Sonographically guided deep plantar fascia injections: where does the injectate go?

PubMed

Maida, Eugene; Presley, James C; Murthy, Naveen; Pawlina, Wojciech; Smith, Jay

2013-08-01

To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach. In each case, 1.5 mL of 50% diluted colored latex was injected deep to the plantar fascia. After a minimum of 72 hours, study coinvestigators dissected each specimen to assess injectate placement. All 10 injections accurately placed latex adjacent to the deep side of the plantar fascia at the anterior calcaneus. However, the flexor digitorum brevis (FDB) origin from the plantar fascia variably limited direct latex contact with the plantar fascia, and small amounts of latex interdigitated with the FDB origin in 90% (9 of 10). In all 10 specimens, latex also covered the traversing first branch of the lateral plantar nerve (FBLPN, ie, Baxter nerve) between the FDB and quadratus plantae muscles. No latex was found in the plantar fat pad or plantar fascia in any specimen. Sonographically guided deep plantar fascia injections reliably deliver latex deep to the plantar fascia while avoiding intrafascial injection. However, the extent of direct plantar fascia contact is variable due to the intervening FDB. On the contrary, the traversing FBLPN is reliably covered by the injection. Deep plantar fascia injections may have a role in the management of refractory plantar fasciitis, particularly following failed superficial perifascial or intrafascial injections, in cases of preferential deep plantar fascia involvement, or when entrapment

Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up.

PubMed

Farzadi, Maede; Safaeepour, Zahra; Mousavi, Mohammad E; Saeedi, Hassan

2015-04-01

Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. Quasi-experimental. Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p < 0.05). In the medial midfoot region, peak pressure, maximum force, and contact area were significantly higher with the foot orthosis than shoe-only before and after the intervention (p = 0.00). A foot orthosis with medial arch support could reduce pressure beneath the hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology. © The International Society for Prosthetics and Orthotics 2014.

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.

Utility of nerve conduction studies for diagnosis of injury to the medial branch of the superficial radial nerve.

PubMed

Kon, Tomoya; Suzuki, Chieko; Hotta, Ryotaro; Funamizu, Yukihisa; Haga, Rie; Ueno, Tatsuya; Nishijima, Haruo; Arai, Akira; Nunomura, Jinichi; Nukada, Hitoshi; Tomiyama, Masahiko; Baba, Masayuki

2017-09-01

The clinical utility of nerve conduction study (NCS) for the distal medial branch of the superficial radial nerve (SRN) has not yet been clarified. Therefore, we investigated the clinical utility of NCS in patients with suspected SRN injury and compared the results with those in healthy control subjects. Bilateral NCS of the medial branch of the SRN was performed in two patients with suspected injury of the medial branch of the SRN, and in 20 healthy control subjects. A surface recording electrode was placed at the medial side of the metacarpophalangeal joint of the thumb. The SRN was then stimulated at a location 12 cm proximal from the recording electrode. The mean sensory nerve action potential in the two patients was significantly lower than that of the controls (6.75 ± 0.92 vs. 23.8 ± 8.2 μV, P  < 0.05). The side-to-side differences in sensory nerve action potential in the two patients were significantly higher than in the controls (55 ± 7.1 vs. 11 ± 7.8%, P  < 0.05). NCS may be useful for diagnosing injury of the medial branch of the SRN.

Dexmedetomidine Added to Local Anesthetic Mixture of Lidocaine and Ropivacaine Enhances Onset and Prolongs Duration of a Popliteal Approach to Sciatic Nerve Blockade.

PubMed

Hu, Xiawei; Li, Jinlei; Zhou, Riyong; Wang, Quanguang; Xia, Fangfang; Halaszynski, Thomas; Xu, Xuzhong

2017-01-01

A literature review of multiple clinical studies on mixing additives to improve pharmacologic limitation of local anesthetics during peripheral nerve blockade revealed inconsistency in success rates and various adverse effects. Animal research on dexmedetomidine as an adjuvant on the other hand has promising results, with evidence of minimum unwanted results. This randomized, double-blinded, contrastable observational study examined the efficacy of adding dexmedetomidine to a mixture of lidocaine plus ropivacaine during popliteal sciatic nerve blockade (PSNB). Sixty patients undergoing varicose saphenous vein resection using ultrasonography-guided PSNB along with femoral and obturator nerve blocks as surgical anesthesia were enrolled. All received standardized femoral and obturator nerve blocks, and the PSNB group was randomized to receive either 0.5 mL (50 µg) of dexmedetomidine (DL group) or 0.5 mL of saline (SL group) together with 2% lidocaine (9.5 mL) plus 0.75% ropovacaine (10 mL). Sensory onset and duration of lateral sural cutaneous nerve, sural nerve, superficial peroneal nerve, deep peroneal nerve, lateral plantar nerve, and medial plantar nerve were recorded. Motor onset and duration of tibial nerve and common peroneal nerve were also examined. Sensory onset of sural nerve, superficial peroneal nerve, lateral plantar nerve, and medial plantar nerve was significantly quicker in the DL group than in the SL group (P < 0.05). Sensory onset of lateral sural cutaneous nerve and deep peroneal nerve was not statistically different between the groups (P > 0.05). Motor onset of tibial nerve and common peroneal nerve was faster in the DL group than in in the SL group (P < 0.05). Duration of both sensory and motor blockade was significantly longer in the DL group than in the SL group (P < 0.05). Perineural dexmedetomidine added to lidocaine and ropivacaine enhanced efficacy of popliteal approach to sciatic nerve blockade with faster onset and longer duration

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.

Anatomical Study of the Neurovascular in Flexor Hallucis Longus Tendon Transfers.

PubMed

Mao, Haijiao; Dong, Wenwei; Shi, Zengyuan; Yin, Weigang; Xu, Dachuan; Wapner, Keith L

2017-10-27

The transfer of the flexor hallucis longus tendon or flexor digitorum longus tendon is frequently used for the treatment of posterior tibial tendon insufficiency or chronic Achilles tendinopathy. According to several anatomical studies, harvesting the flexor hallucis longus (FHL) tendon may cause nerve injury. Sixty-eight embalmed feet were dissected and anatomically classified to define the relationship between Henry's knot and the plantar nerves. Two different configurations were identified. In Pattern 1, which was observed in 64 specimens (94.1%), the distance between the medial plantar nerve and Henry's knot was 5.96 mm (range, 3.34 to 7.84, SD = 1.12). In Pattern 2, which was observed in 4 specimens (5.9%), there was no distance between the medial plantar nerve (MPN) and Henry's knot. No statistically significant difference was observed according to gender or side (p > 0.05). A retraction was performed to harvest the FHL through the posteromedial hindfoot incision using a single minimally invasive technique, and the medial and lateral plantar nerve lesions were scrupulously assessed. In conclusion, medial and lateral plantar nerve injuries did not occur more frequently, even after performing a single minimally invasive incision to harvest the FHL tendon, due to the large distance between the FHL tendon and the medial and lateral plantar nerves.

Normal and sonographic anatomy of selected peripheral nerves. Part III: Peripheral nerves of the lower limb.

PubMed

Kowalska, Berta; Sudoł-Szopińska, Iwona

2012-06-01

The ultrasonographic examination is currently increasingly used in imaging peripheral nerves, serving to supplement the physical examination, electromyography and magnetic resonance imaging. As in the case of other USG imaging studies, the examination of peripheral nerves is non-invasive and well-tolerated by patients. The typical ultrasonographic picture of peripheral nerves as well as the examination technique have been discussed in part I of this article series, following the example of the median nerve. Part II of the series presented the normal anatomy and the technique for examining the peripheral nerves of the upper limb. This part of the article series focuses on the anatomy and technique for examining twelve normal peripheral nerves of the lower extremity: the iliohypogastric and ilioinguinal nerves, the lateral cutaneous nerve of the thigh, the pudendal, sciatic, tibial, sural, medial plantar, lateral plantar, common peroneal, deep peroneal and superficial peroneal nerves. It includes diagrams showing the proper positioning of the sonographic probe, plus USG images of the successively discussed nerves and their surrounding structures. The ultrasonographic appearance of the peripheral nerves in the lower limb is identical to the nerves in the upper limb. However, when imaging the lower extremity, convex probes are more often utilized, to capture deeply-seated nerves. The examination technique, similarly to that used in visualizing the nerves of upper extremity, consists of locating the nerve at a characteristic anatomic reference point and tracking it using the "elevator technique". All 3 parts of the article series should serve as an introduction to a discussion of peripheral nerve pathologies, which will be presented in subsequent issues of the "Journal of Ultrasonography".

Normal and sonographic anatomy of selected peripheral nerves. Part III: Peripheral nerves of the lower limb

PubMed Central

Sudoł-Szopińska, Iwona

2012-01-01

The ultrasonographic examination is currently increasingly used in imaging peripheral nerves, serving to supplement the physical examination, electromyography and magnetic resonance imaging. As in the case of other USG imaging studies, the examination of peripheral nerves is non-invasive and well-tolerated by patients. The typical ultrasonographic picture of peripheral nerves as well as the examination technique have been discussed in part I of this article series, following the example of the median nerve. Part II of the series presented the normal anatomy and the technique for examining the peripheral nerves of the upper limb. This part of the article series focuses on the anatomy and technique for examining twelve normal peripheral nerves of the lower extremity: the iliohypogastric and ilioinguinal nerves, the lateral cutaneous nerve of the thigh, the pudendal, sciatic, tibial, sural, medial plantar, lateral plantar, common peroneal, deep peroneal and superficial peroneal nerves. It includes diagrams showing the proper positioning of the sonographic probe, plus USG images of the successively discussed nerves and their surrounding structures. The ultrasonographic appearance of the peripheral nerves in the lower limb is identical to the nerves in the upper limb. However, when imaging the lower extremity, convex probes are more often utilized, to capture deeply-seated nerves. The examination technique, similarly to that used in visualizing the nerves of upper extremity, consists of locating the nerve at a characteristic anatomic reference point and tracking it using the “elevator technique”. All 3 parts of the article series should serve as an introduction to a discussion of peripheral nerve pathologies, which will be presented in subsequent issues of the “Journal of Ultrasonography”. PMID:26674560

Medialis pedis flap in the reconstruction of palmar skin defects of the digits: clarifying the anatomy of the medial plantar artery.

PubMed

Rodriguez-Vegas, Manuel

2014-05-01

Because of its outstanding texture, bulkiness, pliability and sensory recovery, the medialis pedis is an excellent alternative in the reconstruction of complex volar skin defects of the digits in selected patients. However, the surgical flap anatomy related with the medial plantar artery is still somewhat confusing to the point that the different journal articles and anatomy textbooks and atlases use different terminology and are, to some extent, misleading and/or incomplete. The authors report a clinical series of 15 medialis pedis free flaps in the reconstruction of skin defects of the fingers and evaluate their indications in free flap reconstruction of the skin defects of the digits. A review is made of the most relevant journal articles, anatomy textbooks, and atlases that describe the anatomy of the medial plantar artery with a special emphasis on the cutaneous branches that nourish the medialis pedis flap.

The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications

PubMed Central

Golanó, Pau; Sierevelt, Inger N.; van Dijk, C. Niek

2010-01-01

Despite the fact that the superficial peroneal nerve is the only nerve in the human body that can be made visible; iatrogenic damage to this nerve is the most frequently reported complication in anterior ankle arthroscopy. One of the methods to visualize the nerve is combined ankle plantar flexion and inversion. In the majority of cases, the superficial peroneal nerve can be made visible. The portals for anterior ankle arthroscopy are however created with the ankle in the neutral or slightly dorsiflexed position and not in combined plantar flexion and inversion. The purpose of this study was to undertake an anatomical study to the course of the superficial peroneal nerve in different positions of the foot and ankle. We hypothesize that the anatomical localization of the superficial peroneal nerve changes with different foot and ankle positions. In ten fresh frozen ankle specimens, a window, only affecting the skin, was made at the level of the anterolateral portal for anterior ankle arthroscopy in order to directly visualize the superficial peroneal nerve, or if divided, its terminal branches. Nerve movement was assessed from combined 10° plantar flexion and inversion to 5° dorsiflexion, standardized by the Telos stress device. Also for the 4th toe flexion, flexion of all the toes and for skin tensioning possible nerve movement was determined. The mean superficial peroneal nerve movement was 2.4 mm to the lateral side when the ankle was moved from 10° plantar flexion and inversion to the neutral ankle position and 3.6 mm to the lateral side from 10° plantar flexion and inversion to 5° dorsiflexion. Both displacements were significant (P < 0.01). The nerve consistently moves lateral when the ankle is manoeuvred from combined plantar flexion and inversion to the neutral or dorsiflexed position. If visible, it is therefore advised to create the anterolateral portal medial from the preoperative marking, in order to prevent iatrogenic damage to the superficial

Lipofibromatous Hamartoma of the Plantar Nerve An Extremely Rare Localization.

PubMed

Mert, Murat; Hacısalihoglu, Payam

2018-03-01

Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous hamartoma is associated with pain and sensory and/or motor deficits in the area of innervation of the affected nerve. This report describes a rare case of LFH of the plantar nerve. A 48-year-old woman presented to our outpatient orthopedic clinic with pain and a burning sensation on her left foot. The patient had a history of Morton's neuroma and had undergone a tarsal tunnel operation 2 years earlier at another center. None of her symptoms was alleviated by two previous operations. Magnetic resonance imaging with contrast revealed tenosynovitis of the flexor hallucis longus tendon and signal changes at deep tissue planes of the foot at the levels of the second and third toes, on the dorsal site and subcutaneous soft-tissue planes, suggesting edema and Morton's neuroma. The lesion was excised under spinal anesthesia, and histopathologic examination of the specimen revealed a diagnosis of LFH. The patient was discharged without any symptoms and her foot was normal at 8-month outpatient follow-up, with no indications of postoperative complications and/or recurrence.

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

PubMed Central

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

2015-01-01

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

Abnormal attachments between a plantar aponeurosis and calcaneus

PubMed Central

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

2013-01-01

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

The deep plantar arch in humans: constitution and topography.

PubMed

Gabrielli, C; Olave, E; Mandiola, E; Rodrigues, C F; Prates, J C

2001-01-01

The integrity of the various structures within the feet depends on their blood supply. Lesions of the feet often require revascularization, which if successful avoids the need for amputation. To provide greater anatomical detail to aid vascular surgery and imaging, the anatomy and constitution of the deep plantar arch was studied in 50 adult cadaveric feet. The arteries of the foot were injected with red neoprene latex and dissected under magnification. The deep plantar arch, present in all feet, was the result of anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 72% of specimens (Type I arches) and the lateral plantar artery in 22% (Type II), with the contribution being equal in 6% (Type III). The medial plantar artery contributed to the medial segment of the deep plantar arch by its deep branch in 12% of specimens. The distance between the deep plantar arch and each interdigital commissure was generally constant, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the distal part of this third in 90%. The deep plantar arch is, therefore formed mainly by the deep plantar artery, a branch of the dorsal artery of foot; its location can be estimated if foot length is known.

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

PubMed

Zhang, Xianyi; Li, Bo

2014-04-01

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

Diagnosis and management of plantar fasciitis.

PubMed

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

2014-12-01

Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary. © 2014 The American Osteopathic Association.

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 correlation between plantar fascia thickness and symptoms of plantar fasciitis.

PubMed

Mahowald, Sarah; Legge, Bradford S; Grady, John F

2011-01-01

The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis. Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed. Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ± 1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P < 0.005). This study provides evidence that changing thickness of the plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols.

Arterial Anatomy of the Posterior Tibial Nerve in the Tarsal Tunnel.

PubMed

Manske, Mary Claire; McKeon, Kathleen E; McCormick, Jeremy J; Johnson, Jeffrey E; Klein, Sandra E

2016-03-16

Both vascular and compression etiologies have been proposed as the source of neurologic symptoms in tarsal tunnel syndrome. Advancing the understanding of the arterial anatomy supplying the posterior tibial nerve (PTN) and its branches may provide insight into the cause of tarsal tunnel symptoms. The purpose of this study was to describe the arterial anatomy of the PTN and its branches. Sixty adult cadaveric lower extremities (thirty previously frozen and thirty fresh specimens) were amputated distal to the knee. The vascular supply to the PTN and its branches was identified, measured, and described macroscopically (the thirty previously frozen specimens, prepared using a formerly described debridement technique) and microscopically (the thirty fresh specimens, processed using the Spälteholz technique). On both macroscopic and microscopic evaluation, the PTN and the medial and lateral plantar nerves were observed to have multiple entering vessels within the tarsal tunnel. On microscopic evaluation, a vessel was observed to enter the nerve at the bifurcation of the PTN into the medial and lateral plantar nerves in twenty-two (73%) of the thirty specimens. There was a significant difference (p < 0.05) in vascular density between the PTN and each of its branches. The abundant blood supply to the PTN and its branches identified in this study is consistent with observations of other peripheral nerves. This rich vascular network may render the PTN and its branches susceptible to nerve compression related to vascular congestion. The combination of vascular and structural compression may also elicit neurologic symptoms. Advancing the understanding of the arterial anatomy supplying the PTN and its branches may provide insight into the cause and treatment of tarsal tunnel syndrome. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Entrapment Neuropathies of the Foot and Ankle.

PubMed

Ferkel, Eric; Davis, William Hodges; Ellington, John Kent

2015-10-01

Posterior tarsal tunnel syndrome is the result of compression of the posterior tibial nerve. Anterior tarsal tunnel syndrome (entrapment of the deep peroneal nerve) typically presents with pain radiating to the first dorsal web space. Distal tarsal tunnel syndrome results from entrapment of the first branch of the lateral plantar nerve and is often misdiagnosed initially as plantar fasciitis. Medial plantar nerve compression is seen most often in running athletes, typically with pain radiating to the medial arch. Morton neuroma is often seen in athletes who place their metatarsal arches repetitively in excessive hyperextension. Copyright © 2015 Elsevier Inc. All rights reserved.

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

PubMed

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

2014-01-01

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

Effect of Transcutaneous Electrical Nerve Stimulation on Plantar Flexor Muscle Spasticity and Walking Speed in Stroke Patients.

PubMed

Laddha, Darshan; Ganesh, G Shankar; Pattnaik, Monalisa; Mohanty, Patitapaban; Mishra, Chittaranjan

2016-12-01

Spasticity is a major disabling symptom in patients post stroke. Although studies have demonstrated that transcutaneous electrical nerve stimulation (TENS) can reduce spasticity, the duration of single session TENS is a subject of debate. The purpose of this study was to determine the sustainability of the effects of TENS applied over common peroneal nerve in the reduction of ankle plantar-flexor spasticity and improving gait speed in patients post stroke. Thirty patients (11 women and 19 men) (mean age of 46.46 years) were randomly assigned to group 1 (task oriented exercises), group 2 (TENS for 30 min and task oriented exercises) and group 3 (TENS for 60 min and task oriented exercises) for a period of five sessions per week for 6 weeks. All patients were assessed for ankle plantar-flexor spasticity, passive ankle dorsi-flexion range of motion, clonus and timed up and go test at the time of recruitment to study, at 3 and 6 weeks of therapeutic intervention. The overall results of the study suggest that there was a decrease in ankle plantar flexor spasticity, ankle clonus and timed up and go score in all the groups. A greater reduction of spasticity was seen in TENS groups (groups 2 and 3) when compared to control. No significant improvement was found in timed up and go test (TUG) scores between groups. Both 30 min and 60 min of application of TENS are effective in reducing spasticity of ankle plantar flexors, improving walking ability and increase the effectiveness of task related training. Based on the effect size, we would recommend a longer duration application for the reduction of spasticity. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Variation of plantar pressure in Chinese diabetes mellitus.

PubMed

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

2015-01-01

To investigate dynamic changes in plantar pressure in Chinese diabetes mellitus patients and to provide a basis for further preventing diabetic foot. This is a cross-sectional investigation including 649 Chinese diabetes mellitus patients (diabetes group) and 808 "normal" Chinese persons (nondiabetes group) with normal blood glucose levels. All the subjects provided a complete medical history and underwent a physical examination and a 75-g oral glucose tolerance test. All subjects walked barefoot with their usual gait, and their dynamic plantar forces were measured using the one-step method with a plantar pressure measurement instrument; 5 measurements were performed for each foot. No significant differences were found in age, height, body weight, or body mass index between the two groups. The fasting blood glucose levels, plantar contact time, maximum force, pressure-time integrals and force-time integrals in the diabetes group were significantly higher than those in the nondiabetes group (p < 0.05). However, the maximum pressure was significantly higher in the nondiabetes group than in the diabetes group (p < 0.05). No difference was found in the contact areas between the two groups (p > 0.05). The maximum plantar force distributions were essentially the same, with the highest force found for the medial heel, followed by the medial forefoot and the first toe. The peak plantar pressure was located at the medial forefoot for the nondiabetes group and at the hallucis for the diabetes group. In the diabetes group, the momentum in each plantar region was higher than that in the nondiabetes group; this difference was especially apparent in the heel, the lateral forefoot and the hallucis. The dynamic plantar pressures in diabetic patients differ from those in nondiabetic people with increased maximum force and pressure, a different distribution pattern and significantly increased momentum, which may lead to the formation of foot ulcers. © 2015 by the Wound

Neurovascular Structures at Risk With Curved Retrograde TTC Fusion Nails.

PubMed

de Cesar Netto, Cesar; Johannesmeyer, David; Cone, Brent; Araoye, Ibukunoluwa; Hudson, Parke William; Sahranavard, Bahman; Johnson, Michael; Shah, Ashish

2017-10-01

The purpose of this study was to assess the risk of iatrogenic injury to plantar neurovascular structures of the foot during insertion of a curved retrograde tibiotalocalcaneal (TTC) fusion nail. Ten below-knee thawed fresh-frozen cadaveric specimens underwent curved retrograde nailing of the ankle. The shortest distance between the nail and the main plantar neurovascular branches and injured structures were recorded during dissection. We also evaluated the relative position of these structures along 2 lines (AB, connecting the calcaneus to the first metatarsal, and BC, connecting the first and fifth metatarsal). The lateral plantar artery was found to be in direct contact with the nail 70% of the time, with a macroscopic laceration 30% of the time. The Baxter nerve was injured 20% of the time, as was the lateral plantar nerve. The medial plantar artery and nerve were never injured. The most proximal structure to cross line AB was the Baxter nerve followed by the lateral plantar artery, the nail, the lateral plantar nerve, and the medial plantar nerve. Our cadaveric anatomic study found that the most common structures at risk for iatrogenic injury by lateral curved retrograde TTC fusion nails were the lateral plantar artery and nerve, and the Baxter nerve. Determination of a true neurovascular safe zone is challenging and therefore warrants careful operative dissection to minimize neurovascular injuries.

Anatomical risk evaluation of iatrogenic injury to the infrapatellar branch of the saphenous nerve during medial meniscus arthroscopic surgery.

PubMed

Koch, Guillaume; Kling, Agathe; Ramamurthy, Nitin; Edalat, Faramarz; Cazzato, Roberto Luigi; Kahn, Jean-Luc; Garnon, Julien; Clavert, Philippe

2017-06-01

To determine the relationship of the medial meniscus with the infrapatellar branches of the saphenous nerve, the primary goal is to define and characterize different risk areas for these nerves during medial meniscus surgery. After dissecting 20 embalmed cadaver knees, we defined 7 readily identifiable anatomical landmarks. For each knee, we recorded 2 morphological criteria and 16 measurements. The most common anatomical course is a main trunk that is 8 mm anterior to the tuberculum adductorium and 60 mm posterior to the midpoint of the medial patellar margin. It has two main infrapatellar branches. The nerve division is 23 mm above the joint line. The path is oblique with an angle of 55.5°. The anterior meniscal landmark is 24 mm from the upper branch and 42.5 mm from the lower branch. The posterior meniscal landmark is 55 mm from the upper branch and 38 mm from the lower branch. We defined a common anatomical course for the saphenous nerve and its infrapatellar branches. Then, three different areas were defined at risk for iatrogenic nerve injuries during medial meniscus.

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.

Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy.

PubMed

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

2015-01-01

Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p < .001) and no patient had developed symptom recurrence. Also, none of the patients had developed complex regional pain syndrome. All patients were able to return to regular shoe wear by 3 weeks postoperatively. The technique of plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Mechanical Information of Plantar Fascia during Normal Gait

NASA Astrophysics Data System (ADS)

Gu, Yaodong; Li, Zhiyong

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

Targeting the Plantar Fascia for Corticosteroid Injection.

PubMed

Salvi, Andrea Emilio

2015-01-01

Plantar fasciitis is often a difficult condition to treat. It is related to repetitive strain of the fascia at its attachment to the heel bone. This condition quite often appears with the concomitant presence of a plantar calcaneal heel spur. Corticosteroid injection is a popular treatment choice for plantar fasciitis, and accurate localization of the injected medication is essential for successful resolution of symptoms after the injection. In the present brief technical communication, a method for targeting the attachment of the plantar fascia to the medial tubercle of the tuberosity of the calcaneus is described. The targeting method uses the lateral radiograph of the foot to aid in localization of the proximal attachment of the plantar fascia to the calcaneus. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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

Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs.

PubMed

Chang, Ryan; Kent-Braun, Jane A; Hamill, Joseph

2012-06-01

Due to complexity of the plantar intrinsic foot muscles, little is known about their muscle architecture in vivo. Chronic plantar fasciitis may be accompanied by muscle atrophy of plantar intrinsic foot muscles and tibialis posterior compromising the dynamic support of the foot prolonging the injury. Magnetic resonance images of the foot may be digitized to quantify muscle architecture. The first purpose of this study was to estimate in vivo the volume and distribution of healthy plantar intrinsic foot muscles. The second purpose was to determine whether chronic plantar fasciitis is accompanied by atrophy of plantar intrinsic foot muscles and tibialis posterior. Magnetic resonance images were taken bilaterally in eight subjects with unilateral plantar fasciitis. Muscle perimeters were digitally outlined and muscle signal intensity thresholds were determined for each image for volume computation. The mean volume of contractile tissue in healthy plantar intrinsic foot muscles was 113.3 cm(3). Forefoot volumes of plantar fasciitis plantar intrinsic foot muscles were 5.2% smaller than healthy feet (P=0.03, ES=0.26), but rearfoot (P=0.26, ES=0.08) and total foot volumes (P=0.07) were similar. No differences were observed in tibialis posterior size. While the total volume of plantar intrinsic foot muscles was similar in healthy and plantar fasciitis feet, atrophy of the forefoot plantar intrinsic foot muscles may contribute to plantar fasciitis by destabilizing the medial longitudinal arch. These results suggest that magnetic resonance imaging measures may be useful in understanding the etiology and rehabilitation of chronic plantar fasciitis. Copyright © 2011 Elsevier Ltd. All rights reserved.

Ultrasound evaluation of a spontaneous plantar fascia rupture.

PubMed

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

2010-11-01

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

Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers.

PubMed

Ehrmann, Christine; Maier, Matthias; Mengiardi, Bernard; Pfirrmann, Christian W A; Sutter, Reto

2014-09-01

To determine the spectrum of magnetic resonance (MR) imaging findings at the calcaneal attachment of the plantar fascia in asymptomatic volunteers. The study was approved by the institutional review board, and informed consent was obtained from all subjects. MR imaging was performed in 77 asymptomatic volunteers (mean age, 48.0 years; age range, 23-83 years) with use of a 1.5-T system. There were 40 women (mean age, 49.0 years; age range, 24-83 years) and 37 men (mean age, 48.0 years; age range, 23-83 years). Signal intensity characteristics and thickness of the medial, central, and lateral fascicles of the plantar fascia were assessed independently by two radiologists. The presence of soft-tissue edema, bone marrow edema, and bone spur formation at the attachment of the plantar fascia was noted. Datasets were analyzed with inferential statistic procedures. The mean thickness of the plantar fascia was 0.6 mm (medial fascicle), 4.0 mm (central fascicle), and 2.3 mm (lateral fascicle). Increased signal intensity in the plantar fascia was seen with the T1-weighted sequence in 16 of the 77 volunteers (21%), the T2-weighted sequence in six (7.8%), and the short inversion time inversion-recovery sequence in six (7.8%). Soft-tissue edema was seen deep to the plantar fascia in five of the 77 volunteers (6.5%) and superficial to the plantar fascia in 16 (21%). A calcaneal spur was detected in 15 of the 77 volunteers (19%). Calcaneal bone marrow edema was present in four volunteers (5.2%). T1-weighted signal intensity changes in the plantar fascia, soft-tissue edema superficial to the plantar fascia, and calcaneal spurs are common findings in asymptomatic volunteers and should be used with caution in the diagnosis of plantar fasciitis. Increased signal intensity within the plantar fascia with fluid-sensitive sequences is uncommon in asymptomatic volunteers.

Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis.

PubMed

Wu, Yung-Tsan; Chang, Chih-Ya; Chou, Yu-Ching; Yeh, Chun-Chang; Li, Tsung-Ying; Chu, Heng-Yi; Chen, Liang-Cheng

2017-05-01

To evaluate the therapeutic benefit of ultrasound-guided pulsed radiofrequency (PRF) stimulation at the posterior tibial nerve (PTN) in patients with recalcitrant plantar fasciitis (PF). A prospective, randomized, double-blinded, placebo-controlled trial (12-wk follow-up). Outpatient local medical center settings. Patients (N=36) with recalcitrant PF underwent randomization, and all were included in the final data analysis. Patients in the PRF group were treated with 1 dose of ultrasound-guided PRF stimulation at the PTN, and those in the control group received 1 dose of 2% lidocaine, 0.5mL, injected at the PTN under ultrasound guidance. The visual analog scale (first-step and overall pain), American Orthopedic Foot-Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasonographic thickness of the plantar fascia were evaluated at 1, 4, 8, and 12 weeks after treatment. Thirty-six patients (20 feet per group) completed the study. The PRF group had a significantly larger improvement in first-step pain, overall pain, and AOFAS score (all P<.001), as well as plantar fascia thickness (P<.05), compared with those of the control group at all observed time points. This study shows that ultrasound-guided PRF stimulation at the PTN is effective for treating recalcitrant PF. This simple, reproducible method could be a novel strategy for managing recalcitrant PF. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Arch-Taping Techniques for Altering Navicular Height and Plantar Pressures During Activity

PubMed Central

Newell, Tim; Simon, Janet; Docherty, Carrie L.

2015-01-01

Context Arch tapings have been used to support the arch by increasing navicular height. Few researchers have studied navicular height and plantar pressures after physical activity. Objective To determine if taping techniques effectively support the arch during exercise. Design Crossover study. Setting Athletic training research laboratory. Patients or Other Participants Twenty-five individuals (13 men, 12 women; age = 20.0 ± 1.0 years, height = 172.3 ± 6.6 cm, mass = 70.1 ± 10.2 kg) with a navicular drop of more than 8 mm (12.9 ± 3.3 mm) volunteered. Intervention(s) All individuals participated in 3 days of testing, with 1 day for each tape condition: no tape, low dye, and navicular sling. On each testing day, navicular height and plantar pressures were measured at 5 intervals: baseline; posttape; and after 5, 10, and 15 minutes of running. The order of tape condition was counterbalanced. Main Outcome Measure(s) The dependent variables were navicular height in millimeters and plantar pressures in kilopascals. Plantar pressures were divided into 5 regions: medial forefoot, lateral forefoot, lateral midfoot, lateral rearfoot, and medial rearfoot. Separate repeated-measures analyses of variance were conducted for each dependent variable. Results Navicular height was higher immediately after application of the navicular-sling condition (P = .004) but was reduced after 5 minutes of treadmill running (P = .12). We observed no differences from baseline to posttape for navicular height for the low-dye (P = .30) and no-tape conditions (P = .25). Both the low-dye and navicular-sling conditions increased plantar pressures in the lateral midfoot region compared with the no-tape condition. The low-dye condition created decreased pressure in the medial and lateral forefoot regions compared with the no-tape condition. All changes were identified immediately after application and were maintained during running. No changes were noted in plantar pressures for the no

Plantar pressure asymmetry and risk of stress injuries in the foot of young soccer players.

PubMed

Azevedo, Renato R; da Rocha, Emmanuel S; Franco, Pedro S; Carpes, Felipe P

2017-03-01

Asymmetries in the magnitude of plantar pressure are considered a risk factor for stress fracture of the fifth metatarsal in soccer athletes. To investigate the presence of plantar pressure asymmetries among young soccer athletes. Observational. Laboratory. Thirty young adolescents divided into a soccer player group (n = 15) or a matched control group (n = 15). Mean plantar pressure was determined for seven different regions of the foot. Data were compared between the preferred and non-preferred foot, and between the groups, during barefoot standing on a pressure mat system. Higher pressure was found in the hallux, 5th metatarsal and medial rearfoot of the non-preferred foot in the young soccer players. These asymmetries were not observed in the control group. Magnitudes of plantar pressure did not differ between the groups. Young soccer players present asymmetries in plantar pressure in the hallux, 5th metatarsal and medial rearfoot, with higher pressure observed in the non-preferred foot. Copyright © 2016 Elsevier Ltd. All rights reserved.

Arthroscopic approach and intra-articular anatomy of the dorsal and plantar synovial compartments of the bovine tarsocrural joint.

PubMed

Lardé, Hélène; Nichols, Sylvain; Babkine, Marie; Desrochers, André

2017-01-01

To determine arthroscopic approaches to the dorsal and plantar synovial compartments of the tarsocrural joint in adult cattle, and to describe the arthroscopic intra-articular anatomy from each approach. Ex vivo study. Fresh adult bovine cadavers (n = 7). Two tarsocrural joint were injected with latex to determine arthroscopic portal locations and arthroscopy of the tarsocrural joint of 12 tarsi was performed. The dorsolateral approach was made through the large pouch located between the long digital extensor and peroneus longus tendons. The dorsomedial approach was made just medial to the common synovial sheath of the tibialis cranialis, peroneus tertius, and long digital extensor tendons. The plantarolateral and plantaromedial approaches were made lateral and medial to the tarsal tendon sheath, respectively. Each approach allowed visualization of the distal tibia articulating with the proximal trochlea of the talus. Consistently observed structures included the distal intermediate ridge of the tibia, and the medial and lateral trochlear ridges and trochlear groove of the talus. Lateral and medial malleoli were best assessed from dorsal approaches. From the lateral approaches evaluation of the abaxial surface of the lateral trochlear ridge allowed visualization of the fibulocalcaneal joint. From the plantar approaches additional observed structures included the coracoid process of the calcaneus, plantar trochlea of the talus, and plantar talotibial and talofibular ligaments. In cattle, the dorsolateral and plantarolateral approaches allowed for the best evaluation of the dorsal and plantar aspects of the tarsocrural joint, respectively. © 2017 The American College of Veterinary Surgeons.

Medial and Lateral Plantar Nerve Entrapment

MedlinePlus

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

PubMed

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

2014-01-01

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

Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis.

PubMed

Engkananuwat, Phoomchai; Kanlayanaphotporn, Rotsalai; Purepong, Nithima

2018-01-01

Since the plantar fascia and the Achilles tendon are anatomically connected, it is plausible that stretching of both structures simultaneously will result in a better outcome for plantar fasciitis. Fifty participants aged 40 to 60 years with a history of plantar fasciitis greater than 1 month were recruited. They were prospectively randomized into 2 groups. Group 1 was instructed to stretch the Achilles tendon while group 2 simultaneously stretched the Achilles tendon and plantar fascia. After 4 weeks of both stretching protocols, participants in group 2 demonstrated a significantly greater pressure pain threshold than participants in group 1 ( P = .040) with post hoc analysis. No significant differences between groups were demonstrated in other variables ( P > .05). Concerning within-group comparisons, both interventions resulted in significant reductions in pain at first step in the morning and average pain at the medial plantar calcaneal region over the past 24 hours, while there were increases in the pressure pain threshold, visual analog scale-foot and ankle score, and range of motion in ankle dorsiflexion ( P < .001). More participants in group 2 described their symptoms as being much improved to being completely improved than those in group 1. The simultaneous stretching of the Achilles tendon and plantar fascia for 4 weeks was a more effective intervention for plantar fasciitis. Patients who reported complete relief from symptoms at the end of the 4-week intervention in the simultaneous stretching group (n = 14; 56%) were double that of the stretching of the Achilles tendon-only group (n = 7; 28%). II, lesser quality RCT or prospective comparative study.

Effects of low-dye taping on plantar pressure pre and post exercise: an exploratory study.

PubMed

Nolan, Damien; Kennedy, Norelee

2009-04-21

Low-Dye taping is used for excessive pronation at the subtalar joint of the foot. Previous research has focused on the tape's immediate effect on plantar pressure. Its effectiveness following exercise has not been investigated. Peak plantar pressure distribution provides an indirect representation of subtalar joint kinematics. The objectives of the study were 1) To determine the effects of Low-Dye taping on peak plantar pressure immediately post-application. 2) To determine whether any initial effects are maintained following exercise. 12 asymptomatic subjects participated; each being screened for excessive pronation (navicular drop > 10 mm). Plantar pressure data was recorded, using the F-scan, at four intervals during the testing session: un-taped, baseline-taped, post-exercise session 1, and post-exercise session 2. Each exercise session consisted of a 10-minute walk at a normal pace. The foot was divided into 6 regions during data analysis. Repeated-measures analysis of variance (ANOVA) was used to assess regional pressure variations across the four testing conditions. Reduced lateral forefoot peak plantar pressure was the only significant difference immediately post tape application (p = 0.039). This effect was lost after 10 minutes of exercise (p = 0.036). Each exercise session resulted in significantly higher medial forefoot peak pressure compared to un-taped; (p = 0.015) and (p = 0.014) respectively, and baseline-taped; (p = 0.036) and (p = 0.015) respectively. Medial and lateral rearfoot values had also increased after the second session (p = 0.004), following their non-significant reduction at baseline-taped. A trend towards a medial-to-lateral shift in pressure present in the midfoot immediately following tape application was still present after 20 minutes of exercise. Low-Dye tape's initial effect of reduced lateral forefoot peak plantar pressure was lost after a 10-minute walk. However, the tape continued to have an effect on the medial forefoot after

Relationship between the Ulnar Nerve and the Branches of the Radial Nerve to the Medial Head of the Triceps Brachii Muscle.

PubMed

Sh, Cho; Ih, Chung; Uy, Lee

2018-05-17

One branch of the radial nerve to the medial head of the triceps brachii muscle (MHN) has been described as accompanying or joining the ulnar nerve. Mostly two MHN branches have been reported, with some reports of one; however, the topographical anatomy is not well documented. We dissected 52 upper limbs from adult cadavers and found one, two, and three MHN branches in 9.6%, 80.8%, and 9.6% of cases, respectively. The MHN accompanying the ulnar nerve was always the superior MHN. The relationship between the ulnar nerve and the MHN was classified into four types according to whether the MHN was enveloped along with the ulnar nerve in the connective tissue sheath and whether it was in contact with the ulnar nerve. It contacted the ulnar nerve in 75.0% of cases and accompanied it over a mean distance of 73.6 mm (range 36-116 mm). In all cases in which the connective tissue sheath enveloped the branch of the MHN and the ulnar nerve, removing the sheath confirmed that the MHN branch originated from the radial nerve. The detailed findings and anatomical measurements of the MHN in this study will help in identifying its branches during surgical procedures. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

Biomechanical investigation of two plating systems for medial column fusion in foot

PubMed Central

Simons, Paul; Sommerer, Theresia; Zderic, Ivan; Wahl, Dieter; Lenz, Mark; Skulev, Hristo; Knobe, Matthias; Gueorguiev, Boyko; Richards, R. Geoff; Klos, Kajetan

2017-01-01

Background Arthrodesis of the medial column (navicular, cuneiform I and metatarsal I) is performed for reasons such as Charcot arthropathy, arthritis, posttraumatic reconstruction or severe pes planus. However, the complication rate is still high and mainly resulting from inadequate fixation. Special plates, designed for medial column arthrodesis, seem to offer potential to reduce the complication rate. The aim of this study was to investigate biomechanically plantar and dorsomedial fusion of the medial column using two new plating systems. Methods Eight matched pairs of human cadaveric lower legs were randomized in two groups and medial column fusion was performed using either plantar or dorsomedial variable-angle locking compression plates. The specimens were biomechanically tested under cyclic progressively increasing axial loading with physiological profile of each cycle. In addition to the machine data, mediolateral x-rays were taken every 250 cycles and motion tracking was performed to determine movements at the arthrodesis site. Statistical analysis of the parameters of interest was performed at a level of significance p = 0.05. Results Displacement of the talo-navicular joint after 1000, 2000 and 4000 cycles was significantly lower for plantar plating (p≤0.039) while there was significantly less movement in the naviculo-cuneiform I joint for dorsal plating post these cycle numbers (p<0.001). Displacements in all three joints of the medial column, as well as angular and torsional deformations between the navicular and metatarsal I increased significantly for each plating technique between 1000, 2000 and 4000 cycles (p≤0.021). The two plating systems did not differ significantly with regard to stiffness and cycles to failure (p≥0.171). Conclusion From biomechanical point of view, although dorsomedial plating showed less movement than plantar plating in the current setup under dynamic loading, there was no significant difference between the two plating

Biomechanical investigation of two plating systems for medial column fusion in foot.

PubMed

Simons, Paul; Sommerer, Theresia; Zderic, Ivan; Wahl, Dieter; Lenz, Mark; Skulev, Hristo; Knobe, Matthias; Gueorguiev, Boyko; Richards, R Geoff; Klos, Kajetan

2017-01-01

Arthrodesis of the medial column (navicular, cuneiform I and metatarsal I) is performed for reasons such as Charcot arthropathy, arthritis, posttraumatic reconstruction or severe pes planus. However, the complication rate is still high and mainly resulting from inadequate fixation. Special plates, designed for medial column arthrodesis, seem to offer potential to reduce the complication rate. The aim of this study was to investigate biomechanically plantar and dorsomedial fusion of the medial column using two new plating systems. Eight matched pairs of human cadaveric lower legs were randomized in two groups and medial column fusion was performed using either plantar or dorsomedial variable-angle locking compression plates. The specimens were biomechanically tested under cyclic progressively increasing axial loading with physiological profile of each cycle. In addition to the machine data, mediolateral x-rays were taken every 250 cycles and motion tracking was performed to determine movements at the arthrodesis site. Statistical analysis of the parameters of interest was performed at a level of significance p = 0.05. Displacement of the talo-navicular joint after 1000, 2000 and 4000 cycles was significantly lower for plantar plating (p≤0.039) while there was significantly less movement in the naviculo-cuneiform I joint for dorsal plating post these cycle numbers (p<0.001). Displacements in all three joints of the medial column, as well as angular and torsional deformations between the navicular and metatarsal I increased significantly for each plating technique between 1000, 2000 and 4000 cycles (p≤0.021). The two plating systems did not differ significantly with regard to stiffness and cycles to failure (p≥0.171). From biomechanical point of view, although dorsomedial plating showed less movement than plantar plating in the current setup under dynamic loading, there was no significant difference between the two plating systems with regard to stiffness and

The relationship between foot posture and plantar pressure during walking in adults: A systematic review.

PubMed

Buldt, Andrew K; Allan, Jamie J; Landorf, Karl B; Menz, Hylton B

2018-02-23

Foot posture is a risk factor for some lower limb injuries, however the underlying mechanism is not well understood. Plantar pressure analysis is one technique to investigate the interaction between foot posture and biomechanical function of the lower limb. The aim of this review was to investigate the relationship between foot posture and plantar pressure during walking. A systematic database search was conducted using MEDLINE, CINAHL, SPORTDiscus and Embase to identify studies that have assessed the relationship between foot posture and plantar pressure during walking. Included studies were assessed for methodological quality. Meta-analysis was not conducted due to heterogeneity between studies. Inconsistencies included foot posture classification techniques, gait analysis protocols, selection of plantar pressure parameters and statistical analysis approaches. Of the 4213 citations identified for title and abstract review, sixteen studies were included and underwent quality assessment; all were of moderate methodological quality. There was some evidence that planus feet display higher peak pressure, pressure-time integral, maximum force, force-time integral and contact area predominantly in the medial arch, central forefoot and hallux, while these variables are lower in the lateral and medial forefoot. In contrast, cavus feet display higher peak pressure and pressure-time integral in the heel and lateral forefoot, while pressure-time integral, maximum force, force-time integral and contact area are lower for the midfoot and hallux. Centre of pressure was more laterally deviated in cavus feet and more medially deviated in planus feet. Overall, effect sizes were moderate, but regression models could only explain a small amount of variance in plantar pressure variables. Despite these significant findings, future research would benefit from greater methodological rigour, particularly in relation to the use of valid foot posture measurement techniques, gait analysis

[Plantar fibromatosis and Dupuytren's contracture in an adolescent].

PubMed

Nikolić, Jelena; Janjić, Zlata; Momcilović, Dragan; Ninković, Srdjan; Harhai, Vladimir

2011-10-01

Fibromatosis represents a wide group of benign, locally proliferative disorders of fibroblasts. Dupuytren's disease is a benign proliferative disease of palmar aponeurosis which usually affects adults between 40 and 60 years of age. Ledderhose's disease or plantar fibromatosis is plantar equivalent of Dupuyten's disease most often affecting middle-aged and older men, usually bilateral, represented with painless nodule in the medial division of plantar fascia. We presented a 19-year old adolescent that turned to a plastic surgeon complaining to his small finger contracture. He noticed palmar thickening with nodule over the metacarpophalangeal joint of small finger of his right hand when he was 16 years old. A year later a finger started to band. During physical checkup we noticed plantar nodule that also had his father and grandmother. Magnetic resonance and tumor biopsy confirmed a suspicion on plantar fibromatosis - Ledderhose's disease. Clinical exam of the hand clearly led to a conclusion that the patient had Dupuytren's contracture with pretendinous cord over the small finger flexor tendons and lack of extension of proximal interphalangeal (PIP) joint. On the extensor side of the PIP joints there were Garrod's nodes. The patient refused surgical treatment of plantar tumor, but agreed to surgical correction of finger contracture. Despite the fact that Dupuytren's disease and plantar fibromatosis are diseases of adults, the possibility of conjoint appearance of these forms of fibromatosis in adolescent period of life should be kept in mind especially in patients with strong genetic predisposition.

Evaluating plantar fascia strain in hyperpronating cadaveric feet following an extra-osseous talotarsal stabilization procedure.

PubMed

Graham, Michael E; Jawrani, Nikhil T; Goel, Vijay K

2011-01-01

Abnormal talotarsal joint mechanics leading to hyperpronation is implicated as one of the most common causes of plantar fasciopathy. In patients with hyperpronating feet, the plantar fascia experiences excessive tensile forces during static and dynamic weight-bearing activities because of excessive medial longitudinal arch depression. For the purposes of this study, we hypothesized that plantar fascia strain in hyperpronating cadaveric feet would decrease after intervention with an extra-osseous talotarsal stabilization (EOTTS) device. A miniature differential variable reluctance transducer was used to quantify the plantar fascia strain in 6 fresh-frozen cadaver foot specimens exhibiting flexible instability of the talotarsal joint complex (i.e., hyperpronation). The strain was measured as the foot was moved from its neutral to maximally pronated position, before and after intervention using the HyProCure(®) EOTTS device. The mean plantar fascia elongation was 0.83 ± 0.27 mm (strain 3.62% ± 1.17%) and 0.56 ± 0.2 mm (strain 2.42% ± 0.88%) before and after intervention, respectively (N = 18, variation reported is ± 1 SD). The average plantar fascia strain decreased by 33%, and the difference was statistically significant with p < .001. From this cadaveric experiment, the reduction in plantar fascia strain suggests that an EOTTS device might be effective in stabilizing the pathologic talotarsal joint complex and the medial longitudinal arch and in eliminating hyperpronation. An EOTTS procedure might offer a possible treatment option for plantar fasciopathy in cases in which the underlying etiology is abnormal talotarsal biomechanics. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Exertional compartment syndrome of the medial foot compartment--diagnosis and treatment: a case report.

PubMed

Izadi, Faye E; Richie, Douglas H

2014-07-01

Exertional compartment syndrome in the foot is rarely reported and often confused with plantar fasciitis as a cause of arch pain in the running athlete. We describe a case involving a 19-year-old competitive collegiate runner who developed a chronic case of bilateral medial arch pain during training, which was initially diagnosed as plantar fasciitis but failed to respond to conventional treatment. After symptoms began to suggest exertional compartment syndrome, the diagnosis was confirmed by measuring an elevated resting pressure in the medial compartment of both feet. The patient underwent a bilateral medial compartment fasciotomy, which allowed a full return to activity, and has remained pain free after a 1-year follow-up.

Gender differences in plantar loading during three soccer-specific tasks.

PubMed

Sims, E L; Hardaker, W M; Queen, R M

2008-04-01

Examine the effect of gender on plantar loading during three football-specific tasks. Thirty-four athletes (17 men, 17 women) ran an agility course five times while wearing the Nike Vitoria hard ground cleat. Plantar loading data were recorded during a side cut, a cross-over cut and a forward acceleration task using Pedar-X insoles. Controlled laboratory study. No history of lower extremity injury in the past 6 months, no previous foot or ankle surgery, not currently wearing foot orthotics and play a cleated sport at least two times per week. Contact area, maximum force and the force-time integral (FTI) in the medial and lateral midfoot, medial, middle and lateral forefoot as well as the hallux. A univariate ANCOVA (alpha = 0.05) was performed on each dependent variable (covariate was course speed). Significant gender differences existed in the force and force-time integral beneath the lateral midfoot and forefoot during the cross-over cut task as well as in the middle forefoot during the side cut task with the men demonstrating an increased force. No significant differences existed in the loading on the medial side of the foot during any tasks. The results of this study indicate that the increase in plantar loading on the lateral portion of the midfoot and forefoot in men could be one possible explanation for the increased incidence of fifth metatarsal stress fractures in men. Gender differences in loading patterns need to be considered when comparing different movements as well as different footwear conditions.

Discrete sensors distribution for accurate plantar pressure analyses.

PubMed

Claverie, Laetitia; Ille, Anne; Moretto, Pierre

2016-12-01

The aim of this study was to determine the distribution of discrete sensors under the footprint for accurate plantar pressure analyses. For this purpose, two different sensor layouts have been tested and compared, to determine which was the most accurate to monitor plantar pressure with wireless devices in research and/or clinical practice. Ten healthy volunteers participated in the study (age range: 23-58 years). The barycenter of pressures (BoP) determined from the plantar pressure system (W-inshoe®) was compared to the center of pressures (CoP) determined from a force platform (AMTI) in the medial-lateral (ML) and anterior-posterior (AP) directions. Then, the vertical ground reaction force (vGRF) obtained from both W-inshoe® and force platform was compared for both layouts for each subject. The BoP and vGRF determined from the plantar pressure system data showed good correlation (SCC) with those determined from the force platform data, notably for the second sensor organization (ML SCC= 0.95; AP SCC=0.99; vGRF SCC=0.91). The study demonstrates that an adjusted placement of removable sensors is key to accurate plantar pressure analyses. These results are promising for a plantar pressure recording outside clinical or laboratory settings, for long time monitoring, real time feedback or for whatever activity requiring a low-cost system. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

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

PubMed

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

2018-07-01

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

Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis.

PubMed

Chang, Ryan; Rodrigues, Pedro A; Van Emmerik, Richard E A; Hamill, Joseph

2014-08-22

Clinically, plantar fasciitis (PF) is believed to be a result and/or prolonged by overpronation and excessive loading, but there is little biomechanical data to support this assertion. The purpose of this study was to determine the differences between healthy individuals and those with PF in (1) rearfoot motion, (2) medial forefoot motion, (3) first metatarsal phalangeal joint (FMPJ) motion, and (4) ground reaction forces (GRF). We recruited healthy (n=22) and chronic PF individuals (n=22, symptomatic over three months) of similar age, height, weight, and foot shape (p>0.05). Retro-reflective skin markers were fixed according to a multi-segment foot and shank model. Ground reaction forces and three dimensional kinematics of the shank, rearfoot, medial forefoot, and hallux segment were captured as individuals walked at 1.35 ms(-1). Despite similarities in foot anthropometrics, when compared to healthy individuals, individuals with PF exhibited significantly (p<0.05) (1) greater total rearfoot eversion, (2) greater forefoot plantar flexion at initial contact, (3) greater total sagittal plane forefoot motion, (4) greater maximum FMPJ dorsiflexion, and (5) decreased vertical GRF during propulsion. These data suggest that compared to healthy individuals, individuals with PF exhibit significant differences in foot kinematics and kinetics. Consistent with the theoretical injury mechanisms of PF, we found these individuals to have greater total rearfoot eversion and peak FMPJ dorsiflexion, which may put undue loads on the plantar fascia. Meanwhile, increased medial forefoot plantar flexion at initial contact and decreased propulsive GRF are suggestive of compensatory responses, perhaps to manage pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

Ground reaction forces and plantar pressure distribution during occasional loaded gait.

PubMed

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

2013-05-01

This study compared the ground reaction forces (GRF) and plantar pressures between unloaded and occasional loaded gait. The GRF and plantar pressures of 60 participants were recorded during unloaded gait and occasional loaded gait (wearing a backpack that raised their body mass index to 30); this load criterion was adopted because is considered potentially harmful in permanent loaded gait (obese people). The results indicate an overall increase (absolute values) of GRF and plantar pressures during occasional loaded gait (p < 0.05); also, higher normalized (by total weight) values in the medial midfoot and toes, and lower values in the lateral rearfoot region were observed. During loaded gait the magnitude of the vertical GRF (impact and thrust maximum) decreased and the shear forces increased more than did the proportion of the load (normalized values). These data suggest a different pattern of GRF and plantar pressure distribution during occasional loaded compared to unloaded gait. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: A prospective, randomised trial.

PubMed

Bhatia, Nidhi; Sen, Indu Mohini; Mandal, Banashree; Batra, Ankita

2018-03-29

Analgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients. This prospective, randomised trial was conducted in 50 ASA I and II male patients≥18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period. There was no significant difference in the total postoperative analgesic consumption [group I: 66.04mg; group II: 68.33mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group. Medial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Reconstruction of a traumatic plantar foot defect with a novel free flap: The medial triceps brachii free flap.

PubMed

Leclère, Franck Marie; Casoli, Vincent

2015-01-01

Lower extremity defects may account for 14.6% of the approximately 117 million visits to emergency departments in the U. S. in 2007. In this article, we present a reconstruction of a traumatic plantar foot defect with a medial triceps brachii (MTB) free flap. A 53-year-old man sustained an accidental gunshot wound to the right foot. The patient was admitted after the failure of a sural flap procedure performed in another hospital. He presented with a soft-tissue defect with calcaneal exposition and osteomyelitis. The defect was reconstructed with a MTB free flap anastomosed to his dorsalis pedis vessels. Flap raising time was 52 min. There were no intraoperative complications. The total flap surface was 38.5 cm². The pedicle length was 3 cm. The diameters of the artery and vein of the flap pedicle were 1.1 mm and 1.4 mm, respectively. Ischemia time was 28 min. His donor site healed uneventfully without any morbidity, and the scar was well concealed. The flaps survived and there was no partial flap necrosis. A split-thickness skin graft was performed 12 days postoperatively. Two months later, he had a completely healed wound with no contour abnormality. The total follow-up was 24 months. The patient was able to walk normally. MTB free flap appears to be an excellent option for plantar foot defects in patients with preserved vascularization of the foot. Due to the anatomical shape of the flap, the position of its pedicle, and the moldability of the muscle, we predict that the use of the MTB free flap will grow and develop rapidly for reconstruction of ankle and foot defects.

Biomechanical properties of the forefoot plantar soft tissue as measured by an optical coherence tomography-based air-jet indentation system and tissue ultrasound palpation system.

PubMed

Chao, Clare Y L; Zheng, Yong-Ping; Huang, Yan-Ping; Cheing, Gladys L Y

2010-07-01

The forefoot medial plantar area withstand high plantar pressure during locomotion, and is a common site that develops foot lesion problems among elderly people. The aims of the present study were to (1) determine the correlation between the biomechanical properties of forefoot medial plantar soft tissue measured by a newly developed optical coherence tomography-based air-jet indentation system and by tissue ultrasound palpation system, and (2) to compare the biomechanical properties of plantar soft tissues of medial forefoot between a young and old adult group. Thirty healthy subjects were classified as the young or older group. The biomechanical properties of plantar soft tissues measured at the forefoot by the air-jet indentation system and tissue ultrasound palpation system were performed, and the correlation of the findings obtained in the two systems were compared. A strong positive correlation was obtained from the findings in the two systems (r=0.88, P<0.001). The forefoot plantar soft tissue of the older group was significantly stiffer at the second metatarsal head and thinner at both metatarsal heads than that of the young group (all P<0.05). The stiffness coefficient at the second metatarsal head was 28% greater than that at the first metatarsal head in both study groups. Older subjects showed a loss of elasticity and reduced thickness in their forefoot plantar soft tissue, with the second metatarsal head displaying stiffer and thicker plantar tissue than the first metatarsal head. The air-jet indentation system is a useful instrument for characterizing the biomechanical properties of soft tissue. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

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

Effects of running-induced fatigue on plantar pressure distribution in novice runners with different foot types.

PubMed

Anbarian, Mehrdad; Esmaeili, Hamed

2016-07-01

This study aimed to assess the effects of running-induced fatigue on plantar pressure parameters in novice runners with low and high medial longitudinal arch. Plantar pressure data from 42 novice runners (21 with high, and 21 with low arch) were collected before and after running-induced fatigue protocol during running at 3.3m/s along the Footscan(®) platform. Peak plantar pressure, peak force and force-time integral (impulse) were measured in ten anatomical zones. Relative time for foot roll-over phases and medio-lateral force ratio were calculated before and after the fatigue protocol. After the fatigue protocol, increases in the peak pressure under the first-third metatarsal zones and reduction under the fourth-fifth metatarsal regions were observed in the low arch individuals. In the high arch group, increases in peak pressure under the fourth-fifth metatarsal zones after the running-induced fatigue was observed. It could be concluded that running-induced fatigue had different effects on plantar pressure distribution pattern among novice runners with low and high medial longitudinal foot arch. These findings could provide some information related to several running injuries among individuals with different foot types. Copyright © 2016 Elsevier B.V. All rights reserved.

Plantar pressure during running in subjects with chronic ankle instability.

PubMed

Morrison, Katherine E; Hudson, David J; Davis, Irene S; Richards, James G; Royer, Todd D; Dierks, Tracy A; Kaminski, Thomas W

2010-11-01

It has been suggested that dynamic foot and ankle mechanics predispose individuals with CAI to repetitive episodes of the ankle ``giving way.'' Plantar pressure variations during a walking gait have been detected in those with CAI, but more dynamic conditions for analysis are needed. The purpose of this study was to evaluate plantar pressure distributions during a running gait in individuals with CAI, individuals who suffered a lateral ankle sprain, but did not develop CAI (AS), and subjects with no history of a lateral ankle sprain (CON). Forty-five subjects [15 in each group, healthy males (18) and females (27), age 18 to 45] were recruited from University communities to participate in this study. Plantar pressure distributions were analyzed on a Tekscan© plantar pressure mat at 66 frames per second during a running gait at a controlled speed. The following variables were obtained: rearfoot medial/lateral (M/L) pressure ratio at foot strike (FS) and center-of-pressure (COP) trajectory during the initial loading response (heel strike to initial peak GRF). Separate one-way ANOVA with Tukey's post-hoc were used to test for group differences. The significance level was defined as p < 0.05. The CAI group had a significantly more lateral ratio (0.97 ± 0.12) at FS when compared to the CON (1.01 ± 0.13) and AS (1.11 ± 0.13) groups. The CAI subjects had a lateral COP trajectory during the loading phase (7.97 degrees ± 11.02), while both the AS (-3.68 degrees ± 10.24) and CON groups (-6.27 degrees ± 9.86) had medial trajectories. The difference was significant between the CAI group and both the AS and CON groups (all significant {\\it p} values were less than 0.05). Our results confirm that CAI subjects have a more lateral foot positioning and loading pattern during a barefoot running gait when compared to both the CON and LAS groups. Clinicians treating patients with CAI should consider providing interventions to decrease the amount of rearfoot inversion at FS and

A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report.

PubMed

Yildiz, Necmettin; Ardic, Füsun

2008-04-21

Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow.

A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report

PubMed Central

2008-01-01

Introduction Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow. PMID:18426569

The influence of foot position on stretching of the plantar fascia.

PubMed

Flanigan, Ryan M; Nawoczenski, Deborah A; Chen, Linlin; Wu, Hulin; DiGiovanni, Benedict F

2007-07-01

A recent study found nonweightbearing stretching exercises specific to the plantar fascia to be superior to the standard program of weightbearing Achilles tendon-stretching exercises in patients with chronic plantar fasciitis. The present study used a cadaver model to demonstrate the influence of foot and ankle position on stretching of the plantar fascia. Twelve fresh-frozen lower-leg specimens were tested in 15 different configurations representing various combinations of ankle and metatarsophalangeal (MTP) joint dorsiflexion, midtarsal transverse plane abduction and adduction, and forefoot varus and valgus. Measurements were recorded by a differential variable reluctance transducer (DVRT) implanted into the medial band of the plantar fascia, and primary measurement was a percent deformation of the plantar fascia (stretch) with respect to a reference position (90 degrees ankle dorsiflexion, 0 degrees midtarsal and forefoot orientation, and 0 degrees MTP dorsiflexion). Ankle and MTP joint dorsiflexion produced a significant increase (14.91%) in stretch compared to the position of either ankle dorsiflexion alone (9.31% increase, p < 0.001) or MTP dorsiflexion alone (7.33% increase, p < 0.01). There was no significant increase in stretch with positions of abduction or varus (2.49%, p = 0.27 and 0.55%, p = 0.79). This study provides a mechanical explanation for enhanced outcomes in recent clinical trials using plantar fascia tissue-specific stretching exercises and lends support to the use of ankle and MTP joint dorsiflexion when employing stretching protocols for nonoperative treatment in patients with chronic proximal plantar fasciitis.

Endoscopic plantar fascia release via a suprafascial approach is effective for intractable plantar fasciitis.

PubMed

Miyamoto, Wataru; Yasui, Youichi; Miki, Shinya; Kawano, Hirotaka; Takao, Masato

2017-10-14

To evaluate the medium-term clinical results of endoscopic plantar fascia release (EPFR) using a suprafascial approach for recalcitrant plantar fasciitis. Twenty-four feet of twenty-three patients who underwent EPFR using a suprafascial approach were followed up for more than 2 years using the American Orthopedic Foot and Ankle Society (AOFAS) score. The AOFAS score at final follow-up was compared between patients who participated in athletic activity (group A) and those who were sedentary (group S) and between those with and those without calcaneal spur (group with CS and group without CS, respectively). The ability of patients to return to athletic activity, and if so, the time interval between surgery and return to athletic activity, were investigated in group A. Complications were recorded. The median follow-up duration was 48 months. The mean AOFAS score in all patients increased significantly between before surgery and final follow-up (P < 0.001). The mean score in group A at final follow-up was significantly higher than that in group S (P < 0.05). However, there was no significant difference in the mean score at final follow-up between the groups with and without CS. In group A, all patients could return to athletic activity after a median 8 weeks. Injury to the first branch of the lateral plantar nerve occurred in three feet. EPFR using a suprafascial approach was effective for recalcitrant plantar fasciitis. However, the prognosis of sedentary patients was inferior to that of patients engaged in athletic activity. IV.

Increased plantar force and impulse in American football players with high arch compared to normal arch

PubMed Central

Carson, Daniel W.; Myer, Gregory D.; Hewett, Timothy E.; Heidt, Robert S.; Ford, Kevin R.

2014-01-01

Background Risk of overuse injury among athletes is high due in part to repeated loading of the lower extremities. Compared to individuals with normal arch (NA) structure, those with high (HA) or low arch (LA) may be at increased risk of specific overuse injuries, including stress fractures. A high medial longitudinal arch may result in decreased shock absorbing properties due to increased rigidity in foot mechanics. While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied. Objective The purpose of this study was to determine if differences in plantar loading in football players occur during both walking and pivoting movements. Method Plantar loading was examined in 9 regions of the foot for 26 participants (16 NA, 10 HA). Results High arch athletes demonstrated increased maximum force in the lateral rear foot and medial forefoot, and force time integral in the medial forefoot while walking. HA athletes also demonstrated increased maximum force in the medial rear foot and medial and central forefoot during rapid pivoting. Conclusions The current findings demonstrate that loading patterns differ between football players with high and normal arch structure, which could possibly influence injury risk in this population. PMID:23141809

Plantar fascia anatomy and its relationship with Achilles tendon and paratenon

PubMed Central

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

2013-01-01

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

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

PubMed

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

2013-12-01

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

The Effect of Landing Surface on the Plantar Kinetics of Chinese Paratroopers Using Half-Squat Landing

PubMed Central

Li, Yi; Wu, Ji; Zheng, Chao; Huang, Rong Rong; Na, Yuhong; Yang, Fan; Wang, Zengshun; Wu, Di

2013-01-01

The objective of the study was to determine the effect of landing surface on plantar kinetics during a half-squat landing. Twenty male elite paratroopers with formal parachute landing training and over 2 years of parachute jumping experience were recruited. The subjects wore parachuting boots in which pressure sensing insoles were placed. Each subject was instructed to jump off a platform with a height of 60 cm, and land on either a hard or soft surface in a half-squat posture. Outcome measures were maximal plantar pressure, time to maximal plantar pressure (T-MPP), and pressure-time integral (PTI) upon landing on 10 plantar regions. Compared to a soft surface, hard surface produced higher maximal plantar pressure in the 1st to 4th metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5th metatarsal region. Shorter T- MPP was found during hard surface landing in the 1st and 2nd metatarsal and medial rear foot. Landing on a hard surface landing resulted in a lower PTI than a soft surface in the 1stphalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the1st to 4thmetatarsal region for hard surface landing, and the 1stphalangeal and 5thmetatarsal region for soft surface landing. Key Points Understanding plantar kinetics during the half-squat landing used by Chinese paratroopers can assist in the design of protective footwear. Compared to landing on a soft surface, a hard surface produced higher maximal plantar pressure in the 1st to 4th metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5th metatarsal region. A shorter time to maximal plantar pressure was found during a hard surface landing in the 1st and 2nd metatarsals and medial rear foot. Landing on a hard surface resulted in a lower pressure-time integral than landing on a soft surface in the 1st phalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the 1st to 4th metatarsal

Vocal fold medialization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation?

PubMed

Sipp, J Andrew; Kerschner, Joseph E; Braune, Nicole; Hartnick, Christopher J

2007-08-01

To review surgical interventions for pediatric unilateral vocal fold immobility (UVFI). Retrospective medical chart review. Two tertiary academic centers. All children who underwent vocal fold medialization for dysphonia, with or without aspiration, from January 2004 to September 2006. Injection laryngoplasty, ansa cervicalis-recurrent laryngeal nerve anastomosis, or thyroplasty. Age, sex, intervention, etiology, time from onset of UVFI to surgery, subjective success in improving voice, subjective duration of improvement, and complications. Twenty-seven procedures were performed in 15 patients (mean age, 10.6 years). Nineteen injection laryngoplasties, 3 thyroplasties (1 bilateral), 2 ansa cervicalis-recurrent laryngeal nerve reinnervation procedures, 1 adduction arytenoidopexy, and 1 cricothyroid joint subluxation were performed. Causes of UVFI included thoracic surgery in 6 cases (40%), prolonged intubation in 4 (26%), central nervous system neoplasm in 3 (20%), unknown etiology in 1 (7%), and anoxic brain injury in 1 (7%). The mean duration from onset of symptoms to treatment was 47 months. There was 1 surgical complication (postoperative aspiration pneumonia following thyroplasty while the patient was under local anesthesia). Parents reported a satisfactory outcome in all cases. Injection laryngoplasty, thyroplasty, and nerve reinnervation can be performed in pediatric patients with good outcomes and an acceptable safety profile. This article describes the experiences of 2 institutions with phonosurgery for UVFI in children and provides insight into the advantages and disadvantages of each procedure. Prospective studies, with validated quality-of-life measurements, are needed to greater clarify the role of different types of phonosurgery in children with UVFI.

Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function.

PubMed

Mulligan, Edward P; Cook, Patrick G

2013-10-01

A specific training program emphasizing the neuromuscular recruitment of the plantar intrinsic foot muscles, colloquially referred to as "short foot" exercise (SFE) training, has been suggested as a means to dynamically support the medial longitudinal arch (MLA) during functional tasks. A single-group repeated measures pre- and post-intervention study design was utilized to determine if a 4-week intrinsic foot muscle training program would impact the amount of navicular drop (ND), increase the arch height index (AHI), improve performance during a unilateral functional reaching maneuver, or the qualitative assessment of the ability to hold the arch position in single limb stance position in an asymptomatic cohort. 21 asymptomatic subjects (42 feet) completed the 4-week SFE training program. Subject ND decreased by a mean of 1.8 mm at 4 weeks and 2.2 mm at 8 weeks (p < 0.05). AHI increased from 28 to 29% (p < 0.05). Intrinsic foot muscle performance during a static unilateral balancing activity improved from a grade of fair to good (p < 0.001) and subjects experienced a significant improvement during a functional balance and reach task in all directions with the exception of an anterior reach (p < 0.05). This study offers preliminary evidence to suggest that SFE training may have value in statically and dynamically supporting the MLA. Further research regarding the value of this exercise intervention in foot posture type or pathology specific patient populations is warranted. Copyright © 2013 Elsevier Ltd. All rights reserved.

Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis.

PubMed

Cheung, R T H; Sze, L K Y; Mok, N W; Ng, G Y F

2016-09-01

Plantar fasciitis, a common injury in runners, has been speculated to be associated with weakness of the intrinsic foot muscles. A recent study reported that atrophy of the intrinsic forefoot muscles might contribute to plantar fasciitis by destabilizing the medial longitudinal arch. However, intrinsic foot muscle volume difference between individuals with plantar fasciitis and healthy counterparts remains unknown. This study examined the relationship of intrinsic foot muscle volume and incidence of plantar fasciitis. Case-control study. 20 experienced (≥5 years) runners were recruited. Ten of them had bilateral chronic (≥2 years) plantar fasciitis while the others were healthy characteristics-matched runners. Intrinsic muscle volumes of the participants' right foot were scanned with a 1.5T magnetic resonance system and segmented using established methods. Body-mass normalized intrinsic foot muscle volumes were compared between runners with and without chronic plantar fasciitis. There was significant greater rearfoot intrinsic muscle volume in healthy runners than runners with chronic plantar fasciitis (Cohen's d=1.13; p=0.023). A similar trend was also observed in the total intrinsic foot muscle volume but it did not reach a statistical significance (Cohen's d=0.92; p=0.056). Forefoot volume was similar between runners with and without plantar fasciitis. These results suggest that atrophy of intrinsic foot muscles may be associated with symptoms of plantar fasciitis in runners. These findings may provide useful information in rehabilitation strategies of chronic plantar fasciitis. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Increasing preferred step rate during running reduces plantar pressures.

PubMed

Gerrard, James M; Bonanno, Daniel R

2018-01-01

Increasing preferred step rate during running is a commonly used strategy in the management of running-related injuries. This study investigated the effect of different step rates on plantar pressures during running. Thirty-two healthy runners ran at a comfortable speed on a treadmill at five step rates (preferred, ±5%, and ±10%). For each step rate, plantar pressure data were collected using the pedar-X in-shoe system. Compared to running with a preferred step rate, a 10% increase in step rate significantly reduced peak pressure (144.5±46.5 vs 129.3±51 kPa; P=.033) and maximum force (382.3±157.6 vs 334.0±159.8 N; P=.021) at the rearfoot, and reduced maximum force (426.4±130.4 vs 400.0±116.6 N; P=.001) at the midfoot. In contrast, a 10% decrease in step rate significantly increased peak pressure (144.5±46.5 vs 161.5±49.3 kPa; P=.011) and maximum force (382.3±157.6 vs 425.4±155.3 N; P=.032) at the rearfoot. Changing step rate by 5% provided no effect on plantar pressures, and no differences in plantar pressures were observed at the medial forefoot, lateral forefoot or hallux between the step rates. This study's findings indicate that increasing preferred step rate by 10% during running will reduce plantar pressures at the rearfoot and midfoot, while decreasing step rate by 10% will increase plantar pressures at the rearfoot. However, changing preferred step rate by 5% will provide no effect on plantar pressures, and forefoot pressures are unaffected by changes in step rate. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

PubMed

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

1996-07-01

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

Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet.

PubMed

Buldt, Andrew K; Forghany, Saeed; Landorf, Karl B; Levinger, Pazit; Murley, George S; Menz, Hylton B

2018-03-05

Variations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet. Ninety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed ® -x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups. Overall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics. Copyright © 2018 Elsevier B.V. All rights reserved.

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.

Plantar loading during cutting while wearing a rigid carbon fiber insert.

PubMed

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

2014-01-01

Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Crossover study. Laboratory. A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Although a rigid carbon graphite footplate altered some aspects of the plantar-pressure profile during cutting in uninjured participants, it was ineffective in reducing plantar loading beneath the fifth metatarsal.

Contributions of foot muscles and plantar fascia morphology to foot posture.

PubMed

Angin, Salih; Mickle, Karen J; Nester, Christopher J

2018-03-01

The plantar foot muscles and plantar fascia differ between different foot postures. However, how each individual plantar structure contribute to foot posture has not been explored. The purpose of this study was to investigate the associations between static foot posture and morphology of plantar foot muscles and plantar fascia and thus the contributions of these structures to static foot posture. A total of 111 participants were recruited, 43 were classified as having pes planus and 68 as having normal foot posture using Foot Posture Index assessment tool. Images from the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles, and the calcaneal (PF1), middle (PF2) and metatarsal (PF3) regions of the plantar fascia were obtained using a Venue 40 ultrasound system with a 5-13 MHz transducer. In order of decreasing contribution, PF3 > FHB > FHL > PER > FDB were all associated with FPI and able to explain 69% of the change in FPI scores. PF3 was the highest contributor explaining 52% of increases in FPI score. Decreased thickness was associated with increased FPI score. Smaller cross sectional area (CSA) in FHB and PER muscles explained 20% and 8% of increase in FPI score. Larger CSA of FDB and FHL muscles explained 4% and 14% increase in FPI score respectively. The medial plantar structures and the plantar fascia appear to be the major contributors to static foot posture. Elucidating the individual contribution of multiple muscles of the foot could provide insight about their role in the foot posture. Copyright © 2018. Published by Elsevier B.V.

Finite element analysis of plantar fascia during walking: a quasi-static simulation.

PubMed

Chen, Yen-Nien; Chang, Chih-Wei; Li, Chun-Ting; Chang, Chih-Han; Lin, Cheng-Feng

2015-01-01

The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling. A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject. The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism. Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase. Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis. © The Author(s) 2014.

Plantar fascia softening in plantar fasciitis with normal B-mode sonography.

PubMed

Wu, Chueh-Hung; Chen, Wen-Shiang; Wang, Tyng-Guey

2015-11-01

To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography. Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé's test was used to identify where the differences occurred. Compared to healthy participants (red pixel intensity: 146.9 ± 9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4 ± 7.3, p = 0.01), symptomatic sides of unilateral plantar fasciitis (127.1 ± 7.4, p < 0.001), and both sides of bilateral plantar fasciitis (129.4 ± 7.5, p < 0.001). There were no significant differences in plantar fascia thickness or green or blue pixel intensity among these groups. Sonoelastography revealed that the plantar fascia is softer in patients with typical clinical manifestations of plantar fasciitis, even if they exhibit no abnormalities on B-mode sonography.

Comparison of two intramedullary nails for tibiotalocalcaneal fusion: anatomic and radiographic considerations.

PubMed

Mückley, Thomas; Ullm, Sebastian; Petrovitch, Alexander; Klos, Kajetan; Beimel, Claudia; Fröber, Rosemarie; Hofmann, Gunther O

2007-05-01

Retrograde intramedullary nailing is an established procedure for tibiotalocalcaneal arthrodesis. This study was conducted to see whether, and if so to what extent, nail design modifications would influence the risk to anatomic structures and the bony coverage of the nail base. Six pairs of thawed fresh-frozen cadaver legs received two different intramedullary nails (N1: straight nail, lateral-medial tip locking; N2: valgus-curved nail, medial-lateral tip locking) under simulated operative conditions. The specimens were dissected; distances between the at-risk structures and the hardware were measured. The hindfoot axis and the volume of the intracalcaneal nail portion were determined with CT. At the plantar entry site, N2 was significantly farther from the flexor hallucis longus tendon (p=0.047), the medial plantar artery (p=0.026), and the lateral plantar nerve (p=0.026) than N1. The lateral-medial calcaneal locking screw of N1 damaged significantly more often the peroneus brevis tendon (p=0.03) than N2. The proximal tip-locking screw, N2, was significantly farther from the anterior tibial artery (p=0.075) and the deep (p=0.047) and superficial peroneal nerves (p=0.009) than N1; N1 was significantly farther from the great saphenous vein (p=0.075) than N2. The distal tip-locking screw, N1. damaged significantly more often the extensor digitorum longus (p=0.007), the anterior tibial artery(p = 0.04), and the deep and superficial peroneal nerves (p=0.03) than N2. CT did not show any significant changes in the hindfoot axis with either device; intracalcaneal nail volumes were similar. A curved nail can increase the distance to at-risk plantar structures. Medial-lateral nail-tip locking appears to have less risk to neurovascular structures. Safer retrograde intramedullary nailing for tibiotalocalcaneal fusion requires knowledge of the structures at risk and appropriate operative technique.

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.

Modified uniportal endoscopic plantar fasciotomy: a technical report.

PubMed

Angthong, Chayanin; Charoenthamruksa, Chatchavan; Chumchuen, Sukanis; Kanitnate, Supakit; Khadsongkram, Anuwat; Angthong, Wirana

2012-10-01

Several authors have reported the benefits of the recent procedure of the dual portal endoscopic plantar fasciotomy (EPF). However, very little is known concerning its potential capability via the single portal EPF without special cutting device. The present study aimed to demonstrate the effectiveness of uniportal EPF in a patient with severe intractable plantar fasciitis following a failure of several conservative treatments. The recent technique; uniportal EPF under modified method, without a special cutting device, was reviewed in an effort to improve its capability for plantar release and to provide information for the avoidance of this procedure's complications. A patient, with the recalcitrant conditions and the progression of the severe plantar fasciitis of bilateral feet after a failure of the conservative treatments for 13-month period, was included in this report. All data of the preoperative and each successive postoperative period (1, 6 months and last follow-up) were prospectively collected including American Orthopedic Foot and Ankle Society (AOFAS) score, Visual Analogue Scale-Foot and Ankle (VAS-FA) score and any related complications. The operations were carried out by a single surgeon with the modified uniportal EPF via a simple hooked soft-tissue blade, without a special cutting device, on both feet simultaneously. All feet had uniportal EPF with transection of the medial 50% of the plantar fascia. Postoperatively, a patient was instructed to have partial-weight bearing for the first 2 weeks with wearing of full-length silicone insoles. Then, she is allowed to start to fully weightbear with the insoles. She is advised to cautiously return to daily activities and works at 2nd week after the operation. In regard to the EPF in two feet, there were clearly improvements in the comparison between preoperative and last follow-up period in terms of the increasing AOFAS scores, and VAS-FA scores. There were no significant iatrogenic-related complications

Fine dissection of the tarsal tunnel in 60 cases

PubMed Central

Yang, Y.; Du, M. L.; Fu, Y. S.; Liu, W.; Xu, Q.; Chen, X.; Hao, Y. J.; Liu, Z.; Gao, M. J.

2017-01-01

The fine dissection of nerves and blood vessels in the tarsal tunnel is necessary for clinical operations to provide anatomical information. A total of 60 feet from 30 cadavers were dissected. Two imaginary reference lines that passed through the tip of the medial malleolus were applied. A detailed description of the branch pattern and the corresponding position of the posterior tibial nerve, posterior tibial artery, medial calcaneal nerve and medial calcaneal artery was provided, and the measured data were analyzed. Our results can be summarized as follows. I. A total of 81.67% of the bifurcation points of the posterior tibial nerve, which was divided into the medial and lateral plantar nerves, were located within the tarsal tunnel, not distal to the tarsal tunnel. II. The bifurcation points of the posterior tibial artery were all located in the tarsal tunnel. Almost all of the bifurcation points of the posterior tibial artery were lower than those of the posterior tibial nerve. The bifurcation point of the posterior tibial artery situated distal to the tarsal tunnel was not found. III. The number and the origin of the medial calcaneal nerves and arteries were highly variable. PMID:28398291

Plantar fasciitis.

PubMed

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

2012-11-01

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

Plantar fasciitis

PubMed Central

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

2012-01-01

INTRODUCTION In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition. METHODS A literature search was performed using PubMed and MEDLINE®. The following keywords were used, singly or in combination: ‘plantar fasciitis’, ‘plantar heel pain’, ‘heel spur’. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. FINDINGS Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques. PMID:23131221

Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location.

PubMed

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

2013-01-01

We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Diabetic subjects (n=591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure-time integral (PTI) was assessed using Cox regression. During follow-up (2.4years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Location must be considered when assessing the relationship between PPP and plantar ulceration. © 2013.

Anterior superior alveolar nerve injury after extended endoscopic medial maxillectomy: a preclinical study to predict neurological morbidity.

PubMed

Schreiber, Alberto; Mattavelli, Davide; Ferrari, Marco; Rampinelli, Vittorio; Lancini, Davide; Ravanelli, Marco; Bertazzoni, Giacomo; Rodella, Luigi Fabrizio; Buffoli, Barbara; Doglietto, Francesco; Nicolai, Piero

2017-10-01

Endoscopic medial maxillectomies (EMMs) are used to optimize exposure of the maxillary sinus and retromaxillary areas. Although in type D EMM (Sturmann-Canfield procedure) the anterior superior alveolar nerve (ASAN) is always at risk of injury, only 29% of patients complained of alveolar process and dental anesthesia. The purpose of this anatomical study is to assess the neural anastomotic network of the ASAN (ASAN-NAN) and describe different extensions of type D EMMs in a preclinical setting. The ASAN and its medial anastomotic branches (MABs) and lateral anastomotic branches (LABs) were evaluated by cone-beam computerized tomography (CBCT). Five different extensions of type D (D1 to D5) EMMs were identified and nerves at risk of injury in each type were assessed by CBCT. Moreover, quantification of surgical corridors was performed on cadaver heads with a neuronavigation system. Fifty-seven CBCT scans were analyzed. The ASAN would be spared in 16.3% of cases with a type D1 EMM, while it would be injured in the majority of type D2 to D5 resections. At least 1 nerve of the ASAN-NAN was spared in 96.6%, 93%, 74.6%, 0%, and 65.8% of type D1 to D5 EMMs, respectively. Two cadaver heads were dissected and the incremental volume and number of maxillary subsites exposed was assessed in type D1 to D5 EMMs. ASAN function impairment is probably compensated by LABs and MABs. If this hypothesis will be validated in a prospective study on patients, preoperative CBCT evaluation could predict neurological morbidity after type D EMM, and allow tailoring the procedure to minimize impairment of the ASAN-NAN. © 2017 ARS-AAOA, LLC.

MRI-guided Focused Ultrasound Ablation of Lumbar Medial Branch Nerve: Feasibility and Safety Study in a Swine Model

PubMed Central

Kaye, Elena A; Monette, Sebastien; Srimathveeravalli, Govindarajan; Maybody, Majid; Solomon, Stephen B; Gulati, Amitabh

2016-01-01

Purpose About 10–40% of chronic low back pain cases involve facet joints, which are commonly treated with lumbar medial branch (MB) radiofrequency neurotomy. Magnetic Resonance Imaging-guided Focused Ultrasound (MRgFUS), a non-invasive, non-ionizing ablation modality used to treat tumors, neuropathic pain and painful bone metastasis, can also be used to disrupt nerve conduction. This work’s purpose was to study the feasibility and safety of direct MRgFUS ablation of the lumbar MB nerve in acute and subacute swine models. Materials and Methods In vivo MRgFUS ablation was performed in six swine (3 acute and 3 subacute) using a clinical MRgFUS system (ExAblate 2000®; InSightec Ltd., Haifa, Israel) and 3 T MRI scanner (SIGNA; GE Healthcare, Waukesha, WI, USA) combination. Behavioral assessment was performed, and imaging and histology were used to assess the treatment. Results and Conclusions Histological analysis of the in vivo studies confirmed thermal necrosis of the MB nerve could be achieved without damaging the spinal cord or adjacent nerve roots. MRgFUS did not cause changes in the animals’ behavior and ambulation. PMID:27443328

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

PubMed

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

2014-02-12

Context : Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. Objective : To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Design :  Crossover study. Setting : Laboratory. Patients or Other Participants : A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Main Outcome Measure(s) :  Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). Results : During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Conclusions : Although a rigid carbon graphite footplate altered some aspects of the plantar- pressure profile during cutting in uninjured

Plantar Loading During Cutting While Wearing a Rigid Carbon Fiber Insert

PubMed Central

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

2014-01-01

Context Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. Objective: To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Design:  Crossover study. Setting: Laboratory. Patients or Other Participants: A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Main Outcome Measure(s):  Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). Results: During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Conclusions: Although a rigid carbon graphite footplate altered some aspects of the plantar-pressure profile during cutting in uninjured

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

PubMed

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

1999-02-01

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

Diagnostic value of the near-nerve needle sensory nerve conduction in sensory inflammatory demyelinating polyneuropathy.

PubMed

Odabasi, Zeki; Oh, Shin J

2018-03-01

In this study we report the diagnostic value of the near-nerve needle sensory nerve conduction study (NNN-SNCS) in sensory inflammatory demyelinating polyneuropathy (IDP) in which the routine nerve conduction study was normal or non-diagnostic. The NNN-SNCS was performed to identify demyelination in the plantar nerves in 14 patients and in the median or ulnar nerve in 2 patients with sensory IDP. In 16 patients with sensory IDP, routine NCSs were either normal or non-diagnostic for demyelination. Demyelination was identified by NNN-SNCS by dispersion and/or slow nerve conduction velocity (NCV) below the demyelination marker. Immunotherapy was initiated in 11 patients, 10 of whom improved or remained stable. NNN-SNCS played an essential role in identifying demyelinaton in 16 patients with sensory IDP, leading to proper treatment. Muscle Nerve 57: 414-418, 2018. © 2017 Wiley Periodicals, Inc.

Compartment syndrome of the foot.

PubMed

Andermahr, J; Helling, H J; Tsironis, K; Rehm, K E; Koebke, J

2001-05-01

The hindfoot compartment syndrome occurs in 10% of cases after calcaneal fracture. We analyzed the pathological anatomical reasons for this syndrome using the 10 feet from cadavers plastinated and cut into 4-mm thick sequential sections. CT scans of patients with calcaneal fractures were then compared with the anatomical findings. The key component of this compartment syndrome is the quadratus plantae muscle. The sustentacular calcaneal fragment causes bleeding from the bone or the medial calcaneal arteries into this compartment. The medial and lateral plantar nerves and vessels are then compressed between the quadratus plantae muscle and the short flexor digitorum muscle. Relieving pressure by surgical decompression of the quadratus plantae compartment via a medial or plantar approach is the recommended treatment. Copyright 2001 Wiley-Liss, Inc.

Inflammation role in sensory neuropathy in Chinese patients with diabetes/prediabetes.

PubMed

Zeng, Jing; Xu, Yalin; Shi, Yao; Jiang, Chenyin

2018-03-01

Prediabetes involves people with glucose-metabolism impairment, and is related to different diabetic complications, like peripheral neuropathy. We aimed to explore the relationship among inflammatory (tumor necrosis factor alpha [TNFα]) and antiinflammatory (interleukin 10 [IL10]) cytokines as well as neuropathy of very distal-sensory-nerves in Chinese patients with prediabetes/diabetes. In the present study, 55 patients having prediabetes, 55 patients having type 2 diabetes mellitus (DM), and 48 controls were included. TNFα, HbA1c, and IL10 plasma levels were measured. Electrodiagnosis was conducted on dorsal-sural/medial-plantar sensory nerve, that is most distal feet sensory-nerves. Nerve conduction test (NCT) irregularities of dorsal-sural/medial-plantar sensory nerve were considerably greater in patients with prediabetes or diabetes. The means of TNFα levels demonstrated a significant increase in patients with diabetes when compared to prediabetes patients as well as controls showed a significant decrease in patients with prediabetes and diabetes contrasted with controls. No significant contrast with respect to serum biomarkers among patients having regular as well as irregular medial-plantar/dorsal-sural NCT was noted. Critical correlationship among TNFα as well as HbA1c with symptoms severity as well as disability while negative correlations of IL10 with neuropathy severity was noted. Biomarker levels of TNFα, IL10, and HbA1c were noted to differ significantly among patients without/with neuropathy. All in all, the proinflammatory phase appears to start from initial pre-clinical phases, sometime prior to advancement of diabetes. The higher neuropathy frequency in patients with prediabetes indicates conceivable causative impact; although, the prospective part of inflammation in pathogenetics of peripheral neuropathy requires more elucidation. Copyright © 2018 Elsevier B.V. All rights reserved.

Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

PubMed

Cottom, James M; Baker, Joseph S

2016-10-01

When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot. Copyright © 2016 Elsevier Inc. All rights reserved.

Ultrasonographic examination of plantar fasciitis: a comparison of patient positions during examination.

PubMed

Ahn, Jae Hoon; Lee, Choong Woo; Park, ChanJoo; Kim, Yoon-Chung

2016-01-01

Musculoskeletal ultrasound is a non-invasive and low-cost modality for real-time visualisation of the plantar fascia. Ultrasound examination for plantar fasciitis is generally performed with the patient in a prone position, although the rational for using a prone position has not been validated. The aim of the study was to investigate if ultrasound examination in a supine position, which is more comfortable than the prone position, is valid. We conducted a prospective study of 30 participants with plantar fasciitis, 8 men (27 %) and 22 women (73 %), with a mean age of 53.9 ± 12.6 (range, 32 to 77) years, and an equal distribution of left and right feet. The plantar heel was divided into three portions for ultrasound examination: medial, central and lateral. Two measurements of plantar fascia thickness were obtained for each portion, with participants in 2 positions (supine and prone) and for 2 ankle postures (neutral and 15° of plantarflexion). Mean measurements of plantar fascia thickness were compared between the two positions (Wilcoxon signed rank tests for non-normally distributed data and paired t-tests for normally distributed data). Participants were asked to report their preferred position for examination, supine or prone. The measured thickness was comparable for both supine and prone positions, for both ankle postures, neutral and 15° of plantarflexion (p > 0.05). A specific self-reported preferred position was not identified. Ultrasound examination of plantar fasciitis can be performed in the supine position without any significant difference in measurement compared to examination in the conventional prone position. The Catholic Medical Center Office of Human Research Protection Program (CMC-OHRP)/Institutional Review Board approved the current study (Approval No. KC12DISI0338), and all participants provided their written informed consent for participation and publication.

Investigating the role of backward walking therapy in alleviating plantar pressure of patients with diabetic peripheral neuropathy.

PubMed

Zhang, Xingguang; Zhang, Yanqi; Gao, Xiaoxiao; Wu, Jinxiao; Jiao, Xiumin; Zhao, Jing; Lv, Xiaofeng

2014-05-01

To investigate the effect of combination therapy of backward walking training and alpha-lipoic acid (ALA) treatment on the distribution of plantar pressure in patients with diabetic peripheral neuropathy (DPN). This study is a double-blinded, randomized controlled trial. The test group was treated with combination therapy of backward walking exercise and ALA (ALA for 2wk, backward walking exercise for 12wk), and the control group only received ALA treatment. Clinical and laboratory setting. Patients with DPN (N=60) were divided into the test group (n=30) or control group (n=30). Backward walking exercise with ALA treatment for the test group; lipoic acid treatment for the control group. Plantar pressure before and after treatment was tested and analyzed with the flatbed plantar pressure measurement system. After treatment, peak plantar pressure in the forefoot dropped for both the test and control groups; peak plantar pressure for the test group dropped significantly. Peak plantar pressure in the medial foot slightly increased for the test group, suggesting a more even distribution of plantar pressure in the test group after treatment. The combination therapy of ALA and backward walking proved to be more effective than ALA monotherapy. Backward walking also proved to have an ameliorating effect on balance ability and muscle strength of patients with DPN. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The relationship between plantar pressure and footprint shape.

PubMed

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

2013-07-01

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

Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up

PubMed Central

Fernando, Malindu E.; Crowther, Robert G.; Lazzarini, Peter A.; Yogakanthi, Saiumaeswar; Sangla, Kunwarjit S.; Buttner, Petra; Jones, Rhondda; Golledge, Jonathan

2017-01-01

Objective High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls). Methods Standardised protocols were used to measure mean peak plantar pressure and pressure-time integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen’s d) were used to measure effect size. Results Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites including the toes (p = 0.005, Cohen’s d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (p<0.001, d = 0.42), metatarsal 1 (p = 0.02, d = 0.33) and mid-foot (p = 0.04, d = 0.64) compared to controls throughout follow-up. A reduction in pressure-time integral at multiple plantar sites over time was detected in all participants (p<0.05, respectively). Conclusions Plantar pressures assessed during gait are higher in diabetes patients with chronic foot ulcers than controls at several plantar sites throughout prolonged follow-up. Long term offloading is needed in diabetes patients with diabetes-related foot ulcers to facilitate ulcer healing. PMID:28859075

Finite element analysis of plantar fascia under stretch-the relative contribution of windlass mechanism and Achilles tendon force.

PubMed

Cheng, Hsin-Yi Kathy; Lin, Chun-Li; Wang, Hsien-Wen; Chou, Shih-Wei

2008-01-01

Stretching plays an important role in the treatment of plantar fasciitis. Information on the internal stresses/strains of the plantar fascia under stretch is useful in enhancing knowledge on the stretch mechanisms. Although direct measurement can monitor plantar fascia changes, it is invasive and gathers only localized information. The purpose of this paper was to construct a three-dimensional finite element model of the foot to calculate the stretch effects on plantar fascia and monitor its stress/strain distributions and concentrations. A three-dimensional foot model was developed and contained 26 bones with joint cartilages, 67 ligaments and a fan-like solid plantar fascia modeling. All tissues were idealized as linear elastic, homogeneous and isotropic whilst the plantar fascia was assigned as hyperelastic to represent its nonlinearity. The plantar fascia was monitored for its biomechanical responses under various stretch combinations: three toe dorsiflexion angles (windlass effect: 15 degrees , 30 degrees and 45 degrees ) and five Achilles tendon forces (100, 200, 300, 400 and 500N). Our results indicated that the plantar fascia strain increased as the dorsiflexion angles increased, and this phenomenon was enhanced by increasing Achilles tendon force. A stress concentration was found near the medial calcaneal tubercle, and the fascia stress was higher underneath the first foot ray and gradually decreased as it moved toward the fifth ray. The current model recreated the position of the foot when stretch is placed on the plantar fascia. The results provided a general insight into the mechanical and biomechanical aspects of the influences of windlass mechanism and Achilles tendon force on plantar fascia stress and strain distribution. These findings might have practical implications onto plantar fascia stretch approaches, and provide guidelines to its surgical release.

Sericin and swimming on histomorphometric parameters of denervated plantar muscle in Wistar rats.

PubMed

Santana, André Junior; Debastiani, Jean Carlos; Buratti, Pâmela; Peretti, Ana Luiza; Kunz, Regina Inês; Brancalhão, Rose Meire Costa; Ribeiro, Lucinéia de Fátima Chasko; Torrejais, Márcia Miranda; Bertolini, Gladson Ricardo Flor

2018-01-01

Objective To analyze the combined effects of the silk protein sericin and swimming exercise on histomorphometry of the plantar muscle in Wistar rats. Methods Forty adult rats were randomly allocated into 5 groups comprising 8 animals each, as follows: Control, Injury, Sericin, Swim, and Swim plus Sericin. Three days after crushing of the sciatic nerve the rats in the Swim and Swim plus Sericin Groups were submitted to swimming exercise for 21 days. Rats were then euthanized and the plantar muscle harvested and processed. Results Cross-sectional area, peripheral nuclei and muscle fiber counts, nucleus/fiber ratio and smallest muscle fiber width did not differ significantly between groups. Morphological analysis revealed hypertrophic fibers in the Swim Group and evident muscle damage in the Swim plus Sericin and Injury Groups. The percentage of intramuscular collagen was apparently maintained in the Swim Group compared to remaining groups. Conclusion Combined treatment with sericin and swimming exercise did not improve muscle properties. However, physical exercise alone was effective in maintaining intramuscular connective tissue and preventing progression of deleterious effects of peripheral nerve injury.

Effects of turf and cleat footwear on plantar load distributions in adolescent American football players during resisted pushing.

PubMed

Taylor, Jeffrey B; Nguyen, Anh-Dung; Griffin, Janet R; Ford, Kevin R

2018-06-01

Metatarsal and midfoot injuries are common in American football. Footwear design may influence injury rates by altering plantar foot loading patterns in these regions. The purpose of this study was to determine the effect of cleat design on in-shoe plantar foot loading during a football-specific, resisted pushing task. Twenty competitive football players (age 14.7 ± 1.8 years, height 1.72 ± 0.10 m, and mass 71.8 ± 26.9 kg) completed three trials of pushing a weighted sled at maximal effort in a standard shoe (CLEAT) and artificial turf-specific shoe (TURF), with flexible in-shoe force measuring insoles. Repeated measures ANOVAs identified mean differences in maximum force and relative load under all regions of the foot. Results showed higher forces in the CLEAT under the medial (p < 0.001) and lateral (p = 0.004) midfoot, central (p = 0.007) and lateral (p < 0.001) forefoot, and lesser toes (p = 0.01), but lower forces in the hallux (p = 0.02) compared to the TURF shoe. Additionally, relative loading was higher in the CLEAT under the medial (p < 0.001) and lateral (p = 0.002) midfoot and lateral (p < 0.001) forefoot, but lower in the medial forefoot (p = 0.006) and hallux (p < 0.001) compared to the TURF shoe. The two shoes elicited distinct plantar loading profiles and may influence shoe selection decisions during injury prevention or rehabilitation practices.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

The thermoregulation of healthy individuals, overweight-obese, and diabetic from the plantar skin thermogram: a clue to predict the diabetic foot.

PubMed

Renero-C, Francisco-J

2017-01-01

Background : Thermoregulation is a complex autonomic process to keep or to dissipate heat in the human body. Methods : In this work, by means of the thermogram of the plantar skin, the thermoregulation of healthy individuals, overweight-obese, and diabetic is discussed. Results : The thermograms of the plantar skin, for the healthy individuals, are: (1) symmetrical, the temperature distribution of the right foot being a mirror image of that of the left foot ; (2) the thermograms of women, on average, are 3°C colder than those of the men; and (3) the temperature distributions decrease distally from the medial longitudinal arch. The plantar skin thermograms of overweight-obese individuals show: (1) increased average temperature of both feet and for both genders; (2) no symmetry between the left and right feet thermograms; and (3) the temperature distribution is still decreasing from the medial longitudinal arch to the periphery of the foot. However, the standard deviation, for each averaged temperature of the angiosomes, shows greater uncertainty. Most thermograms of diabetic individuals show temperature increase on the plantar skin, and are mostly symmetric between left and right feet. Conclusions: An asymmetric thermogram of the plantar skin of diabetic individuals, where one foot is hotter than the other, may mean that the coldest foot is losing the capacity to communicate properly with the central nervous system and/or that vasoconstriction/vasodilatation is having problems in regulating the passing of blood through the vessels. Thus, the asymmetric thermograms of diabetic patients, and particularly those coldest regions of foot are of interest, because of the reduction of the local autonomic sensing and the lack of achieving properly the passing of the blood.

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.

Shoe inserts alter plantar loading and function in patients with midfoot arthritis.

PubMed

Rao, Smita; Baumhauer, Judith F; Becica, Laura; Nawoczenski, Deborah A

2009-07-01

Experimental laboratory study supplemented by a case series. (1) To assess the effect of a 4-week intervention with a full-length insert on functional outcomes in patients with midfoot arthritis; (2) to examine the effect of the custom molded three-quarter-length (3Q) and full-length (FL) carbon graphite insert on plantar loading in patients with midfoot arthritis. Given the coexistence of pain and lower-arched foot alignment in patients with midfoot arthritis, arch-restoring orthotic devices such as the 3Q insert are frequently recommended. However, patients continue to report foot pain despite using the 3Q insert. The FL insert has been proposed as an alternative, but objective data examining its efficacy are lacking. Twenty female patients with midfoot arthritis participated in the study. Functional outcomes were assessed using the Foot Function Index-Revised (FFI-R). Plantar loading during walking was measured in the following conditions: shoe only, shoe with 3Q insert, and shoe with FL insert. Repeated-measures analyses of variance with post hoc analyses were used for statistical analysis. FL insert use for 4 weeks resulted in a 12% improvement in total FFI-R score (mean +/- SD before, 35.6 +/- 10.9; after, 31.1 +/- 9.8 [P = .03]). FL insert use resulted in a 20% reduction in medial midfoot average pressure loading (mean +/- SD, 64.8 +/- 20.4 and 51.0 +/- 15.4 kPa, with 3Q and FL insert respectively [P = .015]) and an 8.5% reduction in medial midfoot contact time (mean +/- SD, 84.9% +/- 6.4% and 76.4% +/- 7.1% of stance, with 3Q and FL insert respectively [P<.01]), compared to the 3Q insert. No differences in plantar loading were discerned between the shoe-only and FL conditions. Symptomatic improvement in patients with midfoot arthritis treated with a FL insert was accompanied by reduced magnitude and duration of loading under the medial midfoot. These preliminary outcomes suggest that the FL insert may be a viable alternative in the conservative management

Plantar fasciitis

MedlinePlus

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

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

PubMed Central

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

2014-01-01

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

Human ankle plantar flexor muscle–tendon mechanics and energetics during maximum acceleration sprinting

PubMed Central

Schache, Anthony G.; Brown, Nicholas A. T.; Pandy, Marcus G.

2016-01-01

Tendon elastic strain energy is the dominant contributor to muscle–tendon work during steady-state running. Does this behaviour also occur for sprint accelerations? We used experimental data and computational modelling to quantify muscle fascicle work and tendon elastic strain energy for the human ankle plantar flexors (specifically soleus and medial gastrocnemius) for multiple foot contacts of a maximal sprint as well as for running at a steady-state speed. Positive work done by the soleus and medial gastrocnemius muscle fascicles decreased incrementally throughout the maximal sprint and both muscles performed more work for the first foot contact of the maximal sprint (FC1) compared with steady-state running at 5 m s−1 (SS5). However, the differences in tendon strain energy for both muscles were negligible throughout the maximal sprint and when comparing FC1 to SS5. Consequently, the contribution of muscle fascicle work to stored tendon elastic strain energy was greater for FC1 compared with subsequent foot contacts of the maximal sprint and compared with SS5. We conclude that tendon elastic strain energy in the ankle plantar flexors is just as vital at the start of a maximal sprint as it is at the end, and as it is for running at a constant speed. PMID:27581481

Surface electromyography and plantar pressure changes with novel gait training device in participants with chronic ankle instability.

PubMed

Feger, Mark A; Hertel, Jay

2016-08-01

Rehabilitation is ineffective at restoring normal gait in chronic ankle instability patients. Our purpose was to determine if a novel gait-training device could decrease plantar pressure on the lateral column of the foot in chronic ankle instability patients. Ten chronic ankle instability patients completed 30s trials of baseline and gait-training walking at a self-selected pace while in-shoe plantar pressure and surface electromyography were recorded from their anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius. The gait-training device applied a medially-directed force to the lower leg via elastic bands during the entire gait cycle. Plantar pressure measures of the entire foot and 9 specific regions of the foot as well as surface electromyography root mean square areas were compared between the baseline and gait-training conditions using paired t-tests with a priori level of significance of p≤0.05. The gait-training device decreased pressure time integrals and peak pressures in the lateral midfoot (p=0.003 and p=0.003) and lateral forefoot (p=0.023 and p=0.005), and increased pressure time integrals and peak pressures for the total foot (p=0.030 and p=0.017) and hallux (p=0.005 and p=0.002). The center of pressure was shifted medially during the entire stance phase (p<0.003 for all comparisons) due to increased peroneus longus activity prior to (p=0.002) and following initial contact (p=0.002). The gait-training device decreased pressure on the lateral column of the foot and increased peroneus longus muscle activity. Future research should analyze the efficacy of the gait-training device during gait retraining for chronic ankle instability. Copyright © 2016 Elsevier Ltd. All rights reserved.

Selective plantar fascia release for nonhealing diabetic plantar ulcerations.

PubMed

Kim, J Young; Hwang, Seungkeun; Lee, Yoonjung

2012-07-18

Achilles tendon lengthening can decrease plantar pressures, leading to resolution of forefoot ulceration in patients with diabetes mellitus. However, this procedure has been reported to have a complication rate of 10% to 30% and can require a long period of postoperative immobilization. We have developed a new technique, selective plantar fascia release, as an alternative to Achilles tendon lengthening for managing these forefoot ulcers. We evaluated sixty patients with diabetes for a mean of 23.5 months after selective plantar fascia release for the treatment of nonhealing diabetic neuropathic ulcers in the forefoot. Preoperative and postoperative dorsiflexion range of motion of the affected metatarsophalangeal joint and wound-healing data were used to evaluate the effectiveness of the procedure and to determine the relationship between plantar fascia release and ulcer healing. Complications were recorded. Thirty-six (56%) of the ulcers healed within six weeks, including twenty-nine (60%) of the plantar toe ulcers and seven (44%) of the metatarsophalangeal joint ulcers. The mean range of motion of the affected metatarsophalangeal joint increased from 15.3° ± 7.8° to 30.6° ± 14.1° postoperatively (p < 0.05). All patients in whom the preoperative dorsiflexion of the affected metatarsophalangeal joint was between 5° and 30° and in whom the range of motion of that joint increased by ≥13° after the procedure experienced healing of the ulcer. No ulcer recurrence in the original location was identified during follow-up. No patients experienced any complications associated with the selective plantar fascia release. Our results suggest that selective plantar fascia release can lead to healing of neuropathic plantar forefoot ulcers in diabetic patients. Ulcers in patients in whom the preoperative dorsiflexion angle of the affected metatarsophalangeal joint is between 5° and 30° and in whom the increase in range of motion is ≥13° postoperatively have the

Plantar flaps based on perforators of the plantar metatarsal/common digital arteries.

PubMed

Valentin, Georgescu Alexandru; Rodica, Matei Ileana; Manuel, Llusa

2014-09-01

Because of the unique characteristics of its integument, the affirmation "replacing like with like" becomes more than evident in the reconstruction of defects of the ultraspecialized plantar skin. But, the paucity of local resources, and especially in the forefoot, transforms this attempt in a very challenging problem. Many techniques, including skin grafts and various types of flaps were used in the management of defects in the forefoot. We present a new useful flap in the reconstruction of skin defects in the forefoot, based on small perforator vessels originating either from the plantar metatarsal arteries or plantar common digital arteries. Starting with June 2011, this flap was performed, as plantar transposition perforator flap, plantar propeller flap, or plantar propeller perforator plus flap, in seven patients with ulcers over the plantar forefoot. During a follow-up of 7 to 17 months (mean, 9.8 months), the local evolution regarding flap integration, pain, relapse, sensitive recovery, donor site, and footwear quality was analyzed. We registered a 100% survival rate of the flaps, with delayed healing in only one case. The gait resumption was possible after 6 weeks in all cases. This new flap, based on small perforator vessels from the plantar metatarsal or common digital arteries, and which provides a good, stable, and sensory recovery, seems to be a promising method in the reconstruction of plantar skin defects over the metatarsal heads. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy.

PubMed

Cerrahoglu, Lale; Koşan, Umut; Sirin, Tuba Cerrahoglu; Ulusoy, Aslihan

2016-05-01

We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications. Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program. In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P < .001); static pedobarographic values showed significant reduction in right forefoot-medial pressure (P = .010); and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial (P = .007), right forefoot lateral (P = .018), left midfoot (P < .001), and right hindfoot (P = .021) after exercise. No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups (P > .05). A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Comparison of four different nerve conduction techniques of the superficial fibular sensory nerve.

PubMed

Saffarian, Mathew R; Condie, Nathan C; Austin, Erica A; Mccausland, Katie E; Andary, Michael T; Sylvain, James R; Mull, Iian R; Zemper, Eric D; Jannausch, Mary L

2017-09-01

There are many different nerve conduction study (NCS) techniques to study the superficial fibular sensory nerve (SFSN). We present reference distal latency values and comparative data regarding 4 different NCS for the SFSN. Four different NCS techniques, Spartan technique, Izzo techniques (medial and intermediate dorsal cutaneous branches), and Daube technique, were performed on (114) healthy volunteers. A total of 108 subjects with 164 legs were included. The mean latency of the Spartan technique was longest (3.9 ± 0.3 ms) while the Daube technique was the shortest (3.6 ± 0.7 ms). The mean amplitude of the Daube technique displayed the highest (15.2 ± 8.2 μV) with the Spartan technique having the lowest (8.7 ± 4.2 μV). Among the absent sensory nerve action potentials (SNAPs), the Spartan technique was absent only twice (1.2%) and the Izzo Medial technique was absent more than the other techniques (2.9%). All 4 techniques were reliable methods for obtaining the superficial fibular nerve SNAP, present in 95% of individuals. Muscle Nerve 56: 458-462, 2017. © 2017 Wiley Periodicals, Inc.

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

PubMed Central

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

2016-01-01

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

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

PubMed

O'Brien, Davida Louise; Tyndyk, Magdalena

2014-01-01

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

Reduction of plantar pressures in leprosy patients by using custom made shoes and total contact insoles.

PubMed

Tang, Simon Fuk-Tan; Chen, Carl P C; Lin, Shih-Cherng; Wu, Chih-Kuan; Chen, Chih-Kuang; Cheng, Shun-Ping

2015-02-01

The purpose of this study was to observe whether our custom made shoes and total contact insoles can effectively increase the plantar contact areas and reduce peak pressures in patients with leprosy. In the rehabilitation laboratory of a tertiary medical center. Six male and two female leprosy patients were recruited in this study. In this study, parameters related to foot pressures were compared between these patients wearing commercial available soft-lining kung-fu shoes and our custom made shoes with total contact insoles. The custom made shoes were made with larger toe box and were able to accommodate both the foot and the insoles. Custom made total contact insoles were made with the subtalar joints under neutral and non-weight-bearing positions. The insole force measurement system of Novel Pedar-X (Novel, Munich, Germany) was used to measure the plantar forces. The parameters of contact area (cm(2)), peak plantar pressures (kPa), contact time (s), and pressure time integral (kPa s) were measured. There were significant contact area increases in the right and left foot heel areas, left medial arch, and second to fifth toes after wearing the custom made shoes and insoles. There were significant decreases in peak plantar pressures in bilateral heels, left lateral midfoot, bilateral second to fourth metatarsal areas, and left fifth metatarsal head after wearing the custom made shoes and insoles (p<0.05). Plantar ulceration is a common serious disability in leprosy patients. As a result, footwear and measures able to reduce plantar pressures may be beneficial in preventing plantar ulcers from occurring in these patients. Our custom made shoes and total contact insoles were proven to be effective in increasing contact areas and decreasing peak pressures in plantar surfaces, and may therefore be a feasible treatment option in preventing leprosy patients from developing plantar ulcers. © 2015 Elsevier B.V. All rights reserved.

Outcomes After Superior Rectus Transposition and Medial Rectus Recession Versus Vertical Recti Transposition for Sixth Nerve Palsy.

PubMed

Lee, Yeon-Hee; Lambert, Scott R

2017-05-01

To compare the effectiveness of superior rectus transposition and medial rectus recession (SRT/MRc) vs inferior and superior rectus transposition (VRT) for acquired sixth nerve palsy. Consecutive, interventional case series. The medical records of a consecutive series of patients with acquired sixth nerve palsy who underwent VRT or SRT/MRc by a single surgeon were reviewed. The preoperative and postoperative findings were compared between the 2 groups. Eight patients (mean age, 46.8 years) underwent SRT/MRc and 8 patients underwent VRT (mean age, 51.1 years). Lateral fixation was performed on all but 4 patients in the VRT group. Preoperative esotropia in primary position and abduction deficit were similar in both groups (SRT/MRc, 41.9 prism diopter [PD], -4.6; VRT, 55.6 PD, -4.5; P = .195, 1.0). The SRT/MRc group underwent a mean MR recession of 6 (range, 5-7) mm. Four patients in the VRT later underwent MR recession (mean 5.3 mm, range 5-6 mm). In addition, 5 patients in the VRT group had 1 or more botulinum toxin injections in the medial rectus muscle. No additional procedures were performed in the SRT/MR group. Fewer additional procedures were performed with SRT/MR (SRT/MR, 0; VRT, 1.8 ± 1.2; P < .010). At last follow-up, residual esotropia (SRT/MRc, 7.1 PD; VRT, 10.3 PD; P = .442) was similar in both groups, but abduction was better in the SRT/MRc group (SRT/MR, -3.0 ± 0.7; VRT, -3.8 ± 0.4; P = .038). There were no new persistent vertical deviations or torsional diplopia. Final outcomes were similar with SRT/MRc vs VRT. However, fewer additional surgical procedures were needed with SRT/MR. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed Central

2014-01-01

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

Potential sites of compression of tibial nerve branches in foot: a cadaveric and imaging study.

PubMed

Ghosh, Sanjib Kumar; Raheja, Shashi; Tuli, Anita

2013-09-01

Hypertrophy of abductor hallucis muscle is one of the reported causes of compression of tibial nerve branches in foot, resulting in tarsal tunnel syndrome. In this study, we dissected the foot (including the sole) of 120 lower limbs in 60 human cadavers (45 males and 15 females), aged between 45 and 70 years to analyze the possible impact of abductor hallucis muscle in compression neuropathy of tibial nerve branches. We identified five areas in foot, where tibial nerve branches could be compressed by abductor hallucis. Our findings regarding three of these areas were substantiated by clinical evidence from ultrasonography of ankle and sole region, conducted in the affected foot of 120 patients (82 males and 38 females), aged between 42 and 75 years, who were referred for evaluation of pain and/or swelling in medial side of ankle joint with or without associated heel and/or sole pain. We also assessed whether estimation of parameters for the muscle size could identify patients at risk of having nerve compression due to abductor hallucis muscle hypertrophy. The interclass correlation coefficient for dorso-planter thickness of abductor hallucis muscle was 0.84 (95% CI, 0.63-0.92) and that of medio-lateral width was 0.78 (95% CI, 0.62-0.88) in the imaging study, suggesting both are reliable parameters of the muscle size. Receiver operating characteristic curve analysis showed, if ultrasonographic estimation of dorso-plantar thickness is >12.8 mm and medio-lateral width > 30.66 mm in patients with symptoms of nerve compression in foot, abductor hallucis muscle hypertrophy associated compression neuropathy may be suspected. Copyright © 2012 Wiley Periodicals, Inc.

Nerve Entrapment in Ankle and Foot: Ultrasound Imaging.

PubMed

Chari, Basavaraj; McNally, Eugene

2018-07-01

Peripheral nerve entrapment of the ankle and foot is relatively uncommon and often underdiagnosed because electrophysiologic studies may not contribute to the diagnosis. Anatomy of the peripheral nerves is variable and complex, and along with a comprehensive physical examination, a thorough understanding of the applied anatomy is essential. Several studies have helped identify specific areas in which nerves are commonly compressed. Identified secondary causes of nerve compression include previous trauma, osteophytes, ganglion cysts, edema, accessory muscles, tenosynovitis, vascular lesions, and a primary nerve tumor. Imaging plays a key role in identifying primary and secondary causes of nerve entrapment, specifically ultrasound (US) and magnetic resonance imaging. US is a dynamic imaging modality that is cost effective and offers excellent resolution. Symptoms of nerve entrapment may mimic other common foot and ankle conditions such as plantar fasciitis. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Plantar fasciitis

PubMed Central

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

2012-01-01

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

Ultrasound evaluation of foot muscles and plantar fascia in pes planus.

PubMed

Angin, Salih; Crofts, Gillian; Mickle, Karen J; Nester, Christopher J

2014-01-01

Multiple intrinsic and extrinsic soft tissue structures that apply forces and support the medial longitudinal arch have been implicated in pes planus. These structures have common functions but their interaction in pes planus is not fully understood. The aim of this study was to compare the cross-sectional area (CSA) and thickness of the intrinsic and extrinsic foot muscles and plantar fascia thickness between normal and pes planus feet. Forty-nine adults with a normal foot posture and 49 individuals with pes planus feet were recruited from a university population. Images of the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles and the plantar fascia were obtained using a Venue 40 ultrasound system with a 5-13 MHz transducer. The CSA and thickness of AbH, FHB and PER muscles were significantly smaller (AbH -12.8% and -6.8%, FHB -8.9% and -7.6%, PER -14.7% and -10%), whilst FDL (28.3% and 15.2%) and FHL (24% and 9.8%) were significantly larger in the pes planus group. The middle (-10.6%) and anterior (-21.7%) portions of the plantar fascia were thinner in pes planus group. Greater CSA and thickness of the extrinsic muscles might reflect compensatory activity to support the MLA if the intrinsic foot muscle function has been compromised by altered foot structure. A thinner plantar fascia suggests reduced load bearing, and regional variations in structure and function in feet with pes planus. Copyright © 2014 Elsevier B.V. All rights reserved.

Surface electromyography and plantar pressure during walking in young adults with chronic ankle instability.

PubMed

Koldenhoven, Rachel M; Feger, Mark A; Fraser, John J; Saliba, Susan; Hertel, Jay

2016-04-01

Lateral ankle sprains are common and can manifest into chronic ankle instability (CAI) resulting in altered gait mechanics that may lead to subsequent ankle sprains. Our purpose was to simultaneously analyse muscle activation patterns and plantar pressure distribution during walking in young adults with and without CAI. Seventeen CAI and 17 healthy subjects walked on a treadmill at 4.8 km/h. Plantar pressure measures (pressure-time integral, peak pressure, time to peak pressure, contact area, contact time) of the entire foot and nine specific foot regions and medial-lateral location of centre of pressure (COP) were measured. Surface electromyography (EMG) root mean square (RMS) amplitudes throughout the entire stride cycle and area under RMS curve for 100 ms pre-initial contact (IC) and 200 ms post-IC for anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius were collected. The CAI group demonstrated a more lateral COP throughout the stance phase (P < 0.001 and Cohen's d > 0.9 for all 10 comparisons) and significantly increased peak pressure (P = 0.025) and pressure-time integral (P = 0.049) under the lateral forefoot. The CAI group had lower anterior tibialis RMS areas (P < 0.001) and significantly higher peroneus longus, medial gastrocnemius, and gluteus medius RMS areas during 100 ms pre-IC (P < 0.003). The CAI group had higher gluteus medius sEMG amplitudes during the final 50 % of stance and first 25% of swing (P < 0.05). The CAI group had large lateral deviations of their COP location throughout the entire stance phase and increased gluteus medius muscle activation amplitude during late stance through early swing phase. III.

Plantar fasciitis: a concise review.

PubMed

Schwartz, Emily N; Su, John

2014-01-01

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

Nerve stripper-assisted sural nerve harvest.

PubMed

Hassanpour, Esmail; Yavari, Masoud; Karbalaeikhani, Ali; Saremi, Hossein

2014-03-01

Sural nerve has the favorite length and size for nerve graft interposition. Here two techniques, that is, "stocking seam" and "stair-step" or "stepladder," have been used for harvesting sural nerve. The first technique results in an unsightly scar at the posterior calf, and the latter one takes a long time to perform and exert undue traction to the graft during harvesting. The purpose of this article is to describe our experience in harvesting the sural nerve by a nerve stripper. A nerve stripper was used for harvesting sural nerve in 35 adult patients (in 6 patients, sural harvesting was done bilaterally), 27 men and 8 women. Thirty-one sural nerve harvests were done by closed technique (i.e., harvesting of sural nerve only by two incisions, one in the posterior of the lateral malleolus and the other in popliteal fossa), in 8 others by limited open technique, and in 2 cases, there was early laceration of the sural nerve at the beginning of the study. The contralateral sural nerve was harvested in one patient and medial antebrachial nerve in another by open technique. The mean length of the retrieved sural nerve was 34.5 cm in the closed technique group and 35 cm in the limited open technique group. We detected advancing Tinel's sign in all nerve stripper-assisted sural nerve harvested group members in both the closed and limited open groups. Sural nerve harvesting by the nerve stripper is a reliable and simple technique, and it is applicable as a routine technique. Applying controlled rotatory movements of the nerve stripper instead of pushing can result in satisfactory harvesting of the sural nerve without early laceration. Georg Thieme Verlag KG Stuttgart · New York.

Maximum toe flexor muscle strength and quantitative analysis of human plantar intrinsic and extrinsic muscles by a magnetic resonance imaging technique.

PubMed

Kurihara, Toshiyuki; Yamauchi, Junichiro; Otsuka, Mitsuo; Tottori, Nobuaki; Hashimoto, Takeshi; Isaka, Tadao

2014-01-01

The aims of this study were to investigate the relationships between the maximum isometric toe flexor muscle strength (TFS) and cross-sectional area (CSA) of the plantar intrinsic and extrinsic muscles and to identify the major determinant of maximum TFS among CSA of the plantar intrinsic and extrinsic muscles. Twenty six young healthy participants (14 men, 12 women; age, 20.4 ± 1.6 years) volunteered for the study. TFS was measured by a specific designed dynamometer, and CSA of plantar intrinsic and extrinsic muscles were measured using magnetic resonance imaging (MRI). To measure TFS, seated participants optimally gripped the bar with their toes and exerted maximum force on the dynamometer. For each participant, the highest force produced among three trials was used for further analysis. To measure CSA, serial T1-weighted images were acquired. TFS was significantly correlated with CSA of the plantar intrinsic and extrinsic muscles. Stepwise multiple linear regression analyses identified that the major determinant of TFS was CSA of medial parts of plantar intrinsic muscles (flexor hallucis brevis, flexor digitorum brevis, quadratus plantae, lumbricals and abductor hallucis). There was no significant difference between men and women in TFS/CSA. CSA of the plantar intrinsic and extrinsic muscles is one of important factors for determining the maximum TFS in humans.

Plantar Fasciitis: A Concise Review

PubMed Central

Schwartz, Emily N; Su, John

2014-01-01

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

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.

[Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy].

PubMed

Rodríguez-Reyes, Gerardo; López-Gavito, Eduardo; Pérez-Sanpablo, Alberto Isaac; Galván Duque-Gastélum, Carlos; Alvarez-Camacho, Michelín; Mendoza-Cruz, Felipe; Parra-Téllez, Patricia; Vázquez-Escamilla, Jesús; Quiñones-Urióstegui, Ivett

2014-07-01

Percutaneous surgical techniques are suitable for the correction of the hallux valgus deformity. Satisfactory aesthetic and functional results obtained with the Reverdin- Isham osteotomy have been reported. The aim of this study was to describe dynamic plantar pressure redistribution after the correction of the deformity using this technique. A sample of 20 feet with mild or moderate hallux valgus was conformed and surgically treated using the Reverdin-Isham osteotomy. Clinical, radiological, surface and pressure assessments were performed pre and postoperatively. Postoperative mean (± SD) values of the American Orthopaedic Foot and Ankle Society (AOFAS) score, metatarsophalangeal, first intermetatarsal and proximal articular sect angles were 95.7 (3.3), 15.5° (5.4), 9.5° (1.5) y 5.3° (3.0), respectively. A significant decrease was observed in surface values of both lateral (P = 0.003) and medial (P = 0.001) masks of the forefoot. Mean pressure values of the lateral forefoot region denoted a significant increase (P < 0.001) while the medial forefoot region showed no change (P = 0.137). There is evidence that this particular surgical technique promotes a new plantar pressure pattern in the foot that might significantly favour the increase of the pressure observed under the lesser metatarsal heads and might not induce meaningful changes in the mean pressure registered under the first metatarsal head and hallux.

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

PubMed

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

2015-01-01

The effects of gender and various anthropometric variables were previously reported as significant predictors of plantar fascia thickness. Although a strong correlation between either the body weight or body mass index (BMI) and plantar fascia thickness were not demonstrated, a moderate relation was stated. We retrospectively investigated the role of gender, height, weight, and body mass index on plantar fascia thickness at the calcaneal origin (PFCO) and 1 cm distal from the calcaneal origin (PF1cm) and the coronal length of the plantar fascia at the calcaneal origin (CLPF) in healthy subjects. The PFCO, PF1cm, and CLPF were retrospectively measured from magnetic resonance images of 100 healthy subjects. The gender, height, weight, and body mass index of the participants were also noted. Gender was a predictive factor for the length of the CLPF. The subjects with a BMI >25 kg/m(2) had a significantly greater PFCO, PF1cm, and CLPF. Height was mildly and BMI and weight were moderately related to the PFCO. However the CLPF showed a better correlation with height, BMI, and weight than that of plantar fascia thickness. CLPF better reflected the role of weight, BMI, and height than its thickness. It is a new parameter that could be valuable in the evaluation of plantar fascia disorders. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Relationship of Plantar Fascia Thickness and Preoperative Pain, Function, and Quality of Life in Recalcitrant Plantar Fasciitis.

PubMed

Gamba, Carlo; Sala-Pujals, Aleix; Perez-Prieto, Daniel; Ares-Vidal, Jesus; Solano-Lopez, Alberto; Gonzalez-Lucena, Gemma; Ginés-Caspedosa, Alberto

2018-04-01

The measurement of plantar fascia thickness has been advocated as a diagnostic and prognostic instrument in patients with plantar fasciitis, but there are no data relative to it in recalcitrant plantar fasciitis. The aim of the study is to evaluate the correlation between plantar fascia thickness and pain, functional score, and health perception in patients with this condition. Thirty-eight feet were studied with ultrasound and magnetic resonance imaging to measure plantar fascia thickness. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS), and SF-36 were then recorded for each patient. The relationship between the fascia and these scores was analyzed to evaluate the correlation of thickness with pain, functional level, and health perception of patients. In patients with recalcitrant plantar fasciitis, plantar fascia thickness did not correlate with pain (VAS), AOFAS, or any item of the SF-36. The thickness of the plantar fascia in patients with recalcitrant plantar fasciitis did not correlate with its clinical impact, and thus, we believe it should not be used in treatment planning. Level IV, case series.

Determination of functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave treatment in horses.

PubMed

Bolt, David M; Burba, Daniel J; Hubert, Jeremy D; Strain, George M; Hosgood, Giselle L; Henk, William G; Cho, Doo-Youn

2004-12-01

To determine functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave (ESW) treatment in horses. 6 horses. The medial and lateral palmar digital nerves of the left forelimb were treated with nonfocused ESWs. The medial palmar digital nerve of the right forelimb served as a nontreated control nerve. At 3, 7, and 35 days after treatment, respectively, 2 horses each were anesthetized and nerves were surgically exposed. Sensory nerve conduction velocities (SNCVs) of treated and control nerves were recorded, after which palmar digital neurectomies were performed. Morphologic changes in nerves were assessed via transmission electron microscopy. Significantly lower SNCV in treated medial and lateral nerves, compared with control nerves, was found 3 and 7 days after treatment. A significantly lower SNCV was detected in treated medial but not lateral nerves 35 days after treatment. Transmission electron microscopy of treated nerves revealed disruption of the myelin sheath with no evidence of damage to Schwann cell bodies or axons, 3, 7, and 35 days after treatment. Nonfocused ESW treatment of the metacarpophalangeal area resulted in lower SNCV in palmar digital nerves. This effect likely contributes to the post-treatment analgesia observed in horses and may result in altered peripheral pain perception. Horses with preexisting lesions may be at greater risk of sustaining catastrophic injuries when exercised after treatment.

Endoscopic Plantar Fasciotomy vs Open Radiofrequency Microtenotomy for Recalcitrant Plantar Fasciitis.

PubMed

Wang, Weining; Rikhraj, Inderjeet Singh; Chou, Andrew Chia Chen; Chong, Hwei Chi; Koo, Kevin Oon Thien

2018-01-01

Although usually self-limiting, around 10% of patients develop recalcitrant plantar fasciitis despite conservative treatment. In such cases, operative intervention can be offered. Traditionally, plantar fasciotomy has been the treatment of choice, but recently, there has been a push for more minimally invasive approaches. Radiofrequency microtenotomy has also been increasingly used as a treatment option. In this study, we compare the outcomes of endoscopic plantar fasciotomy and open radiofrequency microtenotomy. Patients treated in our institution with either procedure between 2007 and 2015 were included and interviewed at baseline and 3 months, 6 months, and 12 months postoperatively using the American Orthopaedic Foot & Ankle Society (AOFAS) and 36-item Medical Outcomes Short Form (SF-36) questionnaires. They were asked questions to evaluate their expectation and satisfaction postoperatively. Demographic and clinicopathological data were prospectively collected from clinical charts and electronic records. There was no difference in either treatment arms preoperatively and an overall improvement in all functional outcomes postoperatively. However, patients who had endoscopic plantar fasciotomy fared better at 3 months compared to patients who underwent open microtenotomy with the visual analog score component of the AOFAS hindfoot score (HINDVAS) and the social functioning and role-functioning-emotional reaching statistical significance ( P = .027, P = .03, and P = .03, respectively). There was no difference in functional outcomes at 6 or 12 months postoperatively. Endoscopic plantar fasciotomy was associated with an earlier improvement in functional outcome in our study. However, both treatments had equivalent outcomes at 1-year follow-up, suggesting that either method is reasonable in the treatment of chronic plantar fasciitis. Level III, comparative study.

Plantar-to-dorsal compared to dorsal-to-plantar screw fixation for proximal chevron osteotomy: a biomechanical analysis.

PubMed

Sharma, Krishn M; Parks, Brent G; Nguyen, Augustine; Schon, Lew C

2005-10-01

A change in screw orientation in fixing the chevron proximal first metatarsal osteotomy was noted anecdotally to improve fixation strength. The authors hypothesized that plantar-to-dorsal screw orientation would be more stable than the conventional dorsal-to-plantar screw orientation for fixation of the chevron osteotomy. The purpose of this study was to determine if the load-to-failure and stiffness of the chevron type proximal first metatarsal osteotomy stabilized using plantar-to-dorsal screw fixation were greater than with the more conventional dorsal-to-plantar screw fixation method. One foot from each of eight matched cadaver pairs was randomly assigned to one of two groups: 1) fixation with a dorsal-to-plantar lag screw or 2) fixation with a plantar-to-dorsal lag screw. A proximal chevron osteotomy was then created using standard technique and the metatarsal was fixed according to previously established method. The bone was potted in polyester resin, and the construct was fitted into a materials testing system machine in which load was applied to the plantar aspect of the metatarsal until failure. The two groups were compared using a two-tailed Student t test. The average load-to-failure and stiffness of the chevron osteotomy fixed with the plantar-to-dorsal lag screw were significantly greater (p < 0.05) than the group fixed with more conventional dorsal-to-plantar lag screws. Plantar-to-dorsal screw orientation was more stable than the conventional dorsal-to-plantar screw orientation for fixation of the proximal chevron osteotomy. Plantar-to-dorsal screw orientation should be considered when using the chevron proximal first metatarsal osteotomy.

The relationship between trans-femoral prosthesis alignment and the center trajectory of plantar pressure in the frontal plane

PubMed Central

Nomura, Tomohiro; Watanabe, Kota; Nosaka, Toshiya; Matsubara, Hiroyuki; Akiyama, Masaharu; Inui, Kimiharu

2016-01-01

[Purpose] It is difficult to identify by visual observation whether alignment abnormalities in trans-femoral prostheses in the frontal plane are attributable to the adduction angle or the abnormal alignment of the positions of the medial and lateral sides of the socket in relation to the foot. Therefore, we focused on the trajectory of the center of plantar pressure during walking, and we proposed a method for differentiating these two alignment abnormalities. [Subjects and Methods] We recruited 4 trans-femoral unilateral amputees. Bench alignment was achieved initially. We compared the amplitude of the trajectory of the center of plantar pressure when walking under 2 conditions: 1) when changing the adduction angle and 2) when changing the positional relationship between the socket and the foot. [Results] It was not possible to distinguish between the 2 types of malalignment on the prosthesis side. There was a significant difference when changing the positional relationship on the contralateral side. Thereby, the plantar pressure of the contralateral side could be used to distinguish between the 2 types of malalignment. [Conclusion] The results of this study suggested that trans-femoral prosthesis malalignment could be evaluated through the plantar pressure of the contralateral side in amputees. PMID:27065546

Lateral femoral cutaneous nerve transposition: Renaissance of an old concept in the light of new anatomy.

PubMed

Hanna, Amgad S

2017-04-01

Meralgia paresthetica causes pain in the anterolateral thigh. Most surgical procedures involve nerve transection or decompression. We conducted a cadaveric study to determine the feasibility of lateral femoral cutaneous nerve (LFCN) transposition. In three cadavers, the LFCN was exposed in the thigh and retroperitoneum. The two layers of the LFCN canal superficial and deep to the nerve were opened. The nerve was then mobilized medially away from the ASIS, by cutting the septum medial to sartorius. It was possible to mobilize the nerve for 2 cm medial to the ASIS. The nerve acquired a much straighter course with less tension. A new technique of LFCN transposition is presented here as an anatomical feasibility study. The surgical technique is based on the new understanding of the LFCN canal. Clin. Anat. 30:409-412, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Effects of pelvic, pudendal, or hypogastric nerve cuts on Fos induction in the rat brain following vaginocervical stimulation.

PubMed

Pfaus, James G; Manitt, Colleen; Coopersmith, Carol B

2006-12-30

In the female rat, genitosensory input is conveyed to the central nervous system predominantly through the pelvic, pudendal, and hypogastric nerves. The present study examined the relative contribution of those three nerves in the expression of Fos immunoreactivity within brain regions previously shown to be activated by vaginocervical stimulation (VCS). Bilateral transection of those nerves, or sham neurectomy, was conducted in separate groups of ovariectomized, sexually-experienced females. After recovery, females were primed with estrogen and progesterone and given either 50 manual VCSs with a lubricated glass rod over the course of 1 h. VCS increased the number of neurons expressing Fos immunoreactivity in the medial preoptic area, lateral septum, bed nucleus of the stria terminalis, ventromedial hypothalamus, and medial amygdala of sham neurectomized females. Transection of the pelvic nerve reduced Fos immunoreactivity in the medial preoptic area, bed nucleus of the stria terminalis, ventromedial hypothalamus, and medial amygdala, whereas transection of the pudendal nerve had no effect. In contrast, transection of the hypogastric nerve increased Fos immunoreactivity in the medial preoptic area and lateral septum, whereas transaction of the pelvic nerve increased Fos immunoreactivity in the lateral septum, following VCS. All females given VCS, except those with pelvic neurectomy, displayed a characteristic immobility during each application. These data confirm that the pelvic nerve is largely responsible for the neural and behavioral effects of VCS, and support a separate function for the hypogastric nerve.

Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review.

PubMed

Walter, William R; Burke, Christopher J; Adler, Ronald S

2017-06-01

To describe a 4-year clinical experience with ultrasound-guided therapeutic perineural injections of peripheral nerves about the foot and ankle. Retrospective analysis of foot and ankle perineural injections performed between January 2012 and August 2016. Demographics, clinical indications, presence of structural pathology, immediate and interval pain relief, as well as complications were recorded. Fifty-nine therapeutic injections were performed among 46 patients, accounting for multiple injections in a single visit or multiple visits [mean age = 43 years (range 18-75), 31 female (67%) and 15 male (33%)]. Most commonly, perineural injections involved the hallux branch of the medial plantar nerve (n = 17, 22%). Least commonly, perineural injections involved the saphenous nerve (n = 3, 4%). Other injections in our series include sural (10), superficial (11) and deep (7) peroneal, medial (5) and lateral (3) plantar nerves, and the posterior tibial nerve (3). Ultrasound evaluation revealed structural abnormality associated with the nerve in 30 cases (51%)-most commonly thickening with perineural scarring (n = 14). Of 45 injections with complete documentation, immediate relief of symptoms was reported in 43 (96%) cases. Interval symptom relief was achieved in 23 injections [short term (n = 12), intermediate (n = 6), and long term (n = 5)] out of 38 for which follow-up was available (61%). Complications are rare, occurring in only one case. Ultrasound-guided perineural injections about the foot and ankle are safe and provide lasting symptomatic relief for many indications. Concomitant sonographic evaluation identifies structural abnormalities that may contribute to neuropathic symptoms, allowing targeting of injection or clinical therapy.

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

PubMed

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

2017-04-01

Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p < 0.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Surgical anatomy of the radial nerve at the elbow.

PubMed

Artico, M; Telera, S; Tiengo, C; Stecco, C; Macchi, V; Porzionato, A; Vigato, E; Parenti, A; De Caro, R

2009-02-01

An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (+/-11) and 157 (+/-11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (+/-4) and 6 (+/-1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (+/-13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (+/-13) and 121 (+/-13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (+/-6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (+/-14) and 110 (+/-23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries.

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

PubMed Central

Foisy, A.; Gaertner, C.; Matheron, E.; Kapoula, Z.

2015-01-01

The purpose of this study was to assess properties of vergence and saccade eye movements as well as posture in quiet stance, and the effects of thin plantar inserts upon postural and oculomotor control. The performances of 36 young healthy subjects were recorded by a force platform and an eye tracker in three testing conditions: without plantar stimulation, with a 3 millimetre-thick plantar insert, either a Medial or a Lateral Arch Support (MAS / LAS). The results showed a decrease of the Surface and Variance of Speed and a more posterior position of the CoP with either stimulation compared with the control condition. The fractal analysis showed a decrease with MAS. Wavelet analysis in the time-frequency domain revealed an increase in the Cancelling Time of the low frequency band with MAS. These results suggest a better stability for a lower energy cost. Concerning eye movements, the inserts influenced only vergence (not saccades): MAS caused an increase of the phasic amplitude of divergence, and conversely a decrease of the tonic amplitude. In contrast, LAS caused an increase of the tonic amplitude of convergence. Thus, MAS renders divergence less visually driven, while LAS renders convergence more visually driven. We conclude that the CNS uses the podal signal for both postural and vergence control via specific mechanisms. Plantar inserts have an influence upon posture and vergence movements in a different way according to the part of the foot sole being stimulated. These results can be useful to clinicians interested in foot or eye. PMID:26637132

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.

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.

Plantar fascia: imaging diagnosis and guided treatment.

PubMed

McNally, Eugene G; Shetty, Shilpa

2010-09-01

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

Nerve Transfer Versus Nerve Graft for Reconstruction of High Ulnar Nerve Injuries.

PubMed

Sallam, Asser A; El-Deeb, Mohamed S; Imam, Mohamed A

2017-04-01

To assess the efficacy of nerve transfer versus nerve grafting in restoring motor and sensory hand function in patients with complete, isolated high ulnar nerve injuries. A retrospective chart review was performed, at a minimum 2 years of follow-up, of 52 patients suffering complete, isolated high ulnar nerve injury between January 2006 and June 2013 in one specialized hand surgery unit. Twenty-four patients underwent motor and sensory nerve transfers (NT group). Twenty-eight patients underwent sural nerve grafting (NG group). Motor recovery, return of sensibility and complications were examined as outcome measures. The Medical Research Council scale was applied to evaluate sensory and motor recovery. Grip and pinch strengths of the hand were measured. Twenty of 24 patients (83.33%) in the NT group regained M3 grade or greater for the adductor pollicis, the abductor digiti minimi, and the medial 2 lumbricals and interossei, compared with only 16 of 28 patients (57.14%) in the NG group. Means for percentage recovery of grip strengths compared with the other healthy hand were significantly higher for the NT group than the NG group. Sensory recovery of S3 or greater was achieved in more than half of each group with no significant difference between groups. Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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

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

PubMed

Fabrikant, Jerry M; Park, Tae Soon

2011-06-01

Ultrasound, well recognized as an effective diagnostic tool, reveals a thickening of the plantar fascia in patients with plantar fasciitis/fasciosis disease. The authors hypothesized that ultrasound would also reveal a decrease in the plantar fascia thickness for patients undergoing treatment for the disease, a hypothesis that, heretofore, had been only tested on a limited number of subjects. They conducted a more statistically significant study that found that clinical treatment with injection and biomechanical correction does indeed diminish plantar fascia thickness as shown on ultrasound. The study also revealed that patients experience the most heightened plantar fascia tenderness toward the end of the day, and improvement in their symptomatic complaints were associated with a reduction in plantar fascia thickness. As a result, the authors conclude that office-based ultrasound can help diagnose and confirm plantar fasciitis/fasciosis through the measurement of the plantar fascia thickness. Because of the advantages of ultrasound--that it is non-invasive with greater patient acceptance, cost effective and radiation-free--the imaging tool should be considered and implemented early in the diagnosis and treatment of plantar fasciitis/fasciosis. Copyright © 2011 Elsevier Ltd. All rights reserved.

Activation of plantar flexor muscles is constrained by multiple muscle synergies rather than joint torques

PubMed Central

Suzuki, Takahito; Kinugasa, Ryuta; Fukashiro, Senshi

2017-01-01

Behavioral evidence has suggested that a small number of muscle synergies may be responsible for activating a variety of muscles. Nevertheless, such dimensionality reduction may also be explained using the perspective of alternative hypotheses, such as predictions based on linear combinations of joint torques multiplied by corresponding coefficients. To compare the explanatory capacity of these hypotheses for describing muscle activation, we enrolled 12 male volunteers who performed isometric plantar flexor contractions at 10–100% of maximum effort. During each plantar flexor contraction, the knee extensor muscles were isometrically contracted at 0%, 50%, or 100% of maximum effort. Electromyographic activity was recorded from the vastus lateralis, medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus muscles and quantified using the average rectified value (ARV). At lower plantar flexion torque, regression analysis identified a clear linear relationship between the MG and soleus ARVs and between the MG and LG ARVs, suggesting the presence of muscle synergy (r2 > 0.65). The contraction of the knee extensor muscles induced a significant change in the slope of this relationship for both pairs of muscles (MG × soleus, P = 0.002; MG × LG, P = 0.006). Similarly, the slope of the linear relationship between the plantar flexion torque and the ARV of the MG or soleus changed significantly with knee extensor contraction (P = 0.031 and P = 0.041, respectively). These results suggest that muscle synergies characterized by non-mechanical constraints are selectively recruited according to whether contraction of the knee extensor muscles is performed simultaneously, which is relatively consistent with the muscle synergy hypothesis. PMID:29107958

Farris-Tang retractor in optic nerve sheath decompression surgery.

PubMed

Spiegel, Jennifer A; Sokol, Jason A; Whittaker, Thomas J; Bernard, Benjamin; Farris, Bradley K

2016-01-01

Our purpose is to introduce the use of the Farris-Tang retractor in optic nerve sheath decompression surgery. The procedure of optic nerve sheath fenestration was reviewed at our tertiary care teaching hospital, including the use of the Farris-Tang retractor. Pseudotumor cerebri is a syndrome of increased intracranial pressure without a clear cause. Surgical treatment can be effective in cases in which medical therapy has failed and disc swelling with visual field loss progresses. Optic nerve sheath decompression surgery (ONDS) involves cutting slits or windows in the optic nerve sheath to allow cerebrospinal fluid to escape, reducing the pressure around the optic nerve. We introduce the Farris-Tang retractor, a retractor that allows for excellent visualization of the optic nerve sheath during this surgery, facilitating the fenestration of the sheath and visualization of the subsequent cerebrospinal fluid egress. Utilizing a medial conjunctival approach, the Farris-Tang retractor allows for easy retraction of the medial orbital tissue and reduces the incidence of orbital fat protrusion through Tenon's capsule. The Farris-Tang retractor allows safe, easy, and effective access to the optic nerve with good visualization in optic nerve sheath decompression surgery. This, in turn, allows for greater surgical efficiency and positive patient outcomes.

Posterior Branches of Lumbar Spinal Nerves - Part I: Anatomy and Functional Importance.

PubMed

Kozera, Katarzyna; Ciszek, Bogdan

2016-01-01

The aim of this paper is to compare anatomic descriptions of posterior branches of the lumbar spinal nerves and, on this basis, present the location of these structures. The majority of anatomy textbooks do not describe these nerves in detail, which may be attributable to the fact that for many years they were regarded as structures of minor clinical importance. The state of knowledge on these nerves has changed within the last 30 years. Attention has been turned to their function and importance for both diagnostic practice and therapy of lower back pain. Summarising the available literature, we may conclude that the medial and lateral branches separate at the junction of the facet joint and the distal upper edge of the transverse process; that the size, course and area supplied differ between the lateral and the medial branch; and that facet joints receive multisegmental innervation. It has been demonstrated that medial branches are smaller than the respective lateral branches and they have a more constant course. Medial branches supply the area from the midline to the facet joint line, while lateral branches innervate tissues lateral to the facet joint. The literature indicates difficulties with determining specific anatomic landmarks relative to which the lateral branch and the distal medial branch can be precisely located. Irritation of sensory fibres within posterior branches of the lumbar spinal nerves may be caused by pathology of facet joints, deformity of the spine or abnormalities due to overloading or injury. The anatomic location and course of posterior branches of spinal nerves should be borne in mind to prevent damaging them during low-invasive analgesic procedures.

Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve.

PubMed

Prades, J M; Gavid, M; Asanau, A; Timoshenko, A P; Richard, C; Martin, C H

2014-03-01

The purpose of the study was to determine the relationships between the extracranial glossopharyngeal (IX) nerve and the muscles of the styloid diaphragm. In humans, the IX nerve is a hidden retrostyloid nerve which plays a critical role notably in swallowing and has to be preserved during infratemporal fossa and parapharyngeal spaces surgical procedures. In ten adult heads from cadavers (20 sides) fixed in formalin, dissection of the extracranial IX nerve was performed under operating microscope with special attention given to the relationships between this nerve and the styloid muscles of the styloid diaphragm. The three styloid muscles delimit three triangular intermuscular intervals which were each thoroughly explored. Different osseous landmarks were investigated for easy nerve location. The styloid process (SP) is the main superior osseous landmark for the three muscles of the styloid diaphragm. The stylohyoid muscle (SHM) is anteromedially located to the posterior belly of the digastric muscle. The styloglossus muscle (SGM) is medial and anterior to the SHM. The stylopharyngeal muscle (SPM) is the most vertical and medial of the three styloid muscles. It courses from the medial surface of the SP in a deep plane hidden between the SHM and the SGM. The extracranial IX nerve turns around the SPM superiorly with a vertical segment posterior to the SPM and inferiorly with a horizontal segment lateral to the SPM. The meeting point of the two segments of the IX nerve is about 10 mm anteriorly located from the transverse process of the atlas. The external carotid artery and some of its branches lie in contact with the lateral side of the IX nerve. Such relationships between the extracranial IX nerve, the styloid muscles and the transverse process of the atlas should be appreciated by clinician who treats patients with stylohyoid complex syndromes and by the surgeon for the parapharyngeal spaces approach.

Plantar Pressures After Nonoperative Treatment for Clubfoot: Intermediate Follow-up at Age 5 Years.

PubMed

Jeans, Kelly A; Erdman, Ashley L; Karol, Lori A

2017-01-01

Worldwide, a nonoperative approach in the treatment of idiopathic clubfoot has been taken in an attempt to reduce the incidence of surgical outcomes. Although both the Ponseti casting (Ponseti) and the French physiotherapy (PT) methods have shown gait and pedobarograph differences at age 2 years, improved gait results have been reported by age 5 years. The purpose of this study was to assess plantar pressures in feet treated with the Ponseti versus the PT methods at this intermediate stage. Clubfoot patients treated nonoperatively (Ponseti or PT) underwent pedobarograph data collection at age 5 years. The foot was subdivided into the medial/lateral hindfoot, midfoot, and forefoot regions. Variables included Peak Pressure, Maximum Force, Contact Area%, Contact Time%, Pressure Time Integral, the hindfoot-forefoot angle, and displacement of the center of pressure (COP) line. Twenty controls were used for comparison. Pedobarograph data from 164 patients (238 feet; 122 Ponseti and 116 PT) showed no significant differences between the Ponseti and the PT feet, except the PT feet had a significantly less medial movement of the COP than the Ponseti feet (P=0.0379). Compared with controls, both groups had decreased plantar pressures in the hindfoot and first metatarsal regions, whereas the midfoot and lateral forefoot experienced significant increases compared with controls. This lateralization was also reflected in the hindfoot-forefoot angle and the COP. Feet that remain nonoperative and avoid surgical intervention are considered a good clinical result. However, pedobarograph results indicate mild residual deformity in these feet despite clinically successful outcomes. Level II-therapeutic.

[Incarcerated epitrochlear fracture with a cubital nerve injury].

PubMed

Moril-Peñalver, L; Pellicer-Garcia, V; Gutierrez-Carbonell, P

2013-01-01

Injuries of the medial epicondyle are relatively common, mostly affecting children between 7 and 15 years. The anatomical characteristics of this apophysis can make diagnosis difficult in minimally displaced fractures. In a small percentage of cases, the fractured fragment may occupy the retroepitrochlear groove. The presence of dysesthesias in the territory of the ulnar nerve requires urgent open reduction of the incarcerated fragment. A case of a seven-year-old male patient is presented, who required surgical revision due to a displaced medial epicondyle fracture associated with ulnar nerve injury. A review of the literature is also made. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

External laryngeal nerve in thyroid surgery: is the nerve stimulator necessary?

PubMed

Aina, E N; Hisham, A N

2001-09-01

To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them. Prospective, non-randomised study. Teaching hospital, Malaysia. 317 patients who had 447 dissections between early January 1998 and late November 1999. Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them. The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve < 1 cm from the upper edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve. Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve.

Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis.

PubMed

Fong, Daniel Tik-Pui; Pang, Kai-Yip; Chung, Mandy Man-Ling; Hung, Aaron See-Long; Chan, Kai-Ming

2012-12-01

It is a routine practice to prescribe a combination of rocker shoes and custom-made foot orthoses for patients with plantar fasciitis. Recently, there has been a debate on this practice, and studies have shown that the individual prescription of rocker shoes or custom-made foot orthoses is effective in treating plantar fasciitis. The aim of this study was to evaluate and compare the immediate therapeutic effects of individually prescribed rocker sole shoes and custom-made foot orthoses, and a combined prescription of them on plantar fasciitis. This was a cross-over study. Fifteen patients with unilateral plantar fasciitis were recruited; they were from both genders and aged between 40 and 65. Subjects performed walking trials which consisted of one 'unshod' condition and four 'shod' conditions while wearing baseline shoes, rocker shoes, baseline shoes with foot orthotics, and rocker shoes with foot orthotics. The study outcome measures were the immediate heel pain intensity levels as reflected by visual analog scale pain ratings and the corresponding dynamic plantar pressure redistribution patterns as evaluated by a pressure insole system. The results showed that a combination of rocker shoes and foot orthoses produced a significantly lower visual analog scale pain score (9.7 mm) than rocker shoes (30.9 mm) and foot orthoses (29.5 mm). With regard to baseline shoes, it also significantly reduced the greatest amount of medial heel peak pressure (-33.58%) without overloading other plantar regions when compared to rocker shoes (-7.99%) and foot orthoses (-28.82%). The findings indicate that a combined prescription of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects compared to when each treatment had been individually prescribed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Magnetic resonance and diffusion tensor imaging analyses indicate heterogeneous strains along human medial gastrocnemius fascicles caused by submaximal plantar-flexion activity.

PubMed

Karakuzu, Agah; Pamuk, Uluç; Ozturk, Cengizhan; Acar, Burak; Yucesoy, Can A

2017-05-24

Sarcomere length changes are central to force production and excursion of skeletal muscle. Previous modeling indicates non-uniformity of that if mechanical interaction of muscle with its surrounding muscular and connective tissues is taken into account. Hence, quantifying length changes along the fascicles of activated human muscle in vivo is crucial, but this is lacking due to technical complexities. Combining magnetic resonance imaging deformation analyses and diffusion tensor imaging tractography, the aim was to test the hypothesis that submaximal plantar flexion activity at 15% MVC causes heterogeneous length changes along the fascicles of human medial gastrocnemius (GM) muscle. A general fascicle strain distribution pattern shown for all subjects indicates that proximal track segments are shortened, whereas distal ones are lengthened (e.g., by 13% and 29%, respectively). Mean fiber direction strains of different tracts also shows heterogeneity (for up to 57.5% of the fascicles). Inter-subject variability of amplitude and distribution of fascicle strains is notable. These findings confirm the hypothesis and are solid indicators for the functionally dependent mechanics of human muscle, in vivo. Heterogeneity of fascicle strains can be explained by epimuscular myofascial force transmission. To the best of our knowledge, this is the first study, which quantified local deformations along human skeletal muscle fascicles caused by sustained submaximal activation. The present approach and indicated fascicle strain heterogeneity has numerous implications for muscle function in health and disease to estimate the muscle's contribution to the joint moment and excursion and to evaluate mechanisms of muscle injury and several treatment techniques. Copyright © 2017 Elsevier Ltd. All rights reserved.

Changes in crossed spinal reflexes after peripheral nerve injury and repair.

PubMed

Valero-Cabré, Antoni; Navarro, Xavier

2002-04-01

We investigated the changes induced in crossed extensor reflex responses after peripheral nerve injury and repair in the rat. Adults rats were submitted to non repaired sciatic nerve crush (CRH, n = 9), section repaired by either aligned epineurial suture (CS, n = 11) or silicone tube (SIL4, n = 13), and 8 mm resection repaired by tubulization (SIL8, n = 12). To assess reinnervation, the sciatic nerve was stimulated proximal to the injury site, and the evoked compound muscle action potential (M and H waves) from tibialis anterior and plantar muscles and nerve action potential (CNAP) from the tibial nerve and the 4th digital nerve were recorded at monthly intervals for 3 mo postoperation. Nociceptive reinnervation to the hindpaw was also assessed by plantar algesimetry. Crossed extensor reflexes were evoked by stimulation of the tibial nerve at the ankle and recorded from the contralateral tibialis anterior muscle. Reinnervation of the hindpaw increased progressively with time during the 3 mo after lesion. The degree of muscle and sensory target reinnervation was dependent on the severity of the injury and the nerve gap created. The crossed extensor reflex consisted of three bursts of activity (C1, C2, and C3) of gradually longer latency, lower amplitude, and higher threshold in control rats. During follow-up after sciatic nerve injury, all animals in the operated groups showed recovery of components C1 and C2 and of the reflex H wave, whereas component C3 was detected in a significantly lower proportion of animals in groups with tube repair. The maximal amplitude of components C1 and C2 recovered to values higher than preoperative values, reaching final levels between 150 and 245% at the end of the follow-up in groups CRH, CS, and SIL4. When reflex amplitude was normalized by the CNAP amplitude of the regenerated tibial nerve, components C1 (300-400%) and C2 (150-350%) showed highly increased responses, while C3 was similar to baseline levels. In conclusion

An exploratory study on differences in cumulative plantar tissue stress between healing and non-healing plantar neuropathic diabetic foot ulcers.

PubMed

van Netten, Jaap J; van Baal, Jeff G; Bril, Adriaan; Wissink, Marieke; Bus, Sicco A

2018-03-01

Mechanical stress is important in causing and healing plantar diabetic foot ulcers, but almost always studied as peak pressure only. Measuring cumulative plantar tissue stress combines plantar pressure and ambulatory activity, and better defines the load on ulcers. Our aim was to explore differences in cumulative plantar tissue stress between people with healing and non-healing plantar diabetic foot ulcers. We analyzed a subgroup of 31 patients from a randomized clinical trial, treated with a removable offloading device for their plantar diabetic forefoot ulcer. We measured in-device dynamic plantar pressure and daily stride count to calculate cumulative plantar tissue stress at the ulcer location and associated this with ulcer healing and ulcer surface area reduction at four weeks (Student's t and chi-square test for significance, Cohen's d for effect size). In 12 weeks, 68% (n = 21) of the ulcers healed and 32% (n = 10) did not. No statistically significant differences were found for cumulative plantar tissue stress, plantar pressure or ambulatory activity between people with healed and not-healed ulcers. Cumulative plantar tissue stress was 25% lower for people with healed ulcers (155 vs. 207 MPa·s/day; P = 0.71; Effect size: d = 0.29). Post-hoc analyses in the 27 patients who self-reported to be adherent to wearing the device showed that cumulative plantar tissue stress was 49% lower for those who reached ≥75% ulcer surface area reduction at four weeks (140 vs. 275 MPa·s/day; P = 0.09; d = 0.76); smaller differences and effect sizes were found for peak pressure (24%), peak pressure-time integral (30%) and ambulatory activity (26%); (P-value range: 0.14-0.97; Cohen's d range: 0.14-0.70). Measuring cumulative plantar tissue stress may provide insight beyond that obtained from plantar pressure or ambulatory activity alone, with regard to diabetic foot ulcer healing using removable offloading devices. These explorative findings

Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy.

PubMed

Rompe, Jan D; Cacchio, Angelo; Weil, Lowell; Furia, John P; Haist, Joachim; Reiners, Volker; Schmitz, Christoph; Maffulli, Nicola

2010-11-03

Whether plantar fascia-specific stretching or shock-wave therapy is effective as an initial treatment for proximal plantar fasciopathy remains unclear. The aim of this study was to test the null hypothesis of no difference in the effectiveness of these two forms of treatment for patients who had unilateral plantar fasciopathy for a maximum duration of six weeks and which had not been treated previously. One hundred and two patients with acute plantar fasciopathy were randomly assigned to perform an eight-week plantar fascia-specific stretching program (Group I, n = 54) or to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II, n = 48). All patients completed the seven-item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire. Patients were evaluated at baseline and at two, four, and fifteen months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first few steps of walking in the morning) on this index, and satisfaction with treatment. No difference in mean age, sex, weight, or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with plantar fascia-specific stretching than for those managed with shock-wave therapy (p < 0.001), as well as individually for item 2 (p = 0.002). Thirty-five patients (65%) in Group I versus fourteen patients (29%) in Group II were satisfied with the treatment (p < 0.001). These findings persisted at four months. At fifteen months after baseline, no significant between-group difference was measured. A program of manual stretching exercises specific to the plantar fascia is superior to repetitive low-energy radial shock-wave therapy for the treatment of acute symptoms

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.

The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females

PubMed Central

2013-01-01

Background Ill-fitting footwear can be detrimental to foot health with the forefoot being an area for most discomfort. Studies on footwear have primarily examined sports or orthopaedic prescription shoes and little is known about the effects that everyday flat shoes have on the forefoot. The aim of this study was to investigate the effect of toe box shape in a popular slip-on pump on dorsal and plantar pressures with particular interest around the forefoot in a healthy female population. Method A convenience sample of 27 female participants with no known foot pathologies was recruited. After assessment of foot size, plantar foot pressure and interdigital pressures were recorded for each of the 3 different toe box styles; round, square and pointed. Participants walked at a self-selected speed over a 10 m walkway whilst wearing each of the 3 styles of shoe and also whilst barefoot. Processed and analysed data extracted included peak pressure, time to peak pressure, contact time and pressure time integral. ANOVA and Freidman analysis was used to test for statistical significance. Results Shoes with a round toe showed least pressure around the medial aspect of the toes whilst the pointed shoe had least pressure on the lateral toes. Contact times for the plantar regions were not altered in any shoe condition yet contact around the medial aspect of the toes was highest in the pointed shoe. Conclusion This study highlights that the shape of the toe box in footwear can significantly influence the amount of pressure applied to the forefoot. Furthermore, the contours of the shoe also have an impact on the contact time and pressure time integral around the forefoot and also the peak plantar pressure in the toe region. The changes observed could be significant in the development of pathology in certain footwear toe box shapes. Consideration should be given to footwear design around the toe box to improve fit and reduce pressure. Further work is required to investigate the

The neglected cranial nerve: nervus terminalis (cranial nerve N).

PubMed

Vilensky, Joel A

2014-01-01

The nervus terminalis (NT; terminal nerve) was clearly identified as an additional cranial nerve in humans more than a century ago yet remains mostly undescribed in modern anatomy textbooks. The nerve is referred to as the nervus terminalis because in species initially examined its fibers were seen entering the brain in the region of the lamina terminalis. It has also been referred to as cranial nerve 0, but because there is no Roman symbol for zero, an N for the Latin word nulla is a better numerical designation. This nerve is very distinct in human fetuses and infants but also has been repeatedly identified in adult human brains. The NT fibers are unmyelinated and emanate from ganglia. The fibers pass through the cribriform plate medial to those of the olfactory nerve fila. The fibers end in the nasal mucosa and probably arise from autonomic/neuromodulatory as well as sensory neurons. The NT has been demonstrated to release luteinizing-releasing luteinizing hormone and is therefore thought to play a role in reproductive behavior. Based on the available evidence, the NT appears to be functional in adult humans and should be taught in medical schools and incorporated into anatomy/neuroanatomy textbooks. Copyright © 2012 Wiley Periodicals, Inc., a Wiley company.

Plantar fasciitis: what is the diagnosis and treatment?

PubMed

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

2014-01-01

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

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

PubMed

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

2014-12-18

Soft tissue injuries, such as anterior cruciate ligament rupture, ankle sprain and foot skin problems, frequently occur during cutting maneuvers. These injuries are often regarded as associated with abnormal joint torque and interfacial friction caused by excessive external and in-shoe shear forces. This study simultaneously investigated the dynamic in-shoe localized plantar pressure and shear stress during lateral shuffling and 45° sidestep cutting maneuvers. Tri-axial force transducers were affixed at the first and second metatarsal heads, lateral forefoot, and heel regions in the midsole of a basketball shoe. Seventeen basketball players executed both cutting maneuvers with maximum efforts. Lateral shuffling cutting had a larger mediolateral braking force than 45° sidestep cutting. This large braking force was concentrated at the first metatarsal head, as indicated by its maximum medial shear stress (312.2 ± 157.0 kPa). During propulsion phase, peak shear stress occurred at the second metatarsal head (271.3 ± 124.3 kPa). Compared with lateral shuffling cutting, 45° sidestep cutting produced larger peak propulsion shear stress (463.0 ± 272.6 kPa) but smaller peak braking shear stress (184.8 ± 181.7 kPa), of which both were found at the first metatarsal head. During both cutting maneuvers, maximum medial and posterior shear stress occurred at the first metatarsal head, whereas maximum pressure occurred at the second metatarsal head. The first and second metatarsal heads sustained relatively high pressure and shear stress and were expected to be susceptible to plantar tissue discomfort or injury. Due to different stress distribution, distinct pressure and shear cushioning mechanisms in basketball footwear might be considered over different foot regions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness.

PubMed

Granado, Michael J; Lohman, Everett B; Gordon, Keith E; Daher, Noha S

2018-01-01

Ultrasound is an inexpensive method for quantifying plantar fascia thickness, especially in those with plantar fasciitis. Ultrasound has also been used to assess the effectiveness of various treatments for plantar fasciitis by comparing plantar fascia thickness before and after an intervention period. While a plantar fascia thickness over 4 mm via ultrasound has been proposed to be consistent with plantar fasciitis, some researchers believe the 4 mm plantar fascia thickness level to be a dubious guideline for diagnosing plantar fasciitis due to the lack of standardization of the measurement process for plantar fascia thickness. In particular, no universal guidelines exist on the positioning of the metatarsophalangeal (MTP) joints during the procedure and the literature also has inconsistent protocols. The purpose of this study is to investigate and compare the influence of MTP joint extension on plantar fascia thickness in healthy participants and those with unilateral plantar fasciitis. The plantar fascia thickness of forty participants (20 with unilateral plantar fasciitis and 20 control) was measured via ultrasound three times at three different MTP joint positions: 1) at rest, 2) 30° of extension from the plantar surface, and 3) maximal extension possible. The plantar fascia became significantly thinner as MTP joint extension increased in both the plantar fasciitis group ( p  < 0.001) and the control group ( p  < 0.001). In the plantar fasciitis group, the involved plantar fascia was 1.2 to 1.3 mm thicker (p < 0.001) than the uninvolved side depending on the MTP joint position. In the control group, the difference in plantar fascia thickness between the two sides was less than 0.1 mm ( p  < 0.92) at any MTP joint position. MTP joint position can influence the ultrasound measurement of plantar fascia thickness. It is recommended that plantar fascia thickness measurements be performed with the toes at rest. If MTP joints must be extended

The influence of muscle fatigue on electromyogram and plantar pressure patterns as an explanation for the incidence of metatarsal stress fractures.

PubMed

Weist, Roger; Eils, Eric; Rosenbaum, Dieter

2004-12-01

Stress fractures are common overuse injuries in runners and appear most frequently in the metatarsals. To investigate fatigue-related changes in surface electromyographic activity patterns and plantar pressure patterns during treadmill running as potential causative factors for metatarsal stress fractures. Prospective cohort study with repeated measurements. Thirty experienced runners volunteered to participate in a maximally exhaustive run above the anaerobic threshold. Surface electromyographic activity was monitored for 14 muscles, and plantar pressures were measured using an in-shoe monitoring system. Fatigue was documented with blood lactate measurements. The results demonstrated an increased maximal force (5%, P < .01), peak pressure (12%, P < .001), and impulse (9%, P < .01) under the second and third metatarsal head and under the medial midfoot (force = 7%, P < .05; pressure = 6%, P < .05; impulse = 17%, P < .01) toward the end of the fatiguing run. Contact area and contact time were only slightly affected. The mean electromyographic activity was significantly reduced in the medial gastrocnemius (-9%, P < .01), lateral gastrocnemius (-12%, P < .01), and soleus (-9%, P < .001) muscles. The demonstrated alteration of the rollover process with an increased forefoot loading may help to explain the incidence of stress fractures of the metatarsals under fatiguing loading conditions.

Platelet-rich plasma and plantar fasciitis.

PubMed

Monto, Raymond R

2013-12-01

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

Spontaneous distal rupture of the plantar fascia.

PubMed

Gitto, Salvatore; Draghi, Ferdinando

2018-07-01

Spontaneous ruptures of the plantar fascia are uncommon injuries. They typically occur at its calcaneal insertion and usually represent a complication of plantar fasciitis and local treatment with steroid injections. In contrast, distal ruptures commonly result from traumatic injuries. We describe the case of a spontaneous distal rupture of the plantar fascia in a 48-year-old woman with a low level of physical activity and no history of direct injury to the foot, plantar fasciitis, or steroid injections. © 2017 Wiley Periodicals, Inc.

The influence of aging on the isometric torque sharing patterns among the plantar flexor muscles.

PubMed

Oliveira, Liliam F; Verneque, Debora; Menegaldo, Luciano L

2017-01-01

Physiological cross-sectional area (PCSA) reduction of the triceps surae (TS) muscles during aging suggests a proportional loss of torque among its components: soleus, medial and lateral gastrocnemii. However, direct measurements of muscle forces in vivo are not feasible. The purpose of this paper was to compare, between older and young women, isometric ankle joint torque sharing patterns among TS muscles and tibialis anterior (TA). An EMG-driven model was used for estimating individual muscle torque contributions to the total plantar flexor torque, during sustained contractions of 10% and 40% of maximum voluntary contraction (MVC). Relative individual muscle contributions to the total plantar flexion torque were similar between older and young women groups, for both intensities, increasing from LG, MG to SOL. Muscle strength (muscle torque/body mass) was significantly greater for all TS components in 40% MVC contractions. Increased TA activation was observed in 10% of MVC for older people. Despite the reduced maximum isometric torque and muscle strength, the results suggest small variations of ankle muscle synergies during the aging process.

Incidence of plantar fascia ruptures following corticosteroid injection.

PubMed

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

2010-12-01

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

Post-traumatic unilateral plantar hyperhidrosis.

PubMed

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

2016-02-01

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

Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis.

PubMed

Chen, Hongying; Ho, Hok-Ming; Ying, Michael; Fu, Siu Ngor

2013-10-01

Single-cohort laboratory-based study. To identify whether plantar fascia vascularity and thickness are associated with foot pain and dysfunction in individuals with chronic plantar fasciitis. Background Altered plantar fascia vascularity and thickening of the fascia have been identified in individuals with chronic plantar fasciitis. Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. There were significantly higher VI (mean ± SD, 2.4% ± 1.4%) and fascia thickness (5.0 ± 1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4% ± 0.5%; fascia thickness, 3.3 ± 0.7 mm) and with the dominant side of the controls (VI, 1.6% ± 0.4%; fascia thickness, 2.9 ± 0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. Individuals with unilateral chronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia

[Assessment of plantar fasciitis using shear wave elastography].

PubMed

Zhang, Lining; Wan, Wenbo; Zhang, Lihai; Xiao, Hongyu; Luo, Yukun; Fei, Xiang; Zheng, Zhixin; Tang, Peifu

2014-02-01

To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis. The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion. The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126). SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.

Risk factors affecting chronic rupture of the plantar fascia.

PubMed

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

2014-03-01

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

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.

Anatomic observation of the running space of the suprascapular nerve at the suprascapular notch in the same direction as the nerve.

PubMed

Tasaki, Atsushi; Nimura, Akimoto; Mochizuki, Tomoyuki; Yamaguchi, Kumiko; Kato, Ryuichi; Sugaya, Hiroyuki; Akita, Keiichi

2015-09-01

The configuration of suprascapular notch was previously analysed from the anteroposterior viewing. However, the approach direction of the suprascapular nerve (SSN) to the inlet of the suprascapular notch is consistently craniocaudal and mediolateral. We propose a new method to observe the suprascapular notch according to the running course of the SSN. We reviewed the anatomic characteristics of the suprascapular notch in relation to the nerve. In 30 formalin-fixed cadaveric shoulders, the morphology of the suprascapular notch and the attachments of the superior transverse scapular ligament (STSL) were examined from both the anteroposterior and the nerve approach direction. The dimensions of the opening of the SSN passage were measured. By observing from the nerve approach direction, the inlet of the suprascapular notch was recognized to be a space-bordered by the medial wall of the coracoid process, the deep fascia of subscapularis, and the STSL. The STSL formed a sheet-like structure, which ran parallel to the nerve and also to the deep fascia of subscapularis. The attachment of the ligament to the coracoid process was located at the posteromedial corner rather than the medial side. Based on the present study, the space between the STSL and deep fascia of the subscapularis formed the space for the nerve to run through. As a clinical implication, this new method to assess the suprascapular notch in the nerve approach direction might develop the imaging techniques for evaluation of SSN entrapment.

Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area.

PubMed

Leschinger, Tim; Hackl, Michael; Zeifang, Felix; Scaal, Martin; Müller, Lars Peter; Wegmann, Kilian

2017-01-01

The purpose of the study was to evaluate the position of the subscapular nerves relative to surgical landmarks during exposure and to analyze the pattern of innervation of the subscapularis to avoid injury during anterior shoulder surgery. 20 embalmed human cadaveric shoulder specimens were used in the study. The muscular insertions of the subscapular nerves were marked and their closest branches to the musculotendinous junction and the coracoid process were measured in horizontal and vertical distances. In addition, the innervation pattern of each specimen was documented. 14/20 specimens showed an innervation of the subscapularis with an upper, middle and lower subscapular nerve branch. Even though the nerve branches were in average more than 2 cm medial to the musculotendinous junction, minimal distances of 1.1-1.3 cm were found. The mean vertical distance as measured from the medial base of the coracoid to the nerve innervation point into the muscle was 0.7 cm for the upper nerve branch, 2.2 cm for the middle nerve branch and 4.4 cm for the lower nerve branch. The subscapularis has a variable nerve supply, which increases the risk of muscle denervation during open shoulder surgery. Dissection or release should be avoided at the anterior aspect of the subscapularis muscle more than 1 cm medial to the musculotendinous junction. In approaches with a horizontal incision of the subscapularis, splitting should be performed at a vertical distance of 3.2-3.6 cm to the coracoid base to avoid iatrogenic subscapular nerve injuries.

Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases.

PubMed

Dodds, Seth D; Flanagin, Brody A; Bohl, Daniel D; DeLuca, Peter A; Smith, Brian G

2014-09-01

To describe outcomes after surgical management of pediatric elbow dislocation with incarceration of the medial epicondyle. We conducted a retrospective case review of 11 consecutive children and adolescents with an incarcerated medial epicondyle fracture after elbow dislocation. All patients underwent open reduction internal fixation using a similar technique. We characterized outcomes at final follow-up. Average follow-up was 14 months (range, 4-56 mo). All patients had clinical and radiographic signs of healing at final follow-up. There was no radiographic evidence of loss of reduction at intervals or at final follow-up. There were no cases of residual deformity or valgus instability. Average final arc of elbow motion was 4° to 140°. All patients had forearm rotation from 90° supination to 90° pronation. Average Mayo elbow score was 99.5. Four of 11 patients had ulnar nerve symptoms postoperatively and 1 required a second operation for ulnar nerve symptoms. In addition, 1 required a second operation for flexion contracture release with excision of heterotopic ossification. Three patients had ulnar nerve symptoms at final follow-up. Two of these had mild paresthesia only and 1 had both mild paresthesia and weakness. Our results suggest that open reduction internal fixation of incarcerated medial epicondyle fractures after elbow dislocation leads to satisfactory motion and function; however, the injury carries a high risk for complications, particularly ulnar neuropathy. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Comparison of plantar pressures and contact area between normal and cavus foot.

PubMed

Fernández-Seguín, Lourdes M; Diaz Mancha, Juan Antonio; Sánchez Rodríguez, Raquel; Escamilla Martínez, Elena; Gómez Martín, Beatriz; Ramos Ortega, Javier

2014-02-01

In pes cavus, the medial longitudinal arch elevation reduces the contact surface area and consequently increases the corresponding plantar pressure measurements. This poor distribution of loads may produce associated pathology and pain in this or other areas of the body. Normal reference values need to be established in order to determine which patterns are prone to pathology. To compare the plantar pressures and weight-bearing surface in a population with pes cavus to a population with neutral feet. The sample comprised 68 adults, 34 with pes cavus and 34 with neutral feet. The Footscan USB Gait Clinical System(®) was used as a platform to measure the total contact area and plantar pressure under the forefoot, midfoot, hindfoot, each metatarsal head, and the overall metatarsal area. A statistical analysis of the data was performed using Student's t-test for independent samples. The pes cavus subjects showed a significant reduction in their weight-bearing area [neutral feet: 165.04 ( ± 20.68) cm(2); pes cavus: 118.26 ( ± 30.31) cm(2); p < 0.001] and significantly increased pressures under all zones of the forefoot except the fifth metatarsal [metatarsal pressure: in neutral feet 503,797 ( ± 9.32) kPa; in pes cavus 656.12 ( ± 22.39) kPa; p < 0.001]. Compared to neutral feet, pes cavus feet show a reduction in total contact surface and the load under the first toe. A significant increase is present in the load under the metatarsal areas, but the relative distribution of this load is similar in both groups. Copyright © 2013 Elsevier B.V. All rights reserved.

Interosseous nerve transfers for tibialis anterior muscle paralysis (foot drop): a human cadaver-based feasibility study.

PubMed

Pirela-Cruz, Miguel A; Hansen, Uel; Terreros, Daniel A; Rossum, Alfred; West, Priscilla

2009-03-01

This study explored the anatomical feasibility of using an interosseous nerve transfer (routed between the tibia and fibula) to restore motor function to the tibialis anterior (TA) muscle, following injury to the common peroneal nerve (resulting in a foot drop). The specific nerve branches evaluated as possible donor nerves included the nerves to the medial gastrocnemius, the lateral gastrocnemius, and the soleus muscles. All nerve transfers were accomplished using a direct interosseous route and a direct repair (one medial gastrocnemius transfer did require interpositional grafting). The distance from the repair site to the TA muscle was shortest for the transfer using the nerve branch to the soleus. Histologically, the nerve branch to the soleus was most similar to the branch to the TA for both axonal count and cross-sectional area. A two-incision surgical approach using a fibular window (mobilizing a fibular segment after double osteotomy) and interosseous routing of the transfer is proposed.

Plantar pressure with and without custom insoles in patients with common foot complaints.

PubMed

Stolwijk, Niki M; Louwerens, Jan Willem K; Nienhuis, Bart; Duysens, Jacques; Keijsers, Noël L W

2011-01-01

Although many patients with foot complaints receive customized insoles, the choice for an insole design can vary largely among foot experts. To investigate the variety of insole designs used in daily practice, the insole design and its effect on plantar pressure distribution were investigated in a large group of patients. Mean, peak, and pressure-time-integral per sensor for 204 subjects with common foot complaints for walking with and without insoles was measured with the footscan® insole system (RSscan International). Each insole was scanned twice (precision3D), after which the insole height along the longitudinal and transversal cross section was calculated. Subjects were assigned to subgroups based on complaint and medial arch height. Data were analyzed for the total group and for the separate subgroups (forefoot or heel pain group and flat, normal or high medial arch group). The mean pressure significantly decreased under the metatarsal heads II-V and the calcaneus and significantly increased under the metatarsal bones and the lateral foot (p<0.0045) due to the insoles. However, similar redistribution patterns were found for the different foot complaints and arch heights. There was a slight difference in insole design between the subgroups; the heel cup was significantly higher and the midfoot support lower for the heel pain group compared to the forefoot pain group. The midfoot support was lowest in the flat arch group compared to the high and normal arch group (p<0.05). Although the insole shape was specific for the kind of foot complaint and arch height, the differences in shape were very small and the plantar pressure redistribution was similar for all groups. This study indicates that it might be sufficient to create basic insoles for particular patient groups.

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.

Management of plantar fasciitis in the outpatient setting

PubMed Central

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

2016-01-01

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

Management of plantar fasciitis in the outpatient setting.

PubMed

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

2016-04-01

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

Histologic anatomy of the lesser metatarsophalangeal joint plantar plate.

PubMed

Gregg, J; Marks, P; Silberstein, M; Schneider, T; Kerr, J

2007-03-01

The plantar plate is the fibrocartilaginous structure that supports the ball of the foot, withstanding considerable compressive and tensile forces. This study describes the morphology of the plantar plate in order to understand its function and the pathologic disorders associated with it. Eight lesser metatarsophalangeal joint plantar plates from three soft-embalmed cadavers (74-92 years, two males, one female), and eight lesser metatarsophalangeal joint plantar plates from a fresh cadaver (19-year-old male) were obtained for histology assessment. Paraffin sections (10 microm) in the longitudinal and transverse planes were analyzed with bright-field and polarized light microscopy. The central plantar plate collagen bundles run in the longitudinal plane with varying degrees of undulation. The plantar plate borders run transversely and merge with collateral ligaments and the deep transverse intermetatarsal ligament. Bright-field microscopic evaluation shows the plantar aspect of the plantar plate becomes ligament-like the further distally it tapers, containing fewer chondrocytes, and a greater abundance of fibroblasts. The enthesis reveals longitudinal and interwoven collagen bundles entering the proximal phalanx with multiple interdigitations. Longer interdigitations centrally compared to the dorsal and plantar aspects suggest that the central fibers experience the greatest loads.

Central projections of the lateral line and eighth nerves in the bowfin, Amia calva.

PubMed

McCormick, C A

1981-03-20

The first-order connections of the anterior and posterior lateral line nerves and of the eighth nerve were determined in the bowfin, Amia calva, using experimental degeneration and anterograde HRP transport techniques. The termination sites of these nerves define a dorsal lateralis cell column and a ventral octavus cell column. The anterior and posterior lateralis nerves distribute ipsilaterally to two medullary nuclei-nucleus medialis and nucleus caudalis. Nucleus medialis comprises the rostral two-thirds of the lateralis column and contains large, Purkinje-like cells dorsally and polygonal, granule, and fusiform cells ventrally. Nucleus caudalis is located posterior to nucleus medialis and consists of small, granule cells. Anterior lateralis fibers terminate ventrally to ventromedially in both nucleus medialis and nucleus caudalis. Posterior lateralis fibers terminate dorsally to dorsolaterally within these two nuclei. A sparse anterior lateralis input may also be present on the dendrites of one of the nuclei within the octavus cell column, nucleus magnocellularis. In contrast, the anterior and posterior rami of the eighth nerve each terminate within four medullary nuclei which comprise the octavus cell column: the anterior, magnocellular, descending, and posterior octavus nuclei. An eighth nerve projection to the medial reticular formation is also present. Some fibers of the lateralis and eighth nerves terminate within the ipsilateral eminentia granularis of the cerebellum. Lateralis fibers distribute to approximately the lateral half of this structure with posterior lateral line fibers terminating laterally and anterior lateral line fibers terminating medially. Eighth nerve fibers distribute to the medial half of the eminentia granularis.

Anatomy of the Pudendal Nerve and Other Neural Structures Around the Proximal Hamstring Origin in Males.

PubMed

Cvetanovich, Gregory L; Saltzman, Bryan M; Ukwuani, Gift; Frank, Rachel M; Verma, Nikhil N; Bush-Joseph, Charles A; Nho, Shane J

2018-03-29

To define the anatomy of the pudendal nerve in relationship to the proximal hamstring and other nearby neurological structures during proximal hamstring repair. Six fresh-frozen human cadaveric hemi-pelvises from male patients ages 64.0 ± 4.1 years were dissected in prone position with hips in 10° flexion to identify the relationship of proximal hamstring origin to surrounding neurologic structures including the pudendal nerve, sciatic nerve, and posterior femoral cutaneous nerve. Two independent observers used digital calipers to measure distances. The pudendal nerve emerged at the inferior border of the piriformis muscle 6.3 ± 1.4 cm from the superior aspect of the proximal hamstring origin. It passed the superior border of the sacrotuberous ligament 3.0 ± 0.6 cm from the superior aspect and 3.9 ± 0.7 cm from the medial aspect of the hamstring origin. It crossed the inferior border of the sacrotuberous ligament 3.0 ± 0.4 cm from the superior aspect and 2.7 ± 0.7 cm from the medial aspect of the proximal hamstring origin. The shortest distance from the hamstring origin to the pudendal nerve was 2.6 ± 0.5 cm from the superior aspect and 2.3 ± 0.8 cm from the medial aspect. The shortest distance from the hamstring origin to the pudendal nerve was located deep to the sacrotuberous ligament in all cadavers. The sciatic nerve was an average of 1.1 ± 0.1 cm lateral to the lateral aspect of the proximal hamstring origin. The posterior femoral cutaneous nerve was located between the hamstring origin and the sciatic nerve, 0.7 ± 0.2 cm lateral to the lateral aspect of the proximal hamstring origin. The proximal hamstring origin lies in close proximity to surrounding nerves, including the pudendal, sciatic, and posterior femoral cutaneous nerves. Knowledge that the pudendal nerve lies 2 to 3 cm superior and medial to the proximal hamstring origin may help to prevent iatrogenic damage during surgical dissection and retraction when performing proximal

The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery.

PubMed

Kerver, A L A; Leliveld, M S; den Hartog, D; Verhofstad, M H J; Kleinrensink, G J

2013-12-04

Iatrogenic injury to the infrapatellar branch of the saphenous nerve is a common complication of surgical approaches to the anteromedial side of the knee. A detailed description of the relative anatomic course of the nerve is important to define clinical guidelines and minimize iatrogenic damage during anterior knee surgery. In twenty embalmed knees, the infrapatellar branch of the saphenous nerve was dissected. With use of a computer-assisted surgical anatomy mapping tool, safe and risk zones, as well as the location-dependent direction of the nerve, were calculated. The location of the infrapatellar branch of the saphenous nerve is highly variable, and no definite safe zone could be identified. The infrapatellar branch runs in neither a purely horizontal nor a vertical course. The course of the branch is location-dependent. Medially, it runs a nearly vertical course; medial to the patellar tendon, it has a -45° distal-lateral course; and on the patella and patellar tendon, it runs a close to horizontal-lateral course. Three low risk zones for iatrogenic nerve injury were identified: one is on the medial side of the knee, at the level of the tibial tuberosity, where a -45° oblique incision is least prone to damage the nerves, and two zones are located medial to the patellar apex (cranial and caudal), where close to horizontal incisions are least prone to damage the nerves. The infrapatellar branch of the saphenous nerve is at risk for iatrogenic damage in anteromedial knee surgery, especially when longitudinal incisions are made. There are three low risk zones for a safer anterior approach to the knee. The direction of the infrapatellar branch of the saphenous nerve is location-dependent. To minimize iatrogenic damage to the nerve, the direction of incisions should be parallel to the direction of the nerve when technically possible. These findings suggest that iatrogenic damage of the infrapatellar branch of the saphenous nerve can be minimized in anteromedial

Talalgia: plantar fasciitis☆

PubMed Central

Cardenuto Ferreira, Ricardo

2014-01-01

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

Estimation of Foot Plantar Center of Pressure Trajectories with Low-Cost Instrumented Insoles Using an Individual-Specific Nonlinear Model.

PubMed

Hu, Xinyao; Zhao, Jun; Peng, Dongsheng; Sun, Zhenglong; Qu, Xingda

2018-02-01

Postural control is a complex skill based on the interaction of dynamic sensorimotor processes, and can be challenging for people with deficits in sensory functions. The foot plantar center of pressure (COP) has often been used for quantitative assessment of postural control. Previously, the foot plantar COP was mainly measured by force plates or complicated and expensive insole-based measurement systems. Although some low-cost instrumented insoles have been developed, their ability to accurately estimate the foot plantar COP trajectory was not robust. In this study, a novel individual-specific nonlinear model was proposed to estimate the foot plantar COP trajectories with an instrumented insole based on low-cost force sensitive resistors (FSRs). The model coefficients were determined by a least square error approximation algorithm. Model validation was carried out by comparing the estimated COP data with the reference data in a variety of postural control assessment tasks. We also compared our data with the COP trajectories estimated by the previously well accepted weighted mean approach. Comparing with the reference measurements, the average root mean square errors of the COP trajectories of both feet were 2.23 mm (±0.64) (left foot) and 2.72 mm (±0.83) (right foot) along the medial-lateral direction, and 9.17 mm (±1.98) (left foot) and 11.19 mm (±2.98) (right foot) along the anterior-posterior direction. The results are superior to those reported in previous relevant studies, and demonstrate that our proposed approach can be used for accurate foot plantar COP trajectory estimation. This study could provide an inexpensive solution to fall risk assessment in home settings or community healthcare center for the elderly. It has the potential to help prevent future falls in the elderly.

Sonoelastography of the plantar fascia.

PubMed

Wu, Chueh-Hung; Chang, Ke-Vin; Mio, Sun; Chen, Wen-Shiang; Wang, Tyng-Guey

2011-05-01

To compare the stiffness of the plantar fascia by using sonoelastography in healthy subjects of different ages, as well as patients with plantar fasciitis. The study protocol was approved by the Research Ethics Committee of the hospital, and all of the subjects gave their informed consent. Bilateral feet of 40 healthy subjects and 13 subjects with plantar fasciitis (fasciitis group) were examined by using color-coded sonoelastography. Healthy subjects were divided into younger (18-50 years) and older (> 50 years) groups. The color scheme was red (hard), green (medium stiffness), and blue (soft). The color histogram was subsequently analyzed. Each pixel of the image was separated into red, green, and blue components (color intensity range, 0-255). The color histogram then computed the mean intensity of each color component of the pixels within a standardized area. Mixed model for repeated measurements was used for comparison of the plantar fascia thickness and the intensity of the color components on sonoelastogram. Quantitative analysis of the color histogram revealed a significantly greater intensity of blue in older healthy subjects than in younger (94.5 ± 5.6 [± standard deviation] vs 90.0 ± 4.6, P = .002) subjects. The intensity of red and green was the same between younger and older healthy subjects (P = .68 and 0.12). The intensity of red was significantly greater in older healthy subjects than in the fasciitis group (147.8 ± 10.3 vs 133.7 ± 13.4, P < .001). The intensity of green and blue was the same between older healthy subjects and those in the fasciitis group (P = .33 and .71). Sonoelastography revealed that the plantar fascia softens with age and in subjects with plantar fasciitis. RSNA, 2011

Ultrasound-Guided Selective Versus Conventional Block of the Medial Brachial Cutaneous and the Intercostobrachial Nerves: A Randomized Clinical Trial.

PubMed

Magazzeni, Philippe; Jochum, Denis; Iohom, Gabriella; Mekler, Gérard; Albuisson, Eliane; Bouaziz, Hervé

2018-06-13

For superficial surgery of anteromedial and posteromedial surfaces of the upper arm, the medial brachial cutaneous nerve (MBCN) and the intercostobrachial nerve (ICBN) must be selectively blocked, in addition to an axillary brachial plexus block. We compared efficacy of ultrasound-guided (USG) versus conventional block of the MBCN and the ICBN. Eighty-four patients, undergoing upper limb surgery, were randomized to receive either USG (n = 42) or conventional (n = 42) block of the MBCN and the ICBN with 1% mepivacaine. Sensory block was evaluated using light-touch on the upper and lower half of the anteromedial and posteromedial surfaces of the upper arm at 5, 10, 15, 20 minutes after nerve blocks. The primary outcome was the proportion of patients who had no sensation in all 4 regions innervated by the MBCN and the ICBN at 20 minutes. Secondary outcomes were onset time of complete anesthesia, volume of local anesthetic, tourniquet tolerance, and quality of ultrasound images. In the USG group, 37 patients (88%) had no sensation at 20 minutes in any of the 4 areas tested versus 8 patients (19%) in the conventional group (P < 0.001). When complete anesthesia was obtained, it occurred within 10 minutes in more than 90% of patients, in both groups. Mean total volumes of local anesthetic used for blocking the MBCN and the ICBN were similar in the 2 groups. Ultrasound images were of good quality in only 20 (47.6%) of 42 patients. Forty-one patients (97.6%) who received USG block were comfortable with the tourniquet versus 16 patients (38.1%) in the conventional group (P < 0.001). Ultrasound guidance improved the efficacy of the MBCN and ICBN blocks. This study was registered at ClinicalTrials.gov, identifier NCT02940847.

Plantar skin in type II diabetes: an investigation of protein glycation and biomechanical properties of plantar epidermis.

PubMed

Hashmi, Farina; Malone-Lee, James; Hounsell, Elizabeth

2006-01-01

The generation of thickened plantar stratum corneum (SC) in response to elevated pressures, places individuals with diabetes at risk of ulceration. Such a response may culminate from altered biochemical and physical states of the epidermis as a result of non-enzymatic glycation (NEG). The objective of this study was to quantify specific glycation products generated in plantar epidermal proteins in individuals with Type 2 Diabetes Mellitus (T2DM) and age-matched controls (n = 103 and n = 87, respectively) and to compare these data with the viscoelastic properties (in vivo) of the epidermis. Plantar SC and venous blood samples were collected from all participants for the quantification of furosine and pentosidine using high performance liquid chromatography (HPLC). The viscoelastic properties of plantar epidermis were measured by the application of negative pressure on the surface of the skin. Plantar epidermal thickness was measured using high frequency (20 MHz) ultrasonography. There was a significantly greater concentration of pentosidine in the SC samples from people with T2DM (p = 0.001). There was no correlation between the concentration of glycated proteins in the epidermal proteins and serum proteins (furosine r = - 0.115, pentosidine r = - 0.023). The plasticity of the epidermis was significantly lower in the T2DM group than the control group (p = 0.007). The results suggest that alterations in the glycation of plantar epidermal proteins may constitute additional aggravators of ulceration in people with T2DM.

A need for logical and consistent anatomical nomenclature for cutaneous nerves of the limbs.

PubMed

Gest, Thomas R; Burkel, William E; Cortright, Gerald W

2009-01-01

The system of anatomical nomenclature needs to be logical and consistent. However, variations in translation to English of the Latin and Greek terminology used in Nomina Anatomica and Terminologia Anatomica have led to some inconsistency in the nomenclature of cutaneous nerves in the limbs. An historical review of cutaneous nerve nomenclature reveals that there are two general naming conventions: one primarily American and one primarily British. The American convention presents cutaneous nerves of the limbs in the format "medial brachial cutaneous nerve," while the British convention presents the same nerve as "medial cutaneous nerve of the arm," thereby translating "brachii" to "of the arm." If logically and consistently applied throughout the body, the British convention would rename the sural nerve to the "nerve of the calf," the brachial artery would become the "artery of the arm," the femoral nerve would be "nerve of the thigh," and femur would be "bone of the thigh" or "thigh bone." The British convention leads to many other nomenclatural inconsistencies, which would seem to make learning anatomy more difficult for the beginning student. In this era of contracting anatomy curricula, every effort should be made to keep anatomical nomenclature simple, logical, and consistent. Copyright 2009 American Association of Anatomists.

Development of a nerve conduction technique for the recurrent laryngeal nerve.

PubMed

J Kim, Sang; G Lee, Dae; Kwon, Jeong-Yi

2014-12-01

To develop a reliable and safe laryngeal nerve conduction technique and to obtain consistent parameters as normal reference values. A prospective single-arm study. A nerve conduction test was performed on the contralateral normal side in 42 patients with unilateral vocal fold palsy. The recording was performed in the intact thyroarytenoid muscle using a monopolar needle. The electrical stimulation using a 37-mm monopolar needle was applied 3 cm below the lower margin of the cricoid cartilage, just lateral to the trachea and medial to the carotid artery, and its intensity was gradually increased until the amplitude of the electrical response reached the maximum level. The latency of the evoked muscle response was acquired at the first evoked waveform deflection from the baseline. The average latency of the recurrent laryngeal nerves was 1.98 ± 0.26 ms. The latencies showed normal distribution according to the quantile-quantile plot and Kolmogorov-Smirnov test (P = .098). There was no significant difference in latencies between the right and left recurrent laryngeal nerves. Anthropometric factors including height and weight did not show any correlation with the latencies. We developed a reliable and safe laryngeal nerve conduction technique and obtained normal reference values for the recurrent laryngeal nerve conduction study. This laryngeal nerve conduction study can be an additional tool for detecting recurrent laryngeal nerve injury if it is performed in combination with the conventional laryngeal electromyography. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.

PubMed

Pfeffer, G; Bacchetti, P; Deland, J; Lewis, A; Anderson, R; Davis, W; Alvarez, R; Brodsky, J; Cooper, P; Frey, C; Herrick, R; Myerson, M; Sammarco, J; Janecki, C; Ross, S; Bowman, M; Smith, R

1999-04-01

Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness.

PubMed

Nakale, Ngenomeulu T; Strydom, Andrew; Saragas, Nick P; Ferrao, Paulo N F

2018-03-01

An association between plantar fasciitis and isolated gastrocnemius tightness (IGT) has been postulated in the literature; however, there have been few studies to prove this relationship. This prospective cross-sectional cohort study was aimed at determining the association between plantar fasciitis and IGT. Three groups comprising 45 patients with plantar fasciitis (group 1), 117 patients with foot and ankle pathology other than plantar fasciitis (group 2), and 61 patients without foot and ankle pathology (group 3) were examined for the presence of IGT using the Silfverskiöld test. Statistical tests included chi-square test, Student t test, and analysis of variance. Of the patients, 101 (45.3%) had IGT: 36 (80%) in group 1, 53 (45.3%) in group 2, and 12 (19.7%) in group 3. The difference in IGT prevalence between the groups was statistically significant at P < .001. The prevalence of IGT was similar between acute and chronic plantar fasciitis at 78.9% and 80.6%, respectively. There was a very strong association between plantar fasciitis and IGT using group 3 as a reference. This study suggests that IGT should be actively sought out and managed in patients with plantar fasciitis. Level II, cross-sectional cohort prospective study.

Plantar Fascia Rupture: Ultrasound to Facilitate Recognition.

PubMed

Servey, Jessica T; Jonas, Christopher

2018-01-01

Plantar fascia rupture in the absence of previous diagnosis of plantar fasciitis, corticosteroid injection, or injury is a rare occurrence with only 7 case reports in the literature since 1978. This is a case of spontaneous plantar fascia rupture in a 38-year-old active-duty US military member with current considerations in musculoskeletal ultrasound, other radiologic imaging, treatment, and followup of this diagnosis. © Copyright 2018 by the American Board of Family Medicine.

Foot Plantar Pressure Measurement System: A Review

PubMed Central

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

2012-01-01

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

Hyperemia in plantar fasciitis determined by power Doppler ultrasound.

PubMed

McMillan, Andrew M; Landorf, Karl B; Gregg, Julie M; De Luca, Jason; Cotchett, Matthew P; Menz, Hylton B

2013-12-01

Cross-sectional observational study. To investigate the presence of soft tissue hyperemia in plantar fasciitis with power Doppler ultrasound. Localized hyperemia is an established feature of tendinopathy, suggesting that neurovascular in-growth may contribute to tendon-associated pain in some patients. The presence of abnormal soft tissue vascularity can be assessed with Doppler ultrasound, and a positive finding can assist with targeted treatment plans. However, very little is known regarding the presence of hyperemia in plantar fasciitis and the ability of routine Doppler ultrasound to identify vascular in-growth in the plantar fascia near its proximal insertion. This observational study included 30 participants with plantar fasciitis unrelated to systemic disease and 30 age- and sex-matched controls. Ultrasound examination was performed with a 13- to 5-MHz linear transducer, and power Doppler images were assessed by 2 blinded investigators. Hyperemia of the plantar fascia was present in 8 of 30 participants with plantar fasciitis and in 2 of 30 controls. The between-group difference for hyperemia, using a 4-point scale, was statistically significant, with participants with plantar fasciitis showing increased Doppler ultrasound signal compared to controls (Mann-Whitney U, P = .03). However, the majority of participants with plantar fasciitis with evidence of hyperemia demonstrated very mild color changes, and only 3 were found to have moderate or marked hyperemia. Mild hyperemia can occur with plantar fasciitis, but most individuals will not exhibit greater soft tissue vascularity when assessed with routine Doppler ultrasound. Clinicians treating plantar fasciitis should not consider a positive Doppler signal as essential for diagnosis of the condition but, rather, as a feature that may help to refine the treatment plan for an individual patient.

Blocking the buccal nerve using two methods of inferior alveolar block injection.

PubMed

Aker, F D

2001-01-01

The anatomic relations of the buccal nerve branch of the mandibular division of the trigeminal nerve were studied to explain the rationale for the discrepancy in blocking the buccal nerve using two methods of blocking the inferior alveolar nerve, the conventional method and the Gow-Gates method. The conventional method rarely blocks the buccal nerve, while the Gow-Gates method is reported to consistently block the buccal nerve. Eight head and mandibular specimens were dissected to observe the path of buccal nerve and its relationship to the path of needles in the conventional and Gow-Gates techniques. The buccal nerve descends on the medial and then anterior aspect of the deep head of the temporalis muscle (Tdh). At the latter position the buccal nerve enters the retromolar fossa and is encased in a fascial sleeve created by a dense fascial band that spans between the temporalis muscle tendons and the buccinator muscle. At the level of the conventional block injection the buccal nerve was shielded from the path of the needle by the Tdh and the fascial band. In the Gow-Gates block injection, the buccal nerve was exposed on the medial surface of the Tdh, immediately lateral to the path of the needle and proximal to the fascial sleeve. Consequently, the anatomical relations of the buccal nerve in the conventional block method essentially shield the nerve from being bathed by anesthetic solution while in the Gow-Gates method the relations are such that the buccal nerve can be exposed to anesthetic solution and thus blocked, explaining the findings in clinical dentistry. Copyright Wiley-Liss, Inc.

Comparative Evaluation of Chitosan Nerve Guides with Regular or Increased Bendability for Acute and Delayed Peripheral Nerve Repair: A Comprehensive Comparison with Autologous Nerve Grafts and Muscle-in-Vein Grafts.

PubMed

Stößel, Maria; Wildhagen, Vivien M; Helmecke, Olaf; Metzen, Jennifer; Pfund, Charlotte B; Freier, Thomas; Haastert-Talini, Kirsten

2018-05-08

Reconstruction of joint-crossing digital nerves requires the application of nerve guides with a much higher flexibility than used for peripheral nerve repair along larger bones. Nevertheless, collapse-resistance should be preserved to avoid secondary damage to the regrowing nerve tissue. In recent years, we presented chitosan nerve guides (CNGs) to be highly supportive for the regeneration of critical gap length peripheral nerve defects in the rat. Now, we evidently increased the bendability of regular CNGs (regCNGs) by developing a wavy wall structure, that is, corrugated CNGs (corrCNGs). In a comprehensive in vivo study, we compared both types of CNGs with clinical gold standard autologous nerve grafts (ANGs) and muscle-in-vein grafts (MVGs) that have recently been highlighted in the literature as a suitable alternative to ANGs. We reconstructed rat sciatic nerves over a critical gap length of 15 mm either immediately upon transection or after a delay period of 45 days. Electrodiagnostic measurements were applied to monitor functional motor recovery at 60, 90, 120, and 150 (only delayed repair) days postreconstruction. Upon explanation, tube properties were analyzed. Furthermore, distal nerve ends were evaluated using histomorphometry, while connective tissue specimens were subjected to immunohistological stainings. After 120 days (acute repair) or 150 days (delayed repair), respectively, compression-stability of regCNGs was slightly increased while it remained stable in corrCNGs. In both substudies, regCNGs and corrCNGs supported functional recovery of distal plantar muscles in a similar way and to a greater extent when compared with MVGs, while ANGs demonstrated the best support of regeneration. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

Effect of peripheral nerve injury on receptive fields of cells in the cat spinal cord.

PubMed

Devor, M; Wall, P D

1981-06-20

When the sciatic and saphenous nerves are cut and ligated in adult cats, the immediate effect is the production of a completely anesthetic foot and a region in medial lumbar dorsal horn where almost all cells have lost their natural receptive fields (RFs). Beginning at about 1 week and maturing by 4 weeks, some 40% of cells in the medial dorsal horn gain a novel RF on proximal skin, that is, upper and lower leg, thigh, lower back, or perineum. This new RF is supplied by intact proximal nerves and not by sciatic and saphenous nerve fibers that sprouted in the periphery. During the period of switching of RFs from distal to proximal skin there was no gross atrophy of dorsal horn grey matter and no Fink-Heimer stainable degeneration of central arbors and terminals of peripherally axotomized afferents. In intact animals medial dorsal horn cells showed no sign of response to mechanical stimulation of proximal skin. RFs of some of the cells had spontaneous variations in size and sensitivity, but these were not nearly sufficient to explain the large shifts observed after chronic nerve section. Tetanic electrical stimulation of skin or peripheral nerves often caused RFs to shrink, but never to expand. Although natural stimuli of proximal skin would not excite medial dorsal horn cells in intact or acutely deafferented animals, it was found that electrical stimulation of proximal nerves did excite many of these cells, often at short latencies. In the discussion we justify our working hypothesis that the appearance of novel RFs is due to the strengthening or unmasking of normally present but ineffective afferent terminals, rather than to long-distance sprouting of new afferent arbors within the spinal cord.

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

PubMed

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

2011-01-01

Several studies have already reported that specific foot/ankle muscle reinforcement strategies induced strength and joint position sense performance enhancement. Nevertheless the effects of such protocols on sprint performance and plantar loading distribution have not been addressed yet. The objective of the study is to investigate the influence of a 5-wk foot/ankle strength training program on plantar loading characteristics during sprinting in adolescent males. Sixteen adolescent male athletes of a national training academy were randomly assigned to either a combined foot/ankle electromyostimulation and resistance training (FAST) or a control (C) group. FAST consisted of foot medial arch and extrinsic ankle muscles reinforcement exercises, whereas C maintained their usual training routine. Before and after training, in-shoe loading patterns were measured during 30-m running sprints using pressure sensitive insoles (right foot) and divided into nine regions for analysis. Although sprint times remained unchanged in both groups from pre- to post- training (3.90 ± 0.32 vs. 3.98 ± 0.46 s in FAST and 3.83 ± 0.42 vs. 3.81 ± 0.44 s in C), changes in force and pressure appeared from heel to forefoot between FAST and C. In FAST, mean pressure and force increased in the lateral heel area from pre- to post- training (67.1 ± 44.1 vs. 82.9 ± 28.6 kPa [p = 0.06]; 25.5 ± 17.8 vs. 34.1 ± 14.3 N [p = 0.05]) and did not change in the medial forefoot (151.0 ± 23.2 vs. 146.1 ± 30.0 kPa; 142.1 ± 29.4 vs. 136.0 ± 33.8; NS). Mean area increased in FAST under the lateral heel from pre- to post- (4.5 ± 1.3 vs. 5.7 ± 1.6 cm(2) [p < 0.05]) and remained unchanged in C (5.5 ± 2.8 vs. 5.0 ± 3.0 cm(2)). FAST program induced significant promising lateral and unwanted posterior transfer of the plantar loads without affecting significantly sprinting performance. Key pointsWe have evaluated the effects of a foot/ankle strength training program on sprint performance and on related

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

PubMed Central

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

2011-01-01

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

[Linear accelerator-based stereotactic radiation treatment of patients with medial middle fossa meningiomas].

PubMed

Golanov, A V; Cherekaev, V A; Serova, N K; Pronin, I N; Gorlachev, G E; Kotel'nikova, T M; Podoprigora, A E; Kudriavtseva, P A; Galkin, M V

2010-01-01

Medial middle fossa meningiomas are challenging for neurosurgical treatment. Invasion of cranial nerves and vessels leads to high risk of complications after removal of such meningiomas. Currently methods of conformal stereotactic radiation treatment are applied wider and wider for the discussed lesions. During a 3.5-year period 80 patients with medial middle fossa meningiomas were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator "Novalis". In 31 case radiation treatment was preceded by surgical resection. In majority of patients symptoms included cranial nerve dysfunction: oculomotor disturbances in 62.5%, trigeminal impairment--in 37.5%, visual deficit--in 43.8%, facial nerve palsy--in 1.25%. 74 patients underwent radiotherapy with classical fractioning, 2--in hypofractionated mode and 4 received radiosurgery. In cases of classical fractioning mean marginal dose reached 46.3 Gy during 28-33 fractions, in hypofractioning (7 fractions)--31.5 Gy, in radiosurgery--16.25 Gy. Mean follow-up period was 18.4 months (6-42 months). Control of tumor growth was achieved in 97.5% of cases (78 patients): in 42 (52.5%) lesion shrinked, in 36 (45%) stabilization was observed. Clinical examination revealed improvement of visual function in 15 patients (18%) and deterioration in 2 (2.5%). No new neuropathies were found. Stereotactic radiation treatment is the method of choice for medial anterior and middle fossa meningiomas due to effective control of tumor progression and minimal rate of complications.

Ultrasound-guided, percutaneous peripheral nerve stimulation: technical note.

PubMed

Chan, Isaac; Brown, Anthony R; Park, Kenneth; Winfree, Christopher J

2010-09-01

Peripheral nerve stimulation is a form of neuromodulation that applies electric current to peripheral nerves to induce stimulation paresthesias within the painful areas. To report a method of ultrasound-guided, percutaneous peripheral nerve stimulation. This technique utilizes real-time imaging to avoid injury to adjacent vascular structures during minimally invasive placement of peripheral nerve stimulator electrodes. We describe a patient that presented with chronic, bilateral foot pain following multiple foot surgeries, for whom a comprehensive, pain management treatment strategy had failed. We utilized ultrasound-guided, percutaneous tibial nerve stimulation at a thigh level to provide durable pain relief on the right side, and open peripheral nerve stimulation on the left. The patient experienced appropriate stimulation paresthesias and excellent pain relief on the plantar aspect of the right foot with the percutaneous electrode. On the left side, we were unable to direct the stimulation paresthesias to the sole of the foot, despite multiple electrode repositionings. A subsequent, open placement of a left tibial nerve stimulator was performed. This revealed that the correct electrode position against the tibial nerve was immediately adjacent to the popliteal artery, and was thus not appropriate for percutaneous placement. We describe a method of ultrasound-guided peripheral nerve stimulation that avoids the invasiveness of electrode placement via an open procedure while providing excellent pain relief. We further describe limitations of the percutaneous approach when navigating close to large blood vessels, a situation more appropriately managed with open peripheral nerve stimulator placement. Ultrasound-guided placement may be considered for patients receiving peripheral nerve stimulators placed within the deep tissues, and not easily placed in a blind fashion.

Influence of nerve growth factor on developing dorso-medial and ventro-lateral neurons of chick and mouse trigeminal ganglia.

PubMed

Davies, A; Lumsden, A

1983-01-01

Trigeminal ganglia have been removed from five, six, seven and eight day chick embryos and explants of the dorso-medial (DM) and ventro-lateral (VL) parts of the maxillomandibular lobe were grown in tissue culture. Quantitative methods were used to assess the influence of nerve growth factor (NGF) on fiber outgrowth from these explants. At all ages outgrowth from DM explants was significantly greater than from VL explants, the difference being most pronounced between the extreme DM and VL poles of the maxillomandibular lobe. These observations are interpreted as indicating the existence of two distinct populations of neurons in terms of their response to NGF rather than the consequence of the asynchronous differentiation and maturation of the VL and DM neurons. A similar study of 10, 11 and 12 day embryonic mouse trigeminal ganglia revealed no significant difference in neurite outgrowth between DM and VL regions grown in the presence or absence of NGF. Copyright © 1983. Published by Elsevier Ltd.

Plantar fasciitis and its relationship with hallux limitus.

PubMed

Aranda, Yolanda; Munuera, Pedro V

2014-05-01

We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, -0.441; P < .01). Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.

Spinal cord projections of the rat main forelimb nerves, studied by transganglionic transport of WGA-HRP and by the disappearance of acid phosphatase.

PubMed

Castro-Lopes, J M; Coimbra, A

1991-03-01

The spinal cord projections of the 3 main forelimb nerves-median, radial and ulnar, were studied in the rat dorsal horn with transganglionic transport of wheat germ agglutinin-horseradish peroxidase (WGA-HRP), or using the disappearance of fluoride resistant acid phosphatase (FRAP) after nerve section. The projection patterns in lamina II were similar following the two procedures. The median and the radial nerve fibers projected to the medial and the intermediate thirds, respectively, of the dorsal horn lamina II in spinal cord segments C4-C8. The ulnar nerve projected to segments C6-C8 between the areas occupied by the other two nerves. The FRAP method also showed that the lateral part of lamina II, which was not filled by radial nerve fibers, received the projections from the dorsal cutaneous branches of cervical spinal nerves. In addition, FRAP disappeared from the medial end of segment T1 after skin incisions extending from the medial brachium to the axilla, which seemed due to severance of the cutaneous branchlets of the lateral anterior thoracic nerve. The FRAP procedure is thus sensitive enough to detect fibers in lamina II arising from small peripheral nerves, and may be used as an alternative to the anterograde tracing methods whenever there are no overlapping projections.

Contoured in-shoe foot orthoses increase mid-foot plantar contact area when compared with a flat insert during cycling.

PubMed

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

2013-01-01

To determine the effect of contouring of an in-shoe foot orthosis on plantar contact area and surface pressure, as well as perceived comfort and support at the foot-orthosis interface during stationary cycling. A randomised, repeated measures control study. Twelve cyclists performed steady-state seated cycling at a cadence of 90 rpm using a contoured orthosis and a flat insert of similar hardness. Contact area (CA) and plantar mean pressure (PP) were measured using the PEDAR® system, determined for seven discrete plantar regions and represented as the percentage of the total CA and PP respectively (CA% and PP%). Perceived comfort and support were rated using a visual analogue scale (VAS). The contoured orthosis produced a significantly greater CA% at the medial midfoot (p=0.001) and lateral midfoot (p=0.009) with a standardised mean difference (SMD) of 1.3 and 0.9 respectively. The contoured orthosis also produced a significantly greater PP% at the hallux (p=0.003) compared to the flat insert with a SMD of 1.1. There was a small non-significant effect (SMD<0.4) for the perceived comfort measures between conditions, but perceived support was significantly greater at the arch (p=0.000) and heel (p=0.013) with the contoured orthoses (SMD of 1.5 and 0.9, respectively). Contoured orthoses influenced the plantar surface of the foot by increasing contact area as well as a perception of greater support at the midfoot while increasing relative pressure through the hallux when compared to a flat insert during stationary cycling. No difference in perceived comfort was noted. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Biomechanical analysis of suture locations of the distal plantar fascia in partial foot.

PubMed

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

2015-12-01

The aim of this study was to evaluate the rationality of the suture locations of distal plantar fascia (DPF) after foot amputation to avoid the risk factors of re-amputation or plantar fasciitis. The tensile strain of plantar fascia (PF) in the different regions was measured by uni-axial tensile experiment. A three-dimensional (3D) finite element model was also developed to simulate tensile behaviour of PF in weight bearing conditions. The model includes 12 bones, ligaments, PF, cartilage and soft tissues. Four suture location models for the DPF were considered: the fourth and fifth DPF were sutured on the third metatarsal, the cuboid, and both the third metatarsal and the cuboid, and one un-sutured model. The peak tensile strain of the first, second and third PF was 0.134, 0.128 and 0.138 based on the mechanical test, respectively. The fourth and fifth DPF sutured at the cuboid and the third metatarsal could offer more favourable outcomes. The peak strain of 4.859 × 10(-2), 2.347 × 10(-2) and 1.364 × 10(-2) in the first, second and third PF showed the least outcomes in stance phase. Also, peak strain and stress of the residual PF reduced to 4.859 × 10(-2) and 1.834 MPa, respectively. The stress region was redistributed on the mid-shaft of the first and third PF and the peak stress of medial cuneiform bone evidently decreased. The fourth and fifth DPF suture at the third metatarsal and cuboid was appropriate for the partial foot. The findings are expected to suggest optimal surgical plan of the DPF suture and guide further therapeutic planning of partial foot patients.

Differences in muscle sympathetic nerve response to isometric exercise in different muscle groups.

PubMed

Saito, M

1995-01-01

The aim of this study was to examine the effects of muscle fibre composition on muscle sympathetic nerve activity (MSNA) in response to isometric exercise. The MSNA, recorded from the tibial nerve by a microneurographic technique during contraction and following arterial occlusion, was compared in three different muscle groups: the forearm (handgrip), anterior tibialis (foot dorsal contraction), and soleus muscles (foot plantar contraction) contracted separately at intensities of 20%, 33% and 50% of the maximal voluntary force. The increases in MSNA relative to control levels during contraction and occlusion were significant at all contracting forces for handgrip and at 33% and 50% of maximal for dorsal contraction, but there were no significant changes, except during exercise at 50%, for plantar contraction. The size of the MSNA response correlated with the contraction force in all muscle groups. Pooling data for all contraction forces, there were different MSNA responses among muscle groups in contraction forces (P = 0.0001, two-way analysis of variance), and occlusion periods (P = 0.0001). The MSNA increases were in the following order of magnitude: handgrip, dorsal, and plantar contractions. The order of the fibre type composition in these three muscles is from equal numbers of types I and II fibres in the forearm to increasing number of type I fibres in the leg muscles. The different MSNA responses to the contraction of different muscle groups observed may have been due in part to muscle metaboreflex intensity influenced by their metabolic capacity which is related to by their metabolic capacity which is related to the fibre type.

Screening Method Based on Walking Plantar Impulse for Detecting Musculoskeletal Senescence and Injury

PubMed Central

Fan, Yifang; Fan, Yubo; Li, Zhiyu; Newman, Tony; Lv, Changsheng; Zhou, Yi

2013-01-01

No consensus has been reached on how musculoskeletal system injuries or aging can be explained by a walking plantar impulse. We standardize the plantar impulse by defining a principal axis of plantar impulse. Based upon this standardized plantar impulse, two indexes are presented: plantar pressure record time series and plantar-impulse distribution along the principal axis of plantar impulse. These indexes are applied to analyze the plantar impulse collected by plantar pressure plates from three sources: Achilles tendon ruptures; elderly people (ages 62–71); and young people (ages 19–23). Our findings reveal that plantar impulse distribution curves for Achilles tendon ruptures change irregularly with subjects’ walking speed changes. When comparing distribution curves of the young, we see a significant difference in the elderly subjects’ phalanges plantar pressure record time series. This verifies our hypothesis that a plantar impulse can function as a means to assess and evaluate musculoskeletal system injuries and aging. PMID:24386288

Screening method based on walking plantar impulse for detecting musculoskeletal senescence and injury.

PubMed

Fan, Yifang; Fan, Yubo; Li, Zhiyu; Newman, Tony; Lv, Changsheng; Zhou, Yi

2013-01-01

No consensus has been reached on how musculoskeletal system injuries or aging can be explained by a walking plantar impulse. We standardize the plantar impulse by defining a principal axis of plantar impulse. Based upon this standardized plantar impulse, two indexes are presented: plantar pressure record time series and plantar-impulse distribution along the principal axis of plantar impulse. These indexes are applied to analyze the plantar impulse collected by plantar pressure plates from three sources: Achilles tendon ruptures; elderly people (ages 62-71); and young people (ages 19-23). Our findings reveal that plantar impulse distribution curves for Achilles tendon ruptures change irregularly with subjects' walking speed changes. When comparing distribution curves of the young, we see a significant difference in the elderly subjects' phalanges plantar pressure record time series. This verifies our hypothesis that a plantar impulse can function as a means to assess and evaluate musculoskeletal system injuries and aging.

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.

Running with a minimalist shoe increases plantar pressure in the forefoot region of healthy female runners.

PubMed

Bergstra, S A; Kluitenberg, B; Dekker, R; Bredeweg, S W; Postema, K; Van den Heuvel, E R; Hijmans, J M; Sobhani, S

2015-07-01

Minimalist running shoes have been proposed as an alternative to barefoot running. However, several studies have reported cases of forefoot stress fractures after switching from standard to minimalist shoes. Therefore, the aim of the current study was to investigate the differences in plantar pressure in the forefoot region between running with a minimalist shoe and running with a standard shoe in healthy female runners during overground running. Randomized crossover design. In-shoe plantar pressure measurements were recorded from eighteen healthy female runners. Peak pressure, maximum mean pressure, pressure time integral and instant of peak pressure were assessed for seven foot areas. Force time integral, stride time, stance time, swing time, shoe comfort and landing type were assessed for both shoe types. A linear mixed model was used to analyze the data. Peak pressure and maximum mean pressure were higher in the medial forefoot (respectively 13.5% and 7.46%), central forefoot (respectively 37.5% and 29.2%) and lateral forefoot (respectively 37.9% and 20.4%) for the minimalist shoe condition. Stance time was reduced with 3.81%. No relevant differences in shoe comfort or landing strategy were found. Running with a minimalist shoe increased plantar pressure without a change in landing pattern. This increased pressure in the forefoot region might play a role in the occurrence of metatarsal stress fractures in runners who switched to minimalist shoes and warrants a cautious approach to transitioning to minimalist shoe use. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

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

PubMed

Broholm, R; Pingel, J; Simonsen, L; Bülow, J; Johannsen, F

2017-12-01

Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularization in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). Twenty patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5), and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients, a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Predicting plantar fasciitis in runners.

PubMed

Warren, B L; Jones, C J

1987-02-01

Ninety-one runners were studied to determine whether specific variables were indicative of runners who had suffered with plantar fasciitis either presently or formerly vs runners who had never suffered with plantar fasciitis. Each runner was asked to complete a running history, was subjected to several anatomical measurements, and was asked to run on a treadmill in both a barefoot and shoe condition at a speed of 3.35 mps (8 min mile pace). Factor coefficients were used in a discriminant function analysis which revealed that, when group membership was predicted, 63% of the runners could be correctly assigned to their group. Considering that 76% of the control group was correctly predicted, it was concluded that the predictor variables were able to correctly predict membership of the control group, but not able to correctly predict the presently or formerly injured sufferers of plantar fasciitis.

[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

Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis.

PubMed

Gurcay, Eda; Kara, Murat; Karaahmet, Ozgur Zeliha; Ata, Ayşe Merve; Onat, Şule Şahin; Özçakar, Levent

We compared the effectiveness of ultrasound (US)-guided corticosteroid, injected superficial or deep to the fascia, in patients with plantar fasciitis. Thirty patients (24 females [75%] and 6 males [25%]) with unilateral chronic plantar fasciitis were divided into 2 groups according to the corticosteroid injection site: superficial (n = 15) or deep (n = 15) to the plantar fascia. Patient heel pain was measured using a Likert pain scale and the Foot Ankle Outcome Scale (FAOS) for foot disability, evaluated at baseline and repeated in the first and sixth weeks. The plantar fascia and heel pad thicknesses were assessed on US scans at baseline and the sixth week. The groups were similar in age, gender, and body mass index (p > .05 for all). Compared with the baseline values, the Likert pain scale (p < .001 for all) and FAOS subscale (p < .01 for all) scores had improved at the first and sixth week follow-up visits in both groups. Although the plantar fascia thickness had decreased significantly in both groups at the sixth week (p < .001 for both), the heel pad thickness remained unchanged (p > .05 for both). The difference in the FAOS subscales (pain, p = .002; activities of daily living, p = .003; sports/recreational activities, p = .008; quality of life, p = .009) and plantar fascia thickness (p = .049) showed better improvement in the deep than in the superficial injection group. US-guided corticosteroid injections are safe and effective in the short-term therapeutic outcome of chronic plantar fasciitis. Additionally, injection of corticosteroid deep to the fascia might result in greater reduction in plantar fascia thickness, pain, and disability and improved foot-related quality of life. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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.

Surgery for Patients With Recalcitrant Plantar Fasciitis

PubMed Central

Wheeler, Patrick; Boyd, Kevin; Shipton, Mary

2014-01-01

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

Nonlinear Inverted-U Shaped Relationship between Aging and Epidermal Innervation in the Rat Plantar Hind Paw: a Laser Scanning Confocal Microscopy Study.

PubMed

Kaliappan, Sankaranarayanan; Simone, Donald A; Banik, Ratan K

2018-04-13

The under-reporting of pain and atypical manifestations of painful syndromes within the elderly population have been well-documented, however, the specific relationship between pain and aging remains ambiguous. Previous studies have reported degenerative changes in primary afferents with aging. In this study, we questioned whether there is any change in the density of primary afferent endings within the epidermis of aged animals. Rats were categorically assessed in four age groups, each representing a key developmental stage across their life span: juvenile (2 months); adult (7 months); aged (18 months); and senescent (24-26 months). The plantar hind paw skin was removed, post-fixed, cut, and immunostained for protein gene product 9.5 and type IV collagen. Rats in the adult aged groups had significantly increased epidermal nerve densities and total lengths of immunoreactive nerve fibers, compared to both juvenile and senescent rats. However, the paw withdrawal thresholds to punctate mechanical stimulation progressively increased with age, and did not exhibit a clear relationship with epidermal innervation. We conclude a non-linear, inverted-U shaped relationship between rat plantar epidermal nerve density with aging, which does not correlate with mechanically-induced paw withdrawal behaviors. This article presents age-related decreased epidermal innervation in rat hind paw skin, which partly explains mechanisms underlying decreased pain sensitivity in aged subjects. The article may help clinicians to understand that any compromise of pain-sensing pathway can lead to under-reporting of pain, inadequate analgesia, and slower recovery from a painful condition. Copyright © 2018. Published by Elsevier Inc.

STAPP: Spatiotemporal analysis of plantar pressure measurements using statistical parametric mapping.

PubMed

Booth, Brian G; Keijsers, Noël L W; Sijbers, Jan; Huysmans, Toon

2018-05-03

Pedobarography produces large sets of plantar pressure samples that are routinely subsampled (e.g. using regions of interest) or aggregated (e.g. center of pressure trajectories, peak pressure images) in order to simplify statistical analysis and provide intuitive clinical measures. We hypothesize that these data reductions discard gait information that can be used to differentiate between groups or conditions. To test the hypothesis of null information loss, we created an implementation of statistical parametric mapping (SPM) for dynamic plantar pressure datasets (i.e. plantar pressure videos). Our SPM software framework brings all plantar pressure videos into anatomical and temporal correspondence, then performs statistical tests at each sampling location in space and time. Novelly, we introduce non-linear temporal registration into the framework in order to normalize for timing differences within the stance phase. We refer to our software framework as STAPP: spatiotemporal analysis of plantar pressure measurements. Using STAPP, we tested our hypothesis on plantar pressure videos from 33 healthy subjects walking at different speeds. As walking speed increased, STAPP was able to identify significant decreases in plantar pressure at mid-stance from the heel through the lateral forefoot. The extent of these plantar pressure decreases has not previously been observed using existing plantar pressure analysis techniques. We therefore conclude that the subsampling of plantar pressure videos - a task which led to the discarding of gait information in our study - can be avoided using STAPP. Copyright © 2018 Elsevier B.V. All rights reserved.

Plantar Hyperhidrosis: An Overview.

PubMed

Vlahovic, Tracey C

2016-07-01

Plantar hyperhidrosis, excessive sweating on the soles of feet, can have a significant impact on patients' quality of life and emotional well-being. Hyperhidrosis is divided into primary and secondary categories, depending on the cause of the sweating, with plantar hyperhidrosis typically being primary and idiopathic. There is an overall increased risk of cutaneous infection in the presence of hyperhidrosis, including fungal, bacterial, and viral infections. This article discusses a range of treatment options including topical aluminum chloride, iontophoresis, injectable botulinum toxin A, glycopyrrolate, oxybutynin, laser, and endoscopic lumbar sympathectomy. Lifestyle changes regarding hygiene, shoe gear, insoles, and socks are also discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity.

PubMed

Bisi-Balogun, Adebisi; Cassel, Michael; Mayer, Frank

2016-04-13

This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC.

Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity

PubMed Central

Bisi-Balogun, Adebisi; Cassel, Michael; Mayer, Frank

2016-01-01

This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC. PMID:27089369

Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome.

PubMed

Saeki, Junya; Nakamura, Masatoshi; Nakao, Sayaka; Fujita, Kosuke; Yanase, Ko; Morishita, Katsuyuki; Ichihashi, Noriaki

2017-01-01

A high proportion of flexor digitorum longus attachment is found at the posteromedial border of the tibia, which is the most common location of medial tibial stress syndrome (MTSS). Therefore, plantar flexion strength of the lesser toes could be related to MTSS; however, the relationship between MTSS and muscle strength of the hallux and lesser toes is not yet evaluated due to the lack of quantitative methods. This study investigated the muscle strength characteristics in runners with a history of MTSS by using a newly developed device to measure the muscle strength of the hallux, lesser toes, and ankle. This study comprised 27 collegiate male runner participants (20.0 ± 1.6 years, 172.1 ± 5.1 cm, 57.5 ± 4.0 kg). Maximal voluntary isometric contraction (MVIC) torque of the plantar flexion, dorsiflexion, inversion, and eversion of the ankle were measured by using an electric dynamometer. MVIC torque of the 1st metatarsophalangeal joint (MTPJ) and 2nd-5th MTPJ were measured by using a custom-made torque-measuring device. MVIC torques were compared between runners with and without a history of MTSS. MVIC torque of the 1st MTPJ plantar flexion was significantly higher in runners with a history of MTSS than in those without it. In contrast, there were no significant differences in the MVIC torque values of the 2nd-5th MTPJ plantar flexion and each MVIC torque of the ankle between runners with and without a history of MTSS. A history of MTSS increased the isometric FHL strength.

Comparison of plantar pressure distribution in CAD-CAM and prefabricated foot orthoses in patients with flexible flatfeet.

PubMed

Khodaei, Banafsheh; Saeedi, Hassan; Jalali, Maryam; Farzadi, Maede; Norouzi, Ehsan

2017-12-01

The effect of foot orthoses on plantar pressure distribution has been proven by researchers but there are some controversies about advantages of custom-made foot orthoses to less expensive prefabricated foot orthoses. Nineteen flatfeet adults between 18 and 45 participated in this study. CAD-CAM foot orthoses were made for these patients according to their foot scan. Prefabricated foot orthoses were prepared according to their foot size. Plantar pressure, force and contact area were measured using pedar ® -x in-shoe system wearing shoe alone, wearing CAD-CAM foot orthoses and wearing prefabricated foot orthoses. Repeated measures ANOVA model with post-hoc, Bonferroni comparison were used to test differences. CAD-CAM and prefabricated foot orthoses both decreased pressure and force under 2nd, 3-5 metatarsal and heel regions comparing to shoe alone condition. CAD-CAM foot orthosis increased pressure under lateral toe region in comparison to shoe alone and prefabricated foot orthosis. Both foot orthoses increased pressure and contact area in medial midfoot region comparing to shoe alone condition. Increased forces were seen at hallux and lateral toes by prefabricated foot orthoses in comparison with CAD-CAM foot orthoses and control condition, respectively. According to the results, both foot orthoses could decrease the pressure under heel and metatarsal area. It seems that the special design of CAD-CAM foot orthoses could not make great differences in plantar pressure distribution in this sample. Further research is required to determine whether these results are associated with different scan systems or design software. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparison of plantar flexor musculotendinous stiffness, geometry, and architecture in male runners with and without a history of tibial stress fracture.

PubMed

Pamukoff, Derek N; Blackburn, J Troy

2015-02-01

Greater lower extremity joint stiffness may be related to the development of tibial stress fractures in runners. Musculotendinous stiffness is the largest contributor to joint stiffness, but it is unclear what factors contribute to musculotendinous stiffness. The purpose of this study was to compare plantar flexor musculotendinous stiffness, architecture, geometry, and Achilles tendon stiffness between male runners with and without a history of tibial stress fracture. Nineteen healthy runners (age = 21 ± 2.7 years; mass = 68.2 ± 9.3 kg; height = 177.3 ± 6.0 cm) and 19 runners with a history of tibial stress fracture (age = 21 ± 2.9 years; mass = 65.3 ± 6.0 kg; height = 177.2 ± 5.2 cm) were recruited from community running groups and the university's varsity and club cross-country teams. Plantar flexor musculotendinous stiffness was estimated from the damped frequency of oscillatory motion about the ankle follow perturbation. Ultrasound imaging was used to measure architecture and geometry of the medial gastrocnemius. Dependent variables were compared between groups via one-way ANOVAs. Previously injured runners had greater plantar flexor musculotendinous stiffness (P < .001), greater Achilles tendon stiffness (P = .004), and lesser Achilles tendon elongation (P = .003) during maximal isometric contraction compared with healthy runners. No differences were found in muscle thickness, pennation angle, or fascicle length.

Ultrasound elastography in the early diagnosis of plantar fasciitis.

PubMed

Lee, So-Yeon; Park, Hee Jin; Kwag, Hyon Joo; Hong, Hyun-Pyo; Park, Hae-Won; Lee, Yong-Rae; Yoon, Kyung Jae; Lee, Yong-Taek

2014-01-01

The purpose of this study was to investigate whether ultrasound (US) elastography is useful for the early diagnosis of plantar fasciitis. We retrospectively reviewed US elastography findings of 18 feet with a clinical history and physical examination highly suggestive of plantar fasciitis but with normal findings on conventional US imaging as well as 18 asymptomatic feet. Softening of the plantar fascia was significantly greater in the patient than in the control group [Reviewers 1 and 2: 89% (16/18) vs. 50% (9/18), P=.027, respectively]. US elastography is useful for the early diagnosis of plantar fasciitis. Copyright © 2014 Elsevier Inc. All rights reserved.

Accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints.

PubMed

Siegenthaler, Andreas; Mlekusch, Sabine; Trelle, Sven; Schliessbach, Juerg; Curatolo, Michele; Eichenberger, Urs

2012-08-01

Cervical zygapophysial joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints using fluoroscopy as control. Sixty volunteers were studied. Ultrasound-imaging was used to place the needle to the bony target of cervical zygapophysial joint nerve blocks. The levels of needle placement were determined randomly (three levels per volunteer). After ultrasound-guided needle placement and application of 0.2 ml contrast dye, fluoroscopic imaging was performed for later evaluation by a blinded pain physician and considered as gold standard. Raw agreement, chance-corrected agreement κ, and chance-independent agreement Φ between the ultrasound-guided placement and the assessment using fluoroscopy were calculated to quantify accuracy. One hundred eighty needles were placed in 60 volunteers. Raw agreement was 87% (95% CI 81-91%), κ was 0.74 (0.64-0.83), and Φ 0.99 (0.99-0.99). Accuracy varied significantly between the different cervical nerves: it was low for the C7 medial branch, whereas all other levels showed very good accuracy. Ultrasound-imaging is an accurate technique for performing cervical zygapophysial joint nerve blocks in volunteers, except for the medial branch blocks of C7.

The use of shock waves in peripheral nerve regeneration: new perspectives?

PubMed

Hausner, Thomas; Nógrádi, Antal

2013-01-01

Low-energy extracorporeal shock wave treatment (ESWT) is a relatively new therapeutic tool that is widely used for the treatment of epicondylitis and plantar fasciitis and to foster bone and wound healing. Shock waves, sonic pulses with high energy impact, are thought to induce biochemical changes within the targeted tissues through mechanotransduction. The biological effects of ESWT are manifested in improved vascularization, the local release of growth factors, and local anti-inflammatory effects, but the target cells too are influenced. ESWT appears to have differential effects on peripheral nerves and has been proved to promote axonal regeneration after axotomy. This review discusses the effects of ESWT on intact and injured peripheral nerves and suggests a multiple mechanism of action. © 2013 Elsevier Inc. All rights reserved.

The Relationships between Foot Arch Volumes and Dynamic Plantar Pressure during Midstance of Walking in Preschool Children

PubMed Central

Chang, Hsun-Wen; Chieh, Hsiao-Feng; Lin, Chien-Ju; Su, Fong-Chin; Tsai, Ming-June

2014-01-01

Objectives The purpose of this study was to examine the correlation between the foot arch volume measured from static positions and the plantar pressure distribution during walking. Methods A total of 27 children, two to six years of age, were included in this study. Measurements of static foot posture were obtained, including navicular height and foot arch volume in sitting and standing positions. Plantar pressure, force and contact areas under ten different regions of the foot were obtained during walking. Results The foot arch index was correlated (r = 0.32) with the pressure difference under the midfoot during the foot flat phase. The navicular heights and foot arch volumes in sitting and standing positions were correlated with the mean forces and pressures under the first (r = −0.296∼−0.355) and second metatarsals (r = −0.335∼−0.504) and midfoot (r = −0.331∼−0.496) during the stance phase of walking. The contact areas under the foot were correlated with the foot arch parameters, except for the area under the midfoot. Conclusions The foot arch index measured in a static position could be a functional index to predict the dynamic foot functions when walking. The foot arch is a factor which will influence the pressure distribution under the foot. Children with a lower foot arch demonstrated higher mean pressure and force under the medial forefoot and midfoot, and lower contact areas under the foot, except for the midfoot region. Therefore, children with flatfoot may shift their body weight to a more medial foot position when walking, and could be at a higher risk of soft tissue injury in this area. PMID:24736650

Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks.

PubMed

Cho, Hyejin; Lee, Hye-Yeon; Gil, Young-Chun; Choi, Yun-Rak; Yang, Hee-Jun

2013-10-01

Understanding of the anatomy of the radial nerve and its branches is vital to the treatment of humeral fracture or the restoration of upper extremity function. In this study, we dissected 40 upper extremities from adult cadavers to locate the course of the radial nerve and the origins and insertions of the branches of the radial nerve using surface landmarks. The radial nerve reached and left the radial groove and pierced the lateral intermuscular septum, at the levels of 46.7, 60.5, and 66.8% from the acromion to the transepicondylar line, respectively. Branches to the long head of the triceps brachii originated in the axilla, and branches to the medial and lateral heads originated in the axilla or in the arm. The muscular attachments to the long, medial, and lateral heads were on average 34.0 mm proximal, 16.4 mm distal, and 19.3 mm proximal to the level of inferior end of the deltoid muscle, respectively. The radial nerve innervated 65.0% of the brachialis muscles. Branches to the brachioradialis and those to the extensor carpi radialis longus arose from the radial nerve above the transepicondylar line. Branches to the extensor carpi radialis brevis usually arose from the deep branch of radial nerve (67.5%); however, in some cases, branches to the extensor carpi radialis brevis arose from either the radial nerve (20.0%) or the superficial branch of the radial nerve (12.5%). Using these data, the course of the radial nerve can be estimated by observing the surface of the arm. Copyright © 2012 Wiley Periodicals, Inc.

Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs.

PubMed

Campoy, Luis; Bezuidenhout, Abraham J; Gleed, Robin D; Martin-Flores, Manuel; Raw, Robert M; Santare, Carrie L; Jay, Ariane R; Wang, Annie L

2010-03-01

To describe an ultrasound-guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. Prospective experimental trial. Four hound-cross dogs aged 2 +/- 0 years (mean +/- SD) weighing 30 +/- 5 kg and four Beagles aged 2 +/- 0 years and weighing 8.5 +/- 0.5 kg. Axillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation-guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. Axillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve block Landmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve block. Ultrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. Ultrasound-guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.

Relative contributions of plantar fascia and ligaments on the arch static stability: a finite element study.

PubMed

Tao, Kai; Ji, Wen-Ting; Wang, Dong-Mei; Wang, Cheng-Tao; Wang, Xu

2010-10-01

The plantar fascia (PF) and major ligaments play important roles in keeping the static foot arch structure. Their functions and relative contributions to the arch stability have not been well studied. A three-dimensional finite element foot model was created based on the reconstruction of magnetic resonance images. During balanced standing, four cases after individual releases of the PF, spring ligament (SL), and long and short plantar ligaments (LPL and SPL) were simulated, to compare their biomechanical consequences with the normal predictions under the intact structure. Although the predictions showed the arch did not collapse obviously after each structure sectioning, the internal mechanical behaviors changed considerably. The PF release resulted in the maximal increases of approximately 91%, 65% and 47% in the tensions of the LPF, SPL and SL, produced the largest changes in all bone rotations, and brought an obvious shift of high stress from the medial metatarsals to the lateral metatarsals. The SL release mainly enhanced bone rotation angles and weakened the joint stability of the arch structure. The LPL and the SPL performed the roles of mutual compensation as either one was released. The influence of the LPL on the load distribution among metatarsals was greater than for the SPL and the SL.

Plantar hyperhidrosis: A review of current management.

PubMed

Singh, Sanjay; Kaur, Simranjit; Wilson, Paul

2016-11-01

To critically appraise current literature regarding the management of plantar hyperhidrosis in the form of a structured review. A literature search was conducted using various databases and search criteria. The literature reports the use of conservative, medical and surgical treatment modalities for the management of plantar hyperhidrosis. However, long-term follow-up data are rare and some treatment modalities currently available are not fully understood. There is a considerable dearth in the literature on the management of plantar hyperhidrosis. Further study in larger populations with longer follow-up times is critical to access the long-term effects of treatment. Nonetheless, iontophoresis, botulinum toxin injection and lumbar sympathectomy are promising treatment modalities for this disorder.

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.

Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis.

PubMed

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

2015-01-01

Calcaneal spurs, as a cause of plantar fasciitis, are currently debatable. A prospective study was performed to classify calcaneal spurs according to the findings from an investigation of the relationship between calcaneal spurs and plantar fasciitis. Thirty patients with calcaneal spurs and plantar heel pain underwent calcaneal spur removal and endoscopic plantar fasciotomy. The relationship between the classification of calcaneal spurs and plantar fasciitis was evaluated by endoscopic findings, clinical symptoms, radiographic images, and biopsy findings. The visual analog scale for pain and the American Orthopedic Foot and Ankle Society ankle-hindfoot scores for functional evaluation were used preoperatively and postoperatively, respectively. The mean follow-up period was 24 months. Two separate types of calcaneal spurs were recognized. Type A calcaneal spurs were located superior to the plantar fascia insertion, and type B calcaneal spurs were located within the plantar fascia. Magnetic resonance imaging results showed a more severe plantar fasciitis grade in type B calcaneal spurs preoperatively. Histologic examination showed that the numbers of granulocytes per image in type B spurs were significantly increased compared with those in type A spurs. Statistically significant improvements were found in the mean visual analog scale and American Orthopedic Foot and Ankle Society scores and magnetic resonance imaging results in both groups. The amount of change in the visual analog scale score and American Orthopedic Foot and Ankle Society score, the number of granulocytes per image, and calcaneal spur length showed a high association with the classification of the calcaneal spurs. Calcaneal spurs were completely removed and did not recur in any of the patients on radiographic assessment during the follow-up period. Calcaneal spurs can be classified into 2 distinct types that are indicative of the severity of plantar fasciitis. Copyright © 2015 American College of

Adipose-derived mesenchymal stem cells accelerate nerve regeneration and functional recovery in a rat model of recurrent laryngeal nerve injury.

PubMed

Li, Yun; Xu, Wen; Cheng, Li-Yu

2017-09-01

Medialization thyroplasty or injection laryngoplasty for unilateral vocal fold paralysis cannot restore mobility of the vocal fold. Recent studies have shown that transplantation of mesenchymal stem cells is effective in the repair of nerve injuries. This study investigated whether adipose-derived stem cell transplantation could repair recurrent laryngeal nerve injury. Rat models of recurrent laryngeal nerve injury were established by crushing with micro forceps. Adipose-derived mesenchymal stem cells (ADSCs; 8 × 10 5 ) or differentiated Schwann-like adipose-derived mesenchymal stem cells (dADSCs; 8 × 10 5 ) or extracellular matrix were injected at the site of injury. At 2, 4 and 6 weeks post-surgery, a higher density of myelinated nerve fiber, thicker myelin sheath, improved vocal fold movement, better recovery of nerve conduction capacity and reduced thyroarytenoid muscle atrophy were found in ADSCs and dADSCs groups compared with the extracellular matrix group. The effects were more pronounced in the ADSCs group than in the dADSCs group. These experimental results indicated that ADSCs transplantation could be an early interventional strategy to promote regeneration after recurrent laryngeal nerve injury.

Changes in leg spring behaviour, plantar loading and foot mobility magnitude induced by an exhaustive treadmill run in adolescent middle-distance runners.

PubMed

Fourchet, François; Girard, Olivier; Kelly, Luke; Horobeanu, Cosmin; Millet, Grégoire P

2015-03-01

This study aimed to determine adjustments in spring-mass model characteristics, plantar loading and foot mobility induced by an exhaustive run. Within-participants repeated measures. Eleven highly-trained adolescent middle-distance runners ran to exhaustion on a treadmill at a constant velocity corresponding to 95% of velocity associated with VO₂max (17.8 ± 1.4 kmh(-1), time to exhaustion=8.8 ± 3.4 min). Contact time obtained from plantar pressure sensors was used to estimate spring-mass model characteristics, which were recorded (during 30 s) 1 min after the start and prior to exhaustion using pressure insoles. Foot mobility magnitude (a composite measure of vertical and medial-lateral mobility of the midfoot) was measured before and after the run. Mean contact area (foot to ground), contact time, peak vertical ground reaction force, centre of mass vertical displacement and leg compression increased significantly with fatigue, while flight time, leg stiffness and mean pressure decreased. Leg stiffness decreased because leg compression increased to a larger extent than peak vertical ground reaction forces. Step length, step frequency and foot mobility magnitude did not change at exhaustion. The stride pattern of adolescents when running on a treadmill at high constant velocity deteriorates near exhaustion, as evidenced by impaired leg-spring behaviour (leg stiffness) and altered plantar loading. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Plantar keloids: diagnostic and therapeutic issues in six patients.

PubMed

Vanhaecke, C; Hickman, G; Cavelier-Balloy, B; Masson, V; Duron, J-B; Gorj, M; May, P; Schneider, P; Vilmer, C; Bagot, M; Battistella, M; Petit, A

2015-07-01

Keloids are benign fibro-proliferative skin lesions that very rarely occur on the soles. Because of their rarity, the diagnosis of plantar keloids can be difficult. We describe the clinical and histopathological characteristics of eight plantar keloids. All patients presenting with plantar keloids between 2005 and 2012 in our Dermatology unit were retrospectively included. Diagnosis was definitely established by re-reading of pathological slides in all cases. Clinical characteristics, histopathological features, treatments given and their results were collected. Six patients were included. Five patients had a single plantar keloid and one had three lesions. They all were of African descent. Only one patient remembered of a previous injury at the site of the keloid. Three patients presented with associated extra-plantar keloids. In four patients, the diagnosis of keloid was not initially suspected clinically or histologically. Re-reading of the clinical photographs showed that the eight plantar keloids shared common morphological features, leading to a distinctive clinical picture, defined by a hardened lesion of rounded or polycyclic shape, with a pink surface crossed by keratotic furrows and the presence of a hyperkeratotic rim. Concerning pathological features, typical hyalinized collagen can be missing and deep fibrosis should not rule out the diagnosis of keloid. Intralesional injection of triamcinolone acetonide and orthopaedic shoes were useful. All patients who had surgical excision presented recurrence. The knowledge of the clinical features of plantar keloids is helpful to the diagnosis. There is no well-established treatment, but supportive measures are important. © 2014 European Academy of Dermatology and Venereology.

In-shoe plantar pressure distribution and lower extremity muscle activity patterns of backward compared to forward running on a treadmill.

PubMed

Sterzing, Thorsten; Frommhold, Clivia; Rosenbaum, Dieter

2016-05-01

Backward locomotion in humans occurs during leisure, rehabilitation, and competitive sports. Little is known about its general biomechanical characteristics and how it affects lower extremity loading as well as muscle coordination. Thus, the purpose of this research was to analyze in-shoe plantar pressure patterns and lower extremity muscle activity patterns for backward compared to forward running. On a treadmill, nineteen runners performed forward running at their individually preferred speed, followed by backward running at 70% of their self-selected forward speed. In-shoe plantar pressures of nine foot regions and muscular activity of nine lower extremity muscles were recorded simultaneously over a one-minute interval. Backward and forward running variables were averaged over the accumulated steps and compared with Wilcoxon-signed rank tests (p<.05). For backward compared to forward running, in-shoe plantar pressure distribution showed a load increase under metatarsal heads I and II, as well as under the medial midfoot. This was indicated by higher maximum forces and peak pressures, and by longer contact times. Muscle activity showed significantly higher mean amplitudes during backward running in the semitendinosus, rectus femoris, vastus lateralis, and gluteus medius during stance, and in the rectus femoris during swing phase, while significantly lower mean amplitudes were observed in the tibialis anterior during swing phase. Observations indicate plantar foot loading and muscle activity characteristics that are specific for the running direction. Thus, backward running may be used on purpose for certain rehabilitation tasks, aiming to strengthen respective lower extremity muscles. Furthermore, the findings are relevant for sport specific backward locomotion training. Finally, results provide an initial baseline for innovative athletic footwear development aiming to increase comfort and performance during backward running. Copyright © 2016 Elsevier B.V. All

Treatment of Plantar Fasciitis With Botulinum Toxin.

PubMed

Ahmad, Jamal; Ahmad, Stacy H; Jones, Kennis

2017-01-01

This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial. Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection. At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group ( P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group ( P < .05). By that time, 0 (0%) and 3 (12%) patients who received IBTA and saline, respectively, underwent surgery for recalcitrant plantar fasciitis ( P < .005). Compared with placebo saline injection, using IBTA to treat plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis. I, Randomized, double-blinded, placebo-controlled study.

Medial shoe-ground pressure and specific running injuries: A 1-year prospective cohort study.

PubMed

Brund, René B K; Rasmussen, Sten; Nielsen, Rasmus O; Kersting, Uwe G; Laessoe, Uffe; Voigt, Michael

2017-09-01

Achilles tendinitis, plantar fasciopathy and medial tibial stress syndrome injuries (APM-injuries) account for approximately 25% of the total number of running injuries amongst recreational runners. Reports on the association between static foot pronation and APM-injuries are contradictory. Possibly, dynamic measures of pronation may display a stronger relationship with the risk of APM-injuries. Therefore, the purpose of the present study was to investigate if running distance until the first APM-injury was dependent on the foot balance during stance phase in recreational male runners. Prospective cohort study. Foot balance for both feet was measured during treadmill running at the fastest possible 5000-m running pace in 79 healthy recreational male runners. Foot balance was calculated by dividing the average of medial pressure with the average of lateral pressure. Foot balance was categorized into those which presented a higher lateral shod pressure (LP) than medial pressure, and those which presented a higher medial shod pressure (MP) than lateral pressure during the stance phase. A time-to-event model was used to compare differences in incidence between foot balance groups. Compared with the LP-group (n=59), the proportion of APM-injuries was greater in the MP-group (n=99) after 1500km of running, resulting in a cumulative risk difference of 16%-points (95% CI=3%-point; 28%-point, p=0.011). Runners displaying a more medial pressure during stance phase at baseline sustained a greater amount of APM-injuries compared to those displaying a lateral shod pressure during stance phase. Prospective studies including a greater amount of runners are needed to confirm this relationship. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis.

PubMed

Chou, Andrew Chia Chen; Ng, Sean Yung Chuan; Su, David Hsien Ching; Singh, Inderjeet Rikhraj; Koo, Kevin

2016-12-01

Radiofrequency microtenotomy (RM) is effective for treating plantar fasciitis. No studies have compared it to the plantar fasciotomy (PF). We hypothesized that RM is equally effective and provides no additional benefit when performed with PF. Between 2007 and 2014, all patients who underwent either or both procedures concurrently at our institution were analyzed. Data collected included demographics, SF-36 Health Survey, AOFAS Ankle-Hindfoot Scale, and two questions regarding satisfaction and expectations, all of which were assessed pre-operatively and post-operatively at 6-months and 1-year. ANOVA with Bonferroni correction was used to compare scores at each interval. Logistic regression was used to identify pre-operative factors that predicted for satisfaction and expectations. There were no differences in patient outcomes. No pre-operative factors predicted for satisfaction and expectations. RM is as effective as PF in the treatment of plantar fasciitis. Patients who underwent both procedures experienced no benefit and a higher rate of complications. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Can foot anthropometric measurements predict dynamic plantar surface contact area?

PubMed

McPoil, Thomas G; Vicenzino, Bill; Cornwall, Mark W; Collins, Natalie

2009-10-28

Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area. Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 +/- 3.5 years). The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform. A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (R2 = 0.77, p < 0.0001)). A three variable model was also found to describe the relationship between the foot measures/ratio and plantar contact area minus the toe region (R2 = 0.76, p < 0.0001). The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region.

Can foot anthropometric measurements predict dynamic plantar surface contact area?

PubMed Central

2009-01-01

Background Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area. Methods Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 ± 3.5 years). The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform. Results A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (R2 = 0.77, p < 0.0001)). A three variable model was also found to describe the relationship between the foot measures/ratio and plantar contact area minus the toe region (R2 = 0.76, p < 0.0001). Conclusion The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region. PMID:19863799

Potential Relationship between Passive Plantar Flexor Stiffness and Running Performance.

PubMed

Ueno, Hiromasa; Suga, Tadashi; Takao, Kenji; Tanaka, Takahiro; Misaki, Jun; Miyake, Yuto; Nagano, Akinori; Isaka, Tadao

2018-02-01

The present study aimed to determine the relationship between passive stiffness of the plantar flexors and running performance in endurance runners. Forty-eight well-trained male endurance runners and 24 untrained male control subjects participated in this study. Plantar flexor stiffness during passive dorsiflexion was calculated from the slope of the linear portion of the torque-angle curve. Of the endurance runners included in the present study, running economy in 28 endurance runners was evaluated by measuring energy cost during three 4-min trials (14, 16, and 18 km/h) of submaximal treadmill running. Passive stiffness of the plantar flexors was significantly higher in endurance runners than in untrained subjects. Moreover, passive plantar flexor stiffness in endurance runners was significantly correlated with a personal best 5000-m race time. Furthermore, passive plantar flexor stiffness in endurance runners was significantly correlated with energy cost during submaximal running at 16 km/h and 18 km/h, and a trend towards such significance was observed at 14 km/h. The present findings suggest that stiffer plantar flexors may help achieve better running performance, with greater running economy, in endurance runners. Therefore, in the clinical setting, passive stiffness of the plantar flexors may be a potential parameter for assessing running performance. © Georg Thieme Verlag KG Stuttgart · New York.

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

PubMed

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

2009-12-01

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

[Reconstruction of chronic Achilles tendon rupture with flexor hallucis longus tendon harvested using a minimally invasive technique].

PubMed

Miao, Xudong; Wu, Yongping; Tao, Huimin; Yang, Disheng

2011-07-01

To evaluate the effectiveness of flexor hallucis longus tendon harvested using a minimally invasive technique in reconstruction of chronic Achilles tendon rupture. Between July 2006 and December 2009, 22 patients (22 feet) with chronic Achilles tendon rupture were treated, including 16 males and 6 females with a median age of 48 years (range, 28-65 years). The disease duration was 27-1,025 days (median, 51 days). Twenty-one patients had hooflike movement's history and 1 patient had no obvious inducement. The result of Thompson test was positive in 22 cases. The score was 53.04 +/- 6.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. MRI indicated that the gap of the chronic Achilles tendon rupture was 4.2-8.0 cm. A 3 cm-long incision was made vertically in the plantar aspect of the midfoot and a 1 cm-long transverse incision was made in a plantar flexor crease at the base of the great toe to harvest flexor hallucis longus tendon. The flexor hallucis longus tendon was 10.5-13.5 cm longer from tuber calcanei to the end of the Achilles tendon, and then the tendon was fixed to the tuber calcanei using interface screws or anchor nail after they were woven to form reflexed 3-bundle and sutured. Wound healed by first intention in all patients and no early complication occurred. Twenty-two patients were followed up 12-42 months (mean, 16.7 months). At 12 months after operation, The AOFAS ankle and hindfoot score was 92.98 +/- 5.72, showing significant difference when compared with that before operation (t= -40.903, P=0.000). The results were excellent in 18 cases, good in 2 cases, and fair in 2 cases with an excellent and good rate of 90.9%. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury, and lateral plantar nerve injury occurred. Chronic Achilles tendon rupture reconstruction with flexor hallucis longus tendon harvested using a minimally invasive technique offers a

[Anatomical rationale for lingual nerve injury prevention during mandibular block].

PubMed

Semkin, V A; Dydikin, S S; Kuzin, A V; Sogacheva, V V

2015-01-01

The topographic and anatomical study of lingual nerve structural features was done. It was revealed that during mandibular anesthesia possible lingual nerve injury can occur if puncture needle is lower than 1 cm. of molars occlusal surface level. The position of the lingual nerve varies withmandible movements. At the maximum open mouth lingual nerve is not mobile and is pressed against the inner surface of the mandibular ramus by the medial pterygoid muscle and the temporal muscle tendon. When closing the mouth to 1.25±0.2 cmfrom the physiological maximum, lingual nerve is displaced posteriorly from the internal oblique line of the mandible and gets mobile. On the basis of topographic and anatomic features of the lingual nervestructure the authors recommend the re-do of inferior alveolar nerve block, a semi-closed mouth position or the use the "high block techniques" (Torus anesthesia, Gow-Gates, Vazirani-Akinozi).

Dilation of the oropharynx via selective stimulation of the hypoglossal nerve

NASA Astrophysics Data System (ADS)

Huang, Jingtao; Sahin, Mesut; Durand, Dominique M.

2005-12-01

The functional effects of selective hypoglossal nerve (HG) stimulation with a multi-contact peripheral nerve electrode were assessed using images of the upper airways and the tongue in anesthetized beagles. A biphasic pulse train of 50 Hz frequency and 2 s duration was applied through each one of the tripolar contact sets of the nerve electrode while the pharyngeal images were acquired into a computer. The stimulation current was limited to 20% above the activation threshold for maximum selectivity. The images showed that various contact sets could generate several different activation patterns of the tongue muscles resulting in medial and/or lateral dilation and closing of the airways at the tongue root. Some of these patterns translated into an increase in the oropharyngeal size while others did not have any effect. The pharyngeal sizes were not statistically different during stimulation either between the two different positions of the head (30° and 60°), or when the lateral contacts were compared with the medial ones. The contacts that had the least effect generated an average of 53 ± 15% pharyngeal dilation relative to the best contacts, indicating that the results are marginally sensitive to the contact position around the HG nerve trunk. These results suggest that selective HG nerve stimulation can be a useful technique to produce multiple tongue activation patterns that can dilate the pharynx. This may in turn increase the size of the patient population who can benefit from HG nerve stimulation as a treatment method for obstructive sleep apnea.

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

PubMed

Black, Georgia; Waddington, Gordon; Adams, Roger

2014-02-01

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

Changes in Plantar Loading Based on Shoe Type and Sex During a Jump-Landing Task

PubMed Central

DeBiasio, Justin C.; Russell, Mary E.; Butler, Robert J.; Nunley, James A.; Queen, Robin M.

2013-01-01

Context: Metatarsal stress fractures are common in cleated-sport athletes. Previous authors have shown that plantar loading varies with footwear, sex, and the athletic task. Objective: To examine the effects of shoe type and sex on plantar loading in the medial midfoot (MMF), lateral midfoot (LMF), medial forefoot (MFF), middle forefoot (MidFF), and lateral forefoot (LFF) during a jump-landing task. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Twenty-seven recreational athletes (14 men, 13 women) with no history of lower extremity injury in the last 6 months and no history of foot or ankle surgery. Main Outcome Measure(s): The athletes completed 7 jumping trials while wearing bladed-cleat, turf-cleat, and running shoes. Maximum force, contact area, contact time, and the force-time integral were analyzed in each foot region. We calculated 2 × 3 analyses of variance (α = .05) to identify shoe-condition and sex differences. Results: We found no shoe × sex interactions, but the MMF, LMF, MFF, and LFF force-time integrals were greater in men (P < .03). The MMF maximum force was less with the bladed-cleat shoes (P = .02). Total foot and MidFF maximum force was less with the running shoes (P < .01). The MFF and LFF maximum forces were different among all shoe conditions (P < .01). Total foot contact area was less in the bladed-cleat shoes (P = .01). The MMF contact area was greatest in the running shoes (P < .01). The LFF contact area was less in the running shoes (P = .03). The MFF and LFF force-time integrals were greater with the bladed-cleat shoes (P < .01). The MidFF force-time integral was less in the running shoes (P < .01). Conclusions: Independent of shoe, men and women loaded the foot differently during a jump landing. The bladed cleat increased forefoot loading, which may increase the risk for forefoot injury. The type of shoe should be considered when choosing footwear for athletes returning to activity after metatarsal

Changes in plantar loading based on shoe type and sex during a jump-landing task.

PubMed

Debiasio, Justin C; Russell, Mary E; Butler, Robert J; Nunley, James A; Queen, Robin M

2013-01-01

Metatarsal stress fractures are common in cleated-sport athletes. Previous authors have shown that plantar loading varies with footwear, sex, and the athletic task. To examine the effects of shoe type and sex on plantar loading in the medial midfoot (MMF), lateral midfoot (LMF), medial forefoot (MFF), middle forefoot (MidFF), and lateral forefoot (LFF) during a jump-landing task. Crossover study. Laboratory. Twenty-seven recreational athletes (14 men, 13 women) with no history of lower extremity injury in the last 6 months and no history of foot or ankle surgery. The athletes completed 7 jumping trials while wearing bladed-cleat, turf-cleat, and running shoes. Maximum force, contact area, contact time, and the force-time integral were analyzed in each foot region. We calculated 2 × 3 analyses of variance (α = .05) to identify shoe-condition and sex differences. We found no shoe × sex interactions, but the MMF, LMF, MFF, and LFF force-time integrals were greater in men (P < .03). The MMF maximum force was less with the bladed-cleat shoes (P = .02). Total foot and MidFF maximum force was less with the running shoes (P < .01). The MFF and LFF maximum forces were different among all shoe conditions (P < .01). Total foot contact area was less in the bladed-cleat shoes (P = .01). The MMF contact area was greatest in the running shoes (P < .01). The LFF contact area was less in the running shoes (P = .03). The MFF and LFF force-time integrals were greater with the bladed-cleat shoes (P < .01). The MidFF force-time integral was less in the running shoes (P < .01). Independent of shoe, men and women loaded the foot differently during a jump landing. The bladed cleat increased forefoot loading, which may increase the risk for forefoot injury. The type of shoe should be considered when choosing footwear for athletes returning to activity after metatarsal stress fractures.

Using Plantar Electrical Stimulation to Improve Postural Balance and Plantar Sensation Among Patients With Diabetic Peripheral Neuropathy: A Randomized Double Blinded Study

PubMed Central

Najafi, Bijan; Talal, Talal K.; Grewal, Gurtej Singh; Menzies, Robert; Armstrong, David G.; Lavery, Lawrence A.

2017-01-01

Objective: People with diabetic peripheral neuropathy (DPN) often exhibit deteriorations in motor-performance mainly due to lack of plantar-sensation. The study explored effectiveness of plantar electrical-stimulation therapy to enhance motor-performance among people with DPN. Design and methods: Using a double-blinded model, 28 volunteers with DPN (age: 57.8 ± 10.2 years) were recruited and randomized to either intervention (IG: n = 17) or control (CG: n = 11) group. Both groups received identical plantar-stimulation devices for six weeks of daily use at home; however, only the IG devices were set to deliver stimulation. Balance (ankle, hip, and center of mass [COM] sway) and gait (stride velocity [SV], stride time [ST], stride length [SL], and cadence) were measured using validated wearable sensors. Outcomes were assessed at baseline and at six-week. Clinical assessment including vascular as measured by ankle-brachial-index (ABI) and plantar-sensation as quantified by vibratory plantar threshold (VPT) were also measured at baseline and six weeks. Results: No difference were observed between groups for baseline characteristics (P > .050). Posttherapy, ankle and COM sway with eyes open were significantly improved (P < .05, Cohen’s effect size d = 0.67-0.76) in the IG with no noticeable changes in CG. All gait parameters were significantly improved in the IG with highest effect size observed for cadence (d = 1.35, P = .000). Results revealed improvement in VPT (P = .004, d = 1.15) with significant correlation with stride velocity improvement (r = .56, P = .037). ABI was improved in the IG in particulate among those with ABI>1.20 (P = .041, d = 0.99) Conclusion: This study suggests that daily home use of plantar electrical-stimulation may be a practical means to enhance motor-performance and plantar-sensation in people with DPN. PMID:28627217

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.

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

PubMed

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

2014-08-01

Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

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

Comparison of renal artery, soft tissue, and nerve damage after irrigated versus nonirrigated radiofrequency ablation.

PubMed

Sakakura, Kenichi; Ladich, Elena; Fuimaono, Kristine; Grunewald, Debby; O'Fallon, Patrick; Spognardi, Anna-Maria; Markham, Peter; Otsuka, Fumiyuki; Yahagi, Kazuyuki; Shen, Kai; Kolodgie, Frank D; Joner, Michael; Virmani, Renu

2015-01-01

The long-term efficacy of radiofrequency ablation of renal autonomic nerves has been proven in nonrandomized studies. However, long-term safety of the renal artery (RA) is of concern. The aim of our study was to determine if cooling during radiofrequency ablation preserved the RA while allowing equivalent nerve damage. A total of 9 swine (18 RAs) were included, and allocated to irrigated radiofrequency (n=6 RAs, temperature setting: 50°C), conventional radiofrequency (n=6 RAs, nonirrigated, temperature setting: 65°C), and high-temperature radiofrequency (n=6 RAs, nonirrigated, temperature setting: 90°C) groups. RAs were harvested at 10 days, serially sectioned from proximal to distal including perirenal tissues and examined after paraffin embedding, and staining with hematoxylin-eosin and Movat pentachrome. RAs and periarterial tissue including nerves were semiquantitatively assessed and scored. A total of 660 histological sections from 18 RAs were histologically examined by light microscopy. Arterial medial injury was significantly less in the irrigated radiofrequency group (depth of medial injury, circumferential involvement, and thinning) than that in the conventional radiofrequency group (P<0.001 for circumference; P=0.003 for thinning). Severe collagen damage such as denatured collagen was also significantly less in the irrigated compared with the conventional radiofrequency group (P<0.001). Nerve damage although not statistically different between the irrigated radiofrequency group and conventional radiofrequency group (P=0.36), there was a trend toward less nerve damage in the irrigated compared with conventional. Compared to conventional radiofrequency, circumferential medial damage in highest-temperature nonirrigated radiofrequency group was significantly greater (P<0.001). Saline irrigation significantly reduces arterial and periarterial tissue damage during radiofrequency ablation, and there is a trend toward less nerve damage. © 2014 American Heart

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

PubMed

Cottom, James M; Maker, Jared M

2016-01-01

Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Sonography-guided recording for superficial peroneal sensory nerve conduction study.

PubMed

Kim, Ki Hoon; Park, Byung Kyu; Kim, Dong Hwee; Kim, Yuntae

2018-04-01

We sought to establish the optimal recording position for antidromic conduction of the superficial peroneal nerve (SPN) by using ultrasonography (USG). The sensory nerve action potentials (SNAPs) of the intermediate dorsal cutaneous nerve (IDCN) and medial dorsal cutaneous nerve (MDCN) in 64 limbs of 32 healthy participants were recorded (nerve conduction study [NCS]-1). Both nerves were identified by using USG, and the SNAPs were obtained from the USG-guided repositioned electrodes (NCS-2). The IDCN and MDCN were located at 29.3% ± 5.1% and 43.9% ± 4.9% of the intermalleolar distance from the lateral malleolus, respectively. Significantly greater amplitude was shown for SNAPs of both nerves in NCS-2 versus NCS-1. The optimal recording position is likely to be lateral, one-third from the lateral malleolus for the IDCN, and just lateral to the midpoint of the intermalleolar line for the MDCN. When the SPN response is unexpectedly attenuated, USG-guided repositioning of the electrodes should be considered. Muscle Nerve 57: 628-633, 2018. © 2017 Wiley Periodicals, Inc.

Relationship between the posterior cerebral artery and the cisternal segment of the oculomotor nerve.

PubMed

Uz, Aysun; Tekdemir, Ibrahim

2006-12-01

The aim of this study was to evaluate the relationship between the cisternal segment of the oculomotor nerve and the posterior cerebral artery and its branches. The oculomotor nerve and the posterior cerebral artery of 15 cadaver brains (30 hemispheres) were examined using a surgical microscope. The dorsal portion of the cisternal segment of the oculomotor nerve had a close relationship with the P(1) and P(2) segments of the posterior cerebral artery in 100% of cases, the thalamoperforating arteries in 97%, the collicular arteries in 97%, the short circumferential arteries in 33% and the posterior medial choroidal arteries in 20%. The proximal portion of the nerve had a close relationship with the P(1) segment of the posterior cerebral artery, the thalamoperforating arteries, the collicular arteries and the short circumferential arteries, whereas the distal portion had a close relationship with the P(2) segment of the posterior cerebral artery and the posterior medial choroidal arteries. The oculomotor nerve was perforated by various arteries in different portions. These arteries were the thalamoperforating arteries in 10% of the hemispheres, the collicular arteries in 16% and the short circumferential arteries in 11%. It can be concluded that the dorsal portion of the cisternal segment of the oculomotor nerve has a close relationship with the branches arising from the P(1) and P(2) segments of the posterior cerebral artery. These arteries supply the cisternal segment of the oculomotor nerve.

The influence of a small insert, in the footbed of a shoe, upon plantar pressure distribution.

PubMed

Burgess, S; Jordan, C; Bartlett, RM

1997-04-01

INTRODUCTION:: A recent development in plantar pressure distribution research, has been the study of the effects of sensory input on pressure distribution. It has been suggested that proprioceptive and exteroceptive information received from the plantar surface of the foot plays an important role in adapting to high pressures in shoes. Robbins and Gouw (1991) suggested that surface irregularities should be added to the insoles of running shoes to gain correct sensory input. Hayda et al. (1994) found that placing a pad proximal to the metatarsal heads produced significant reductions in forefoot plantar pressures around the first and second metatarsal heads. A development by Villeneuve (1993), 'La Posteropodle', utilized a small insert to maintain postural equilibrium, by stimulating the mechanoreceptors in the plantar surface of the foot. The aim of this study was to measure changes in plantar pressure distribution using a small circular insert. METHODS:: Ten non-pathological male subjects were tested whilst walking, after one day of wearing a pair of oxfords (hard) and running shoes (soft), containing an insert of 4 mm in height placed on a 0.8 mm EVA insole. The foot was split into five sections: (1) midfoot, (2) first metatarsal head, (3) 2nd and 3rd metatarsal heads, (4) 4th and 5th metatarsal heads, (5) the phalanges. A PEDAR system (Novel GmbH) was used to collect in-shoe plantar pressure data, with data collections at the beginning and end of a working day. Subjects were tested under two conditions: (1) the insert 5 mm proximal to the metatarsal heads, between the 2nd and 3rd heads, (2) a control, with no insert. RESULTS:: Preliminary results indicate that whilst wearing a hard shoe the insert had the effect of shifting peak pressures from the first metatarsal head, to the area of the second and third metatarsal heads. Peak pressures were found to be lower with the insert present. This has not yet been tested for significance. With the running shoe there

Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study.

PubMed

Koo, Seungbum; Lee, Kyoung Min; Cha, Young Joo

2015-10-01

Gross motion of the ankle joint complex (AJC) is a summation of the ankle and subtalar joints. Although AJC kinematics have been widely used to evaluate the function of the AJC, the coordinated movements of the ankle and subtalar joints are not well understood. The purpose of this study was to accurately quantify the individual kinematics of the ankle and subtalar joints in the intact foot during ground walking by using a bi-planar fluoroscopic system. Bi-planar fluoroscopic images of the foot and ankle during walking and standing were acquired from 10 healthy subjects. The three-dimensional movements of the tibia, talus, and calcaneus were calculated with a three-dimensional/two-dimensional registration method. The skeletal kinematics were quantified from 9% to 86% of the full stance phase because of the limited camera speed of the X-ray system. At the beginning of terminal stance, plantar-flexion of the AJC was initiated in the subtalar joint on average at 75% ranging from 62% to 76% of the stance phase, and plantar-flexion of the ankle joint did not start until 86% of the stance phase. The earlier change to plantar-flexion in the AJC than the ankle joint due to the early plantar-flexion in the subtalar joint was observed in 8 of the 10 subjects. This phenomenon could be explained by the absence of direct muscle insertion on the talus. Preceding subtalar plantar-flexion could contribute to efficient and stable ankle plantar-flexion by locking the midtarsal joint, but this explanation needs further investigation. Copyright © 2015 Elsevier B.V. All rights reserved.

Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults.

PubMed

Nahin, Richard L

2018-03-26

This study provides prevalence estimates of plantar fasciitis in U.S. adults, as well as the types and frequencies of pharmaceutical treatment specifically for this pain. Data are from the 2013 National Health and Wellness Survey, a large (n = 75,000) internet panel survey designed to approximate the adult U.S. Strengths of associations are determined using multivariable logistic regression. It was estimated that .85% (95% confidence interval [CI] = .77-.92) of the sample reported diagnosed plantar fasciitis with pain in the past month. Higher prevalence of plantar fasciitis was seen in women (1.19%; referent) versus men (.47%), in those aged 45 to 64 (1.33%) versus those aged 18 to 44 (.53%; referent) years, and in the obese (1.48%) versus those with a body mass <25 (.29%; referent). Prescription medications for pain were used by 41.04% of plantar fasciitis respondents, but only 6.31% attributed this use specifically to plantar fasciitis pain. Nonsteroidal anti-inflammatory drugs (4.01%) and opioids (2.21%) were the most prevalent prescription drugs used specifically for plantar fasciitis pain. Almost 70% of individuals with plantar fasciitis used over the counter (OTC) analgesics for general pain management, with OTC nonsteroidal anti-inflammatory drugs being used by 49.47% and acetaminophen by 26.93% of respondents. Individuals diagnosed by medical specialists had twice the odds of using prescription drugs as those diagnosed by other providers (odds ratio = 2.12; 95% CI = 1.01-4.46). Non-Hispanic black individuals were more likely to use prescription pain medications specifically for plantar fasciitis pain than non-Hispanic white individuals (odds ratio = 3.02; 95% CI = 1.05-8.70). The current study provides additional insights into the pain and disability associated with plantar fasciitis, as well as the pharmaceutical treatments being used for its management. Prescription as well as OTC medications are used to manage plantar fasciitis symptoms

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.

Reproducibility of sonographic measurement of thickness and echogenicity of the plantar fascia.

PubMed

Cheng, Ju-Wen; Tsai, Wen-Chung; Yu, Tung-Yang; Huang, Kuo-Yao

2012-01-01

To evaluate the intra- and interrater reliability of ultrasonographic measurements of the thickness and echogenicity of the plantar fascia. Eleven patients (20 feet), who complained of inferior heel pain, and 26 volunteers (52 feet) were enrolled. Two sonographers independently imaged the plantar fascia in both longitudinal and transverse planes. Volunteers were assessed twice to evaluate intrarater reliability. Quantitative evaluation of the echogenicity of the plantar fascia was performed by measuring the mean gray level of the region of interest using Digital Imaging and Communications in Medicine viewer software. Sonographic evaluation of the thickness of the plantar fascia showed high reliability. Sonographic evaluations of the presence or absence of hypoechoic change in the plantar fascia showed surprisingly low agreement. The reliability of gray-scale evaluations appears to be much better than subjective judgments in the evaluation of echogenicity. Transverse scanning did not show any advantage in sonographic evaluation of the plantar fascia. The reliability of sonographic examination of the thickness of the plantar fascia is high. Mean gray-level analysis of quantitative sonography can be used for the evaluation of echogenicity, which could reduce discrepancies in the interpretation of echogenicity by different sonographers. Longitudinal instead of transverse scanning is recommended for imaging the plantar fascia. Copyright © 2011 Wiley Periodicals, Inc.

The effect of the gastrocnemius on the plantar fascia.

PubMed

Pascual Huerta, Javier

2014-12-01

Although anatomic and functional relationship has been established between the gastrocnemius muscle, via the Achilles tendon, and the plantar fascia, the exact role of gastrocnemius tightness in foot and plantar fascia problems is not completely understood. This article summarizes past and current literature linking these 2 structures and gives a mechanical explanation based on functional models of the relationship between gastrocnemius tightness and plantar fascia. The effect of gastrocnemius tightness on the sagittal behavior of the foot is also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Can static foot posture measurements predict regional plantar surface area?

PubMed

McPoil, Thomas G; Haager, Mathew; Hilt, John; Klapheke, John; Martinez, Ray; VanSteenwyk, Cory; Weber, Nicholas; Cornwall, Mark W; Bade, Michael

2014-12-01

The intent of this study was to determine if the use of a single or combination of static foot posture measurements can be used to predict rearfoot, midfoot, and forefoot plantar surface area in individuals with pronated or normal foot types. Twelve foot measurements were collected on 52 individuals (mean age 25.8 years) with the change in midfoot width used to place subjects in a pronated or normal foot mobility group. Dynamic plantar contact area was collected during walking with a pressure sensor platform. The 12 measures were entered into a stepwise regression analysis to determine the optimal set of measures associated with regional plantar surface area. A two variable model was found to describe the relationship between the foot measurements and forefoot plantar contact area (r(2)=0.79, p<0.0001). A four variable model was found to describe the relationship between the foot measurements and midfoot plantar contact area (r(2)=0.85, p<0.0001) in those individuals with a 1.26cm or greater change in midfoot width. The results indicate that clinicians can use a combination of simple, reliable and time efficient foot measures to explain 79% and 85% of the plantar surface area in the forefoot and midfoot, respectively. Copyright © 2014 Elsevier Ltd. All rights reserved.

Phrenic nerve conduction studies: normative data and technical aspects.

PubMed

Maranhão, Analucia Abreu; Carvalho, Sonia Regina da Silva; Caetano, Marcelo Ribeiro; Alamy, Alexandre Hofke; Peixoto, Eduardo Mesquita; Filgueiras, Pedro Del Esporte Peçanha

2017-12-01

The aim of the present study was to define normative data of phrenic nerve conduction parameters of a healthy population. Phrenic nerve conduction studies were performed in 27 healthy volunteers. The normative limits for expiratory phrenic nerve compound muscle action potential were: amplitude (0.47 mv - 0.83 mv), latency (5.74 ms - 7.10 ms), area (6.20 ms/mv - 7.20 ms/mv) and duration (18.30 ms - 20.96 ms). Inspiratory normative limits were: amplitude (0.67 mv - 1.11 mv), latency (5.90 ms - 6.34 ms), area (5.62 ms/mv - 6.72 ms/mv) and duration (13.77 ms - 15.37 ms). The best point of phrenic nerve stimulus in the neck varies among individuals between the medial and lateral border of the clavicular head of the sternocleidomastoid muscle and stimulation of both sites, then choosing the best phrenic nerve response, seems to be the appropriate procedure.

[Analysis of plantar pressure patterns among obese population].

PubMed

Leidecker, Eleonóra; Kellermann, Péter; Galambosné Tiszberger, Mónika; Molics, Bálint; Bohner-Beke, Aliz; Nyárády, József; Kránicz, János

2016-11-01

Although the role of body weight on foot health and load has been widely documented in research, the effect of the extra load due to body weight on plantar pressure characteristics is not well known. The aim of this study was to evaluate the impact of obesity on plantar pressure patterns among the working-age population. 180 participants were involved. Two groups were evaluated according to body mass index categories regarding eight regions of the plantar area, focusing on the following parameters: contact area, maximum pressure and peak pressure. Compared with non-obese subjects, the peak pressure was the highest on the midfoot (p<0.001) and the forefoot (p<0.001). Regarding the maximum force, significant statistical difference was detected on the toes (p<0.001), with a value lower among the obese group. The contact area on the total foot and the midfoot was lower among the non-obese subjects (p<0.001). Loading is greatly increasing on the whole plantar area, especially at the midfoot and the forefoot region. Orv. Hetil., 2016, 157(48), 1919-1925.

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

PubMed

Sutera, R; Iovane, A; Sorrentino, F; Candela, F; Mularo, V; La Tona, G; Midiri, M

2010-03-01

This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR) imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients' history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position. Imaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position.

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

PubMed

Foisy, Arnaud; Kapoula, Zoï

2016-01-01

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

Changing central nervous system control following intercostal nerve transfer.

PubMed

Malessy, M J; Thomeer, R T; van Dijk, J G

1998-10-01

The goal of this study was to find which central nervous system (CNS) pathways are involved in volitional control over reinnervated biceps or pectoral muscles. Intercostal nerves (ICNs) were coapted to the musculocutaneous nerve (MCN) or the medial pectoral nerve (MPN) in 23 patients with root avulsions of the brachial plexus to restore biceps or pectoral muscle function. The facilitatory effects of respiration and voluntary contraction on cortical motor-evoked potentials of biceps or pectoral muscles were used to study CNS control over the reinnervated muscles. The time course of the facilitatory effect of respiration and voluntary contraction differed significantly. In the end stage of nerve regeneration, the facilitatory effect of voluntary contraction was significantly larger than that of respiration, indicating that the CNS control network over the muscle comes to resemble that of the recipient nerve (MCN or MPN) rather than that of the donor nerve (ICN). The strengthening of previously subthreshold synaptic connections in a CNS network connecting ICN to MCN or MPN neurons may underlie changing excitability.

Postoperative full abduction in a patient of Duane retraction syndrome without an abducens nerve: a case report.

PubMed

Kim, Jae Hyoung; Hwang, Jeong-Min

2017-05-19

Duane retraction syndrome (DRS) consists of abduction deficit, globe retraction and upshoots or downshoots with adduction. The abducens nerve on the affected side is absent in type 1 DRS. After bilateral medial rectus muscle recession in unilateral type 1 DRS may improve the abduction limitation, but still more than -3 limitation remains. A 6-month-old boy presented with esotropia which had been noticed in early infancy. He showed limited abduction, fissure narrowing on attempted adduction and a small upshoot OS. Left abducens nerve was not identified on magnetic resonance imaging compatible with Duane retraction syndrome type 1. He showed full abduction after bilateral medial rectus recession of 6.0 mm at the age of 9 months, and remained orthotropia with full abduction OU 2 years postoperatively. He is my only patient with Duane retraction syndrome who showed full abduction after bilateral medial rectus recession. A patient with the type 1 Duane retraction syndrome rarely may show full abduction after bilateral medial rectus recession mimicking infantile esotropia.

Impaired peripheral nerve regeneration in type-2 diabetic mouse model.

PubMed

Pham, Vuong M; Tu, Nguyen Huu; Katano, Tayo; Matsumura, Shinji; Saito, Akira; Yamada, Akihiro; Furue, Hidemasa; Ito, Seiji

2018-01-01

Peripheral neuropathy is one of the most common and serious complications of type-2 diabetes. Diabetic neuropathy is characterized by a distal symmetrical sensorimotor polyneuropathy, and its incidence increases in patients 40 years of age or older. In spite of extensive research over decades, there are few effective treatments for diabetic neuropathy besides glucose control and improved lifestyle. The earliest changes in diabetic neuropathy occur in sensory nerve fibers, with initial degeneration and regeneration resulting in pain. To seek its effective treatment, here we prepared a type-2 diabetic mouse model by giving mice 2 injections of streptozotocin and nicotinamide and examining the ability for nerve regeneration by using a sciatic nerve transection-regeneration model previously established by us. Seventeen weeks after the last injection, the mice exhibited symptoms of type-2 diabetes, that is, impaired glucose tolerance, decreased insulin level, mechanical hyperalgesia, and impaired sensory nerve fibers in the plantar skin. These mice showed delayed functional recovery and nerve regeneration by 2 weeks compared with young healthy mice and by 1 week compared with age-matched non-diabetic mice after axotomy. Furthermore, type-2 diabetic mice displayed increased expression of PTEN in their DRG neurons. Administration of a PTEN inhibitor at the cutting site of the nerve for 4 weeks promoted the axonal transport and functional recovery remarkably. This study demonstrates that peripheral nerve regeneration was impaired in type-2 diabetic model and that its combination with sciatic nerve transection is suitable for the study of the pathogenesis and treatment of early diabetic neuropathy. © 2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

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

PubMed Central

Malone, Terry R.

2004-01-01

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

Finite element modelling of Plantar Fascia response during running on different surface types

NASA Astrophysics Data System (ADS)

Razak, A. H. A.; Basaruddin, K. S.; Salleh, A. F.; Rusli, W. M. R.; Hashim, M. S. M.; Daud, R.

2017-10-01

Plantar fascia is a ligament found in human foot structure located beneath the skin of human foot that functioning to stabilize longitudinal arch of human foot during standing and normal gait. To perform direct experiment on plantar fascia seems very difficult since the structure located underneath the soft tissue. The aim of this study is to develop a finite element (FE) model of foot with plantar fascia and investigate the effect of the surface hardness on biomechanical response of plantar fascia during running. The plantar fascia model was developed using Solidworks 2015 according to the bone structure of foot model that was obtained from Turbosquid database. Boundary conditions were set out based on the data obtained from experiment of ground reaction force response during running on different surface hardness. The finite element analysis was performed using Ansys 14. The results found that the peak of stress and strain distribution were occur on the insertion of plantar fascia to bone especially on calcaneal area. Plantar fascia became stiffer with increment of Young’s modulus value and was able to resist more loads. Strain of plantar fascia was decreased when Young’s modulus increased with the same amount of loading.

The effect of aging on efferent nerve fibers regeneration in mice.

PubMed

Verdú, E; Butí, M; Navarro, X

1995-10-23

This study evaluates the influence of aging on nerve regeneration and reinnervation of target organs in mice aged 2, 6, 9, 12, 18 and 24 months. In animals of each age group the sciatic nerve was subjected to crush, section or section and suture. Reinnervation of plantar muscles and sweat glands (SG) was evaluated over three months after operation by functional methods. Reappearance of SG secretion and motor responses occurred slightly earlier in young than older mice. The degree of motor and sudomotor reinnervation, with respect to preoperative control values, was also significantly higher in young than old animals. The differences were more pronounced after 12 months of age. The degree of recovery progressively decreased with the severity of the lesion, differences being more marked in older mice. Neurorraphy improved recovery, comparatively more in older than in young mice. These results indicate that, after injuries of peripheral nerves, axonal regeneration and reinnervation are maintained throughout life, but tend to be more delayed and slightly less effective with aging.

Prognostic Value of Diagnostic Sonography in Patients With Plantar Fasciitis.

PubMed

Fleischer, Adam E; Albright, Rachel H; Crews, Ryan T; Kelil, Tatiana; Wrobel, James S

2015-10-01

The primary objective of this study was to determine whether the sonographic appearance of the plantar fascia is predictive of the treatment (ie, pain) response in patients receiving supportive therapy for proximal plantar fasciitis. This study was a secondary analysis of data obtained from a randomized controlled trial of ambulatory adults, which examined the efficacy of 3 different foot supports for plantar fasciitis. Participants underwent diagnostic sonographic examinations of their heel at baseline and again at 3 months by a single experienced foot and ankle surgeon. Quantitative (eg, thickness) and qualitative (eg, biconvexity) characteristics of the fascia were recorded according to a standard protocol. Logistic regression models were used to identify predictors of the pain response. Seventy patients completed a baseline evaluation, and 63 patients completed a 3-month follow-up assessment. The pain response was not associated with the type of foot support (P> .05). The only significant indicator of an unfavorable response in the univariate and multivariate analyses was biconvexity of the plantar fascia on sonography at presentation (multivariate odds ratio, 4.76 [95% confidence interval, 1.16-19.5; P= .030). Furthermore, changes in self-reported pain over the 3-month study period were not accompanied by alterations in plantar fascia thickness over this time (r = .056; P = .671). We conclude that patients who present with biconvexity of the plantar fascia may be less responsive to tier 1 treatment regimens that center around mechanical support of the plantar fascia. Furthermore, follow-up measurements of the fascia in this population should not weigh heavily in decisions such as return to play. © 2015 by the American Institute of Ultrasound in Medicine.

Fetal development of deep back muscles in the human thoracic region with a focus on transversospinalis muscles and the medial branch of the spinal nerve posterior ramus

PubMed Central

Sato, Tatsuo; Koizumi, Masahiro; Kim, Ji Hyun; Kim, Jeong Hyun; Wang, Bao Jian; Murakami, Gen; Cho, Baik Hwan

2011-01-01

Fetal development of human deep back muscles has not yet been fully described, possibly because of the difficulty in identifying muscle bundle directions in horizontal sections. Here, we prepared near-frontal sections along the thoracic back skin (eight fetuses) as well as horizontal sections (six fetuses) from 14 mid-term fetuses at 9–15 weeks of gestation. In the deep side of the trapezius and rhomboideus muscles, the CD34-positive thoracolumbar fascia was evident even at 9 weeks. Desmin-reactivity was strong and homogeneous in the superficial muscle fibers in contrast to the spotty expression in the deep fibers. Thus, in back muscles, formation of the myotendinous junction may start from the superficial muscles and advance to the deep muscles. The fact that developing intramuscular tendons were desmin-negative suggested little possibility of a secondary change from the muscle fibers to tendons. We found no prospective spinalis muscle or its tendinous connections with other muscles. Instead, abundant CD68-positive macrophages along the spinous process at 15 weeks suggested a change in muscle attachment, an event that may result in a later formation of the spinalis muscle. S100-positive intramuscular nerves exhibited downward courses from the multifidus longus muscle in the original segment to the rotatores brevis muscles in the inferiorly adjacent level. The medial cutaneous nerve had already reached the thoracolumbar fascia at 9 weeks, but by 15 weeks the nerve could not penetrate the trapezius muscle. Finally, we propose a folded myotomal model of the primitive transversospinalis muscle that seems to explain a fact that the roofing tile-like configuration of nerve twigs in the semispinalis muscle is reversed in the multifidus and rotatores muscles. PMID:21954879

Nonlinear finite element analysis of the plantar fascia due to the windlass mechanism.

PubMed

Cheng, Hsin-Yi Kathy; Lin, Chun-Li; Chou, Shih-Wei; Wang, Hsien-Wen

2008-08-01

Tightening of plantar fascia by passively dorsiflexing the toes during walking has functional importance. The purpose of this research was to evaluate the influence of big toe dorsiflexion angles upon plantar fascia tension (the windlass effect) with a nonlinear finite element approach. A two-dimensional finite element model of the first ray was constructed for biomechanical analysis. In order to imitate the windlass effect and to evaluate the mechanical responses of the plantar fascia under various conditions, 12 model simulations--three dorsiflexion angles of the big toe (45 degrees, 30 degrees, and 15 degrees), two plantar fascia properties (linear, nonlinear), and two weightbearing conditions (with body weight, without body weight)--were designed and analyzed. Our results demonstrated that nonlinear modeling of the plantar fascia provides a more sophisticated representation of experimental data than the linear one. Nonlinear plantar fascia setting also predicted a higher stress distribution along the fiber directions especially with larger toe dorsiflexion angles (45 degrees>30 degrees>15 degrees). The plantar fascia stress was found higher near the metatarsal insertion and faded as it moved toward the calcaneal insertion. Passively dorsiflexing the big toe imposes tension onto the plantar fascia. Windlass mechanism also occurs during stance phase of walking while the toes begin to dorsiflex. From a biomechanical standpoint, the plantar fascia tension may help propel the body upon its release at the point of push off. A controlled stretch via dorsiflexing the big toe may have a positive effect on treating plantar fasciitis by providing proper guidance for collagen regeneration. The windlass mechanism is also active during the stance phase of walking when the toes begin to dorsiflex.

Drilling through lateral transmuscular portal lowers the risk of suprascapular nerve injury during arthroscopic SLAP repair.

PubMed

Kocaoglu, Baris; Ulku, Tekin Kerem; Sayilir, Safiye; Ozbaydar, Mehmet Ugur; Bayramoglu, Alp; Karahan, Mustafa

2017-10-01

The aim of our study was to evaluate the risk of medial glenoid perforation and possible injury to suprascapular nerve during arthroscopic SLAP repair using lateral transmuscular portal. Ten cadaveric shoulder girdles were isolated and drilled at superior glenoid rim from both anterior-superior portal (1 o'clock) and lateral transmuscular portal (12 o'clock) for SLAP repairs. Drill hole depth was determined by the manufacturer's drill stop (20 mm), and any subsequent drill perforations through the medial bony surface of the glenoid were directly confirmed by dissection. The bone tunnel depth and subsequent distance to the suprascapular nerve, scapular height and width, were compared for investigated locations. Four perforations out of ten (40 %) occurred through anterior-superior portal with one associated nerve injury. One perforation out of ten (10 %) occurred through lateral transmuscular portal without any nerve injury. The mean depth was calculated as 17.6 mm (SD 3) for anterior-superior portal and 26.5 mm (SD 3.6) for lateral transmuscular portal (P < 0.001). It is anatomically possible that suprascapular nerve could sustain iatrogenic injury during labral anchor placement during SLAP repair. However, lateral transmuscular portal at 12 o'clock drill entry location has lower risk of suprascapular nerve injury compared with anterior-superior portal at 1 o'clock drill entry location.

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

Variability and repeatability analysis of plantar pressure during gait in older people.

PubMed

Franco, Pedro S; Silva, Caio Borella P da; Rocha, Emmanuel S da; Carpes, Felipe P

2015-01-01

Repeatability and variability of the plantar pressure during walking are important components in the clinical assessment of the elderly. However, there is a lack of information on the uniformity of plantar pressure patterns in the elderly. To analyze the repeatability and variability in plantar pressure considering mean, peak and asymmetries during aged gait. Plantar pressure was monitored in four different days for ten elderly subjects (5 female), with mean±standard-deviation age of 73±6 years, walking barefoot at preferred speed. Data were compared between steps for each day and between different days. Mean and peak plantar pressure values were similar between the different days of evaluation. Asymmetry indexes were similar between the different days evaluated. Plantar pressure presented a consistent pattern in the elderly. However, the asymmetry indexes observed suggest that the elderly are exposed to repetitive asymmetric loading during locomotion. Such result requires further investigation, especially concerning the role of these asymmetries for development of articular injuries. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

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

PubMed Central

Thiagarajah, Anandan Gerard

2017-01-01

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

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

PubMed

Thiagarajah, Anandan Gerard

2017-02-01

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

Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy.

PubMed

Liang, Huey-Wen; Wang, Tyng-Guey; Chen, Wen-Shiang; Hou, Sheng-Mou

2007-07-01

Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.

Effect of Achilles tendon loading on plantar fascia tension in the standing foot.

PubMed

Cheung, Jason Tak-Man; Zhang, Ming; An, Kai-Nan

2006-02-01

The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.

Medial surface dynamics of the vocal folds in an in vivo canine model

NASA Astrophysics Data System (ADS)

Doellinger, Michael; Berke, Gerald S.; Chhetri, Dinesh K.; Berry, David A.

2004-05-01

Quantitative measurement of the medial surface dynamics of the vocal folds is important for understanding how sound is generated in the larynx. However, such data are hard to gather because of the inaccessibility of the vocal folds. Recent studies have applied hemi-larynx methodology to excised human larynges, to visualize these dynamics. The present study extends this methodology to obtain similar quantitative measurements using an in vivo canine hemi-larynx setup, with varying levels of stimulation to the recurrent laryngeal nerve. Use of an in vivo model allows us to examine effects of intrinsic muscle contraction on the medial surface of the vocal folds, to provide greater insight into mechanisms of vocal control. Data were collected using digital high-speed imaging with a sampling frequency of up to 4000 Hz, and a spatial resolution of up to 1024×1024 pixels. Three-dimensional motion will be extracted, computed, visualized, and contrasted as a function of the level of stimulation to the recurrent laryngeal nerve. Results will also be compared to patterns of vibration in excised larynges. Finally, commonly applied quantitative analyses will be performed to investigate the underlying modes of vibration. [Work supported by NIH/NIDCD.

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

PubMed

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

2015-01-01

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

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.

Modeling the time-varying and level-dependent effects of the medial olivocochlear reflex in auditory nerve responses.

PubMed

Smalt, Christopher J; Heinz, Michael G; Strickland, Elizabeth A

2014-04-01

The medial olivocochlear reflex (MOCR) has been hypothesized to provide benefit for listening in noisy environments. This advantage can be attributed to a feedback mechanism that suppresses auditory nerve (AN) firing in continuous background noise, resulting in increased sensitivity to a tone or speech. MOC neurons synapse on outer hair cells (OHCs), and their activity effectively reduces cochlear gain. The computational model developed in this study implements the time-varying, characteristic frequency (CF) and level-dependent effects of the MOCR within the framework of a well-established model for normal and hearing-impaired AN responses. A second-order linear system was used to model the time-course of the MOCR using physiological data in humans. The stimulus-level-dependent parameters of the efferent pathway were estimated by fitting AN sensitivity derived from responses in decerebrate cats using a tone-in-noise paradigm. The resulting model uses a binaural, time-varying, CF-dependent, level-dependent OHC gain reduction for both ipsilateral and contralateral stimuli that improves detection of a tone in noise, similarly to recorded AN responses. The MOCR may be important for speech recognition in continuous background noise as well as for protection from acoustic trauma. Further study of this model and its efferent feedback loop may improve our understanding of the effects of sensorineural hearing loss in noisy situations, a condition in which hearing aids currently struggle to restore normal speech perception.

Effects of plantar fascia stiffness on the biomechanical responses of the ankle-foot complex.

PubMed

Cheung, Jason Tak-Man; Zhang, Ming; An, Kai-Nan

2004-10-01

The plantar fascia is one of the major stabilizing structures of the longitudinal arch of human foot, especially during midstance of the gait cycle. Knowledge of its functional biomechanics is important for establishing the biomechanical rationale behind different rehabilitation, orthotic and surgical treatment of plantar fasciitis. This study aims at quantifying the biomechanical responses of the ankle-foot complex with different plantar fascia stiffness. A geometrical detailed three-dimensional finite element model of the human foot and ankle, incorporating geometric and contact nonlinearities was constructed by 3D reconstruction of MR images. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the plantar fascia on the stress/strain distribution of the bony, ligamentous and encapsulated soft tissue structures. The results showed that decreasing the Young's modulus of plantar fascia would increase the strains of the long and short plantar and spring ligaments significantly. With zero fascia Young's modulus to simulate the plantar fascia release, there was a shift in peak von Mises stresses from the third to the second metatarsal bones and increased stresses at the plantar ligament attachment area of the cuboid bone. Decrease in arch height and midfoot pronation were predicted but did not lead to the total collapse of foot arch. Surgical dissection of the plantar fascia may induce excessive strains or stresses in the ligamentous and bony structures. Surgical release of plantar fascia should be well-planned to minimise the effect on its structural integrity to reduce the risk of developing arch instability and subsequent painful foot syndrome.

Foot Modeling and Smart Plantar Pressure Reconstruction from Three Sensors

PubMed Central

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

2014-01-01

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

Foot modeling and smart plantar pressure reconstruction from three sensors.

PubMed

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

2014-01-01

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

Augmented superior rectus transposition procedure in Duane retraction syndrome compared with sixth nerve palsy.

PubMed

Akbari, Mohammadreza; Shomali, Setareh; Mirmohammadsadeghi, Arash; Fard, Masoud Aghsaei

2018-05-01

Superior rectus transposition (SRT) with medial rectus recession has been used for the treatment of sixth nerve palsy and esotropic Duane retraction syndrome (DRS). The purpose of this study was to compare the results of augmented SRT (with scleral fixation) without medial rectus recession in DRS and sixth nerve palsy. Patients with unilateral esotropic DRS (DRS group) and sixth nerve palsy were included in this prospective, comparative study and underwent SRT. Preoperative forced duction testing was negative or slightly positive in both groups. Prospective measurements were compared between the two groups. There were 11 patients in the DRS group and 11 patients in the sixth nerve palsy group. The mean preoperative esotropia decreased from 20.9 ± 6.0 prism diopter (PD) at far to 13.2 ± 5.8 PD in the DRS group (P = 0.003). The same measurement improved from 28.0 ± 8.5 PD to 8.4 ± 7.3 PD in the sixth nerve palsy group (P = 0.003). In the sixth nerve palsy group, the improvement in primary gaze esotropia and abnormal head posture was more than the DRS group (Both P < 0.001).The average dose effect for SRT was 7.8 ± 2.2 PD in the DRS group and 19.2 ± 4.6 PD in the sixth nerve palsy group. Although objective intorsion was significantly induced after SRT, subjective torsion was not significant after surgery in both groups. SRT appears to be more effective in improving primary gaze deviation and head posture in sixth nerve palsy compared with DRS. Subjective torsional and vertical diplopia were rare in both groups.

POFBG-Embedded Cork Insole for Plantar Pressure Monitoring

PubMed Central

Vilarinho, Débora; Theodosiou, Antreas; Domingues, Maria de Fátima; André, Paulo; Marques, Carlos

2017-01-01

We propose a novel polymer optical fiber (POF) sensing system based on fiber Bragg gratings (FBGs) to measure foot plantar pressure. The plantar pressure signals are detected by five FBGs, in the same piece of cyclic transparent optical polymer (CYTOP) fiber, which are embedded in a cork insole for the dynamic monitoring of gait. The calibration and measurements performed with the suggested system are presented, and the results obtained demonstrate the accuracy and reliability of the sensing platform to monitor the foot plantar pressure distribution during gait motion and the application of pressure. This architecture does not compromise the patient’s mobility nor interfere in their daily activities. The results using the CYTOP fiber showed a very good response when compared with solutions using silica optical fibers, resulting in a sensitivity almost twice as high, with excellent repeatability and ease of handling. The advantages of POF (e.g., high flexibility and robustness) proved that this is a viable solution for this type of application, since POF’s high fracture toughness enables its application in monitoring patients with higher body mass compared with similar systems based on silica fiber. This study has demonstrated the viability of the proposed system based on POF technology as a useful alternative for plantar pressure detection systems. PMID:29258166

POFBG-Embedded Cork Insole for Plantar Pressure Monitoring.

PubMed

Vilarinho, Débora; Theodosiou, Antreas; Leitão, Cátia; Leal-Junior, Arnaldo G; Domingues, Maria de Fátima; Kalli, Kyriacos; André, Paulo; Antunes, Paulo; Marques, Carlos

2017-12-16

We propose a novel polymer optical fiber (POF) sensing system based on fiber Bragg gratings (FBGs) to measure foot plantar pressure. The plantar pressure signals are detected by five FBGs, in the same piece of cyclic transparent optical polymer (CYTOP) fiber, which are embedded in a cork insole for the dynamic monitoring of gait. The calibration and measurements performed with the suggested system are presented, and the results obtained demonstrate the accuracy and reliability of the sensing platform to monitor the foot plantar pressure distribution during gait motion and the application of pressure. This architecture does not compromise the patient's mobility nor interfere in their daily activities. The results using the CYTOP fiber showed a very good response when compared with solutions using silica optical fibers, resulting in a sensitivity almost twice as high, with excellent repeatability and ease of handling. The advantages of POF (e.g., high flexibility and robustness) proved that this is a viable solution for this type of application, since POF's high fracture toughness enables its application in monitoring patients with higher body mass compared with similar systems based on silica fiber. This study has demonstrated the viability of the proposed system based on POF technology as a useful alternative for plantar pressure detection systems.

A novel variation of the recurrent laryngeal nerve.

PubMed

Wu, Gaosong; Wang, Kun

2017-06-02

Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Several anatomic variations of the nerve increase the likelihood of iatrogenic damage. A 50-year-old woman was presented to our department with a nodule in the right thyroid lobe, and she reported no voice changes. She had no history of surgery or radiation to the head or neck. Fine-needle aspiration was recorded as papillary thyroid carcinoma. The preoperative laryngoscopy revealed left vocal cord paralysis. Right thyroid lobectomy was performed. A scarce course of the left recurrent laryngeal nerve was found during the operation that ascended along the medial edge of the superior thyroid pole and finally disappeared beneath the superior cornu of the thyroid cartilage without any tracheal, esophageal, or laryngeal branches. The patient was discharged on the third postoperative day with the diagnoses of papillary thyroid carcinoma and congenital left vocal cord paralysis. The novel variation of the recurrent laryngeal nerve may challenge the current concept of the anatomy of the nerve. The vocal folds mobility should be examined routinely before surgery in patients undergoing thyroid operation.

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2013-12-01

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

[The use of papain in plantar ulcers].

PubMed

Otuka, E S; Pedrazzani, E S; Pioto, M P

1996-01-01

This work has as a goal to contribute to decrease the inability in leprosy and continuous recurrence of plantar ulcers, through the use of a treatment method using papaine and actions of health education. This work has been done in a health centre with patients that presented plantar ulcers and agreed to participate in the proposed treatment. Analysing and comparing the obtained data before and after treatment, a greater adhesion of patients to this treatment, a quicker healing in relation to other methods used before and a greater interaction with the patient has been observed.

Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer?

PubMed

Naemi, R; Chatzistergos, P; Suresh, S; Sundar, L; Chockalingam, N; Ramachandran, A

2017-04-01

To investigate if the assessment of the mechanical properties of plantar soft tissue can increase the accuracy of predicting Diabetic Foot Ulceration (DFU). 40 patients with diabetic neuropathy and no DFU were recruited. Commonly assessed clinical parameters along with plantar soft tissue stiffness and thickness were measured at baseline using ultrasound elastography technique. 7 patients developed foot ulceration during a 12months follow-up. Logistic regression was used to identify parameters that contribute to predicting the DFU incidence. The effect of using parameters related to the mechanical behaviour of plantar soft tissue on the specificity, sensitivity, prediction strength and accuracy of the predicting models for DFU was assessed. Patients with higher plantar soft tissue thickness and lower stiffness at the 1st Metatarsal head area showed an increased risk of DFU. Adding plantar soft tissue stiffness and thickness to the model improved its specificity (by 3%), sensitivity (by 14%), prediction accuracy (by 5%) and prognosis strength (by 1%). The model containing all predictors was able to effectively (χ 2 (8, N=40)=17.55, P<0.05) distinguish between the patients with and without DFU incidence. The mechanical properties of plantar soft tissue can be used to improve the predictability of DFU in moderate/high risk patients. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

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

PubMed

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

2016-11-01

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

The initial safe range of motion of the ankle joint after three methods of internal fixation of simulated fractures of the medial malleolus.

PubMed

Shimamura, Yoshio; Kaneko, Kazuo; Kume, Kazuhiko; Maeda, Mutsuhiro; Iwase, Hideaki

2006-07-01

Previous studies have demonstrated the safe passive range of ankle motion for inter-bone stiffness after internal fixation under load but there is a lack of information about the safe range of ankle motion for early rehabilitation in the absence of loading. The present study was designed to assess the effect of ankle movement on inter-bone displacement characteristics of medial malleolus fractures following three types of internal fixation to determine the safe range of motion. Five lower legs obtained during autopsy were used to assess three types of internal fixation (two with Kirschner-wires alone; two with Kirschner-wires plus tension band wiring; and, one with an AO/ASIF malleolar screw alone). Following a simulated fracture by sawing through the medial malleolus the displacement between the fractured bone ends was measured during a passive range of movement with continuous monitoring using omega (Omega) shaped transducers and a biaxial flexible goniometer. Statistical analysis was performed with repeated measures analysis of variance. Inter-bone displacement was not proportional to the magnitude of movement throughout the range of ankle motion as, when separation exceeded 25 microm, there was increasingly wide separation as plantar-flexion or dorsal-flexion was increased. There was no statistical significant difference between the small amount of inter-bone displacement observed with three types of fixation within the safe range of dorsal-flexion and plantar-flexion for early rehabilitation. However the inter-bone separation when fixation utilized two Kirschner-wires alone tended to be greater than when using the other two types of fixation during dorsal-flexion and eversion. The present study revealed a reproducible range of ankle motion for early rehabilitation which was estimated to be within the range of 20 degrees of dorsal-flexion and 10 degrees of plantar-flexion without eversion. Also, internal fixation with two Kirschner-wires alone does not seem to

Regeneration of the eighth cranial nerve in the bullfrog, Rana catesbeiana.

PubMed

Newman, A; Honrubia, V

1992-01-01

The present study was done in order to document the ability of the eighth cranial nerve of the bullfrog (Rana catesbeiana) to regenerate, the anatomic characteristics of the regenerated fibers, and the specificity of projections from individual endorgan branches of the nerve. The eighth cranial nerve was sharply transected between the ganglion cells and the brain stem in 40 healthy bullfrogs and allowed to regenerate. Anatomic studies were performed in these animals a minimum of 3 months postoperatively. Horseradish peroxidase was used to label the whole vestibular nerve or its individual endorgan branches. Labeled regenerated fibers could be identified crossing the site of the nerve section and projecting centrally to the vestibular nuclei in a pattern similar to that of normal frogs. Labeling of individual branches showed that regenerated fibers innervated the same specific areas found in normal frogs. Unlike normal animals, both thick and thin fibers projected to the medial nucleus.

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

PubMed Central

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

2015-01-01

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

Accessory branch of median nerve supplying the brachialis muscle: a case report and clinical significance.

PubMed

Paraskevas, George; Anastasopoulos, Nikolaos; Nitsa, Zoi; Kitsoulis, Panagiotis; Spyridakis, Ioannis

2014-12-01

A very rare case of an accessory branch of the median nerve taking its origin in the region of the right arm was observed to supply the infero-medial portion of the brachialis muscle in a male cadaver. Simultaneously, the ipsilateral musculocutaneous nerve was innervating the muscles of the anterior compartment of the arm. Such an aberrant muscular branch of the median nerve for the brachialis muscle is very rarely reported in the literature. Lesion of the median nerve proximal to the branch's origin site could induce weak flexion of the elbow, whereas injury of the musculocutaneous nerve could lead to misinterpretation of symptoms. We discuss the patterns of brachialis muscle innervation as well as the clinical applications of such a variant.

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

PubMed

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

2017-03-01

The aim was to critically evaluate the literature investigating strength training interventions in the treatment of plantar fasciitis and improving intrinsic foot musculature strength. A search of PubMed, CINHAL, Web of Science, SPORTSDiscus, EBSCO Academic Search Complete and PEDRO using the search terms plantar fasciitis, strength, strengthening, resistance training, intrinsic flexor foot, resistance training. Seven articles met the eligibility criteria. Methodological quality was assessed using the modified Downs and Black checklist. All articles showed moderate to high quality, however external validity was low. A comparison of the interventions highlights significant differences in strength training approaches to treating plantar fasciitis and improving intrinsic strength. It was not possible to identify the extent to which strengthening interventions for intrinsic musculature may benefit symptomatic or at risk populations to plantar fasciitis. There is limited external validity that foot exercises, toe flexion against resistance and minimalist running shoes may contribute to improved intrinsic foot musculature function. Despite no plantar fascia thickness changes being observed through high-load plantar fascia resistance training there are indications that it may aid in a reduction of pain and improvements in function. Further research should use standardised outcome measures to assess intrinsic foot musculature strength and plantar fasciitis symptoms. Copyright © 2016 Elsevier Ltd. All rights reserved.

Foot mobility and plantar fascia elasticity in patients with plantar fasciitis.

PubMed

Sahin, Namık; Oztürk, Alpaslan; Atıcı, Teoman

2010-01-01

In this study, we investigated the radiologic changes of feet in sagittal plane under weightbearing either with or without plantar fasciitis. The study includes 64 feet of the 42 subjects with heel pain (Group 1: 32 women, 10 men, mean age 48 years, range 33-57 years) and 80 feet of the 40 patients (Group 2: 30 women, 10 men, mean age 47.2 years, range 35-56 years) without heel pain. Calcaneal inclination angle (CIA), calcaneal-first metatarsal angle (CMA), and plantar fascia length (PFL) were measured in the lateral radiographs of the weightbearing and non-weightbearing foot. The values of Group 1 and Group 2 were compared. The mean CIA was 26° (range 18-35°), CMA was 121° (range 115-133°), and PFL was 131 mm (range 110-158 mm) in non-weightbearing position for Group 1. The mean CIA was 27° (range 17-38°), CMA was 122° (range 110-135°), and PFL was 136 mm (range 120-155 mm) in non-weightbearing position for Group 2. The mean CIA was 13.6° (range 5-25°), CMA was 138° (range 130-153°), and PFU was 143.8 mm (range 118-158 mm) in weightbearing position for Group 1. The mean CIA was 9.9° (range 4-25°), CMA was 145° (range 130-155°), and PFU was 151.4 mm (range 137-167 mm) in weightbearing position for Group 2. The difference between CIA, CMA, and PFL values were -13°, 17°, and 12 mm under condition of weightbearing and nonweightbearing position values for Group 1; and -17°, 23°, and 15 mm for Group 2. The differences were significant between weightbearing and non-weightbearing position values (p<0.05). The reduced CIA, CMA, and PFL changes during weight bearing might show reduced foot mobility and plantar fascia elasticity, which may lead to posterior heel pain syndrome.

Palmar and plantar pustulosis elicited by Candida antigen.

PubMed

Uehara, M

1978-05-01

Intracutaneous injection of Candida albicans was done on the forearm of 30 patients with palmar and plantar pustulosis. This induced an aggravation of pustular eruptions on the palms and soles in 11 (37%) of the 30 patients. The aggravation occurred only in those patients who had a positive delayed skin reaction to the Candida antigen. It is suggested that a delayed hypersensitivity inflammatory reaction somewhere in the body is attended with an aggravation of palmar plantar pustulosis.

Clinical Utility of Ultrasound Measurements of Plantar Fascia Width and Cross-Sectional AreaA Novel Technique.

PubMed

Bisi-Balogun, Adebisi; Rector, Michael

2017-09-01

We sought to develop a standardized protocol for ultrasound (US) measurements of plantar fascia (PF) width and cross-sectional area (CSA), which may serve as additional outcome variables during US examinations of both healthy asymptomatic PF and in plantar fasciopathy and determine its interrater and intrarater reliability. Ten healthy individuals (20 feet) were enrolled. Participants were assessed twice by two raters each to determine intrarater and interrater reliability. For each foot, three transverse scans of the central bundle of the PF were taken at its insertion at the medial calcaneal tubercle, identified in real time on the plantar surface of the foot, using a fine wire technique. Reliability was determined using intraclass correlation coefficients (ICC), standard errors of measurement (SEM), and limits of agreement (LOA) expressed as percentages of the mean. Reliability of PF width and CSA measurements was determined using PF width and CSA measurements from one sonogram measured once and the mean of three measurements from three sonograms each measured once. Ultrasound measurements of PF width and CSA showed a mean of 18.6 ± 2.0 mm and 69.20 ± 13.6 mm 2 respectively. Intra-reliability within both raters showed an ICC > 0.84 for width and ICC > 0.92 for CSA as well as a SEM% and LOA% < 10% for both width and CSA. Inter-rater reliability showed an ICC of 0.82 for width and 0.87 for CSA as well as a SEM% and LOA% < 10% for width and a SEM% < 10% and LOA% < 20% for CSA. Relative and absolute reliability within and between raters were higher when using the mean of three sonographs compared to one sonograph. Using this novel technique, PF CSA and width may be determined reliably using measurements from one sonogram or the mean of three sonograms. Measurement of PF CSA and width in addition to already established thickness and echogenicity measurements provides additional information on structural properties of the PF for clinicians and researchers in healthy

Early experience with endoscopic lumbar sympathectomy for plantar hyperhidrosis.

PubMed

Singh, Sanjay; Kaur, Simranjit; Wilson, Paul

2016-05-01

We describe our endoscopic lumbar sympathectomy technique and our early experience using it to treat plantar hyperhidrosis. We reviewed 20 lumbar sympathectomies performed in our vascular unit for plantar hyperhidrosis in 10 patients from 2011 and 2014. Demographics and outcomes were analyzed and a review of the literature conducted. All procedures were carried out endoscopically with no intraoperative or postoperative morbidity. Plantar anhidrosis was achieved in all the patients, although two patients (20%) suffered a relapse. Unwanted side-effects occurred in the form of compensatory sweating in three patients (30%) and post-sympathectomy neuralgia in two patients (20%). None of the patients experienced sexual dysfunction. Management of plantar hyperhidrosis may be based upon a therapeutic ladder starting with conservative measures and working up to surgery depending on the severity of the disease. Minimally invasive (endoscopic) sympathectomy for the thoracic chain is well established, but minimally invasive sympathectomy for the lumbar chain is a relatively new technique. Endoscopic lumbar sympathectomy provides an effective, minimally invasive method of surgical management, but long-term data are lacking. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

Pathological Location of Cranial Nerves in Petroclival Lesions: How to Avoid Their Injury during Anterior Petrosal Approach.

PubMed

Borghei-Razavi, Hamid; Tomio, Ryosuke; Fereshtehnejad, Seyed-Mohammad; Shibao, Shunsuke; Schick, Uta; Toda, Masahiro; Yoshida, Kazunari; Kawase, Takeshi

2016-02-01

Objectives  Numerous surgical approaches have been developed to access the petroclival region. The Kawase approach, through the middle fossa, is a well-described option for addressing cranial base lesions of the petroclival region. Our aim was to gather data about the variation of cranial nerve locations in diverse petroclival pathologies and clarify the most common pathologic variations confirmed during the anterior petrosal approach. Method  A retrospective analysis was made of both videos and operative and histologic records of 40 petroclival tumors from January 2009 to September 2013 in which the Kawase approach was used. The anatomical variations of cranial nerves IV-VI related to the tumor were divided into several location categories: superior lateral (SL), inferior lateral (IL), superior medial (SM), inferior medial (IM), and encased (E). These data were then analyzed taking into consideration pathologic subgroups of meningioma, epidermoid, and schwannoma. Results  In 41% of meningiomas, the trigeminal nerve is encased by the tumor. In 38% of the meningiomas, the trigeminal nerve is in the SL part of the tumor, and it is in 20% of the IL portion of the tumor. In 38% of the meningiomas, the trochlear nerve is encased by the tumor. The abducens nerve is not always visible (35%). The pathologic nerve pattern differs from that of meningiomas for epidermoid and trigeminal schwannomas. Conclusion  The pattern of cranial nerves IV-VI is linked to the type of petroclival tumor. In a meningioma, tumor origin (cavernous, upper clival, tentorial, and petrous apex) is the most important predictor of the location of cranial nerves IV-VI. Classification of four subtypes of petroclival meningiomas using magnetic resonance imaging is very useful to predict the location of deviated cranial nerves IV-VI intraoperatively.

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

PubMed Central

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

2016-01-01

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

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

PubMed

Bleck, E E; Berzins, U J

1977-01-01

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

A constitutive model for the mechanical characterization of the plantar fascia.

PubMed

Natali, Arturo N; Pavan, Piero G; Stecco, Carla

2010-10-01

A constitutive model is proposed to describe the mechanical behavior of the plantar fascia. The mechanical characterization of the plantar fascia regards the role in the foot biomechanics and it is involved in many alterations of its functional behavior, both of mechanical and nonmechanical origin. The structural conformation of the plantar fascia in its middle part is characterized by the presence of collagen fibers reinforcing the tissue along a preferential orientation, which is that supporting the major loading. According to this anatomical evidence, the tissue is described by developing an isotropic fiber-reinforced constitutive model and since the elastic response of the fascia is here considered, the constitutive model is based on the theory of hyperelasticity. The model is consistent with a kinematical description of large strains mechanical behavior, which is typical of soft tissues. A fitting procedure of the constitutive model is implemented making use of experimental curves taken from the literature and referring to specimens of human plantar fascia. A satisfactory fitting of the tensile behavior of the plantar fascia has been performed, showing that the model correctly interprets the mechanical behavior of the tissue in the light of comparison to experimental data at disposal. A critical analysis of the model with respect to the problem of the identification of the constitutive parameters is proposed as the basis for planning a future experimental investigation of mechanical behavior of the plantar fascia.

Fetal facial nerve course in the ear region revisited.

PubMed

Jin, Zhe Wu; Cho, Kwang Ho; Abe, Hiroshi; Katori, Yukio; Murakami, Gen; Rodríguez-Vázquez, Jose Francisco

2017-08-01

The aim of this study was to re-examine the structures that determine course of the facial nerve (FN) in the fetal ear region. We used sagittal or horizontal sections of 28 human fetuses at 7-8, 12-16, and 25-37 weeks. The FN and the chorda tympani nerve ran almost parallel until 7 weeks. The greater petrosal nerve (GPN) ran vertical to the distal FN course due to the trigeminal nerve ganglion being medial to the geniculate ganglion at 7 weeks. Afterwards, due to the radical growth of the former ganglion, the GPN became an anterior continuation of the FN. The lesser petrosal nerve ran straight, parallel to the FN at 7 weeks, but later, it started to wind along the otic capsule, possibly due to the upward invasion of the tympanic cavity epithelium. Notably, the chorda tympanic nerve origin from the FN, and the crossing between the vagus nerve branch and the FN, was located outside of the temporal bone even at 37 weeks. The second knee of the FN was not evident, in contrast to the acute anterior turn below the chorda tympanic nerve origin. In all examined fetuses, the apex of the cochlea did not face the middle cranial fossa, but the tympanic cavity. Topographical relation among the FN and related nerves in the ear region seemed not to be established in the fetal age but after birth depending on growth of the cranial fossa.

Characteristics of Plantar Loads During Walking in Patients with Knee Osteoarthritis.

PubMed

Zhang, Zhiwang; Wang, Lin; Hu, Kaijun; Liu, Yu

2017-12-01

BACKGROUND Knee osteoarthritis (KOA) is a common disease that can change the load on lower limbs during walking. Plantar loads in patients with KOA may provide a basis for clinical decisions regarding footwear and foot orthoses. This study aimed to compare plantar loads in females with and without KOA during gait. MATERIAL AND METHODS Plantar pressure during walking was recorded in 23 females with KOA and 23 females without KOA. Maximum force (MF), contact area (CA), and peak pressure (PP) were measured at 7 different regions underneath the foot, named heel (M1), midfoot (M2), first metatarsophalangeal joint (MPJ) (M3), second MPJ (M4), third to fifth MPJ (M5), hallux (M6), and lesser toes (M7). RESULTS PPs for M2 and (M3) in females with KOA were higher than those in females without KOA. High PPs were also found in females with KOA for M2, M3, and M4. CONCLUSIONS Increased plantar loading in females with KOA may lead to foot pronation and gait changes during walking. Plantar loading may be offered to patients with KOA when considering footwear and foot orthoses.

A real-time plantar pressure feedback device for foot unloading.

PubMed

Femery, Virginie G; Moretto, Pierre G; Hespel, Jean-Michel G; Thévenon, André; Lensel, Ghislaine

2004-10-01

To develop and test a plantar pressure control device that provides both visual and auditory feedback and is suitable for correcting plantar pressure distribution patterns in persons susceptible to neuropathic foot ulceration. Pilot test. Sports medicine laboratory in a university in France. One healthy man in his mid thirties. Not applicable. Main outcome measures A device was developed based on real-time feedback, incorporating an acoustic alarm and visual signals, adjusted to a specific pressure load. Plantar pressure measured during walking, at 6 sensor locations over 27 steps under 2 different conditions: (1) natural and (2) unloaded in response to device feedback. The subject was able to modify his gait in response to the auditory and visual signals. He did not compensate for the decrease of peak pressure under the first metarsal by increasing the duration of the load shift under this area. Gait pattern modification centered on a mediolateral load shift. The auditory signal provided a warning system alerting the user to potentially harmful plantar pressures. The visual signal warned of the degree of pressure. People who have lost nociceptive perception, as in cases of diabetic neuropathy, may be able to change their walking pattern in response to the feedback provided by this device. The visual may have diagnostic value in determining plantar pressures in such patients. This pilot test indicates that further studies are warranted.

Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique.

PubMed

Ellis, Richard; Hing, Wayne; Dilley, Andrew; McNair, Peter

2008-08-01

Diagnostic ultrasound provides a technique whereby real-time, in vivo analysis of peripheral nerve movement is possible. This study measured sciatic nerve movement during a "slider" neural mobilisation technique (ankle dorsiflexion/plantar flexion and cervical extension/flexion). Transverse and longitudinal movement was assessed from still ultrasound images and video sequences by using frame-by-frame cross-correlation software. Sciatic nerve movement was recorded in the transverse and longitudinal planes. For transverse movement, at the posterior midthigh (PMT) the mean value of lateral sciatic nerve movement was 3.54 mm (standard error of measurement [SEM] +/- 1.18 mm) compared with anterior-posterior/vertical (AP) movement of 1.61 mm (SEM +/- 0.78 mm). At the popliteal crease (PC) scanning location, lateral movement was 6.62 mm (SEM +/- 1.10 mm) compared with AP movement of 3.26 mm (SEM +/- 0.99 mm). Mean longitudinal sciatic nerve movement at the PMT was 3.47 mm (SEM +/- 0.79 mm; n = 27) compared with the PC of 5.22 mm (SEM +/- 0.05 mm; n = 3). The reliability of ultrasound measurement of transverse sciatic nerve movement was fair to excellent (Intraclass correlation coefficient [ICC] = 0.39-0.76) compared with excellent (ICC = 0.75) for analysis of longitudinal movement. Diagnostic ultrasound presents a reliable, noninvasive, real-time, in vivo method for analysis of sciatic nerve movement.

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

PubMed

Bae, Youngsook

2016-06-01

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

Ultrasound-guided plantar fascia release technique: a retrospective study of 46 feet.

PubMed

Vohra, Praveen K; Japour, Christopher J

2009-01-01

Ultrasound-guided plantar fascia release offers the surgeon clear visualization of anatomy at the surgical site. This technique uses small arthroscopic dissecting instruments through a 0.5-cm incision, allowing the surgeon to avoid the larger and more tissue-disruptive incision that is traditionally used for plantar heel spur resection and plantar fascia releases. Forty-one patients (46 feet) were selected for the study. The mean patient age was 47 years. Twenty-nine were considered obese with a body mass index greater than 30 kg/m(2). Patients were functionally and subjectively evaluated 4 weeks after surgery using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Rating Scale. Results from the study show a significant improvement (P = .05 confidence level) 4 weeks postoperatively for the 41 patients (46 feet), compared to their preoperative condition. The mean pretest score was 33.6 (range 10-52); this score improved to 88.0 (range 50-100), 4 weeks postoperatively. There were no postoperative infections or complications. The ultrasound-guided plantar fascia release technique is a practical surgical procedure for the relief of chronic plantar fascia pain because the surgeon is able to clearly visualize the plantar fascia by ultrasound. In addition, there is minimal disruption to surrounding tissue because small instruments are passed through a small 0.5-cm incision. The traditional open method of heel spur surgery, in contrast, uses a larger skin incision of 3 to 5 cm, followed by larger instruments to dissect to the plantar fascia.

In vivo diffusion characteristics following perineural injection of the deep branch of the lateral plantar nerve with mepivacaine or iohexol in horses.

PubMed

Contino, E K; King, M R; Valdés-Martínez, A; McIlwraith, C W

2015-03-01

Hindlimb proximal suspensory desmopathy is a common injury of sport horses but diagnosis can be difficult because diagnostic analgesia of the region lacks specificity. Perineural analgesia of the deep branch of the lateral plantar nerve (DBLPN) has been proposed as a more specific method of isolating pain of the proximal aspect of the suspensory ligament but the technique has not been evaluated in vivo. To determine the extent of diffusion of contrast medium and mepivacaine following DBLPN analgesia using a single-needle injection technique and to determine if there is inadvertent involvement of the tarsal sheath and/or tarsometatarsal (TMT) joint using this technique. In vivo experimental study. Perineural injection of the DBLPN was performed in 16 limbs with 3 ml of either mepivacaine hydrochloride or positive contrast medium. Contrast medium-injected limbs were radiographed 5, 15, and 30 min post injection and diffusion characteristics were described. In mepivacaine-injected limbs, synovial fluid from the TMT joint was obtained 10 and 20 min post injection and mepivacaine concentrations were analysed. At 5, 15 and 30 min post injection, the contrast medium extended, on average, 19.6, 20.6 and 21.0 mm proximal and 38.0, 43.5 and 51.9 mm distal to the injection site, respectively. Three of 8 (37.5%) limbs had evidence of contrast medium in the tarsal sheath. Two of 8 (25%) limbs had mepivacaine concentrations within the TMT joint sufficient to produce analgesia (>300 mg/l) at 10 min post injection. Contrast medium diffused further in a distal direction than in a proximal direction. Analgesia of the DBLPN can result in inadvertent involvement of the tarsal sheath and/or TMT joint. © 2014 EVJ Ltd.

Dupuytren-Like Contracture of the Foot: Ledderhose Disease.

PubMed

Akdag, Osman; Yildiran, Gokce; Karamese, Mehtap; Tosun, Zekeriya

2016-07-01

Introduction  Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report  A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion  Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion  The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.

Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes.

PubMed

Begg, Lindy; McLaughlin, Patrick; Vicaretti, Mauro; Fletcher, John; Burns, Joshua

2016-01-01

The total contact cast (TCC) is an effective intervention to reduce plantar pressure in patients with diabetes and a plantar forefoot ulcer. The walls of the TCC have been indirectly shown to bear approximately 30 % of the plantar load. A new direct method to measure inside the TCC walls with capacitance sensors has shown that the anterodistal and posterolateral-distal regions of the lower leg bear the highest load. The objective of this study was to directly measure these two regions in patients with Diabetes and a plantar forefoot ulcer to further understand the mechanism of pressure reduction in the TCC. A TCC was applied to 17 patients with Diabetes and a plantar forefoot ulcer. TCC wall load (contact area, peak pressure and max force) at the anterodistal and posterolateral-distal regions of the lower leg were evaluated with two capacitance sensor strips measuring 90 cm(2) (pliance®, novel GmbH, Germany). Plantar load (contact area, peak pressure and max force) was measured with a capacitance sensor insole (pedar®, novel GmbH, Germany) placed inside the TCC. Both pedar® and pliance® collected data simultaneously at a sampling rate of 50Hz synchronised to heel strike. The magnitude of TCC wall load as a proportion of plantar load was calculated. The TCC walls were then removed to determine the differences in plantar loading between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and forefoot (region of interest). TCC wall load was substantial. The anterodistal lower leg recorded 48 % and the posterolateral-distal lower leg recorded 34 % of plantar contact area. The anterodistal lower leg recorded 28 % and the posterolateral-distal lower leg recorded 12 % of plantar peak pressure. The anterodistal lower leg recorded 12 % and the posterolateral-distal lower leg recorded 4 % of plantar max force. There were significant differences in plantar load between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and

Resolution of long standing tinnitus following radiofrequency ablation of C2-C3 medial branches--a case report.

PubMed

Gritsenko, Karina; Caldwell, William; Shaparin, Naum; Vydyanathan, Amaresh; Kosharskyy, Boleslav

2014-01-01

Tinnitus is described as an auditory phantom perception analogous to central neuropathic pain. Despite the high prevalence of this debilitating symptom, no intervention is recognized that reliably eliminates tinnitus symptoms; a cause has yet to be determined. A 65-year-old healthy man presented with a 3 year history of left-sided tinnitus. Full workup performed by the primary care physician including blood tests for electrolyte imbalance, consultations by 2 independent otholaryngologists, and imaging did not reveal abnormalities to provide etiology of the tinnitus. No other complaints were noted except for occasional minimal left sided neck pain. Cervical spine x-ray showed degenerative changes with facet hypertrophy more pronounced on the left side. Subsequently, the patient underwent diagnostic left-sided C2-C3 medial branch block, resulting in complete resolution of tinnitus for more than 6 hours. After successful radiofrequency ablation of left C2-C3 medial branches, the patient became asymptomatic. At one year follow-up, he continued to be symptom free. Sparce studies have shown interaction between the somatosensory and auditory system at dorsal cochlear nucleus (DCN), inferior colliculus, and parietal association areas. Upper cervical nerve (C2) electrical stimulation evokes potentials in the DCN, eliciting strong patterns of inhibition and weak excitation of the DCN principal cells. New evidence demonstrated successful transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for treatment of somatic tinnitus in 240 patients. This case indicates that C2-C3 facet arthropathy may cause tinnitus and radiofrequency ablation of C2-C3 medial branches can provide an effective approach not previously considered.

Benign Peripheral Nerve Sheath Tumor in a Wild Toco Toucan ( Ramphastos toco ).

PubMed

Carvalho, Marcelo P N; Fernandes, Natalia C C A; Nemer, Viviane C; Neto, Ramiro N Dias; Teixeira, Rodrigo H F; Miranda, Bruna S; Mamprim, Maria J; Catão-Dias, José L; Réssio, Rodrigo A

2016-09-01

Peripheral nerve sheath tumors are a heterogeneous group of neoplasms that comprise neurofibromas, schwannomas, neurilemmomas, and perineuromas. In animals, peripheral nerve sheath neoplasms are most commonly diagnosed in dogs and cattle, followed by horses, goats, and cats, but their occurrence is uncommon in birds. An adult, free-living, male toco (common) toucan ( Ramphastos toco ) was admitted to the zoo animal clinic with weight loss, dehydration, and presence of a soft nodule adhered to the medial portion of the left pectoral muscle. Clinical, cytologic, and computed tomography scan results were indicative of a neoplasm. The toucan died during surgical resection of the mass. Necropsy, histopathologic, and immunohistochemical findings confirmed the diagnosis of benign peripheral nerve sheath tumor. To our knowledge, benign peripheral nerve sheath tumor has not previously been reported in a toucan or any other species in the order Piciformes.

Pattern analysis of nerve enlargement using ultrasonography in chronic inflammatory demyelinating polyneuropathy.

PubMed

Jang, Jae Hong; Cho, Charles S; Yang, Kyung-Sook; Seok, Hung Youl; Kim, Byung-Jo

2014-09-01

Focal nerve enlargement is a characteristic finding in chronic inflammatory demyelinating polyneuropathy (CIDP). We performed this study to assess the distribution of nerve enlargement through ultrasonographic examination of peripheral nerves and to correlate the ultrasonographic findings with clinical features. To compare the ultrasonographic features of 10 subjects with CIDP with those of 18 healthy controls, we bilaterally measured the cross-sectional areas (CSA) of the vagus, brachial plexus, musculocutaneous, median, ulnar, radial, sciatic, tibial, common peroneal, and sural nerves. We also analyzed correlations between CSAs and various clinical and electrophysiological features. Mean CSAs were significantly larger in CIDP patients than controls, especially at proximal and non-entrapment sites. CSAs were significantly correlated with muscle strength at initial presentation, but not at the time of ultrasonography. The CSAs of the median and ulnar nerves at the mid-forearm, tibial nerve at 7 cm proximal to the medial malleolus, and sural nerve correlated with the nerve conduction velocity of the corresponding region. Ultrasonography revealed widely distributed nerve enlargement, especially in proximal regions and non-entrapment sites, in patients with CIDP compared with healthy controls. Nerve enlargement correlated well with the electrophysiologic function of the nerve, but not current clinical status. Pattern analysis of nerve enlargement using ultrasonography is a supportive tool in the diagnosis of CIDP. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Transthoracic Arteriovenous Graft Repair With the Pectoralis (PECS) II Nerve Block for Primary Intraoperative Anesthesia and Postoperative Analgesia: A Case Report.

PubMed

Farkas, Gabriel; Weber, Garret; Miller, Jonathon; Xu, Jeff

2018-05-07

The PECS II nerve block is a relatively new regional anesthetic technique that targets the medial and lateral pectoral nerves, as well as the lateral cutaneous branches of the intercostal nerves. It has been described for surgical cases involving the breast, as an adjunct or alternative to neuraxial or paravertebral techniques. This case report describes the first successful use of the PECS II nerve block placed using ultrasound guidance as the primary anesthetic and postoperative analgesic in a non-breast-related chest wall surgery.

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

PubMed Central

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

2015-01-01

[Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain.

PubMed

Rompe, Jan D; Furia, John; Cacchio, Angelo; Schmitz, Christoph; Maffulli, Nicola

2015-12-01

Whether shock wave therapy or shock wave therapy combined with plantar fascia-specific stretching is more efficient in treating chronic plantar heel pain remains unclear. The aim of the study was to test the null hypothesis of no difference of these two forms of management for patients who had unilateral plantar fasciopathy for a minimum duration of twelve months and which had failed at least three other forms of treatment. One hundred and fifty-two patients with chronic plantar fasciopathy were assigned to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group 1, n = 73) or to receive the identical shock wave treatment and to perform an eight-week plantar fascia-specific stretching program (Group 2, n = 79). All patients completed the nine-item pain subscale of the validated Foot Function Index and a subject-relevant outcome questionnaire. Patients were evaluated at baseline, and at two, four, and twenty-four months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first steps of walking in the morning) on this Index, and satisfaction with treatment. No difference in mean age, sex, weight or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with shock-wave therapy plus plantar fascia-specific stretching than those managed with shock-wave therapy alone (p < 0.001), as well as individually for item 2 (p < 0.001). Twenty-four patients in Group 1 (32%) versus forty-seven patients in Group 2 (59%) were satisfied with the treatment (p < 0.001). Significant differences persisted at four months, but not at twenty-four months. A program of manual stretching exercises specific to the plantar fascia in combination with repetitive low-energy radial

Treatment of subtotal medial rectus myectomy complicating functional endoscopic sinus surgery.

PubMed

Trotter, W L; Kaw, P; Meyer, D R; Simon, J W

2000-08-01

During the past 2 decades, the introduction of functional endoscopic sinus surgery (FESS) has dramatically improved the treatment of sinus disorders. However, a variety of orbital complications have been reported, including optic nerve damage, hemorrhage, infection, compromise of the lacrimal drainage apparatus, and strabismus. At least 10 cases have reported damage to the medial rectus muscle. (1-8) Treatment options for such patients have been limited, especially because most are adults at risk for anterior segment ischemia after transposition of vertical rectus muscles. We describe 2 patients whose medial rectus myectomies were repaired by using nonabsorbable "hang-back" sutures in combination with a botulinum toxin (Botox) injection of the antagonist lateral rectus muscle. Good primary position alignment was achieved in both patients, and one patient was able to regain binocular function. We recommend this surgical approach, especially in patients at increased risk for anterior segment ischemia.

Detection of normal plantar fascia thickness in adults via the ultrasonographic method.

PubMed

Abul, Kadir; Ozer, Devrim; Sakizlioglu, Secil Sezgin; Buyuk, Abdul Fettah; Kaygusuz, Mehmet Akif

2015-01-01

Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18-65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4-5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5-5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8-4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8-4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8-5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8-5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

Congenital oculomotor nerve synkinesis associated with fetal retinoid syndrome.

PubMed

Morrison, David G; Elsas, Frederick J; Descartes, Maria

2005-04-01

Isotretinoin (RA), used for the treatment of cystic acne, is a powerful teratogen, causing craniofacial dysmorphisms and neural tube defects. We present two patients with RA embryopathy and oculomotor nerve synkinesis. Retrospective review of patient records. Two patients presented with third nerve synkinesis and fetal RA exposure. Both had marked elevation of the upper eyelids on adduction such that the lid fissures alternately opened and closed on gaze from side to side. Both patients showed typical dysmorphisms of RA embryopathy. The first patient had complete agenesis of the cerebellar vermix and died at 2 years. The second patient had restricted extraocular muscles in one eye and was exotropic and hypotropic. Both patients demonstrated simultaneous innervation of the medial rectus and levator palpebrae muscles causing coincident lid elevation in adduction. This evidence of oculomotor nerve synkinesis is consistent with animal studies showing abnormalities in the formation of cranial nerve ganglia following fetal RA exposure. RA is a powerful teratogen. These patients provide additional clinical evidence of its influence on neural migration during early development.

Risk factors correlated with plantar pressure in Chinese patients with type 2 diabetes.

PubMed

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

2013-12-01

Plantar pressure is a key factor for predicting ulceration in the foot of a diabetes patient. We recruited a group of 100 Chinese patients with type 2 diabetes and an age-, sex-, weight-, and height-matched group of 100 Chinese subjects without diabetes. We obtained plantar pressure data using a Footscan(®) gait system (RsScan International, Olen, Belgium) when the subjects with and without diabetes walked barefoot across a sensor platform. We recorded the maximum force, maximum pressure, impulse, pressure-time integral, and loading rate from 10 regions of the foot. We collected the data of 11 history-based variables, 10 anthropometric variables, and three metabolic variables regarding the clinical characteristics of the diabetes patients. Weight was identified as a determining factor for high plantar pressure. Height, the Neuropathy Symptom Score (NSS), and ankle-brachial index (ABI) were correlated positively with plantar pressure measurements, respectively. The sex, history of ulcer and callus, intima-media membrane of the lower limb blood vessels, and fasting blood glucose (FBG) could also explain a portion of the variability of the plantar pressure measurements. However, the correlations were low or weak. High plantar pressure in diabetes patients could be predicted, in part, based on weight, height, NSS, ABI, sex, history of ulcer and callus, intima-media membrane of the lower limb blood vessels, and FBG. Therefore, interventions should be taken specifically before high plantar pressure emerges.

Plantar Fasciitis: Will Physical Therapy Help My Foot Pain?

PubMed

2017-02-01

One out of 10 people in the United States experience persistent pain along the bottom of the foot, a condition known as plantar fasciitis. In 2014, the Orthopaedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition. In a more recent study published in the February 2017 issue of JOSPT, researchers reviewed the records of people with plantar fasciitis who were sent to physical therapy. The results of this study support prior studies that show faster recovery time for those who receive evidence-based physical therapy for their foot pain. J Orthop Sports Phys Ther 2017;47(2):56. doi:10.2519/jospt.2017.0501.

Management of Plantar Hyperhidrosis with Endoscopic Lumbar Sympathectomy.

PubMed

Rieger, Roman

2016-11-01

Primary plantar hyperhidrosis is defined as excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle and reduction of health-related quality of life. Conservative therapy measures usually fail to provide sufficient relieve of symptoms and do not allow long-lasting elimination of hyperhidrosis. Endoscopic lumbar sympathectomy appears to be a safe and effective procedure for eliminating excessive sweating of the feet and improves quality of life of patients with severe plantar hyperhidrosis. Copyright © 2016 Elsevier Inc. All rights reserved.

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

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

PubMed

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

2012-10-01

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

Peripheral innervation patterns of vestibular nerve afferents in the bullfrog utriculus

NASA Technical Reports Server (NTRS)

Baird, Richard A.; Schuff, N. R.

1994-01-01

Vestibular nerve afferents innervating the bullfrog utriculus differ in their response dynamics and sensitivity to natural stimulation. They also supply hair cells that differ markedly in hair bundle morphology. To examine the peripheral innervation patterns of individual utricular afferents more closely, afferent fibers were labeled by the extracellular injection of horseradish peroxidase (HRP) into the vestibular nerve after sectioning the vestibular nerve medial to Scarpa's ganglion to allow the degeneration of sympathetic and efferent fibers. The peripheral arborizations of individual afferents were then correlated with the diameters of their parent axons, the regions of the macula they innervate, and the number and type of hair cells they supply. The utriculus is divided by the striola, a narrow zone of distinctive morphology, into media and lateral parts. Utiricular afferents were classified as striolar or extrastriolar according to the epithelial entrance of their parent axons and the location of their terminal fields. In general, striolar afferents had thicker parent axons, fewer subepithelial bifurcations, larger terminal fields, and more synaptic endings than afferents in extrstriolar regions. Afferents in a juxtastriolar zone, immediately adjacent to the medial striola, had innervation patterns transitional between those in the striola and more peripheral parts of the medial extrastriola. moast afferents innervated only a single macular zone. The terminal fields of striolar afferents, with the notable exception of a few afferents with thin parent axons, were generally confined to one side of the striola. Hair cells in the bullfrog utriculus have perviously been classified into four types based on hair bundle morphology. Afferents in the extrastriolar and juxtastriolar zones largely or exclusively innervated Type B hair cells, the predominant hair cell type in the utricular macula. Striolar afferents supplied a mixture of four hair cell types, but largely

Gait-related strategies for the prevention of plantar ulcer development in the high risk foot.

PubMed

Bowling, Frank L; Reeves, Neil D; Boulton, Andrew J

2011-05-01

High plantar pressures lead to ulceration in the diabetic foot, particularly in the forefoot region around the metatarsal heads. High plantar pressures persist during gait due to factors such as peripheral neuropathy, foot deformities, limited ankle dorsi flexion range of motion and reduced plantar tissue thickness. Strategies impinging upon gait such as the use of appropriate therapeutic footwear, custom-moulded insoles and injectable silicone can help to reduce plantar pressures and attenuate the risk for ulceration. Shoes adapted with external rocker profiles facilitate plantar flexion and restrict sagittal plane motion of the metatarsophalangeal joint, reducing pressures in the region of the metatarsal heads. Insoles custom-moulded to patient's feet help to reduce plantar pressures and minimise the risk of ulceration in the forefoot region. The loss of subcutaneous fat tissue in the diabetic foot enhances bony prominences and predisposes the foot to high-pressure areas. Silicone is a biocompatible material that can be safely injected into plantar soft tissue to augment tissue thickness and prevent the development of ulceration. This enhancement to the subcutaneous layer is remarkably well retained and is a generally well-adopted procedure in the clinical setting.

Outcome of palmar/plantar digital neurectomy in horses with foot pain evaluated with magnetic resonance imaging: 50 cases (2005-2011).

PubMed

Gutierrez-Nibeyro, S D; Werpy, N M; White, N A; Mitchell, M A; Edwards, R B; Mitchell, R D; Gold, S J; Allen, A K

2015-03-01

There is limited knowledge of the foot lesions that influence the outcome of palmar/plantar digital neurectomy (PDN). 1) To report the short- and long-term outcomes of horses that underwent PDN to alleviate chronic foot pain due to lesions diagnosed by magnetic resonance imaging (MRI) and 2) factors that may influence the outcome of PDN. Multicentre retrospective study. Medical records of 50 horses subjected to PDN due to chronic foot pain were reviewed. Age, breed, sex, athletic activity, duration of lameness, affected limb(s), response to anaesthesia of the palmar/plantar digital nerves, MRI findings and surgical technique were analysed together with follow-up data to identify factors that influenced the long-term outcomes. Forty-six of 50 horses (92%) responded positively to surgery; 40 (80%) were able to return to their previous athletic use for a median time of 20 months (range: 12-72 months). Eighteen (36%) horses developed post operative complications including residual lameness, painful neuromas, or early recurrence of lameness. Horses with pre-existing core or linear lesions of the deep digital flexor tendon (DDFT) had significantly shorter periods of lameness resolution after surgery than horses with dorsal border lesions of the DDFT or other foot lesions. Palmar/plantar digital neurectomy can improve or resolve lameness in horses with foot pain unresponsive to medical therapy without serious post operative complications. However, horses with core or linear lesions of the DDFT should not be subjected to PDN as these horses experience residual lameness or early recurrent lameness after surgery. Magnetic resonance imaging can be used to identify these horses. © 2014 EVJ Ltd.

Enthesopathy of the lateral cord of the plantar fascia.

PubMed

Hoffman, Douglas F; Nazarian, Levon N; Smith, Jay

2014-09-01

The objective of this study was to raise awareness of the diagnosis of enthesopathy of the lateral cord of the plantar fascia (LCPF) and describe its sonographic findings. We conducted a retrospective case series of 13 sonographic examinations with the diagnosis of LCPF enthesopathy. Two cadaver dissections of the plantar foot were performed for anatomic correlation. Sonographic findings of LCPF enthesopathy included generalized or focal hypoechoic thickening, loss of the normal fibrillar echo texture, cortical irregularity of the fifth metatarsal tuberosity, and vascularity on color Doppler imaging. Anatomic dissections of the plantar foot detailed the course of the LCPF and served as a guide for optimal sonographic imaging. Enthesopathy of the LCPF is an important etiology of nontraumatic pain at the base of the fifth metatarsal. Sonographic evaluation can readily show the characteristic findings of LCPF enthesopathy. © 2014 by the American Institute of Ultrasound in Medicine.

Plantar Fasciitis: Prescribing Effective Treatments.

ERIC Educational Resources Information Center

Shea, Michael; Fields, Karl B.

2002-01-01

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

Plantar pressure changes after long-distance walking.

PubMed

Stolwijk, Niki M; Duysens, Jacques; Louwerens, Jan Willem K; Keijsers, Noël L W

2010-12-01

The popularity of long-distance walking (LDW) has increased in the last decades. However, the effects of LDW on plantar pressure distribution and foot complaints, in particular, after several days of walking, have not been studied. We obtained the plantar pressure data of 62 subjects who had no history of foot complaints and who walked a total distance of 199.8 km for men (n = 30) and 161.5 km for women (n = 32) during four consecutive days. Plantar pressure was measured each day after the finish (posttests I–IV) and compared with the baseline plantar pressure data, which was obtained 1 or 2 d before the march (pretest). Mean, peak, and pressure–time integral per pixel as well as the center of pressure (COP) trajectory of each foot per measurement day were calculated using the normalization method of Keijsers et al. A paired t-test with an adjusted P value was used to detect significant differences between pretest and posttest. Short-term adjustment to LDW resulted in a significant decreased loading on the toes accompanied with an increased loading on the metatarsal head III–V (P < 0.001). At all stages, particularly at later stages, there was significantly more heel loading (P < 0.001). Furthermore, the COP significantly displaced in the posterior direction but not in the mediolateral direction after marching. Contact time increased slightly from 638.5 +/- 24.2 to 675.4 +/- 22.5 ms (P < 0.001). The increased heel loading and decreased function of the toes found after marching indicate a change of walking pattern with less roll-off. It is argued that these changes reflect the effect of fatigue of the lower leg muscles and to avoid loading of the most vulnerable parts of the foot.

Motor neuron activation in peripheral nerves using infrared neural stimulation

NASA Astrophysics Data System (ADS)

Peterson, E. J.; Tyler, D. J.

2014-02-01

Objective. Localized activation of peripheral axons may improve selectivity of peripheral nerve interfaces. Infrared neural stimulation (INS) employs localized delivery to activate neural tissue. This study investigated INS to determine whether localized delivery limited functionality in larger mammalian nerves. Approach. The rabbit sciatic nerve was stimulated extraneurally with 1875 nm wavelength infrared light, electrical stimulation, or a combination of both. Infrared-sensitive regions (ISR) of the nerve surface and electromyogram (EMG) recruitment of the Medial Gastrocnemius, Lateral Gastrocnemius, Soleus, and Tibialis Anterior were the primary output measures. Stimulation applied included infrared-only, electrical-only, and combined infrared and electrical. Main results. 81% of nerves tested were sensitive to INS, with 1.7 ± 0.5 ISR detected per nerve. INS was selective to a single muscle within 81% of identified ISR. Activation energy threshold did not change significantly with stimulus power, but motor activation decreased significantly when radiant power was decreased. Maximum INS levels typically recruited up to 2-9% of any muscle. Combined infrared and electrical stimulation differed significantly from electrical recruitment in 7% of cases. Significance. The observed selectivity of INS indicates that it may be useful in augmenting rehabilitation, but significant challenges remain in increasing sensitivity and response magnitude to improve the functionality of INS.

Motor Neuron Activation in Peripheral Nerves Using Infrared Neural Stimulation

PubMed Central

Peterson, EJ; Tyler, DJ

2014-01-01

Objective Localized activation of peripheral axons may improve selectivity of peripheral nerve interfaces. Infrared neural stimulation (INS) employs localized delivery to activate neural tissue. This study investigated INS to determine whether localized delivery limited functionality in larger mammalian nerves. Approach The rabbit sciatic nerve was stimulated extraneurally with 1875 nm-wavelength infrared light, electrical stimulation, or a combination of both. Infrared-sensitive regions (ISR) of the nerve surface and electromyogram (EMG) recruitment of the Medial Gastrocnemius, Lateral Gastrocnemius, Soleus, and Tibialis Anterior were the primary output measures. Stimulation applied included infrared-only, electrical-only, and combined infrared and electrical. Main results 81% of nerves tested were sensitive to INS, with 1.7± 0.5 ISR detected per nerve. INS was selective to a single muscle within 81% of identified ISR. Activation energy threshold did not change significantly with stimulus power, but motor activation decreased significantly when radiant power was decreased. Maximum INS levels typically recruited up to 2–9% of any muscle. Combined infrared and electrical stimulation differed significantly from electrical recruitment in 7% of cases. Significance The observed selectivity of INS indicates it may be useful in augmenting rehabilitation, but significant challenges remain in increasing sensitivity and response magnitude to improve the functionality of INS. PMID:24310923

Gastrocnemius recession for recalcitrant plantar fasciitis in overweight and obese patients.

PubMed

Ficke, Brooks; Elattar, Osama; Naranje, Sameer M; Araoye, Ibukunoluwa; Shah, Ashish B

2017-06-07

Plantar fasciitis is a common foot pathology that is typically treated non-operatively. However, a minority of patients fail non-operative management, develop chronic symptoms, and request a surgical option. Gastrocnemius recession has recently been shown to be effective for the treatment of chronic plantar fasciitis. The purpose of this paper is to present evidence that gastrocnemius recession is safe and effective in the subset of chronic plantar fasciitis patients who are overweight and obese. We retrospectively reviewed 18 cases (17 patients) of chronic plantar fasciitis in overweight or obese patients who underwent gastrocnemius recession (mean age=46years, mean body mass index=34.7kg/m 2 , mean follow-up=20months). Data was gathered regarding pre-operative and post-operative pain (visual analog scale, 0-10), Foot Function Index score, and complications. Mean Foot Function Index score improved from 66.4 (range, 32.3-97.7) preoperatively to 26.5 (range, 0-89.4) postoperatively (p<0.01). Mean pain score improved from 8.3 (range, 5-10) preoperatively to 2.4 (range, 0-7) at final follow-up (p<0.01). Gastrocnemius recession improved foot function and pain symptoms in overweight and obese patients with chronic plantar fasciitis. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Anatomical variations of the facial nerve in first branchial cleft anomalies.

PubMed

Solares, C Arturo; Chan, James; Koltai, Peter J

2003-03-01

To review our experience with branchial cleft anomalies, with special attention to their subtypes and anatomical relationship to the facial nerve. Case series. Tertiary care center. Ten patients who underwent resection for anomalies of the first branchial cleft, with at least 1 year of follow-up, were included in the study. The data from all cases were collected in a prospective fashion, including immediate postoperative diagrams. Complete resection of the branchial cleft anomaly was performed in all cases. Wide exposure of the facial nerve was achieved using a modified Blair incision and superficial parotidectomy. Facial nerve monitoring was used in every case. The primary outcome measurements were facial nerve function and incidence of recurrence after resection of the branchial cleft anomaly. Ten patients, 6 females and 4 males,with a mean age of 9 years at presentation, were treated by the senior author (P.J.K.) between 1989 and 2001. The lesions were characterized as sinus tracts (n = 5), fistulous tracts (n = 3), and cysts (n = 2). Seven lesions were medial to the facial nerve, 2 were lateral to the facial nerve, and 1 was between branches of the facial nerve. There were no complications related to facial nerve paresis or paralysis, and none of the patients has had a recurrence. The successful treatment of branchial cleft anomalies requires a complete resection. A safe complete resection requires a full exposure of the facial nerve, as the lesions can be variably associated with the nerve.

Validation of Plantar Pressure Measurements for a Novel In-Shoe Plantar Sensory Replacement Unit

PubMed Central

Ferber, Reed; Webber, Talia; Kin, B; Everett, Breanne; Groenland, Marcel

2013-01-01

Background Research concerning prevention of diabetic foot complications is critical. A novel in-shoe plantar sensory replacement unit (PSRU) has been developed that provides alert-based feedback derived from analyzing plantar pressure threshold measurements in real time. The purpose of this study was to compare the PSRU device to a gold standard pressure-sensing device (GS-PSD) to determine the correlation between concurrent measures of plantar pressure during walking. Methods The PSRU had an array of eight sensors with a range of 10–75 mm Hg and collected data at 4 Hz, whereas the GS-PSD had 99 sensors with a range of 1–112 mm Hg and collected data at 100 Hz. Based on an a priori power analysis, data were collected from 10 participants (3 female, 7 male) while walking over ground in both devices. The primary variable of interest was the number of data points recorded that were greater than 32 mm Hg (capillary arterial pressure—the minimum pressure reported to cause pressure ulcers) for each of the eight PSRU sensors and corresponding average recordings from the GS-PSD sensor clusters. Intraclass correlation coefficient (2,1) was used to compare data between the two devices. Results Compared with the GS-PSD, we found good-to-very-good correlations (r-value range 0.67–0.86; p-value range 0.01–0.05) for six of the PSRU’s eight sensors and poor correlation for only two sensors (r = 0.41, p = .15; r = 0.38, p = .18) when measuring the number of data points recorded that were greater than 32 mm Hg. Conclusions Based on the results of the present study, we conclude the PSRU provides analogous data when compared with a GS-PSD. PMID:24124942

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis

PubMed Central

Ragab, Ehab Mohamed

2009-01-01

Background Planter fasciitis is a common cause of heel pain in adults. Many treatment options exist. Most of patients resolve with conservative management. Approximately 10% of patients develop persistent and often disabling symptoms. Patients and methods This prospective study includes 37 patients with an established diagnosis of chronic plantar fasciitis, aiming to compare two different techniques of treatment. First group includes 17 patients with a mean age of 42 years treated by endoscopic plantar fasciotomy (EPF); the mean follow-up was 11 months. Second group includes 20 patients with a mean age of 45 years treated by extracorporeal shock Wave Therapy (ESWT); the mean follow-up was 7.6 months. Results In the first group (EPF), using the visual analog scale the average post-operative pain was improved from 9.1 to 1.6. Post-operatively, 58.8% had no limitation of functional activities, 35.3% had minimal limitation of activities and 5.9% had moderate limitation of activities. Concerning patient satisfaction, 82.3% of patients were completely satisfied, 11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied. For the second group (ESWT), using the visual analog scale the average post-operative pain was improved from 9 to 2.1. Post-operatively, 50% had no functional limitation of activities, 35% had minimal limitation of activities, 10% had moderate limitation of activities, and 5% had severe limitation of activities. Concerning patient satisfaction, 75% of patients were completely satisfied and 25% were satisfied with reservation or unsatisfied. Conclusion Because of better results with endoscopic release versus the benefits of no complications, no immobilization, and early resumption of full activities with ESWT, we conclude that ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF. PMID:20033696

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.

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

Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: case report.

PubMed

Dorsi, Michael J; Belzberg, Allan J

2012-01-01

Transverse myelitis (TM) may result in permanent neurologic dysfunction. Nerve transfers have been developed to restore function after peripheral nerve injury. Here, we present a case report of a child with permanent right upper extremity weakness due to TM that underwent nerve transfers. The following procedures were performed: double fascicle transfer from median nerve and ulnar nerve to the brachialis and biceps branches of the musculocutaneous nerve, spinal accessory to suprascapular nerve, and medial cord to axillary nerve end-to-side neurorraphy. At 22 months, the patient demonstrated excellent recovery of elbow flexion with minimal improvement in shoulder abduction. We propose that the treatment of permanent deficits from TM represents a novel indication for nerve transfers in a subset of patients. Copyright © 2011 Wiley Periodicals, Inc.

Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial

PubMed Central

Hewitt, Catherine; Hicks, Kate; Jayakody, Shalmini; Kang’ombe, Arthur Ricky; Stamuli, Eugena; Turner, Gwen; Thomas, Kim; Curran, Mike; Denby, Gary; Hashmi, Farina; McIntosh, Caroline; McLarnon, Nichola; Torgerson, David; Watt, Ian

2011-01-01

Objective To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts. Design A multicentre, open, two arm randomised controlled trial. Setting University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland. Participants 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. Interventions Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks. Main outcome measures Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment. Results There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI –8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients’ preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference –3.15% (–16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar

Computerized analysis of plantar pressure variation in flip-flops, athletic shoes, and bare feet.

PubMed

Carl, Tanya J; Barrett, Stephen L

2008-01-01

High peak plantar pressures predispose to foot problems and may exacerbate existing conditions. For podiatric physicians to make educated recommendations to their patients, it is important and necessary to begin to look at different shoes and how they affect peak plantar pressure. To determine how flip-flops change peak plantar pressure while walking, we compared peak plantar pressures in the same test subjects wearing flip-flops, wearing athletic shoes, and in bare feet. Ten women with size 7 feet and a body mass index less than 25 kg/m2 were tested with an in-shoe pressure-measurement system. These data were collected and analyzed by one-way analysis of variance and computer software. Statistically significant results were obtained for nine of the 18 comparisons. In each of these comparisons, flip-flops always demonstrated higher peak plantar pressures than athletic shoes but lower pressures than bare feet. Although these data demonstrate that flip-flops have a minor protective role as a shock absorber during the gait cycle compared with pressures measured while barefoot, compared with athletic shoes, they increase peak plantar pressures, placing the foot at greater risk for pathologic abnormalities.

Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects.

PubMed

Pascual Huerta, Javier; Alarcón García, Juan María

2007-06-01

The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. There were statistically significant differences in plantar fascia thickness at the four different locations (p<0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1cm proximal to the insertion. At origin and 1cm distal to insertion weight was an independent predictor of plantar fascia thickness. There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1cm proximal to the insertion is influenced by sex and thickness at origin and at 1cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.

The Effectiveness of Low-Dye Taping in Reducing Pain Associated With Plantar Fasciitis.

PubMed

Verbruggen, Laura A; Thompson, Melissa M; Durall, Chris J

2018-01-01

Plantar fasciitis is one of the most common musculoskeletal disorders of the foot. Initial treatment of plantar fasciitis is typically conservative and may include heel padding, steroid injections, night splinting, calf stretching, ultrasound, foot orthoses, and taping. However, while custom foot orthoses are a common treatment method for plantar fasciitis, there is often a waiting period of a few weeks for them to be manufactured and delivered. Therefore, taping of the foot is often used as a temporary treatment to alleviate pain during the initial waiting period. Furthermore, taping may also be used as an alternative to foot orthoses for patients who may not tolerate the plantar pressures of an orthotic or for tight-fitting footwear that may not accommodate insoles. Specifically, the low-Dye taping (LDT) technique is one of the most frequently used methods, and recent literature has suggested that it may improve pain outcomes. Therefore, this critically appraised topic was conducted to determine the extent to which current evidence supports the use of LDT to reduce pain in patients with plantar fasciitis.

Influence of dental occlusion on postural control and plantar pressure distribution.

PubMed

Scharnweber, Benjamin; Adjami, Frederic; Schuster, Gabriele; Kopp, Stefan; Natrup, Jörg; Erbe, Christina; Ohlendorf, Daniela

2017-11-01

The number of studies investigating correlations between the temporomandibular system and body posture, postural control or plantar pressure distribution is continuously increasing. If a connection can be found, it is often of minor influence or for only a single parameter. However, small subject groups are critical. This study was conducted to define correlations between dental parameters, postural control and plantar pressure distribution in healthy males. In this study, 87 male subjects with an average age of 25.23 ± 3.5 years (ranging from 18 to 35 years) were examined. Dental casts of the subjects were analyzed. Postural control and plantar pressure distribution were recorded by a force platform. Possible orthodontic and orthopedic factors of influence were determined by either an anamnesis or a questionnaire. All tests performed were randomized and repeated three times each for intercuspal position (ICP) and blocked occlusion (BO). For a statistical analysis of the results, non-parametric tests (Wilcoxon-Matched-Pairs-Test, Kruskall-Wallis-Test) were used. A revision of the results via Bonferroni-Holm correction was considered. ICP increases body sway in the frontal (p ≤ 0.01) and sagittal planes (p ≤ 0.03) compared to BO, whereas all other 29 correlations were independent of the occlusion position. For both of the ICP or BO cases, Angle-class, midline-displacement, crossbite, or orthodontic therapy were found to have no influence on postural control or plantar pressure distribution (p > 0.05). However, the contact time of the left foot decreased (p ≤ 0.001) while detecting the plantar pressure distribution in each position. Persistent dental parameters have no effect on postural sway. In addition, postural control and plantar pressure distribution have been found to be independent postural criteria.

Quality of life after endoscopic lumbar sympathectomy for primary plantar hyperhidrosis.

PubMed

Rieger, Roman; Pedevilla, Sonja; Lausecker, Johannes

2015-04-01

Primary plantar hyperhidrosis is characterised by excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle. The aim of this prospective study was to assess the effect of endoscopic lumbar sympathectomy (ESL) on the quality of life (QL) of patients with primary plantar hyperhidrosis. Bilateral ESL was performed on 52 patients, 31 men and 21 women with primary plantar hyperhidrosis. Perioperative morbidity and clinical results were evaluated in all patients after a mean follow-up of 15 months. Postoperative QL was examined with the SF-36V2 questionnaire and the hyperhidrosis-specific questionnaires devised by Milanez de Campos and Keller. All procedures were carried out endoscopically with no perioperative morbidity. Plantar hyperhidrosis was eliminated in 50 patients (96%) and two patients (4%) suffered a relapse. Unwanted side effects occurred in the form of compensatory sweating in 34 (65%) and in the form of postsympathectomy neuralgia in 19 patients (37%). Ninety six percentage of patients were satisfied with the postoperative result and 88% would have the surgery repeated. The SF-36V2 questionnaire revealed a significant improvement of QL after lumbar sympathectomy in physical health (physical component summary, p < 0.01) as well as mental health (mental component summary, p < 0.05). Improved QL was also demonstrated in the Milanez de Campos questionnaire in the dimensions functionality/social interactions (p < 0.01), intimacy (p < 0.01), emotionality (p < 0.01) and specific circumstances (p < 0.01) as well as in the Keller questionnaire in the area of plantar hyperhidrosis (p < 0.01). The performance of an ESL in patients with primary plantar hyperhidrosis leads to the effective elimination of excessive sweat secretion of the feet and to an increase in QL.

The influence of athletic activity on the plantar fascia in healthy young adults.

PubMed

Uzel, Murat; Cetinus, Ercan; Ekerbicer, H Cetin; Karaoguz, Ahmet

2006-01-01

Complaints deriving from the plantar fascia are relatively common in athletes. This study aimed to investigate the changes of thickness of plantar fascia via sonography in healthy young adults with different levels of activity. One hundred ten adults with normal body mass index were separated into three groups according to activity level: sedentary (group 1, n = 50), athletic activity less than 7 hours per week (group 2, n = 30), and athletic activity 7 or more hours per week (group 3, n = 30). The thicknesses of the plantar fascia at origin and at a point 5 mm distal to origin were measured via sonography. The mean values of the thickness of the proximal plantar fascia (PFp) and the distal plantar fascia (PFd) in group 1 were similar to those of groups 2 and 3 (p > 0.05). The mean values of PFp and PFd were significantly higher in men than in women (p < 0.05). The mean values of PFp and PFd were similar in left and right feet (p > 0.05). There were moderate positive correlations between PFp and weight, height, and body mass index but no correlation between PFp and amount of athletic activity. The thickness of the plantar fascia at origin did not change with athletic activity at the amateur level. Copyright 2006 Wiley Periodicals, Inc.

Estimation of ultrasound reference values for the lower limb peripheral nerves in adults: A cross-sectional study.

PubMed

Bedewi, Mohamed Abdelmohsen; Abodonya, Ahmed; Kotb, Mamdouh; Kamal, Sanaa; Mahmoud, Gehan; Aldossari, Khaled; Alqabbani, Abdullah; Swify, Sherine

2018-03-01

The objective of this study is to estimate the reference values for the lower limb peripheral nerves in adults.The demographics and physical characteristics of 69 adult healthy volunteers were evaluated and recorded. The estimated reference values and their correlations with the age, weight, height, body mass index (BMI) were evaluated.The cross sectional area reference values were obtained at 5 predetermined sites for 3 important lower limb peripheral nerves. Our CSA values correlated significantly with age, weight, and BMI. The normal reference values for each nerve were as follows: Tibial nerve at the popliteal fossa 19 mm ± 6.9, tibial nerve at the level of the medial malleolus 12.7 mm ± 4.5, common peroneal nerve at the popliteal fossa 9.5 mm ± 4, common peroneal nerve fibular head 8.9 mm ± 3.2, sural nerve 3.5 mm ± 1.4.The reference values for the lower limb peripheral nerves were identified. These values could be used for future management of peripheral nerve disorders.

Arched needle technique for inferior alveolar mandibular nerve block.

PubMed

Chakranarayan, Ashish; Mukherjee, B

2013-03-01

One of the most commonly used local anesthetic techniques in dentistry is the Fischer's technique for the inferior alveolar nerve block. Incidentally this technique also suffers the maximum failure rate of approximately 35-45%. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space by arching and changing the approach angle of the conventional technique and estimated its efficacy. The needle after the initial insertion is arched and inserted in a manner that it approaches the medial surface of the ramus at an angle almost perpendicular to it. The technique was applied to 100 patients for mandibular molar extraction and the anesthetic effects were assessed. A success rate of 98% was obtained.

Recording and labeling at a site along the cochlea shows alignment of medial olivocochlear and auditory nerve tonotopic mappings

PubMed Central

2016-01-01

Medial olivocochlear (MOC) neurons provide an efferent innervation to outer hair cells (OHCs) of the cochlea, but their tonotopic mapping is incompletely known. In the present study of anesthetized guinea pigs, the MOC mapping was investigated using in vivo, extracellular recording, and labeling at a site along the cochlear course of the axons. The MOC axons enter the cochlea at its base and spiral apically, successively turning out to innervate OHCs according to their characteristic frequencies (CFs). Recordings made at a site in the cochlear basal turn yielded a distribution of MOC CFs with an upper limit, or “edge,” due to usually absent higher-CF axons that presumably innervate more basal locations. The CFs at the edge, normalized across preparations, were equal to the CFs of the auditory nerve fibers (ANFs) at the recording sites (near 16 kHz). Corresponding anatomical data from extracellular injections showed spiraling MOC axons giving rise to an edge of labeling at the position of a narrow band of labeled ANFs. Overall, the edges of the MOC CFs and labeling, with their correspondences to ANFs, suggest similar tonotopic mappings of these efferent and afferent fibers, at least in the cochlear basal turn. They also suggest that MOC axons miss much of the position of the more basally located cochlear amplifier appropriate for their CF; instead, the MOC innervation may be optimized for protection from damage by acoustic overstimulation. PMID:26823515

Recording and labeling at a site along the cochlea shows alignment of medial olivocochlear and auditory nerve tonotopic mappings.

PubMed

Brown, M Christian

2016-03-01

Medial olivocochlear (MOC) neurons provide an efferent innervation to outer hair cells (OHCs) of the cochlea, but their tonotopic mapping is incompletely known. In the present study of anesthetized guinea pigs, the MOC mapping was investigated using in vivo, extracellular recording, and labeling at a site along the cochlear course of the axons. The MOC axons enter the cochlea at its base and spiral apically, successively turning out to innervate OHCs according to their characteristic frequencies (CFs). Recordings made at a site in the cochlear basal turn yielded a distribution of MOC CFs with an upper limit, or "edge," due to usually absent higher-CF axons that presumably innervate more basal locations. The CFs at the edge, normalized across preparations, were equal to the CFs of the auditory nerve fibers (ANFs) at the recording sites (near 16 kHz). Corresponding anatomical data from extracellular injections showed spiraling MOC axons giving rise to an edge of labeling at the position of a narrow band of labeled ANFs. Overall, the edges of the MOC CFs and labeling, with their correspondences to ANFs, suggest similar tonotopic mappings of these efferent and afferent fibers, at least in the cochlear basal turn. They also suggest that MOC axons miss much of the position of the more basally located cochlear amplifier appropriate for their CF; instead, the MOC innervation may be optimized for protection from damage by acoustic overstimulation. Copyright © 2016 the American Physiological Society.

Quantitative tissue parameters of Achilles tendon and plantar fascia in healthy subjects using a handheld myotonometer.

PubMed

Orner, Sarah; Kratzer, Wolfgang; Schmidberger, Julian; Grüner, Beate

2018-01-01

The aim of the study was to examine the quantitative tissue properties of the Achilles tendon and plantar fascia using a handheld, non-invasive MyotonPRO device, in order to generate normal values and examine the biomechanical relationship of both structures. Prospective study of a large, healthy sample population. The study sample included 207 healthy subjects (87 males and 120 females) for the Achilles tendon and 176 healthy subjects (73 males and 103 females) for the plantar fascia. For the correlations of the tissue parameters of the Achilles tendon and plantar fascia an intersection of both groups was formed which included 150 healthy subjects (65 males and 85 females). All participants were measured in a prone position. Consecutive measurements of the Achilles tendon and plantar fascia were performed by MyotonPRO device at defined sites. For the left and right Achilles tendons and plantar fasciae all five MyotonPRO parameters (Frequency [Hz], Decrement, Stiffness [N/m], Creep and Relaxation Time [ms]) were calculated of healthy males and females. The correlation of the tissue parameters of the Achilles tendon and plantar fascia showed a significant positive correlation of all parameters on the left as well as on the right side. The MyotonPRO is a feasible device for easy measurement of passive tissue properties of the Achilles tendon and plantar fascia in a clinical setting. The generated normal values of the Achilles tendon and plantar fascia are important for detecting abnormalities in patients with Achilles tendinopathy or plantar fasciitis in the future. Biomechanically, both structures are positively correlated. This may provide new aspects in the diagnostics and therapy of plantar fasciitis and Achilles tendinopathy. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed

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

2017-01-01

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

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

PubMed

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

2017-02-01

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

Investigation of the acute plantar fasciitis with contrast-enhanced ultrasound and shear wave elastography - first results.

PubMed

Putz, Franz Josef; Hautmann, Matthias G; Banas, Miriam C; Jung, Ernst Michael

2017-01-01

The plantar fasciitis is a common disease with a high prevalence in public and a frequent cause of heel pain. In our pilot study, we wanted to characterise the feasibility of shear-wave elastography and contrast-enhanced ultrasound (CEUS) in the assessment of the plantar fasciitis. 23 cases of painful heels were examined by B-Mode ultrasound, Power Doppler (PD), shear wave elastography and contrast-enhanced ultrasound before anti-inflammatory radiation. Time-intensity-curves were analysed by the integrated software. The results for area-under-the-curve (AUC), peak, time-to-peak (TTP) and mean-transit-time (MTT) were compared between the plantar fascia and the surrounding tissue. All cases showed thickening of the plantar fascia, in most cases with interstitial oedema (87.0%). Shear wave elastography showed inhomogeneous stiffness of the plantar fascia. 83.3% of cases showed a visible hyperperfusion in CEUS at the proximal plantar fascia in comparison to the surrounding tissue. This hyperperfusion could also be found in 75.0% of cases with no signs of vascularisation in PD. AUC (p = 0.0005) and peak (p = 0.037) were significantely higher in the plantar fascia than in the surrounding tissue. CEUS and shear wave elastography are new diagnostic tools in the assessment of plantar fasciitis and can provide quantitative parameters for monitoring therapy.

Local anesthetic-induced myotoxicity as a cause of severe trismus after inferior alveolar nerve block.

PubMed

Smolka, Wenko; Knoesel, Thomas; Mueller-Lisse, Ullrich

2018-01-01

A case of a 60-year-old man with severe trismus after inferior alveolar nerve block is presented. MRI scans as well as histologic examination revealed muscle fibrosis and degeneration of the medial part of the left temporal muscle due to myotoxicity of a local anesthetic agent.

Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy?

PubMed

Leis, A Arturo; Smith, Benn E; Kosiorek, Heidi E; Omejec, Gregor; Podnar, Simon

2017-08-01

Recurrent complete ulnar nerve dislocation has been perceived as a risk factor for development of ulnar neuropathy at the elbow (UNE). However, the role of dislocation in the pathogenesis of UNE remains uncertain. We studied 133 patients with complete ulnar nerve dislocation to determine whether this condition is a risk factor for UNE. In all, the nerve was palpated as it rolled over the medial epicondyle during elbow flexion. Of 56 elbows with unilateral dislocation, UNE localized contralaterally in 17 elbows (30.4%) and ipsilaterally in 10 elbows (17.9%). Of 154 elbows with bilateral dislocation, 26 had UNE (16.9%). Complete dislocation decreased the odds of having UNE by 44% (odds ratio = 0.475; P =  0.028), and was associated with less severe UNE (P = 0.045). UNE occurs less frequently and is less severe on the side of complete dislocation. Complete dislocation may have a protective effect on the ulnar nerve. Muscle Nerve 56: 242-246, 2017. © 2016 Wiley Periodicals, Inc.

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.

Ulnar neuropathy and medial elbow pain in women's fastpitch softball pitchers: a report of 6 cases.

PubMed

Smith, Adam M; Butler, Thomas H; Dolan, Michael S

2017-12-01

Elite-level women's fastpitch softball players place substantial biomechanical strains on the elbow that can result in medial elbow pain and ulnar neuropathic symptoms. There is scant literature reporting the expected outcomes of the treatment of these injuries. This study examined the results of treatment in a series of these patients. We identified 6 female softball pitchers (4 high school and 2 collegiate) with medial elbow pain and ulnar neuropathic symptoms. Trials of conservative care failed in all 6, and they underwent surgical treatment with subcutaneous ulnar nerve transposition. These patients were subsequently monitored postoperatively to determine outcome. All 6 female pitchers had early resolution of elbow pain and neuropathic symptoms after surgical treatment. Long-term follow-up demonstrated that 1 patient quit playing softball because of other injuries but no longer reported elbow pain or paresthesias. One player was able to return to pitching at the high school level but had recurrent forearm pain and neuritis 1 year later while playing a different sport and subsequently stopped playing competitive sports. Four patients continued to play at the collegiate level without further symptoms. Medial elbow pain in women's softball pitchers caused by ulnar neuropathy can be treated effectively with subcutaneous ulnar nerve transposition if nonsurgical options fail. Further study is necessary to examine the role of overuse, proper training techniques, and whether pitching limits may be necessary to avoid these injuries. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Sonographic evaluation of the plantar fascia in asymptomatic subjects.

PubMed

Gadalla, N; Kichouh, M; Boulet, C; Machiels, F; De Mey, J; De Maeseneer, M

2014-01-01

To evaluate the appearance of the plantar fascia in asymptomatic subjects. Thirty-one asymptomatic subjects were examined by 2 musculoskeletal radiologists. The plantar fascia was evaluated for thickness, echogenicity, vascularity on power Doppler, rupture, fluid adjacent to the fascia, andcalcifications. The study included 14 men and 17 women (age, 17-79 years; mean, 45 years). The mean thickness of the plantar fascia in men was 3.7 mm (range 2.5-7 mm), and in women 3.5 mm (range, 1.7-5.1 mm). The thickness was greater than 4 mm in 4 men (bilateral in 2). The mean thickness of fascias thicker than 4 mm in men was 5.4 mm (range, 4.3-7 mm). The thickness was greater than 4 mm in 5 women ( bilateral in 4). The mean thickness of fascias thicker than 4 mm in women was 4.7 mm (range, 4.2-5.1 mm). There was no statistically significant difference between men and women and between both heels. Hypoechogenicity was observed in 3 men (bilateral in 2), and in 5 women (bilateral in 6). Hypervascularity, rupture, fluid adjacent to the fascia, and calcifications were not observed. A thickness greater than 4 mm and hypoechogenicity, are common in the plantar fascia of asymptomatic subjects. Findings that were not seen in asymptomatic subjects include a thickness greater than 7 mm, hypervascularity on power Doppler, rupture, fluid adjacent to the fascia, and calcifications.

Plantar-plate disruptions: "the severe turf-toe injury." three cases in contact athletes.

PubMed

Drakos, Mark C; Fiore, Russell; Murphy, Conor; DiGiovanni, Christopher W

2015-05-01

To present 3 cases of plantar-plate rupture and turf-toe injury in contact athletes at 1 university and to discuss appropriate diagnosis and treatment algorithms for each case. Turf toe is a common injury in athletes participating in outdoor cutting sports. However, it has been used as an umbrella term to describe many different injuries of the great toe. In some cases, the injury can be so severe that the plantar plate and sesamoid apparatus may be ruptured. These patients may be better managed with surgery than with traditional nonoperative interventions. Turf toe, plantar-plate disruption, sesamoid fracture. For stable injuries in which the plantar plate is not completely disrupted, nonoperative treatment with casting or a stiff-soled shoe, gradual weight bearing, and rehabilitation is the best practice. Unstable injuries require surgical intervention and plantar-plate repair. Turf toe and injury to the first metatarsophalangeal joint are relatively common injuries in athletes, but few researchers have detailed the operative and nonoperative treatments of plantar-plate disruption in these patients. We examine 3 cases that occurred over 4 seasons on a collegiate football team. Turf toe represents a wide array of pathologic conditions involving the first metatarsophalangeal joint. Stress and instability testing are key components to assess in determining whether surgical intervention is warranted to restore optimal function. Stiffer-soled shoes or shoes with steel-plate insertions may help to prevent these injuries and are useful tools for protection during the rehabilitation period.

Analysis of vestibular testing in patients with vestibular schwannoma based on the nerve of origin, the localization, and the size of the tumor.

PubMed

Suzuki, Mitsuya; Yamada, Chikako; Inoue, Rika; Kashio, Akinori; Saito, Yuki; Nakanishi, Wakako

2008-10-01

We aimed to analyze the factors influencing caloric response and vestibular evoked myogenic potential (VEMP) in vestibular schwannoma. The subjects comprised 130 patients with unilateral vestibular schwannoma pathologically diagnosed by surgery. Caloric response and the amplitude and latency of VEMP were measured and analyzed based on the nerve of origin, localization, and size of the tumor. The tumors were classified into 3 types based on localization: intracanalicular, intermediate, and medial; and into 4 grades based on size: 9 mm or less, 10 to 19 mm, 20 to 29 mm, and 30 mm or greater. : Abnormal rates of caloric response and VEMP in patients with tumors arising from the superior vestibular nerve were not significantly different from those in patients with tumors of the inferior vestibular nerve. In the intermediate and medial type-but not in the intracanalicular type-a significant difference in tumor size was observed between patients with normal caloric response and those with canal paresis as also between patients with normal VEMP and those with abnormal VEMP. In patients with tumors that maximally measured 10 to 19 mm or of the intermediate type, the p- and n-wave latencies of VEMP were significantly prolonged compared with those in the normal opposite ear. 1) The nerve of origin of tumors cannot be predicted based on caloric response and VEMP. 2) In the intermediate and medial types, caloric response and the VEMP amplitude are significantly diminished in association with an increase in tumor size. 3) Prolonged VEMP latencies seem to be not only caused by tumor compression to the brainstem or vestibular spinal tract but also by tumor compression isolated to the inferior vestibular nerve.

Rearfoot eversion has indirect effects on plantar fascia tension by changing the amount of arch collapse.

PubMed

Lee, Sae Yong; Hertel, Jay; Lee, Sung Cheol

2010-01-01

Rearfoot eversion motion and arch height are believed to contribute to increased tension on the plantar fascia and arch collapse during gait but the specifics of these relationships are not clear. To examine the relationships among static arch height, rearfoot eversion, dynamic arch height, and plantar fascia tension. 28 healthy males participated. After static arch height was measured, the subjects were asked to run at 4.5m/s while frontal plane rearfoot motion, dynamic arch height, and ground reaction forces were collected. The relationships among variables were examined with bivariate correlations and path analysis. The results indicated a high correlation between dynamic arch height and static arch height (r=0.642), plantar fascia tension (r=-0.797), and maximum rearfoot eversion motion during gait (r=-0.518). The path analysis model without the direct rearfoot eversion effect explained 81.2% of the variance in plantar fascia tension, while the model with the direct rearfoot eversion effect explained 82.1% of the variance in plantar fascia tension. Including the indirect effect of maximum rearfoot eversion motion on plantar fascia tension through control of dynamic arch height is the model that best explains the interrelationships of these foot characteristics. The amount of maximum rearfoot eversion motion itself is not a good predictor of plantar fascia tension, however, together with the arch height, maximum rearfoot eversion motion is a good predictor because it has a pronounced indirect effect on plantar fascia tension. Copyright 2010. Published by Elsevier Ltd.

Managing the patient with oculomotor nerve palsy.

PubMed

Sadagopan, Karthikeyan A; Wasserman, Barry N

2013-09-01

To provide clinically relevant information regarding the evaluation and current treatment options for oculomotor nerve palsies. We survey recent literature and provide some insights into these studies. Recent case reports highlight emerging new causes of oculomotor cranial nerve palsies, including sellar chordoma, odontogenic abscess, nonaneurysmal subarachnoid hemorrhage, polycythemia, sphenoiditis, neurobrucellosis, interpeduncular fossa lipoma, metastatic pancreatic cancer, leukemia, and lymphoma. Surgical studies have focused on modifications and innovations regarding strabismus surgery for this condition. New globe fixation procedures may include fixation to the medial orbital wall by precaruncular and retrocaruncular approaches, apically based orbital bone periosteal flap fixation and the suture/T-plate anchoring platform system. Management of oculomotor nerve palsy depends in part upon the underlying cause and anatomical location of the lesion. Careful clinical evaluation and appropriate imaging can identify a definitive cause in most cases. Surgical options depend on the number, extent, and severity of the muscles involved as well as the presence or absence of signs of aberrant regeneration. The clinician should also address issues that arise due to involvement of the pupil and accommodation. Strabismus surgery can be challenging but also rewarding with appropriate selection and staging of procedures.

Delayed appearance of hypaesthesia and paralysis after femoral nerve block

PubMed Central

Landgraeber, Stefan; Albrecht, Thomas; Reischuck, Ulrich; von Knoch, Marius

2012-01-01

We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible. PMID:22577509

Effects of hypothermically reduced plantar skin inputs on anticipatory and compensatory balance responses.

PubMed

Germano, Andresa M C; Schmidt, Daniel; Milani, Thomas L

2016-06-29

Anticipatory and compensatory balance responses are used by the central nervous system (CNS) to preserve balance, hence they significantly contribute to the understanding of physiological mechanisms of postural control. It is well established that various sensory systems contribute to the regulation of balance. However, it is still unclear which role each individual sensory system (e.g. plantar mechanoreceptors) plays in balance regulation. This becomes also evident in various patient populations, for instance in diabetics with reduced plantar sensitivity. To investigate these sensory mechanisms, approaches like hypothermia to deliberately reduce plantar afferent input have been applied. But there are some limitations regarding hypothermic procedures in previous studies: Not only plantar aspects of the feet might be affected and maintaining the hypothermic effect during data collection. Therefore, the aim of the present study was to induce a permanent and controlled plantar hypothermia and to examine its effects on anticipatory and compensatory balance responses. We hypothesized deteriorations in anticipatory and compensatory balance responses as increased center of pressure excursions (COP) and electromyographic activity (EMG) in response to the hypothermic plantar procedure. 52 healthy and young subjects (23.6 ± 3.0 years) performed balance tests (unexpected perturbations). Subjects' foot soles were exposed to three temperatures while standing upright: 25, 12 and 0 °C. COP and EMG were analyzed during two intervals of anticipatory and one interval of compensatory balance responses (intervals 0, 1 and 2, respectively). Similar plantar temperatures confirmed the successful implementation of the thermal platform. No significant COP and EMG differences were found for the anticipatory responses (intervals 0 and 1) under the hyperthermia procedure. Parameters in interval 2 showed generally decreased values in response to cooling. No changes in anticipatory

Comparison of plantar pressure distribution between three different shoes and three common movements in futsal.

PubMed

Teymouri, Meghdad; Halabchi, Farzin; Mirshahi, Maryam; Mansournia, Mohammad Ali; Mousavi Ahranjani, Ali; Sadeghi, Amir

2017-01-01

Analysis of in-shoe pressure distribution during sport-specific movements may provide a clue to improve shoe design and prevent injuries. This study compared the mean and the peak pressures over the whole foot and ten separate areas of the foot, wearing different shoes during specific movements. Nine male adult recreational futsal players performed three trials of three sport-specific movements (shuffle, sprint and penalty kick), while they were wearing three brands of futsal shoes (Adidas, Lotto and Tiger). Plantar pressures on dominant feet were collected using the F-SCAN system. Peak and mean pressures for whole foot and each separate area were extracted. For statistical analysis, the mean differences in outcome variables between different shoes and movements were estimated using random-effects regression model using STATA ver.10. In the average calculation of the three movements, the peak pressure on the whole foot in Adidas shoe was less than Lotto [8.8% (CI95%: 4.1-13.6%)] and Tiger shoes [11.8% (CI95%:7-16.7%)], (P<0.001). Also, the recorded peak pressure on the whole foot in penalty kick was 61.1% (CI95%: 56.3-65.9%) and 57.6% (CI95%: 52.8-62.3%) less than Shuffle and Sprint tests, respectively (P<0.001). Areas with the highest peak pressure during all 3 movements were not different between all shoes. This area was medial forefoot in cases of shuffle and sprint movements and medial heel in case of penalty kick.

Comparison of plantar pressure distribution between three different shoes and three common movements in futsal

PubMed Central