in perception of cutaneous electrical stimulation across the sole of the foot.

PubMed

Frahm, Ken Steffen; Mørch, Carsten Dahl; Grill, Warren M; Andersen, Ole Kæseler

2013-09-01

During electrocutaneous stimulations, variation in skin properties across locations can lead to differences in neural activation. However, little focus has been given to the effect of different skin thicknesses on neural activation. Electrical stimulation was applied to six sites across the sole of the foot. The intensities used were two and four times perception threshold. The subjects (n = 8) rated the perception quality and intensity using the McGill Pain Questionnaire and a visual analog scale (VAS). A finite element model was developed and combined with the activation function (AF) to estimate neural activation. Electrical stimulation was perceived as significantly less sharp at the heel compared to all other sites, except one site in the forefoot (logistic regression, p < 0.05). The VAS scores were significantly higher in the arch than at the heel (RM ANOVA, p < 0.05). The model showed that the AF was between 91 and 231 % higher at the five other sites than at the heel. The differences in perception across the sole of the foot indicated that the CNS received different inputs depending on the stimulus site. The lower AF at the heel indicated that the skin thicknesses could contribute to the perceived differences.

Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy.

PubMed

Willerslev-Olsen, Maria; Lorentzen, Jakob; Nielsen, Jens Bo

2014-01-01

Foot drop and toe walking are frequent concerns in children with cerebral palsy (CP). Increased stiffness of the ankle joint muscles may contribute to these problems. Does four weeks of daily home based treadmill training with incline reduce ankle joint stiffness and facilitate heel strike in children with CP? Seventeen children with CP (4-14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied stretches below and above reflex threshold. Gait kinematics were recorded by 3-D video-analysis during treadmill walking. Foot pressure was measured by force-sensitive foot soles during treadmill and over-ground walking. Children with increased passive stiffness showed a significant reduction in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking. Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP.

Effect of Breast-Feeding and Maternal Holding in Relieving Painful Responses in Full-Term Neonates: A Randomized Clinical Trial.

PubMed

Obeidat, Hala M; Shuriquie, Mona A

2015-01-01

This randomized clinical trial was conducted to determine the efficacy of breast-feeding with maternal holding as compared with maternal holding without breast-feeding in relieving painful responses during heel lance blood drawing in full-term neonates. A convenience sample of 128 full-term newborn infants, in their fourth to sixth days of life, undergoing heel lance blood drawing for screening of hypothyroidism were included in the study. The neonates were randomly assigned into 2 equivalent groups. During heel lance blood drawing for infants, they either breast-fed with maternal holding (group I) or were held in their mother's lap without breast-feeding (group II). The painful responses were assessed simultaneously by 2 neonatal nurses blinded to the purpose of the study. Outcome measures for painful responses of the full-term neonates were evaluated with the Premature Infant Pain Profile scale. Independent t test showed significant differences in Premature Infant Pain Profile scale scores among the 2 groups (t = -8.447, P = .000). Pain scores were significantly lower among infants who were breast-fed in addition to maternal holding. Evidence from this study indicates that the combination of breast-feeding with maternal holding reduces painful responses of full-term infants during heel lance blood drawing.

Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes.

PubMed

Bates-Jensen, Barbara M; McCreath, Heather E; Nakagami, Gojiro; Patlan, Anabel

2018-04-01

We examined subepidermal moisture (SEM) and visual skin assessment of heel pressure injury (PrI) among 417 nursing home residents in 19 facilities over 16 weeks. Participants were older (mean age 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, 21% Hispanic), and at risk for PrI (mean Braden Scale Risk score = 15.6). Blinded concurrent visual assessments and SEM measurements were obtained at heels weekly. Visual skin damage was categorised as normal, erythema, stage 1 PrI, deep tissue injury (DTI) or stage 2 or greater PrI. PrI incidence was 76%. Off-loading occurred with pillows (76% of residents) rather than heel boots (21%) and often for those with DTI (91%). Subepidermal moisture was measured with a device where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with normal skin values significantly different from values in the presence of skin damage. Subepidermal moisture was associated with concurrent damage and damage 1 week later in generalised multinomial logistic models adjusting for age, diabetes and function. Subepidermal moisture detected DTI and differentiated those that resolved, remained and deteriorated over 16 weeks. Subepidermal moisture may be an objective method for detecting PrI. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

17. VIEW OF SETTLING BASIN, SHOWING FLUME TRACK SPUR CROSSING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. VIEW OF SETTLING BASIN, SHOWING FLUME TRACK SPUR CROSSING OVER SETTLING BASIN, SPARE BENT MATERIAL IN RIGHT-HAND FOREGROUND, BYPASS FLUME, AND SHACK #6 IN BACKGROUND, LOOKING NORTHWEST - Electron Hydroelectric Project, Along Puyallup River, Electron, Pierce County, WA

Telephoto lens view of Silver Spur in the Hadley Delta region from Apollo 15

NASA Technical Reports Server (NTRS)

1971-01-01

A telephoto lens view of the prominent feature called Silver Spur in the Hadley Delta region, photographed during the Apollo 15 lunar surface extravehicular activity at the Hadley-Apennine landing site. The distance from the camera to the spur is about 10 miles. The field of view across the bottom is about one mile. Structural formations in the mountain are clearly visible. There are two major units. The upper unit is characterized by massive subunits, each one of which is approximately 200 feet deep. The lower major unit is characterized by thinner bedding and cross bedding.

An analytical method to predict efficiency of aircraft gearboxes

NASA Technical Reports Server (NTRS)

Anderson, N. E.; Loewenthal, S. H.; Black, J. D.

1984-01-01

A spur gear efficiency prediction method previously developed by the authors was extended to include power loss of planetary gearsets. A friction coefficient model was developed for MIL-L-7808 oil based on disc machine data. This combined with the recent capability of predicting losses in spur gears of nonstandard proportions allows the calculation of power loss for complete aircraft gearboxes that utilize spur gears. The method was applied to the T56/501 turboprop gearbox and compared with measured test data. Bearing losses were calculated with large scale computer programs. Breakdowns of the gearbox losses point out areas for possible improvement.

Drivers of epibenthic megafaunal composition in the sponge grounds of the Sackville Spur, northwest Atlantic

NASA Astrophysics Data System (ADS)

Beazley, Lindsay; Kenchington, Ellen; Yashayaev, Igor; Murillo, Francisco Javier

2015-04-01

Deep-water sponges are considered ecosystem engineers, and the presence of large aggregations of these organisms, commonly referred to as sponge grounds, is associated with enhanced biodiversity and abundance of epibenthic fauna compared to non-sponge habitat. However, the degree and magnitude to which the presence of these sponge grounds elicits large changes in composition of the associated megafaunal community remains unknown. Here we identify the external drivers of epibenthic megafaunal community composition and explore the patterns and magnitude of compositional change in the megafaunal community within the sponge grounds of the Sackville Spur, northwest Atlantic. Epibenthic megafauna were quantified from five image transects collected on the Sackville Spur in 2009 between 1080 and 1723 m depth. Using Gradient Forest Modelling we found that the abundance of structure-forming sponges was the most important variable for predicting compositional patterns in the Sackville Spur megafaunal community, followed by depth, range in bottom current speed, in situ salinity, and longitude. Along the gradient in structure-forming sponge abundance, the largest turnover in megafaunal community composition occurred when the sponges reached 15 individuals m-2. Examination of the regional hydrographic conditions suggests that the dense sponge grounds of the Sackville Spur are associated with a warm, salty water mass that occurs between ~1300 and 1800 m.

Randomized controlled trial of accelerated rehabilitation versus standard protocol following surgical repair of ruptured Achilles tendon.

PubMed

Porter, Mark D; Shadbolt, Bruce

2015-05-01

There is no consensus regarding the optimal management of the acutely ruptured Achilles tendon (TA). Functional bracing alone achieves outcomes similar to those of surgical repair. Surgical repair combined with immediate mobilization may improve the clinical outcome further. The purpose of our study was to determine if an accelerated rehabilitation programme following surgical repair of the ruptured TA could improve clinical outcome, relative to the standard protocol. Patients with an acutely ruptured TA were randomly allocated to undergo an accelerated programme (AP) or standard programme (SP), following surgery. Outcome was assessed at 12 months post-surgery using the Achilles tendon Total Rupture Score (ATRS), the heel-raise height and the time taken to return to running. Fifty-one patients completed the study, 25 in the AP group and 26 in the SP group. At 12 months post-surgery, the ATRS results were similar in the two treatment groups (87.46 in AP with standard error (SE) of 0.735 versus 87.12 in SP with SE of 0.75) while the AP group had less lengthening of the TA (0.385 cm, SE 0.166 versus 1.00 cm, SE 0.169) and a more rapid return to running (17.231 weeks, SE 0.401 versus 21.08 weeks, SE 0.409), than the SP group. The accelerated rehabilitation programme resulted in less tendon lengthening, more rapid return to running, but similar ATRS relative to the standard rehabilitation. Immobilization following TA repair may prolong recovery. © 2014 Royal Australasian College of Surgeons.

Evaluation of Extended Wall OSB Sheathing Connection under Combined Uplift and Shear Loading for 24-inch Heel Trusses

Treesearch

Vladimir Kochkin; Andrew DeRenzis; Xiping Wang

2014-01-01

This study was designed to evaluate the performance of the extended wall structural panel connection in resisting combined uplift and shear forces at the roof-to-wall interface with a focus on a truss heel height of 24 in. to address the expected increases in the depth of attic insulation used in Climate Zones 5 and higher. Five full-size roof-wall assemblies were...

A Study of H-Reflexes in Subjects with Acute Ankle Inversion Injuries

DTIC Science & Technology

1996-12-09

stress to the injured ankle at heel- strike .(57) Any increased inversion stress by way of joint loading in the presence of compromised joint...the present study, may play a role in decreasing the degree of calcaneal inversion just prior to heel- strike and minimize the stress on the lateral...Presentation: * Significant edema/ecchymosis on lateral and medial aspects of ankle. * Possible pitting edema on forefoot (several days post- injury

Neuroprosthetics and Solutions for Restoring Sensorimotor Functions

DTIC Science & Technology

2009-01-01

in the stab wound control (A, C) and the 1-week implantation of the electrode (B, D). Striking neurofilament loss occurred surrounding both the stab...force. (Like in heel strike and toe of in normal gait cycle). (B) The Proof Test is a static test for foot ankle unit in which maximum load is...applied on heel and forefoot in one single time successively. Project 1. Develop a somatosensory neural interface (SSNI) -Completed pilot testing of

Leg Muscle Usage on Tibial Elasticity During Running

DTIC Science & Technology

2005-01-01

relative risk of forefoot versus heel- strike running. In summary, there is no evidence in the literature that either study arm is at more risk than...tested in TSF, or even studied in runners. These basic validation studies will determine if modulators of tibial stress, .such as heel- strike mechanics...the other for acute injuries, although it was agreed that forefoot runners will be periodically evaluated for injuries to the Achilles tendon. After

The relationship between foot pain, anthropometric variables and footwear among older people.

PubMed

Paiva de Castro, Alessandra; Rebelatto, José Rubens; Aurichio, Thaís Rabiatti

2010-01-01

To verify the prevalence of pain among older people when wearing shoes, and the relationships between foot pain, high-heeled shoes and anthropometric variables. Both feet of 227 older women and 172 older men were evaluated with respect to anthropometric variables, arch index and foot posture index. The participants were also asked about the presence of foot pain while wearing high-heeled shoes. The data were analyzed using the Chi-square test, Pearson's correlation, MANOVA, multiple regression analysis, t test, and analysis of probability. The prevalence of foot pain when wearing shoes was high and was associated with the female gender, however wearing high-heeled shoes was not associated with pain. The women with foot pain presented larger values for the circumferences of the metatarsal heads and the instep (after normalization with the foot length) than those without pain. The men with pain did not present different measurements from those without pain.

Selectively Lockable Knee Brace

NASA Technical Reports Server (NTRS)

Myers, W. Neill (Inventor); Shadoan, Michael D. (Inventor); Forbes, John C. (Inventor); Baker, Kevin J. (Inventor); Rice, Darron C. (Inventor)

1996-01-01

A knee brace for aiding in rehabilitation of damaged leg muscles includes upper and lower housings normally pivotable one relative to the other about the knee joint axis of a patient. The upper housing is attachable to the thigh of the patient above the knee joint while the lower housing is secured to a stirrup which extends downwardly along the patient's leg and is attached to the patient's shoe. An actuation rod is carried within the lower housing and is coupled to a cable. The upper and lower housings carry cooperative clutch/brake elements which normally are disengaged to permit relative movement between the upper and lower housings. When the cable is extended the clutch/brake elements engage and lock the housings together. A heel strike mechanism fastened to the stirrup and the heel of the shoe is connected to the cable to selectively extend the cable and lock the brace in substantially any position when the patient places weight on the heel.

Plantar fascia: imaging diagnosis and guided treatment.

PubMed

McNally, Eugene G; Shetty, Shilpa

2010-09-01

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

Robots in human biomechanics--a study on ankle push-off in walking.

PubMed

Renjewski, Daniel; Seyfarth, André

2012-09-01

In biomechanics, explanatory template models are used to identify the basic mechanisms of human locomotion. However, model predictions often lack verification in a realistic environment. We present a method that uses template model mechanics as a blueprint for a bipedal robot and a corresponding computer simulation. The hypotheses derived from template model studies concerning the function of heel-off in walking are analysed and discrepancies between the template model and its real-world anchor are pointed out. Neither extending the ground clearance of the swinging leg nor an impact reduction at touch-down as an effect of heel lifting was supported by the experiments. To confirm the relevance of the experimental findings, a comparison of robot data to human walking data is discussed and we speculate on an alternative explanation of heel-off in human walking, i.e. that the push-off powers the following leg swing.

Selectively lockable knee brace

NASA Technical Reports Server (NTRS)

Myers, Neill (Inventor); Shadoan, Mike (Inventor); Forbes, John (Inventor); Baker, Kevin (Inventor)

1994-01-01

A knee brace for aiding in rehabilitation of damaged leg muscles includes upper and lower housings, normally pivotable, one relative to the other about the knee joint axis of a patient. The upper housing is attachable to the thigh of the patient above the knee joint, while the lower housing is secured to a stirrup which extends downwardly along the patient's leg and is attached to the patient's shoe. An actuation rod is carried within the lower housing and is coupled to a cable. The upper and lower housings carry cooperative clutch/brake elements which normally are disengaged to permit relative movement between the upper and lower housings. When the cable is extended, the clutch/brake elements engage and lock the housings together. A heel strike mechanism fastened to the stirrup and the heel of the shoe is connected to the cable to selectively extend the cable and lock the brace in substantially any position when the patient places weight on the heel.

9. VIEW OF FLOOR 2 LOOKING EAST; SHOWS GREAT SPUR ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. VIEW OF FLOOR 2 LOOKING EAST; SHOWS GREAT SPUR WHEEL AND TWO STONE NUTS, AND THE CHUTES, HOPPERS, HORSES AND SHOES OF THE GRAIN FEED SYSTEM - Hook Windmill, North Main Street at Pantigo Road, East Hampton, Suffolk County, NY

5. VIEW OF THE LOCATION FOR A PROPOSED SPUR ROAD ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. VIEW OF THE LOCATION FOR A PROPOSED SPUR ROAD FROM KINGS CANYON ROAD TO THE PROPOSED HELICOPTER LANDING SITE #11. LOCATED AT MILEPOST 0.55, FACING NORTH 53ø EAST (53 ). - Kings Canyon Road, Carson City, Carson City, NV

West 73rd Street pedestrian underpass, with spur of old Miller ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

West 73rd Street pedestrian underpass, with spur of old Miller Highway, Trump Place towers in background, looking south. - Henry Hudson Parkway, Extending 11.2 miles from West 72nd Street to Bronx-Westchester border, New York County, NY

Procedure for Tooth Contact Analysis of a Face Gear Meshing With a Spur Gear Using Finite Element Analysis

NASA Technical Reports Server (NTRS)

Bibel, George; Lewicki, David G. (Technical Monitor)

2002-01-01

A procedure was developed to perform tooth contact analysis between a face gear meshing with a spur pinion using finite element analysis. The face gear surface points from a previous analysis were used to create a connected tooth solid model without gaps or overlaps. The face gear surface points were used to create a five tooth face gear Patran model (with rim) using Patran PCL commands. These commands were saved in a series of session files suitable for Patran input. A four tooth spur gear that meshes with the face gear was designed and constructed with Patran PCL commands. These commands were also saved in a session files suitable for Patran input. The orientation of the spur gear required for meshing with the face gear was determined. The required rotations and translations are described and built into the session file for the spur gear. The Abaqus commands for three-dimensional meshing were determined and verified for a simplified model containing one spur tooth and one face gear tooth. The boundary conditions, loads, and weak spring constraints were determined to make the simplified model work. The load steps and load increments to establish contact and obtain a realistic load was determined for the simplified two tooth model. Contact patterns give some insight into required mesh density. Building the two gears in two different local coordinate systems and rotating the local coordinate systems was verified as an easy way to roll the gearset through mesh. Due to limitation of swap space, disk space and time constraints of the summer period, the larger model was not completed.

Longitudinal study of iris concavity, corneal biomechanics, and correlations to ocular biometry in a cohort of 10- to 12-year-old UK schoolboys: 2-year follow-up data.

PubMed

Shah, Ameet; Lascaratos, Gerassimos; Garway-Heath, David F; Foster, Paul J; Barton, Keith

2014-06-10

To explore changes in iris curvature over a 2-year period. To investigate associations between iris curvature and ocular biometric parameters. To explore relationships between a number of nonocular measurements and ocular biometric parameters. Schoolboys enrolled 2 years previously were invited to return for anterior segment optical coherence tomography, corneal hysteresis (CH), corneal resistance factor (CRF), and axial biometric measurements. Refractive error was assessed and measures of height, weight, waist circumference, digit ratio, and percentage body fat taken. Mean spherical equivalent refraction reduced by 0.76 diopters and mean iris concavity, defined as a measurement of less than or equal to -0.1 mm, increased by 0.018 mm at distance fixation and 0.04 mm on accommodation. Compared with 2 years previously, the prevalence of iris concavity increased from 24% to 32% on distance fixation and from 65% to 84% on accommodation. Variables significantly associated with nonaccommodating iris curvature were anterior chamber depth (ACD, P = 0.029) and mean scleral spur angle (P = 0.0001). Variables significantly associated with accommodating iris curvature were ACD (P = 0.02), lens vault (P = 0.047), and scleral spur angle (P < 0.0001). Significant association was again found between CH and accommodating spur-to-spur distance (R(2) = 0.13, P = 0.007). Iris concavity was more prevalent in this cohort of schoolboys than 2 years earlier. The degree of concavity remains related to ACD and lens vault. The association between spur-to-spur distance and CH was similar at baseline and after 2 years. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

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

REVIEW OF ALTERNATIVE ENHANCED CHEMICAL CLEANING OPTIONS FOR SRS WASTE TANKS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hay, M.; Koopman, D.

2009-08-01

A literature review was conducted to support the Task Technical and Quality Assurance Plan for Alternative Enhanced Chemical Cleaning (AECC) for sludge heel removal funded as part of the EM-21 Engineering and Technology program. The goal was to identify potential technologies or enhancements to the baseline oxalic acid cleaning process for chemically dissolving or mobilizing Savannah River Site (SRS) sludge heels. The issues with the potentially large volume of oxalate solids generated from the baseline process have driven an effort to find an improved or enhanced chemical cleaning technology for the tank heels. This literature review builds on a previousmore » review conducted in 2003. A team was charged with evaluating the information in these reviews and developing recommendations of alternative technologies to pursue. The new information in this report supports the conclusion of the previous review that oxalic acid remains the chemical cleaning agent of choice for dissolving the metal oxides and hydroxides found in sludge heels in carbon steel tanks. The potential negative impact of large volumes of sodium oxalate on downstream processes indicates that the amount of oxalic acid used for chemical cleaning needs to be minimized as much as possible or the oxalic acid must be destroyed prior to pH adjustment in the receipt tank. The most straightforward way of minimizing the volume of oxalic acid needed for chemical cleaning is through more effective mechanical cleaning. Using a mineral acid to adjust the pH of the sludge prior to adding oxalic acid may also help to minimize the volume of oxalic acid used in chemical cleaning. If minimization of oxalic acid proves insufficient in reducing the volume of oxalate salts, several methods were found that could be used for oxalic acid destruction. For some waste tank heels, another acid or even caustic treatment (or pretreatment) might be more appropriate than the baseline oxalic acid cleaning process. Caustic treatment of high aluminum sludge heels may be appropriate as a means of reducing oxalic acid usage. Reagents other than oxalic acid may also be needed for removing actinide elements from the tank heels. A systems engineering evaluation (SEE) was performed on the various alternative chemical cleaning reagents and organic oxidation technologies discussed in the literature review. The objective of the evaluation was to develop a short list of chemical cleaning reagents and oxalic acid destruction methods that should be the focus of further research and development. The results of the SEE found that eight of the thirteen organic oxidation technologies scored relatively close together. Six of the chemical cleaning reagents were also recommended for further investigation. Based on the results of the SEE and plan set out in the TTQAP the following broad areas are recommended for future study as part of the AECC task: (1) Basic Chemistry of Sludge Dissolution in Oxalic Acid: A better understanding of the variables effecting dissolution of sludge species is needed to efficiently remove sludge heels while minimizing the use of oxalic acid or other chemical reagents. Tests should investigate the effects of pH, acid concentration, phase ratios, temperature, and kinetics of the dissolution reactions of sludge components with oxalic acid, mineral acids, and combinations of oxalic/mineral acids. Real waste sludge samples should be characterized to obtain additional data on the mineral phases present in sludge heels. (2) Simulant Development Program: Current sludge simulants developed by other programs for use in waste processing tests, while compositionally similar to real sludge waste, generally have more hydrated forms of the major metal phases and dissolve more easily in acids. Better simulants containing the mineral phases identified by real waste characterization should be developed to test chemical cleaning methods. (3) Oxalic Acid Oxidation Technologies: The two Mn based oxidation methods that scored highly in the SEE should be studied to evaluate long term potential. One of the AOP's (UV/O{sub 3}/Solids Separator) is currently being implemented by the SRS liquid waste organization for use in tank heel chemical cleaning. (4) Corrosion Issues: A program will be needed to address potential corrosion issues from the use of low molarity mineral acids and mixtures of oxalic/mineral acids in the waste tanks for short durations. The addition of corrosion inhibitors to the acids to reduce corrosion rates should be investigated.« less

New generation methods for spur, helical, and spiral-bevel gears

NASA Technical Reports Server (NTRS)

Litvin, F. L.; Tsung, W.-J.; Coy, J. J.; Handschuh, R. F.; Tsay, C.-B. P.

1986-01-01

New methods for generating spur, helical, and spiral-bevel gears are proposed. These methods provide the gears with conjugate gear tooth surfaces, localized bearing contact, and reduced sensitivity to gear misalignment. Computer programs have been developed for simulating gear meshing and bearing contact.

New generation methods for spur, helical, and spiral-bevel gears

NASA Technical Reports Server (NTRS)

Litvin, F. L.; Tsung, W.-J.; Coy, J. J.; Handschuh, R. F.; Tsay, C.-B. P.

1987-01-01

New methods for generating spur, helical, and spiral-bevel gears are proposed. These methods provide the gears with conjugate gear tooth surfaces, localized bearing contact, and reduced sensitivity to gear misalignment. Computer programs have been developed for simulating gear meshing and bearing contact.

76 FR 1532 - Determinations of Attainment by the Applicable Attainment Date for the Hayden, Nogales, Paul Spur...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-11

... indicated that we plan to address the PM 10 needs for Nogales and Paul Spur/Douglas areas over the next few... certain columns and rows and thereby causes a mismatch between concentrations and the corresponding years...

X-ray evidence of low-energy photon therapy for cervical lordosis restoration and radial head spur healing

NASA Astrophysics Data System (ADS)

Fitz-Ritson, Donald; Filonenko, Natalia; Salansky, Norman M.

1994-09-01

X rays were used for low energy photon therapy (LEPT) efficacy assessment for cervical lordosis restoration and radial head spur healing. Two cases, their evaluation, and treatment are discussed along with the follow-up results.

Workshop on Numerical Analysis of Human and Surrogate Response to Accelerative Loading

DTIC Science & Technology

2014-05-01

calcaneal fractures with high rates of amputation and poor outcome [1].The first body part in contact with the loading boundary is the heel fat pad...Laboratory • “Material Properties of the Human Heel Fat Pad Across Loading Rates” by Grigoris Grigoriadis, Nic Newell, Spyros Masouros, and Anthony Bull...and Micro/Sub-structural Details on the Fracture Response of Human Cortical Bones” by Tusit Weerasooriya, ARL • “Recent Developments in a

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.

Development of a Fitness-for-Duty Assessment Battery for Recovering Dismounted Warriors

DTIC Science & Technology

2014-04-07

pressure waves and can include injury to internal organs due to air pressure; secondary effects are due to objects that strike the victim, and tertiary...battery with a narrow stance ( knee to heel ) 3 lane configuration 1 target at a time, 10 targets total, targets appear at 75m; Targets appear at...balance himself due to the narrow base of support ( knee -to- heel ). 23 Figure 12. Phase 2: Mean (±SE

Is the foot striking pattern more important than barefoot or shod conditions in running?

PubMed

Shih, Yo; Lin, Kuan-Lun; Shiang, Tzyy-Yuang

2013-07-01

People have advocated barefoot running, claiming that it is better suited to human nature. Humans usually run barefoot using a forefoot strike and run shod using a heel strike. The striking pattern was thought to be a key factor that contributes to the benefit of barefoot running. The purpose of this study is to use scientific data to prove that the striking pattern is more important than barefoot or shod conditions for runners on running injuries prevention. Twelve habitually male shod runners were recruited to run under four varying conditions: barefoot running with a forefoot strike, barefoot running with a heel strike, shod running with a forefoot strike, and shod running with a heel strike. Kinetic and kinematic data and electromyography signals were recorded during the experiments. The results showed that the lower extremity can gain more compliance when running with a forefoot strike. Habitually shod runners can gain more shock absorption by changing the striking pattern to a forefoot strike when running with shoes and barefoot conditions. Habitually shod runners may be subject to injuries more easily when they run barefoot while maintaining their heel strike pattern. Higher muscle activity in the gastrocnemius was observed when running with a forefoot strike, which may imply a greater training load on the muscle and a tendency for injury. Copyright © 2013 Elsevier B.V. All rights reserved.

Foot strike patterns and collision forces in habitually barefoot versus shod runners.

PubMed

Lieberman, Daniel E; Venkadesan, Madhusudhan; Werbel, William A; Daoud, Adam I; D'Andrea, Susan; Davis, Irene S; Mang'eni, Robert Ojiambo; Pitsiladis, Yannis

2010-01-28

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

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.

Avoiding Pitfalls of Tibiotalocalcaneal Nail Malposition With Internal Rotation Axial Heel View.

PubMed

Callahan, Ryan; Juliano, Paul; Aydogan, Umur; Clayton, Justin

2018-04-01

Tibiotalocalcaneal (TTC) nails are often used for complex hind foot arthrodesis and deformity correction. The natural valgus alignment of the hindfoot creates a challenge to optimum placement of the guidewire and eventual nail with a straight or valgus-curved nail. Five fresh frozen cadavers were used for placement of a TTC guidewire with standard anterior-posterior (AP), lateral, and Harris axial heel views as a reference for proper placement. The limb was then rotated 15°, 30°, and 45° both internally and externally to evaluate the perceived amount of osseous purchase within the calcaneus. The TTC nail was then inserted and dissection was performed to demonstrate proximity of the nail to the sustentaculum tali and neurovascular structures. A 30° internal rotation Harris axial heel view demonstrated the most accurate representation of osseous purchase within the calcaneus with the guidewire and nail placement. When the guidewire was placed with standard imaging the nail was often ultimately placed in close proximity to the sustentaculum tali and neurovascular structures. Careful placement of the guidewire prior to reaming and nail placement should be undertaken to avoid neurovascular injury and to increase osseous purchase. For optimal guidewire placement, the authors suggest using appropriate anatomic landmarks and using a 30° internally rotated Harris axial heel view to verify correct placement. Level V: Expert opinion.

Morphological study on the pressure ulcer-like dermal lesions formed in the rat heel skin after transection of the sciatic nerves.

PubMed

Haba, Daijiro; Minami, Chie; Miyagawa, Miki; Arakawa, Takamitsu; Miki, Akinori

2017-01-01

Due to transection of bilateral sciatic nerves, pressure ulcer-like dermal lesion occurred in the hairy skin covering of the heel skin in almost all rats. In the present study, chronological changes of the rat heel skin after the transection were morphologically and immunohistochemically examined. In the heel skin, redness and swelling began by 3days after the operation, and open wound formed by 17days. At the redness and swelling stage, edema extensively occurred in the dermis. At the thickening stage, the epidermis at the pressed site became transiently thicker, and at the whitening stage, rapidly thinner. At these stages, the epidermis in the skin surrounding the pressed site became gradually thicker. At the yellow scar stage, the skin was covered only by necrotic tissues and horny layer. These layers were scratched during walking and turning, and the yellow scar stage became the open wound stage. Inflammatory reaction began at the thickening stage, and at the yellow scar and open wound stages, necrosis, infiltration of inflammatory cells and dilation of small blood vessels were observed. These morphological features are quite similar to those in the human pressure ulcer. These findings suggest that these dermal injuries could compare the human pressure ulcer for medical treatment and depressurization in future study. Copyright © 2016 Elsevier GmbH. All rights reserved.

Inertial Gait Phase Detection for control of a drop foot stimulator Inertial sensing for gait phase detection.

PubMed

Kotiadis, D; Hermens, H J; Veltink, P H

2010-05-01

An Inertial Gait Phase Detection system was developed to replace heel switches and footswitches currently being used for the triggering of drop foot stimulators. A series of four algorithms utilising accelerometers and gyroscopes individually and in combination were tested and initial results are shown. Sensors were positioned on the outside of the upper shank. Tests were performed on data gathered from a subject, sufferer of stroke, implanted with a drop foot stimulator and triggered with the current trigger, the heel switch. Data tested includes a variety of activities representing everyday life. Flat surface walking, rough terrain and carpet walking show 100% detection and the ability of the algorithms to ignore non-gait events such as weight shifts. Timing analysis is performed against the current triggering method, the heel switch. After evaluating the heel switch timing against a reference system, namely the Vicon 370 marker and force plates system. Initial results show a close correlation between the current trigger detection and the inertial sensor based triggering algorithms. Algorithms were tested for stairs up and stairs down. Best results are observed for algorithms using gyroscope data. Algorithms were designed using threshold techniques for lowest possible computational load and with least possible sensor components to minimize power requirements and to allow for potential future implantation of sensor system.

Evaluation of forelimb horseshoe characteristics of thoroughbreds racing on dirt surfaces.

PubMed

Gross, Diane K; Stover, Susan M; Hill, Ashley E; Gardner, Ian A

2004-07-01

To describe forelimb horseshoe characteristics of horses racing on dirt surfaces and determine whether these characteristics vary with region of California, season, horse characteristics, and race-related factors. 5,730 Thoroughbred racehorses. From June 17, 2000, to June 16, 2001, the characteristics of 1 forelimb horseshoe of horses that raced on dirt surfaces at 5 major racetracks in California were recorded. These characteristics included shoe type; toe grab height; and presence of a rim, pad, and heel traction devices (jar caulks, heel stickers, heel blocks, and special nails). Horse and race information was obtained from commercial records. One race/horse was randomly selected. 99% of forelimb horseshoes were aluminum racing plates, 35% had a pad, 23% had a rim, and 8% had a heel traction device. A toe grab was observed on 75% of forelimb horseshoes (14% very low [< or = 2 mm], 30% low [> 2 and < or = 4 mm], 30% regular [> 4 and < or = 6 mm], and 1% high [> 6 and < or = 8 mm]). Forelimb horseshoe characteristics varied with region of California, season, age and sex of the horse, race purse and distance, and track surface condition. Log-linear modeling revealed that all of these factors were significantly interrelated. Complex interrelationships among forelimb horseshoe characteristics and region, season, age and sex of the horse, and race-related factors need to be considered when evaluating the relationships between injury and horseshoe characteristics in Thoroughbred racehorses.

EMG and tibial shock upon the first attempt at barefoot running.

PubMed

Olin, Evan D; Gutierrez, Gregory M

2013-04-01

As a potential means to decrease their risk of injury, many runners are transitioning into barefoot running. Habitually shod runners tend to heel-strike (SHS), landing on their heel first, while barefoot runners tend to mid-foot or toe-strike (BTS), landing flat-footed or on the ball of their foot before bringing down the rest of the foot including the heel. This study compared muscle activity, tibial shock, and knee flexion angle in subjects between shod and barefoot conditions. Eighteen habitually SHS recreational runners ran for 3 separate 7-minute trials, including SHS, barefoot heel-strike (BHS), and BTS conditions. EMG, tibial shock, and knee flexion angle were monitored using bipolar surface electrodes, an accelerometer, and an electrogoniometer, respectively. A one-way MANOVA for repeated measures was conducted and several significant changes were noted between SHS and BTS, including significant increases in average EMG of the medial gastrocnemius (p=.05), average and peak tibial shock (p<.01), and the minimum knee flexion angle (p<.01). Based on our data, the initial change in mechanics may have detrimental effects on the runner. While it has been argued that BTS running may ultimately be less injurious, these data indicate that habitually SHS runners who choose to transition into a BTS technique must undertake the process cautiously. Copyright © 2012 Elsevier B.V. All rights reserved.

Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters.

PubMed

Giannotti, Erika; Merlo, Andrea; Zerbinati, Paolo; Longhi, Maria; Prati, Paolo; Masiero, Stefano; Mazzoli, Davide

2016-06-01

Equinovarus foot deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature. The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment. Retrospective observational cohort study. Inpatient rehabilitation clinic. Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years). A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient. All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, P<0.0001), becoming neutral at IC. Significant (P<0.05) variations were found for stride length, stride width, anterior step length of the affected side and for the duration of the double support phase of the contralateral side. The postsurgery ankle DF at St was found to be correlated (R=0.81, P<0.0001) with its pre-surgery value, thus being predictable. Weaker significant correlations were found for DF at Sw and DF at IC, where contribution from the dorsiflexor muscles is required in addition to calf muscle passive lengthening. An orthosis-assisted immediate rehabilitation associated with surgical procedure is safe and may be suitable to correct EVFD by restoring both the neutral heel foot-ground contact and the ankle DF peaks during stance and swing at one month from surgery. The proposed protocol is a safe and potentially useful rehabilitative approach after EVFD surgical correction in stroke patients.

NREL Achieves Solar-Electric Record

Science.gov Websites

Solar-Electric Record New Technology Could Spur Growth in Photovoltaic Panels For more information 2000, the photovoltaic industry increased production by 29 percent in the United States and 39 percent worldwide. In recent months the rising cost of fuels and the California power crisis have spurred an even

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

PubMed Central

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

2001-01-01

Objectives To study associations between patterns of physical activity and ultrasound attenuation by the heel bone in men and women. Design Cross sectional, population based study. Setting Norfolk. Participants 2296 men and 2914 women aged 45-74 registered with general practices participating in European Prospective Investigation into Cancer (EPIC Norfolk). Results Self reported time spent in high impact physical activity was strongly and positively associated with ultrasound attenuation by the heel bone, independently of age, weight, and other confounding factors. Men who reported participating in ⩾2 hours/week of high impact activity had 8.44 dB/MHz (95% confidence interval 4.49 to 12.40) or 9.5%, higher ultrasound attenuation than men who reported no activity of this type. In women, the difference in ultrasound attenuation between those reporting any high impact activity and those reporting none was 2.41 dB/MHz (0.45 to 4.37) or 3.4% higher. In women this effect was similar in size to that of an age difference of four years. Moderate impact activity had no effect. However, climbing stairs was strongly independently associated with ultrasound attenuation in women (0.64 dB/MHz (0.19 to 1.09) for each additional five flights of stairs). There was a significant negative association in women between time spent watching television or video and heel bone ultrasound attenuation, which decreased by 0.08 dB/MHz (0.02 to 0.14) for each additional hour of viewing a week. Conclusions High impact physical activity is independently associated with ultrasound attenuation by the heel bone in men and women. As low ultrasound attenuation has been shown to predict increased risk of hip fracture, interventions to promote participation in high impact activities may help preserve bone density and reduce the risk of fracture. However, in older people such interventions may be inappropriate as they could increase the likelihood of falls. PMID:11159572

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

Detection of normal plantar fascia thickness in adults via the ultrasonographic method.

PubMed

Abul, Kadir; Ozer, Devrim; Sakizlioglu, Secil Sezgin; Buyuk, Abdul Fettah; Kaygusuz, Mehmet Akif

2015-01-01

Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18-65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4-5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5-5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8-4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8-4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8-5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8-5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

Neuromuscular Characteristics of Individuals Displaying Excessive Medial Knee Displacement

PubMed Central

Padua, Darin A.; Bell, David R.; Clark, Micheal A.

2012-01-01

Context Knee-valgus motion is a potential risk factor for certain lower extremity injuries, including anterior cruciate ligament injury and patellofemoral pain. Identifying neuromuscular characteristics associated with knee-valgus motion, such as hip and lower leg muscle activation, may improve our ability to prevent lower extremity injuries. Objective We hypothesized that hip and lower leg muscle-activation amplitude would differ among individuals displaying knee valgus (medial knee displacement) during a double-legged squat compared with those who did not display knee valgus. We further suggested that the use of a heel lift would alter lower leg muscle activation and frontal-plane knee motion in those demonstrating medial knee displacement. Design Descriptive laboratory study. Setting Research laboratory. Patients or Other Participants A total of 37 healthy participants were assigned to the control (n = 19) or medial-knee-displacement (n = 18) group based on their double-legged squat performance. Main Outcome Measure(s) Muscle-activation amplitude for the gluteus maximus, gluteus medius, adductor magnus, medial and lateral gastrocnemius, and tibialis anterior was measured during 2 double-legged squat tasks. The first task consisted of performing a double-legged squat without a heel lift; the second consisted of performing a double-legged squat task with a 2-in (5.08-cm) lift under the heels. Results Muscle-activation amplitude for the hip adductor, gastrocnemius, and tibialis anterior was greater in those who displayed knee valgus than in those who did not (P < .05). Also, use of heel lifts resulted in decreased activation of the gluteus maximus, hip adductor, gastrocnemius, and tibialis anterior muscles (P < .05). Use of heel lifts also eliminated medially directed frontal-plane knee motion in those displaying medial knee displacement. Conclusions Medial knee displacement during squatting tasks appears to be associated with increased hip-adductor activation and increased coactivation of the gastrocnemius and tibialis anterior muscles. PMID:23068590

Mechanisms of ACL injury in professional rugby union: a systematic video analysis of 36 cases.

PubMed

Montgomery, Connor; Blackburn, Jeff; Withers, Daniel; Tierney, Gregory; Moran, Cathal; Simms, Ciaran

2016-12-30

The mechanisms of ACL injury in rugby are not well defined. To describe the mechanisms of ACL injury in male professional rugby players using systematic video analysis. 36 cases from games played in top professional leagues and international matches were analysed. 5 analysts independently assessed all videos to record the estimated frame/time of initial ground contact, frame/time of ACL tear and a range of play specific variables. This included contact versus non-contact ACL injuries, injury timing, joint flexion angles and foot contact with the ground. 37 side-stepping manoeuvres from a control game were analysed to allow comparison of non-injury versus injury situations. 57% of ACL injuries occurred in a contact manner. 2 main scenarios were identified: (1) offensive running and (2) being tackled, indicating that the ball carrier might be at higher risk of ACL injury. The majority of non-contact ACL injuries resulted from a side-stepping manoeuvre. In most non-contact cases, initial ground contact was through heel strike. Statistical assessment of heel strike at initial ground contact versus non-heel strike cases showed a significant difference in injury versus non-injury outcomes, with heel strike associated with higher injury risk. Non-contact ACL injuries had lower median knee flexion angles and a more dorsiflexed ankle when compared with a control group (10° vs 20°, p≤0.001 and 10° vs 0°, p=0.033 respectively). Over half of ACL injuries in rugby in our analysis resulted from a contact mechanism. For non-contact injuries, lower knee flexion angles and heel-first ground contact in a side-stepping manoeuvre were associated with ACL injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Tradeoffs between impact loading rate, vertical impulse and effective mass for walkers and heel strike runners wearing footwear of varying stiffness.

PubMed

Addison, Brian J; Lieberman, Daniel E

2015-05-01

Humans experience repetitive impact forces beneath the heel during walking and heel strike running that cause impact peaks characterized by high rates and magnitudes of loading. Impact peaks are caused by the exchange of momentum between the ground and a portion of the body that comes to a full stop (the effective mass) during the period of the impact peak. A number of factors can influence this exchange of momentum, including footwear stiffness. This study presents and tests an impulse-momentum model of impact mechanics which predicts that effective mass and vertical impulse is greater in walkers and heel strike runners wearing less stiff footwear. The model also predicts a tradeoff between impact loading rate and effective mass, and between impact loading rate and vertical impulse among individuals wearing footwear of varying stiffness. We tested this model using 19 human subjects walking and running in minimal footwear and in two experimental footpads. Subjects walked and ran on an instrumented treadmill and 3D kinematic data were collected. As predicted, both vertical impulse (walking: F(2,54)=52.0, p=2.6E-13; running: F(2,54)=25.2, p=1.8E-8) and effective mass (walking: F(2,54)=12.1, p=4.6E-5; running: F(2,54)=15.5, p=4.7E-6) increase in less stiff footwear. In addition, there is a significant inverse relationship between impact loading rate and vertical impulse (walking: r=-0.88, p<0.0001; running: r=-0.78, p<0.0001) and between impact loading rate and effective mass (walking: r=-0.88, p<0.0001; running: r=-0.82, p<0.0001). The tradeoff relationships documented here raise questions about how and in what ways the stiffness of footwear heels influence injury risk during human walking and running. Copyright © 2015 Elsevier Ltd. All rights reserved.

[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.

Looking Inside the Black Box of “Attendance at Services”: New Measures for Exploring an Old Dimension in Religion and Health Research

PubMed Central

Idler, Ellen L.; Boulifard, David A.; Labouvie, Erich; Chen, Yung Y.; Krause, Tyrone J.; Contrada, Richard J.

2008-01-01

Research in religion and health has spurred new interest in measuring religiousness. Measurement efforts have focused on subjective facets of religiousness such as spirituality and beliefs, and less attention has been paid to congregate aspects, beyond the single item measuring attendance at services. We evaluate some new measures for religious experiences occurring during congregational worship services. Respondents (N=576) were religiously-diverse community-dwelling adults interviewed prior to cardiac surgery. Exploratory factor analysis of the new items with a pool of standard items yielded a readily interpretable solution, involving seven correlated but distinct factors and one index variable, with high levels of internal consistency. We describe religious affiliation and demographic differences in these measures. Attendance at religious services provides multifaceted physical, emotional, social, and spiritual experiences that may promote physical health through multiple pathways. PMID:19214241

Analgesic Effect of Oral Glucose in Neonates.

PubMed

Jatana, S K; Dalal, S S; Wilson, C G

2003-04-01

The International Association for the Study of Pain, has defined pain as "an unpleasant sensory and emotional experience connected with actual or potential tissue damage or described in terms of such damage". It was thought that the newborn baby does not experience pain because of incompletely developed nervous system. However, it has been shown that neurological system known to be associated with pain transmission and modulation, is intact and functional. A study was conducted in our center to study the analgesic effect of administration of oral glucose in various concentrations, in neonates undergoing heel punctures, for collection of blood for investigations. This was compared with the analgesic effects of breast milk (which contains lactose). 125 full term normal neonates with no history of birth asphyxia or underlying neurological abnormality, requiring heel punctures for collection of blood for various investigations were selected for the study. They were matched for gestational age, birth weight and sex distribution and divided into 5 groups of 25 each. One group comprised control subjects and was administered sterile water. 3 groups were administered 1 ml of varying strengths of glucose solutions i.e. 10%, 25% and 50% respectively. The last group was given 1 ml of expressed breast milk (EBM). Prior to heel pricks, state of arousal, baseline heart rate (HR) and transcutaneous oxygen saturation (SpO2) were recorded by pulse oximeter in each neonate. Autolet, a mechanical device for capillary sampling, was used for heel pricks to give equal strength of painful stimulus in each procedure. Audio tape recorder was used to record the cry. The oral solution was administered slowly over 30 seconds by means of a syringe placed in the mouth. Heel puncture was done after 2 minutes, taking all aseptic precautions. HR and SpO2 were monitored using pulse oximeter. Pain response was assessed, by recording duration of crying, change in HR, change in SpO2 and facial action score after the procedure. Mean duration of cry and total cry over 5 minutes was significantly less in groups given 25% and 50% glucose solutions as compared to the control group and babies given EBM. Difference in mean increase in HR, fall in SpO2 were statistically significant between control group, EBM group and neonates given 25% and 50% glucose solutions respectively. Compared to control group, all other administered solutions (10%, 25%, 50% glucose and EBM) were found to reduce physiological and behavioral responses in neonates undergoing heel punctures. 25% and 50% glucose solutions were found to have maximal analgesic effect and both were found to be equally effective. EBM and 10% glucose solution have an equal analgesic effect but less than 25% or 50% glucose. This simple, cheap and safe method of oral analgesia can be easily used in neonates undergoing heel prick procedures during routine neonatal care.

Using Tri-Axial Accelerometers to Assess the Dynamic Control of Head Posture During Gait

NASA Technical Reports Server (NTRS)

Lawrence, John H., III

2003-01-01

Long duration spaceflight is known to cause a variety of biomedical stressors to the astronaut. One of the more functionally destabilizing effects of spaceflight involves microgravity-induced changes in vestibular or balance control. Balance control requires the integration of the vestibular, visual, and proprioceptive systems. In the microgravity environment, the normal gravity vector present on Earth no longer serves as a reference for the balance control system. Therefore, adaptive changes occur to the vestibular system to affect control of body orientation with altered, or non-present, gravity and/or proprioceptive inputs. Upon return to a gravity environment, the vestibular system must re-incorporate the gravity vector and gravity-induced proprioceptive inputs into the balance control regime. The result is often a period of postural instability, which may also be associated with space motion sickness (oscillopsia, nausea, and vertigo). Previous studies by the JSC Neuroscience group have found that returning astronauts often employ alterations in gait mechanics to maintain postural control during gait. It is believed that these gait alterations are meant to decrease the transfer of heel strike shock energy to the head, thus limiting the contradictory head and eye movements that lead to gait instability and motion sickness symptoms. We analyzed pre- and post-spaceflight tri-axial accelerometer data from the NASA/MIR long duration spaceflight missions to assess the heel to head transfer of heel strike shock energy during locomotion. Up to seven gait sessions (three preflight, four postflight) of head and shank (lower leg) accelerometer data was previously collected from six astronauts who engaged in space flights of four to six months duration. In our analysis, the heel to head transmission of shock energy was compared using peak vertical acceleration (a), peak jerk (j) ratio, and relative kinetic energy (a). A host of generalized movement variables was produced in an effort to isolate those that best highlighted vestibular adaptation due to spaceflight. Data suggest that astronauts used either head or body centered control to reduce the effects of heel strike shock on head position during normal walking at self-selected speeds. Moreover, the form of that control appears to fall under one of two categories: homeostatic or adaptive. Homeostatic control refers to tight constraint (small error) over the value of a given variable before and after spaceflight with little or no adaptive changes. Adaptive control refers to lesser constraint over a given movement variable with clear adaptation to earth gravity upon return from spaceflight. Heel strike shock absorption (ratio of heel to head peak acceleration) best-discriminated head and body centered control strategies. Further, peak jerk data was useful for illustrating pre- and postflight differences in segmental (shank versus head) movement energy. Results from kinetic energy analysis show high consistency between subjects and across test dates. Whether this result highlights a control strategy or is an artifact of approximating body segments using anthropometric tables is, at this point, unclear.

Integrating Oil Debris and Vibration Gear Damage Detection Technologies Using Fuzzy Logic

NASA Technical Reports Server (NTRS)

Dempsey, Paula J.; Afjeh, Abdollah A.

2002-01-01

A diagnostic tool for detecting damage to spur gears was developed. Two different measurement technologies, wear debris analysis and vibration, were integrated into a health monitoring system for detecting surface fatigue pitting damage on gears. This integrated system showed improved detection and decision-making capabilities as compared to using individual measurement technologies. This diagnostic tool was developed and evaluated experimentally by collecting vibration and oil debris data from fatigue tests performed in the NASA Glenn Spur Gear Fatigue Test Rig. Experimental data were collected during experiments performed in this test rig with and without pitting. Results show combining the two measurement technologies improves the detection of pitting damage on spur gears.

Melorheostosis of the hand with complicating bony spur formation and bursal inflammation: diagnosis and treatment.

PubMed

Ameen, S; Nagy, L; Gerich, U; Anderson, S E

2002-08-01

A 37-year old woman presented with intolerable pain associated with a slowly growing mass on the dorsum of the right hand. The radiographs were characteristic of melorheostosis involving the third and fourth metacarpals, with a cortical bony projection extending from the base of the third metacarpal eroding slightly into the fourth metacarpal, associated with bursal formation. Magnetic resonance imaging (MRI) demonstrated an inflamed bursal collection adjacent to the spur. This region corresponded to the patient's severe clinical, focal pain. To our knowledge, this is the first case report in which melorheostosis of the hand has been associated with bony spur formation and complicated by an inflamed bursa.

Telephoto lens view of Silver Spur in the Hadley Delta region from Apollo 15

NASA Image and Video Library

1971-07-31

AS15-84-11250 (31 July-2 Aug. 1971) --- A telephoto lens view of the prominent feature called Silver Spur in the Hadley Delta region, photographed during the Apollo 15 lunar surface extravehicular activity (EVA) at the Hadley-Apennine landing site. The distance from the camera to the spur is about 10 miles. The field of view across the bottom is about one mile. Structural formations in the mountain are clearly visible. There are two major units. The upper unit is characterized by massive subunits, each one of which is approximately 200 feet deep. The lower major unit is characterized by thinner bedding and cross bedding.

Optimal design of compact spur gear reductions

NASA Technical Reports Server (NTRS)

Savage, M.; Lattime, S. B.; Kimmel, J. A.; Coe, H. H.

1992-01-01

The optimal design of compact spur gear reductions includes the selection of bearing and shaft proportions in addition to gear mesh parameters. Designs for single mesh spur gear reductions are based on optimization of system life, system volume, and system weight including gears, support shafts, and the four bearings. The overall optimization allows component properties to interact, yielding the best composite design. A modified feasible directions search algorithm directs the optimization through a continuous design space. Interpolated polynomials expand the discrete bearing properties and proportions into continuous variables for optimization. After finding the continuous optimum, the designer can analyze near optimal designs for comparison and selection. Design examples show the influence of the bearings on the optimal configurations.

Strength Evaluation and Failure Prediction of Short Carbon Fiber Reinforced Nylon Spur Gears by Finite Element Modeling

NASA Astrophysics Data System (ADS)

Hu, Zhong; Hossan, Mohammad Robiul

2013-06-01

In this paper, short carbon fiber reinforced nylon spur gear pairs, and steel and unreinforced nylon spur gear pairs have been selected for study and comparison. A 3D finite element model was developed to simulate the multi-axial stress-strain behaviors of the gear tooth. Failure prediction has been conducted based on the different failure criteria, including Tsai-Wu criterion. The tooth roots, where has stress concentration and the potential for failure, have been carefully investigated. The modeling results show that the short carbon fiber reinforced nylon gear fabricated by properly controlled injection molding processes can provide higher strength and better performance.

HBO and gas gangrene. A case report.

PubMed

Ferraù, S; Sallusti, R; Lozano Valdes, A; Gonzales, C; Jónsson, M; Gunnlaugsson, G; Gullo, A

2001-10-01

A 58-year old man, in a mediocre health condition, was admitted into Landspitallin Fossvogur, the University of Reykjavik City Hospital, Iceland, because of fever, chills, local pain and swelling due to the presence of a big old wound in his left heel. The first clinical appearance showed a gas gangrene of the area. The patient immediately underwent a surgical debridement and a fasciotomy, and antibiotic intravenous therapy and hyperbaric oxygen therapy (HBOT) were started. During the treatment the patient suffered for a multi-organ failure syndrome (MOFS), was admitted in ICU and survived. A total of 52 HBO sessions were performed and one month since the admission into the hospital the patient received a skin transplant. He achieved a complete restitutio ad integrum after 78 days of hospitalization. Gas gangrene is a fulminating infection caused by the genus of Clostridia. If not treated, it leads to the death of the host. The actual treatment for gas gangrene includes surgery, antibiotics, general resuscitative measures and HBOT.

Study of Wearable Knee Assistive Instruments for Walk Rehabilitation

NASA Astrophysics Data System (ADS)

Zhu, Yong; Nakamura, Masahiro; Ito, Noritaka; Fujimoto, Hiroshi; Horikuchi, Kenichi; Wakabayashi, Shojiro; Takahashi, Rei; Terada, Hidetsugu; Haro, Hirotaka

A wearable Knee Assistive Instrument for the walk rehabilitation was newly developed. Especially, this system aimed at supporting the rehabilitation for the post-TKA (Total Knee Arthroplasty) which is a popular surgery for aging people. This system consisted of an assisting mechanism for the knee joint, a hip joint support system and a foot pressure sensor system. The driving system of this robot consisted of a CPU board which generated the walking pattern, a Li-ion battery, DC motors with motor drivers, contact sensors to detect the state of foot and potentiometers to detect the hip joint angle. The control method was proposed to reproduce complex motion of knee joint as much as possible, and to increase hip or knee flexion angle. Especially, this method used the timing that heel left from the floor. This method included that the lower limb was raised to prevent a subject's fall. Also, the prototype of knee assisting system was tested. It was confirmed that the assisting system is useful.

75 FR 60859 - Petition for Waiver of Compliance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... passenger car maintenance requirements. See also 49 CFR 232.17(b)(2). OERM is a non-profit corporation that... Jacinto Industrial Spur for approximately \\1/4\\ mile in order to reach the Historic Perris Depot. As the San Jacinto Industrial Spur is part of the general system of transportation, compliance with part 232...

110. NORTH PLANT RAILROAD SPUR, WITH ASSEMBLY PLANT/WAREHOUSE (BUILDING 1601/1606/1701) ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

110. NORTH PLANT RAILROAD SPUR, WITH ASSEMBLY PLANT/WAREHOUSE (BUILDING 1601/1606/1701) AT LEFT AND GB MANUFACTURING PLANT (BUILDING 1501) AT CENTER. VIEW TO NORTH. - Rocky Mountain Arsenal, Bounded by Ninety-sixth Avenue & Fifty-sixth Avenue, Buckley Road, Quebec Street & Colorado Highway 2, Commerce City, Adams County, CO

111. DETAIL OF NORTH PLANT RAILROAD SPUR, WITH ASSEMBLY PLANT/WAREHOUSE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

111. DETAIL OF NORTH PLANT RAILROAD SPUR, WITH ASSEMBLY PLANT/WAREHOUSE (BUILDING 1601/1606/1701) AT LEFT AND GB MANUFACTURING PLANT (BUILDING 1501) AT CENTER. VIEW TO NORTH. - Rocky Mountain Arsenal, Bounded by Ninety-sixth Avenue & Fifty-sixth Avenue, Buckley Road, Quebec Street & Colorado Highway 2, Commerce City, Adams County, CO

76 FR 47645 - CSX Transportation, Inc.-Trackage Rights Exemption-Norfolk Southern Railway Company

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-05

... Crossing Agreement and replace the current crossing diamond with a turnout and switches lining CSXT's spur into NSR's spur north of Craven's Yard. CSXT states that, by retiring the crossing diamond, the parties... served on Steven C. Armbrust, Esq., CSX Transportation, Inc., 500 Water Street J-150, Jacksonville, FL...

35. SOUTH PLANT NORTHCENTER RAILROAD SPUR, SHOWING POWER PLANT (BUILDINGS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

35. SOUTH PLANT NORTH-CENTER RAILROAD SPUR, SHOWING POWER PLANT (BUILDINGS 325 AND 321) AT LEFT, FUEL TOWER AT CENTER AND CHLORINE EVAPORATOR (BUILDING 251) AT RIGHT. VIEW TO WEST - Rocky Mountain Arsenal, Bounded by Ninety-sixth Avenue & Fifty-sixth Avenue, Buckley Road, Quebec Street & Colorado Highway 2, Commerce City, Adams County, CO

Effects of age and sex on the results of an ankle plantar-flexor manual muscle test.

PubMed

Jan, Mei-Hwa; Chai, Huei-Ming; Lin, Yeong-Fwu; Lin, Janice Chien-Ho; Tsai, Li-Ying; Ou, Yu-Chih; Lin, Da-Hon

2005-10-01

The ability to perform 20 or more one-leg heel-rises is considered a "normal" grade for muscle strength (force-generating capacity of muscle) of the ankle plantar flexors, regardless of age and sex. Because muscle strength is closely related to age and sex, the "normal" test criterion was re-evaluated in different groups categorized by age and sex. One hundred eighty sedentary volunteers (21-80 years of age) without lower-limb lesions performed as many repetitions of one-leg heel-rise as possible. Lunsford and Perry criteria were used to determine completion of the test. The age and sex of the participants influenced the maximal repetitions of heel-rise, and the repetitions decreased with age and in female subjects. The muscle strength of the ankle plantar flexors, as measured by manual muscle testing, varied with age and sex. Clinicians should consider the variances of age and sex when they perform manual muscle testing of the ankle plantar flexors.

Calf Endurance and Achilles Tendon Structure in Classical Ballet Dancers.

PubMed

Zellers, Jennifer A; van Ostrand, Katrina; Silbernagel, Karin Grävare

2017-06-15

Optimal lower leg function is critical for ballet dancers to meet their occupational requirements. Achilles tendon injury is particularly detrimental to ballet dancers. While standardized measures have been validated and incorporated into clinical practice for use in people with Achilles tendon injury, normative ranges specific to the dancer population have not been described. The purpose of this pilot study was to observe the performance of pre-professional ballet students and professional ballet dancers on a well-established test battery for lower leg functional performance as well as ultra-sonographic evaluation of the structure of their Achilles tendons. The dancers in this study had significantly shorter Achilles tendons than non-dancers (p = 0.016). Dancers demonstrated significantly higher maximum heel-rise height on the heel-rise test for calf endurance (p < 0.001) but performed significantly less work than non-dancers (p = 0.014). The results of this study support the use of the heel-rise test as a tool for screening and to guide rehabilitation.

[Reconstruction of the heel in a two-year-old boy after lawn mower injury].

PubMed

Kraus, R; Albrecht, J; Schnettler, R; von Pichler, M

2012-04-01

Lawn mower injuries in children usually involve the lower extremities and can lead to serious amputation injuries. Treatment should look not only at the acute reconstruction, but also on maintaining the ability to grow. We report the case of a two-year-old boy with amputation of the heel. The boy was run over by a lawn mower. He suffered a complete loss of heel soft tissue, 30 % of the os calcis and the Achilles tendon. The one-stage reconstruction was performed by transplantation of an iliac crest graft, fascia lata to reconstruct the Achilles tendon and a microvascular latissimus dorsi flap. After one year, the functional and cosmetic result is excellent, the bone graft is healed completely and shows growth trends. The successful treatment of such a severe amputation injury requires the interdisciplinary cooperation between paediatric traumatologists, plastic surgeons, physical therapists and orthopaedic shoemaker. The result justifies the great effort. © Georg Thieme Verlag KG Stuttgart · New York.

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

PubMed

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

2012-01-01

The present research is aimed to introduce Heel-ball (HB) index from foot dimensions and determine whether this index exhibits sexual dimorphism. The study was conducted on a sample of 303 North Indian individuals (154 men, and 149 women) aged between 13 and 18 years. The stature, body weight, foot breadth at the ball (BBAL), and foot breadth at heel (BHEL) were measured. The HB index was derived by the formula BHEL × 100/BBAL. Although the mean HB index was larger in women in both feet it showed statistically significant sex differences in the right foot only. The study shows that while the foot dimensions show a positive correlation with stature and weight, the HB index is independent of the stature and weight of an individual. This novel index (HB index) may be utilized in sex determination when a part of the foot is brought for medico-legal investigation. © 2011 American Academy of Forensic Sciences.

"SPURS" in the North Atlantic Salinity Maximum

NASA Astrophysics Data System (ADS)

Schmitt, Raymond

2014-05-01

The North Atlantic Salinity Maximum is the world's saltiest open ocean salinity maximum and was the focus of the recent Salinity Processes Upper-ocean Regional Study (SPURS) program. SPURS was a joint venture between US, French, Irish, and Spanish investigators. Three US and two EU cruises were involved from August, 1012 - October, 2013 as well as surface moorings, glider, drifter and float deployments. Shipboard operations included underway meteorological and oceanic data, hydrographic surveys and turbulence profiling. The goal is to improve our understanding of how the salinity maximum is maintained and how it may be changing. It is formed by an excess of evaporation over precipitation and the wind-driven convergence of the subtropical gyre. Such salty areas are getting saltier with global warming (a record high SSS was observed in SPURS) and it is imperative to determine the relative roles of surface water fluxes and oceanic processes in such trends. The combination of accurate surface flux estimates with new assessments of vertical and horizontal mixing in the ocean will help elucidate the utility of ocean salinity in quantifying the changing global water cycle.

Suzaku and XMM-Newton observations of the North Polar Spur: Charge exchange or ISM absorption?

NASA Astrophysics Data System (ADS)

Gu, Liyi; Mao, Junjie; Costantini, Elisa; Kaastra, Jelle

2016-10-01

By revisiting the Suzaku and XMM-Newton data of the North Polar Spur, we discovered that the spectra are inconsistent with the traditional model consisting of pure thermal emission and neutral absorption. The most prominent discrepancies are the enhanced O vii and Ne ix forbidden-to-resonance ratios, and a high O viii Lyβ line relative to other Lyman series. A collisionally ionized absorption model can naturally explain both features, while a charge exchange component can only account for the former. By including the additional ionized absorption, the plasma in the North Polar Spur can be described by a single-phase collisional ionization equilibrium (CIE) component with a temperature of 0.25 keV, and nitrogen, oxygen, neon, magnesium, and iron abundances of 0.4-0.8 solar. The abundance pattern of the North Polar Spur is well in line with those of the Galactic halo stars. The high nitrogen-to-oxygen ratio reported in previous studies can be migrated to the large transmission of the O viii Lyα line. The ionized absorber is characterized by a balance temperature of 0.17-0.20 keV and a column density of 3-5 × 1019 cm-2. Based on the derived abundances and absorption, we speculate that the North Polar Spur is a structure in the Galactic halo, so that the emission is mostly absorbed by the Galactic interstellar medium in the line of sight.

Hemiparetic stepping to the beat: asymmetric response to metronome phase shift during treadmill gait.

PubMed

Pelton, Trudy A; Johannsen, Leif; Huiya Chen; Wing, Alan M

2010-06-01

Walking in time with a metronome is associated with improved spatiotemporal parameters in hemiparetic gait; however, the mechanism linking auditory and motor systems is poorly understood. Hemiparetic cadence control with metronome synchronization was examined to determine specific influences of metronome timing on treadmill walking. A within-participant experiment examined correction processes used to maintain heel strike synchrony with the beat by applying perturbations to the timing of a metronome. Eight chronic hemiparetic participants (mean age = 70 years; standard deviation = 12) were required to synchronize heel strikes with metronome pulses set according to each individual's comfortable speed (mean 0.4 m/s). During five 100-pulse trials, a fixed-phase baseline was followed by 4 unpredictable metronome phase shifts (20% of the interpulse interval), which amounted to 10 phase shifts on each foot. Infrared cameras recorded the motion of bilateral heel markers at 120 Hz. Relative asynchrony between heel strike responses and metronome pulses was used to index compensation for metronome phase shifts. Participants demonstrated compensation for phase shifts with convergence back to pre-phase shift asynchrony. This was significantly slower when the error occurred on the nonparetic side (requiring initial correction with the paretic limb) compared with when the error occurred on the paretic side (requiring initial nonparetic correction). Although phase correction of gait is slowed when the phase shift is delivered to the nonparetic side compared with the paretic side, phase correction is still present. This may underlie the utility of rhythmic auditory cueing in hemiparetic gait rehabilitation.

Immediate combined effect of gastrocnemius stretching and sustained talocrural joint mobilization in individuals with limited ankle dorsiflexion: A randomized controlled trial.

PubMed

Kang, Min-Hyeok; Oh, Jae-Seop; Kwon, Oh-Yun; Weon, Jong-Hyuk; An, Duk-Hyun; Yoo, Won-Gyu

2015-12-01

Although gastrocnemius stretching and talocrural joint mobilization have been suggested as effective interventions to address limited ankle dorsiflexion passive range of motion (DF PROM), the effects of a combination of the two interventions have not been identified. The aim of the present study was to compare the effects of gastrocnemius stretching combined with joint mobilization and gastrocnemius stretching alone. A randomized controlled trial. In total, 24 individuals with limited ankle DF PROM were randomized to undergo gastrocnemius stretching combined with joint mobilization (12 feet in 12 individuals) or gastrocnemius stretching alone (12 feet in 12 individuals) for 5 min. Ankle kinematics during gait (time to heel-off and ankle DF before heel-off), ankle DF PROM, posterior talar glide, and displacement of the myotendinous junction (MTJ) of the gastrocnemius were assessed before and after the interventions. The groups were compared using two-way repeated measures analysis of variance. Greater increases in the time to heel-off and ankle DF before heel-off during gait and posterior talar glide were observed in the stretching combined with joint mobilization group versus the stretching alone group. Ankle DF PROM and displacement of the MTJ of the gastrocnemius were increased significantly after the interventions in both groups, with no significant difference between them. These findings suggest that gastrocnemius stretching with joint mobilization needs to be considered to improve ankle kinematics during gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Footwear according to the "business dress code", and the health condition of women's feet--computer-assisted holistic evaluation].

PubMed

Lorkowski, Jacek; Mrzygłód, Mirosław; Kotela, Ireneusz; Kiełbasiewicz-Lorkowska, Ewa; Teul, Iwona

2013-01-01

According to the verdict of the Supreme Court in 2005, an employer may dismiss an employee if their conduct (including dress) exposes the employer to losses or threatens his interests. The aim of the study was a holistic assessment of the pleiotropic effects of high-heeled pointed shoes on the health condition of women's feet, wearing them at work, in accordance with the existing rules of the "business dress code". A holistic multidisciplinary analysis was performed. It takes into account: 1) women employees of banks and other large corporations (82 persons); 2) 2D FEM computer model developed by the authors of foot deformed by pointed high-heeled shoes; 3) web site found after entering the code "business dress code". Over 60% of women in the office wore high-heeled shoes. The following has been found among people walking to work in high heels: 1) reduction in the quality of life in about 70% of cases, through periodic occurrence of pain and reduction of functional capacity of the feet; 2) increase in the pressure on the plantar side of the forefoot at least twice; 3) the continued effects the forces deforming the forefoot. 1. An evolutionary change of "dress code" shoes is necessary in order to lead to a reduction in non-physiological overload of feet and the consequence of their disability. 2. These changes are particularly urgent in patients with so-called "sensitive foot".

The role of foot morphology on foot function in diabetic subjects with or without neuropathy.

PubMed

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

2013-04-01

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03). While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions. Copyright © 2012 Elsevier B.V. All rights reserved.

The use of hemoglobin saturation ratio as a means of measuring tissue perfusion in the development of heel pressure sores.

PubMed

Aliano, Kristen A; Stavrides, Steve; Davenport, Thomas

2013-09-01

The heel is a common site of pressure ulcers. The amount of pressure and time needed to develop these wounds is dependent on various factors including pressure surface, the patient's anatomy, and co-morbidities. We studied the use of the hemoglobin saturation ratio as a means of assessing heel perfusion in various pressure settings. The mixed perfusion ratio in the heels of 5 volunteers was assessed on 3 pressure surfaces and at the time of off-load. The surfaces studied included: stretcher pad, plastic backboard without padding, and pressure reduction gel. Each surface was measured for 5 minutes with a real-time reading. On the stretcher, the average StO2% decrease for each pressure surface was 26.2 ± 10 (range 18-43). The average StO2% decrease on the backboard was 22.8 ± 12.3 (range 8-37), and 24.0 ± 4.8 (range 19-30) on the gel pad. The StO2% drop plateaued with the stretcher and gel pad, but with the backboard there was a continued slow drop at 5 minutes. This study demonstrates that hemoglobin oxygenation ratio may be effective in assessing a tissue's direct perfusion in the setting of tissue pressure and may also be beneficial to better assess the effects of pressure-reduction surfaces. Further studies will be needed to determine time to skin breakdown as it pertains to pressure and tissue oxygenation.

Early functional outcome of a modified Brostrom-Gould surgery using bioabsorbable suture anchor for chronic lateral ankle instability.

PubMed

Shahrulazua, A; Ariff Sukimin, M S; Tengku Muzaffar, T M; Yusof, M I

2010-03-01

The purpose of this study was to evaluate the early functional outcome following the use of a bioabsorbable suture anchor to simplify the repair of injured lateral ankle structures as a variation of an established technique known as the Brostrom-Gould procedure. This was a prospective study of 30 ankles with chronic lateral instability that underwent a modified Brostrom-Gould surgery using a bioabsorbable suture anchor, performed by a single surgeon. A total of 29 patients, aged 15 to 52 (mean is 33) years, were enrolled in the study. The follow-up period ranged from three to six (mean is four) months. The function of the patients' ankles was scored using the Kaikkonen Functional Scale, both preoperatively and postoperatively. Preoperatively, all ankles had poor scores (less than 50). Postoperatively, 28 ankles showed excellent scores and two ankles showed good scores, while none obtained a fair or poor score. The difference in the overall means between the postoperative and preoperative scores was statistically significant (p-value is 0.001). Post surgery, 24 ankles had no symptoms, while six had only mild ankle tightness with extreme inversion movement at the last review. All patients were able to walk normally, and 29 ankles regained their normal running capability. There was marked improvement in the ability to descend stairs, to rise on heels and toes, to perform a single-limb stance, and in range of motions of the ankle dorsiflexion as well as in ankle laxity. The modified Brostrom-Gould procedure using a bioabsorbable suture anchor allowed for early ankle rehabilitation and offered a reproducible and excellent early functional outcome with minimal complications.

Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study.

PubMed

Krieg, Marc-Antoine; Cornuz, Jacques; Ruffieux, Christiane; Van Melle, Guy; Büche, Daniel; Dambacher, Maximilian A; Hans, Didier; Hartl, Florian; Häuselmann, Hansjorg J; Kraenzlin, Marius; Lippuner, Kurt; Neff, Maurus; Pancaldi, Pierro; Rizzoli, Rene; Tanzi, Franco; Theiler, Robert; Tyndall, Alan; Wimpfheimer, Claus; Burckhardt, Peter

2006-09-01

To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women > or =70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not. As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose. The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women > or =70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters. From the 7609 women who were included in the study, 7062 women 75.2 +/- 3.1 (SD) years of age were prospectively followed for 2.9 +/- 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s). In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.

Evaluation of skin surface hydration state and barrier function of stratum corneum of dorsa of hands and heels treated with PROTECT X2 skin protective cream.

PubMed

Kubota, Takahiro

2012-06-01

Skin roughness is a term commonly used in Japan to describe a poor skin condition related to a rough and dry skin surface that develops as a result of various damaging effects from the environment or skin inflammation. Recovery from skin roughness requires skin care for a long period, thus it is important to prevent development of such skin changes. PROTECT X2 contains agents used for a protective covering of the skin from frequent hand washing or use of alcohol-based disinfectants. These unique components are also thought to be effective to treat skin roughness of the dorsa of the hands and heels. In the present study, we evaluated the effectiveness of PROTECT X2 to increase skin surface hydration state, as well as enhance the barrier function of the stratum corneum of the dorsa of the hands and heels in elderly individuals. A total of 8 elderly subjects and their caretakers without any skin diseases participated in the study. They applied PROTECT X2 by themselves to the dorsum area of 1 hand and heel 3 to 5 times daily for 1 month, while the opposite sides were left untreated. We measured stratum corneum (SC) hydration and transepidermal water loss (TEWL) before beginning treatment, then 1 week and 1 month after the start of treatment to compare between the treated and untreated skin. SC hydration state after applications of PROTECT X2 was 1.5- to 3.0-fold higher than that of the untreated skin in the dorsa of both hands and heels, indicating that the moisturizing ingredients accompanied by water were replenished in those areas where the cream was applied. Also, TEWL in the dorsum of the hands was 17.0-27.9% lower on the treated side, indicating improvement in SC barrier function. On the basis of these findings, we concluded that PROTECT X2 enhances water-holding in the SC and aids the barrier function of the skin in the dorsum of the hands. In addition, we consider that this formulation is useful for not only protecting the hands from the effects of such agents as detergents and alcohol-based disinfectants, but also for protecting heel skin covered by a thick SC from dry and cold conditions such as those encountered in winter. However, since the SC in that area is much thicker than that of the hands, the barrier function was not significantly improved within 1 month of daily treatments.

C2 spondylotic radiculopathy: the nerve root impingement mechanism investigated by para-sagittal CT/MRI, dynamic rotational CT, intraoperative microscopic findings, and treated by microscopic posterior foraminotomy.

PubMed

Fujiwara, Yasushi; Izumi, Bunichiro; Fujiwara, Masami; Nakanishi, Kazuyoshi; Tanaka, Nobuhiro; Adachi, Nobuo; Manabe, Hideki

2017-04-01

C2 radiculopathy is known to cause occipito-cervical pain, but their pathology is unclear because of its rarity and unique anatomy. In this paper, we investigated the mechanism of C2 radiculopathy that underwent microscopic cervical foraminotomies (MCF). Three cases with C2 radiculopathy treated by MCF were investigated retrospectively. The mean follow-up period was 24 months. Pre-operative symptoms, imaging studies including para-sagittal CT and MRI, rotational dynamic CT, and intraoperative findings were investigated. There were 1 male and 2 females. The age of patients were ranged from 50 to 79 years. All cases had intractable occipito-cervical pain elicited by the cervical rotation. C2 nerve root block was temporally effective. There was unilateral spondylosis in symptomatic side without obvious atlatoaxial instability. Para-sagittal MRI and CT showed severe foraminal stenosis at C1-C2 due to the bony spur derived from the lateral atlanto-axial joints. In one case, dynamic rotational CT showed that the symptomatic foramen became narrower on rotational position. MCF was performed in all cases, and the C2 nerve root was impinged between the inferior edge of the C1 posterior arch and bony spur from the C1-C2 joint. After surgery, occipito-cervical pain disappeared. This study demonstrated that mechanical impingement of the C2 nerve root is one of the causes of occipito-cervical pain and it was successfully treated by microscopic resection of the inferior edge of the C1 posterior arch. Para-sagittal CT and MRI, rotational dynamic CT, and nerve root block were effective for diagnosis.

Characteristics of Reduction Gear in Electric Agricultural Vehicle

NASA Astrophysics Data System (ADS)

Choi, W. S.; Pratama, P. S.; Supeno, D.; Jeong, S. W.; Byun, J. Y.; Woo, J. H.; Lee, E. S.; Park, C. S.

2018-03-01

In electric agricultural machine a reduction gear is needed to convert the high speed rotation motion generated by DC motor to lower speed rotation motion used by the vehicle. The reduction gear consists of several spur gears. Spur gears are the most easily visualized gears that transmit motion between two parallel shafts and easy to produce. The modelling and simulation of spur gears in DC motor reduction gear is important to predict the actual motion behaviour. A pair of spur gear tooth in action is generally subjected to two types of cyclic stress: contact stress and bending stress. The stress may not attain their maximum values at the same point of contact fatigue. These types of failure can be minimized by analysis of the problem during the design stage and creating proper tooth surface profile with proper manufacturing methods. To improve its life expectation in this study modal and stress analysis of reduction gear is simulated using ANSYS workbench based on finite element method (FEM). The modal analysis was done to understand reduction gear deformation behaviour when vibration occurs. FEM static stress analysis is also simulated on reduction gear to simulate the gear teeth bending stress and contact stress behaviour.

Three-dimensional quantitative analysis of healthy foot shape: a proof of concept study.

PubMed

Stanković, Kristina; Booth, Brian G; Danckaers, Femke; Burg, Fien; Vermaelen, Philippe; Duerinck, Saartje; Sijbers, Jan; Huysmans, Toon

2018-01-01

Foot morphology has received increasing attention from both biomechanics researches and footwear manufacturers. Usually, the morphology of the foot is quantified by 2D footprints. However, footprint quantification ignores the foot's vertical dimension and hence, does not allow accurate quantification of complex 3D foot shape. The shape variation of healthy 3D feet in a population of 31 adult women and 31 adult men who live in Belgium was studied using geometric morphometric methods. The effect of different factors such as sex, age, shoe size, frequency of sport activity, Body Mass Index (BMI), foot asymmetry, and foot loading on foot shape was investigated. Correlation between these factors and foot shape was examined using multivariate linear regression. The complex nature of a foot's 3D shape leads to high variability in healthy populations. After normalizing for scale, the major axes of variation in foot morphology are (in order of decreasing variance): arch height, combined ball width and inter-toe distance, global foot width, hallux bone orientation (valgus-varus), foot type (e.g. Egyptian, Greek), and midfoot width. These first six modes of variation capture 92.59% of the total shape variation. Higher BMI results in increased ankle width, Achilles tendon width, heel width and a thicker forefoot along the dorsoplantar axis. Age was found to be associated with heel width, Achilles tendon width, toe height and hallux orientation. A bigger shoe size was found to be associated with a narrow Achilles tendon, a hallux varus, a narrow heel, heel expansion along the posterior direction, and a lower arch compared to smaller shoe size. Sex was found to be associated with differences in ankle width, Achilles tendon width, and heel width. Frequency of sport activity was associated with Achilles tendon width and toe height. A detailed analysis of the 3D foot shape, allowed by geometric morphometrics, provides insights in foot variations in three dimensions that can not be obtained from 2D footprints. These insights could be applied in various scientific disciplines, including orthotics and shoe design.

Quantifying skin motion artifact error of the hindfoot and forefoot marker clusters with the optical tracking of a multi-segment foot model using single-plane fluoroscopy.

PubMed

Shultz, R; Kedgley, A E; Jenkyn, T R

2011-05-01

The trajectories of skin-mounted markers tracked with optical motion capture are assumed to be an adequate representation of the underlying bone motions. However, it is well known that soft tissue artifact (STA) exists between marker and bone. This study quantifies the STA associated with the hindfoot and midfoot marker clusters of a multi-segment foot model. To quantify STA of the hindfoot and midfoot marker clusters with respect to the calcaneus and navicular respectively, fluoroscopic images were collected on 27 subjects during four quasi-static positions, (1) quiet standing (non-weight bearing), (2) at heel strike (weight-bearing), (3) at midstance (weight-bearing) and (4) at toe-off (weight-bearing). The translation and rotation components of STA were calculated in the sagittal plane. Translational STA at the calcaneus varied from 5.9±7.3mm at heel-strike to 12.1±0.3mm at toe-off. For the navicular the translational STA ranged from 7.6±7.6mm at heel strike to 16.4±16.7mm at toe-off. Rotational STA was relatively smaller for both bones at all foot positions. For the calcaneus they varied between 0.1±2.2° at heel-strike to 0.2±0.6° at toe-off. For the navicular, the rotational STA ranged from 0.6±0.9° at heel-strike to 0.7±0.7° at toe-off. The largest translational STA found in this study (16mm for the navicular) was smaller than those reported in the literature for the thigh and the lower leg, but was larger than the STA of individual spherical markers affixed to the foot. The largest errors occurred at toe-off position for all subjects for both the hindfoot and midfoot clusters. Future studies are recommended to quantify true three-dimensional STA of the entire foot during gait. Copyright © 2011. Published by Elsevier B.V.

Calf Muscle Performance Deficits Remain 7 Years After an Achilles Tendon Rupture.

PubMed

Brorsson, Annelie; Grävare Silbernagel, Karin; Olsson, Nicklas; Nilsson Helander, Katarina

2018-02-01

Optimizing calf muscle performance seems to play an important role in minimizing impairments and symptoms after an Achilles tendon rupture (ATR). The literature lacks long-term follow-up studies after ATR that describe calf muscle performance over time. The primary aim was to evaluate calf muscle performance and patient-reported outcomes at a mean of 7 years after ATR in patients included in a prospective, randomized controlled trial. A secondary aim was to evaluate whether improvement in calf muscle performance continued after the 2-year follow-up. Cohort study; Level of evidence, 2. Sixty-six subjects (13 women, 53 men) with a mean age of 50 years (SD, 8.5 years) were evaluated at a mean of 7 years (SD, 1 year) years after their ATR. Thirty-four subjects had surgical treatment and 32 had nonsurgical treatment. Patient-reported outcomes were evaluated with Achilles tendon Total Rupture Score (ATRS) and Physical Activity Scale (PAS). Calf muscle performance was evaluated with single-leg standing heel-rise test, concentric strength power heel-rise test, and single-legged hop for distance. Limb Symmetry Index (LSI = injured side/healthy side × 100) was calculated for side-to-side differences. Seven years after ATR, the injured side showed decreased values in all calf muscle performance tests ( P < .001-.012). Significant improvement in calf muscle performance did not continue after the 2-year follow-up. Heel-rise height increased significantly ( P = .002) between the 1-year (10.8 cm) and the 7-year (11.5 cm) follow-up assessments. The median ATRS was 96 (of a possible score of 100) and the median PAS was 4 (of a possible score of 6), indicating minor patient-reported symptoms and fairly high physical activity. No significant differences were found in calf muscle performance or patient-reported outcomes between the treatment groups except for the LSI for heel-rise repetitions. Continued deficits in calf muscle endurance and strength remained 7 years after ATR. No continued improvement in calf muscle performance occurred after the 2-year follow-up except for heel-rise height.

Heel quantitative ultrasound in HIV-infected patients: a cross-sectional study.

PubMed

Pinzone, Marilia Rita; Castronuovo, Daniela; Di Gregorio, Adriana; Celesia, Benedetto Maurizio; Gussio, Maria; Borderi, Marco; Maggi, Paolo; Santoro, Carmen Rita; Madeddu, Giordano; Cacopardo, Bruno; Nunnari, Giuseppe

2016-04-01

HIV infection has been associated with increased risk of osteoporosis and fragility fractures. Dual-energy X-ray absorptiometry (DXA) is the reference standard to assess bone mineral density (BMD); however, it is not easily accessible in several settings. Heel Quantitative ultrasound (QUS) is a radiation-free, easy-to-perform technique, which may help reducing the need for DXA. In this cross-sectional study, we used heel QUS (Hologic Sahara(®)) to assess bone status in a cohort of HIV-infected patients. A QUS stiffness index (QUI) threshold >83 was used to identify patients with a low likelihood of osteoporosis. Moreover, we compared QUS results with those of 36 sex- and age-matched HIV-negative controls. 244 HIV-positive patients were enrolled. Median heel QUI value was 83 (73-96) vs. 93 (IQR 84-104) in the control group (p = 0.04). 110 patients (45 %) had a QUI value ≤83. Risk factors for low QUI values were age (OR 1.04 per year, 95 % CI 1.01-1.07, p = 0.004), current use of protease inhibitors (OR 1.85, CI 1.03-3.35, p = 0.039), current use of tenofovir (OR 2.28, CI 1.22-4.27, p = 0.009) and the number of risk factors for secondary osteoporosis (OR 1.46, CI 1.09-1.95, p = 0.01). Of note, QUI values were significantly correlated with FRAX score (r = -0.22, p = 0.004). According to EACS guidelines, 45 % of patients had risk factors for osteoporosis which make them eligible for DXA. By using QUS, we may avoid DXA in around half of them. As HIV-positive patients are living longer, the prevalence of osteoporosis is expected to increase over time. Appropriate screening, prevention and treatment are crucial to preserve bone health in this population. The use of screening techniques, such as heel QUS, may help reducing the need for DXA. Further studies are needed to define the diagnostic accuracy of this promising technique in the setting of HIV.

Prospective study of percutaneous radiofrequency nerve ablation for chronic plantar fasciitis.

PubMed

Erken, H Yener; Ayanoglu, Semih; Akmaz, Ibrahim; Erler, Kaan; Kiral, Ahmet

2014-02-01

Chronic plantar heel pain is one of the most painful foot conditions and is generally associated with plantar fasciitis. This study reports 2-year follow-up results of radiofrequency nerve ablation (RFNA) of the calcaneal branches of the inferior calcaneal nerve in patients with chronic heel pain associated with plantar fasciitis. After receiving approval from the institutional review board, we prospectively evaluated the results of the RFNA of the calcaneal branches of the inferior calcaneal nerve on 35 feet in 29 patients with plantar heel pain between 2008 and 2011. All of the patients who were treated had been complaining of heel pain for more than 6 months and had failed conservative treatment. All of the patients were evaluated (quantitatively) using the average 10-point Visual Analog Scale (VAS) before treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. We also evaluated 26 feet in 20 patients with American Orthopaedic Foot and Ankle Society scale (AOFAS) scores before the treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. The average VAS score of the feet was 9.2 ± 1.9 before treatment, 0.5 ± 1.3 at 1 month after the procedure, 1.5 ± 2.1 at 1-year follow-up, and 1.3 ± 1.8 at 2-year follow-up (P < .001). The average AOFAS scores of the patients were 66.9 ± 8.1 (range, 44-80) before treatment, 95.2 ± 6.1 (range, 77-100) at 1 month after the procedure, 93 ± 7.5 (range, 71-100) at the 1-year follow-up, and 93.3 ± 7.9 (range, 69-100) at the 2-year follow-up. At the 1- and 2-year follow-up, 85.7% of the patients rated their treatment as very successful or successful. These findings suggest that RFNA of the calcaneal branches of the inferior calcaneal nerve was an effective pain treatment option for chronic heel pain associated with plantar fasciitis that did not respond to other conservative treatment options. Level IV, retrospective case series.

The relationship between social deprivation, osteoporosis, and falls.

PubMed

Pearson, Derek; Taylor, Rachel; Masud, Tahir

2004-02-01

The aim of this study was to assess the relationship between heel BMD, risk factors for osteoporosis, falls history, and the Jarman Underprivileged Area Score in an older community population. From the general practice register, 1,187 women (mean age 70, range 60 to 94) were recruited. BMD of the heel was measured using the GE Lunar PIXI densitometer. A T-score cutoff for predicted osteoporosis at the spine or hip of -1.7 was used. A risk factor questionnaire was completed that included fracture history and falls history. The odds ratio (OR) with a 95% confidence interval (CI) was calculated for each risk factor for each quartile of Jarman score and for the diagnosis of osteoporosis. Logistic regression was used to identify the risk factors that predict lone bone mass in the heel. There were no significant differences between women in different quartiles of Jarman score in terms of age and body mass index (BMI). Women in the highest two quartiles of Jarman score (i.e., most deprived) had a significantly higher likelihood of osteoporosis (OR=1.82; 95% CI, 1.03 to 1.63; and OR=1.85; 95% CI, 1.04 to 1.64, respectively) and significantly lower BMD ( p=0.008). Women in these two quartiles were significantly more likely to have had a history of previous fracture (OR=1.66; 95% CI, 1.01 to 1.53), but there was no difference in falls history. Women in the lowest quartile (least deprived) were also significantly less likely to smoke ( p=0.011) but were not significantly different in terms of other risk factors (e.g., dietary calcium and activity). BMI, age, kyphosis, significant visual problems, and quartile of Jarman score were significant risk factors for low bone mass. Risk factors identified those with low bone mass at the heel with a sensitivity and specificity of 72%. In conclusion, women in the lowest quartile of Jarman score (i.e., least deprived) have significantly higher heel BMD compared with the rest of the population.

Direct dynamics simulation of the impact phase in heel-toe running.

PubMed

Gerritsen, K G; van den Bogert, A J; Nigg, B M

1995-06-01

The influence of muscle activation, position and velocities of body segments at touchdown and surface properties on impact forces during heel-toe running was investigated using a direct dynamics simulation technique. The runner was represented by a two-dimensional four- (rigid body) segment musculo-skeletal model. Incorporated into the muscle model were activation dynamics, force-length and force-velocity characteristics of seven major muscle groups of the lower extremities: mm. glutei, hamstrings, m. rectus femoris, mm. vasti, m. gastrocnemius, m. soleus and m. tibialis anterior. The vertical force-deformation characteristics of heel, shoe and ground were modeled by a non-linear visco-elastic element. The maximum of a typical simulated impact force was 1.6 times body weight. The influence of muscle activation was examined by generating muscle stimulation combinations which produce the same (experimentally determined) resultant joint moments at heelstrike. Simulated impact peak forces with these different combinations of muscle stimulation levels varied less than 10%. Without this restriction on initial joint moments, muscle activation had potentially a much larger effect on impact force. Impact peak force was to a great extent influenced by plantar flexion (85 N per degree of change in foot angle) and vertical velocity of the heel (212 N per 0.1 m s-1 change in velocity) at touchdown. Initial knee flexion (68 N per degree of change in leg angle) also played a role in the absorption of impact. Increased surface stiffness resulted in higher impact peak forces (60 N mm-1 decrease in deformation).(ABSTRACT TRUNCATED AT 250 WORDS)

The synchronisation of lower limb responses with a variable metronome: the effect of biomechanical constraints on timing.

PubMed

Chen, Hui-Ya; Wing, Alan M; Pratt, David

2006-04-01

Stepping in time with a metronome has been reported to improve pathological gait. Although there have been many studies of finger tapping synchronisation tasks with a metronome, the specific details of the influences of metronome timing on walking remain unknown. As a preliminary to studying pathological control of gait timing, we designed an experiment with four synchronisation tasks, unilateral heel tapping in sitting, bilateral heel tapping in sitting, bilateral heel tapping in standing, and stepping on the spot, in order to examine the influence of biomechanical constraints on metronome timing. These four conditions allow study of the effects of bilateral co-ordination and maintenance of balance on timing. Eight neurologically normal participants made heel tapping and stepping responses in synchrony with a metronome producing 500 ms interpulse intervals. In each trial comprising 40 intervals, one interval, selected at random between intervals 15 and 30, was lengthened or shortened, which resulted in a shift in phase of all subsequent metronome pulses. Performance measures were the speed of compensation for the phase shift, in terms of the temporal difference between the response and the metronome pulse, i.e. asynchrony, and the standard deviation of the asynchronies and interresponse intervals of steady state synchronisation. The speed of compensation decreased with increase in the demands of maintaining balance. The standard deviation varied across conditions but was not related to the compensation speed. The implications of these findings for metronome assisted gait are discussed in terms of a first-order linear correction account of synchronisation.

A test of the universal applicability of a commonly used principle of hoof balance.

PubMed

Caldwell, M N; Allan, L A; Pinchbeck, G L; Clegg, P D; Kissick, K E; Milner, P I

2016-01-01

This study used a UK trimming protocol to determine whether hoof balance is achieved (as defined by equivalence of geometric proportions) in cadaver limbs (n = 49) and two cohorts of horses (shod, n = 6, and unshod, n = 20; three trimming cycles). To determine equivalence, dorsal hoof wall length (DHWL), distance from the heel buttress to the centre of pressure (HBUT-COP) and distance from dorsal toe to centre of rotation (DT-COR) were calculated as a proportion of bearing border length (BBL) using digital photography. Geometric proportions were tested using Fieller's test of equivalence with limits of difference of 2.8%. In 22 cadaver limbs the location of external COR and COP was also mapped radiographically to the extensor process of the third phalanx and the centre of rotation of the distal interphalangeal joint. Equivalence of geometric proportions was not present following trimming in cadaver limbs or in the two cohorts. Although the dorsal hoof wall to heel wall ratio improved in cadaver and unshod horses after trimming, dorsal hoof wall and lateral heel parallelism was absent in all groups and COP was not consistently in line with the extensor process. Increased COP-COR distance occurred in shod horses and may relate to solar arch flattening. Palmar heel migration, however, occurred more in unshod horses. The study shows that equivalence of geometric proportions as a measure of static hoof balance was not commonly present and widely published measures and ratios of hoof balance rarely occurred in this sample population of horses. Copyright © 2015 Elsevier Ltd. All rights reserved.

Combination of Heel-strike like Mechanical Loading with Deproteinized Cancellous Bone Scaffold Implantation to Repair Segmental Bone Defects in Rabbits.

PubMed

Huang, Guofeng; Liu, Guojun; Zhang, Feng; Gao, Jianting; Wang, Jiangze; Chen, Qi; Wu, Benwen; Ding, Zhenqi; Cai, Taoyi

2017-01-01

Under physiological conditions bone defects often occur at mechanical load bearing sites and bone substitutes used for regeneration should be similarly subjected to mechanical loading stress. In this study, we investigated whether a novel heel-strike like mechanical loading method can be used as a complementary therapy to promote bone regeneration following bone substitute grafting. To test this, three groups of rabbits with segmental bone defects in the tibia were implanted with bovine deproteinized cancellous bone scaffold (DCBS), with one group also receiving heel-strike like mechanical loading generated by a rap stress stimulator. From weeks 4-12 post-operation X-ray and micro-CT scanning showed that rabbits receiving combination therapy had significantly more callus at the bone defect. Moreover, bone defects in the combination group were completely replaced with new bone at week 12, while the DCBS implantation alone group healed only partially and rabbits receiving neither DCBS nor mechanical loading developed only small calluses throughout the observation period. Analysis of micro-CT scanning results demonstrated that new bone density in the combination group was significantly higher than the DCBS only group at weeks 4 and 12 ( p <0.05). H&E staining results also indicated a significantly higher percentage of new bone in the bone defect area and a lower percentage of residual scaffold in the combination group compared to the DCBS only group ( p <0.05). Thus, this heel-strike like mechanical loading method appears to accelerate bone regeneration following substitute implantation by restoring a local mechanical loading environment in segmental bone defects.

A pilot study comparing custom contoured and planar support surfaces for pressure ulcer risk over the heels for night time postural management using interface pressure mapping and discomfort scores.

PubMed

Hosking, J

2017-08-01

Custom contouring techniques are effective for reducing pressure ulcer risk in wheelchair seating. These techniques may assist the management of pressure ulcer risk during sleep for night time postural management. To investigate the effectiveness of custom contoured night time postural management components against planar support surfaces for pressure ulcer risk measures over the heels. Supine posture was captured from five healthy participants using vacuum consolidation and 3-dimensional laser scanning. Custom contoured abduction wedges were carved from polyurethane and chipped foams. Pressure mapping and the visual analog scale were used to evaluate the effectiveness of the contoured foams in reducing pressure and discomfort under the posterior heel against standard planar support surfaces. Custom contoured shapes significantly reduced interface pressures (p < 0.05) and discomfort scores (p < 0.05) when compared to planar support surfaces. Polyurethane foam was the most effective material but it did not differ significantly from chipped foam. Linear regression revealed a significant relationship between the Peak Pressure Index and discomfort scores (r = 0.997, p = 0.003). The findings of this pilot study suggested that custom contoured shapes were more effective than planar surfaces at reducing pressure ulcer risk surrogate measures over the posterior heels with polyurethane foam being the most effective material investigated. It is recommended that Evazote foam should not be used as a support surface material for night time postural management. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

PubMed

Santamaria, Nick; Liu, Wei; Gerdtz, Marie; Sage, Sarah; McCann, Jane; Freeman, Amy; Vassiliou, Theresa; DeVincentis, Stephanie; Ng, Ai W; Manias, Elizabeth; Knott, Jonathan; Liew, Danny

2015-06-01

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

The effect of bridge exercise method on the strength of rectus abdominis muscle and the muscle activity of paraspinal muscles while doing treadmill walking with high heels.

PubMed

Kang, Taewook; Lee, Jaeseok; Seo, Junghoon; Han, Dongwook

2017-04-01

[Purpose] The purpose of this research is to investigate the effect of the method of bridge exercise on the change of rectus abdominis muscle and the muscle activity of paraspinal muscles while doing treadmill walking with high heels. [Subjects and Methods] The subjects of this research are healthy female students consisting of 10 persons performing bridge exercises in a supine group, 10 persons performing bridge exercises in a prone group, and 10 persons in a control group while in S university in Busan. Bridge exercise in supine position is performed in hook lying position. Bridge exercise in prone position is plank exercise in prostrate position. To measure the strength of rectus abdominis muscle, maintaining times of the posture was used. To measure the muscle activity of paraspinal muscles, EMG (4D-MT & EMD-11, Relive, Korea) was used. [Results] The strength of rectus abdominis muscle of both bridge exercises in the supine group and bridge exercises in the prone group increases significantly after exercise. The muscle activity of paraspinal muscle such as thoracic parts and lumbar parts in bridge exercises in the prone group decreases statistically while walking on a treadmill with high heels. Muscle activity of thoracic parts paraspinal muscle and bridge exercises in the supine group decreased significantly. [Conclusion] According to this study, we noticed that bridge exercise in a prone position is desirable for women who prefer wearing high heels as a back pain prevention exercise method.

The development and production of thermo-mechanically forged tool steel spur gears

NASA Technical Reports Server (NTRS)

Bamberger, E. N.

1973-01-01

A development program to establish the feasibility and applicability of high energy rate forging procedures to tool steel spur gears was performed. Included in the study were relatively standard forging procedures as well as a thermo-mechanical process termed ausforming. The subject gear configuration utilized was essentially a standard spur gear having 28 teeth, a pitch diameter of 3.5 inches and a diametral pitch of 8. Initially it had been planned to use a high contact ratio gear design, however, a comprehensive evaluation indicated that severe forging problems would be encountered as a result of the extremely small teeth required by this type of design. The forging studies were successful in achieving gear blanks having integrally formed teeth using both standard and thermo-mechanical forging procedures.

Alternative Chemical Cleaning Methods for High Level Waste Tanks: Simulant Studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rudisill, T.; King, W.; Hay, M.

Solubility testing with simulated High Level Waste tank heel solids has been conducted in order to evaluate two alternative chemical cleaning technologies for the dissolution of sludge residuals remaining in the tanks after the exhaustion of mechanical cleaning and sludge washing efforts. Tests were conducted with non-radioactive pure phase metal reagents, binary mixtures of reagents, and a Savannah River Site PUREX heel simulant to determine the effectiveness of an optimized, dilute oxalic/nitric acid cleaning reagent and pure, dilute nitric acid toward dissolving the bulk non-radioactive waste components. A focus of this testing was on minimization of oxalic acid additions duringmore » tank cleaning. For comparison purposes, separate samples were also contacted with pure, concentrated oxalic acid which is the current baseline chemical cleaning reagent. In a separate study, solubility tests were conducted with radioactive tank heel simulants using acidic and caustic permanganate-based methods focused on the “targeted” dissolution of actinide species known to be drivers for Savannah River Site tank closure Performance Assessments. Permanganate-based cleaning methods were evaluated prior to and after oxalic acid contact.« less

The foldase CYPB is a component of the secretory pathway of Aspergillus niger and contains the endoplasmic reticulum retention signal HEEL.

PubMed

Derkx, P M; Madrid, S M

2001-12-01

Here we report the isolation and characterization of the cypB gene from Aspergillus niger. The cypB gene encodes a protein with a predicted molecular weight of 20.7 kDa, which shows a high degree of identity to the cyclophilin family of peptidyl prolyl cis-trans isomerases (PPIases) from other eukaryotes. The 5' untranslated region of cypB includes three sequences resembling UPREs (unfolded protein response elements). The expression of cypB is upregulated by tunicamycin and DTT, suggesting that at least one UPRE is functional. The CYPB protein also has a 23-amino acid sequence which serves to target the protein to the endoplasmic reticulum (ER), and the ER retention sequence HEEL. CYPB-(His)(6) was expressed in Escherichia coli; the purified protein is capable of isomerizing a substrate peptide in vitro. This is also the first report to show that C-terminal addition of the sequence HEEL is sufficient to ensure retention of the green fluorescent protein (GFP) within the ER.

Plantar fasciitis

PubMed Central

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

2012-01-01

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

Correlation between mobility assessed by the Modified Rivermead Mobility Index and physical function in stroke patients

PubMed Central

Park, Gi-Tae; Kim, Mihyun

2016-01-01

[Purpose] The purpose of this study was to investigate the relationship between mobility assessed by the Modified Rivermead Mobility Index and variables associated with physical function in stroke patients. [Subjects and Methods] One hundred stroke patients (35 males and 65 females; age 58.60 ± 13.91 years) participated in this study. Modified Rivermead Mobility Index, muscle strength (manual muscle test), muscle tone (Modified Ashworth Scale), range of motion of lower extremity, sensory function (light touch and proprioception tests), and coordination (heel to shin and lower-extremity motor coordination tests) were assessed. [Results] The Modified Rivermead Mobility Index was correlated with all the physical function variables assessed, except the degree of knee extension. In addition, stepwise linear regression analysis revealed that coordination (heel to shin test) was the explanatory variable closely associated with mobility in stroke patients. [Conclusion] The Modified Rivermead Mobility Index score was significantly correlated with all the physical function variables. Coordination (heel to shin test) was closely related to mobility function. These results may be useful in developing rehabilitation programs for stroke patients. PMID:27630440

Effect of footwear on minimum foot clearance, heel slippage and spatiotemporal measures of gait in older women.

PubMed

Davis, Annette M; Galna, Brook; Murphy, Anna T; Williams, Cylie M; Haines, Terry P

2016-02-01

Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls. Copyright © 2015 Elsevier B.V. All rights reserved.

Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

PubMed Central

Kataria, Kamal; Sagar, Sushma; Singhal, Manish; Yadav, Rajni

2012-01-01

Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature. PMID:29181131

[Decubitus ulcer in the calcaneus region: rapid development, difficult recovery].

PubMed

Fugazza, G; Bona, F

1996-03-01

Heel pressure sores frequently arise in patients kept in bed for a long time independently of their primary disease. In account of this event the authors completed a study concerning possible mutual relations between heel pressure sores and primary disease of the patients; to validate the pharmacological treatment in less severe sores and the surgical resolution in more serious cutaneous lesions. In the last 3 years (1992-1995) at the Rehabilitation Centre of Montescano the authors have treated 39 patients suffering from 63 different severe cutaneous lesions: from phlycten to deep necrosis. The therapeutic plane utilized pharmacological treatment for 1st, 2nd, 3rd degree pressure sores, and surgical treatment for 4th degree. Pharmacological treatment included: enzymatic drugs, bactericidal and bacteriostatic medicines and cicatrizing substances. Different healing times were related to different pressure sore severity. Surgical treatment consisted of transposition of flap into wound defect. This system caused considerable reduction in resolution times. The authors noticed how easily pressure sores arise in the heel region, and how difficultly they heal. This is probably connected with particular anatomical and vascular characteristics of this region.

Investigation of Concrete Floor Vibration Using Heel-Drop Test

NASA Astrophysics Data System (ADS)

Azaman, N. A. Mohd; Ghafar, N. H. Abd; Azhar, A. F.; Fauzi, A. A.; Ismail, H. A.; Syed Idrus, S. S.; Mokhjar, S. S.; Hamid, F. F. Abd

2018-04-01

In recent years, there is an increased in floor vibration problems of structures like residential and commercial building. Vibration is defined as a serviceability issue related to the comfort of the occupant or damage equipment. Human activities are the main source of vibration in the building and it could affect the human comfort and annoyance of residents in the building when the vibration exceed the recommend level. A new building, Madrasah Tahfiz located at Yong Peng have vibration problem when load subjected on the first floor of the building. However, the limitation of vibration occurs on building is unknown. Therefore, testing is needed to determine the vibration behaviour (frequency, damping ratio and mode shape) of the building. Heel-drop with pace 2Hz was used in field measurement to obtain the vibration response. Since, the heel-drop test results would vary in light of person performance, test are carried out three time to reduce uncertainty. Natural frequency from Frequency Response Function analysis (FRF) is 17.4Hz, 16.8, 17.4Hz respectively for each test.

Conservation assessment for great-spurred violet in the Black Hills National Forest, South Dakota and Wyoming

Treesearch

J. Hope Hornbeck; Carolyn Hull Sieg; Deanna J. Reyher

2003-01-01

Great-spurred violet (Viola selkirkii Pursh ex Goldie; Violaceae) is an early spring flowering herb that occurs in the boreal and Rocky Mountain regions of North America, and cool temperate regions of Eurasia, eastern China and Japan. In the Black Hills, the species is restricted to spruce-dominated forests in cold, shady ravines from 5,400 to 7,000...