[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

Pulsed Compared to Thermal Radiofrequency to the Medial Calcaneal Nerve for Management of Chronic Refractory Plantar Fasciitis: A Prospective Comparative Study.

PubMed

Osman, Ayman M; El-Hammady, Dina H; Kotb, Mohamed M

2016-01-01

Radiofrequency (RF) treatment is a minimally invasive procedure that has been used for more than 3 decades in treating various chronic pain syndromes. Conventional (continuous) RF treatment occasionally results in worsening or even initiating a new type of pain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructive neuromodulatory effect, serves as an alternative to conventional RF therapy in many medical situations. To evaluate the effect of applying PRF for 6 minutes vs. thermal radiofrequency (TRF) for 90 seconds to the medial calcaneal nerve for treatment of chronic refractory plantar fasciitis pain. Prospective comparative study. Pain, Orthopedic, and Rheumatology and Rehabilitation Clinics of Assiut University Hospital. Twenty patients with refractory chronic bilateral plantar fasciitis received PRF to the medial calcaneal nerve for 6 minutes for one heel and TRF to the same nerve on the other heel (as their own control) for 90 seconds. Numerical verbal rating scale (NVRS) at waking up from bed and after prolonged walking, and satisfaction score were used for assessment of studied patients at one, 3, 6, 12, and 24 weeks from the intervention. All studied patients showed significant improvement in their pain scale after the intervention that lasted for 24 weeks; however, the PRF heels had significantly better pain scale and satisfaction scores at the first and third weeks assessments when compared to the TRF heels. Effective analgesia was achieved after one week or less after PRF compared to 3 weeks for the TRF (P < 0.001). No randomization. PRF to the medial calcaneal nerve is a safe and effective method for treatment of chronic plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidly with PRF compared to TRF on the same nerve. Further randomized trials are needed to confirm the therapeutic effect and optimizing the dose of RF needed.Key words: Pulsed radiofrequency, thermal radiofrequency, medial

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.

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.

Skiving stacked sheets of paper into test paper for rapid and multiplexed assay

PubMed Central

Yang, Mingzhu; Zhang, Wei; Yang, Junchuan; Hu, Binfeng; Cao, Fengjing; Zheng, Wenshu; Chen, Yiping; Jiang, Xingyu

2017-01-01

This paper shows that stacked sheets of paper preincubated with different biological reagents and skiving them into uniform test paper sheets allow mass manufacturing of multiplexed immunoassay devices and simultaneous detection of multiplex targets that can be read out by a barcode scanner. The thickness of one sheet of paper can form the width of a module for the barcode; when stacked, these sheets of paper can form a series of barcodes representing the targets, depending on the color contrast provided by a colored precipitate of an immunoassay. The uniform thickness of sheets of paper allows high-quality signal readout. The manufacturing method allows highly efficient fabrication of the materials and substrates for a straightforward assay of targets that range from drugs of abuse to biomarkers of blood-transmitted infections. In addition, as a novel alternative to the conventional point-of-care testing method, the paper-based barcode assay system can provide highly efficient, accurate, and objective diagnoses. PMID:29214218

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.

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.

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.

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.

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 ...

How I Manage Heel Spur Syndrome.

ERIC Educational Resources Information Center

Seder, Joseph I.

1987-01-01

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

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.

Proximally pedicled medial plantar flap based on superficial venous system alone for venous drainage.

PubMed

Wright, Thomas C; Mossaad, Bassem M; Chummun, Shaheel; Khan, Umraz; Chapman, Thomas W L

2013-07-01

The proximally pedicled medial plantar flap is well described for coverage of wounds around the ankle and heel. This flap is usually based on the deep venae comitantes for venous drainage, with the superficial veins divided during dissection. Usually any disruption of the deep venous system of the flap would result in abandoning this choice of flap. Venous congestion is a recognised complication of medial plantar flaps. The patient described in this case report had a medial ankle defect with exposed bone, for which a proximally pedicled medial plantar flap was used. As we raised the flap, both venae comitantes of the medial planter artery were found to be disrupted. The flap was raised based on the superficial veins draining into the great saphenous, as the only system for venous drainage, with no evidence of venous congestion. The flap was successfully transposed into the defect and healed with no complications. The proximally pedicled medial plantar flap can safely rely on the superficial venous system alone for drainage. In addition, preserving the superficial veins minimise the risk of venous congestion in this flap. We recommend preservation of superficial venous system when possible. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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

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

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...

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.

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.

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.

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.

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).

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

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

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

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...

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 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.

When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists

PubMed Central

Uden, Hayley; Kumar, Saravana; Banwell, Helen A.

2018-01-01

Background Flexible pes planus (flat feet) in children is a common reason parents and caregivers seek health professionals consult and a frequent reason podiatrists prescribe foot orthoses. Yet no universal agreement exists on the diagnosis of this condition, or when and how foot orthoses should be prescribed. The aim of this study was to garner consensus and agreement among podiatrists on the use of FOs for paediatric flexible pes planus. Methods A three round Delphi consensus survey was undertaken with 15 podiatry experts from Australia, New Zealand and the United Kingdom. Round One gathered consensus on the diagnosis and intervention into paediatric pes planus with specific questions on types of FOs and prescription variables used. Round Two and Three were based on answers from Round One and gathered agreement (rationale for choices) on a five point Likert scale. 70% of respondents had to agree to a statement for it to be accepted as consensus or agreement. Results Consensus and agreement was achieved for 83 statements directing the diagnosis of pes planus (using FPI-6 and/or rearfoot measures), common signs and symptoms (e.g., pain, fatigue, abnormal gait and other functional concerns) that direct when to intervene into paediatric flexible pes planus. Prefabricated orthoses were the preferred intervention where adequate control is gained with their use. When customised orthoses are prescribed, a vertical [heel] cast pour (71.4%) and minimal arch fill (76.9%) are the prescription variables of choice, plus or minus additional variables (i.e., medial heel (Kirby) skive, the use of a University of California Biomechanical Laboratory device or a medial flange) dependent on level of disorder and plane of excessive motion. Conclusions This study identified consensus and agreement on a series of diagnosis methods and interventions for the paediatric flexible pes planus. A clinical protocol was developed from the resultant consensus statements which provides clinicians

[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.

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.

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.

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.

The soleus syndrome. A cause of medial tibial stress (shin splints).

PubMed

Michael, R H; Holder, L E

1985-01-01

Radionuclide bone scans have demonstrated linear uptake along the posterior medial border of the tibia in patients with shin splints. This area was investigated by anatomical dissection (14 human cadavers), electromyographic (EMG) and muscle stimulation studies (10 patients), and open biopsy (1 patient). Histologically, the increased metabolic activity manifested on the radionuclide scan is due to a periostitis with new bone formation. The soleus muscle and its investing fascia are anatomically and biomechanically implicated in the production of these stress changes, particularly when the heel is in the pronated position. The soleus muscle and fascia form a tough "soleus bridge" over the deep compartment which is thought to be important in patients requiring surgical decompression.

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.

Gait retraining and incidence of medial tibial stress syndrome in army recruits.

PubMed

Sharma, Jagannath; Weston, Matthew; Batterham, Alan M; Spears, Iain R

2014-09-01

Gait retraining, comprising biofeedback and/or an exercise intervention, might reduce the risk of musculoskeletal conditions. The purpose was to examine the effect of a gait-retraining program on medial tibial stress syndrome incidence during a 26-wk basic military training regimen. A total of 450 British Army recruits volunteered. On the basis of a baseline plantar pressure variable (mean foot balance during the first 10% of stance), participants classified as at risk of developing medial tibial stress syndrome (n = 166) were randomly allocated to an intervention (n = 83) or control (n = 83) group. The intervention involved supervised gait retraining, including exercises to increase neuromuscular control and flexibility (three sessions per week) and biofeedback enabling internalization of the foot balance variable (one session per week). Both groups continued with the usual military training regimen. Diagnoses of medial tibial stress syndrome over the 26-wk regimen were made by physicians blinded to the group assignment. Data were modeled in a survival analysis using Cox regression, adjusting for baseline foot balance and time to peak heel rotation. The intervention was associated with a substantially reduced instantaneous relative risk of medial tibial stress syndrome versus control, with an adjusted HR of 0.25 (95% confidence interval, 0.05-0.53). The number needed to treat to observe one additional injury-free recruit in intervention versus control at 20 wk was 14 (11 to 23) participants. Baseline foot balance was a nonspecific predictor of injury, with an HR per 2 SD increment of 5.2 (1.6 to 53.6). The intervention was effective in reducing incidence of medial tibial stress syndrome in an at-risk military sample.

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

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…

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.

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.

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 ...

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)

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.

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.

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.

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.

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.

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 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

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

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.

Inferior heel pain in soccer players: a retrospective study with a proposal for guidelines of treatment

PubMed Central

Saggini, Raoul; Migliorini, Maurizio; Carmignano, Simona Maria; Ancona, Emilio; Russo, Chiara; Bellomo, Rosa Grazia

2018-01-01

Background The cause of heel pain among soccer players is multifactorial and is related to repetitive microtrauma due to impact forces involving technical moves, but also the playground, the exercise mode, the recovery time, the climatic conditions and the footwear used. Aim To investigate the aetiology of plantar heel pain of soccer players with the objective of proposing an example of guidelines for treatment. Methods We investigated the prevalence and characteristics of inferior heel pain of 1473 professional, semiprofessional and amateur players. All evaluated subjects were submitted to a specific rehabilitation protocol that involved advanced physical therapies and viscoelastic insoles depending on the aetiology of pain. Results Clinical and instrumental examinations revealed that 960 of 1473 athletes had inferior heel pain. These patients were divided into seven groups based on aetiology: sural nerve compression, abductor digiti minimi compression, atrophy and inflammation of the fat pad, plantar fasciitis, stress injury of the heel spur, stress fracture of the heel bone and heel spur. The proposed rehabilitation treatment aims for a reduction of pain and an early return to sports, with excellent results. Conclusions According to what was observed in the present study, related also to the specific treatment of inferior heel pain, and considering the technological progress achieved in recent years, we can now propose an integrated therapeutic approach to treatment of heel pain, properly differentiated according to specific aetiology. PMID:29527319

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

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.

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

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.

Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis.

PubMed

Ahmad, Jamal; Karim, Ammar; Daniel, Joseph N

2016-09-01

This study classified plantar heel spurs and their relationship to plantar fasciitis. Patients included those with plantar fasciitis who were treated from 2012 through 2013. Plantar heel spur shape and size were assessed radiographically and correlated to function and pain before and after treatment. Function and pain were scored with the Foot and Ankle Ability Measures and a visual analog scale, respectively. This study included 109 patients with plantar fasciitis. The plantar heel spur shape was classified as 0/absent in 26 patients, 1/horizontal in 66 patients, 2/vertical in 4 patients, and 3/hooked in 13 patients. The plantar heel spur size was less than 5 mm in 75 patients, 5-10 mm in 28 patients, and greater than 10 mm in 6 patients. Initially, patients with any shape or size to their spur had no difference in function and pain. With treatment, patients with horizontal and hooked spurs had the greatest improvement in function and pain (P < .05). With treatment, patients with larger spurs had the greatest improvement in function and pain (P < .05). Plantar heel spurs can be classified by shape and size in patients with plantar fasciitis. Before treatment, neither the spur shape nor size significantly correlated with symptoms. After treatment, patients with larger horizontal or hooked spurs had the greatest improvement in function and pain. These findings may be important when educating patients about the role of heel spurs with plantar fasciitis and the effect of nonsurgical treatment with certain spurs. Level III, comparative series. © The Author(s) 2016.

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.

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.

Ipsilateral Medial and Lateral Discoid Meniscus with Medial Meniscus Tear

PubMed Central

Shimozaki, Kengo; Nakase, Junsuke; Ohashi, Yoshinori; Numata, Hitoaki; Oshima, Takeshi; Takata, Yasushi; Tsuchiya, Hiroyuki

2016-01-01

Introduction: Discoid meniscus is a well-documented knee pathology, and there are many cases of medial or lateral discoid meniscus reported in the literature. However, ipsilateral concurrent medial and lateral discoid meniscus is very rare, and only a few cases have been reported. Herein, we report a case of concurrent medial and lateral discoid meniscus. Case Report: A 27-year-old Japanese man complained of pain on medial joint space in his right knee that was diagnosed as a complete medial and lateral discoid meniscus. In magnetic resonance imaging, although the lateral discoid meniscus had no tear, the medial discoid meniscus had a horizontal tear. Arthroscopic examination of his right knee similarly revealed that the medial discoid meniscus had a horizontal tear. In addition, the discoid medial meniscus also had an anomalous insertion to the anterior cruciate ligament, and there was also mild fibrillation of the medial tibial cartilage surface. We performed arthroscopic partial meniscectomy for the torn medial discoid meniscus but not for the asymptomatic lateral discoid meniscus. The latest follow-up at 18 months indicated satisfactory results. Conclusion: We report a rare case of ipsilateral medial and lateral discoid meniscus with medial meniscus tear. The medial discoid meniscus with tear was treated with partial meniscectomy, whereas the lateral discoid meniscus without tear was only followed up. PMID:28164045

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.

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

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

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

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.

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.

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

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...

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.

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.

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

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

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.

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.

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.

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.

Medial elbow pain

PubMed Central

Barco, Raul; Antuña, Samuel A.

2017-01-01

Medial elbow pain is uncommon when compared with lateral elbow pain. Medial epicondylitis is an uncommon diagnosis and can be confused with other sources of pain. Overhead throwers and workers lifting heavy objects are at increased risk of medial elbow pain. Differential diagnosis includes ulnar nerve disorders, cervical radiculopathy, injured ulnar collateral ligament, altered distal triceps anatomy or joint disorders. Children with medial elbow pain have to be assessed for ‘Little League elbow’ and fractures of the medial epicondyle following a traumatic event. This paper is primarily focused on the differential diagnosis of medial elbow pain with basic recommendations on treatment strategies. Cite this article: EFORT Open Rev 2017;2:362-371. DOI: 10.1302/2058-5241.2.160006 PMID:28932488

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.

Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

PubMed

Barber, F Alan; Getelman, Mark H; Berry, Kathy L

2017-04-01

To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

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...

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.

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).

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.

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.

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

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.

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.

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.

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

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.

Bone imaging of the heel in Reiter's syndrome. [/sup 99m/Tc-pyrophosphate

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

Khalkhali, I.; Stadalnik, R.C.; Wiesner, K.B.

1979-01-01

Classic Reiter's syndrome, which affects young adult males, is characterized by arthritis, conjunctivitis, and nongonococcal urethritis. Other features of probably equal significance include circinate balanitis, shallow ulcerations of the buccal mucosa, and a dermatitis. Reiter's arthritis is usually asymmetrical and tends to involve lower extremity joints. Talalgia, or heel pain, is an often underrated characteristic feature of the arthritis. With an incidence of 50% talalgia can be localized to either the posterior aspect of the heel or to the plantar surface of the heel. Radiographic alterations in these regions are common in patients with recurrent or chronic disease, but aremore » infrequent or minimal in patients with acute Reiter's syndrome. Recent observation of a young male with Reiter's syndrome suggests that bone imaging may help substantiate this clinical feature before radiography reveals calcaneal spurs.« less

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.

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.

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

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.

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

Outside-In Deep Medial Collateral Ligament Release During Arthroscopic Medial Meniscus Surgery.

PubMed

Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel

2016-08-01

Arthroscopic partial medial meniscectomy is a very common orthopaedic procedure performed for symptomatic, irreparable meniscus tears. It is usually associated with a very good outcome and minimal complications. In some patients with tight medial compartment, the posterior horn of the medial meniscus can be difficult to visualize, and access in this area with instruments may be challenging. To increase the opening of the medial compartment, after valgus-extension stress position of the knee, different techniques of deep medial collateral ligament release have been described. The outside-in pie-crusting technique shown in this technical note has documented effectiveness and good outcomes with minimal or no morbidity.

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

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.

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.

Posterior medial meniscus detachment: a unique type of medial meniscal tear.

PubMed

Rubinstein, Richard A; DeHaan, Alex; Baldwin, James L

2009-10-01

Patients with posterior medial meniscal detachment, as determined at knee arthroscopy, were evaluated retrospectively. Mean follow-up was 5.3 years for 8 men and 20 women (30 knees; mean age, 57 years). Most patients had acute onset of pain with a minor specific incident. Seventeen patients were obese, 9 were overweight, and 2 were normal. Eleven of 22 magnetic resonance imaging evaluations detected a tear at the site of the posterior medial meniscus root. Nine of 16 bone scan evaluations showed moderate uptake medially. Arthroscopic treatment included partial medial meniscectomy or meniscal repair. Twelve knees (40%) showed significant progression of arthritis. Of the 7 patients with severe arthritic knees, 5 have subsequently undergone total knee arthroplasty, 1 is considering total knee arthroplasty, and the other has minimal symptoms. Patients should be counseled about the clinical course of posterior medial meniscus detachment and its potential for progressive arthritis in the joint.

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

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.

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.

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

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.

Comparison of lower limb muscle activation with ballet movements (releve and demi-plie) and general movements (heel rise and squat) in healthy adults.

PubMed

Kim, Min-Ju; Kim, Joong-Hwi

2016-01-01

[Purpose] The aim of this study was to demonstrate therapeutic grounds for rehabilitation exercise approach by comparing and analyzing muscular activities of Ballet movements: the releve movement (RM) and the demi-plie movement (DM). [Methods] Four types of movements such as RM vs. heel rise (HM) and DM vs. squat movement (SM) were randomized and applied in 30 healthy male and female individuals while measuring 10-s lower limb muscular activities (gluteus maximus [GMa], gluteus medius [GMe], rectus femoris [RF], adductor longus [AL], medial gastrocnemius [MG], and lateral gastrocnemius [LG]) by using surface electromyography (EMG). [Results] Significant differences were found in GMa, GMe, AL and MG activities for DM and in all of the six muscles for RM, in particular when the two groups were compared (RM vs HM and DM vs SM). [Conclusion] The RM and DM have a greater effect on lower limb muscular force activities compared to HM and SM and could be recommended as clinical therapeutic exercises for lower limb muscle enhancement.

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

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.

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

PubMed

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

2012-02-01

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

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.

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.

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.

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.

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

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...

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.

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

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.

Larger medial femoral to tibial condylar dimension may trigger posterior root tear of medial meniscus.

PubMed

Chung, Jun Young; Song, Hyung Keun; Jung, Myung Kuk; Oh, Hyeong Tak; Kim, Joon Ho; Yoon, Ji-Sang; Min, Byoung-Hyun

2016-05-01

The major meniscal functions are load bearing, load distribution, and shock absorption by increasing the tibiofemoral joint (TFJ) contact area and dissipating axial loads by conversion into hoop stresses. The increased hoop strain stretches the meniscus in outward direction towards radius, causing extrusion, which is associated with the root tear and resultant degenerative osteoarthritis. Since the larger contact area of medial TFJ may increase the hoop stresses, we hypothesized that the larger medial femoral to tibial condylar dimension would contribute to the development of medial meniscus posterior root tear (MMPRT). Thus, the purpose of the study was to assess the relationship between MMPRT and medial femoral to tibial condylar dimension. A case-control study was conducted to compare medial femoral to tibial condylar dimensions of patients with complete MMPRT (n = 59) with those of demography-matched controls (n = 59) during the period from 2010 to 2013. In each patient, MRIs were reviewed and several parameters were measured including articulation width of medial femoral condyle (MFC) at 0°, 30°, 60°, and 90°, medial tibial condyle (MTC) width, degree of meniscal extrusion, and medial femoral to tibial condylar width ratio (MFC/MTC) at 0°, 30°, 60°, and 90°, respectively. Demographic and radiographic data were assessed. A larger medial femoral to tibial condylar dimension was associated with MMPRT at 0° and 30° knee angles. Patients with MFC/MTC greater than 0.9 at 0° also showed about 2.5-fold increase in the chance of MMPRT. Those with meniscal extrusion greater than 3 mm also had about 17.1 times greater chance for the presence of MMPRT accordingly. A larger medial femoral to tibial condylar dimension may be considered as one of the regional contributors to the outbreak of MMPRT, and medial femoral to tibial condylar width ratio greater than 0.9 at 0° knee angle may be considered as a significant risk factor for MMPRT. III.

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.

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.

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.

The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis.

PubMed

Resorlu, Mustafa; Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

2017-12-01

This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

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.

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)

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.

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.

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.

The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis

PubMed Central

Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

2017-01-01

Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear. PMID:29333118

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.

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.

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

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

PubMed Central

Thapa, Deepak; Ahuja, Vanita

2014-01-01

Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF. PMID:24963184

Comparison of lower limb muscle activation with ballet movements (releve and demi-plie) and general movements (heel rise and squat) in healthy adults

PubMed Central

Kim, Min-Ju; Kim, Joong-Hwi

2016-01-01

[Purpose] The aim of this study was to demonstrate therapeutic grounds for rehabilitation exercise approach by comparing and analyzing muscular activities of Ballet movements: the releve movement (RM) and the demi-plie movement (DM). [Methods] Four types of movements such as RM vs. heel rise (HM) and DM vs. squat movement (SM) were randomized and applied in 30 healthy male and female individuals while measuring 10-s lower limb muscular activities (gluteus maximus [GMa], gluteus medius [GMe], rectus femoris [RF], adductor longus [AL], medial gastrocnemius [MG], and lateral gastrocnemius [LG]) by using surface electromyography (EMG). [Results] Significant differences were found in GMa, GMe, AL and MG activities for DM and in all of the six muscles for RM, in particular when the two groups were compared (RM vs HM and DM vs SM). [Conclusion] The RM and DM have a greater effect on lower limb muscular force activities compared to HM and SM and could be recommended as clinical therapeutic exercises for lower limb muscle enhancement. PMID:26957762

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.

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.

Traumatic posterior root tear of the medial meniscus in patients with severe medial instability of the knee.

PubMed

Ra, Ho Jong; Ha, Jeong Ku; Jang, Ho Su; Kim, Jin Goo

2015-10-01

To examine the incidence and diagnostic rate of traumatic medial meniscus posterior root tear associated with severe medial instability and to evaluate the effectiveness of pullout repair. From 2007 to 2011, 51 patients who underwent operation due to multiple ligament injuries including medial collateral ligament rupture were reviewed retrospectively. The International Knee Documentation Committee (IKDC) subjective and Lysholm score were evaluated pre- and postoperatively. Postoperative magnetic resonance imaging (MRI) was performed, and if indicated, a second-look arthroscopic examination was conducted. Fourteen out of 51 patients were associated with severe medial instability. Seven patients were diagnosed with traumatic medial meniscus posterior root tear and underwent arthroscopic pullout repair. Five of them were missed at initial diagnosis using MRI. In seven patients, the mean Lysholm and IKDC subjective scores improved from 74.6 ± 10.3 and 47.6 ± 7.3 to 93.0 ± 3.7 and 91.6 ± 2.6, respectively. All showed complete healing of meniscus root on follow-up MRI and second-look arthroscopy. Medial meniscus posterior root tear may occur in severe medial instability from trauma. It is a common mistake that surgeons may not notice on the diagnosis of those injuries using MRI. Therefore, a high index of suspicion is required for the diagnosis of medial meniscus posterior root tear in this type of injuries. The traumatic medial meniscus posterior root tear could be healed successfully using arthroscopic pullout repair technique. The possibility of the medial meniscus posterior root tear should be considered in severe medial instability and arthroscopic pullout repair can be an effective option for treatment. Case series with no comparison group, Level IV.

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.

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

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.

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.

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.

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

PubMed

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

2016-04-01

Mechanical loading of the Achilles tendon during isolated eccentric contractions could induce immediate and region-dependent changes in mechanical properties. Three-dimensional ultrasound was used to examine the immediate effect of isolated eccentric exercise on the mechanical properties of the distal (free tendon) and proximal (gastrocnemii) regions of the Achilles tendon. Participants (n = 14) underwent two testing sessions in which tendon measurements were made at rest and during a 30% and 70% isometric plantar flexion contractions immediately before and after either: (a) 3 × 15 eccentric heel drops or (b) 10-min rest. There was a significant time-by-session interaction for free tendon length and strain for all loading conditions (P < 0.05). Pairwise comparisons revealed a significant increase in free tendon length and strain at all contraction intensities after eccentric exercise (P < 0.05). There was no significant time-by-session interaction for the gastrocnemii (medial or lateral) aponeurosis or tendon for any of the measured parameters. Immediate changes in Achilles tendon mechanical properties were specific to the free tendon and consistent with changes due to mechanical creep. These findings suggest that the mechanical properties of the free tendon may be more vulnerable to change with exercise compared with the gastrocnemii aponeurosis or tendon. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Parametric study of orthopedic insole of valgus foot on partial foot amputation.

PubMed

Guo, Jun-Chao; Wang, Li-Zhen; Chen, Wei; Du, Cheng-Fei; Mo, Zhong-Jun; Fan, Yu-Bo

2016-01-01

Orthopedic insole was important for partial foot amputation (PFA) to achieve foot balance and avoid foot deformity. The inapposite insole orthosis was thought to be one of the risk factors of reamputation for foot valgus patient, but biomechanical effects of internal tissues on valgus foot had not been clearly addressed. In this study, plantar pressure on heel and metatarsal regions of PFA was measured using F-Scan. The three-dimensional finite element (FE) model of partial foot evaluated different medial wedge angles (MWAs) (0.0°-10.0°) of orthopedic insole on valgus foot. The effect of orthopedic insole on the internal bone stress, the medial ligament tension of ankle, plantar fascia tension, and plantar pressure was investigated. Plantar pressure on medial heel region was about 2.5 times higher than that of lateral region based on the F-Scan measurements. FE-predicted results showed that the tension of medial ankle ligaments was the lowest, and the plantar pressure was redistributed around the heel, the first metatarsal, and the lateral longitudinal arch regions when MWA of orthopedic insole ranged from 7.5° to 8.0°. The plantar fascias maintained about 3.5% of the total load bearing on foot. However, the internal stresses from foot bones increased. The simulation in this study would provide the suggestion of guiding optimal design of orthopedic insole and therapeutic planning to pedorthist.

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

Evaluation of the effectiveness and cost-effectiveness of lightweight fibreglass heel casts in the management of ulcers of the heel in diabetes: a randomised controlled trial.

PubMed Central

Jeffcoate, William; Game, Frances; Turtle-Savage, Vivienne; Musgrove, Alison; Price, Patricia; Tan, Wei; Bradshaw, Lucy; Montgomery, Alan; Fitzsimmons, Deborah; Farr, Angela; Winfield, Thomas; Phillips, Ceri

2017-01-01

BACKGROUND Ulcers of the foot in people with diabetes mellitus are slow to heal and result in considerable cost and patient suffering. The prognosis is worst for ulcers of the heel. OBJECTIVE To assess both the clinical effectiveness and the cost-effectiveness of lightweight fibreglass casts in the management of heel ulcers. DESIGN A pragmatic, multicentre, parallel, observer-blinded randomised controlled trial. A central randomisation centre used a computer-generated random number sequence to allocate participants to groups. SETTING Thirty-five specialist diabetic foot secondary care centres in the UK. Those recruited were aged ≥ 18 years and had diabetes mellitus complicated by ulcers of the heel of grades 2-4 on the National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel scale. PARTICIPANTS In total, 509 participants [68% male, 15% with type 1 diabetes mellitus, mean age 67.5 years (standard deviation 12.4 years)] were randomised 1 : 1 to the intervention (n = 256) or the control (n = 253) arm. The primary outcome data were available for 425 participants (212 from the intervention arm and 213 from the control arm) and exceeded the total required; attrition was 16.5%. The median ulcer area at baseline was 275 mm(2) [interquartile range (IQR) 104-683 mm(2)] in the intervention group and 206 mm(2) (IQR 77-649 mm(2)) in the control group. There were no differences between the two groups at baseline in any parameter, neither in relation to the participant nor in relation to their ulcer. INTERVENTIONS The intervention group received usual care supplemented by the addition of an individually moulded, lightweight, fibreglass heel cast. The control group received usual care alone. The intervention phase continued either until the participant's ulcer had healed (maintained for 28 days) or for 24 weeks, whichever occurred first. During this intervention phase, the participants were reviewed every 2 weeks, and the fibreglass

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.

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

PubMed

Flensmark, Jarl

2004-01-01

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

Bilateral discoid medial menisci: a rare phenomenon

PubMed Central

Samal, Puspak; Bhagwat, Kishan; Panigrahi, Tapas; Gopinathan, Nirmalraj

2014-01-01

Discoid medial meniscus is a relatively rare pathology of the knee joint, with bilateral cases even rarer. Herein, we report the case of a 25-year-old man diagnosed with discoid medial meniscus in the right knee with a horizontal tear. Increased cupping of the medial condyle of the tibia, widening of the medial joint space and the presence of discoid meniscus in the right knee prompted investigation of the asymptomatic left knee with magnetic resonance imaging. The contralateral asymptomatic knee also showed evidence of discoid medial meniscus. The symptomatic knee was successfully treated by arthroscopic partial meniscectomy, with excellent functional outcome. PMID:25273941

Medial Patella Subluxation: Diagnosis and Treatment

PubMed Central

McCarthy, Mark A.; Bollier, Mathew J.

2015-01-01

Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity. PMID:26361441

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.

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.

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

Selected plantar pressure characteristics associated with the skating performance of national in-line speed skaters.

PubMed

Wu, Wen-Lan; Hsu, Hsiu-Tao; Chu, I-Hua; Tsai, Feng-Hua; Liang, Jing-Min

2017-06-01

In order to help coaches analyse the techniques of professional in-line speed skaters for making the required fine adjustments and corrections in their push-off work, this study analysed the specific plantar pressure characteristics during a 300-m time-trial test. Fourteen elite in-line speed skaters from the national team were recruited in this study. The total completion time of the 300-m time-trial test, duration of each skating phase, and plantar pressure distribution were measured. The correlation between plantar pressure distribution and skating performance was assessed using Pearson correlation analyses. The results showed that the contact time of the total foot and force-time integral (FTI) in the medial forefoot were significantly correlated with the duration of the start phase, and the FTIs in the medial forefoot of the gliding (left) leg and lateral forefoot of the pushing (right) leg were significantly correlated with the duration of the turning phase. The maximum force in the medial heel, medial forefoot, and median forefoot and the FTI in the medial heel and medial forefoot were significantly correlated with the duration of the linear acceleration phase. The results suggest that a correct plantar loading area and push-off strategy can enhance the skating performance.

A Systematic Review of Clinical Functional Outcomes After Medial Stabilized Versus Non-Medial Stabilized Total Knee Joint Replacement

PubMed Central

Young, Tony; Dowsey, Michelle M.; Pandy, Marcus; Choong, Peter F.

2018-01-01

Background Medial stabilized total knee joint replacement (TKJR) construct is designed to closely replicate the kinematics of the knee. Little is known regarding comparison of clinical functional outcomes of patients utilising validated patient reported outcome measures (PROM) after medial stabilized TKJR and other construct designs. Purpose To perform a systematic review of the available literature related to the assessment of clinical functional outcomes following a TKJR employing a medial stabilized construct design. Methods The review was performed with a Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) algorithm. The literature search was performed using variouscombinations of keywords. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. Results In the nineteen unique studies identified, there were 2,448 medial stabilized TKJRs implanted in 2,195 participants, there were 1,777 TKJRs with non-medial stabilized design constructs implanted in 1,734 subjects. The final mean Knee Society Score (KSS) value in the medial stabilized group was 89.92 compared to 90.76 in the non-medial stabilized group, with the final KSS mean value difference between the two groups was statistically significant and favored the non-medial stabilized group (SMD 0.21; 95% CI: 0.01 to 0.41; p = 004). The mean difference in the final WOMAC values between the two groups was also statistically significant and favored the medial stabilized group (SMD: −0.27; 95% CI: −0.47 to −0.07; p = 0.009). Moderate to high values (I2) of heterogeneity were observed during the statistical comparison of these functional outcomes. Conclusion Based on the small number of studies with appropriate statistical analysis, we are unable to reach a clear conclusion in the clinical performance of medial stabilized knee replacement construct. Level of Evidence Level II PMID:29696144

A Systematic Review of Clinical Functional Outcomes After Medial Stabilized Versus Non-Medial Stabilized Total Knee Joint Replacement.

PubMed

Young, Tony; Dowsey, Michelle M; Pandy, Marcus; Choong, Peter F

2018-01-01

Medial stabilized total knee joint replacement (TKJR) construct is designed to closely replicate the kinematics of the knee. Little is known regarding comparison of clinical functional outcomes of patients utilising validated patient reported outcome measures (PROM) after medial stabilized TKJR and other construct designs. To perform a systematic review of the available literature related to the assessment of clinical functional outcomes following a TKJR employing a medial stabilized construct design. The review was performed with a Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) algorithm. The literature search was performed using variouscombinations of keywords. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. In the nineteen unique studies identified, there were 2,448 medial stabilized TKJRs implanted in 2,195 participants, there were 1,777 TKJRs with non-medial stabilized design constructs implanted in 1,734 subjects. The final mean Knee Society Score (KSS) value in the medial stabilized group was 89.92 compared to 90.76 in the non-medial stabilized group, with the final KSS mean value difference between the two groups was statistically significant and favored the non-medial stabilized group (SMD 0.21; 95% CI: 0.01 to 0.41; p = 004). The mean difference in the final WOMAC values between the two groups was also statistically significant and favored the medial stabilized group (SMD: -0.27; 95% CI: -0.47 to -0.07; p = 0.009). Moderate to high values ( I 2 ) of heterogeneity were observed during the statistical comparison of these functional outcomes. Based on the small number of studies with appropriate statistical analysis, we are unable to reach a clear conclusion in the clinical performance of medial stabilized knee replacement construct. Level II.

Medial Tibial Stress Syndrome: Evidence-Based Prevention

PubMed Central

Craig, Debbie I

2008-01-01

Reference: Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32–40. Clinical Question: Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Data Sources: Studies were identified by searching MEDLINE (1966–2000), Current Contents (1996–2000), Biomedical Collection (1993–1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Study Selection: Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. Data Extraction: A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Main Results: Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. Conclusions: No current evidence supports any single prevention method for MTSS. The most

Medial tibial stress syndrome: evidence-based prevention.

PubMed

Craig, Debbie I

2008-01-01

Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32-40. Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Studies were identified by searching MEDLINE (1966-2000), Current Contents (1996-2000), Biomedical Collection (1993-1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. No current evidence supports any single prevention method for MTSS. The most promising outcomes support the use of shock-absorbing insoles. Well-designed and controlled trials are critically needed

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

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.

[Hidradenocarcinoma of the heel associated with inguinal metastases].

PubMed

Labbardi, W; Hali, F; Marnissi, F; Cribier, B; Chiheb, S

Hidradenocarcinoma is a rare malignant tumour involving the sweat glands. It classically arises de novo, only rarely resulting from pre-existing hidradenoma. The literature contains few reports of lymph node metastasis in this tumour. We report a case of a patient with hidradenocarcinoma of the heel associated with inguinal node metastases. We report the case of a 64-year-old patient with a history of chronic smoking, who in the last two years developed a painless nodule in his right heel, with no prior injury, and which gradually increased in size to become an ulcerated tumour. Physical examination revealed a rounded tumour mass, ulcerated in the centre, and associated with multiple inguinal adenopathies. Histological and immunohistochemical examination was suggestive of hidradenocarcinoma. The patient had undergone extensive local excision with inguinal lymphadenectomy. Histological examination showed infiltration of lymph nodes by the tumour with capsular rupture. Radiotherapy was subsequently given. The outcome was good without recurrence after 34 months of follow-up. Hidradenocarcinoma is a rare malignant tumour. Diagnosis is based on histological and immunohistochemical examination. However, hidradenocarcinoma may on occasion be difficult to differentiate from hidradenoma, a benign tumour, hence the interest of complete surgical resection with safety margins even in the absence of cytological malignancy. Local recurrences are common. The occurrence of lymph node metastasis during hidradenocarcinoma has been described only rarely in the literature. Such metastases usually occur after tumour resection. The specific features of our case are the rarity of lymph node metastases in hidradenocarcinoma coupled with the fact that these metastases were discovered upon diagnosis of the primary tumour. Copyright © 2017. Published by Elsevier Masson SAS.

Perturbation-enhanced neuromuscular training alters muscle activity in female athletes.

PubMed

Hurd, Wendy J; Chmielewski, Terese L; Snyder-Mackler, Lynn

2006-01-01

Female athletes involved in jumping and cutting sports injure their anterior cruciate ligaments (ACL) 4-6 times more frequently than their male counterparts in comparable sports. Neuromuscular factors, including quadriceps dominance, has been incriminated as contributing to the higher rates of injury in women. Currently, the most effective form of intervention developed to reduce female ACL injury rates has been neuromuscular training. The purpose of this study was to (1) identify gender based muscle activity patterns during disturbed walking that may contribute to ACL injury, and (2) determine if a novel training program could positively influence patterns among healthy female athletes utilizing a disturbed gait paradigm. Twenty healthy athletes (female=10, male=10) were tested. All subjects participated in five trials during which a platform translated horizontally in a lateral direction at heel contact before and after completing ten sessions of a perturbation training program. Electromyographic (EMG) data from the vastus lateralis, medial and lateral hamstrings, and medial gastrocnemius were collected. Trials were analyzed for the muscle onset, termination of activity, peak amplitude, time to peak amplitude, and integrated EMG activity. Muscle cocontraction, the simultaneous activation of antagonistic muscles (lateral hamstrings-vastus lateralis, and medial gastrocnemius-vastus lateralis), was calculated as indicators of active knee stiffness in preparation for heel strike, during weight acceptance and midstance. Prior to training, women had significantly higher peak quadriceps activity and higher integrated quadriceps activity during midstance than men. Both medial and lateral hamstring integrals during midstance increased from pre to posttraining. Onset times to peak activities for hamstrings and quadriceps were similar before training except for medial hamstring time to peak which occurred after heel strike in most women. Time to peak medial hamstring

Medial cortex activity, self-reflection and depression.

PubMed

Johnson, Marcia K; Nolen-Hoeksema, Susan; Mitchell, Karen J; Levin, Yael

2009-12-01

Using functional magnetic resonance imaging, we investigated neural activity associated with self-reflection in depressed [current major depressive episode (MDE)] and healthy control participants, focusing on medial cortex areas previously shown to be associated with self-reflection. Both the MDE and healthy control groups showed greater activity in anterior medial cortex (medial frontal gyrus, anterior cingulate gyrus) when cued to think about hopes and aspirations compared with duties and obligations, and greater activity in posterior medial cortex (precuneus, posterior cingulate) when cued to think about duties and obligations (Experiment 1). However, the MDE group showed less activity than controls in the same area of medial frontal cortex when self-referential cues were more ambiguous with respect to valence (Experiment 2), and less deactivation in a non-self-referential condition in both experiments. Furthermore, individual differences in rumination were positively correlated with activity in both anterior and posterior medial cortex during non-self-referential conditions. These results provide converging evidence for a dissociation of anterior and posterior medial cortex depending on the focus of self-relevant thought. They also provide neural evidence consistent with behavioral findings that depression is associated with disruption of positively valenced thoughts in response to ambiguous cues, and difficulty disengaging from self-reflection when it is appropriate to do so.

Medial cortex activity, self-reflection and depression

PubMed Central

Nolen-Hoeksema, Susan; Mitchell, Karen J.; Levin, Yael

2009-01-01

Using functional magnetic resonance imaging, we investigated neural activity associated with self-reflection in depressed [current major depressive episode (MDE)] and healthy control participants, focusing on medial cortex areas previously shown to be associated with self-reflection. Both the MDE and healthy control groups showed greater activity in anterior medial cortex (medial frontal gyrus, anterior cingulate gyrus) when cued to think about hopes and aspirations compared with duties and obligations, and greater activity in posterior medial cortex (precuneus, posterior cingulate) when cued to think about duties and obligations (Experiment 1). However, the MDE group showed less activity than controls in the same area of medial frontal cortex when self-referential cues were more ambiguous with respect to valence (Experiment 2), and less deactivation in a non-self-referential condition in both experiments. Furthermore, individual differences in rumination were positively correlated with activity in both anterior and posterior medial cortex during non-self-referential conditions. These results provide converging evidence for a dissociation of anterior and posterior medial cortex depending on the focus of self-relevant thought. They also provide neural evidence consistent with behavioral findings that depression is associated with disruption of positively valenced thoughts in response to ambiguous cues, and difficulty disengaging from self-reflection when it is appropriate to do so. PMID:19620180

Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy.

PubMed

Hastings, Mary K; Mueller, Michael J; Woodburn, James; Strube, Michael J; Commean, Paul; Johnson, Jeffrey E; Cheuy, Victor; Sinacore, David R

2016-02-01

Diabetes mellitus related medial column foot deformity is a major contributor to ulceration and amputation. However, little is known about the relationship between medial column alignment and function and the integrity of the soft tissues that support and move the medial column. The purposes of this study were to determine the predictors of medial column alignment and function in people with diabetes and peripheral neuropathy. 23 participants with diabetes and neuropathy had radiographs, heel rise kinematics, magnetic resonance imaging and isokinetic muscle testing to measure: 1) medial column alignment (Meary's angle--the angle between the 1st metatarsal longitudinal axis and the talar head and neck), 2) medial column function (forefoot relative to hindfoot plantarflexion during heel rise), 3) intrinsic foot muscle and fat volume, ratio of posterior tibialis to flexor digitorum tendon volume, 4) plantar fascia function (Meary's angle change from toes flat to extended) and 5) plantarflexor peak torque. Predictors of medial column alignment and function were determined using simultaneous entry multiple regression. Posterior tibialis to flexor digitorum tendon volume ratio and intrinsic foot muscle volume were significant predictors of medial column alignment (P<.05), accounting for 44% of the variance. Intrinsic foot fat volume and plantarflexor peak torque were significant predictors of medial column function (P<.05), accounting for 37% of the variance. Deterioration of medial column supporting structures predicted alignment and function. Prospective research is required to monitor alignment, structure, and function over time to inform early intervention strategies to prevent deformity, ulceration, and amputation. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty.

PubMed

Sim, Jae Ang; Lee, Yong Seuk; Kwak, Ji Hoon; Yang, Sang Hoon; Kim, Kwang Hui; Lee, Beom Koo

2013-12-01

During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.

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

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)

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

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

Callaway, William S.

Eight samples of heel solids from tank 241-C-109 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, one-half to two-thirds of the solids were off-white to tan solids that, visually, were fairly evenly graded in size from coarse silt (30-60 μm) to medium pebbles (8-16 mm). The remaining solids were mostly strongly cemented aggregates ranging from coarse pebbles (16-32 mm) to fine cobbles (6-15 cm) in size. Solid phase characterization and chemical analysis indicated that the air-dry heel solids contained ≈58 wt% gibbsite [Al(OH){sub 3}] and ≈37 wt% natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}·19H{sub 2}O].more » The strongly cemented aggregates were mostly fine-grained gibbsite cemented with additional gibbsite. Dissolution testing was performed on two test samples. One set of tests was performed on large pieces of aggregate solids removed from the heel solids samples. The other set of dissolution tests was performed on a composite sample prepared from well-drained, air-dry heel solids that were crushed to pass a 1/4-in. sieve. The bulk density of the composite sample was 2.04 g/mL. The dissolution tests included water dissolution followed by caustic dissolution testing. In each step of the three-step water dissolution tests, a volume of water approximately equal to 3 times the initial volume of the test solids was added. In each step, the test samples were gently but thoroughly mixed for approximately 2 days at an average ambient temperature of 25 °C. The caustic dissolution tests began with the addition of sufficient 49.6 wt% NaOH to the water dissolution residues to provide ≈3.1 moles of OH for each mole of Al estimated to have been present in the starting composite sample and ≈2.6 moles of OH for each mole of Al potentially present in the starting aggregate sample. Metathesis of gibbsite to sodium aluminate was then allowed to proceed over 10 days of gentle mixing of the test samples

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.

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

[SPECIFIC DIAGNOSTIC SIGNIFICANCE OF "RIPPLE SIGN" OF MEDIAL FEMORAL CONDYLE UNDER ARTHROSCOPE IN MEDIAL LONGITUDINAL MENISCAL TEARS].

PubMed

Ren Shiyou; Sun, Limang; Chen, Guofei; Jiang, Changqing; Zhang, Xintao; Zhang Wentao

2015-01-01

To investigate the reliability of the "ripple sign" on the upper surface of the medial femoral condyle in the diagnosis of medial longitudinal meniscal tears under arthroscope. Between June 2013 and June 2014, 56 patients with knee injuries were included. There were 35 males and 21 females with an average age of 22.2 years (range, 12-38 years). The causes of injury were sports in 40 cases, falling in 10 cases, and traffic accident in 6 cases. The injury was located at the left knee in 22 cases and at the right knee in 34 cases. The disease duration was 10-40 days (mean, 20.2 days). Of 56 patients, 15 cases had simple medial meniscal injury; 41 cases had combined injuries, including anterior cruciate ligament injury in 38 cases, posterior cruciate ligament injury in 2 cases, and patellar dislocation in 1 case. The "ripple sign" was observed under arthroscope before operation. Repair of medial meniscal injury and reconstruction of cruciate ligament were performed. The positive "ripple sign" was seen under arthroscope in all patients, who were diagnosed to have longitudinal meniscal tears, including 23 cases of mild "ripple sign" , 28 cases of moderate "ripple sign", and 5 cases of severe "ripple sign". The "ripple sign" on the upper surface of the medial femoral condyle is a reliable diagnostic evidence of medial longitudinal meniscal tears.

Medial extrusion of the posterior segment of medial meniscus is a sensitive sign for posterior horn tears.

PubMed

Ohishi, Tsuyoshi; Suzuki, Daisuke; Yamamoto, Kazufumi; Banno, Tomohiro; Shimizu, Yuta; Matsuyama, Yukihiro

2014-01-01

To evaluate medial extrusion of the posterior segment of the medial meniscus in posterior horn tears. This study enrolled 72 patients without medial meniscal tears (group N), 72 patients with medial meniscal tears without posterior horn tears (group PH-), 44 patients with posterior horn tears of the medial meniscus (group PH+). All meniscal tears were confirmed by arthroscopy. Medial extrusion of the middle segment and the posterior segment was measured on coronal MRIs. Extrusions of both middle and posterior segments in groups PH- and PH+ (middle segment; 2.94±1.51 mm for group PH- and 3.75±1.69 mm for group PH+, posterior segment; 1.85±1.82 mm for group PH- and 4.59±2.74 mm for group PH+) were significantly larger than those in group N (middle segment; 2.04±1.20, posterior segment; 1.21±1.86). Both indicators of extrusion in group PH+ were larger than those in group PH-. In the early OA category, neither middle nor posterior segment in group PH- extruded more than in group N. However, only the posterior segment in group PH+ extruded significantly more than in group N. Multiple lineal regression analyses revealed that posterior segment extrusion was strongly correlated with the posterior horn tears (p<0.001) among groups PH- and PH+. The newly presented indicator for extrusion of the posterior segment of the medial meniscus is associated with posterior horn tears in comparison with the extrusion of the middle segment, especially in the early stages of osteoarthritis. Level II--Diagnostic Study. Copyright © 2013 Elsevier B.V. All rights reserved.

Selective Medial Release Technique Using the Pie-Crusting Method for Medial Tightness During Primary Total Knee Arthroplasty.

PubMed

Ha, Chul-Won; Park, Yong-Beom; Lee, Choong-Hee; Awe, Soo-Ik; Park, Yong-Geun

2016-05-01

The pie-crusting method is popular in releasing lateral tightness during primary total knee arthroplasty (TKA) but is not well described for medial release. We established a selective medial release technique using the pie-crusting technique and investigated the effectiveness and safety of the technique during primary TKA. We retrospectively reviewed 729 primary TKAs with varus deformity between October 2009 and June 2012. Medial tightness in flexion was released by traditional subperiosteal stripping for the anterior portion of the medial collateral ligament (aMCL). Medial tightness in extension was released by the pie crusting for the tight fibers in the posterior portion of the MCL and/or posteromedial corner structures (pMCL/PMCS). Clinical outcomes were evaluated by Knee Society (KS) scores and the Western Ontario and McMaster Universities Osteoarthritis Index. Any complications, including late medial instability that may be related to our surgical technique, were carefully inspected. Among the 729 knees, 170 (23.3%) required subperiosteal stripping for balancing in flexion only, 186 (25.5%) required the pie-crusting for balancing in extension only and 142 (19.5%) required subperiosteal stripping and the pie-crusting for balancing in flexion and extension. The KS knee score was improved from 52.5 to 83.4, KS function score from 58.2 to 91.9, and Western Ontario and McMaster Universities Osteoarthritis Index from 42.7 to 21.8 (P < .001, all). No specific complications related to our technique were identified. The selective medial release technique appears to be an effective and safe method to obtain a balanced mediolateral gap in primary TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis

PubMed Central

Parkes, Matthew J.; Maricar, Nasimah; Lunt, Mark; LaValley, Michael P.; Jones, Richard K.; Segal, Neil A.; Takahashi-Narita, Kayoko; Felson, David T.

2015-01-01

IMPORTANCE There is no consensus regarding the efficacy of lateral wedge insoles as a treatment for pain in medial knee osteoarthritis. OBJECTIVE To evaluate whether lateral wedge insoles reduce pain in patients with medial knee osteoarthritis compared with an appropriate control. DATA SOURCES Databases searched include the Cochrane Central Register of Controlled Trials, EMBASE, AMED, MEDLINE, CINAHL Plus, ScienceDirect, SCOPUS, Web of Science, and BIOSIS from inception to May 2013, with no limits on study date or language. The metaRegister of Controlled Trials and the NHS Evidence website were also searched. STUDY SELECTION Included were randomized trials comparing shoe-based treatments (lateral heel wedge insoles or shoes with variable stiffness soles) aimed at reducing medial knee load, with a neutral or no wedge control condition in patients with painful medial knee osteoarthritis. Studies must have included patient-reported pain as an outcome. DATA EXTRACTION AND SYNTHESIS Trial data were extracted independently by 2 researchers using a standardized form. Risk of bias was assessed using the Cochrane Risk of Bias tool by 2 observers. Eligible studies were pooled using a random-effects approach. MAIN OUTCOME AND MEASURES Change in self-reported knee pain at follow-up. RESULTS Twelve trials met inclusion criteria with a total of 885 participants of whom 502 received lateral wedge treatment. The pooled standardized mean difference (SMD) suggested a favorable association with lateral wedges compared with control (SMD, −0.47; 95% CI, −0.80 to −0.14); however, substantial heterogeneity was present (I2 = 82.7%). This effect size represents an effect of −2.12 points on the 20-point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale. Larger trials with a lower risk of bias suggested a null association. Meta-regression analyses showed that higher effect sizes (unstandardized β, 1.07 [95% CI, 0.28 to 1.87] for trials using a no treatment

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.

Endoscopic medial maxillectomy breaking new frontiers.

PubMed

Mohanty, Sanjeev; Gopinath, M

2013-07-01

Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management of benign sino-nasal tumours. We present our experience of endoscopic medial maxillectomy in the management of sinonasal pathologies.

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

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.

Rearfoot Transcutaneous Oximetry is a Useful Tool to Highlight Ischemia of the Heel

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

Izzo, Valentina, E-mail: valentina-izzo@virgilio.it; Meloni, Marco, E-mail: meloni.marco@libero.it; Fabiano, Sebastiano, E-mail: sebas575@yahoo.it

PurposeTo demonstrate the usefulness of rearfoot transcutaneous oximetry to assess the peripheral arterial disease in diabetic patients with heel ulcer.MethodsFrom our database of 550 critical limb ischemia diabetic patients followed after a percutaneous transluminal angioplasty, we have selected patients with below the knee arterial disease. Patients were grouped according to the dorsal transcutaneous oximetry value (Group A < 30 mmHg; Group B ≥ 30 mmHg). Patients of Group B had a second oximetry performed at the rearfoot, close to the lesion localized in all cases at the heel. Finally, the analysis of the arterial pattern disease has been done.ResultsWe selected 191 patients: Group A (151 patients),more » dorsal transcutaneous oximetry of 11.8 ± 0.7 mmHg; Group B (40 patients), dorsal transcutaneous oximetry of 44.2 ± 10.1 mmHg. In Group B, rearfoot oximetry was 20.5 ± 5 mmHg, significantly lower than dorsal oximetry (p = 0.0179). The anterior tibial artery was involved in all patients of Group A. In Group B, the anterior tibial artery was involved in 15 subjects and never alone; the posterior tibial artery was involved in 20 subjects and in 11 cases alone. The peroneal artery was affected in 20 subjects and in 14 patients alone.ConclusionWhen a heel lesion is present and the transcutaneous oximetry recorded on the dorsum of the foot does not confirm the presence of critical limb ischemia (not ≤30 mmHg), a second oximetry recorded on the rearfoot is useful to point out ischemia of the peroneal artery and/or of the posterior tibial artery.« less

Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis.

PubMed

Dessery, Yoann; Belzile, Étienne; Turmel, Sylvie; Corbeil, Philippe

2017-08-01

There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. To verify if such effects occur in participants with medial knee osteoarthritis. Randomized single-blinded study. Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.

[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.

The Anatomy of the Medial Patellofemoral Complex.

PubMed

Tanaka, Miho J

2017-06-01

The term "medial patellofemoral complex" (MPFC) was proposed to describe the static medial stabilizer of the patella, typically referred to as the medial patellofemoral ligament. In light of our increasing understanding of the attachment of its fibers to the quadriceps tendon in addition to the patella, the term MPFC is used in this article. The purpose of this article is to describe and discuss the anatomy of the MPFC.

Arthroscopic pullout repair of posterior root tear of the medial meniscus: the anterior approach using medial collateral ligament pie-crusting release.

PubMed

Park, Young-Sik; Moon, Hong-Kyo; Koh, Yong-Gon; Kim, Yong-Chan; Sim, Dong-Sik; Jo, Seung-Bae; Kwon, Se-Kwang

2011-08-01

Posterior root tears of the medial meniscus are frequently encountered and should be repaired if possible to prevent osteoarthritis of the medial compartment. Various surgical techniques have been proposed to repair posterior root tears. The anterior arthroscopic approach can cause an iatrogenic chondral injury due to the narrow medial joint space. The posterior approaches might be technically unfamiliar to many surgeons because they require the establishment of a posteromedial or trans-septal portal. This paper describes the medial collateral ligament pie-crusting release technique for arthroscopic double transosseous pullout repair of posterior root tears of the medial meniscus through the anterior approach to provide the good visualization of the footprint and sufficient working space.

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.

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.

Experimental estimation of energy absorption during heel strike in human barefoot walking.

PubMed

Baines, Patricia M; Schwab, A L; van Soest, A J

2018-01-01

Metabolic energy expenditure during human gait is poorly understood. Mechanical energy loss during heel strike contributes to this energy expenditure. Previous work has estimated the energy absorption during heel strike as 0.8 J using an effective foot mass model. The aim of our study is to investigate the possibility of determining the energy absorption by more directly estimating the work done by the ground reaction force, the force-integral method. Concurrently another aim is to compare this method of direct determination of work to the method of an effective foot mass model. Participants of our experimental study were asked to walk barefoot at preferred speed. Ground reaction force and lower leg kinematics were collected at high sampling frequency (3000 Hz; 1295 Hz), with tight synchronization. The work done by the ground reaction force is 3.8 J, estimated by integrating this force over the foot-ankle deformation. The effective mass model is improved by dropping the assumption that foot-ankle deformation is maximal at the instant of the impact force peak. On theoretical grounds it is clear that in the presence of substantial damping that peak force and peak deformation do not occur simultaneously. The energy absorption results, due the vertical force only, corresponding to the force-integral method is similar to the results of the improved application of the effective mass model (2.7 J; 2.5 J). However the total work done by the ground reaction force calculated by the force-integral method is significantly higher than that of the vertical component alone. We conclude that direct estimation of the work done by the ground reaction force is possible and preferable over the use of the effective foot mass model. Assuming that energy absorbed is lost, the mechanical energy loss of heel strike is around 3.8 J for preferred walking speeds (≈ 1.3 m/s), which contributes to about 15-20% of the overall metabolic cost of transport.

Medial meniscus posterior horn avulsion.

PubMed

Marzo, John M

2009-05-01

Avulsion of the posterior horn of the medial meniscus can occur from acute trauma or chronic degeneration, leading to meniscus extrusion, articular cartilage loss, osteophyte formation, and medial joint space narrowing. With meniscus extrusion, the meniscus is unable to resist hoop stresses and cannot shield the adjacent articular cartilage from excessive axial load. Over time, this can lead to symptomatic knee osteoarthritis. Patients typically report pain, swelling, mechanical symptoms, and general functional loss. Although nonsurgical care may relieve symptoms, it is unlikely to alter either the natural history of meniscal loss or the fate of the medial compartment. Surgical repair of posterior horn meniscal avulsion is done in an attempt to restore the anatomy and biomechanical function of the meniscus, and to slow or prevent degenerative joint disease. Meniscal transplantation is reserved for salvage situations.

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.

Medial orbital wall reconstruction with flexible Ethisorb patches.

PubMed

Pohlenz, P; Adler, W; Li, L; Schmelzle, R; Klatt, J

2013-03-01

The aim of this study was to analyse the long-term result after reconstruction of the medial orbital wall with a flexible, biodegradable material (Ethisorb). During a period of almost 8 years, 31 patients with a medial orbital wall fracture were analysed retrospectively. Inclusion criteria were patients with a maximum size fracture of the orbital medial wall measuring 1.5-2 cm(2). Exophthalmos, enophthalmos, bulbus motility, diplopia and skin sensation were investigated over a period of 6 months. In all patients, the medial orbital wall was reconstructed with Ethisorb patches. No significant intraoperative complications were detected. No postoperative infection, abscess or seroma was found in any of the patients receiving an Ethisorb patch. The advantage of the semiflexibility of the Ethisorb patch is that it supplies an anatomically correct fit to the orbital medial wall but does not require fixation by screws or the use of sutures. The low rate of reported bulbus motility disturbance, diplopia, exophthalmos and enophthalmos demonstrates acceptable results after medial orbital wall reconstruction using the Ethisorb patch.

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

Medial and Lateral Discoid Menisci of Both Knees

PubMed Central

Kan, Hiroyuki; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Minami, Ginjiro; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2016-01-01

Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared. PMID:27894182

Persistently active neurons in human medial frontal and medial temporal lobe support working memory

PubMed Central

Kamiński, J; Sullivan, S; Chung, JM; Ross, IB; Mamelak, AN; Rutishauser, U

2017-01-01

Persistent neural activity is a putative mechanism for the maintenance of working memories. Persistent activity relies on the activity of a distributed network of areas, but the differential contribution of each area remains unclear. We recorded single neurons in the human medial frontal cortex and the medial temporal lobe while subjects held up to three items in memory. We found persistently active neurons in both areas. Persistent activity of hippocampal and amygdala neurons was stimulus-specific, formed stable attractors, and was predictive of memory content. Medial frontal cortex persistent activity, on the other hand, was modulated by memory load and task set but was not stimulus-specific. Trial-by-trial variability in persistent activity in both areas was related to memory strength, because it predicted the speed and accuracy by which stimuli were remembered. This work reveals, in humans, direct evidence for a distributed network of persistently active neurons supporting working memory maintenance. PMID:28218914

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.

Mid-Sole Release of the Plantar Fascia Combined With Percutaneous Drilling of the Calcaneus for Treatment of Resistant Heel Pain.

PubMed

Rizk, Ahmed Shawkat; Kandel, Wael A; Tabl, Eslam Abd Elshafi; Kandil, Mahmoud I

2017-11-01

Heel pain with or without calcaneal spur is a challenging problem. Once conservative measures have failed, surgery may be indicated; there has been debate about the best surgical procedure. Two standard operative procedures have been either releasing the plantar fascia or removing the spur with drilling of the calcaneus. In this study, we evaluated the results of percutaneous drilling of the calcaneus combined with mid-sole release of the plantar fascia for treatment of resistant heel pain. This study included 20 cases with resistant heel pain after failure of conservative measures for 6 months. Clinical, radiological evaluation and scoring patients' conditions according to the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scale was done preoperatively and postoperatively. Percutaneous drilling of the calcaneus combined with mid-sole release of the plantar fascia was done in all cases, and the functional results were evaluated through the follow-up period that extended from 9 to 16 months with a mean duration of 12 ± 2.3 months. There was statistically significant improvement in the mean AOFAS Ankle-Hindfoot scale score from 50.8 ± 7.5 preoperatively to 91.6 ± 7 postoperatively at the last follow-up. There were no surgery-related complications, and the mean time for full recovery was 8 ± 3.7 weeks with no recurrence of pain by the last follow-up. The results were very satisfactory with using this minimally invasive and simple technique for treatment for resistant heel pain. Level IV, retrospective case series.

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…

Proximal Tibia Medial Biplanar Retrotubercle Open Wedge Osteotomy for Varus Knees with Medial Gonarthrosis

PubMed Central

Türkmen, İsmail; Esenkaya, İrfan; Ünay, Koray; Türkmensoy, Fatih; Özkut, Afşar Timuçin

2014-01-01

Objectives: The purpose of this study is to evaluate the early results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for varus gonarthrosis and compare the results with the literatüre. Methods: The results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for 23 knees of 22 patients with medial gonarthrosis were evaluated clinically and radiologically. Results: Twenty of the patients were female and two were male. Mean age of the patients was 56.24; mean boy mass index was 31.95 and preoperative HSS (Hospital for Special Surgery) score was 68.7. Mean tibiofemoral axis was 186.39° and mean Insall-Salvatti index value was 1.04 preoperatively. Mean follow up period was 30.19 months. Mean HSS score was 86.48, femorotibial anatomic axis angle was 175° and Insall-Salvati index value 1.06 during the last follow-up. The improvement of the HSS score and the femorotibial anatomic axis angle was statistically significant. However, the change in Insall Salvati index values was statistically insignificant. Nonfatal pulmonary embolus in 1 patient, and deep vein thrombosis that occured one year after the procedure in 1 patient, rhabdomyolysis in 1 patient and loss of correction (relapse) in 1 patient were encountered as complications. Conclusion: Our results show that proximal tibia medial biplanar retrotubercle open wedge osteotomy improves the frontal and sagittal plane deformities without changing the patellar tendon length. Hence, possible patellofemoral problems are prevented and the clinical results are improved.

A radiographic and anthropometric study of the effect of a contoured sandal and foot orthosis on supporting the medial longitudinal arch.

PubMed

Escalona-Marfil, Carles; McPoil, Thomas G; Mellor, Rebecca; Vicenzino, Bill

2014-01-01

In-shoe foot orthoses improve conditions such as plantar heel pain (fasciitis), probably due to their ability to raise the medial longitudinal arch of the foot and lower the stress on the plantar tissues. Increasingly the arch-profile form of the in-shoe foot orthosis is being incorporated into sandal footwear, providing an alternative footwear option for those who require an orthosis. The purpose of this study was to evaluate if a sandal that incorporates the arch-profile of an in-shoe foot orthosis does indeed raise the medial longitudinal arch. Three commercially available non-medical devices (contoured and flat sandal, prefabricated in-shoe orthosis) worn by healthy individuals were studied in two independent experiments, one using radiographic measurements in Australia (n = 11, 6 female, age 26.1 ± 4.3 yrs, BMI 22.0 ± 2.4 kg/m(2)) and the other utilising anthropometric measures in the USA (n = 10, 6 female, age 26.3 ± 3.8 yrs, BMI 23.5 ± 3.7 kg/m(2)). A barefoot condition was also measured. Dorsal arch height was measured in both experiments, as well as in subtalar neutral in the anthropometric experiment. One way repeated measures ANOVA with follow up Bonferroni-corrected pairwise comparisons were used to test differences between the conditions (contoured and flat sandal, orthosis, barefoot). Mean difference and 95% confidence intervals (CI) and standardised mean differences (SMD) were also calculated. The contoured sandal significantly increased dorsal arch height compared to barefoot and flat sandal in both the anthropometric and radiographic experiments with SMD ranging from 0.95 (mean difference 5.1 mm (CI: 0.3, 1.6)) to 1.8 (4.3 mm (1.9, 6.6)). There were small differences between the contoured sandal and orthosis of 1.9 mm (0.6, 3.3) in the radiographic experiment and 1.2 mm (-0.4, 0.9) in the anthropometric experiment. The contoured sandal approximated the subtalar neutral position (0.4 mm (-0.5, 0.7)). Medial

Stimulation of the medial amygdala enhances medial preoptic dopamine release: implications for male rat sexual behavior.

PubMed

Dominguez, J M; Hull, E M

2001-11-02

Increased dopamine (DA) in the medial preoptic area (MPOA) facilitates male sexual behavior. A major source of innervation to the MPOA is the medial amygdala (MeA). We now report that chemical stimulation of the MeA enhanced levels of extracellular MPOA DA in anesthetized male rats. These results suggest that DA activity in the MPOA can be regulated by input from the MeA to the MPOA.

Trypanosome resistance to human innate immunity: targeting Achilles’ heel

PubMed Central

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

2015-01-01

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

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...

An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty.

PubMed

Athwal, Kiron K; El Daou, Hadi; Inderhaug, Eivind; Manning, William; Davies, Andrew J; Deehan, David J; Amis, Andrew A

2017-08-01

The aim of this study was to quantify the medial soft tissue contributions to stability following constrained condylar (CC) total knee arthroplasty (TKA) and determine whether a medial reconstruction could restore stability to a soft tissue-deficient, CC-TKA knee. Eight cadaveric knees were mounted in a robotic system and tested at 0°, 30°, 60°, and 90° of flexion with ±50 N anterior-posterior force, ±8 Nm varus-valgus, and ±5 Nm internal-external torque. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were transected and their relative contributions to stabilising the applied loads were quantified. After complete medial soft tissue transection, a reconstruction using a semitendinosus tendon graft was performed, and the effect on kinematic behaviour under equivocal conditions was measured. In the CC-TKA knee, the sMCL was the major medial restraint in anterior drawer, internal-external, and valgus rotation. No significant differences were found between the rotational laxities of the reconstructed knee to the pre-deficient state for the arc of motion examined. The relative contribution of the reconstruction was higher in valgus rotation at 60° than the sMCL; otherwise, the contribution of the reconstruction was similar to that of the sMCL. There is contention whether a CC-TKA can function with medial deficiency or more constraint is required. This work has shown that a CC-TKA may not provide enough stability with an absent sMCL. However, in such cases, combining the CC-TKA with a medial soft tissue reconstruction may be considered as an alternative to a hinged implant.

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 percutaneous pie-crusting medial release during arthroscopic procedures of the medial meniscus does neither affect valgus laxity nor clinical outcome.

PubMed

Jeon, Sang-Woo; Jung, Min; Chun, Yong-Min; Lee, Su-Keon; Jung, Woo Seok; Choi, Chong Hyuk; Kim, Sung-Jae; Kim, Sung-Hwan

2017-12-28

To analyze the effect of percutaneous pie-crusting medial release on valgus laxity before and after surgery and on clinical outcomes. Eight-hundred fourteen consecutive patients who underwent an arthroscopic procedure for the medial compartment of the knee were evaluated retrospectively. Sex, age, type of operation (meniscectomy, meniscal repair, and posterior root repair), type of accompanying surgery (none, cartilage procedure, ligament procedure and osteotomy) were documented. Sixty-four patients who underwent percutaneous pie-crusting medial release (release group) and 64 who did not undergo medial release (non-release group) were matched using the propensity score method. Each patient was evaluated for the following variables: degree of valgus laxity on stress radiographs, Lysholm knee score, visual analog scale score, and International Knee Documentation Committee knee score and grade. At the 24-month follow-up, no significant increase in side-to-side differences in the valgus gap was observed in comparison to the preoperative value in the release group [preoperative, - 0.1 ± 1.3 mm; follow-up, - 0.1 ± 1.4 mm; (n.s.)]. The follow-up Lysholm score, visual analog scale score and International Knee Documentation Committee knee score and grade were similar between the two groups. Percutaneous pie-crusting medial release is an additional procedure that can be performed during arthroscopic surgery for patients with a narrow medial joint space of the knee. Percutaneous pie-crusting medial release reduces iatrogenic injury to the cartilage and does not produce any residual valgus laxity of the knee. IV.

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.

Persistent medial foot pain in an adolescent athlete.

PubMed

Hensley, Craig P; Reischl, Stephen F

2013-03-01

The patient was a 15-year-old adolescent male who was referred to a physical therapist for a chief complaint of worsening right medial foot pain. Given the worsening nature of the patient's right medial foot pain, palpatory findings, and a prior recommendation for computed tomography from a radiologist, the patient was referred to his physician. Subsequent computed tomography imaging of the right foot revealed a nondisplaced fracture through the dorsal-medial aspect of the navicular.

The effect of moderate running on foot posture index and plantar pressure distribution in male recreational runners.

PubMed

Escamilla-Martínez, Elena; Martínez-Nova, Alfonso; Gómez-Martín, Beatriz; Sánchez-Rodríguez, Raquel; Fernández-Seguín, Lourdes María

2013-01-01

Fatigue due to running has been shown to contribute to changes in plantar pressure distribution. However, little is known about changes in foot posture after running. We sought to compare the foot posture index before and after moderate exercise and to relate any changes to plantar pressure patterns. A baropodometric evaluation was made, using the FootScan platform (RSscan International, Olen, Belgium), of 30 men who were regular runners and their foot posture was examined using the Foot Posture Index before and after a 60-min continuous run at a moderate pace (3.3 m/sec). Foot posture showed a tendency toward pronation after the 60-min run, gaining 2 points in the foot posture index. The total support and medial heel contact areas increased, as did pressures under the second metatarsal head and medial heel. Continuous running at a moderate speed (3.3 m/sec) induced changes in heel strike related to enhanced pronation posture, indicative of greater stress on that zone after physical activity. This observation may help us understand the functioning of the foot, prevent injuries, and design effective plantar orthoses in sport.

Cartilage Delamination Flap Mimicking a Torn Medial Meniscus

PubMed Central

Bin Abd Razak, Hamid Rahmatullah; Amit Kanta, Mitra

2016-01-01

We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis. PMID:28070434

Effects of varying material properties on the load deformation characteristics of heel cushions.

PubMed

Sun, Pi-Chang; Wei, Hung-Wen; Chen, Chien-Hua; Wu, Chun-Hao; Kao, Hung-Chan; Cheng, Cheng-Kung

2008-07-01

Various insole materials were used in attenuation of heel-strike impact. This study presented a compression test to investigate the deformation characteristics of common heel cushions. There were two materials (thermoplastic elastomer "TPE" and silicone) with three hardness and six thickness being analyzed. They underwent consecutive loading-unloading cycles with a load control mode. The displacement of material thickness was recorded during cyclic compression being applied and released from 0 to 1050 N. The energy input, return and dissipation were evaluated based on the load deformation curves when new and after repeated compression. The TPE recovered more deformed energy and thickness than the silicone after the first loading cycle. The silicone would preserve more strain energy with increasing its hardness for the elastic recovery in the unloading process. The deformed energy was decreased as the original thickness did not completely recover under cyclic tests. The reduction in hysteresis area was gradually converged within 20 cycles. The silicone attenuated more impact energy in the initial cycles, but its energy dissipation was reduced after repeated loading. To increase hardness or thickness should be considered to improve resilience or accommodate persistent compression without flattening. The careful selection of cushion materials is imperative to meet individual functional demands.

[Influence of the posterior tibial tendon on the medial arch of the foot: an in vitro kinetic and kinematic study].

PubMed

Emmerich, J; Wülker, N; Hurschler, C

2003-04-01

The respective contributions of the active and passive structures of the foot to the stability of the medical arch were investigated using an in vitro kinetic and kinematic model. The effect of the tibialis posterior tendon on foot and ankle movements, and plantar pressure distribution of the foot were tested in a cadaveric human foot. The stance phase from heel-contact to toe-off of normal walking gait and after tibialis posterior tendon rupture was simulated in eight roentenographically normal human feet (age 66 +/- 19 years, males). Ground reaction force and tibial inclination was simulated by means of a tilting angle and force-controlled translation stage. Plantar pressure was measured using a pressure-measuring platform. The force developed by the flexors and extensor muscles of the foot were simulated via cables attached to 7 force-controlled hydraulic cylinders. Tibial rotation was produced by an electric servo-motor, and foot movements measured with an ultrasonic analysis system. The model was verified against the plantar distribution and kinematics of healthy subjects measured during normal gait. Tibialis posterior deficit did not result in any detectable changes in pressure or force-time integral in the medial regions of the foot--a common sign of flat foot (pressure: midfoot 0.2 < or = 0.9; medial forefoot 0.5 < or = p < or = 0.9; hallux 0.5 < or = p < or = 0.9; force-time integral: midfoot p = 0-871; medial forefoot p = 0.632; hallux p = 0.068). Only small tendential changes in the kinematics of the talus and calcaneus were observed in dorsiflexion (0-58 sec; talus 0.1 < or = p < or = 0.6; calcaneus 0.4 < or = p < or = 0.06) and eversion (talus: 0-60 sec. 0.1 < or = p < or = 0.6; calcaneus: 37-60 sec. 0.2 < or = p < or = 0.7). The results of this in vitro study show that defective tibialis posterior alone does not produce significant changes in the kinetics or kinematics of the stance phase of normal gait. This suggests that the development of flat foot

Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study.

PubMed

Roussignol, X; Gauthe, R; Rahali, S; Mandereau, C; Courage, O; Duparc, F

2015-09-01

Arthroscopic treatment of tears in the middle and posterior parts of the medial meniscus can be difficult when the medial tibiofemoral compartment is tight. Passage of the instruments may damage the cartilage. The primary objective of this cadaver study was to perform an arthroscopic evaluation of medial tibiofemoral compartment opening after pie-crusting release (PCR) of the superficial medial collateral ligament (sMCL) at its distal insertion on the tibia. The secondary objective was to describe the anatomic relationships at the site of PCR (saphenous nerve, medial saphenous vein). We studied 10 cadaver knees with no history of invasive procedures. The femur was held in a vise with the knee flexed at 45°, and the medial aspect of the knee was dissected. PCR of the sMCL was performed under arthroscopic vision, in the anteroposterior direction, at the distal tibial insertion of the sMCL, along the lower edge of the tibial insertion of the semi-tendinosus tendon. Continuous 300-N valgus stress was applied to the ankle. Opening of the medial tibiofemoral compartment was measured arthroscopically using graduated palpation hooks after sequential PCR of the sMCL. The compartment opened by 1mm after release of the anterior third, 2.3mm after release of the anterior two-thirds, and 3.9mm after subtotal release. A femoral fracture occurred in 1 case, after completion of all measurements. Both the saphenous nerve and the medial saphenous vein were located at a distance from the PCR site in all 10 knees. PCR of the sMCL is chiefly described as a ligament-balancing method during total knee arthroplasty. This procedure is usually performed at the joint line, where it opens the compartment by 4-6mm at the most, with some degree of unpredictability. PCR of the sMCL at its distal tibial insertion provides gradual opening of the compartment, to a maximum value similar to that obtained with PCR at the joint space. The lower edge of the semi-tendinosus tendon is a valuable landmark

Medial meniscus anatomy-from basic science to treatment.

PubMed

Śmigielski, Robert; Becker, Roland; Zdanowicz, Urszula; Ciszek, Bogdan

2015-01-01

This paper focuses on the anatomical attachment of the medial meniscus. Detailed anatomical dissections have been performed and illustrated. Five zones can be distinguished in regard to the meniscus attachments anatomy: zone 1 (of the anterior root), zone 2 (anteromedial zone), zone 3 (the medial zone), zone 4 (the posterior zone) and the zone 5 (of the posterior root). The understanding of the meniscal anatomy is especially crucial for meniscus repair but also for correct fixation of the anterior and posterior horn of the medial meniscus.

Anatomical medial surfaces with efficient resolution of branches singularities.

PubMed

Gil, Debora; Vera, Sergio; Borràs, Agnés; Andaluz, Albert; González Ballester, Miguel A

2017-01-01

Medial surfaces are powerful tools for shape description, but their use has been limited due to the sensibility of existing methods to branching artifacts. Medial branching artifacts are associated to perturbations of the object boundary rather than to geometric features. Such instability is a main obstacle for a confident application in shape recognition and description. Medial branches correspond to singularities of the medial surface and, thus, they are problematic for existing morphological and energy-based algorithms. In this paper, we use algebraic geometry concepts in an energy-based approach to compute a medial surface presenting a stable branching topology. We also present an efficient GPU-CPU implementation using standard image processing tools. We show the method computational efficiency and quality on a custom made synthetic database. Finally, we present some results on a medical imaging application for localization of abdominal pathologies. Copyright © 2016 Elsevier B.V. All rights reserved.

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.

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.

Natural history of medial clavicle fractures.

PubMed

Salipas, Andrew; Kimmel, Lara A; Edwards, Elton R; Rakhra, Sandeep; Moaveni, Afshin Kamali

2016-10-01

Fractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre. A retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV). Sixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n=53), with a median age of 53.5 years (interquartile range (IQR) 37.5-74.5 years). The most common mechanism of injury was motor vehicle accident (n=28). The in-hospital mortality rate was 4.4%. The fracture pattern was almost equally distributed between extra articular (n=35) and intra-articular (n=33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n=31). All fractures were initially managed non-operatively, with a broad arm sling. Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome. Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1-6 years). The mean ASES

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

Cutaneous stimulation of discrete regions of the sole during locomotion produces “sensory steering” of the foot

PubMed Central

2014-01-01

Background While the neural and mechanical effects of whole nerve cutaneous stimulation on human locomotion have been previously studied, there is less information about effects evoked by activation of discrete skin regions on the sole of the foot. Electrical stimulation of discrete foot regions evokes position-modulated patterns of cutaneous reflexes in muscles acting at the ankle during standing but data during walking are lacking. Here, non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. Methods Non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. Results The results demonstrate statistically significant dynamic changes in reflex amplitudes, kinematics and foot sole pressures that are site-specific and phase-dependent. The general trends demonstrate responses producing decreased underfoot pressure at the site of stimulation. Conclusions The responses to

Categorization of biologically relevant chemical signals in the medial amygdala

PubMed Central

Samuelsen, Chad L.; Meredith, Michael

2009-01-01

Many species employ chemical signals to convey messages between members of the same species (conspecific), but chemosignals may also provide information to another species (heterospecific). Here, we found that conspecific chemosignals (male, female mouse urine) increased immediate early gene-protein (IEG) expression in both anterior and posterior medial amygdala of male mice, whereas most heterospecific chemosignals (e.g.: hamster vaginal fluid, steer urine) increased expression only in anterior medial amygdala. This categorization of responses in medial amygdala conforms to our previously reported findings in male hamsters. The same characteristic pattern of IEG expression appears in the medial amygdala of each species in response to conspecific stimuli for that species. These results suggest that the amygdala categorizes stimuli according to the biological relevance for the tested species. Thus, a heterospecific predator (cat collar) stimulus, which elicited behavioral avoidance in mice, increased IEG expression in mouse posterior medial amygdala (like conspecific stimuli). Further analysis suggests reproduction related and potentially threatening stimuli produce increased IEG expression in different sub-regions of posterior medial amygdala (dorsal and ventral, respectively). These patterns of IEG expression in medial amygdala may provide glimpses of a tertiary sorting of chemosensory signals beyond the primary-level selectivity of chemosensory neurons and the secondary sorting in main and accessory olfactory bulbs. PMID:19368822

Isolated medial medullary infarction due to vertebral artery dissection.

PubMed

Wakita, M; Matsuoka, H; Hamada, R; Kasuya, J; Osame, M

2003-12-01

A 54-year-old man developed left hemiparesis and tactile and deep sensory disturbance following onset of rightside cervical pain. These symptoms resulted from an isolated infarct in the right medial area of the upper medulla oblongata and intracranial vertebral artery (VA) dissection. Atherosclerotic disease of the VA is the most common cause of medial medullary infarction. In past reports of isolated medial medullary infarction, only a few cases involved VA dissection.

Medial vestibulospinal tract lesions impair sacculo-collic reflexes.

PubMed

Kim, Seonhye; Lee, Hak-Seung; Kim, Ji Soo

2010-05-01

The medial vestibulospinal tract (VST) is known to mediate the vestibular-evoked myogenic potential (VEMP) in the contracting sternocleidomastoid muscle (SCM). To determine whether disruption of the medial VST in the medulla impairs formation of VEMP, we measured VEMP in 14 patients with medial medullary infarction (MMI). VEMP was induced by a short tone burst and was recorded in contracting SCM while patients turned their heads forcefully to the contralateral side against resistance. Normative data were obtained from 47 healthy volunteers. Seven patients (50%) had abnormal VEMP in the side of the MMI lesion, absent in two, decreased in four, and delayed in two. One patient showed both decreased and delayed response. Of the seven patients with abnormal VEMP, five had the lesions that extended to the dorsal tegmentum while five of the seven patients with normal VEMP showed restricted anteromedial lesions mainly involving the pyramids. Spontaneous nystagmus (4/7, 57%), gaze-evoked nystagmus (6/7, 86%), and ocular tilt reaction/tilt of the subjective visual vertical (4/7, 57%) were frequently observed in the patients with abnormal VEMP. The abnormal VEMP in patients with infarctions involving the medullary tegmentum supports that VEMP is mediated by the medial VST descending within the medial longitudinal fasciculus.

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.

Dendrites of medial olivocochlear neurons in mouse.

PubMed

Brown, M C; Levine, J L

2008-06-12

Stains for acetylcholinesterase (AChE) and retrograde labeling with Fluorogold (FG) were used to study olivocochlear neurons and their dendritic patterns in mice. The two methods gave similar results for location and number of somata. The total number of medial olivocochlear (MOC) neurons in the ventral nucleus of the trapezoid body (VNTB) is about 170 per side. An additional dozen large olivocochlear neurons are located in the dorsal periolivary nucleus (DPO). Dendrites of all of these neurons are long and extend in all directions from the cell bodies, a pattern that contrasts with the sharp frequency tuning of their responses. For VNTB neurons, there were greater numbers of dendrites directed medially than laterally and those directed medially were longer (on average, 25-50% longer). Dendrite extensions were most pronounced for neurons located in the rostral portion of the VNTB. When each dendrite from a single neuron was represented as a vector, and all the vectors summed, the result was also skewed toward the medial direction. DPO neurons, however, had more symmetric dendrites that projected into more dorsal parts of the trapezoid body, suggesting that this small group of olivocochlear neurons has very different physiological properties. Dendrites of both types of neurons were somewhat elongated rostrally, about 20% longer than those directed caudally. These results can be interpreted as extensions of dendrites of olivocochlear neurons toward their synaptic inputs: medially to meet crossing fibers from the cochlear nucleus that are part of the MOC reflex pathway, and rostrally to meet descending inputs from higher centers.

TCDD alters medial epithelial cell differentiation during palatogenesis

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

Abbott, B.D.; Birnbaum, L.S.

1989-06-15

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a widely distributed, persistent environmental contaminant that is teratogenic in mice, where it induces hydronephrosis and cleft palate. The incidence of clefting has been shown to be dose dependent after exposure on either gestation Day (GD) 10 or 12, although the embryo is more susceptible on GD 12. TCDD-exposed palatal shelves meet but do not fuse, and programmed cell death of the medial epithelial cells is inhibited. The mechanism of action through which TCDD alters the program of medial cell development has not been examined in earlier studies, and it is not known whether the mechanism ismore » the same regardless of the dose or developmental stage of exposure. In this study, C57BL/6N mice, a strain sensitive to TCDD, were dosed orally on GD 10 or 12 with 0, 6, 12, 24, or 30 micrograms/kg body wt, in 10 ml corn oil/kg. Embryonic palatal shelves were examined on GD 14, 15, or 16. The degree of palatal closure, epithelial surface morphology, and cellular ultrastructure, the incorporation of (3H)TdR, the expression of EGF receptors, and the binding of 125I-EGF were assessed. After exposure on GD 10 or 12, TCDD altered the differentiation pathway of the medial epithelial cells. The palatal shelves were of normal size and overall morphology, but fusion of the medial epithelia of the opposing shelves did not occur. TCDD prevented programmed cell death of the medial peridermal cells. The expression of EGF receptors by medial cells continued through Day 16 and the receptors were able to bind ligand. The medial cells differentiated into a stratified, squamous, keratinizing epithelium. The shift in phenotype to an oral-like epithelium occurred after exposure on either GD 10 or 12. At the lower dose (6 micrograms/kg), fewer cleft palates were produced, but those shelves which did respond had a fully expressed shift in differentiation.« less

The "safe zone" in medial percutaneous calcaneal pin placement.

PubMed

Gamie, Zakareya; Donnelly, Leo; Tsiridis, Eleftherios

2009-05-01

Percutaneous pin insertion into the medial calcaneus places a number of structures at risk. Evidence suggests that the greatest risk is to the medial calcaneal nerve (MCN). The medial calcaneal region of 24 cadavers was dissected to determine the major structures at risk. By using four palpable anatomical landmarks, the inferior tip of the medial malleolus (point A), the posterior superior portion of the calcaneal tuberosity (point B), the navicular tuberosity (point C), and the medial process of the calcaneal tuberosity (point D), we attempted to define the safe zone taking into account all possible variables in our dissections including ankle position, side, gender, and possible anatomical variations of the MCN. The commonest arrangement of the MCN was two MCNs that arose independently, one arising before the bifurcation of the tibial nerve and the other arising from the medial plantar nerve. A zone could be defined posterior to 75% of the distance along the lines AB, CD, AD, and CB which would avoid most structures. The posterior branches of the MCN, however, would still be at risk and placing the pin too far posteriorly risks an avulsion fracture. This is the first study to employ four palpable anatomical landmarks to identify a zone to minimize damage to neurovascular structures. It may not be possible, however, to avoid injury of the MCN and consequent sensory loss to the sole of the foot.

The mechanism of force transference in feet of children ages two to six.

PubMed

Hu, Mingyu; Zhou, Nan; Xu, Bo; Chen, Wuyong; Wu, Jianxin; Zhou, Jin

2017-05-01

The aim of this study was to design an algorithm to quantify the plantar force transference of children from ages 2-6. In total, 319 healthy children without abnormal gait patterns, foot deformities or injuries, able to walk independently, and with normal BMIs were recruited, and their plantar force distributions were measured. Their plantar areas were divided into ten parts: the hallux, toes #2-5, the first to fifth metatarsal heads (1st-5th MTH), the mid-foot (MF), medial heel (MH) and lateral heel (LH), in which a relative force-time integral (FTIrel) (%) was calculated. Our results show that the FTIrel was significantly transferred along either the transverse or longitudinal arches. The middle of the forefoot and the toe areas were the two main loading regions in children aged 2-3, and posterior to anterior FTIrel shifting was typical. However, anterior to posterior and lateral to medial FTI transferences were found in children aged 5-6, and major loading was found in the heel area. Further, loading in the mid-foot varied with the child's development and was observed to tend to decrease over time. Overall, according to the algorithm designed in this study, these results demonstrated that the development of the arches, both in transverse and longitudinal directions, had already begun in early stages of toddlerhood. Meanwhile, the arches were an important attractor engaged in the windlass mechanism while walking, and they played a major role as bridges to promote posterior to anterior and medial to lateral force transference. Copyright © 2017 Elsevier B.V. All rights reserved.

The measurement of medial knee gap width using ultrasound.

PubMed

Slane, Laura C; Slane, Josh A; Scheys, Lennart

2017-08-01

Medial knee instability is a key clinical parameter for assessing ligament injury and arthroplasty success, but current methods for measuring stability are typically either qualitative or involve ionizing radiation. The purpose of this study was to perform a preliminary analysis of whether ultrasound (US) could be used as an alternate approach for quantifying medial instability by comparing an US method with an approach mimicking the current gold standard fluoroscopy method. US data from the medial knee were collected, while cadaveric lower limbs (n = 8) were loaded in valgus (10 Nm). During post-processing, the US gap width was measured by identifying the medial edges of the femur and tibia and computing the gap width between these points. For comparison, mimicked fluoroscopy (mFluoro) images were created from specimen-specific bone models, developed from segmented CT scans, and from kinematic data collected during testing. Then, gap width was measured in the mFluoro images based on two different published approaches with gap width measured either at the most medial or at the most distal aspect of the femur. Gap width increased significantly with loading (p < 0.001), and there were no significant differences between the US method (unloaded: 8.7 ± 2.4 mm, loaded: 10.7 ± 2.2 mm) and the mFluoro method that measured gap width at the medial femur. In terms of the change in gap width with load, no correlation with the change in abduction angle was observed, with no correlation between the various methods. Inter-rater reliability for the US method was high (0.899-0.952). Ultrasound shows promise as a suitable alternative for quantifying medial instability without radiation exposure. However, the outstanding limitations of existing approaches and lack of true ground-truth data require that further validation work is necessary to better understand the clinical viability of an US approach for measuring medial knee gap width.

Posterior medial meniscus root ligament lesions: MRI classification and associated findings.

PubMed

Choi, Ja-Young; Chang, Eric Y; Cunha, Guilherme M; Tafur, Monica; Statum, Sheronda; Chung, Christine B

2014-12-01

The purposes of this study were to determine the prevalence of altered MRI appearances of "posterior medial meniscus root ligament (PMMRL)" lesions, introduce a classification of lesion types, and report associated findings. We retrospectively reviewed 419 knee MRI studies to identify the presence of PMMRL lesions. Classification was established on the basis of lesions encountered. The medial compartment was assessed for medial meniscal tears in the meniscus proper, medial meniscal extrusion, insertional PMMRL osseous changes, regional synovitis, osteoarthritis, insufficiency fracture, and cruciate ligament abnormality. PMMRL abnormalities occurred in 28.6% (120/419) of the studies: degeneration, 14.3% (60/419) and tear, 14.3% (60/419). Our classification system included degeneration and tearing. Tearing was categorized as partial or complete with delineation of the point of failure as entheseal, midsubstance, or junction to meniscus. Of all tears, 93.3% (56/60) occurred at the meniscal junction. Univariate analysis revealed significant differences between the knees with and without PMMRL lesions in age, medial meniscal tear, medial meniscal extrusion, insertional PMMRL osseous change, regional synovitis, osteoarthritis, insufficiency fracture (p=0.017), and cruciate ligament degeneration (p<0.001). PMMRL lesions are commonly detected in symptomatic patients. We have introduced an MRI classification system. PMMRL lesions are significantly associated with age, medial meniscal tears, medial meniscal extrusion, insertional PMMRL osseous change, regional synovitis, osteoarthritis, insufficiency fracture, and cruciate ligament degeneration.

Episodic snapping of the medial head of the triceps due to weightlifting.

PubMed

Spinner, R J; Wenger, D E; Barry, C J; Goldner, R D

1999-01-01

We describe two patients who had episodic elbow snapping and ulnar nerve dysesthesias only after weightlifting. These symptoms would disappear soon afterward. The episodic nature of their complaints and findings led to misdiagnosis. We documented by repeated clinical examinations and magnetic resonance imaging that the presence of these symptoms correlated directly with the finding of intermittent, activity-related snapping of the medial triceps. In both patients, the symptoms disappeared when the medial portion of the triceps migrated medially but did not dislocate over the medial epicondyle with elbow flexion. Thus, a minor change in the configuration of the medial portion of the triceps (fluid accumulation) in the same individual at different times can cause intermittent dislocation of the medial triceps. Previous papers dealing with patients with snapping of the medial triceps describe symptoms exacerbated by athletic activities, but the constant finding of snapping on sequential examinations.

Medial Auditory Thalamus Inactivation Prevents Acquisition and Retention of Eyeblink Conditioning

ERIC Educational Resources Information Center

Halverson, Hunter E.; Poremba, Amy; Freeman, John H.

2008-01-01

The auditory conditioned stimulus (CS) pathway that is necessary for delay eyeblink conditioning was investigated using reversible inactivation of the medial auditory thalamic nuclei (MATN) consisting of the medial division of the medial geniculate (MGm), suprageniculate (SG), and posterior intralaminar nucleus (PIN). Rats were given saline or…

The medial patellofemoral complex.

PubMed

Loeb, Alexander E; Tanaka, Miho J

2018-06-01

The purpose of this review is to describe the current understanding of the medial patellofemoral complex, including recent anatomic advances, evaluation of indications for reconstruction with concomitant pathology, and surgical reconstruction techniques. Recent advances in our understanding of MPFC anatomy have found that there are fibers that insert onto the deep quadriceps tendon as well as the patella, thus earning the name "medial patellofemoral complex" to allow for the variability in its anatomy. In MPFC reconstruction, anatomic origin and insertion points and appropriate graft length are critical to prevent overconstraint of the patellofemoral joint. The MPFC is a crucial soft tissue checkrein to lateral patellar translation, and its repair or reconstruction results in good restoration of patellofemoral stability. As our understanding of MPFC anatomy evolves, further studies are needed to apply its relevance in kinematics and surgical applications to its role in maintaining patellar stability.

Foot orthoses for plantar heel pain: a systematic review and meta-analysis.

PubMed

Whittaker, Glen A; Munteanu, Shannon E; Menz, Hylton B; Tan, Jade M; Rabusin, Chantel L; Landorf, Karl B

2018-03-01

To investigate the effectiveness of foot orthoses for pain and function in adults with plantar heel pain. Systematic review and meta-analysis. The primary outcome was pain or function categorised by duration of follow-up as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks). Medline, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to June 2017. Studies must have used a randomised parallel-group design and evaluated foot orthoses for plantar heel pain. At least one outcome measure for pain or function must have been reported. A total of 19 trials (1660 participants) were included. In the short term , there was very low-quality evidence that foot orthoses do not reduce pain or improve function. In the medium term , there was moderate-quality evidence that foot orthoses were more effective than sham foot orthoses at reducing pain (standardised mean difference -0.27 (-0.48 to -0.06)). There was no improvement in function in the medium term. In the longer term , there was very low-quality evidence that foot orthoses do not reduce pain or improve function. A comparison of customised and prefabricated foot orthoses showed no difference at any time point. There is moderate-quality evidence that foot orthoses are effective at reducing pain in the medium term, however it is uncertain whether this is a clinically important change. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Results of step-cut medial malleolar osteotomy.

PubMed

Thordarson, David B; Kaku, Shawn K

2006-12-01

Treatment of certain complex ankle pathology, such as a talar body fracture or osteochondral lesion requiring grafting, can necessitate medial malleolar osteotomy for adequate operative exposure. This paper evaluates the step-cut medial malleolar osteotomy for exposure of the ankle joint. Fourteen patients with intra-articular pathology, including talar body fractures or osteochondral lesions necessitating extensive intra-articular exposure had step-cut malleolar osteotomy. The average age of the patients was 37 (range 20-90) years, and the average followup was 8 months. All 14 patients had an uncomplicated intraoperative course, with excellent exposure of the ankle joint. All patients had prompt healing of the osteotomy by 6 weeks after surgery without loss of reduction. None of the patients had pain at the osteotomy site. Step-cut medial malleolar osteotomy is an excellent, reproducible method for extensive exposure of the talar dome.

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis.

PubMed

Tam, Samantha; Sun, Hongmei; Sarma, Sisira; Siu, Jennifer; Fung, Kevin; Sowerby, Leigh

2017-02-20

Medialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty. Cost minimization analysis conducted using a decision tree model. A decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events. Sixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626. Treatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar

Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment.

PubMed

Berber, Reshid; Lewis, Charlotte P; Copas, David; Forward, Daren P; Moran, Christopher G

2014-04-01

This study demonstrates the utility of a modified postero-medial surgical approach to the knee in treating a series of patients with complex tibial plateau injuries with associated postero-medial and postero-lateral shear fractures. Posterior coronal shear fractures are underappreciated and their clinical relevance has recently been characterised. Less-invasive surgery and indirect reduction techniques are inadequate for treating these coronal plane fractures. Our approach includes an inverted 'L'-shaped incision situated within the posterior flexor knee crease, followed by the retraction or incision of the medial head of the gastrocnemius tendon, while protecting the neurovascular structures. This provides a more extensile exposure, as far as the postero-lateral corner, than previously described. Our case series included eight females and eight males. The average age was 53 years. The majority of these injuries were sustained through high-energy trauma. All patients' fractures were classified as Schatzker grade 4, or above, with a postero-medial split depression. Eight patients had associated postero-lateral corner fractures. Two were open, two had vascular compromise and one had neurological injury. The average time to surgery was 6.4 days (range 0-12), operative time 142 min (range 76-300) and length of stay 17 days (range 7-46). A total of 11 patients were treated using the postero-medial approach alone and in five the treatment was combined with an antero-lateral approach. Two patients suffered a reduced range of movement requiring manipulation and physiotherapy, and three patients had a 5-degree fixed flexion deformity. Two patients developed superficial wound infections treated with antibiotics alone. Anatomical reduction and fracture union was achieved in 15 patients. These are complex fractures to treat, and our modified posterior approach allows direct reduction and optimal positioning of plates to act as buttress devices. It can be extended across the

Resection of Grade III cranial horn tears of the equine medial meniscus alter the contact forces on medial tibial condyle at full extension: an in-vitro cadaveric study.

PubMed

Fowlie, Jennifer; Arnoczky, Steven; Lavagnino, Michael; Maerz, Tristan; Stick, John

2011-12-01

To evaluate the magnitude and distribution of joint contact pressure on the medial tibial condyle after grade III cranial horn tears of the medial meniscus. Experimental study. Cadaveric equine stifles (n = 6). Cadaveric stifles were mounted in a materials testing system and electronic pressure sensors were placed between the medial tibial condyle and medial meniscus. Specimens were loaded parallel to the longitudinal axis of the tibia to 1800 N at 130°, 140°, 150°, and 160° stifle angle. Peak pressure and contact area were recorded from the contact maps. Testing was repeated after surgical creation of a grade III cranial horn tear of the medial meniscus, and after resection of the simulated tear. In the intact specimens, a significantly smaller contact area was observed at 160° compared with the other angles (P < .05). Creation of a grade III cranial horn tear in the medial meniscus did not significantly alter the pressure or contact area measurements at any stifle angle compared with intact specimens (P > .05). Resection of the tear resulted in significantly higher peak pressures in the central region of the medial tibial condyle at a stifle angle of 160° relative to the intact (P = .026) and torn (P = .012) specimens. Resection of grade III cranial horn tears in the medial meniscus resulted in a central focal region of increased pressure on the medial tibial condyle at 160° stifle angle. © Copyright 2011 by The American College of Veterinary Surgeons.

Clinical study of medial area infarction in the region of posterior inferior cerebellar artery.

PubMed

Ogawa, Katsuhiko; Suzuki, Yutaka; Oishi, Minoru; Kamei, Satoshi; Shigihara, Shuntaro; Nomura, Yasuyuki

2013-05-01

Our objective is to study the neurological characteristics of medial area infarction in the caudal cerebellum. Medial area of the caudal cerebellum is supplied with 2 branches of the posterior inferior cerebellar artery (PICA). The medial hemispheric branch of the PICA distributes to the medial area of the caudal cerebellar hemisphere. The medial branch of the PICA (mPICA) distributes to the inferior vermis. We studied the neurological characteristics of 18 patients with medial area infarction of the caudal cerebellum. The infarction was located in the medial area of the cerebellar hemisphere and vermis (medial ch/vermis) in 11 patients and in the medial area of the cerebellar hemisphere (medial ch) in 7 patients. All the 18 patients showed acute vertigo and disturbance of standing and gait at onset. On admission, the lateropulsion and wide-based gait were present in 13 patients, respectively. Mild ataxia of the extremities was shown in 7 patients. Acute vertigo and unsteadiness were prominent at onset in the 18 patients, although their ataxia of the extremities was mild or none. This result was consistent with the characteristics of medial area infarction of the caudal cerebellum. Comparing the neurological symptoms between the medial ch/vermis group and medial ch group, both lateropulsion and wide-based gait were significantly infrequent in medial ch group. This result indicated that the vermis was spared because the mPICA was not involved in the medial ch group. It is necessary to make a careful diagnosis when we encounter patients who present acute vertigo because truncal and gait ataxia are unremarkable on admission in patients with the medial area infarction of the caudal cerebellum without vermis involvement. Published by Elsevier Inc.

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

PubMed

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

2015-01-01

Haglund's deformity is a symptomatic posterosuperior deformity of the heel. The lateral radiograph of the ankle will show a prominent, large, posterosuperior part of the calcaneus, which can be measured using the Fowler and Philips angle (FPA, the angle between the posterior and plantar surface of the calcaneus) and the calcaneal pitch angle (CPA, the angle between the sole of the foot and the plantar part of the calcaneus). Although these angles are commonly used, these radiographic angle measurements have never shown a relationship with Haglund's deformity. In 78 patients (51% male) with symptomatic Haglund's deformity and a control group of 100 patients (41% male) with no heel complaints, we measured the FPA and CPA on weightbearing lateral radiographs of the foot. Using an unpaired t tests, no significant difference was found between the 2 groups in the FPA (p = .40). We measured a significant difference in the CPA between the Haglund group and the control group (p = .014). Subgroup analysis showed that this difference was mainly found in females (p < .00), with no significant difference seen in the males (p < .48). Females with Haglund's deformity will have a greater CPA than will females without Haglund's deformity. The CPA showed a difference between the Haglund and non-Haglund groups, although mainly in females. Although the evidence from our study is limited, it would be interesting to study the CPA further, because it implicates the verticalization of the calcaneus. This change in position results in extra traction on the Achilles tendon and can eventually cause tendinitis and bursitis. Radiographic measurement should be used as an auxiliary tool. If the calcaneus tends to change position, it would be interesting to understand this process, which could eventually lead to improvement in the treatment of Haglund's deformity. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: 'SCOPEX', a randomised control trial protocol.

PubMed

Hall, Michelle; Hinman, Rana S; Wrigley, Tim V; Roos, Ewa M; Hodges, Paul W; Staples, Margaret; Bennell, Kim L

2012-11-27

Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. 62 people aged 30-50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee

A clinical evaluation of alternative fixation techniques for medial malleolus fractures.

PubMed

Barnes, Hayley; Cannada, Lisa K; Watson, J Tracy

2014-09-01

Medial malleolus fractures have traditionally been managed using partially threaded screws and/or Kirschner wire fixation. Using these conventional techniques, a non-union rate of as high as 20% has been reported. In addition too many patients complaining of prominent hardware as a source of pain post-fixation. This study was designed to assess the outcomes of medial malleolar fixation using a headless compression screw in terms of union rate, the need for hardware removal, and pain over the hardware site. Saint Louis University and Mercy Medical Center, Level 1 Trauma Centers, St. Louis, MO. After IRB approval, we used billing records to identify all patients with ankle fractures involving the medial malleolus. Medical records and radiographs were reviewed to identify patients with medial malleolar fractures treated with headless compression screw fixation. Our inclusion criteria included follow-up until full weight bearing and a healed fracture. Follow-up clinical records and radiographs were reviewed to determine union, complication rate and perception of pain over the site of medial malleolus fixation. Sixty-four ankles were fixed via headless compression screws and 44 had adequate follow-up for additional evaluation. Seven patients had isolated medial malleolar fractures, 23 patients had bimalleolar fractures, and 14 patients had trimalleolar fractures. One patient (2%) required hardware removal due to cellulitis. One patient (2%) had a delayed union, which healed without additional intervention. Ten patients (23%) reported mild discomfort to palpation over the medial malleolus. The median follow-up was 35 weeks (range: 12-208 weeks). There were no screw removals for painful hardware and no cases of non-union. Headless compression screws provide effective compression of medial malleolus fractures and result in good clinical outcomes. The headless compression screw is a beneficial alternative to the conventional methods of medial malleolus fixation. Copyright �

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.

Transcaruncular Approach for Treatment of Medial Wall and Large Orbital Blowout Fractures.

PubMed

Nguyen, Dennis C; Shahzad, Farooq; Snyder-Warwick, Alison; Patel, Kamlesh B; Woo, Albert S

2016-03-01

We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular-transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data of patients who underwent either a transcaruncular or a combined transcaruncular-transconjunctival approach by a single surgeon for orbital fractures between June 2007 and June 2013 was undertaken. Seven patients with isolated medial wall fractures underwent a transcaruncular approach, and nine patients with combined medial wall and floor fractures underwent a transcaruncular-transconjunctival approach with a lateral canthotomy. Reconstruction was performed using a porous polyethylene implant. All patients with isolated medial wall fractures presented with enophthalmos. In the combined medial wall and floor group, five out of eight patients had enophthalmos with two also demonstrating hypoglobus. The size of the medial wall defect on preoperative computed tomography (CT) scan ranged from 2.6 to 4.6 cm(2); the defect size of combined medial wall and floor fractures was 4.5 to 12.7 cm(2). Of the 11 patients in whom postoperative CT scans were obtained, all were noted to have acceptable placement of the implant. All patients had correction of enophthalmos and hypoglobus. One complication was noted, with a retrobulbar hematoma having developed 2 days postoperatively. The transcaruncular approach is a safe and effective method for reconstruction of medial orbital floor fractures. Even large fractures involving the orbital medial wall and floor can be adequately exposed and reconstructed with a combined transcaruncular-transconjunctival-lateral canthotomy approach. The level of evidence of this study is IV (case series with pre/posttest).

Retrospective evaluation of the effectiveness of radiotherapy in patients with plantar fascitis (heel spurs).

PubMed

Kędzierawski, Piotr; Stando, Rafał; Macek, Paweł

2017-01-01

The aim of the study was the evaluation of the effectiveness of radiotherapy in patients with the feet pain caused by heel spurs. Treatment options for patients reporting these symptoms include use of suitable orthopedic footwear, the use of general or topical non-steroidal anti-inflammatory drugs or steroids, physiotherapy, manual therapy, shock wave or appropriate surgical procedures. Radiotherapy is one of the method used in patients with chronic pain syndrome. The material consisted of 47 patients treated in Radiotherapy Department at the Holycross Cancer Center. The time of follow-up ranged from 1 to 129 months. After treatment patients were observed. During the first follow-up visit a complete relief of symptoms was observed in 37 patients, and the pain was felt by 10 patients for 4 months after the treatment. One patient was re-irradiated 6 months after treatment because of persistent pain. At 16 and 17 months after the onset of treatment, pain was reported by two patients. These patients were re-irradiated. One patient had recurrence of pain 48 months after completion of radiation. After the second irradiation the pain was relieved. The remaining patients, with the exception of two, experienced remission of pain, which has been documented. Tolerance of the treatment was very good. No complications of radiation were observed. Radiotherapy remains an attractive treatment for patients with inflammation of the heel fascia.

Alternate hot and cold application in the management of heel pain: A pilot study.

PubMed

Arankalle, Dhananjay; Wardle, Jon; Nair, Pradeep M K

2016-12-01

Despite a long-standing tradition of naturopathic physical therapy and hydrotherapy use in the treatment of musculoskeletal conditions, neither naturopathy, nor specific aspects of hydrotherapy have been tested for efficacy in the treatment of heel pain. Patients (n=20) were assigned to standard naturopathic physiotherapy care (NPC) with two adjuvant therapy groups: a control group (therapeutic ultrasound, n=10), or alternating compresses (n=10). Pain scores were measured before and after treatment using Visual Analog Scale (VAS) and foot functionality was measured using the Foot Function Index (FFI). FFI reduced from 46.97 to 31.98 (p=0.005) among normal protocol patients and from 49.72 to 21.35 (p=<0.001) among patients receiving the alternating compress protocol. Average VAS pain intensity in the seven days of treatment decreased from 3.53 to 2.53cm (p=<0.001) among patients receiving NPC and from 4.09 to 2.61cm (p=<0.001) amongst those receiving NPC plus alternating compresses. There was no significant difference in pain score reduction between the two groups (p=0.206), but patients with alternating compresses as part of their treatment had significant improvements in foot functionality (p=0.007). Naturopathic physical therapy significantly improves foot functionality and pain scores in heel pain. Additionally, alternating compresses improve foot functionality scores. Copyright © 2016 Elsevier Ltd. All rights reserved.

Double PCL sign does not always indicate a bucket-handle tear of medial meniscus.

PubMed

Liu, Chen; Zheng, Hua Yong; Huang, Yan; Li, Hai Peng; Wu, Han; Sun, Tian Sheng; Yao, Jian Hua

2016-09-01

The discoid medial meniscus is an extremely rare anomaly. Bilateral discoid medial menisci are much more rare but intermittently reported. We report the first case of bilateral discoid medial menisci with positive double PCL sign, which typically indicates a bucket-handle tear of medial meniscus. A literature review was also conducted on bilateral discoid medial menisci.

[Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of 
medial meniscus in knee joint].

PubMed

Zhu, Weihong; Tang, Qi; Liao, Lele; Li, Ding; Yang, Yang; Chen, You

2017-09-28

To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
 Methods: Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months.
 Results: The mean follow-up was 28 (24-36) months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P<0.05) at the 1st day, 5.5 mm and 4.2 mm 
(P<0.05) in the 4th week and 4.8 mm and 4.3 mm (P>0.05) at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561, P<0.05). Lysholm scores was changed from 52.3±5.8 preoperatively to 93.2±6.3 at the final follow-up (t=-41.353, P<0.05). Tegner scores was changed from 4.1±1.1 preoperatively to 5.5±0.6 at the final follow-up (t=-18.792, P<0.05). IKDC scores was changed from 54.5±6.2 preoperative to 93.8±4.5 at the final follow-up (t=-38.253, P<0.05).
 Conclusion: Pie-crusting the medial collateral ligament release is a safe, minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee

[Sinus tarsi approach combined with medial distraction technique for treatment of intra-articular calcaneus fractures].

PubMed

Zhou, Haichao; Ren, Haoyang; Li, Bing; Yu, Tao; Yang, Yunfeng

2016-07-08

implants in the extensile incision group. The bone healing time was (9.9±0.8) weeks in the minimally invasive group, and was (10.1±0.7) weeks in the extensile incision group, showing no significant difference (t=0.613, P=0.845 ). Böhler angle, Gissane angle, calcaneal varus angle, AOFAS score, and VAS score were significantly improved at last follow-up when compared with preoperative values in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05), and the corrective value of angle showed no significant difference between 2 groups (P>0.05). ?Limited open reduction via sinus tarsi approach for intra-articular calcaneus fractures could reduce the incidence of wound complications effectively. Meanwhile, the medial distraction technique is helpful to correct the heel varus deformity.

Dysphagia in a patient with bilateral medial medullary infarcts.

PubMed

Paliwal, Vimal K; Kalita, Jayanti; Misra, Usha K

2009-09-01

Bilateral medial medullary infarct is a rare stroke syndrome and only a handful of cases have been described. Dysphagia as a manifestation of medullary infarcts is well recognized but often associated with lateral medullary infarct. Bilateral medial medullary infarcts are commonly associated with severe dysphagia in addition to a number of other signs and symptoms. We describe a patient who had bilateral medial medullary infarct with severe dysphagia in addition to quadriplegia and respiratory difficulty, and analyze infarct topography with respect to dysphagia, risk factors, vascular territories involved, and prognosis in view of previously reported cases.

Modified tension band wiring of medial malleolar ankle fractures.

PubMed

Georgiadis, G M; White, D B

1995-02-01

Twenty-two displaced medial malleolar ankle fractures that were treated surgically using the modified tension band method of Cleak and Dawson were retrospectively reviewed at an average follow-up of 25 months. The technique involves the use of a screw to anchor a figure-of-eight wire. There were no malreductions and all fractures healed. Problems with the technique included technical errors with hardware placement, medial ankle pain, and asymptomatic wire migration. Despite this, modified tension band wiring remains an acceptable method for fixation of selected displaced medial malleolar fractures. It is especially suited for small fracture fragments and osteoporotic bone.

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.

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.

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.

The medial tibial stress syndrome. A cause of shin splints.

PubMed

Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R

1982-01-01

The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

Ultrastructure of medial rectus muscles in patients with intermittent exotropia.

PubMed

Yao, J; Wang, X; Ren, H; Liu, G; Lu, P

2016-01-01

PURPOSE To study the ultrastructure of the medial rectus in patients with intermittent exotropia at different ages.PATIENTS AND METHODS The medial recti were harvested surgically from 20 patients with intermittent exotropia. Patients were divided into adolescent (age<18 years, n=10) and adult groups (age >18 years, n=10). The normal control group included five patients without strabismus and undergoing eye enucleation. Hematoxylin and eosin staining and transmission electron microscopy were used to visualize the medial recti. Western blot was used to determine the levels of myosin and actin.RESULTS Varying fiber thickness, atrophy, and misalignment of the medial recti were visualized under optical microscope in patients with exotropia. Electron microscopy revealed sarcomere destruction, myofilament disintegration, unclear dark and light bands, collagen proliferation, and fibrosis. The adolescent group manifested significantly higher levels of myosin and actin than the adult group (P<0.05).CONCLUSION Younger patients with intermittent exotropia show stronger contraction of the medial recti compared with older patients. Our findings suggest that childhood was the appropriate time for surgery as the benefit of the intervention was better than in adulthood.

Effects of active feedback gait retraining to produce a medial weight transfer at the foot in subjects with symptomatic medial knee osteoarthritis.

PubMed

Erhart-Hledik, Jennifer C; Asay, Jessica L; Clancy, Caitlin; Chu, Constance R; Andriacchi, Thomas P

2017-10-01

This study aimed to determine if active feedback gait retraining to produce a medial weight transfer at the foot significantly reduces the knee adduction moment in subjects with medial compartment knee osteoarthritis. Secondarily, changes in peak knee flexion moment, frontal plane knee and ankle kinematics, and center of pressure were investigated. Ten individuals with medial compartment knee osteoarthritis (9 males; age: 65.3 ± 9.8 years; BMI: 27.8 ± 3.0 kg/m 2 ) were tested at self-selected normal and fast speeds in two conditions: Intervention, with an active feedback device attached to the shoe of their more affected leg, and control, with the device de-activated. Kinematics and kinetics were assessed using a motion capture system and force plate. The first peak, second peak, and impulse of the knee adduction moment were significantly reduced by 6.0%, 13.9%, and 9.2%, respectively, at normal speed, with reductions of 10.7% and 8.6% in first peak and impulse at fast speed, respectively, with the active feedback system, with no significant effect on the peak knee flexion moment. Significant reductions in peak varus knee angle and medialized center of pressure in the first half of stance were observed, with reductions in peak varus knee angle associated with reductions in the knee adduction moment. This study demonstrated that active feedback to produce a medial weight-bearing shift at the foot reduces the peaks and impulse of the knee adduction moment in patients with medial compartment knee osteoarthritis. Future research should determine the long-term effect of the active feedback intervention on joint loading, pain, and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2251-2259, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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

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.

The Anatomic Midpoint of the Attachment of the Medial Patellofemoral Complex.

PubMed

Tanaka, Miho J; Voss, Andreas; Fulkerson, John P

2016-07-20

The medial patellofemoral ligament varies in attachment of its fibers to the patella and vastus intermedius tendon. Our aim was to identify and describe its anatomic midpoint. To account for the variability of the attachment site, we refer to it as the medial patellofemoral complex. Using AutoCAD software, we identified the midpoint of the medial patellofemoral complex attachment on photographs of 31 cadaveric knee dissections. The midpoint was referenced relative to the superior articular surface of the patella (P1) and was described in terms of the percentage of the patellar articular length distal to this point. A second point, at the junction of the medial border of the vastus intermedius tendon with the superior articular border of the patella, was identified (P2). The distances of the midpoint to P1 and P2 were calculated and were compared using paired t tests. Twenty-five images had appropriate quality and landmarks for digital analysis. The midpoint of the medial patellofemoral complex was located a mean (and standard deviation) of 2.3% ± 15.8% of the patellar articular length distal to the superior pole and was at or proximal to P1 in 12 knees. In all knees, the midpoint was at or proximal to P2. After exclusion of 2 knees with vastus intermedius tendon attachments only, the medial patellofemoral complex midpoint was closer to P2 (5.3% ± 8.6% of the patellar articular length) than to P1 (9.3% ± 8.5% of the patellar articular length) (p = 0.06). The midpoint of the medial patellofemoral complex was 2.3% of the articular length distal to the superior pole of the patella. Additionally, we describe an anatomic landmark at the junction of the medial border of the vastus intermedius tendon and the articular border of the patella that approximates the midpoint of this complex. Our study shows that the anatomic midpoint of the attachment of the medial patellofemoral complex is proximal to the junction of the medial vastus intermedius tendon and the articular

Changes in articular cartilage following arthroscopic partial medial meniscectomy.

PubMed

Eichinger, Martin; Schocke, Michael; Hoser, Christian; Fink, Christian; Mayr, Raul; Rosenberger, Ralf E

2016-05-01

To examine degenerative changes in all cartilage surfaces of the knee following arthroscopic partial medial meniscectomy. For this prospective cohort study, 14 patients (five female) with a mean age of 47.9 ± 12.9 years who had undergone isolated arthroscopic partial medial meniscectomy were evaluated. Cartilage-sensitive magnetic resonance imaging (MRI) scans were acquired from the operated knees before the index operations, as well as at 6, 12, and 24 months after surgery. The MRI scans were assessed for the prevalence, severity, and size of cartilage degenerations. The clinical outcome was assessed using the SF-36 physical and mental component score and the International Knee Documentation Committee Knee Evaluation Form and was correlated with radiological findings. There was a significant increase in the severity of cartilage lesions in the medial tibial plateau (P = 0.019), as well as a trend towards an increase in the lateral tibial plateau. The size of the cartilage lesions increased significantly in the medial femoral condyle (P = 0.005) and lateral femoral condyle (P = 0.029), as well as in the patella (P = 0.019). Functional outcome scores improved significantly throughout the follow-up period. There was no correlation between cartilage wear and functional outcome. Arthroscopic partial medial meniscectomy is associated with adverse effects on articular cartilage and may lead to an increase in the severity and size of cartilage lesions. Post-operative cartilage wear predominantly affected the medial compartment and also affected the other compartments of the knee. Strategies to reduce subsequent osteoarthritic changes need to involve all compartments of the knee. IV.

The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: ‘SCOPEX’ a randomised control trial protocol

PubMed Central

2012-01-01

Background Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. Methods/design 62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. Discussion The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist

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

PubMed

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

2008-04-24

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

Common medial frontal mechanisms of adaptive control in humans and rodents

PubMed Central

Frank, Michael J.; Laubach, Mark

2013-01-01

In this report, we describe how common brain networks within the medial frontal cortex facilitate adaptive behavioral control in rodents and humans. We demonstrate that low frequency oscillations below 12 Hz are dramatically modulated after errors in humans over mid-frontal cortex and in rats within prelimbic and anterior cingulate regions of medial frontal cortex. These oscillations were phase-locked between medial frontal cortex and motor areas in both rats and humans. In rats, single neurons that encoded prior behavioral outcomes were phase-coherent with low-frequency field oscillations particularly after errors. Inactivating medial frontal regions in rats led to impaired behavioral adjustments after errors, eliminated the differential expression of low frequency oscillations after errors, and increased low-frequency spike-field coupling within motor cortex. Our results describe a novel mechanism for behavioral adaptation via low-frequency oscillations and elucidate how medial frontal networks synchronize brain activity to guide performance. PMID:24141310

Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture

PubMed Central

2016-01-01

Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient. PMID:27656305

Etiology and Treatment of Delayed-Onset Medial Malleolar Pain Following Total Ankle Arthroplasty.

PubMed

Lundeen, Gregory A; Dunaway, Linda J

2016-08-01

Total ankle arthroplasty (TAA) has become a successful treatment for end-stage ankle arthritis. Some patients may still have pain or may present with new pain. Suggested sources of medial pain include tibialis posterior tendonitis, impingement, or medial malleolar stress fracture. Etiology and treatment remain unclear. The objective of our study was to evaluate patients with delayed-onset medial malleolar pain following TAA who underwent treatment with percutaneous medial malleolar screw placement and propose an etiology. Patients who had undergone TAA at our institution were reviewed and those with medial malleolar pain were identified. Clinical and radiographic examinations were performed pre- and postoperatively. Radiographs were compared with those from a cohort of controls without a history of medial pain. All affected patients failed conservative therapy and were treated with percutaneous placement of medial malleolar screws positioned from the malleolar tip and extending proximally beyond the tibial component. Postoperatively, patients were placed in an ace wrap and allowed to be weightbearing to tolerance, except for 1 patient initially restricted to partial weightbearing. Visual analog scale (VAS) scores were recorded. Seventy-four (74) patients underwent TAA by the corresponding author. All (100%) were female with an average age of 66 (range, 57-73) years. Average follow-up since screw placement was 21.4 (range, 10-41) months. Six (8.1%) underwent placement of 2 percutaneous medial malleolar screws. Patients presented with pain an average of 12 (range, 4-24) months postoperatively and underwent screw placement an average of 2.8 (range, 1-6) months after presentation. At the time of TAA, none had a coronal plane deformity and none underwent a deltoid ligament release as part of balancing. All (100%) patients had pain and swelling directly over the medial malleolus prior to screw placement. Postoperatively, 1 (17%) had mild pain clinically at this site and

[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.

Effects of Body Mass Index on Mechanical Properties of the Plantar Fascia and Heel Pad in Asymptomatic Participants.

PubMed

Taş, Serkan; Bek, Nilgün; Ruhi Onur, Mehmet; Korkusuz, Feza

2017-07-01

Musculoskeletal foot disorders have a high incidence among overweight and obese individuals. One of the important factors causing this high incidence may be plantar fascia and heel pad (HP)-related mechanical changes occurring in these individuals. The aim of the present study was to investigate the plantar fascia and HP stiffness and thickness parameters in overweight and obese individuals and compare these values with those of normal-weight individuals. This study was carried out in 87 (52 female, 35 male) healthy sedentary individuals between the ages of 19 and 58 years (34 ± 11 years). Participants were subsequently categorized according to body mass index (BMI) as normal weight (18.5 kg/m 2 < BMI < 25 kg/m 2 ) or overweight and obese (BMI ≥25 kg/m 2 ). Plantar fascia and HP thickness and stiffness were measured with an ultrasonography device using a linear ultrasonography probe. Overweight and obese individuals had higher HP thickness ( P < .001), plantar fascia thickness ( P = .001), heel pad microchamber layer (MIC) stiffness ( P < .001), and heel pad macrochamber layer (MAC) stiffness ( P < .001), whereas they had lower plantar fascia stiffness ( P < .001) compared with the individuals with normal weight. BMI had a moderate correlation with HP thickness ( P < .001, r = 0.500), plantar fascia thickness ( P = .001, r = 0.536), MIC stiffness ( P < .001, r = 0.496), and MAC stiffness ( P < .001, r = 0.425). A negative and moderate correlation was found between BMI and plantar fascia stiffness ( P < .001, r = -0.439). Increased BMI causes a decrease in the stiffness of plantar fascia and an increase in the thickness of the plantar fascia as well as the thickness and stiffness of HP. Increased body mass could cause changes in the mechanical properties of HP and plantar fascia. Level 3, comparative study.

Temporary Medial Upper Eyelid Lagophthalmos after External Dacryocystorhinostomy.

PubMed

Haefliger, I O; Meienberg, O; Pimentel de Figueiredo, A R

2016-04-01

Background. Report of three cases of medial upper eyelid lagophthalmos as complication of external dacryocystorhinostomy. History and Signs. Shortly after dacryocystorhinostomy (skin incision on the side of the nose), three of ten consecutive patients (28 ± 4 years; mean ± standard deviation), presented with an ipsilateral lagophthalmos of 4 ± 1 mm in voluntary eyelid closure and 6 ± 1 mm in spontaneous blink. The lagophthalmos was due to a selective paresis of the medial part of the orbicularis oculi muscle of the upper eyelid. Patient 1 complained bitterly of dry eye symptoms and of her lagophthalmos. Patient 2 had mild symptoms but became very concerned after peers made her aware of her asymmetric blink. Patient 3 was asymptomatic and did not notice anything particular. Therapy and Outcome. Lagophthalmos resolved spontaneously within three months after surgery, first by improvement of voluntary eyelid closure and then of spontaneous blinking. Conclusions. Temporary lagophthalmos can occur as a complication of external dacryocystorhinostomy, most likely due to damage of the (only recently described) superficial buccal and/or zygomatic branches of the facial nerve that run upward to cross over the medial ligament and innervate the medial part of the orbicularis oculi muscle. Georg Thieme Verlag KG Stuttgart · New York.

Medial malleolar stress fracture secondary to chronic ankle impingement.

PubMed

Jowett, Andrew J L; Birks, Christopher L; Blackney, Mark C

2008-07-01

Medial malleolar stress fractures are uncommon even in the sporting population. We believe that stress fractures of the medial malleolus may be the end stage of chronic anteromedial ankle impingement in elite running and jumping athletes. We present five cases of elite athletes who presented to our institution with stress fractures of the medial malleolus over a 3-year period (2004 to 2007). In each case preoperative imaging revealed an anteromedial bony spur on the tibia. All fractures were internally fixed and at the same sitting had arthroscopic debridement of the bony spur. All fractures united without further intervention, average time to union was 10.2 (range, 6 to 16) weeks. At most recent review (average, 18 months; range, 8 to 37 months), all patients had resumed sporting activity to their previous level. No patient had suffered a recurrent fracture of the medial malleolus. We believe this region of impingement to be important in the development of the stress fracture and should be addressed at the time of fracture fixation.

Extracorporeal shock wave treatment for chronic plantar fasciitis (heel pain).

PubMed

Ho, C

2007-01-01

(1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis (or heel pain). These waves may help to accelerate the healing process via an unknown mechanism. (2) ESWT, which is performed as an outpatient procedure, is intended to alleviate the pain due to chronic plantar fasciitis. (3) Results from randomized controlled trials have been conflicting. Six trials reported data that favour ESWT over placebo or conservative treatment for efficacy outcomes, while three trials showed no significant difference between the ESWT group and the placebo group. (4) The lack of convergent findings from randomized trials of ESWT for chronic plantar fasciitis suggests uncertainty about its effectiveness. The evidence reviewed in this bulletin does not support the use of this technology for this condition.

Temporal characteristics of Punjabi word-medial singletons and geminates.

PubMed

Hussain, Qandeel

2015-10-01

Many studies have investigated the temporal characteristics of the word-medial singletons and geminates in Indo-Aryan languages. However, little is known about the acoustic cues distinguishing between the word-medial singletons and geminates of Punjabi. The present study examines the temporal characteristics of Punjabi word-medial singleton and geminate stops in a C1V1C2V2 template. The results from five Punjabi speakers showed that, unlike previous studies of Indo-Aryan languages, the durations of C2 and V2 are the most important acoustic correlates of singleton and geminate stops in Punjabi. These findings therefore point towards the cross-linguistic differences in the acoustic correlates of singletons and geminates.

Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles.

PubMed

Durr, Megan L; Goldberg, Andrew N

2014-01-01

To describe a technique of endoscopic medial maxillectomy with mucosal flap for postoperative maxillary sinus mucoceles and to present a case series of subjects who underwent this procedure. This case series includes four subjects with postoperative maxillary sinus mucoceles who underwent resection via endoscopic partial medial maxillectomy with a mucosal flap. We will discuss the clinical presentation, imaging characteristics, operative details, and outcomes. Four subjects are included in this study. The average age at the time of medial maxillectomy was 52 years (range 35-65 years). Three subjects (75%) were female. One subject (25%) had bilateral postoperative maxillary sinus mucoceles. Two subjects (50%) had unilateral right sided mucoceles, and the remaining subject had a unilateral left sided mucocele. All subjects had a history of multiple sinus procedures for chronic sinusitis including Caldwell-Luc procedures ipsilateral to the postoperative mucocele. All subjects underwent endoscopic medial maxillectomy without complication and were symptom free at the last follow up appointment, average 24 months (range 3-71 months) after medial maxillectomy. For postoperative maxillary sinus mucoceles in locations that are difficult to access via the middle meatus antrostomy, we recommend endoscopic medial maxillectomy with mucosal flap. Our preliminary experience with four subjects demonstrates complete resolution of symptoms after this procedure. Copyright © 2014 Elsevier Inc. 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.

Increased expression of c-fos in the medial preoptic area after mating in male rats: role of afferent inputs from the medial amygdala and midbrain central tegmental field.

PubMed

Baum, M J; Everitt, B J

1992-10-01

Immunocytochemical methods were used to localize the protein product of the immediate-early gene, c-fos, in male rats after exposure to, or direct physical interaction with, oestrous females. Increasing amounts of physical contact with a female, with resultant olfactory-vomeronasal and/or genital-somatosensory inputs, caused corresponding increments in c-fos expression in the medial preoptic area, the caudal part of the bed nucleus of the stria terminalis, the medial amygdala, and the midbrain central tegmental field. Males bearing unilateral electrothermal lesions of the olfactory peduncle showed a significant reduction in c-fos expression in the ipsilateral medial amygdala, but not in other structures, provided their coital interaction with oestrous females was restricted to mount-thrust and occasional intromissive patterns due to repeated application of lidocaine anaesthetic to the penis. No such lateralization of c-fos expression occurred in other males with unilateral olfactory lesions which were allowed to intromit and ejaculate with a female. These results suggest that olfactory inputs, possibly of vomeronasal origin, contribute to the activation of c-fos in the medial amygdala. However, lesion-induced deficits in this type of afferent input to the nervous system appear to be readily compensated for by the genital somatosensory input derived from repeated intromissions. Unilateral excitotoxic lesions of the medial preoptic area, made by infusing quinolinic acid, failed to reduce c-fos expression in the ipsilateral or contralateral medial amygdala or central tegmental field following ejaculation. By contrast, combined, unilateral excitotoxic lesions of the medial amygdala and the central tegmental field significantly reduced c-fos expression in the ipsilateral bed nucleus of the stria terminalis and medial preoptic area after mating; no such asymmetry in c-fos expression occurred when lesions were restricted to either the medial amygdala or central tegmental

Anatomical analysis of medial branches of dorsal rami of cervical nerves for radiofrequency thermocoagulation.

PubMed

Kweon, Tae Dong; Kim, Ji Young; Lee, Hye Yeon; Kim, Myung Hwa; Lee, Youn-Woo

2014-01-01

Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation. Twenty cervical specimens were harvested from 20 adult cadavers. The anatomical parameters of the C4-C7 cervical medial branches were measured. The 3-dimensional computed tomography reconstruction images of the bone were also analyzed. Based on cadaveric analysis, most of the cervical dorsal rami gave off 1 medial branch; however, the cervical dorsal rami gave off 2 medial branches in 27%, 15%, 2%, and 0% at the vertebral level C4, C5, C6, and C7, respectively. The diameters of the medial branches varied from 1.0 to 1.2 mm, and the average distance from the notch of inferior articular process to the medial branches was about 2 mm. Most of the bifurcation sites were located at the medial side of the posterior tubercle of the transverse process. On the analysis of 3-dimensional computed tomography reconstruction images, cervical medial branches (C4 to C6) passed through the upper 49% to 53% of a line between the tips of 2 consecutive superior articular processes (anterior line). Also, cervical medial branches passed through the upper 28% to 35% of a line between the midpoints of 2 consecutive facet joints (midline). The present anatomical study may help improve accuracy and safety during radiofrequency denervation of the cervical medial branches.

Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty.

PubMed

van der List, J P; McDonald, L S; Pearle, A D

2015-12-01

Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies. A search was performed using PubMed, Embase and Cochrane systems. Ninety-six eligible studies reported survivorship, of which fifty-eight reported medial and sixteen reported lateral UKA survivorship. Nineteen cohort studies and seven registry-based studies reported combined medial and lateral survivorship. The five-year, ten-year and fifteen-year medial UKA survivorship was 93.9%, 91.7% and 88.9%, respectively. Lateral UKA survivorship was 93.2%, 91.4% and 89.4% at five-year, ten-year and fifteen-year, respectively. No statistical difference between both compartments was found. At twenty years and twenty-five years survivorship of medial UKA was 84.7% and 80%, respectively, but no studies reported lateral UKA survivorship at these follow-up intervals. Survivorship of cohort studies was not significantly higher compared to registry-based studies at five years (94.3 vs. 91.7, respectively, p=0.133) but was significantly higher at ten years (90.5 vs. 84.1, p=0.015). This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies. Copyright © 2015 Elsevier B.V. All rights reserved.

Morphometry of medial gaps of human brain artery branches.

PubMed

Canham, Peter B; Finlay, Helen M

2004-05-01

The bifurcation regions of the major human cerebral arteries are vulnerable to the formation of saccular aneurysms. A consistent feature of these bifurcations is a discontinuity of the tunica media at the apex of the flow divider. The objective was to measure the 3-dimensional geometry of these medial gaps or "medial defects." Nineteen bifurcations and 2 junctions of human cerebral arteries branches (from 4 male and 2 female subjects) were formalin-fixed at physiological pressure and processed for longitudinal serial sectioning. The apex and adjacent regions were examined and measurements were made from high-magnification photomicrographs, or projection microscope images, of the gap dimensions at multiple levels through the bifurcation. Plots were made of the width of the media as a function of distance from the apex. The media at each edge of the medial gap widened over a short distance, reaching the full width of the media of the contiguous daughter vessel. Medial gap dimensions were compared with the planar angle of the bifurcation, and a strong negative correlation was found, ie, the acute angled branches have the more prominent medial gaps. A discontinuity of the media at the apex was seen in all the bifurcations examined and was also found in the junction regions of brain arteries. We determined that the gap width is continuous with well-defined dimensions throughout its length and average length-to-width ratio of 6.9. The gaps were generally centered on the prominence of the apical ridge.

Association of medial meniscal extrusion with medial tibial osteophyte distance detected by T2 mapping MRI in patients with early-stage knee osteoarthritis.

PubMed

Hada, Shinnosuke; Ishijima, Muneaki; Kaneko, Haruka; Kinoshita, Mayuko; Liu, Lizu; Sadatsuki, Ryo; Futami, Ippei; Yusup, Anwajan; Takamura, Tomohiro; Arita, Hitoshi; Shiozawa, Jun; Aoki, Takako; Takazawa, Yuji; Ikeda, Hiroshi; Aoki, Shigeki; Kurosawa, Hisashi; Okada, Yasunori; Kaneko, Kazuo

2017-09-12

Medial meniscal extrusion (MME) is associated with progression of medial knee osteoarthritis (OA), but no or little information is available for relationships between MME and osteophytes, which are found in cartilage and bone parts. Because of the limitation in detectability of the cartilage part of osteophytes by radiography or conventional magnetic resonance imaging (MRI), the rate of development and size of osteophytes appear to have been underestimated. Because T2 mapping MRI may enable us to evaluate the cartilage part of osteophytes, we aimed to examine the association between MME and OA-related changes, including osteophytes, by using conventional and T2 mapping MRI. Patients with early-stage knee OA (n = 50) were examined. MRI-detected OA-related changes, in addition to MME, were evaluated according to the Whole-Organ Magnetic Resonance Imaging Score. T2 values of the medial meniscus and osteophytes were measured on T2 mapping images. Osteophytes surgically removed from patients with end-stage knee OA were histologically analyzed and compared with findings derived by radiography and MRI. Medial side osteophytes were detected by T2 mapping MRI in 98% of patients with early-stage knee OA, although the detection rate was 48% by conventional MRI and 40% by radiography. Among the OA-related changes, medial tibial osteophyte distance was most closely associated with MME, as determined by multiple logistic regression analysis, in the patients with early-stage knee OA (β = 0.711, p < 0.001). T2 values of the medial meniscus were directly correlated with MME in patients with early-stage knee OA, who showed ≥ 3 mm of MME (r = 0.58, p = 0.003). The accuracy of osteophyte evaluation by T2 mapping MRI was confirmed by histological analysis of the osteophytes removed from patients with end-stage knee OA. Our study demonstrates that medial tibial osteophyte evaluated by T2 mapping MRI is frequently observed in the patients with early-stage knee

Medial tibial pain. A prospective study of its cause among military recruits.

PubMed

Milgrom, C; Giladi, M; Stein, M; Kashtan, H; Margulies, J; Chisin, R; Steinberg, R; Swissa, A; Aharonson, Z

1986-12-01

In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

Comparative techniques of medial rectus muscle retraction for endoscopic exposure of the medial intraconal space.

PubMed

Lin, Giant C; Freitag, Suzanne K; Kocharyan, Armine; Yoon, Michael K; Lefebvre, Daniel R; Bleier, Benjamin S

2016-05-01

The medial rectus muscle (MRM) is the medial boundary to the intraconal space of the orbit, and retraction of the MRM is oftentimes necessary for endoscopic removal of intraconal tumors, e.g., orbital hemangioma. We evaluated each of the reported methods of MRM retraction for endoscopic orbital surgery and quantified the degree of intraconal exposure conferred by each method. Eight orbits from four cadaver heads were dissected. In each orbit, medial orbital decompression was performed and the MRM was retracted by using four previously described techniques: (1) external MRM retraction at the globe insertion point by using vessel loop (external group), (2) transseptal MRM retraction by using vessel loop (transseptal group), (3) transchoanal retraction of the MRM by using vessel loop (choanal group), and (4) transseptal four-handed technique by using double ball retraction by a second surgeon (transseptal double ball group). The length, height, and area of exposure of the medial intraconal space were quantified and compared. The average ± standard deviation (SD) anterior-posterior exposures for the external group, transseptal group, and transseptal double ball group were 17.51 ± 3.39 mm, 16.59 ± 4.16 mm, and 18.0 ± 15.25 mm, respectively. The choanal group provided significantly less exposure (12.39 ± 3.44 mm, p = 0.049) than the other groups. The average ± SD vertical exposures for the transseptal group, choanal group, and transseptal double ball group were 12.53 ± 4.38 mm, 13.05 ± 5.86 mm, and 13.57 ± 3.74 mm, respectively. The external group provided significantly less exposure (4.51 ± 1.56 mm, p = 0.0072) than the other groups. The transseptal and transseptal double ball groups provided the greatest total access by surface area (58.88 ± 26.96 mm(2) and 62.94 ± 34.74 mm(2), respectively) compared with the external and choanal groups (34.82 ± 23.37 mm(2) and 43.10 ± 23.68 mm(2), respectively). Although the transseptal trajectory of MRM retraction was

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.

Medial Meniscal Extrusion Relates to Cartilage Loss in Specific Femorotibial Subregions- Data from the Osteoarthritis Initiative

PubMed Central

Bloecker, K.; Wirth, W.; Guermazi, A.; Hunter, DJ; Resch, H.; Hochreiter, J.; Eckstein, F.

2015-01-01

Objective Medial meniscal extrusion is known to be related to structural progression of knee OA. However, it is unclear whether medial meniscal extrusion is more strongly associated with cartilage loss in certain medial femorotibial subregions than to others. Methods Segmentation of the medial tibial and femoral cartilage (baseline; 1-year follow-up) and the medial meniscus (baseline) was performed in 60 participants with frequent knee pain (age 61.3±9.2y, BMI 31.3±3.9 kg/m2) and with unilateral medial radiographic joint space narrowing (JSN) grade 1–3, using double echo steady state MR-images. Medial meniscal extrusion distance and extrusion area (%) between the external meniscal and tibial margin at baseline, and longitudinal medial cartilage loss in eight anatomical subregions were determined. Results A significant association (Pearson correlation coefficient) was seen between medial meniscus extrusion area in JSN knees and cartilage loss over one year throughout the entire medial femorotibial compartment. The strongest correlation was with cartilage loss in the external medial tibia (r=−0.34 [p<0.01] in JSN, and r=−0.30 [p=0.02] in noJSN knees). Conclusion Medial meniscus extrusion was associated with subsequent medial cartilage loss. The external medial tibial cartilage may be particularly vulnerable to thinning once the meniscus extrudes and its surface is “exposed” to direct, non-physiological, cartilage-cartilage contact. PMID:25988986

Pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy.

PubMed

Lee, Kee Byoung; Song, Si Young; Kwon, Duck Joo; Shin, Jun; Paik, Sang Hoon

2009-09-01

We describe a case of 43-year-old man who had a pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy with standard anterolateral and anteromedial portals. Pseudoaneurysm of the medial superior genicular artery has been reported at the previous superomedial portal site after arthroscopy. Described herein is a unique case that involved the medial superior genicular artery at the previous anteromedial portal site after arthroscopy. The pseudoaneurysm was successfully treated with transcatheter embolization.

Pseudoaneurysm of the Medial Superior Genicular Artery after Arthroscopic Partial Meniscectomy

PubMed Central

Lee, Kee Byoung; Kwon, Duck Joo; Shin, Jun; Paik, Sang Hoon

2009-01-01

We describe a case of 43-year-old man who had a pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy with standard anterolateral and anteromedial portals. Pseudoaneurysm of the medial superior genicular artery has been reported at the previous superomedial portal site after arthroscopy. Described herein is a unique case that involved the medial superior genicular artery at the previous anteromedial portal site after arthroscopy. The pseudoaneurysm was successfully treated with transcatheter embolization. PMID:19885054

Dissociating medial frontal and posterior cingulate activity during self-reflection.

PubMed

Johnson, Marcia K; Raye, Carol L; Mitchell, Karen J; Touryan, Sharon R; Greene, Erich J; Nolen-Hoeksema, Susan

2006-06-01

Motivationally significant agendas guide perception, thought and behaviour, helping one to define a 'self' and to regulate interactions with the environment. To investigate neural correlates of thinking about such agendas, we asked participants to think about their hopes and aspirations (promotion focus) or their duties and obligations (prevention focus) during functional magnetic resonance imaging and compared these self-reflection conditions with a distraction condition in which participants thought about non-self-relevant items. Self-reflection resulted in greater activity than distraction in dorsomedial frontal/anterior cingulate cortex and posterior cingulate cortex/precuneus, consistent with previous findings of activity in these areas during self-relevant thought. For additional medial areas, we report new evidence of a double dissociation of function between medial prefrontal/anterior cingulate cortex, which showed relatively greater activity to thinking about hopes and aspirations, and posterior cingulate cortex/precuneus, which showed relatively greater activity to thinking about duties and obligations. One possibility is that activity in medial prefrontal cortex is associated with instrumental or agentic self-reflection, whereas posterior medial cortex is associated with experiential self-reflection. Another, not necessarily mutually exclusive, possibility is that medial prefrontal cortex is associated with a more inward-directed focus, while posterior cingulate is associated with a more outward-directed, social or contextual focus.

Dissociating medial frontal and posterior cingulate activity during self-reflection

PubMed Central

Johnson, Marcia K.; Raye, Carol L.; Mitchell, Karen J.; Touryan, Sharon R.; Greene, Erich J.; Nolen-Hoeksema, Susan

2006-01-01

Motivationally significant agendas guide perception, thought and behaviour, helping one to define a ‘self’ and to regulate interactions with the environment. To investigate neural correlates of thinking about such agendas, we asked participants to think about their hopes and aspirations (promotion focus) or their duties and obligations (prevention focus) during functional magnetic resonance imaging and compared these self-reflection conditions with a distraction condition in which participants thought about non-self-relevant items. Self-reflection resulted in greater activity than distraction in dorsomedial frontal/anterior cingulate cortex and posterior cingulate cortex/precuneus, consistent with previous findings of activity in these areas during self-relevant thought. For additional medial areas, we report new evidence of a double dissociation of function between medial prefrontal/anterior cingulate cortex, which showed relatively greater activity to thinking about hopes and aspirations, and posterior cingulate cortex/precuneus, which showed relatively greater activity to thinking about duties and obligations. One possibility is that activity in medial prefrontal cortex is associated with instrumental or agentic self-reflection, whereas posterior medial cortex is associated with experiential self-reflection. Another, not necessarily mutually exclusive, possibility is that medial prefrontal cortex is associated with a more inward-directed focus, while posterior cingulate is associated with a more outward-directed, social or contextual focus. PMID:18574518

The "moving valgus stress test" for medial collateral ligament tears of the elbow.

PubMed

O'Driscoll, Shawn W M; Lawton, Richard L; Smith, Adam M

2005-02-01

The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. Cohort study (diagnosis); Level of evidence, 2. Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

Fiber Tracts of the Medial and Inferior Surfaces of the Cerebrum.

PubMed

Baydin, Serhat; Gungor, Abuzer; Tanriover, Necmettin; Baran, Oguz; Middlebrooks, Erik H; Rhoton, Albert L

2017-02-01

Fiber dissection studies of the cerebrum have focused on the lateral surface. No comparable detailed studies have been done on the medial and inferior surfaces. The object of this study was to examine the fiber tracts, cortical, and subcortical structures of the medial and inferior aspects of the brain important in planning operative approaches along the interhemispheric fissure, parafalcine area, and basal surfaces of the cerebrum. Twenty formalin-fixed human hemispheres (10 brains) were examined by fiber dissection technique under ×6-×40 magnifications. The superior longitudinal fasciculus I, cingulum, inferior longitudinal fasciculus, uncinate fasciculus, optic radiations, tapetum, and callosal fibers were dissected step by step from medial to lateral, exposing the nucleus accumbens, subthalamic nucleus, red nucleus, and central midline structures (fornix, stria medullaris, and stria terminalis). Finally, the central core structures were dissected from medial to lateral. Understanding the fiber network underlying the medial and inferior aspects of the brain is important in surgical planning for approaches along the interhemispheric fissure, parafalcine area, and basal surfaces of the cerebrum. Copyright © 2016. Published by Elsevier Inc.

Pediatric obesity and walking duration increase medial tibiofemoral compartment contact forces.

PubMed

Lerner, Zachary F; Board, Wayne J; Browning, Raymond C

2016-01-01

With the high prevalence of pediatric obesity there is a need for structured physical activity during childhood. However, altered tibiofemoral loading during physical activity in obese children likely contribute to their increased risk of orthopedic disorders of the knee. The goal of this study was to determine the effects of pediatric obesity and walking duration on medial and lateral tibiofemoral contact forces. We collected experimental biomechanics data during treadmill walking at 1 m•s(-1) for 20 min in 10 obese and 10 healthy-weight 8-12 year-olds. We created subject-specific musculoskeletal models using radiographic measures of tibiofemoral alignment and centers-of-pressure, and predicted medial and lateral tibiofemoral contact forces at the beginning and end of each trial. Obesity and walking duration affected tibiofemoral loading. At the beginning of the trail, the average percent of the total load passing through the medial compartment during stance was 85% in the obese children and 63% in the healthy-weight children; at the end of the trial, the medial distribution was 90% in the obese children and 72% in the healthy-weight children. Medial compartment loading rates were 1.78 times greater in the obese participants. The medial compartment loading rate increased 17% in both groups at the end compared to the beginning of the trial (p = 0.001). We found a strong linear relationship between body-fat percentage and the medial-lateral load distribution (r(2) = 0.79). Altered tibiofemoral loading during walking in obese children may contribute to their increased risk of knee pain and pathology. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Electrophysiological evidence during episodic prospection implicates medial prefrontal and bilateral middle temporal gyrus.

PubMed

Hsu, Chia-Fen; Sonuga-Barke, Edmund J S

2016-08-01

fMRI studies have implicated the medial prefrontal cortex and medial temporal lobe, components of the default mode network (DMN), in episodic prospection. This study compared quantitative EEG localized to these DMN regions during prospection and during resting and while waiting for rewards. EEG was recorded in twenty-two adults while they were asked to (i) envision future monetary episodes; (ii) wait for rewards and (iii) rest. Activation sources were localized to core DMN regions. EEG power and phase coherence were compared across conditions. Prospection, compared to resting and waiting, was associated with reduced power in the medial prefrontal gyrus and increased power in the bilateral medial temporal gyrus across frequency bands as well as greater phase synchrony between these regions in the delta band. The current quantitative EEG analysis confirms prior fMRI research suggesting that medial prefrontal and medial temporal gyrus interactions are central to the capacity for episodic prospection. Copyright © 2016 Elsevier B.V. All rights reserved.

Surface-NMR measurements of the longitudinal relaxation time T1 in a homogeneous sandy aquifer in Skive, Denmark

NASA Astrophysics Data System (ADS)

Walbrecker, J.; Behroozmand, A.

2011-12-01

employing the pcPSR scheme and compare it to conventional T1 data. For our feasibility study we have chosen a site in Skive, Denmark, that features excellent signal/noise conditions, allowing us to collect high quality data in reasonable survey time. In addition, proximate boreholes and TEM measurements suggest a relatively homogeneous aquifer extending from 5 to more than 25m below surface. We may therefore expect roughly constant T1 relaxation times throughout the shallow aquifer, providing us a simple framework for our comparative study. We used a 50x50m surface-NMR loop and employed 16 pulse moments selected to spatially cover the shallow aquifer region. For each pulse moment, we recorded surface-NMR T1 data densely sampled at 14 delay times τ between 250 and 4'000 ms. On this high-quality data set we demonstrate that the pcPSR acquisition approach yields to a good degree homogeneous T1 relaxation times, whereas the conventional approach leads to variations in T1 that could be misinterpreted in terms of changes of aquifer characteristics. Thereby we provide first empirical evidence for the superiority of the pcPSR scheme for surface NMR T1 acquisition.

Inverted distal clavicle anatomic locking plate for displaced medial clavicle fracture.

PubMed

Wang, Yong; Jiang, Jiannong; Dou, Bin; Zhang, Panjun

2015-09-01

Fractures of the medial clavicle are rare injuries. Recently, open reduction and internal fixation has been recommended for displaced medial clavicle fractures in order to prevent non-union and dysfunction. Because of the rarity of this injury, the optimal fixation device has not yet been established. In this report, we describe a case of a 40-year-old male patient who sustained a significantly displaced medial clavicle fracture treated by open reduction and internal fixation using an inverted distal clavicle anatomic locking plate. At the 12 months follow-up, the patient recovered well, had returned to pre-injury job, and was quite satisfied with the outcome. Internal fixation of medial clavicle fracture using an inverted distal clavicle anatomic locking plate of the ipsilateral side appears to be a good treatment option.

Decreased knee adduction moment does not guarantee decreased medial contact force during gait.

PubMed

Walter, Jonathan P; D'Lima, Darryl D; Colwell, Clifford W; Fregly, Benjamin J

2010-10-01

Excessive contact force is believed to contribute to the development of medial compartment knee osteoarthritis. The external knee adduction moment (KAM) has been identified as a surrogate measure for medial contact force during gait, with an abnormally large peak value being linked to increased pain and rate of disease progression. This study used in vivo gait data collected from a subject with a force-measuring knee implant to assess whether KAM decreases accurately predict corresponding decreases in medial contact force. Changes in both quantities generated via gait modification were analyzed statistically relative to the subject's normal gait. The two gait modifications were a "medial thrust" gait involving knee medialization during stance phase and a "walking pole" gait involving use of bilateral walking poles. Reductions in the first (largest) peak of the KAM (32-33%) did not correspond to reductions in the first peak of the medial contact force. In contrast, reductions in the second peak and angular impulse of the KAM (15-47%) corresponded to reductions in the second peak and impulse of the medial contact force (12-42%). Calculated reductions in both KAM peaks were highly sensitive to rotation of the shank reference frame about the superior-inferior axis of the shank. Both peaks of medial contact force were best predicted by a combination of peak values of the external KAM and peak absolute values of the external knee flexion moment (R(2) = 0.93). Future studies that evaluate the effectiveness of gait modifications for offloading the medial compartment of the knee should consider the combined effect of these two knee moments. Published by Wiley Periodicals, Inc. J Orthop Res 28:1348-1354, 2010.

A combinatorial optogenetic approach to medial habenula function

NASA Astrophysics Data System (ADS)

Turner, Eric E.; Hsu, Yun-Wei; Wang, Si; Morton, Glenn; Zeng, Hongkui

2013-03-01

The habenula is a brain region found in all vertebrate species. It consists of medial and lateral subnuclei which make complex descending connections to the brainstem. Although the medial habenula (MHb) and its projection, the fasciculus retroflexus (FR), have been recognized for decades, their function remains obscure. The small size of the MHb in rodents, and the cellular and molecular complexity of this region, have made it difficult to study the function of this region with high specificity. Here we describe a Cre-mediated genetic system for expressing the microbial opsin channelrhodopsin (ChR2) specifically in the dorsal (dMHb) and ventral (vMHb) medial habenula. Genetically targeted expression of ChR2 allows MHb neurons to be selectively activated with light in acute brain slices with electrophysiological readouts, and in vivo by means of custom-built fiber optic cannulas. These tools will allow highly specific studies of MHb circuitry and the role of the MHb in behaviors related to addiction and mood regulation.

Volition and conflict in human medial frontal cortex.

PubMed

Nachev, Parashkev; Rees, Geraint; Parton, Andrew; Kennard, Christopher; Husain, Masud

2005-01-26

Controversy surrounds the role of human medial frontal cortex in controlling actions. Although damage to this area leads to severe difficulties in spontaneously initiating actions, the precise mechanisms underlying such "volitional" deficits remain to be established. Previous studies have implicated the medial frontal cortex in conflict monitoring and the control of voluntary action, suggesting that these key processes are functionally related or share neural substrates. Here, we combine a novel behavioral paradigm with functional imaging of the oculomotor system to reveal, for the first time, a functional subdivision of the pre-supplementary motor area (pre-SMA) into anatomically distinct areas that respond exclusively to either volition or conflict. We also demonstrate that activity in the supplementary eye field (SEF) distinguishes between success and failure in changing voluntary action plans during conflict, suggesting a role for the SEF in implementing the resolution of conflicting actions. We propose a functional architecture of human medial frontal cortex that incorporates the generation of action plans and the resolution of conflict.

Bilateral medial medullary infarction due to bilateral vertebral artery dissection.

PubMed

Fukuda, Masafumi; Aiba, Toyotaka; Takahashi, Sho

2004-03-01

We describe a 52-year-old woman who experienced transient motor weakness and numbness of the left extremities and presented 2 days later with severe hemiparesis and sensory impairment of the right extremities and right lingual palsy. Magnetic resonance imaging (MRI) revealed bilateral upper medial medullary infarction, primarily in the left ventral portion. The findings of both three-dimensional (3D) computed tomographic and conventional angiography suggested dissection of both intracranial vertebral arteries (VAs). Medial medullary infarction is generally caused by atherosclerosis within a VA or anterior spinal artery. This is the first report of bilateral medial medullary infarction due to dissection of both intracranial VAs.

Benefit of cup medialization in total hip arthroplasty is associated with femoral anatomy.

PubMed

Terrier, Alexandre; Levrero Florencio, Francesc; Rüdiger, Hannes A

2014-10-01

Medialization of the cup with a respective increase in femoral offset has been proposed in THA to increase abductor moment arms. Insofar as there are potential disadvantages to cup medialization, it is important to ascertain whether the purported biomechanical benefits of cup medialization are large enough to warrant the downsides; to date, studies regarding this question have disagreed. The purpose of this study was to quantify the effect of cup medialization with a compensatory increase in femoral offset compared with anatomic reconstruction for patients undergoing THA. We tested the hypothesis that there is a (linear) correlation between preoperative anatomic parameters and muscle moment arm increase caused by cup medialization. Fifteen patients undergoing THA were selected, covering a typical range of preoperative femoral offsets. For each patient, a finite element model was built based on a preoperative CT scan. The model included the pelvis, femur, gluteus minimus, medius, and maximus. Two reconstructions were compared: (1) anatomic position of the acetabular center of rotation, and (2) cup medialization compensated by an increase in the femoral offset. Passive abduction-adduction and flexion-extension were simulated in the range of normal gait. Muscle moment arms were evaluated and correlated to preoperative femoral offset, acetabular offset, height of the greater trochanter (relative to femoral center of rotation), and femoral antetorsion angle. The increase of muscle moment arms caused by cup medialization varied among patients. Muscle moment arms increase by 10% to 85% of the amount of cup medialization for abduction-adduction and from -35% (decrease) to 50% for flexion-extension. The change in moment arm was inversely correlated (R(2) = 0.588, p = 0.001) to femoral antetorsion (anteversion), such that patients with less femoral antetorsion gained more in terms of hip muscle moments. No linear correlation was observed between changes in moment arm and

Dynamic Changes in Acetylcholine Output in the Medial Striatum during Place Reversal Learning

ERIC Educational Resources Information Center

Ragozzino, Michael E.; Choi, Daniel

2004-01-01

The present studies explored the role of the medial striatum in learning when task contingencies change. Experiment 1 examined whether the medial striatum is involved in place reversal learning. Testing occurred in a modified cross-maze across two consecutive sessions. Injections of the local anesthetic, bupivacaine, into the medial striatum, did…

Increased GABA Levels in Medial Prefrontal Cortex of Young Adults with Narcolepsy

PubMed Central

Kim, Seog Ju; Lyoo, In Kyoon; Lee, Yujin S.; Sung, Young Hoon; Kim, Hengjun J.; Kim, Jihyun H.; Kim, Kye Hyun; Jeong, Do-Un

2008-01-01

Study Objectives: To explore absolute concentrations of brain metabolites including gamma amino-butyric acid (GABA) in the medial prefrontal cortex and basal ganglia of young adults with narcolepsy. Design: Proton magnetic resonance (MR) spectroscopy centered on the medial prefrontal cortex and the basal ganglia was acquired. The absolute concentrations of brain metabolites including GABA and glutamate were assessed and compared between narcoleptic patients and healthy comparison subjects. Setting: Sleep and Chronobiology Center at Seoul National University Hospital; A high strength 3.0 Tesla MR scanner in the Department of Radiology at Seoul National University Hospital. Patients or Participants: Seventeen young adults with a sole diagnosis of HLA DQB1 0602 positive narcolepsy with cataplexy (25.1 ± 4.6 years old) and 17 healthy comparison subjects (26.8 ± 4.8 years old). Interventions: N/A. Measurements and Results: Relative to comparison subjects, narcoleptic patients had higher GABA concentration in the medial prefrontal cortex (t = 4.10, P <0.001). Narcoleptic patients with nocturnal sleep disturbance had higher GABA concentration in the medial prefrontal cortex than those without nocturnal sleep disturbance (t = 2.45, P= 0.03), but had lower GABA concentration than comparison subjects (t = 2.30, P = 0.03). Conclusions: The current study reports that young adults with narcolepsy had a higher GABA concentration in the medial prefrontal cortex, which was more prominent in patients without nocturnal sleep disturbance. Our findings suggest that the medial prefrontal GABA level may be increased in narcolepsy, and the increased medial prefrontal GABA might be a compensatory mechanism to reduce nocturnal sleep disturbances in narcolepsy. Citation: Kim SJ; Lyoo IK; Lee YS; Sung YH; Kim HJ; Kim JH; Kim KH; Jeong DU. Increased GABA levels in medial prefrontal cortex of young adults with narcolepsy. SLEEP 2008;31(3):342-347. PMID:18363310

[SECOT consensus on medial femorotibial osteoarthritis].

PubMed

Moreno, A; Silvestre, A; Carpintero, P

2013-01-01

A consensus, prepared by SECOT, is presented on the management of medial knee compartment osteoarthritis, in order to establish clinical criteria and recommendations directed at unifying the criteria in its management, dealing with the factors involved in the pathogenesis of medial femorotibial knee osteoarthritis, the usefulness of diagnostic imaging techniques, and the usefulness of arthroscopy. Conservative and surgical treatments are also analysed. The experts consulted showed a consensus (agreed or disagreed) in 65.8% of the items considered, leaving 14items where no consensus was found, which included the aetiopathogenesis of the osteoarthritis, the value of NMR in degenerative disease, the usefulness of COX-2 and the chondroprotective drugs, as well as on the ideal valgus tibial osteotomy technique. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Disruption of the Aortic Elastic Lamina and Medial Calcification Share Genetic Determinants in Mice

PubMed Central

Wang, Susanna S.; Martin, Lisa J.; Schadt, Eric E.; Meng, Haijin; Wang, Xuping; Zhao, Wei; Ingram-Drake, Leslie; Nebohacova, Martina; Mehrabian, Margarete; Drake, Thomas A.; Lusis, Aldons J.

2010-01-01

Background Disruption of the elastic lamina, as an early indicator of aneurysm formation, and vascular calcification frequently occur together in atherosclerotic lesions of humans. Methods and Results We now report evidence of shared genetic basis for disruption of the elastic lamina (medial disruption) and medial calcification in an F2 mouse intercross between C57BL/6J and C3H/HeJ on a hyperlipidemic apolipoprotein E (ApoE−/−) null background. We identified 3 quantitative trait loci (QTLs) on chromosomes 6, 13, and 18, which are common to both traits, and 2 additional QTLs for medial calcification on chromosomes 3 and 7. Medial disruption, including severe disruptions leading to aneurysm formation, and medial calcification were highly correlated and occurred concomitantly in the cross. The chromosome 18 locus showed a striking male sex-specificity for both traits. To identify candidate genes, we integrated data from microarray analysis, genetic segregation, and clinical traits. The chromosome 7 locus contains the Abcc6 gene, known to mediate myocardial calcification. Using transgenic complementation, we show that Abcc6 also contributes to aortic medial calcification. Conclusions Our data indicate that calcification, though possibly contributory, does not always lead to medial disruption and that in addition to aneurysm formation, medial disruption may be the precursor to calcification. PMID:20031637

The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players.

PubMed

Xu, Huan; Wang, Pin; Ye, Zhuo'er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

2016-01-01

Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

Ecological divergence and medial cuneiform morphology in gorillas.

PubMed

Tocheri, Matthew W; Solhan, Christyna R; Orr, Caley M; Femiani, John; Frohlich, Bruno; Groves, Colin P; Harcourt-Smith, William E; Richmond, Brian G; Shoelson, Brett; Jungers, William L

2011-02-01

Gorillas are more closely related to each other than to any other extant primate and are all terrestrial knuckle-walkers, but taxa differ along a gradient of dietary strategies and the frequency of arboreality in their behavioral repertoire. In this study, we test the hypothesis that medial cuneiform morphology falls on a morphocline in gorillas that tracks function related to hallucial abduction ability and relative frequency of arboreality. This morphocline predicts that western gorillas, being the most arboreal, should display a medial cuneiform anatomy that reflects the greatest hallucial abduction ability, followed by grauer gorillas, and then by mountain gorillas. Using a three-dimensional methodology to measure angles between articular surfaces, relative articular and nonarticular areas, and the curvatures of the hallucial articular surface, the functional predictions are partially confirmed in separating western gorillas from both eastern gorillas. Western gorillas are characterized by a more medially oriented, proportionately larger, and more mediolaterally curved hallucial facet than are eastern gorillas. These characteristics follow the predictions for a more prehensile hallux in western gorillas relative to a more stable, plantigrade hallux in eastern gorillas. The characteristics that distinguish eastern gorilla taxa from one another appear unrelated to hallucial abduction ability or frequency of arboreality. In total, this reexamination of medial cuneiform morphology suggests differentiation between eastern and western gorillas due to a longstanding ecological divergence and more recent and possibly non-adaptive differences between eastern taxa. Published by Elsevier Ltd.

Bilateral medial medullary syndrome secondary to Takayasu arteritis.

PubMed

Deshpande, Anirudda; Chandran, Vijay; Pai, Aparna; Rao, Suryanarayana; Shetty, Ranjan

2013-08-13

Medial medullary syndrome (MMS) is a rare type of stroke which results due to occlusion of the anterior spinal artery or vertebral artery or its branches. In this case report we present a patient who developed MMS secondary to Takayasu arteritis (TA). TA is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of subclavian arteries as well as infarction of the medial medulla bilaterally. To our knowledge this is the first time that MMS has been found to occur secondary to TA.

Phonatory Effects of Type I Thyroplasty Implant Shape and Depth of Medialization in Unilateral Vocal Fold Paralysis

PubMed Central

Orestes, Michael I.; Neubauer, Juergen; Sofer, Elazar; Salinas, Jonathon; Chhetri, Dinesh K.

2015-01-01

Objectives/Hypothesis Medialization thyroplasty (MT) is commonly used to treat glottic insufficiency. In this study, we investigated the phonatory effects of MT implant medialization depth and medial surface shape. Methods Recurrent laryngeal nerve (RLN) and vagal paralysis were simulated in an in vivo canine. A type 1 MT was performed using a silicone elastomer implant with variable medialization depths and medial surface shapes: rectangular, V-shaped, divergent, and convergent. The effects on phonation onset flow/pressure relationships and acoustics were measured. Results Increasing depth of medialization led to improvements in fundamental frequency (F0) range and normalization of the slope of pressure/flow relationship toward baseline activation conditions. The effects of implant medial shape also depended on depth of medialization. Outcome measures were similar among the implants at smaller medialization depths. With large medialization depths and vagal paralysis conditions, the divergent implant maintained pressure/flow relationship closer to baseline. The vagal paralysis conditions also demonstrated decreased fundamental frequency range and worse flow/pressure relationship compared to RLN paralysis. Conclusions The depth and medial shape of a medialization laryngoplasty (ML) implant significantly affect both the F0 range and aerodynamic power required for phonation. These effects become more notable with increasing depth of medialization. The study also illustrates that ML is less effective in vagal paralysis compared to RLN paralysis. PMID:25046146

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...

Lateral Meniscal Allograft Transplant via a Medial Approach Leads to Less Extrusion.

PubMed

Choi, Nam-Hong; Choi, Jeong-Ki; Yang, Bong-Seok; Lee, Doe-Hyun; Victoroff, Brian N

2017-10-01

Accurate positioning of the bony bridge is crucial to prevent extrusion of meniscal allografts after transplant. However, oblique or lateralized placement of the bony bridge of the lateral meniscal allograft may occur due to technical error or a limited visual field. The patellar tendon may be an obstacle to approaching the anterior horn of the lateral meniscus, resulting in a laterally placed allograft. Therefore, lateral meniscal transplant through a medial arthrotomy would be an alternative approach. However, no report exists regarding allograft extrusion when comparing medial and lateral arthrotomy techniques in lateral meniscal transplants. Extrusion of the midbody of the allograft is less severe and the rotation of the bony bridge is less oblique in lateral meniscal allograft transplants through the medial parapatellar approach than those through the lateral approach. Cohort study; Level of evidence, 3. A bony bridge was used to perform 55 lateral meniscal transplants through either a medial or a lateral arthrotomy. Thirty-two allografts were transplanted through a medial arthrotomy and 23 were transplanted through a lateral arthrotomy, not randomly. Because correct positioning of the bony trough through the medial arthrotomy was easier than that through the lateral arthrotomy, the method of the arthrotomy was changed for the latter. The procedure for both groups was identical except for the arthrotomy technique, and rehabilitation was identical for both groups. Follow-up magnetic resonance imaging was conducted for all patients to measure the postoperative extrusion and obliquity of the bony bridge of the allograft. On the coronal view, extrusion was measured as the distance between the outer edge of the articular cartilage of the lateral tibial plateau and the outer edge of the meniscal allograft. On the axial view, a line (line B) was drawn along the longitudinal axis of the bony bridge. The posterior tibial condylar tangential line was drawn between the

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.

Does Medial Meniscal Allograft Transplantation With the Bone-Plug Technique Restore the Anatomic Location of the Native Medial Meniscus?

PubMed

Kim, Nam-Ki; Bin, Seong-Il; Kim, Jong-Min; Lee, Chang-Rack

2015-12-01

Previous work has shown the importance of restoring the normal structure of the native meniscus with meniscal allograft transplantation. The purpose of this study was to compare the anatomic positions of the anterior horn and posterior horn between the preoperative medial meniscus and the postoperative meniscal allograft after medial meniscal allograft transplantation with the bone-plug technique. The hypothesis was that the bone-plug technique could restore the preoperative structure of the native medial meniscus. Case series; Level of evidence, 4. Between December 1999 and December 2013, a total of 59 patients (49 male, 10 female) underwent medial meniscal allograft transplantation by use of the bone-plug technique. The anatomic positions of both horns in the native medial meniscus and in the meniscal allograft were measured via MRI. The percentage reference method was used to measure the locations of both horns. On coronal MRI, the mean absolute distance of the posterior horn from the lateral border of the tibial plateau changed from 45.2 ± 3.3 to 48.1 ± 4.2 mm (P < .05), and the percentage distance of the posterior horn changed from 59.6% to 63.0% (P < .05). On sagittal MRI, the mean absolute distance of the posterior horn from the anterior reference point changed from 40.3 ± 3.0 to 42.0 ± 3.5 mm (P < .05), and the mean percentage distance of the posterior horn changed from 76.5% to 79.4% (P <.05). On coronal MRI, the mean absolute distance of the anterior horn from the lateral border of the tibial plateau changed from 41.3 ± 4.2 to 48.5 ± 5.6 mm (P < .05), and the mean percentage distance of the anterior horn changed from 54.5% to 63.8% (P < .05). On sagittal MRI, the mean absolute distance of the anterior horn from the anterior reference point changed from 5.5 ± 1.0 to 9.9 ± 2.9 mm (P < .05), and the mean percentage distance of the anterior horn changed from 10.6% to 19.0% (P < .05). Despite attempts to place the meniscal allograft in the same

Lateral trunk lean and medializing the knee as gait strategies for knee osteoarthritis.

PubMed

Gerbrands, T A; Pisters, M F; Theeven, P J R; Verschueren, S; Vanwanseele, B

2017-01-01

To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics. Thirty patients with symptomatic medial knee osteoarthritis underwent 3-dimensional gait analysis. Participants received verbal instructions on two gait strategies (Trunk Lean and Medial Thrust) in randomized order after comfortable walking was recorded. The peaks and impulse of the EKAM and strategy-specific kinematic and kinetic variables were calculated for all conditions. Early stance EKAM peak was significantly reduced during Medial Thrust (-29%). During Trunk Lean, early and late stance EKAM peak and EKAM impulse reduced significantly (38%, 21% and -25%, respectively). In 79% of the subjects, the Trunk Lean condition was significantly more effective in reducing EKAM peak than Medial Thrust. Peak ankle dorsi and plantar flexion, knee flexion and hip extension and adduction moments were not significantly increased. Medial Thrust and Trunk Lean reduced the EKAM during gait in patients with knee osteoarthritis. Individual selection of the most effective gait modification strategy seems vital to optimally reduce dynamic knee loading during gait. No detrimental effects on external ankle and hip moments or knee flexion moments were found for these conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

Bilateral Vocal Fold Medialization: A Treatment for Abductor Spasmodic Dysphonia.

PubMed

Dewan, Karuna; Berke, Gerald S

2017-11-10

Abductor spasmodic dysphonia, a difficult-to-treat laryngologic condition, is characterized by spasms causing the vocal folds to remain abducted despite efforts to adduct them during phonation. Traditional treatment for abductor spasmodic dysphonia-botulinum toxin injection into the posterior cricoarytenoid muscle-can be both technically challenging and uncomfortable. Due to the difficulty of needle placement, it is often unsuccessful. The purpose of this investigation is to present a previously undescribed treatment for abductor spasmodic dysphonia-bilateral vocal fold medialization. A retrospective case review of all cases of abductor spasmodic dysphonia treated in a tertiary care laryngology practice with bilateral vocal fold medialization over a 10-year period was performed. The Voice Handicap Index and the Voice-Related Quality of Life surveys were utilized to assess patient satisfaction with voice outcome. Six patients with abductor spasmodic dysphonia treated with bilateral vocal fold medialization were identified. Disease severity ranged from mild to severe. All six patients reported statistically significant improvement in nearly all Voice Handicap Index and Voice-Related Quality of Life parameters. They reported fewer voice breaks and greater ease of communication. Results were noted immediately and symptoms continue to be well controlled for many years following medialization. Bilateral vocal fold medialization is a safe and effective treatment for abductor spasmodic dysphonia. It is performed under local anesthesia and provides phonation improvement in the short and long term. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children.

PubMed

Gourineni, Prasad; Gupta, Asheesh

2011-10-01

Tillaux and Triplane fractures occur in children predominantly from external rotation mechanism. We hypothesized that in displaced fractures, the talus would shift laterally along with the distal fibula and the distal tibial epiphyseal fragment increasing the medial joint space. Consecutive cases evaluated retrospectively. Level I and Level II centers. Twenty-two skeletally immature patients with 14 displaced Triplane fractures and eight displaced Tillaux fractures were evaluated for medial joint space widening. Measurement of fracture displacement and medial joint space widening before and after intervention. Thirteen Triplane and six Tillaux fractures (86%) showed medial space widening of 1 to 9 mm and equal to the amount of fracture displacement. Reduction of the fracture reduced the medial space to normal. There were no known complications. Medial space widening of the ankle may be a sign of ankle fracture displacement. Anatomic reduction of the fracture reduces the medial space and may improve the results in Tillaux and Triplane fractures.

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

Volition and conflict in human medial frontal cortex

PubMed Central

Nachev, Parashkev; Rees, Geraint; Parton, Andrew; Kennard, Christopher; Husain, Masud

2009-01-01

Summary Controversy surrounds the role of human medial frontal cortex in controlling actions[1-5]. Although damage to this area leads to severe difficulties in spontaneously initiating actions[6], the precise mechanisms underlying such ‘volitional’ deficits remain to be established. Previous studies have implicated the medial frontal cortex in conflict monitoring[7-10] and the control of voluntary action[11, 12], suggesting that these key processes are functionally related or share neural substrates. Here we combine a novel behavioural paradigm with functional imaging of the oculomotor system to reveal for the first time a functional subdivision of the pre-supplementary motor area (pre-SMA) into anatomically distinct areas responding exclusively to volition or to conflict. We also demonstrate that activity in the supplementary eye field (SEF) distinguishes between success and failure in changing voluntary action plans during conflict, suggesting a role for the SEF in implementing the resolution of conflicting actions. We propose a functional architecture of human medial frontal cortex that incorporates the generation of action plans and the resolution of conflict. PMID:15668167

Medial Tibial Stress Shielding: A Limitation of Cobalt Chromium Tibial Baseplates.

PubMed

Martin, J Ryan; Watts, Chad D; Levy, Daniel L; Kim, Raymond H

2017-02-01

Stress shielding is a well-recognized complication associated with total knee arthroplasty. However, this phenomenon has not been thoroughly described. Specifically, no study to our knowledge has evaluated the radiographic impact of utilizing various tibial component compositions on tibial stress shielding. We retrospectively reviewed 3 cohorts of 50 patients that had a preoperative varus deformity and were implanted with a titanium, cobalt chromium (CoCr), or an all polyethylene tibial implant. A radiographic comparative analysis was performed to evaluate the amount of medial tibial bone loss in each cohort. In addition, a clinical outcomes analysis was performed on the 3 cohorts. The CoCr was noted to have a statistically significant increase in medial tibial bone loss compared with the other 2 cohorts. The all polyethylene cohort had a statistically significantly higher final Knee Society Score and was associated with the least amount of stress shielding. The CoCr tray is the most rigid of 3 implants that were compared in this study. Interestingly, this cohort had the highest amount of medial tibial bone loss. In addition, 1 patient in the CoCr cohort had medial soft tissue irritation which was attributed to a prominent medial tibial tray which required revision surgery to mitigate the symptoms. Copyright © 2016 Elsevier Inc. All rights reserved.

Medial prefrontal cortex supports source memory accuracy for self-referenced items

PubMed Central

Leshikar, Eric D.; Duarte, Audrey

2013-01-01

Previous behavioral work suggests that processing information in relation to the self enhances subsequent item recognition. Neuroimaging evidence further suggests that regions along the cortical midline, particularly those of the medial prefrontal cortex, underlie this benefit. There has been little work to date, however, on the effects of self-referential encoding on source memory accuracy or whether the medial prefrontal cortex might contribute to source memory for self-referenced materials. In the current study, we used fMRI to measure neural activity while participants studied and subsequently retrieved pictures of common objects superimposed on one of two background scenes (sources) under either self-reference or self-external encoding instructions. Both item recognition and source recognition were better for objects encoded self-referentially than self-externally. Neural activity predictive of source accuracy was observed in the medial prefrontal cortex (BA 10) at the time of study for self-referentially but not self-externally encoded objects. The results of this experiment suggest that processing information in relation to the self leads to a mnemonic benefit for source level features, and that activity in the medial prefrontal cortex contributes to this source memory benefit. This evidence expands the purported role that the medial prefrontal cortex plays in self-referencing. PMID:21936739

Medial prefrontal cortex supports source memory accuracy for self-referenced items.

PubMed

Leshikar, Eric D; Duarte, Audrey

2012-01-01

Previous behavioral work suggests that processing information in relation to the self enhances subsequent item recognition. Neuroimaging evidence further suggests that regions along the cortical midline, particularly those of the medial prefrontal cortex (PFC), underlie this benefit. There has been little work to date, however, on the effects of self-referential encoding on source memory accuracy or whether the medial PFC might contribute to source memory for self-referenced materials. In the current study, we used fMRI to measure neural activity while participants studied and subsequently retrieved pictures of common objects superimposed on one of two background scenes (sources) under either self-reference or self-external encoding instructions. Both item recognition and source recognition were better for objects encoded self-referentially than self-externally. Neural activity predictive of source accuracy was observed in the medial PFC (Brodmann area 10) at the time of study for self-referentially but not self-externally encoded objects. The results of this experiment suggest that processing information in relation to the self leads to a mnemonic benefit for source level features, and that activity in the medial PFC contributes to this source memory benefit. This evidence expands the purported role that the medial PFC plays in self-referencing.

Aging, self-referencing, and medial prefrontal cortex.

PubMed

Gutchess, Angela H; Kensinger, Elizabeth A; Schacter, Daniel L

2007-01-01

The lateral prefrontal cortex undergoes both structural and functional changes with healthy aging. In contrast, there is little structural change in the medial prefrontal cortex, but relatively little is known about the functional changes to this region with age. Using an event-related fMRI design, we investigated the response of medial prefrontal cortex during self-referencing in order to compare age groups on a task that young and elderly perform similarly and that is known to actively engage the region in young adults. Nineteen young (M age = 23) and seventeen elderly (M age = 72) judged whether adjectives described themselves, another person, or were presented in upper case. We assessed the overlap in activations between young and elderly for the self-reference effect (self vs. other person), and found that both groups engage medial prefrontal cortex and mid-cingulate during self-referencing. The only cerebral differences between the groups in self versus other personality assessment were found in somatosensory and motor-related areas. In contrast, age-related modulations were found in the cerebral network recruited for emotional valence processing. Elderly (but not young) showed increased activity in the dorsal prefrontal cortex for positive relative to negative items, which could reflect an increase in controlled processing of positive information for elderly adults.

The potential effect of anatomic relationship between the femur and the tibia on medial meniscus tears.

PubMed

Bozkurt, Murat; Unlu, Serhan; Cay, Nurdan; Apaydin, Nihal; Dogan, Metin

2014-10-01

The anatomic and the kinematical relationships between the femur and the tibia have been previously examined in both normal and diseased knees. However, less attention has been directed to the effect of these relationships on the meniscal diseases. Therefore, we aimed to investigate the impact of femorotibial incongruence on both lateral and medial meniscal tears. A total of 100 images obtained from MRI of 100 patients (39 males and 61 females) were included in the study. Diameters of the medial and the lateral femoral condyles, thicknesses of the menisci, and diameters of the medial and the lateral tibial articular surfaces were measured. The medial meniscus tear was detected in 40 (40 %) patients. However, no lateral meniscus tear was found. Significant relationships were found between the diameters of the posterior medial femoral condyle and the medial tibial superior articular surface and between the diameters of the posterior lateral femoral condyle and the lateral tibial superior articular surface. The mean values for the diameter of the medial condyle of the femur, the lateral condyle of the femur, the medial superior articular surface of the tibia, and the lateral superior articular surface of the tibia were found to be significantly higher in cases with meniscus tear compared to cases without meniscus tear. However, no significant difference was present regarding the thicknesses of the medial and the lateral menisci. A positive relationship between the diameter of the posterior medial femoral condyle and the tibial medial superior articular surface was found in cases with (n = 40) (r (2) = 0.208, p = 0.003) and without tear (n = 60) (r (2) = 0.182, p = 0.001). In addition, a significant positive relationship was found between the diameter of the posterior medial femoral condyle and the medial tibial superior articular surface in cases with and without tear. The impact of femorotibial incongruence on the medial meniscus tear is important for

Are repeated single-limb heel raises and manual muscle testing associated with peak plantar-flexor force in people with inclusion body myositis?

PubMed

Harris-Love, Michael O; Shrader, Joseph A; Davenport, Todd E; Joe, Galen; Rakocevic, Goran; McElroy, Beverly; Dalakas, Marinos

2014-04-01

Repeated heel raises have been proposed as a method of ankle plantar-flexor strength testing that circumvents the limitations of manual muscle testing (MMT). The study objective was to examine the relationships among ankle plantar-flexion isometric maximum voluntary contraction (MVC), repeated single-limb heel raises (SLHRs), and MMT in people with myositis. This was a cross-sectional study with a between-group design. The ability to complete 1 SLHR determined group assignment (SLHR group, n=24; no-SLHR group, n=19). Forty-three participants with myositis (13 women; median age=64.9 years) participated. Outcome measures included MVC, predicted MVC, Kendall MMT, and Daniels-Worthingham MMT. The Kendall MMT was unable to detect significant ankle plantar-flexor weakness established by quantitative methods and was unable to discriminate between participants who could and those who could not perform the SLHR task. Ankle plantar-flexion MVC was not associated with the number of heel-raise repetitions in the SLHR group (pseudo R(2)=.13). No significant relationship was observed between MVC values and MMT grades in the SLHR and no-SLHR groups. However, a moderate relationship between MVC values and MMT grades was evident in a combined-group analysis (ρ=.50-.67). The lower half of both MMT grading scales was not represented in the study despite the profound weakness of the participants. Both Kendall MMT and Daniels-Worthingham MMT had limited utility in the assessment of ankle plantar-flexor strength. Repeated SLHRs should not be used as a proxy measure of ankle plantar-flexion MVC in people with myositis.

Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: A test-retest intra- and intertester study.

PubMed

Johannsen, Finn; Jensen, Signe; Stallknecht, Sandra E; Olsen, Lars Otto; Magnusson, S Peter

2016-10-01

To determine intra- and interobserver reliability and precision of sonographic (US) scanning in measuring thickness of the Achilles tendon, plantar fascia, and heel fat pad in patients with heel pain. Seventeen consecutive patients referred with heel pain were included. Two evaluators blinded to the diagnosis performed independently US scanning of both feet without any dialogue with the patient. The examiner left the room, and the next examiner entered. All patients had two US scans performed by each examiner. Two months later, the US images were randomly presented to the evaluators for measurements. Reliability and agreement were assessed by calculation of intraclass correlation coefficient (ICC), 95% limits of agreement (LOA), and typical error (TE). LOA was calculated as a percentage of the mean thickness of each structure to obtain a unitless parameter. We found excellent intratester reliability (ICC 0.78-0.98) and good intertester reliability using one measurement (ICC 0.72-0.91) and excellent (ICC 0.85-0.95) when using average of two measurements. The intratester agreements were good with LOA: 9.5-23.4% and TE: 3.4-8.4%. The intertester agreements were acceptable using one measurement with LOA: 16.1-36.4%, and better using two measurements with LOA: 14.4-33.2%. US is a reliable technique of measurement in the daily clinic, and one single measurement is sufficient. In research, we recommend that the same observer performs the US measurements, if one single scanning is preferred; if more researchers are involved, the average measurement of two US scans is recommended. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:480-486, 2016. © 2016 Wiley Periodicals, Inc.

Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study.

PubMed

Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-Ichi

2017-06-18

To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.

Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study

PubMed Central

Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-ichi

2017-01-01

AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. RESULTS Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. CONCLUSION We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau. PMID:28660141

Pullout failure strength of the posterior horn of the medial meniscus with root ligament tear.

PubMed

Kim, Young-Mo; Joo, Yong-Bum

2013-07-01

To evaluate the reparability of the posterior horn of the medial meniscus with root ligament tear by measuring the actual pullout failure strength of a simple vertical suture of an arthroscopic subtotal meniscectomized posterior horn of the medial meniscus. From November 2009 to May 2010, nine posterior horns of the medial meniscus specimens were collected from arthroscopic subtotal meniscectomy performed as a treatment for root ligament rupture of the posterior horn of the medial meniscus. Simple vertical sutures were performed on the specimens, and pullout failure load was tested with a biaxial servohydraulic testing machine (Model 8874; Instron Corp., Norwood, MA, USA). The degree of degeneration, extrusion, and medial displacement of the medial meniscus were evaluated with magnetic resonance imaging (MRI). The Kellgren-Lawrence classification was used in standing plain radiography, and mechanical alignment was measured using orthoroentgenography. Tear morphology was classified into ligament proper type or meniscoligamentous junctional type according to the site of the torn root ligament of the posterior horn of the medial meniscus during arthroscopy. The mean pullout failure strength of the posterior horn of the medial meniscus was 71.6 ± 23.2 N (range, 41.4-107.7 N). The degree of degeneration of the posterior horn of the medial meniscus on MRI showed statistically significant correlation with pullout failure strength and Kellgren-Lawrence classification. Pullout failure strength showed correlation with mechanical alignment and Kellgren-Lawrence classification (P < 0.05). The measurement of pullout failure strength of the posterior horn of the medial meniscus with root ligament tear showed a degree of repairability. The degree of degeneration of the posterior horn of the medial meniscus on MRI showed a significant correlation with the pullout failure strength. The pullout failure strength was also not only correlated with the degree of degeneration of the

Functional specialization of medial auditory belt cortex in the alert rhesus monkey.

PubMed

Kusmierek, Pawel; Rauschecker, Josef P

2009-09-01

Responses of neural units in two areas of the medial auditory belt (middle medial area [MM] and rostral medial area [RM]) were tested with tones, noise bursts, monkey calls (MC), and environmental sounds (ES) in microelectrode recordings from two alert rhesus monkeys. For comparison, recordings were also performed from two core areas (primary auditory area [A1] and rostral area [R]) of the auditory cortex. All four fields showed cochleotopic organization, with best (center) frequency [BF(c)] gradients running in opposite directions in A1 and MM than in R and RM. The medial belt was characterized by a stronger preference for band-pass noise than for pure tones found medially to the core areas. Response latencies were shorter for the two more posterior (middle) areas MM and A1 than for the two rostral areas R and RM, reaching values as low as 6 ms for high BF(c) in MM and A1, and strongly depended on BF(c). The medial belt areas exhibited a higher selectivity to all stimuli, in particular to noise bursts, than the core areas. An increased selectivity to tones and noise bursts was also found in the anterior fields; the opposite was true for highly temporally modulated ES. Analysis of the structure of neural responses revealed that neurons were driven by low-level acoustic features in all fields. Thus medial belt areas RM and MM have to be considered early stages of auditory cortical processing. The anteroposterior difference in temporal processing indices suggests that R and RM may belong to a different hierarchical level or a different computational network than A1 and MM.

[Tibial periostitis ("medial tibial stress syndrome")].

PubMed

Fournier, Pierre-Etienne

2003-06-01

Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

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 medial tenderness predict deep deltoid ligament incompetence in supination-external rotation type ankle fractures?

PubMed

DeAngelis, Nicola A; Eskander, Mark S; French, Bruce G

2007-04-01

To identify whether medial tenderness is a predictor of deep deltoid ligament incompetence in supination-external rotation ankle fractures. All Weber B lateral malleolar fractures with normal medial clear space over a 9 month period were prospectively included in the study. Fracture patterns not consistent with a supination-external rotation mechanism were excluded. High-volume tertiary care referral center and Level I trauma center. Fifty-five skeletally mature patients with a Weber B lateral malleolar fracture and normal medial clear space presenting to our institution were included. All study patients had ankle anteroposterior, lateral, and mortise radiographs. Each patient was seen and evaluated by an orthopedic specialist and the mechanism of injury was recorded. Each patient was assessed for tenderness to palpation in the region of the deltoid ligament and then had an external rotation stress mortise radiograph. Correlating medial tenderness with deep deltoid competence as measured by stress radiographs. Thirteen patients (23.6%) were tender medially and had a positive external rotation stress radiograph. Thirteen patients (23.6%) were tender medially and had a negative external rotation stress radiograph. Nineteen patients (34.5%) were nontender medially and had a negative external rotation stress radiograph. Ten patients (18.2%) were nontender medially and had a positive external rotation stress radiograph. We calculated a chi statistic of 2.37 as well as the associated P value of 0.12. Medial tenderness as a measure of deep deltoid ligament incompetence had a sensitivity of 57%, a specificity of 59%, a positive predictive value of 50%, a negative predictive value of 66%, and an accuracy of 42%. There was no statistical significance between the presence of medial tenderness and deep deltoid ligament incompetence. There is a 25% chance of the fracture in question with medial tenderness having a positive external rotation stress and a 25% chance the fracture

Medial Frontal Event-Related Potentials and Reward Prediction: Do Responses Matter?

ERIC Educational Resources Information Center

Martin, Laura E.; Potts, Geoffrey F.

2011-01-01

Medial frontal event-related potentials (ERPs) following rewarding feedback index outcome evaluation. The majority of studies examining the feedback related medial frontal negativity (MFN) employ active tasks during which participants' responses impact their feedback, however, the MFN has been elicited during passive tasks. Many of the studies…

Complications in posteromedial arthroscopic suture of the medial meniscus.

PubMed

Jan, N; Sonnery-Cottet, B; Fayard, J-M; Kajetanek, C; Thaunat, M

2016-12-01

All-inside posteromedial suture for lesions of the posterior horn of the medial meniscus in anterior cruciate ligament (ACL) repair provides effective freshening and good healing. The posteromedial portal provides satisfactory healing rates without increasing morbidity or complications rates. Intra- and postoperative complications were collected for a consecutive single-center series of 132 patients undergoing posteromedial hook suture of the medial meniscus in ACL repair. Meniscal healing was assessed as the rate of recurrence of symptomatic medial meniscus lesions (Barret criteria) and on revision surgery, if any, in terms of the aspect and extent of the iterative lesion. The severity of any sensory disorder was assessed by questionnaire. The intraoperative complications rate was 1.5% (2 saphenous vein punctures). At a mean 31months (range, 28-35months), there was no loss to follow-up. Twelve patients (9%) showed symptomatic recurrence of the medial meniscus lesion, requiring 10 repeat surgeries. In 6 cases (4.5%), the iterative lesion involved a smaller, more central part of the meniscus anterior to the sutures, of "postage-stamp" effect, possibly implicating the suture hook and/or non-absorbable sutures. There were no cases of infection or fistula. Postoperative hematoma occurred in 7% of patients. In total, 1.8% reported dysesthesia areas equal to or greater than the size of a credit card (45cm 2 ). Some retears, or "partial failures", may implicate a new lesion caused by the suture hook and possibly prolonged by non-resorbable sutures. Hematoma and sensory disorder rates were comparable to those reported in isolated ACL repair without posteromedial portal. The present results show that posteromedial arthroscopic hook suture in posterior medial meniscus tear provides good healing rates without increased morbidity due to the supplementary portal. IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Cam impingement of the posterior femoral condyle in medial meniscal tears.

PubMed

Suganuma, Jun; Mochizuki, Ryuta; Yamaguchi, Kenji; Inoue, Yutaka; Yamabe, Eikou; Ueda, Yoshiyuki; Fujinaka, Tarou

2010-02-01

The aim of this study was to compare the results of meniscal repair of the medial meniscus with or without decompression of the posterior segment of the medial meniscus for the treatment of posteromedial tibiofemoral incongruence at full flexion (PMTFI), which induces deformation of the posterior segment on sagittal magnetic resonance imaging (MRI). For more than 2 years, we followed up 27 patients with PMTFI who were classified into the following 2 groups. Group 1 included 8 patients (5 male joints and 3 female joints) with a medial meniscal tear with instability at the site of the tear who underwent meniscal repair. The mean age was 23.6 years. Group 2 included 19 patients (16 male joints and 3 female joints) who had a meniscal tear with instability at the site of the tear and underwent meniscal repair and decompression. The mean age was 26.5 years. In decompression of the posterior segment, redundant bone tissue on the most proximal part of the medial femoral condyle was excised. The patients were assessed by use of the Lysholm score, sagittal MRI at full flexion, and arthroscopic examination. There were no statistical differences in mean Lysholm score between the 2 groups before surgery, but the mean score in group 2 was significantly higher than that in group 1 after surgery. Meniscal deformation of the posterior segment at full flexion on MRI disappeared in all cases after decompression. On second-look arthroscopy, the rate of complete healing at the site of the tear was 0% in group 1 but 57% in group 2, and it was significantly different between these groups. The addition of decompression of the posterior segment of the medial meniscus to meniscal repair of knee joints with PMTFI allowed more room for the medial meniscus to accommodate and improved both function of the knee joint and the rate of success of repair of isolated medial meniscal tears in patients who regularly performed full knee flexion. (c) 2010 Arthroscopy Association of North America

The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players

PubMed Central

Xu, Huan; Wang, Pin; Ye, Zhuo’er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

2016-01-01

Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs. A randomized controlled clinical study.

PubMed

Costantino, C; Vulpiani, M C; Romiti, D; Vetrano, M; Saraceni, V M

2014-02-01

Plantar fasciitis is one of the most common causes of pain in the inferior heel and is very frequent in some running sports. It affects up to 10% of general population and accounts for 11% to 15% of all foot pain symptomatology. Several treatments have been suggested, but there is no evidence supporting a specific conservative management strategy. Evaluation of the efficacy of combined cryoultrasound therapy on chronic plantar fasciitis with heel spurs resistant to pharmacological and instrumental therapies. Single-blind randomized clinical trial. 102 consecutive patients affected by chronic plantar fasciitis with painful symptomatology for at least 6 months, intensity of pain higher than 5 on the VAS score, presence of heel spurs, use of plantar orthoses and ineffectiveness of previous therapies. The patients were randomized into two groups: Group A treated with cryoultrasound therapy and Group B with cryotherapy. Our protocol was based on 10 daily treatments, lasting 20 minutes. Each participant was evaluated using VAS score before (T0) the treatment and 3 months (T1), 12 months (T2) and 18 months (T3) after. Effectiveness index was calculated from T1 to T3. Both treatments have been found effective. The difference in pain intensity on the VAS scale between the two groups at T2 was 4.35 points in favor of Group A (IC 95% 3.75; 4.95; P<0.001), reaching the primary end point. The difference in pain intensity on the VAS scale between the two groups at T1, T2 and T3 was 3.00, 4.35 and 4.81 respectively, showing a statistically significant difference between VAS average scores at all follow-ups in favor of Group A. Scores of at least 66% at the effectiveness index were only achieved in Group A (P values <0.001). Cryoultrasound therapy could be an efficient treatment option for chronic plantar fasciitis. Cryoultrasound therapy promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis, granted its high therapeutic efficiency

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

Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma.

PubMed

Kamel, Reda H; Abdel Fattah, Ahmed F; Awad, Ayman G

2014-12-01

Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players.

PubMed

Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Takagi, Michiaki

2014-10-01

Although medial epicondylar fragmentation of the humerus is a reported elbow injury in junior tennis players, there have been only a few studies on this entity, and none have investigated the characteristics and prognosis of medial epicondylar fragmentation. Forty-one male junior tennis players, aged 11 to 14 years (mean, 13 years), underwent elbow examination by ultrasonography. Elbow re-examination was performed in subjects with medial epicondylar fragmentation at an average of 20 months (12-30 months) after the initial examination. On examination, 9 subjects (22%) had elbow pain. Ultrasonography showed that 6 subjects (15%) had medial epicondylar fragmentation, all of whom had elbow pain. Medial epicondylar fragmentation was present in 5 (38%) of 13 subjects aged 11 to 12 years and in 1 (4%) of 28 aged 13 to 14 years. More subjects aged 11 to 12 years had medial epicondylar fragmentation (P = .0084). All 6 subjects with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, although ultrasonography showed that 5 developed bone union and 1 had nonunion, 3 subjects (50%) reported elbow pain. Our results demonstrated that subjects aged 11 to 12 years had a high frequency (38%) of medial epicondylar fragmentation. Although medial epicondylar fragmentation was the main cause of elbow pain (67%) at the initial elbow examination, all 6 players with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, 5 subjects presented spontaneous bone union (83%), but 3 subjects (50%) reported elbow pain. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effects of the medial or basolateral amygdala upon social anxiety and social recognition in mice.

PubMed

Wang, Yu; Zhao, Shanshan; Liu, Xu; Fu, Qunying

2014-01-01

Though social anxiety and social recognition have been studied extensively, the roles of the medial or basolateral amygdala in the control of social anxiety and social recognition remain to be determined. This study investigated the effects of excitotoxic bilateral medial or basolateral amygdala lesions upon social anxiety and social recognition in-mice. Animals at 9 weeks of age were given bilateral medial or basolateral amygdala lesions via infusion of N-methyl- D-aspartate and then were used for behavioral tests: anxiety-related tests (including open-field test, light-dark test, and elevated-plus maze test), social behavior test in a novel environment, social recognition test, and flavor recognition test. Medial or basolateral amygdala-lesioned mice showed lower levels of anxiety and increased social behaviors in a novel environment. Destruction of the medial or basolateral amygdala neurons impaired social recognition but not flavor recognition. The medial or basolateral amygdala is involved in the control of anxiety-related behavior (social anxiety and social behaviors) in mice. Moreover, both the medial and the basolateral amygdala are essential for social recognition but not flavor recognition in mice.

Medial Meniscus Root Tear in the Middle Aged Patient: A Case Based Review

PubMed Central

Carreau, Joseph H.

2017-01-01

Abstract Biomechanical studies have shown that medial meniscal root tears result in meniscal extrusion and increased tibiofemoral joint contact pressures, which can accelerate the progression of arthritis. Repair is generally recommended for acute injuries in the young, active patient population. The far more common presentation however, is a subacute root tear with medial meniscal extrusion in a middle aged patient. Coexisting arthritis is common in this population and complicates decision making. Treatment should be based on the severity of the underlying arthritis. In cases of early or minimal arthritis, root repair is ideal to improve symptoms and restore meniscal function. In patients with moderate or severe medial compartment arthritis, medial unloader bracing or injections can be tried initially. When non-operative treatment fails, high tibial osteotomy or arthroplasty is recommended. Long term clinical studies are needed to determine the natural history of medial meniscal root tears in middle aged patients and the best surgical option. PMID:28852346

Proximo-distal patellar position in three small dog breeds with medial patellar luxation.

PubMed

Wangdee, C; Theyse, L F H; Hazewinkel, H A W

2015-01-01

Medial patellar luxation is thought to be associated with a high proximal position of the patella in the trochlear groove. To determine whether the ratio of patellar ligament length and patellar length (L:P) is influenced by the stifle angle (75°, 96°, 113°, 130°, and 148°) in small dog breeds and to compare the L:P ratio in dogs of three small dog breeds with and without medial patellar luxation. A mediolateral radiograph of the stifle joint was used to measure the L:P ratio in the stifle joints of dogs of three small breeds with and without medial patellar luxation. The L:P ratio was evaluated at five stifle angles (75°, 96°, 113°, 130°, and 148°) in 14 cadavers (26 stifle joints) of small dog breeds in order to identify the best stifle angle to measure the L:P ratio. Then the mean ± SD L:P ratio was calculated for normal stifles and stifles with medial patellar luxation grades 1, 2, and 3 in 194 Pomeranians, 74 Chihuahuas, and 41 Toy or Standard Poodles. The L:P ratio was the same for all five stifle angles in the cadavers (p = 0.195). It was also not significantly different in the three breeds (p = 0.135), in normal and medial patellar luxation-affected stifles overall (p = 0.354), and in normal and medial patellar luxation-affected joints within each breed (p = 0.19). We conclude that a proximo-distal patellar position is not associated with medial patellar luxation in Pomeranians, Chihuahuas, and Toy or Standard Poodles. Thus a longer patellar ligament length does not play a role in the pathophysiology of medial patellar luxation in these small dog breeds.

Epidural abscess treated with a medial supraorbital craniotomy through an incision in the eyebrow. Case report.

PubMed

Rosen, David S; Shafizadeh, Stephen; Baroody, Fuad M; Yamini, Bakhtiar

2008-02-01

The authors describe a medial supraorbital craniotomy performed through a medial eyebrow skin incision to approach an epidural abscess located in the medial anterior fossa of the skull. An 8-year-old boy presented with fevers and facial swelling. Imaging demonstrated pansinusitis and an epidural fluid collection adjacent to the frontal sinus. A medial supraorbital craniotomy was performed to access and drain the epidural abscess. The supraorbital nerve laterally and the supratrochlear nerve medially were preserved by incising the frontalis muscle vertically, parallel to the course of the nerves, and dissecting the subperiosteal plane to mobilize the nerves. This approach may be a useful access corridor for other lesions located near the medial anterior fossa.

Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures.

PubMed

Hughes, Meghan; Dua, Karan; O'Hara, Nathan N; Brighton, Brian K; Ganley, Theodore J; Hennrikus, William L; Herman, Martin J; Hyman, Joshua E; Lawrence, J Todd; Mehlman, Charles T; Noonan, Kenneth J; Otsuka, Norman Y; Schwend, Richard M; Shrader, M Wade; Smith, Brian G; Sponseller, Paul D; Abzug, Joshua M

2017-10-18

Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures. A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making. Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making. There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on

Variations in medial-lateral hamstring force and force ratio influence tibiofemoral kinematics.

PubMed

Shalhoub, Sami; Fitzwater, Fallon G; Cyr, Adam J; Maletsky, Lorin P

2016-10-01

A change in hamstring strength and activation is typically seen after injuries or invasive surgeries such as anterior cruciate reconstruction or total knee replacement. While many studies have investigated the influence of isometric increases in hamstring load on knee joint kinematics, few have quantified the change in kinematics due to a variation in medial to lateral hamstring force ratio. This study examined the changes in knee joint kinematics on eight cadaveric knees during an open-chain deep knee bend for six different loading configurations: five loaded hamstring configurations that varied the ratio of a total load of 175 N between the semimembranosus and biceps femoris and one with no loads on the hamstring. The anterior-posterior translation of the medial and lateral femoral condyles' lowest points along proximal-distal axis of the tibia, the axial rotation of the tibia, and the quadriceps load were measured at each flexion angle. Unloading the hamstring shifted the medial and lateral lowest points posteriorly and increased tibial internal rotation. The influence of unloading hamstrings on quadriceps load was small in early flexion and increased with knee flexion. The loading configuration with the highest lateral hamstrings force resulted in the most posterior translation of the medial lowest point, most anterior translation of the lateral lowest point, and the highest tibial external rotation of the five loading configurations. As the medial hamstring force ratio increased, the medial lowest point shifted anteriorly, the lateral lowest point shifted posteriorly, and the tibia rotated more internally. The results of this study, demonstrate that variation in medial-lateral hamstrings force and force ratio influence tibiofemoral transverse kinematics and quadriceps loads required to extend the knee. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1707-1715, 2016. © 2016 Orthopaedic Research Society. Published by

Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.

PubMed

Hein, Christopher N; Deperio, Jennifer Gurske; Ehrensberger, Mark T; Marzo, John M

2011-06-01

Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM. Meniscal root repair will restore the ability of the meniscus to resist extrusion, and reduce gap formation at the defect. Seven fresh frozen human cadaveric knees were dissected and mechanically loaded using a servo-hydraulic load frame (MTS ®) with 0 and 1800 N. The knees were tested under three conditions: native, avulsed, and repaired. Four measurements were obtained: meniscal displacement anteriorly, medially, posteriorly, and gap distance between the root attachment site and MM after transection and repair. The medial displacement of the avulsed MM (3.28 mm) was significantly greater (p < 0.001) than the native knee (1.60mm) and repaired knee (1.46 mm). Gap formation is significantly larger in the avulsed compared to repaired state at 0 (p < 0.02) and 1800N (p < 0.02) and also larger with loading in both avulsed (p < 0.05) and repaired (p < 0.02) conditions. Therefore, MMRA results in MM extrusion from the joint and gap formation between the MM root and the MM. Subsequent surgical repair reduces meniscal displacement and gap formation at the defect. Copyright © 2010 Elsevier B.V. All rights reserved.

Medial maxillectomy in recalcitrant sinusitis: when, why and how?

PubMed

Konstantinidis, Iordanis; Constantinidis, Jannis

2014-02-01

We reviewed all journal articles relevant to endoscopic medial maxillectomy in patients with recalcitrant chronic maxillary sinusitis in order to present all indications, the underlying pathophysiology and the developed surgical techniques. Despite the high success rate of middle meatal antrostomy, cases with persistent maxillary sinus disease exist and often need a more extended endoscopic procedure for the better control of the disease. Such surgical option uses gravity for better sinus drainage and offers better saline irrigation, local application of medications and follow-up inspection. An endoscopic medial maxillectomy and its modified forms offer a wider surgical field and access to all 'difficult' areas of the maxillary sinus. Patients with previous limited endoscopic sinus surgery or extended open surgery, cystic fibrosis, extensive mucoceles, allergic fungal sinusitis, odontogenic infections, foreign bodies and so on may suffer from recurrent disease requiring an endoscopic medial maxillectomy. Depending on the disease, various modifications of the procedure can be performed preserving the anterior buttress, nasolacrimal duct and inferior turbinate if possible.

Avulsion of the anterior medial meniscus root: case report and surgical technique.

PubMed

Feucht, Matthias J; Minzlaff, Philipp; Saier, Tim; Lenich, Andreas; Imhoff, Andreas B; Hinterwimmer, Stefan

2015-01-01

Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau. Level of evidence V.

Medial versus lateral supraspinatus tendon properties: implications for double-row rotator cuff repair.

PubMed

Wang, Vincent M; Wang, Fan Chia; McNickle, Allison G; Friel, Nicole A; Yanke, Adam B; Chubinskaya, Susan; Romeo, Anthony A; Verma, Nikhil N; Cole, Brian J

2010-12-01

Rotator cuff repair retear rates range from 25% to 90%, necessitating methods to improve repair strength. Although numerous laboratory studies have compared single-row with double-row fixation properties, little is known regarding regional (ie, medial vs lateral) suture retention properties in intact and torn tendons. A torn supraspinatus tendon will have reduced suture retention properties on the lateral aspect of the tendon compared with the more medial musculotendinous junction. Controlled laboratory study. Human supraspinatus tendons (torn and intact) were randomly assigned for suture retention mechanical testing, ultrastructural collagen fibril analysis, or histologic testing after suture pullout testing. For biomechanical evaluation, sutures were placed either at the musculotendinous junction (medial) or 10 mm from the free margin (lateral), and tendons were elongated to failure. Collagen fibril assessments were performed using transmission electron microscopy. Intact tendons showed no regional differences with respect to suture retention properties. In contrast, among torn tendons, the medial region exhibited significantly higher stiffness and work values relative to the lateral region. For the lateral region, work to 10-mm displacement (1592 ± 261 N-mm) and maximum load (265 ± 44 N) for intact tendons were significantly higher (P < .05) than that of torn tendons (1086 ± 388 N-mm and 177 ± 71 N, respectively). For medial suture placement, maximum load, stiffness, and work of intact and torn tendons were similar (P > .05). Regression analyses for the intact and torn groups revealed generally low correlations between donor age and the 3 biomechanical indices. For both intact and torn tendons, the mean fibril diameter and area density were greater in the medial region relative to the lateral (P ≤ .05). In the lateral tendon, but not the medial region, torn specimens showed a significantly lower fibril area fraction (48.3% ± 3.8%) than intact specimens

Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees.

PubMed

Yuuki, Arata; Muneta, Takeshi; Ohara, Toshiyuki; Sekiya, Ichiro; Koga, Hideyuki

2017-03-01

Associations of lateral/medial knee instability with anterior cruciate ligament (ACL) injury have not been thoroughly investigated. The purposes of this study were to investigate whether lateral/medial knee instability is associated with ACL injury, and to clarify relevant factors for lateral/medial knee instability in ACL-injured knees. One hundred and nineteen patients with unilateral ACL-injured knees were included. Lateral/medial knee instability was assessed with varus/valgus stress X-ray examination for both injured and uninjured knees by measuring varus/valgus angle, lateral/medial joint opening, and lateral/medial joint opening index. Manual knee instability tests for ACL were evaluated to investigate associations between lateral/medial knee instability and anterior and/or rotational instabilities. Patients' backgrounds were evaluated to identify relevant factors for lateral/medial knee instability. Damage on the lateral collateral ligament (LCL) on MRI was also evaluated. All parameters regarding lateral knee instability in injured knees were significantly greater than in uninjured knees. There were significant correlations between lateral knee instability and the Lachman test as well as the pivot shift test. Patients with LCL damage had significantly greater lateral joint opening than those without LCL damage on MRI. Sensitivity of LCL damage on MRI to lateral joint opening was 100%, while its specificity was 36%. No other relevant factors were identified. In medial knee instability, there were also correlations between medial knee instability and the Lachman test/pivot shift test. However, the correlations were weak and other parameters were not significant. Lateral knee instability was greater in ACL-deficient knees than in uninjured knees. Lateral knee instability was associated with ACL-related instabilities as well as LCL damage on MRI, whereas MRI had low specificity to lateral knee instability. On the other hand, the association of medial knee

Why Do Medial Unicompartmental Knee Arthroplasties Fail Today?

PubMed

van der List, Jelle P; Zuiderbaan, Hendrik A; Pearle, Andrew D

2016-05-01

Failure rates are higher in medial unicompartmental knee arthroplasty (UKA) than total knee arthroplasty. To improve these failure rates, it is important to understand why medial UKA fail. Because individual studies lack power to show failure modes, a systematic review was performed to assess medial UKA failure modes. Furthermore, we compared cohort studies with registry-based studies, early with midterm and late failures and fixed-bearing with mobile-bearing implants. Databases of PubMed, EMBASE, and Cochrane and annual registries were searched for medial UKA failures. Studies were included when they reported >25 failures or when they reported early (<5 years), midterm (5-10 years), or late failures (>10 years). Thirty-seven cohort studies (4 level II studies and 33 level III studies) and 2 registry-based studies were included. A total of 3967 overall failures, 388 time-dependent failures, and 1305 implant design failures were identified. Aseptic loosening (36%) and osteoarthritis (OA) progression (20%) were the most common failure modes. Aseptic loosening (26%) was most common early failure mode, whereas OA progression was more commonly seen in midterm and late failures (38% and 40%, respectively). Polyethylene wear (12%) and instability (12%) were more common in fixed-bearing implants, whereas pain (14%) and bearing dislocation (11%) were more common in mobile-bearing implants. This level III systematic review identified aseptic loosening and OA progression as the major failure modes. Aseptic loosening was the main failure mode in early years and mobile-bearing implants, whereas OA progression caused most failures in late years and fixed-bearing implants. Copyright © 2016 Elsevier Inc. All rights reserved.

Floodplains as an Achilles’ heel of Amazonian forest resilience

PubMed Central

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

2017-01-01

The massive forests of central Amazonia are often considered relatively resilient against climatic variation, but this view is challenged by the wildfires invoked by recent droughts. The impact of such fires that spread from pervasive sources of ignition may reveal where forests are less likely to persist in a drier future. Here we combine field observations with remotely sensed information for the whole Amazon to show that the annually inundated lowland forests that run through the heart of the system may be trapped relatively easily into a fire-dominated savanna state. This lower forest resilience on floodplains is suggested by patterns of tree cover distribution across the basin, and supported by our field and remote sensing studies showing that floodplain fires have a stronger and longer-lasting impact on forest structure as well as soil fertility. Although floodplains cover only 14% of the Amazon basin, their fires can have substantial cascading effects because forests and peatlands may release large amounts of carbon, and wildfires can spread to adjacent uplands. Floodplains are thus an Achilles’ heel of the Amazon system when it comes to the risk of large-scale climate-driven transitions. PMID:28396440

Robot-Assisted Medial Compartment Arthroplasty Following Remote Patellectomy: A Case Report

PubMed Central

Kouk, Shalen; Kalbian, Irene; Wolfe, Elizabeth; Strickland, Sabrina M

2018-01-01

Introduction: Total patellectomies are uncommon procedures that are reserved as salvage treatment for severely comminuted fractures of the patella. Due to the alteration of normal joint mechanics, these patients present later on in life with degenerative cartilage damage to the femorotibial joint and altered extensor mechanism. There are very few reports of unicondylar knee arthroplasties following previous patellectomy and none that specifically address robot-assisted unicompartmental knee arthroplasty. A recent case report by Pang et al. described the use of minimally invasive fixed-bearing unicondylar knee arthroplasty in a patellectomized patient with moderate medial compartment osteoarthritis. Our report details a case with more significant chondral loss along with patellar tendon subluxation. Case Report: This is a case report of a patient with severe medial compartment osteoarthritis after a patellectomy following a motor vehicle collision. After failing conservative treatment, the patient underwent a medial MAKOplasty with complete resolution of arthritic pain. Conclusion: Significant pain relief and improved knee function can be achieved with MAKOPlasty partial knee resurfacing system in a previously patellectomized patient with severe medial compartment osteoarthritis. PMID:29854684

Determination of a steroid profile in heel prick blood using LC-MS/MS.

PubMed

Boelen, Anita; Ruiter, An F C; Claahsen-van der Grinten, Hedi L; Endert, Erik; Ackermans, Mariette T

2016-01-01

The aim of this study was to improve the sensitivity of the congenital adrenal hyperplasia (CAH) neonatal screening by including second-tier steroid profiling on a DBS using LC-MS. We developed a method to measure the steroid profile in DBS and established gestational age-specific reference ranges of cortisol, cortisone, 11-deoxycortisol, 21-deoxycortisol, 17-hydroxyprogesterone, testosterone, Δ4-androstenedione, corticosterone and 11-deoxycorticosterone using 450 heel prick samples of neonates, participating in the Dutch Screening Program. Analyzing 92 cards with a positive CAH screening showed that only 21-deoxycortisol was 100% specific for diagnosed CAH patients. Steroid precursors can be measured in DBS and we suggest to implement the method as a second tier testing for CAH in The Netherlands.

Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy.

PubMed

Bull, Patrick E; Berlet, Gregory C; Canini, Cameron; Hyer, Christopher F

2016-06-01

Access to the medial half of the talus can be challenging even with an osteotomy. Although several techniques are presented in the literature, critical evaluation of fixation, union, and alignment is lacking. The chevron medial malleolar osteotomy provides advantages of perpendicular instrumentation access and wide exposure to the medial talus. Postoperative displacement resulting in malunion, and possibly provoking ankle osteoarthritis, is a known complication. The present study describes our experience with the osteotomy. A consecutive series cohort of 50 bi-plane chevron osteotomies performed from 2004 to 2013 were evaluated. Forty-six were secured using 2 lag screws, and 4 were secured using 2 lag screws and a medial buttress plate. Radiographic studies performed at 2, 6, and 12 weeks and at final follow-up were analyzed for postoperative displacement, malunion, non-union, and hardware-related complications. At initial postoperative follow-up, 47 of 50 had adequate radiographs for review, and 18 of 47 (38.3%) showed some displacement when compared to the initial osteotomy fixation position. By final follow-up, 15 of 50 (30.0%) had measurable incongruence. Hardware removal was performed in 13 (26.0%) cases at an average of 2.4 years postoperation. Bi-plane medial malleolar chevron osteotomy fixed with 2 lag screws showed a 30.0% malunion rate with an average of 2 mm of incongruence on final follow-up radiographs, which is higher than what has been reported in the literature. In our practice, we now use a buttress plate and more recently have eliminated postoperative osteotomy displacement. Level IV, retrospective case series. © The Author(s) 2016.

Medial-row failure after arthroscopic double-row rotator cuff repair.

PubMed

Yamakado, Kotaro; Katsuo, Shin-ichi; Mizuno, Katsunori; Arakawa, Hitoshi; Hayashi, Seigaku

2010-03-01

We report 4 cases of medial-row failure after double-row arthroscopic rotator cuff repair (ARCR) without arthroscopic subacromial decompression (ASAD), in which there was pullout of mattress sutures of the medial row and knots were caught between the cuff and the greater tuberosity. Between October 2006 and January 2008, 49 patients underwent double-row ARCR. During this period, ASAD was not performed with ARCR. Revision arthroscopy was performed in 8 patients because of ongoing symptoms after the index operation. In 4 of 8 patients the medial rotator cuff failed; the tendon appeared to be avulsed at the medial row, and there were exposed knots on the bony surface of the rotator cuff footprint. It appeared that the knots were caught between the cuff and the greater tuberosity. Three retear cuffs were revised with the arthroscopic transtendon technique, and one was revised with a single-row technique after completing the tear. ASAD was performed in all patients. Three of the four patients showed improvement of symptoms and returned to their preinjury occupation. Impingement of pullout knots may be a source of pain after double-row rotator cuff repair. Copyright 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery.

PubMed

Kockelkoren, Remko; Vos, Annelotte; Van Hecke, Wim; Vink, Aryan; Bleys, Ronald L A W; Verdoorn, Daphne; Mali, Willem P Th M; Hendrikse, Jeroen; Koek, Huiberdina L; de Jong, Pim A; De Vis, Jill B

2017-01-01

Intracranial internal carotid artery (iICA) calcification is associated with stroke and is often seen as a proxy of atherosclerosis of the intima. However, it was recently shown that these calcifications are predominantly located in the tunica media and internal elastic lamina (medial calcification). Intimal and medial calcifications are thought to have a different pathogenesis and clinical consequences and can only be distinguished through ex vivo histological analysis. Therefore, our aim was to develop CT scoring method to distinguish intimal and medial iICA calcification in vivo. First, in both iICAs of 16 cerebral autopsy patients the intimal and/or medial calcification area was histologically assessed (142 slides). Brain CT images of these patients were matched to the corresponding histological slides to develop a CT score that determines intimal or medial calcification dominance. Second, performance of the CT score was assessed in these 16 patients. Third, reproducibility was tested in a separate cohort. First, CT features of the score were circularity (absent, dot(s), <90°, 90-270° or 270-360°), thickness (absent, ≥1.5mm, or <1.5mm), and morphology (indistinguishable, irregular/patchy or continuous). A high sum of features represented medial and a lower sum intimal calcifications. Second, in the 16 patients the concordance between the CT score and the dominant calcification type was reasonable. Third, the score showed good reproducibility (kappa: 0.72 proportion of agreement: 0.82) between the categories intimal, medial or absent/indistinguishable. The developed CT score shows good reproducibility and can differentiate reasonably well between intimal and medial calcification dominance in the iICA, allowing for further (epidemiological) studies on iICA calcification.

Preoperative Patellofemoral Chondromalacia is Not a Contraindication for Fixed-Bearing Medial Unicompartmental Knee Arthroplasty.

PubMed

Adams, Alexander J; Kazarian, Gregory S; Lonner, Jess H

2017-06-01

Patellofemoral chondromalacia (PFCM) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA), but there is limited data assessing PFCM's impact on the results of fixed-bearing UKA. Our objective was to assess the impact of medial patellar and/or medial trochlear PFCM on overall and patellofemoral-specific 2-year outcomes after fixed-bearing medial UKA. Intraoperative notes defined the presence and location of PFCM during fixed bearing medial UKA. Outcome measures included the New Knee Society Score (NKSS), Kneeling Ability Score (KAS) and Forgotten Joint Score (FJS-12). Thirty-one knees with PFCM (PFCM group), and 52 knees without PFCM (N-PFCM group) were included for analysis. Mann-Whitney U tests assessed the statistical significance of observed differences, and a Bonferroni correction was applied, adjusting threshold for significance to P = .005. At minimum follow-up of 2 years, no statistical differences were detected between the N-PFCM and PFCM groups in the postoperative NKSS (159 vs 157, P = .731), preoperative to postoperative NKSS change (P = .447), FJS-12 (70.5 vs 67.6, P = .471), or KAS (71% vs 65%, P = .217). Patients with isolated patellar chondromalacia (n = 13) demonstrated trends toward worse outcomes according to NKSS (147, P = .198), FJS-12 (58, P = .094), and KAS (46%, P = .018), but were statistically insignificant. No failures occurred in either group. Functional outcomes of fixed-bearing medial UKA are not adversely impacted by the presence of PFCM involving the medial patellar facet and/or medial or central trochlea. Further follow-up is needed to determine longer-term implications of fixed-bearing medial UKA in patients with PFCM. Copyright © 2017 Elsevier Inc. All rights reserved.

Technique for CT Fluoroscopy-Guided Lumbar Medial Branch Blocks and Radiofrequency Ablation.

PubMed

Amrhein, Timothy J; Joshi, Anand B; Kranz, Peter G

2016-09-01

The purpose of this study is to describe the procedure for CT fluoroscopy-guided lumbar medial branch blocks and facet radiofrequency ablation. CT fluoroscopic guidance allows more-precise needle tip positioning and is an alternative method for performing medial branch blocks and facet radiofrequency ablation.

The JCR:LA-cp rat: a novel rodent model of cystic medial necrosis.

PubMed

Pung, Yuh Fen; Chilian, William M; Bennett, Martin R; Figg, Nichola; Kamarulzaman, Mohd Hamzah

2017-03-01

Although there are multiple rodent models of the metabolic syndrome, very few develop vascular complications. In contrast, the JCR:LA-cp rat develops both metabolic syndrome and early atherosclerosis in predisposed areas. However, the pathology of the normal vessel wall has not been described. We examined JCR:LA control (+/+) or cp/cp rats fed normal chow diet for 6 or 18 mo. JCR:LA-cp rats developed multiple features of advanced cystic medial necrosis including "cysts," increased collagen formation and proteoglycan deposition around cysts, apoptosis of vascular smooth muscle cells, and spotty medial calcification. These appearances began within 6 mo and were extensive by 18 mo. JCR:LA-cp rats had reduced medial cellularity, increased medial thickness, and vessel hypoxia that was most marked in the adventitia. In conclusion, the normal chow-fed JCR:LA-cp rat represents a novel rodent model of cystic medial necrosis, associated with multiple metabolic abnormalities, vascular smooth muscle cell apoptosis, and vessel hypoxia. NEW & NOTEWORTHY Triggers for cystic medial necrosis (CMN) have been difficult to study due to lack of animal models to recapitulate the pathologies seen in humans. Our study is the first description of CMN in the rat. Thus the JCR:LA-cp rat represents a useful model to investigate the underlying molecular changes leading to the development of CMN. Copyright © 2017 the American Physiological Society.

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

PubMed Central

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

2013-01-01

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

Altered medial temporal activation related to local glutamate levels in subjects with prodromal signs of psychosis.

PubMed

Valli, Isabel; Stone, James; Mechelli, Andrea; Bhattacharyya, Sagnik; Raffin, Marie; Allen, Paul; Fusar-Poli, Paolo; Lythgoe, David; O'Gorman, Ruth; Seal, Marc; McGuire, Philip

2011-01-01

Both medial temporal cortical dysfunction and perturbed glutamatergic neurotransmission are regarded as fundamental pathophysiological features of psychosis. However, although animal models of psychosis suggest that these two abnormalities are interrelated, their relationship in humans has yet to be investigated. We used a combination of functional magnetic resonance imaging and magnetic resonance spectroscopy to investigate the relationship between medial temporal activation during an episodic memory task and local glutamate levels in 22 individuals with an at-risk mental state for psychosis and 14 healthy volunteers. We observed a significant between-group difference in the coupling of medial temporal activation with local glutamate levels. In control subjects, medial temporal activation during episodic encoding was positively associated with medial temporal glutamate. However, in the clinical population, medial temporal activation was reduced, and the relationship with glutamate was absent. In individuals at high risk of psychosis, medial temporal dysfunction seemed related to a loss of the normal relationship with local glutamate levels. This study provides the first evidence that links medial temporal dysfunction with the central glutamate system in humans and is consistent with evidence that drugs that modulate glutamatergic transmission might be useful in the treatment of psychosis. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

What to do with medialized tympanostomy tubes? A survey of pediatric otolaryngologists.

PubMed

Bezdjian, Aren; Jiang, Joanna; Maby, Alexandra; Daniel, Sam J

2018-01-01

Tympanostomy tube placement is the most common surgical procedure performed in children. Medial migration of a tympanostomy tube is a rare occurrence where the tube migrates into the middle ear cavity as opposed to its normal extrusion into the external auditory canal. Whether medialized tympanostomy tubes should be surgically removed in asymptomatic patients is controversial. The objective of this study was to determine experience and management approach of medialized tympanostomy tubes among pediatric otolaryngologists. A 12-question cross-section survey was designed and distributed to the American Society of Pediatric Otolaryngology (ASPO) members. The survey study was granted McGill University institutional review board and ASPO research committee approval. The survey data were filtered and cross-tabulated. Descriptive statistics were generated. 128 pediatric otolaryngologists completed the 12-question survey. The majority of respondents had experienced at least one case of medialized tympanostomy tube (90.6%). The majority of patients (82.0%) were asymptomatic. 74 out of 128 respondents (57.8%) indicated that they would not remove a medialized tube in an asymptomatic patient. However, 7.0% of those respondents clarified that they would proceed to surgical removal if the patient were undergoing general anesthesia for another surgery. 30.5% of respondents indicated that they would surgically remove the tube even if the patient were asymptomatic. 6.3% of respondents indicated that opted management in children would be based on a shared decision with parents. Most respondents (80.5%) did not experience complications with surgical removal nor with elected observation. There is no consensus among pediatric otolaryngologists regarding the necessity of surgically removing a medialized tympanostomy tube in asymptomatic patients. The survey suggests that both options are acceptable. If observation is chosen, it is important that parents are well informed of the

Medial gastrocnemius myoelectric control of a robotic ankle exoskeleton.

PubMed

Kinnaird, Catherine R; Ferris, Daniel P

2009-02-01

A previous study from our laboratory showed that when soleus electromyography was used to control the amount of plantar flexion assistance from a robotic ankle exoskeleton, subjects significantly reduced their soleus activity to quickly return to normal gait kinematics. We speculated that subjects were primarily responding to the local mechanical assistance of the exoskeleton rather than directly attempting to reduce exoskeleton mechanical power via decreases in soleus activity. To test this observation we studied ten healthy subjects walking on a treadmill at 1.25 m/s while wearing a robotic exoskeleton proportionally controlled by medial gastrocnemius activation. We hypothesized that subjects would primarily decrease soleus activity due to its synergistic mechanics with the exoskeleton. Subjects decreased medial gastrocnemius recruitment by 12% ( p < 0.05 ) but decreased soleus recruitment by 27% ( p < 0.05). In agreement with our hypothesis, the primary reduction in muscle activity was not for the control muscle (medial gastrocnemius) but for the anatomical synergist to the exoskeleton (soleus). These findings indicate that anatomical morphology needs to be considered carefully when designing software and hardware for robotic exoskeletons.

Case report: comprehensive management of medial tibial stress syndrome

PubMed Central

Krenner, Bernard John

2002-01-01

Abstract Activity or exercise-induced leg pain is a common complication among competitive and “weekend warrior” athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of “shin splints,” one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the injured area should be the primary aim of treatment to optimize shock absorption. The role inflammation plays in medial tibial stress syndrome is controversial, but in this case, seemed to be a causative factor as symptomatology was dramatically decreased with the addition of proteolytic enzymes. Medial tibial stress syndrome can be quite difficult to treat and keeping athletes away from activities that will slow healing or aggravate the condition can be challenging. “Active” rest is the best way in which to allow proper healing while allowing the athlete to maintain their fitness. PMID:19674573

Posterior medial meniscus-femoral insertion into the anterior cruciate ligament. A case report.

PubMed

Bhargava, A; Ferrari, D A

1998-03-01

Medial meniscal anomalies are rare. The anterior horn insertion into the anterior cruciate ligament is the most common. In the course of an arthroscopy for torn lateral meniscus, an anomalous band in continuity with the posterior horn of the medial meniscus was observed to insert into the anterior cruciate ligament. Although the tibial portion of the anterior cruciate was redundant, the anomalous band provided tension to the anterior cruciate ligament and a negative pivot shift. A previously unreported posterior medial meniscal femoral insertion is described.

Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

PubMed

Guelich, David R; Xu, Dali; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

2016-01-01

Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading. Copyright �

Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee.

PubMed

Lee, Stephen J; Aadalen, Kirk J; Malaviya, Prasanna; Lorenz, Eric P; Hayden, Jennifer K; Farr, Jack; Kang, Richard W; Cole, Brian J

2006-08-01

There is no consensus regarding the extent of meniscectomy leading to deleterious effects on tibiofemoral contact mechanics. The meniscus aids in optimizing tibiofemoral contact mechanics, increasing contact area, and decreasing contact stress. Controlled laboratory study. Twelve fresh-frozen human cadaveric knees each underwent 15 separate testing conditions-5 serial 20-mm posterior medial meniscectomy conditions (intact, 50% radial width, 75% radial width, segmental, and total meniscectomy) at 3 flexion angles (0 degrees , 30 degrees , and 60 degrees )-under an 1800-N axial load. Tekscan sensors were used to measure total force and medial force, contact area, mean contact stress, and peak contact stress. All posterior medial meniscectomy conditions resulted in significantly decreased contact areas and increased mean and peak contact stresses compared with the intact state (P < .05). The changes in contact mechanics after segmental and total posterior medial meniscectomies were not statistically different (P > .05). Incremental changes in contact area and mean contact stress increased as more peripheral portions of the medial meniscus were removed, whereas peak contact stresses exhibited similar incremental changes throughout all meniscectomy conditions. The meniscus is a crucial load-bearing structure, optimizing contact area and minimizing contact stress. Loss of hoop tension (ie, segmental meniscectomy) is equivalent to total meniscectomy in load-bearing terms. The peripheral portion of the medial meniscus provides a greater contribution to increasing contact areas and decreasing mean contact stresses than does the central portion, whereas peak contact stresses increase proportionally to the amount of meniscus removed. Because the degree of meniscectomy leading to clinically significant outcomes is unknown, a prudent strategy is to preserve the greatest amount of meniscus possible.

The figure-of-eight radix nasi flap for medial canthal defects.

PubMed

Seyhan, Tamer

2010-09-01

Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars. Copyright 2009 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A giraffe neck sign of the medial meniscus: A characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging.

PubMed

Furumatsu, Takayuki; Fujii, Masataka; Kodama, Yuya; Ozaki, Toshifumi

2017-07-01

The posterior root ligament of the medial meniscus (MM) has a critical role in regulating the MM movement. An accurate diagnosis of the MM posterior root tear (MMPRT) using magnetic resonance imaging (MRI) is important for preventing sequential osteoarthritis following the MMPRT. However, diagnosis of the MMPRT is relatively difficult even after using several characteristic MRI findings. The aim of this study was to identify a useful meniscal body sign of the MMPRT for improving diagnostic MRI reading. Eighty-five patients who underwent surgical treatments for the MMPRT (39 knees) and other types of MM tears (49 knees) were included. The presence of characteristic MRI findings such as cleft sign, ghost sign, radial tear sign, medial extrusion sign, and new meniscal body shape-oriented "giraffe neck sign" was evaluated in 120 MRI examinations. Giraffe neck signs were observed in 81.7% of the MMPRTs and in 3.3% of other MM tears. Cleft, ghost, and radial tear signs were highly positive in the MMPRTs compared with other MM tears. Medial extrusion signs were frequently observed in both groups. Coexistence rates of any 2 MRI signs, except for medial extrusion sign, were 91.7% in the MMPRT group and 5% in other MM tears. This study demonstrated that a new characteristic MRI finding "giraffe neck sign" was observed in 81.7% of the MMPRT. Our results suggest that the combination of giraffe neck, cleft, ghost, and radial tear signs may be important for an accurate diagnostic MRI reading of the MMPRT. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

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

PubMed

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

2015-03-01

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

Novel air-injection technique to locate the medial cut end of lacerated canaliculus.

PubMed

Liu, Bingqian; Li, Yonghao; Long, Chongde; Wang, Zhonghao; Liang, Xuanwei; Ge, Jian; Wang, Zhichong

2013-12-01

Locating the medial cut end of the severed canaliculus is the most difficult aspect of canalicular repair, especially in patients with more medial laceration, severe oedema, persistent errhysis and a narrow canaliculus. Irrigation is a widely used technique to identify the cut end; however, we found that air injected through the intact canaliculus with a straight needle failed to reflux when the common canaliculus or lacrimal sac was not blocked. We describe a simple, safe and efficient air-injection technique to identify the medial cut edge of a lacerated canaliculus. In this method, we initially submersed the medial canthus under normal saline, then injected filtered air through the intact canaliculus using a side port stainless steel probe with a closed round tip. The tip was designed to block the common canaliculus to form a relatively closed system. The efficiency of this novel air-injection technique was equivalent to the traditional technique but does not require the cooperation of the patient to blow air. Using this technique, the medial cut end was successfully identified by locating the air-bubble exit within minutes in 19 cases of mono-canalicular laceration without any complication.

[A case of bilateral medial medullary infarction caused by unilateral vertebral artery dissection].

PubMed

Akimoto, Takayoshi; Hara, Makoto; Saito, Mari; Takahashi, Keiko; Kamei, Satoshi

2015-01-01

A 34-year-old man developed right neck pain. Several hours later, he felt numbness of his extremities and presented at our hospital. He developed right hemiparesis and hypoesthesia of the right extremities. A few hours later, upbeat nystagmus and dysarthria appeared along with a sensory disturbance that spread to all extremities, and right hemiparesis progressed to tetraplegia. Brain MR diffusion-weighted images revealed a high-intensity lesion in the bilateral medial medulla oblongata and we diagnosed this bilateral medial medullary infarction. Three dimentional CT angiography revealed dissection of the right VA. We administered intravenous argatroban, edaravone, glycerin and oral clopidogrel. He was assessed as having modified Rankin scale 4 and was transferred to another hospital for rehabilitation on day 30. When the medial medulla oblongata is supplied by the unilateral VA, a unilateral VA dissection can cause bilateral medial medullary infarction.

Medial joint line bone bruising at MRI complicating acute ankle inversion injury: what is its clinical significance?

PubMed

Chan, V O; Moran, D E; Shine, S; Eustace, S J

2013-10-01

To assess the incidence and clinical significance of medial joint line bone bruising following acute ankle inversion injury. Forty-five patients who underwent ankle magnetic resonance imaging (MRI) within 2 weeks of acute ankle inversion injury were included in this prospective study. Integrity of the lateral collateral ligament complex, presence of medial joint line bone bruising, tibio-talar joint effusion, and soft-tissue swelling were documented. Clinical follow-up at 6 months was carried out to determine the impact of injury on length of time out of work, delay in return to normal walking, delay in return to sports activity, and persistence of medial joint line pain. Thirty-seven patients had tears of the anterior talofibular ligament (ATFL). Twenty-six patients had medial joint line bone bruising with altered marrow signal at the medial aspect of the talus and congruent surface of the medial malleolus. A complete ATFL tear was seen in 92% of the patients with medial joint line bone bruising (p = 0.05). Patients with an ATFL tear and medial joint line bone bruising had a longer delay in return to normal walking (p = 0.0002), longer delay in return to sports activity (p = 0.0001), and persistent medial joint line pain (p = 0.0003). There was no statistically significant difference in outcome for the eight patients without ATFL tears. Medial joint line bone bruising following an acute ankle inversion injury was significantly associated with a complete ATFL tear, longer delay in the return to normal walking and sports activity, as well as persistent medial joint line pain. Its presence should prompt detailed assessment of the lateral collateral ligament complex, particularly the ATFL. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Usefulness of StereoEEG-based tailored surgery for medial temporal lobe epilepsy. Preliminary results in 11 patients.

PubMed

Kubota, Yuichi; Ochiai, Taku; Hori, Tomokatsu; Kawamata, Takakazu

2017-07-01

Surgical options for medial temporal lobe epilepsy (MTLE) include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Optimal criteria for choosing the appropriate surgical approach remain uncertain. This article reports 11 consecutive cases in which electrophysiological findings of stereoelectroencephalography (SEEG) were used to determine the optimal surgical approach. Eleven consecutive patients with MTLE underwent SEEG evaluation and were placed in either the medial or the medial+lateral group based on the findings. Patients in the medial group underwent SAH using the subtemporal approach, and patients in the medial+lateral group underwent SEEG-guided anterior temporal lobectomy. SEEG findings were also compared with other examinations including flumazenil (FMZ)-positron emission tomography (PET), fluorine-18 labeled fluorodeoxyglucose (FDG)-PET, and magnetoencephalography (MEG). Results were evaluated to determine which examinations most consistently identified the epileptogenic zone. Of the 11 cases, 4 patients were placed in the medial group, and 7 patients in the medial+lateral group. Of patients, 90.9% were classified in class I of the Engel Epilepsy Surgery Outcome Scale, while 72.7% were classified in class I by the International League Against Epilepsy (ILAE) system. Analyzed by group, 100% of the medial group experienced an Engel class I outcome in the medial group, compared to 85.7% in the medial+lateral group. SEEG findings were comparable with FDG-PET results (10 of 11, 91%). Tailored surgery guided by SEEG is an electrophysiologically feasible treatment for MTLE that can result in favorable outcomes. Although seizures are thought to originate in the medial temporal lobe in MTLE, it is important for involvement of the lateral temporal cortex to be also considered in some cases. Copyright © 2017. Published by Elsevier B.V.

Medial Orbitofrontal Neurons Preferentially Signal Cues Predicting Changes in Reward during Unblocking

PubMed Central

Lopatina, Nina; McDannald, Michael A.; Styer, Clay V.; Peterson, Jacob F.; Sadacca, Brian F.; Cheer, Joseph F.

2016-01-01

The orbitofrontal cortex (OFC) has been broadly implicated in the ability to use the current value of expected outcomes to guide behavior. Although value correlates have been prominently reported in lateral OFC, they are more often associated with more medial areas. Further, recent studies in primates have suggested a dissociation in which the lateral OFC is involved in credit assignment and representation of reward identity and more medial areas are critical to representing value. Previously, we used unblocking to test more specifically what information about outcomes is represented by OFC neurons in rats; consistent with the proposed dichotomy between the lateral and medial OFC, we found relatively little linear value coding in the lateral OFC (Lopatina et al., 2015). Here we have repeated this experiment, recording in the medial OFC, to test whether such value signals might be found there. Neurons were recorded in an unblocking task as rats learned about cues that signaled either more, less, or the same amount of reward. We found that medial OFC neurons acquired responses to these cues; however, these responses did not signal different reward values across cues. Surprisingly, we found that cells developed responses to cues predicting a change, particularly a decrease, in reward value. This is consistent with a special role for medial OFC in representing current value to support devaluation/revaluation sensitive changes in behavior. SIGNIFICANCE STATEMENT This study uniquely examines encoding in rodent mOFC at the single-unit level in response to cues that predict more, less, or no change in reward in rats during training in a Pavlovian unblocking task, finding more cells responding to change-predictive cues and stronger activity in response to cues predictive of less reward. PMID:27511013

GABAergic Projections from the Medial Septum Selectively Inhibit Interneurons in the Medial Entorhinal Cortex

PubMed Central

Gonzalez-Sulser, Alfredo; Parthier, Daniel; Candela, Antonio; McClure, Christina; Pastoll, Hugh; Garden, Derek; Sürmeli, Gülşen

2014-01-01

The medial septum (MS) is required for theta rhythmic oscillations and grid cell firing in the medial entorhinal cortex (MEC). While GABAergic, glutamatergic, and cholinergic neurons project from the MS to the MEC, their synaptic targets are unknown. To investigate whether MS neurons innervate specific layers and cell types in the MEC, we expressed channelrhodopsin-2 in mouse MS neurons and used patch-clamp recording in brain slices to determine the response to light activation of identified cells in the MEC. Following activation of MS axons, we observed fast monosynaptic GABAergic IPSPs in the majority (>60%) of fast-spiking (FS) and low-threshold-spiking (LTS) interneurons in all layers of the MEC, but in only 1.5% of nonstellate principal cells (NSPCs) and in no stellate cells. We also observed fast glutamatergic responses to MS activation in a minority (<5%) of NSPCs, FS, and LTS interneurons. During stimulation of MS inputs at theta frequency (10 Hz), the amplitude of GABAergic IPSPs was maintained, and spike output from LTS and FS interneurons was entrained at low (25–60 Hz) and high (60–180 Hz) gamma frequencies, respectively. By demonstrating cell type-specific targeting of the GABAergic projection from the MS to the MEC, our results support the idea that the MS controls theta frequency activity in the MEC through coordination of inhibitory circuits. PMID:25505326

LOCAL ORTHOGONAL CUTTING METHOD FOR COMPUTING MEDIAL CURVES AND ITS BIOMEDICAL APPLICATIONS

PubMed Central

Einstein, Daniel R.; Dyedov, Vladimir

2010-01-01

Medial curves have a wide range of applications in geometric modeling and analysis (such as shape matching) and biomedical engineering (such as morphometry and computer assisted surgery). The computation of medial curves poses significant challenges, both in terms of theoretical analysis and practical efficiency and reliability. In this paper, we propose a definition and analysis of medial curves and also describe an efficient and robust method called local orthogonal cutting (LOC) for computing medial curves. Our approach is based on three key concepts: a local orthogonal decomposition of objects into substructures, a differential geometry concept called the interior center of curvature (ICC), and integrated stability and consistency tests. These concepts lend themselves to robust numerical techniques and result in an algorithm that is efficient and noise resistant. We illustrate the effectiveness and robustness of our approach with some highly complex, large-scale, noisy biomedical geometries derived from medical images, including lung airways and blood vessels. We also present comparisons of our method with some existing methods. PMID:20628546

Local Orthogonal Cutting Method for Computing Medial Curves and Its Biomedical Applications

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

Jiao, Xiangmin; Einstein, Daniel R.; Dyedov, Volodymyr

2010-03-24

Medial curves have a wide range of applications in geometric modeling and analysis (such as shape matching) and biomedical engineering (such as morphometry and computer assisted surgery). The computation of medial curves poses significant challenges, both in terms of theoretical analysis and practical efficiency and reliability. In this paper, we propose a definition and analysis of medial curves and also describe an efficient and robust method for computing medial curves. Our approach is based on three key concepts: a local orthogonal decomposition of objects into substructures, a differential geometry concept called the interior center of curvature (ICC), and integrated stabilitymore » and consistency tests. These concepts lend themselves to robust numerical techniques including eigenvalue analysis, weighted least squares approximations, and numerical minimization, resulting in an algorithm that is efficient and noise resistant. We illustrate the effectiveness and robustness of our approach with some highly complex, large-scale, noisy biomedical geometries derived from medical images, including lung airways and blood vessels. We also present comparisons of our method with some existing methods.« less

Radial tears associated with cleavage tears of the medial meniscus in athletes.

PubMed

Kidron, Amos; Thein, Rafael

2002-03-01

To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports. Retrospective review. Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment. All 11 patients returned to their former levels of activity after adequate surgery. When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected.

Pediatric Glial Heterotopia in the Medial Canthus.

PubMed

Kim, Soung Min; Amponsah, Emmanuel Kofi; Eo, Mi Young; Cho, Yun Ju; Lee, Suk Keun

2017-11-01

Glial heterotopias are rare, benign, congenital, midline, and nonteratomatous extracranial glial tissue. They may be confused as encephalocele or dermoid cysts and are mostly present in the nose.An 8-month-old African female child presented with a slow growing paranasal mass. The mass had been present at the left upper medial canthus since birth and had slowly and progressively enlarged. There was no communication between the mass and the cranial cavity during the operational procedure. The mass was immunohistochemically positive for S-100 protein as well as for glial fibrillary acidic protein, but negative for proliferating cell nuclear antigen. This suggested that the mass was composed of benign glial tissues with many astrocytes.The purpose of this report is to demonstrate the first patient with pediatric glial heterotopic tissue in the medial canthus and to report the clinical importance of its immunohistochemical findings.

Axonal synapse sorting in medial entorhinal cortex

NASA Astrophysics Data System (ADS)

Schmidt, Helene; Gour, Anjali; Straehle, Jakob; Boergens, Kevin M.; Brecht, Michael; Helmstaedter, Moritz

2017-09-01

Research on neuronal connectivity in the cerebral cortex has focused on the existence and strength of synapses between neurons, and their location on the cell bodies and dendrites of postsynaptic neurons. The synaptic architecture of individual presynaptic axonal trees, however, remains largely unknown. Here we used dense reconstructions from three-dimensional electron microscopy in rats to study the synaptic organization of local presynaptic axons in layer 2 of the medial entorhinal cortex, the site of grid-like spatial representations. We observe path-length-dependent axonal synapse sorting, such that axons of excitatory neurons sequentially target inhibitory neurons followed by excitatory neurons. Connectivity analysis revealed a cellular feedforward inhibition circuit involving wide, myelinated inhibitory axons and dendritic synapse clustering. Simulations show that this high-precision circuit can control the propagation of synchronized activity in the medial entorhinal cortex, which is known for temporally precise discharges.

Efficacy and Safety of a Novel Three-Step Medial Release Technique in Varus Total Knee Arthroplasty.

PubMed

Kim, Min Woo; Koh, In Jun; Kim, Ju Hwan; Jung, Jae Jong; In, Yong

2015-09-01

We investigated the efficacy and safety of our novel three-step medial release technique in varus total knee arthroplasty (TKA) over time. Two hundred sixty seven consecutive varus TKAs were performed by applying the algorithmic release technique which consisted of sequential release of the deep medial collateral ligament (step 1), the semimembranosus (step 2), and multiple needle puncturing of the superficial medial collateral ligament (step 3). One hundred seventeen, 114, and 36 knees were balanced after step 1, 2, and 3 releases, respectively. There were no significant differences in changes of medial and lateral laxities between groups in over a year. Our novel stepwise medial release technique was efficacious and safe in balancing varus knees during TKA. Copyright © 2015 Elsevier Inc. All rights reserved.

Isolated medial meniscal tear in a Border Collie.

PubMed

Ridge, P A

2006-01-01

A three-year-old, female Border Collie was successfully treated for an isolated, torn, medial meniscus by arthroscopic meniscal tear resection. The dog returned to agility competition without recurrence of lameness.

Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

PubMed

Craft, Jason A; Kurzweil, Peter R

2015-06-01

The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same. A detailed physical examination can help determine the severity of the medial-sided injury. When combined with advanced imaging, the examination will delineate damage to associated medial knee structures, including the location of MCL damage, posteromedial capsule injuries, and combined cruciate injuries. Failure to recognize MCL injuries that may be prone to chronic laxity can lead to significant disability, joint damage, and failure of concomitant cruciate ligament reconstructions. Magnetic resonance imaging is the mainstay of diagnostic imaging, with coronal sequences allowing full assessment of the MCL complex. Tangential views aid in the diagnosis of concomitant injuries. Stress radiography can play a role in evaluating MCL healing and subtle chronic laxity. Ultrasonography is also gaining acceptance as a means to assess MCL injuries. Use of a detailed examination and advanced imaging will allow optimal treatment of medial knee injuries and improve clinical outcomes.

Contrasting medial moraine development at adjacent temperate, maritime glaciers: Fox and Franz Josef Glaciers, South Westland, New Zealand

NASA Astrophysics Data System (ADS)

Brook, Martin; Hagg, Wilfried; Winkler, Stefan

2017-08-01

Medial moraines form important pathways for sediment transportation in valley glaciers. Despite the existence of well-defined medial moraines on several glaciers in the New Zealand Southern Alps, medial moraines there have hitherto escaped attention. The evolving morphology and debris content of medial moraines on Franz Josef Glacier and Fox Glacier on the western flank of the Southern Alps is the focus of this study. These temperate maritime glaciers exhibit accumulation zones of multiple basins that feed narrow tongues flowing down steep valleys and terminate 400 m above sea level. The medial moraines at both glaciers become very prominent in the lower ablation zones, where the medial moraines widen, and develop steeper flanks coeval with an increase in relative relief. Medial moraine growth appears somewhat self-limiting in that relief and slope angle increase eventually lead to transport of debris away from the medial moraine by mass-movement-related processes. Despite similarities in overall morphologies, a key contrast in medial moraine formation exists between the two glaciers. At Fox Glacier, the medial moraine consists of angular rockfall-derived debris, folded to varying degrees along flow-parallel axes throughout the tongue. The debris originates above the ELA, coalesces at flow-unit boundaries, and takes a medium/high level transport pathway before subsequently emerging at point-sources aligned with gently dipping fold hinges near the snout. In contrast at Franz Josef Glacier, the medial moraine emerges farther down-glacier immediately below a prominent rock knob. Clasts show a mix of angular to rounded shapes representing high level transport and subglacially transported materials, the latter facies possibly also elevated by supraglacial routing of subglacial meltwater. Our observations confirm that a variety of different debris sources, transport pathways, and structural glaciological processes can interact to form medial moraines within New Zealand

Releasing the circumferential fixation of the medial meniscus does not affect its kinematics.

PubMed

Vrancken, A C T; van Tienen, T G; Hannink, G; Janssen, D; Verdonschot, N; Buma, P

2014-12-01

Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical behavior of the meniscus. Therefore, we aimed to determine whether detaching and resuturing the circumferential fixation of the medial meniscus influence its kinematic pattern. Human cadaveric knee joints were flexed (0°-30°-60°-90°) in a knee loading rig, in neutral orientation and under internal and external tibial torques. Roentgen stereophotogrammetric analysis was used to determine the motion of the meniscus in anteroposterior (AP) and mediolateral (ML) directions. Three fixation conditions were evaluated: (I) intact, (II) detached and (III) resutured. Detaching and resuturing the circumferential fixation did not alter the meniscal motion pattern in either the AP or ML direction. Applying an additional internal tibial torque caused the medial meniscus to move slightly anteriorly, and an external torque caused a little posterior translation with respect to the neutral situation. These patterns did not change when the circumferential fixation condition was altered. This study demonstrated that the motion pattern of the medial meniscus is independent of its fixation to the knee capsule and medial collateral ligament. The outcomes of this study can be deployed to design the fixation strategy of a permanent meniscus prosthesis. As peripheral fixation is a complicated step during meniscal replacement, the surgical procedure is considerably simplified when non-resorbable implants do not require circumferential fixation. Copyright © 2014 Elsevier B.V. All rights reserved.

The operative outcomes of displaced medial-end clavicle fractures.

PubMed

Sidhu, Verinder S; Hermans, Deborah; Duckworth, David G

2015-11-01

Nonoperative treatment of displaced medial clavicle fractures often leads to poor functional outcomes and painful nonunions. This study investigates the functional outcomes of patients undergoing operative fixation of these fractures. We investigated 27 patients undergoing operative fixation of a medial clavicle fracture; 24 had an acute, displaced fracture and 3 had fixation for nonunions. Preoperative radiographs or computed tomography scans were obtained, and data collected included age, sex, mechanism of injury, and fixation method. Follow-up included physical examination and radiographs for assessment of union; Disabilities of the Arm, Shoulder, and Hand scores at 12 months; and the recording of complications. The median age was 37 years (interquartile range, 17-47 years). There were 26 male patients and one female patient included, with 7 physeal injuries and 20 adult injuries. The most common mechanism of fracture was vehicular accident (n = 15). Three patients had operations for nonunions and 2 for a periprosthetic fracture medial to an existing plate. The fracture was fixed with plate and screws in 19 cases and with transosseous sutures in 8 cases. The median Disabilities of the Arm, Shoulder, and Hand score at 12 months was 0.4 (interquartile range, 0-5.0), with a union rate of 100% at 12 months. All patients had full shoulder range of motion at final follow-up and were able to return to preinjury occupational activities. There were no significant complications. Operative fixation of displaced medial clavicle fractures results in anatomic reconstruction and excellent functional outcomes, even in the setting of fixation performed for symptomatic nonunion. Early intervention can minimize the risk of painful nonunion. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Differential effects of unilateral lesions in the medial amygdala on spontaneous and induced ovulation.

PubMed

Sanchez, M A; Dominguez, R

1995-01-01

The possible existence of asymmetry in the control of ovulation by the medial amygdala was explored. Unilateral lesions of the medial amygdala were performed on each day of the estrous cycle. The estral index diminished in almost all animals with a lesion in the right side of medial amygdala. Lesions of the right medial amygdala, when performed on diestrus-1, resulted in a significant decrease in the number of rats ovulating compared to controls (4/8 vs. 8/8, p < 0.05). In ovulating animals a significant reduction in the number of ova shed by the left ovary was found (2.2 +/- 0.8 vs. 6.3 +/- 0.8, p < 0.05). Lesions of the stria terminalis performed on diestrus-1 did not affect ovulation. In a second experiment, administration of GnRH did not restore ovulation in rats with lesions of the right medial amygdala. However, sequential injections of PMSG-hCG did result in ovulation by all members of a group of lesioned animals. In this last condition a significant decrease in the number of ova shed by the right ovary was found compared to animals in the lesion-only condition (1.5 +/- 0.5 vs. 6.0 +/- 1.5, p < 0.05). These data suggest that control of ovulation by the medial amygdala is asymmetric and varies during the estrous cycle.

Relationship between bone turnover markers and the heel stiffness index measured by quantitative ultrasound in middle-aged and elderly Japanese men

PubMed Central

Nishimura, Takayuki; Arima, Kazuhiko; Abe, Yasuyo; Kanagae, Mitsuo; Mizukami, Satoshi; Okabe, Takuhiro; Tomita, Yoshihito; Goto, Hisashi; Horiguchi, Itsuko; Aoyagi, Kiyoshi

2018-01-01

Abstract The aim of the present study was to investigate the age-related patterns and the relationships between serum levels of tartrate-resistant acid phosphatase-5b (TRACP-5b) or bone-specific alkaline phosphatase (BAP), and the heel stiffness index measured by quantitative ultrasound (QUS) in 429 Japanese men, with special emphasis on 2 age groups (40–59 years and 60 years or over). The heel stiffness index (bone mass) was measured by QUS. Serum samples were collected, and TRACP-5b and BAP levels were measured. The stiffness index was significantly decreased with age. Log (TRACP-5b) was significantly increased with age, but Log (BAP) was stable. Generalized linear models showed that higher levels of Log (TRACP-5b) and Log (BAP) were correlated with a lower stiffness index after adjusting for covariates in men aged 60 years or over, but not in men aged 40 to 59 years. In conclusion, higher rates of bone turnover markers were associated with a lower stiffness index only in elderly men. These results may indicate a different mechanism of low bone mass among different age groups of men. PMID:29465590

Gender moderates the association between dorsal medial prefrontal cortex volume and depressive symptoms in a subclinical sample.

PubMed

Carlson, Joshua M; Depetro, Emily; Maxwell, Joshua; Harmon-Jones, Eddie; Hajcak, Greg

2015-08-30

Major depressive disorder is associated with lower medial prefrontal cortex volumes. The role that gender might play in moderating this relationship and what particular medial prefrontal cortex subregion(s) might be implicated is unclear. Magnetic resonance imaging was used to assess dorsal, ventral, and anterior cingulate regions of the medial prefrontal cortex in a normative sample of male and female adults. The Depression, Anxiety, and Stress Scale (DASS) was used to measure these three variables. Voxel-based morphometry was used to test for correlations between medial prefrontal gray matter volume and depressive traits. The dorsal medial frontal cortex was correlated with greater levels of depression, but not anxiety and stress. Gender moderates this effect: in males greater levels of depression were associated with lower dorsal medial prefrontal volumes, but in females no relationship was observed. The results indicate that even within a non-clinical sample, male participants with higher levels of depressive traits tend to have lower levels of gray matter volume in the dorsal medial prefrontal cortex. Our finding is consistent with low dorsal medial prefrontal volume contributing to the development of depression in males. Future longitudinal work is needed to substantiate this possibility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Examination and treatment of a loose medial coronoid process in dogs].

PubMed

Hazewinkel, H A; Voorhout, G

1986-12-15

An ununited medial coronoid process (MCP) is the most common developmental disturbance in the elbow joint of young dogs of large and medium-sized breeds. The clinical and radiological symptoms of ununited medial coronoid processes in thirty-nine dogs are reported, the presence of an ununited medial coronoid process being established by arthrotomy in these cases. Lameness was observed for the first time in these dogs, mainly Rottweilers, Retrievers and Berner Sennenhunde, and more often male dogs than bitches, when they were from four to six months of age. They showed lameness ranging from slight to severe, and the leg was frequently held in a position of abduction and outward rotation. The elbow joints involved often showed abnormal accumulations of fluid, hyperflexion and/or hyperextension being painful. Osteophytes, only occurring along the proximal border of the anconeal process, could be well assessed on the mediolateral radiographs. The appearance of the MCP, varying from normal to ununited, could best be evaluated in the mediolateral and anteroposterior medial oblique radiographs. These two radiographs were also of value in diagnosing an ununited anconeal process which was present at the same time as osteochondrosis of the medial condyle of the humerus in two dogs. The clinical symptoms were not associated with radiologically perceptible changes in some cases. Arthrotomy of the elbows showed that the entire apex or otherwise one or several fragments of the MCP, which are often wedged between the radius and ulna in these cases, may break off. Rapid post-operative improvement of locomotion is frequently reported. Preventive and diagnostic procedures carried out to make possible early institution of surgical treatment are discussed.

Medial elbow injury in young throwing athletes

PubMed Central

Gregory, Bonnie; Nyland, John

2013-01-01

Summary This report reviews the anatomy, overhead throwing biomechanics, injury mechanism and incidence, physical examination and diagnosis, diagnostic imaging and conservative treatment of medial elbow injuries in young throwing athletes. Based on the information a clinical management decision-making algorithm is presented. PMID:23888291

Affective Aprosodia from a Medial Frontal Stroke

ERIC Educational Resources Information Center

Heilman, Kenneth M.; Leon, Susan A.; Rosenbek, John C.

2004-01-01

Background and objectives: Whereas injury to the left hemisphere induces aphasia, injury to the right hemisphere's perisylvian region induces an impairment of emotional speech prosody (affective aprosodia). Left-sided medial frontal lesions are associated with reduced verbal fluency with relatively intact comprehension and repetition…

Improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus.

PubMed

Wang, Hong-De; Li, Tong; Gao, Shi-Jun

2017-10-30

Discoid medial meniscus is an extremely rare abnormality of the knee. During arthroscopic meniscectomy for symptomatic discoid medial meniscus, it is difficult to remove the posterior portion of the meniscus because of the confined working space within the compartment and the obstruction caused by the anterior cruciate ligament and the tibial intercondylar eminence. To overcome these problems, we describe an improved arthroscopic technique for one-piece excision of symptomatic discoid medial meniscus through three unique portals. Three improved portals were made in the injured knee: a standard anteromedial portal, a central transpatellar tendon portal, and a high anterolateral portal. The anterior side of the discoid medial meniscus was cut 7 mm from the periphery of the meniscus. Next, the anterior portion of the free discoid meniscus fragment was pulled in the anterolateral direction with tension. A curve-shaped cut was made along the longitudinal tear to the posterior horn using basket forceps through the standard anteromedial portal. Then, the anterior portion of the free discoid meniscus was pulled in the anteromedial direction. Pulling the fragment under tension made it easier to cut the posterior side of the discoid meniscus. The posterior side of the discoid meniscus was cut 7 mm from the periphery of the meniscus with straight scissors or basket forceps through the central transpatellar tendon portal. This technique resulted in satisfactory results. Excellent visualization of the posterior part of the discoid medial meniscus was gained during the procedure, and it was easy to cut the posterior part of the discoid medial meniscus. No recurrent symptoms were found. This improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus enables the posterior part of the meniscus to be cut satisfactorily. Moreover, compared with previous techniques, this novel technique causes less formation of foreign bodies and less

Repair of the posterior root of the medial meniscus.

PubMed

Jones, Christopher; Reddy, Sudheer; Ma, C Benjamin

2010-01-01

Tears of the posterior root of the medial meniscus are becoming increasingly recognized. Early identification and treatment of these tears help halt the progression of cartilage degeneration and osteoarthritis of the knee. Repair of these tears is essential for recreating the hoop stress of the medial meniscus. In this note, we describe a successful arthroscopic technique to repair this lesion. A posteromedial portal is established by which two 2-0 PDS sutures are placed through the meniscus root and pulled down through a trans-tibial tunnel and fixed using an EndoButton distally along the anterolateral cortex of the tibia. This has been performed successfully in five patients with no complications.

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

PubMed Central

2011-01-01

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

Effectiveness of myofascial release in the management of plantar heel pain: a randomized controlled trial.

PubMed

Ajimsha, M S; Binsu, D; Chithra, S

2014-06-01

Previous studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain (PHP). However, it is unclear whether myofascial release (MFR) can improve the outcomes in this population. To investigate whether myofascial release (MFR) reduces the pain and functional disability associated with plantar heel pain (PHP) in comparison with a control group receiving sham ultrasound therapy (SUST). Randomized, controlled, double blinded trial. Nonprofit research foundation clinic in India. Sixty-six patients, 17 men and 49 women with a clinical diagnosis of PHP were randomly assigned into MFR or a control group and given 12 sessions of treatment per client over 4 weeks. The Foot Function Index (FFI) scale was used to assess pain severity and functional disability. The primary outcome measure was the difference in FFI scale scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation. The simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P<0.001). Patients in the MFR and control groups reported a 72.4% and 7.4% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 60.6% in the follow-up at week 12 in the MFR group compared to the baseline. The mixed ANOVA also revealed significant group-by-time interactions for changes in PPT over the gastrocnemii and soleus muscles, and the calcaneus (P<0.05). This study provides evidence that MFR is more effective than a control intervention for PHP. Copyright © 2014 Elsevier Ltd. All rights reserved.

Recruitment of the Rhesus soleus and medial gastrocnemius before, during and after spaceflight

NASA Technical Reports Server (NTRS)

Roy, R. R.; Hodgson, J. A.; Aragon, J.; Day, M. K.; Kozlovskaya, I.; Edgerton, V. R.

1996-01-01

Electromyograms were recorded from the soleus and medial gastrocnemius muscles and tendon force from the medial gastrocnemius muscle of 2 juvenile Rhesus monkeys before, during and after Cosmos flight 2229 and of ground control animals. Recording sessions were made while the Rhesus were performing a foot pedal motor task. Preflight testing indicated normal patterns of recruitment between the soleus and medial gastrocnemius, i.e. a higher level of recruitment of the soleus compared to the medial gastrocnemius during the task. Recording began two days into the spaceflight and showed that the media gastrocnemius was recruited preferentially over the soleus. This observation persisted throughout the flight and for the 2 week period of postflight testing. These data indicate a significant change in the relative recruitment of slow and fast extensor muscles under microgravity conditions. The appearance of clonic-like activity in one muscle of each Rhesus during flight further suggests a reorganization in the neuromotor system in a microgravity environment.

Correlation between the knee adduction torque and medial contact force for a variety of gait patterns.

PubMed

Zhao, Dong; Banks, Scott A; Mitchell, Kim H; D'Lima, Darryl D; Colwell, Clifford W; Fregly, Benjamin J

2007-06-01

The external knee adduction torque has been proposed as a surrogate measure for medial compartment load during gait. However, a direct link between these two quantities has not been demonstrated using in vivo measurement of medial compartment load. This study uses in vivo data collected from a single subject with an instrumented knee implant to evaluate this link. The subject performed five different overground gait motions (normal, fast, slow, wide, and toe-out) with simultaneous collection of instrumented implant, video motion, and ground reaction data. For each trial, the knee adduction torque was measured externally while the total axial force applied to the tibial insert was measured internally. Based on data collected from the same subject performing treadmill gait under fluoroscopic motion analysis, a regression equation was developed to calculate medial contact force from the implant load cell measurements. Correlation analyses were performed for the stance phase and entire gait cycle to quantify the relationship between the knee adduction torque and both the medial contact force and the medial to total contact force ratio. When the entire gait cycle was analyzed, R(2) for medial contact force was 0.77 when all gait trials were analyzed together and between 0.69 and 0.93 when each gait trial was analyzed separately (p < 0.001 in all cases). For medial to total force ratio, R(2) was 0.69 for all trials together and between 0.54 and 0.90 for each trial separately (p < 0.001 in all cases). When only the stance phase was analyzed, R(2) values were slightly lower. These results support the hypothesis that the knee adduction torque is highly correlated with medial compartment contact force and medial to total force ratio during gait. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.

PubMed

Choi, Chul-Jun; Choi, Yun-Jin; Lee, Jae-Jeong; Choi, Chong-Hyuk

2010-12-01

The purpose of this study was to evaluate the relation between meniscal extrusion on magnetic resonance imaging (MRI) and tearing of the posterior root of the medial meniscus, as well as to understand the relation between meniscal extrusion and chondral lesions. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Of these cases, 248 (64.1%) with MRI were reviewed. Arthroscopic findings were reviewed for the type of tear and medial compartment cartilage lesion. Root tear was defined as a radial tear in the posterior horn of the medial meniscus near the tibial spine (i.e., within 5 mm of the root attachment). An MRI scan of the knee was used to evaluate the presence and extent of meniscal extrusion. Meniscal extrusion of 3 mm or greater was considered pathologic. Arthroscopic findings were compared with respect to the extent of meniscal extrusion. There were 98 male patients and 150 female patients. The mean age was 53.5 years (range, 15 to 81 years). The results showed 127 cases (51.2%) in which the medial meniscus had meniscal extrusion of 3 mm or greater. Posterior root tears were found in 66 (26.6%) of the 248 knees. The mean meniscal extrusion in patients with root tear was 3.8 ± 1.4 mm, whereas the mean extrusion of those who had no root tear was 2.7 ± 1.3 mm. We found an association between pathologic meniscal extrusion and root tear (P < .001). Meniscal extrusion showed a low positive predictive value (39%) and specificity (58%) with regard to the meniscal root tear. Meniscal extrusion was also significantly correlated with severity of chondral lesions (P < .001). Considerable extrusion (≥3 mm) can be associated with tearing of the medial meniscus root and chondral lesion of the medial femoral condyle. Level IV, therapeutic case series. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Diagnostic value of MRI for posterior root tear of medial and lateral meniscus].

PubMed

Qian, Yue-Nan; Liu, Fang; Dong, Yi-Long; Cai, Chun-Yuan

2018-03-25

To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated. Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears.

PubMed

Choi, Chul-Jun; Choi, Yun-Jin; Song, In-Bum; Choi, Chong-Hyuk

2011-06-01

The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.

A clinical sign to detect root avulsions of the posterior horn of the medial meniscus.

PubMed

Seil, Romain; Dück, Klaus; Pape, Dietrich

2011-12-01

The goal of the present report was to describe a new clinical sign to make a clinical diagnosis of meniscal extrusion related to medial meniscal root avulsion. Description of an easy clinical sign to detect extrusion of the medial meniscus at the anteromedial joint line. A varus stress test was applied in full extension before and after transosseous repair of an isolated traumatic avulsion of the posterior root of the medial meniscus in a 21-year-old patient. The clinical sign was verified by sectioning of the meniscotibial ligament during knee arthroplasty surgery in 3 patients. With a deficient posterior root, the clinical sign was positive, showing anteromedial extrusion under varus stress. After repair and at clinical follow-up, extrusion was normalized. Making the clinical diagnosis of medial meniscus extrusion after knee injury by applying a simple varus stress test to the knee and palpating the anteromedial meniscal extrusion might help physicians to suspect a medial meniscus root tear in the early stages after the injury as well as to evaluate its reduction after repair. A varus stress test in full extension should be performed systematically in patients where a root tear of the medial meniscus is suspected as well as after surgery to evaluate the success of the repair.

TopMaker: A Technique for Automatic Multi-Block Topology Generation Using the Medial Axis

NASA Technical Reports Server (NTRS)

Heidmann, James D. (Technical Monitor); Rigby, David L.

2004-01-01

A two-dimensional multi-block topology generation technique has been developed. Very general configurations are addressable by the technique. A configuration is defined by a collection of non-intersecting closed curves, which will be referred to as loops. More than a single loop implies that holes exist in the domain, which poses no problem. This technique requires only the medial vertices and the touch points that define each vertex. From the information about the medial vertices, the connectivity between medial vertices is generated. The physical shape of the medial edge is not required. By applying a few simple rules to each medial edge, the multiblock topology is generated with no user intervention required. The resulting topologies contain only the level of complexity dictated by the configurations. Grid lines remain attached to the boundary except at sharp concave turns where a change in index family is introduced as would be desired. Keeping grid lines attached to the boundary is especially important in the area of computational fluid dynamics where highly clustered grids are used near no-slip boundaries. This technique is simple and robust and can easily be incorporated into the overall grid generation process.

Age-Group Differences in Medial Cortex Activity Associated with Thinking About Self-Relevant Agendas

PubMed Central

Mitchell, Karen J.; Raye, Carol L.; Ebner, Natalie C.; Tubridy, Shannon M.; Frankel, Hillary; Johnson, Marcia K.

2009-01-01

This functional magnetic resonance imaging (fMRI) study compared young and older adults’ brain activity as they thought about motivationally self-relevant agendas (hopes and aspirations, duties and obligations) and concrete control items (e.g., shape of USA). Young adults’ activity replicated a double dissociation (Johnson et al., 2006): an area of medial frontal gyrus/anterior cingulate cortex was most active during hopes and aspirations trials and an area of medial posterior cortex, primarily posterior cingulate, was most active during duties and obligations trials. Compared to young adults, older adults showed attenuated responses in medial cortex, especially in medial prefrontal cortex, with both less activity during self-relevant trials and less deactivation during control trials. The fMRI data, together with post-scan reports and the behavioral literature on age-group differences in motivational orientation, suggest that the differences in medial cortex seen in this study reflect young and older adults’ focus on different information during motivationally self-relevant thought. Differences also may be related to an age-associated deficit in controlled cognitive processes that are engaged by complex self-reflection and mediated by prefrontal cortex. PMID:19485660

Sex hormones and quantitative ultrasound parameters at the heel in men and women from the general population.

PubMed

Pätzug, Konrad; Friedrich, Nele; Kische, Hanna; Hannemann, Anke; Völzke, Henry; Nauck, Matthias; Keevil, Brian G; Haring, Robin

2017-12-01

The present study investigates potential associations between liquid chromatography-mass spectrometry (LC-MS) measured sex hormones, dehydroepiandrosterone sulphate, sex hormone-binding globulin (SHBG) and bone ultrasound parameters at the heel in men and women from the general population. Data from 502 women and 425 men from the population-based Study of Health in Pomerania (SHIP-TREND) were used. Cross-sectional associations of sex hormones including testosterone (TT), calculated free testosterone (FT), dehydroepiandrosterone sulphate (DHEAS), androstenedione (ASD), estrone (E1) and SHBG with quantitative ultrasound (QUS) parameters at the heel, including broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were examined by analysis of variance (ANOVA) and multivariable quantile regression models. Multivariable regression analysis showed a sex-specific inverse association of DHEAS with SI in men (Beta per SI unit = - 3.08, standard error (SE) = 0.88), but not in women (Beta = - 0.01, SE = 2.09). Furthermore, FT was positively associated with BUA in men (Beta per BUA unit = 29.0, SE = 10.1). None of the other sex hormones (ASD, E1) or SHBG was associated with QUS parameters after multivariable adjustment. This cross-sectional population-based study revealed independent associations of DHEAS and FT with QUS parameters in men, suggesting a potential influence on male bone metabolism. The predictive role of DHEAS and FT as a marker for osteoporosis in men warrants further investigation in clinical trials and large-scale observational studies.

Nurses' use of water-filled gloves in preventing heel pressure ulcer in the University College Hospital, Ibadan, Nigeria.

PubMed

Adejumo, Prisca Olabisi; Ingwu, Justin Agorye

2010-12-01

This cross-sectional descriptive survey examined use (knowledge, perception and practices) of water-filled gloves (WFGs) by nurses in the prevention of heel pressure ulcer (PU) in the University College Hospital (UCH), Ibadan, Nigeria. Participants were 250 purposively selected nurses working in the Neurosciences and Surgical units. Quantitative data were generated through the administration of a semi-structured questionnaire, whereas the qualitative data were collected through in-depth interview. Hypotheses were tested using chi-square analysis at a significance level of 0.05, whereas the manual content analysis was used to analyse the qualitative data. Results showed that a significant number of nurses at UCH, Ibadan, were knowledgeable about WFGs and actually used them in their clinical practice. Years of experience in clinical practice was found to be significantly related to knowledge and use of WFGs in heel PU (X(2) = 41·677; DF = 5; P = 0·001). Nurses with adequate knowledge of risk factors in the development of PU used WFGs more than those who were not aware (X(2) = 44·907; DF = 3; P = 0·009). Nurses' perception about WFGs was also significantly related to its use (X(2) = 4·527; DF = 1; P = 0·033). Although knowledge level and perception of WFGs and its use by nurses was fairly adequate, continuous education for practicing nurses should be encouraged in resource-limited settings. © 2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

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.

How tibiofemoral alignment and contact locations affect predictions of medial and lateral tibiofemoral contact forces.

PubMed

Lerner, Zachary F; DeMers, Matthew S; Delp, Scott L; Browning, Raymond C

2015-02-26

Understanding degeneration of biological and prosthetic knee joints requires knowledge of the in-vivo loading environment during activities of daily living. Musculoskeletal models can estimate medial/lateral tibiofemoral compartment contact forces, yet anthropometric differences between individuals make accurate predictions challenging. We developed a full-body OpenSim musculoskeletal model with a knee joint that incorporates subject-specific tibiofemoral alignment (i.e. knee varus-valgus) and geometry (i.e. contact locations). We tested the accuracy of our model and determined the importance of these subject-specific parameters by comparing estimated to measured medial and lateral contact forces during walking in an individual with an instrumented knee replacement and post-operative genu valgum (6°). The errors in the predictions of the first peak medial and lateral contact force were 12.4% and 11.9%, respectively, for a model with subject-specific tibiofemoral alignment and contact locations determined through radiographic analysis, vs. 63.1% and 42.0%, respectively, for a model with generic parameters. We found that each degree of tibiofemoral alignment deviation altered the first peak medial compartment contact force by 51N (r(2)=0.99), while each millimeter of medial-lateral translation of the compartment contact point locations altered the first peak medial compartment contact force by 41N (r(2)=0.99). The model, available at www.simtk.org/home/med-lat-knee/, enables the specification of subject-specific joint alignment and compartment contact locations to more accurately estimate medial and lateral tibiofemoral contact forces in individuals with non-neutral alignment. Copyright © 2015 Elsevier Ltd. All rights reserved.

How Tibiofemoral Alignment and Contact Locations Affect Predictions of Medial and Lateral Tibiofemoral Contact Forces

PubMed Central

Lerner, Zachary F.; DeMers, Matthew S.; Delp, Scott L.; Browning, Raymond C.

2015-01-01

Understanding degeneration of biological and prosthetic knee joints requires knowledge of the in-vivo loading environment during activities of daily living. Musculoskeletal models can estimate medial/lateral tibiofemoral compartment contact forces, yet anthropometric differences between individuals make accurate predictions challenging. We developed a full-body OpenSim musculoskeletal model with a knee joint that incorporates subject-specific tibiofemoral alignment (i.e. knee varus-valgus) and geometry (i.e. contact locations). We tested the accuracy of our model and determined the importance of these subject-specific parameters by comparing estimated to measured medial and lateral contact forces during walking in an individual with an instrumented knee replacement and post-operative genu valgum (6°). The errors in the predictions of the first peak medial and lateral contact force were 12.4% and 11.9%, respectively, for a model with subject-specific tibiofemoral alignment and contact locations determined via radiographic analysis, vs. 63.1% and 42.0%, respectively, for a model with generic parameters. We found that each degree of tibiofemoral alignment deviation altered the first peak medial compartment contact force by 51N (r2=0.99), while each millimeter of medial-lateral translation of the compartment contact point locations altered the first peak medial compartment contact force by 41N (r2=0.99). The model, available at www.simtk.org/home/med-lat-knee/, enables the specification of subject-specific joint alignment and compartment contact locations to more accurately estimate medial and lateral tibiofemoral contact forces in individuals with non-neutral alignment. PMID:25595425

Retrograde amnesia in patients with hippocampal, medial temporal, temporal lobe, or frontal pathology.

PubMed

Bright, Peter; Buckman, Joseph; Fradera, Alex; Yoshimasu, Haruo; Colchester, Alan C F; Kopelman, Michael D

2006-01-01

There is considerable controversy concerning the theoretical basis of retrograde amnesia (R.A.). In the present paper, we compare medial temporal, medial plus lateral temporal, and frontal lesion patients on a new autobiographical memory task and measures of the more semantic aspects of memory (famous faces and news events). Only those patients with damage extending beyond the medial temporal cortex into the lateral temporal regions showed severe impairment on free recall remote memory tasks, and this held for both the autobiographical and the more semantic memory tests. However, on t-test analysis, the medial temporal group was impaired in retrieving recent autobiographical memories. Within the medial temporal group, those patients who had combined hippocampal and parahippocampal atrophy (H+) on quantified MRI performed somewhat worse on the semantic tasks than those with atrophy confined to the hippocampi (H-), but scores were very similar on autobiographical episodic recall. Correlational analyses with regional MRI volumes showed that lateral temporal volume was correlated significantly with performance on all three retrograde amnesia tests. The findings are discussed in terms of consolidation, reconsolidation, and multiple trace theory: We suggest that a widely distributed network of regions underlies the retrieval of past memories, and that the extent of lateral temporal damage appears to be critical to the emergence of a severe remote memory impairment.

Endoscopic modified medial maxillectomy for odontogenic cysts and tumours.

PubMed

Nakayama, Tsugihama; Otori, Nobuyoshi; Asaka, Daiya; Okushi, Tetsushi; Haruna, Shin-ichi

2014-12-01

Odontogenic maxillary cysts and tumours originate from the tooth root and have traditionally been treated through an intraoral approach. Here, we report the efficacy and utility of endoscopic modified medial maxillectomy (EMMM) for the treatment of odontogenic maxillary cysts and a tumour. We undertook EMMM under general anaesthesia in six patients: four had radicular cysts, one had a dentigerous cyst, and one had a keratocystic odontogenic tumour. The cysts and tumours were completely excised and the inferior turbinate and nasolacrimal duct were preserved in all patients. There were no peri- or postoperative complications, and no incidences of recurrence. Endoscopic modified medial maxillectomy appears to be an effective and safe technique for treating odontogenic cysts and tumours.

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

PubMed Central

Thulasidas, Ponnaiah; Vaidyanathan, Venkatraman

2014-01-01

Introduction Functional endoscopic sinus surgery has a long-term high rate of success for symptomatic improvement in patients with medically refractory chronic rhinosinusitis. As the popularity of the technique continues to grow, however, so does the population of patients with postsurgical persistent sinus disease, especially in those with a large window for ventilation and drainage. In addition, chronic infections of the sinuses especially fungal sinusitis have a higher incidence of recurrence even though a wide maxillary ostium had been performed earlier. This subset of patients often represents a challenge to the otorhinolaryngologist. Objectives To identify the patients with chronic recalcitrant maxillary sinusitis and devise treatment protocols for this subset of patients. Methods A retrospective review was done of all patients with persistent maxillary sinus disease who had undergone modified endoscopic medial maxillectomy between 2009 and 2012. We studied patient demographics, previous surgical history, and follow-up details and categorized the types of endoscopic medial maxillectomies performed in different disease situations. Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences. Conclusion Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis. PMID:25992084

Detection of defects in formed sheet metal using medial axis transformation

NASA Astrophysics Data System (ADS)

Murmu, Naresh C.; Velgan, Roman

2003-05-01

In the metal forming processes, the sheet metals are often prone to various defects such as thinning, dents, wrinkles etc. In the present manufacturing environments with ever increasing demand of higher quality, detecting the defects of formed sheet metal using an effective and objective inspection system is the foremost norm to remain competitive in market. The defect detection using optical techniques aspire to satisfy its needs to be non-contact and fast. However, the main difficulties to achieve this goal remain essentially on the development of efficient evaluation technique and accurate interpretation of extracted data. The defect like thinning is detected by evaluating the deviations of the thickness in the formed sheet metal against its nominal value. The present evaluation procedure for determination of thickness applied on the measurements data is not without deficiency. To improve this procedure, a new evaluation approach based on medial axis transformation is proposed here. The formed sheet metals are digitized using fringe projection systems in different orientations, and afterwards registered into one coordinate frame. The medial axis transformation (MAT) is applied on the point clouds, generating the point clouds of MAT. This data is further processed and medial surface is determined. The thinning defect is detected by evaluating local wall thickness and other defects like wrinkles are determined using the shape recognition on the medial surface. The applied algorithm is simple, fast and robust.

Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique.

PubMed

Harner, Christopher D; Mauro, Craig S; Lesniak, Bryson P; Romanowski, James R

2009-10-01

Tears of the posterior root of the medial meniscus are becoming increasingly recognized. They can cause rapidly progressive arthritis, yet their biomechanical effects are not understood. The goal of this study was to determine the effects of posterior root tears of the medial meniscus and their repairs on tibiofemoral joint contact pressure and kinematics. Nine fresh-frozen cadaver knees were used. An axial load of 1000 N was applied with a custom testing jig at each of four knee-flexion angles: 0 degrees , 30 degrees , 60 degrees , and 90 degrees . The knees were otherwise unconstrained. Four conditions were tested: (1) intact, (2) a posterior root tear of the medial meniscus, (3) a repaired posterior root tear, and (4) a total medial meniscectomy. Fuji pressure-sensitive film was used to record the contact pressure and area for each testing condition. Kinematic data were obtained by using a robotic arm to record the position of the knees for each loading condition. Three-dimensional knee kinematics were analyzed with custom programs with use of previously described transformations. The measured variables were axial rotation, varus angulation, lateral translation, and anterior translation. In the medial compartment, a posterior root tear of the medial meniscus caused a 25% increase in peak contact pressure compared with that found in the intact condition (p < 0.001). Repair restored the peak contact pressure to normal. No difference was detected between the peak contact pressure after the total medial meniscectomy and that associated with the root tear. The peak contact pressure in the lateral compartment after the total medial meniscectomy was up to 13% greater than that for all other conditions (p = 0.026). Significant increases in external rotation and lateral tibial translation, compared with the values in the intact knee, were observed in association with the posterior root tear (2.98 degrees and 0.84 mm, respectively) and the meniscectomy (4.45 degrees and 0

Person-specific theory of mind in medial pFC.

PubMed

Welborn, B Locke; Lieberman, Matthew D

2015-01-01

Although research on theory of mind has strongly implicated the dorsomedial pFC (incuding medial BA 8 and BA 9), the unique contributions of medial pFC (MPFC; corresponding to medial BA 10) to mentalizing remain uncertain. The extant literature has considered the possibility that these regions may be specialized for self-related cognition or for reasoning about close others, but evidence for both accounts has been inconclusive. We propose a novel theoretical framework: MPFC selectively implements "person-specific theories of mind" (ToMp) representing the unique, idiosyncratic traits or attributes of well-known individuals. To test this hypothesis, we used fMRI to assess MPFC responses in Democratic and Republican participants as they evaluated more or less subjectively well-known political figures. Consistent with the ToMp account, MPFC showed greater activity to subjectively well-known targets, irrespective of participants' reported feelings of closeness or similarity. MPFC also demonstrated greater activity on trials in which targets (whether politicians or oneself) were judged to be relatively idiosyncratic, making a generic theory of mind inapplicable. These results suggest that MPFC may supplement the generic theory of mind process, with which dorsomedial pFC has been associated, by contributing mentalizing capacities tuned to individuated representations of specific well-known others.

Arthroscopic Medial Meniscus Posterior Root Reconstruction Using Auto-Gracilis Tendon.

PubMed

Lee, Dhong Won; Haque, Russel; Chung, Kyu Sung; Kim, Jin Goo

2017-08-01

There have been several techniques to repair the medial meniscus posterior root tears (MMPRTs) with the goal of restoring the anatomic and firm fixation of the meniscal root to bone. Many anatomic studies about the menisci also have been developed, so a better understanding of the anatomy could help surgeons perform correct fixation of the MMPRTs. The meniscal roots have ligament-like structures that firmly attach the menisci to the tibial plateau, and this structural concept is important to restore normal biomechanics after anatomic root repair. We present arthroscopic transtibial medial meniscus posterior root reconstruction using auto-gracilis tendon.

Effect of Posterior Horn Medial Meniscus Root Tear on In Vivo Knee Kinematics.

PubMed

Marsh, Chelsea A; Martin, Daniel E; Harner, Christopher D; Tashman, Scott

2014-07-01

Medial meniscus root tear (MMRT) is a recently recognized yet frequently missed meniscal tear pattern that biomechanically creates an environment approaching meniscal deficiency. The purpose of this study was to assess the effect of MMRT on tibiofemoral kinematics and arthrokinematics during daily activities by comparing the injured knees of subjects with isolated MMRT to their uninjured contralateral knees. The hypothesis was that the injured knee will demonstrate significantly more lateral tibial translation and adduction than the uninjured knee, and that the medial compartment will exhibit significantly different arthrokinematics than the lateral compartment in the affected limb. Cross-sectional study; Level of evidence, 3. Seven subjects with isolated MMRT were recruited and volumetric, density-based 3-dimensional models of their distal femurs and proximal tibia were created from computed tomography scans. High-speed, biplane radiographs were obtained of both their affected and unaffected knees. Moving 3-dimensional models of tibiofemoral kinematics were calculated using model-based tracking to assess overall kinematic variables and specific measures of tibiofemoral joint contact. The affected knees of the subjects were then compared to their unaffected contralateral knees. Affected knees demonstrated significantly more lateral tibial translation than the uninjured contralateral limb in all dynamic activities. Additionally, the medial compartment displayed greater amounts of mobility than the lateral compartment in the injured limbs. This study suggests that MMRT causes significant changes in in vivo knee kinematics and arthrokinematics and that the magnitude of these changes is influenced by dynamic task difficulty. Medial meniscus root tears lead to significant changes in joint arthrokinematics, with increased lateral tibial translation and greater medial compartment excursion. With complete root tears, essentially 100% of circumferential fibers are lost

Root avulsion of the posterior horn of the medial meniscus in skeletally immature patients.

PubMed

Sonnery-Cottet, Bertrand; Mortati, Rafael; Archbold, Pooler; Gadea, François; Clechet, Julien; Thaunat, Mathieu

2014-12-01

Meniscal root avulsion has been predominantly reported in an adult population but little is known about this meniscal lesion in children and adolescents. The of this article is to describe the clinical symptoms and a new MRI sign of a medial meniscus posterior root avulsion in skeletally immature patients, and to report the arthroscopic procedure for its reinsertion in the presence of open physes. We report two skeletally immature patients who had a medial meniscus posterior root avulsion [MMPRA]. Diagnosis of a MMPRA was suspected on MRI by intense T2 hypersignal located at the postero-medial part of the tibial plateau reflecting trabecular bone oedema ("Bone bruise") at the level of the medial meniscal posterior root attachment. Arthroscopic reduction and fixation of the posterior root of the medial meniscus with transosseous sutures was performed. The patients returned to sport at the end of 6 months without residual symptoms. At one year, the radiographs showed no modification of the physis. Healing of the medial meniscal posterior root was noted on MRI. In a skeletally immature patient it is important that this rare meniscal lesion is diagnosed early and adequately treated. We emphasize the importance of the indirect MRI signs that can lead a clinician to suspect the diagnosis of MMPRA. The aim of the surgery was to restore the anatomical footprint of the meniscal root and to re-establish its function thus preventing future chondral damage without damage to the tibial physeal growth plate. Level IV. Copyright © 2014 Elsevier B.V. All rights reserved.

Tibial avulsion fracture of the posterior root of the medial meniscus in children.

PubMed

Iversen, Jonas Vestergård; Krogsgaard, Michael Rindom

2014-01-01

Few reports have described avulsion fractures of the posterior root of the medial meniscus in skeletally immature patients. This lesion should not be overlooked as it damages the load absorptive (distributive) function of the meniscus, increasing the risk of cartilage degeneration. Two cases of displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures with a good clinical result at 2-years follow-up, and in one case, the avulsion was found at re-arthroscopy after 6 weeks to have healed.

Multi-parameter analysis of titanium vocal fold medializing implant in an excised larynx model

PubMed Central

Witt, Rachel E.; Hoffman, Matthew R.; Friedrich, Gerhard; Rieves, Adam L.; Schoepke, Benjamin J.; Jiang, Jack J.

2010-01-01

Objective Evaluate the efficacy of the titanium vocal fold medializing implant (TVFMI) for the treatment of unilateral vocal fold paralysis (UVFP) based on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup. Methods Measurements were recorded on eight excised canine larynges with simulated UVFP before and after medialization with the TVFMI. Results Phonation threshold flow (PTF) and phonation threshold power (PTW) decreased significantly after medialization (p<0.001; p=0.008). Phonation threshold pressure (PTP) also decreased, but this difference was not significant (p=0.081). Percent jitter and percent shimmer decreased significantly after medialization (p=0.005; p=0.034). Signal to noise ratio (SNR) increased significantly (p=0.05). Differences in mucosal wave characteristics were discernable, but not significant. Phase difference between the normal and paralyzed vocal fold and amplitude of the paralyzed vocal fold decreased (p=0.15; p=0.78). Glottal gap decreased significantly (p=0.004). Conclusions The TVFMI was effective in achieving vocal fold medialization, improving vocal aerodynamic and acoustic characteristics of phonation significantly and mucosal wave characteristics discernibly. This study provides objective, quantitative support for the use of the TVFMI in improving vocal function in patients with unilateral vocal fold paralysis. PMID:20336924

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

PubMed

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

2017-01-01

Accurate identification of the material properties of the plantar soft tissue is important for computer-aided analysis of foot pathologies and design of therapeutic footwear interventions based on subject-specific models of the foot. However, parameter identification of the hyperelastic material properties of plantar soft tissues usually requires an inverse finite element analysis due to the lack of a practical contact model of the indentation test. In the present study, we derive an analytical contact model of a spherical indentation test in order to directly estimate the material properties of the plantar soft tissue. Force-displacement curves of the heel pads are obtained through an indentation experiment. The experimental data are fit to the analytical stress-strain solution of the spherical indentation in order to obtain the parameters. A spherical indentation approach successfully predicted the non-linear material properties of the heel pad without iterative finite element calculation. The force-displacement curve obtained in the present study was found to be situated lower than those identified in previous studies. The proposed framework for identifying the hyperelastic material parameters may facilitate the development of subject-specific FE modeling of the foot for possible clinical and ergonomic applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

TopMaker: Technique Developed for Automatic Multiblock Topology Generation Using the Medial Axis

NASA Technical Reports Server (NTRS)

Rigby, David L.

2004-01-01

The TopMaker technique was developed in an effort to reduce the time required for grid generation in complex numerical studies. Topology generation accounts for much of the man-hours required for structured multiblock grids. With regard to structured multiblock grids, topology refers to how the blocks are arranged and connected. A two-dimensional multiblock topology generation technique has been developed at the NASA Glenn Research Center. Very general configurations can be addressed by the technique. A configuration is defined by a collection of non-intersecting closed curves, which will be referred to as loops. More than a single loop implies that holes exist in the domain, which poses no problem. This technique requires only the medial vertices and the touch points that define each vertex. From the information about the medial vertices, the connectivity between medial vertices is generated. The physical shape of the medial edge is not required. By applying a few simple rules to each medial edge, a multiblock topology can be generated without user intervention. The resulting topologies contain only the level of complexity dictated by the configurations. Grid lines remain attached to the boundary except at sharp concave turns, where a change in index family is introduced as would be desired. Keeping grid lines attached to the boundary is especially important in computational fluid dynamics, where highly clustered grids are used near no-slip boundaries. This technique is simple and robust and can easily be incorporated into the overall grid-generation process.

A new surgical technique for medial collateral ligament balancing: multiple needle puncturing.

PubMed

Bellemans, Johan; Vandenneucker, Hilde; Van Lauwe, Johan; Victor, Jan

2010-10-01

In this article, we present our experience with a new technique for medial soft tissue balancing, where we make multiple punctures in the medial collateral ligament (MCL) using a 19-gauge needle, to progressively stretch the MCL until a correct ligament balance is achieved. Ligament status was evaluated both before and after the procedure using computer navigation and mediolateral stress testing. The procedure was considered successful when 2 to 4-mm mediolateral joint line opening was obtained in extension and 2 to 6 mm in flexion. In 34 of 35 cases, a progressive correction of medial tightness was achieved according to the above described criteria. One case was considered overreleased in extension. Needle puncturing is a new, effective, and safe technique for progressive correction of MCL tightness in the varus knee. Copyright © 2010 Elsevier Inc. All rights reserved.

The benefit of therapeutic medial branch blocks after cervical operations.

PubMed

Klessinger, Stephan

2010-01-01

Persistent neck pain is a common problem after surgery of the cervical spine. No therapy recommendation exists for these patients. The objective of this study was to determine if a therapeutic medial branch block is a rational treatment for patients with postoperative neck pain after cervical spine operations. Retrospective practice audit. Review of charts of all patients who underwent cervical spine operations for degenerative reasons during a time period of 3 years. Patients with persistent postsurgical pain were treated with therapeutic medial branch blocks (local anesthetic and steroid). A positive treatment response was defined if at least 80% reduction of pain could be achieved or if the patient was sufficiently satisfied with the relief. All patients with a minimum follow up time of 6 months were included. Of the 312 operations performed, 128 were artificial disc operations, 125 were stand alone cages, and 59 were fusions with cage and plate. Persistent neck pain occurred in 33.3% of the patients. There was no difference between the patients with neck pain and the whole group of patients. More than half of the patients with neck pain--52.9%--were treated successfully with therapeutic medial branch blocks. Since no further treatment was necessary, the initial treatment was considered successful. Nearly a third--32.2%--of the patients were initially treated successfully, but their pain recurred and further diagnostics and treatments were necessary. In this group of patients, significantly more with double level operations were found (P = 0.003). Patients not responding to the medial branch block were 14.9%. This audit is retrospective and observational, and therefore does not represent a high level of evidence. However, to our knowledge, since this information has not been previously reported and no recommendation for the treatment of post-operative zygapophysial joint pain exists, it appears to be the best available research upon which to recommend treatment

Double transosseous pull out suture technique for transection of posterior horn of medial meniscus.

PubMed

Ahn, Jin Hwan; Wang, Joon Ho; Lim, Hong Chul; Bae, Ji Hoon; Park, Joon Soo; Yoo, Jae Chul; Shyam, Ashok Kumar

2009-03-01

Transection injury (complete radial tear, root tear) in the posterior horn of medial meniscus will lead to loss of hoop strain, extrusion of the meniscus and early degenerative changes. The posterior horn of medial meniscus is amenable to repair due to its good blood supply and repair is the procedure of choice for these injuries. In cases of transection of the medial meniscus posterior horn, the meniscus can be repaired by a pull out suture technique using trans-septal portal. The single transosseous pull out suturing technique is a point fixation technique with limited contact area having low and inhomogeneous contact pressure. This article describes a double transosseous pull out suture technique using trans-septal portal for the repair of transection of posterior horn of medial meniscus. Use of double transosseous technique provides more secure fixation, more homogeneous and wider contact pressure area between meniscus and the bone, improving the healing potential of the repair.

Analysis of 3D strain in the human medial meniscus.

PubMed

Kolaczek, S; Hewison, C; Caterine, S; Ragbar, M X; Getgood, A; Gordon, K D

2016-10-01

This study presents a method to evaluate three-dimensional strain in meniscal tissue using medical imaging. Strain is calculated by tracking small teflon markers implanted within the meniscal tissue using computed tomography imaging. The results are presented for strains in the middle and posterior third of the medial menisci of 10 human cadaveric knees, under simulated physiologically relevant loading. In the middle position, an average compressive strain of 3.4% was found in the medial-lateral direction, and average tensile strains of 1.4% and 3.5% were found in the anterior-posterior and superior-inferior directions respectively at 5° of knee flexion with an applied load of 1× body weight. In the posterior position, under the same conditions, average compressive strains of 2.2% and 6.3% were found in the medial-lateral and superior-inferior directions respectively, and an average tensile strain of 3.8% was found in the anterior-posterior direction. No statistically significant difference between strain in the middle or posterior of the meniscus or between the global strains is uncovered. Copyright © 2016 Elsevier Ltd. All rights reserved.

Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus.

PubMed

Thaunat, Mathieu; Fayard, Jean Marie; Guimaraes, Tales M; Jan, Nicolas; Murphy, Colin G; Sonnery-Cottet, Bertrand

2016-08-01

Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial- or full-thickness tear) and associated meniscotibial ligament disruption. An original technique of arthroscopic suture placement through a single posteromedial portal with a 25° curved suture hook device is described.

Acute Medial Plantar Fascia Tear.

PubMed

Pascoe, Stephanie C; Mazzola, Timothy J

2016-06-01

A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

Medial vestibular connections with the hypocretin (orexin) system

NASA Technical Reports Server (NTRS)

Horowitz, Seth S.; Blanchard, Jane; Morin, Lawrence P.

2005-01-01

The mammalian medial vestibular nucleus (MVe) receives input from all vestibular endorgans and provides extensive projections to the central nervous system. Recent studies have demonstrated projections from the MVe to the circadian rhythm system. In addition, there are known projections from the MVe to regions considered to be involved in sleep and arousal. In this study, afferent and efferent subcortical connectivity of the medial vestibular nucleus of the golden hamster (Mesocricetus auratus) was evaluated using cholera toxin subunit-B (retrograde), Phaseolus vulgaris leucoagglutinin (anterograde), and pseudorabies virus (transneuronal retrograde) tract-tracing techniques. The results demonstrate MVe connections with regions mediating visuomotor and postural control, as previously observed in other mammals. The data also identify extensive projections from the MVe to regions mediating arousal and sleep-related functions, most of which receive immunohistochemically identified projections from the lateral hypothalamic hypocretin (orexin) neurons. These include the locus coeruleus, dorsal and pedunculopontine tegmental nuclei, dorsal raphe, and lateral preoptic area. The MVe itself receives a projection from hypocretin cells. CTB tracing demonstrated reciprocal connections between the MVe and most brain areas receiving MVe efferents. Virus tracing confirmed and extended the MVe afferent connections identified with CTB and additionally demonstrated transneuronal connectivity with the suprachiasmatic nucleus and the medial habenular nucleus. These anatomical data indicate that the vestibular system has access to a broad array of neural functions not typically associated with visuomotor, balance, or equilibrium, and that the MVe is likely to receive information from many of the same regions to which it projects.

Medial malleolar fractures: a biomechanical study of fixation techniques.

PubMed

Fowler, T Ty; Pugh, Kevin J; Litsky, Alan S; Taylor, Benjamin C; French, Bruce G

2011-08-08

Fracture fixation of the medial malleolus in rotationally unstable ankle fractures typically results in healing with current fixation methods. However, when failure occurs, pullout of the screws from tension, compression, and rotational forces is predictable. We sought to biomechanically test a relatively new technique of bicortical screw fixation for medial malleoli fractures. Also, the AO group recommends tension-band fixation of small avulsion type fractures of the medial malleolus that are unacceptable for screw fixation. A well-documented complication of this technique is prominent symptomatic implants and secondary surgery for implant removal. Replacing stainless steel 18-gauge wire with FiberWire suture could theoretically decrease symptomatic implants. Therefore, a second goal was to biomechanically compare these 2 tension-band constructs. Using a tibial Sawbones model, 2 bicortical screws were compared with 2 unicortical cancellous screws on a servohydraulic test frame in offset axial, transverse, and tension loading. Second, tension-band fixation using stainless steel wire was compared with FiberWire under tensile loads. Bicortical screw fixation was statistically the stiffest construct under tension loading conditions compared to unicortical screw fixation and tension-band techniques with FiberWire or stainless steel wire. In fact, unicortical screw fixation had only 10% of the stiffness as demonstrated in the bicortical technique. In a direct comparison, tension-band fixation using stainless steel wire was statistically stiffer than the FiberWire construct. Copyright 2011, SLACK Incorporated.