Clinics in diagnostic imaging (170)

A 30-year-old woman presented with a six-month history of left posterior heel pain. Physical examination revealed a tender, inflamed and indurated posterior heel with a visible bony prominence of the posterosuperior aspect of the calcaneus. Lateral ankle radiography showed a prominent left posterosuperior calcaneal tuberosity and thickening of the distal Achilles tendon outline. Magnetic resonance imaging demonstrated high-signal inflammatory fluid in the retrocalcaneal bursa, increased signal intensity and thickening of the Achilles tendon, and prominence of the posterior calcaneus tuberosity with reactive marrow oedema. The findings are consistent with Haglund's deformity. The patient underwent hind foot surgery after failing a six-month course of conservative therapy. There was no further recurrence of symptoms after surgery. The clinical and radiological features of Haglund's deformity are described, including a short discussion of other causes of hind foot pain.

Topography of human ankle joint: focused on posterior tibial artery and tibial nerve / 대한해부학회지

Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain.

Formulated Composite Insoles Reduce Foot Pain and Fatigue and Increase Working Efficiency in Healthcare Workers: A Pilot Non-controlled Experimental Study.

Aim: The aim was to evaluate self-assessed foot health status and working efficiency of healthcare workers when using composite insoles to treat foot problems. Introduction: Foot pain and fatigue are two of the most common problems facing healthcare workers owing to many hours of walking and standing per day. Many choices of conservative treatment are available such as the use of insoles and orthotic support. Commercially prefabricated insoles are one of the most widely used treatments for foot pain and fatigue as they are easily accessible at reasonable prices. However, there is limited evidence supporting the effectiveness of these treatments. Methodology: Test subjects included 49 volunteers from Tung Song Hospital screened by an orthopedist and physical therapist to meet predetermined criteria. Data collected included demographic data, validated foot function score of a Foot Health Status Questionnaire (FHSQ), and a synthetic working efficiency score generated using the Thai Questionnaire of Working Efficiency for Healthcare workers. A self-evaluation form was designed to record the efficacy of using Smile feet™ insoles before and after one month of treatment. Statistical analysis was performed using the Wilcoxon signed rank test. Results: Responses to the Foot Heath Status Questionnaire showed a statistically significant change in several foot health metrics (p-value < 0.01) after using the composite insoles for 1 month: Improvement greater than the minimal important difference was achieved by 75.5% in foot pain, 44.9% in foot function, 89.8% in foot wear, and a 57.1% in general foot health. Respondents to the Thai Working Efficiency questionnaire reported improvement in sections of working, reducing muscle soreness and fatigue in 30 of the 49 volunteers (61.2%). Among those that experienced improvement, [self-reported] work productivity increased by 73%. Conclusion: Healthcare workers reported improvements after using a commercially available composite insole in all criteria on a self assessment questionnaire, including muscle soreness, working efficiency, work productivity, fatigue, foot pain, foot function, foot wear, and general foot health. Level of Evidence: Level IV, therapeutic case series.

Symptomatic Hallucal Interphalangeal Sesamoid Bones Successfully Treated with Ultrasound-guided Injection: A Case Report

The hallucal interphalangeal sesamoid bone is usually asymptomatic, but it is not uncommon for it to be symptomatic in cases of undue pressure, overuse, or trauma. Even in symptomatic cases, however, patients often suffer for extended periods due to misdiagnosis, resulting in depression and anxiety that can steadily worsen to the extent that symptoms are sometimes mistaken for a somatoform disorder. Dynamic ultrasound-guided evaluations can be an effective means of detecting symptomatic sesamoid bones, and a simple injection of a small dose of local anesthetics mixed with steroids is an easily performed and effective treatment option in cases, for example, of tenosynovitis.

Painful Os Peroneum Syndrome Presenting as Lateral Plantar Foot Pain

Lateral plantar foot pain can be caused by various entities, and the painful os peroneum syndrome should be considered in the differential diagnosis. Recent developments in musculoskeletal ultrasonography are very useful for initial diagnosis. We discuss a 69-year-old female who experienced lateral plantar foot pain for over one month. Through physical examination, radiography, ultrasound and magnetic resonance imaging, she was diagnosed with the painful os peroneum syndrome with a chronic fatigue fracture of multipartite os peroneum and peroneus longus tenosynovitis, for which she underwent surgery. We herein report this rare condition and reviewed the relevant literature.

A pilot study: Efficacy of simple customized shoe-insert to decrease abnormal plantar pressure in patients with plantar foot pain.

Objective: To evaluate the efficacy of a simple customized shoe-insert in decreasing abnormal plantar pressure and in changing the pain score in patients with chronic plantar foot pain Methods: Ten patients with chronic plantar foot pain were initially recruited from the outpatient unit of the Department of Rehabilitation Medicine, Siriraj Hospital. The simple customized shoe-inserts were fabricated from 2 layers of EVA foam. Some pieces of foam were attached to the specific locations between the two layers by using the subjects’ foot pressure graph as blueprint. The plantar pressures were measured during walking by digital foot scanning (FootscanTM insole system), with and without the customized shoe-inserts in. The average pain scores were altogether reported by the patients in terms of a visual analog scale. The same measurements were repeated again with the shoe-inserts in after 2 weeks of use. Results: Nine participants (3 males, 6 females) were evaluated completely. The diagnoses were plantar fasciitis (all 9 subjects) and matatarsalgia (3 of the 9 subjects). Immediately after applying the shoe-inserts, foot pressures were significantly decreased (p = 0.011) when walking. However after 2 weeks, the pressures were no longer significantly reduced (p = 0.859, p = 0.173) compared to the baseline before fitting. Also, for the pain score change, most subjects initially reported pain relieved (7 in 9 subjects), but the second visit showed no significant difference (p = 0.081) compared to the first day before using. Conclusion: The simple customized shoe-inserts could potentially decrease average plantar pressure as well as the average pain score in most cases. However the pain score reductions were not significantly different after 2 weeks of the device applications. Future investigations with an appropriate sample size are required to precisely conclude the efficacy of the shoe-inserts.

Ageing feet and plantar arch characteristics of the Thai elderly

Background: Ageing feet may lead to painful deformity and disability. There are different patterns of degenerative changes among each population. Objectives: To determine the prevalence, characteristics, and related factors of ageing foot disorders in healthy Thai older persons. Methods: A cross-section analytic study was done at the Faculty of Medicine, Chulalongkorn University, during September 2006 – August 2007. Healthy volunteers aged between 60-80 years old were recruited from urban areas of Bangkok. Medical status, musculoskeletal foot problems, plantar arch, and footwear used were assessed. Footprints were taken from standing, weight bearing position, and calculated for Staheli arch index. Factors for the foot disorders were analyzed. Results: There were 108 men and 105 women with a mean age = 68.7±5.4 years, mean body mass index (BMI) = 24.6±3.4 kg/m². Foot deformities were 87% (hallux valgus 45.5%, mallet toe 45%, hammer toe 25%, and claw toe 21.5%). Hallux valgus was more severe in women, having arch index value increasing with the severity. No other demographic or biomechanical variables including footwear types were found associated with foot deformities. More than 85% of the subjects had foot callus related to deformities and tight shoes. Thirty subjects (14%) had foot pain (1/5 of women, 1/20 of men). The pain resulted from plantar fasciitis, hallux valgus, callus, metatarsalgia, and improper footwear. Subjects with plantar fasciitis had higher BMI and higher arch index. Pes planus were more common in women (42% vs. 32%). Only 9% had pes cavus, all of when were men. The Staheli arch index showed good reliability in discriminating the plantar arch types. Conclusions: Ageing feet caused problems, mostly in women. Hallux valgus related to pes planus. Plantar fasciitis associated with overweight and pes planus.

Radiologic Study of Calcaneonavicular Coalition / 实用放射学杂志

Objective To study the incidence and radiologic findings of calcaneonavicular coalition.Methods CR films of foot andankle in 1361 cases were presented,which were evaluated for acute trauma or chronic pain.There were 588 cases of foot CR and 773 cases of ankle CR,age ranged from 10 years to 91 years(984 cases of 20~40 years).The prevalence of calcaneonavicular coalition was determined and the different significance of both male and female,acute trauma and chronic pain group were analysed.Results In 1361 cases,72 cases of calcaneonavicular coalition(5.3%) were demonstrated,8.7%(47/588)on foot CR films and 3.2%(25/773) on ankle CR films.Calcaneonavicular coalition was more dipicted on foot CR films than on ankle CR films(P0.05).Conclusion The foot CR films is more superexcellent than the ankle CR films on demonstrating calcaneonavicular coalition.

Radiologic Study of Talocalcaneal Coalition / 实用放射学杂志

20 years)was 8.60%(48/558) , which was more than that in the second decade of life ( 5.22% ). The incidence of painful group was 9.79%(14/143),which was more than that in foot trauma group 6.78%(40/630).The positive C sign was presented in 61.1%(33/54),posterior-type coalition in 38.9%(21/54),short talar neck sign in 61.1%(33/54)and talar beak sign in 22.2%(12/54). Conclusion The talocalcaneal coalition is a common development abnormality in our country. We must pay attention to the diagnosis of talocalcaneal coalition for painful foot adulthood.