Retalho plantar medial para reconstrução de defeitos em calcanhar após ressecção de melanoma lentiginoso acral: Uma série de 7 casos / Medial plantar flap for reconstruction of heel defects after resection of acral lentiginous melanoma: A series of seven cases

Introdução: A reconstrução da região plantar ainda é um dos grandes desafios da cirurgia plástica reconstrutiva. Os tecidos dessa região apresentam características únicas e que são essenciais para a manutenção da funcionalidade do membro. De toda a região plantar, a região do calcanhar é a área de maior sustentação do peso e submetida ao maior impacto. O retalho fasciocutâneo plantar medial é uma das opções reconstrutivas, pois representa tecido semelhante e mantém a sensibilidade para a área receptora. Método: Foi realizado um estudo retrospectivo através da coleta de dados de prontuário de pacientes que realizaram reconstruções da região do calcanhar com retalho plantar medial, no período de julho de 2013 a setembro de 2019. O estudo foi aprovado pelo Comitê de Ética para Análise de Projetos de Pesquisa do HCFMUSP (Número CAAE: 56849422.0.0000.0068). Resultados: A reconstrução de calcanhar após ressecção de melanoma lentiginoso acral foi realizada em 7 pacientes. Complicações cirúrgicas foram observadas em 3 pacientes, sendo que todos eles tinham idade acima de 50 anos e/ou alguma comorbidade associada. Houve 57,1% de complicações, sendo 37,5% relacionadas ao retalho e 12,5% relacionadas à área doadora. Ocorreram 3 necroses totais de retalho (42,9%) e 1 perda total de enxerto na área doadora (14,3%). Conclusão: O retalho plantar medial se apresenta como uma boa alternativa para a realização de reconstruções oncológicas de defeitos na região plantar do pé. Contudo, deve-se ponderar a escolha do paciente ideal e lembrar que a dissecção do seu pedículo vascular não é de fácil execução.

Introduction: Resurfacing the sole is still one of the great challenges of reconstructive plastic surgery. The tissues on the sole of the foot have unique characteristics essential for maintaining the limbs functionality. The heel has the most significant weight support and is subjected to the entire soles greatest impact. The medial plantar artery flap is one of the reconstructive options, as it represents similar tissue and maintains sensitivity to the recipient area. Methods: A retrospective study was performed by collecting data from medical records of patients who underwent reconstructions of the heel with a medial plantar artery flap from July 2013 to September 2019. The study was approved by the Ethics Committee for Analysis of Research Projects of HCFMUSP (CAAE number: 56849422.0.0000.0068). Results: Heel reconstruction was performed in 7 patients after acral lentiginous melanoma excision. Surgical complications were observed in 3 patients, all of whom were aged over 50 years or have associated comorbidity. There were 57.1% of complications, 37.5% related to the flap, and 12.5% related to the donor area. There were three total flap necroses (42.9%) and one total graft loss in the donor area (14.3%). Conclusion: The medial plantar flap presents itself as a good alternative for performing oncological reconstructions of defects in the plantar region of the foot. However, the choice of the ideal patient should be considered and we must remember that the dissection of its vascular pedicle is not easily executed.

O desempenho e as respostas fisiológicas ao teste de elevação do calcanhar bipodal são influenciados pela cadência e posição dos tornozelos / Bilateral heel-rise test performance and physiological response are influenced by cadence and ankle position

INTRODUÇÃO: Diferentes protocolos do teste de elevação do calcanhar (TEC) têm sido utilizados, sendo necessário analisar o impacto das variações nas respostas do teste. OBJETIVO: Comparar o desempenho e respostas de oxigenação muscular (OM) e frequência cardíaca (FC) de adultos em diferentes protocolos do TEC bipodal. MATERIAIS E MÉTODOS: Este foi um estudo transversal do tipo cruzado. Trinta participantes (23,1±2,9 anos; 16 homens) realizaram quatro protocolos do TEC bipodal, variando cadenciamento (autocadenciado e cadenciado externamente) e posição dos tornozelos (neutra e dorsiflexão). Para a OM, analisamos a saturação tecidual de oxigênio (StO2 ) e variação da concentração de oxihemoglobina (∆[O2 Hb]) e calculamos a variação entre os menores valores e os valores finais (∆Nadir-Final) e área sob a curva (AUC). Para a FC, calculamos a variação dos valores iniciais e finais (∆FC) e constante de tempo (τ). O teste de Friedman foi utilizado para comparar as variáveis entre os protocolos. A ANOVA de dois fatores foi utilizada para identificar o impacto da cadência e/ou posição dos tornozelos. RESULTADOS: O número de repetições e o tempo de execução foram maiores nos protocolos em posição neutra e cadenciado externamente (p<0,001 para ambos). ∆Nadir-Final (StO2: p<0,001; ∆[O2Hb]: p=0,005) e AUC (StO2: p<0,001; ∆[O2Hb]: p<0,001) dea mbas as variáveis de OM foram maiores nos protocolos em posição neutra. Protocolos autocadenciados apresentaram maior aumento da FC e τ mais rápida (p=0,006 e p=0,046). CONCLUSÃO: O TEC realizado em posição neutra e cadenciamento externo gera maiores repetições e tempo de execução. A dorsiflexão promoveu menor reperfusão muscular e o autocadenciamento, maior e mais rápido aumento da FC.

INTRODUCTION: Different heel-rise test (HRT) protocols have been used, possibly leading to varied responses. It is necessary to analyse the impact of protocol variation on test responses. PURPOSE: To compare the performance, muscle oxygenation (MO), and heart rate (HR) responses of adults in bilateral HRT protocols. METHODS: This was a cross-sectional crossover study. Thirty participants (23.1±2.9 years; 16 men) performed four bilateral HRT protocols with varying cadence (self-cadenced; externally cadenced) and ankle position (neutral; dorsiflexion). For MO responses, we analysed tissue oxygen saturation (StO2) and oxyhemoglobin concentration variation (∆[O2Hb]) and calculated the variation between the smallest and final values (∆Nadir-Final) and the area under the curve (AUC). The variation between the initial and final HR values (∆HR) and the time constant (τ) were calculated. Friedman's test was used to compare the variables among the protocols. Two-way ANOVA was used to identify the impact of cadence and/or ankle position. RESULTS: The number of repetitions and execution time were higher in the neutral position and externally cadenced protocols (p<0.001 for both). ∆Nadir-Final (StO2: p<0.001;∆[O2Hb]: p=0.005) and AUC (StO2: p<0.001; ∆[O2Hb]: p<0.001) of both MO variables were higher in the neutral position protocols. Selfcadenced protocols presented higher HR increase and faster τ (p=0.006 and p=0.046). CONCLUSION: Bilateral HRT performed in a neutral position, and external cadence promotes more repetitions and a longer execution time. Dorsiflexion promotes lower muscle reperfusion, and self-cadence higher and faster HR increase.

The relationship between age-related incidences of heel spur with sex and side / Relación entre la incidencia del espolón calcáneo con la edad, sexo y lado

SUMMARY: Heel spur is an osteophytic protrusion larger than 2 mm that lies just anterior to the tuberosity of the calcaneus. Heel spur can be of two types: plantar heel spur and dorsal heel spur. The aim of this study was to evaluate the relationship between the heel spurs incidence with age, sex and side. A total of 2000 bilateral radiographs of 1000 patients (518 men and 482 women) aged 20-93 years who applied to Terme state hospital, Samsun, Turkey due to trauma were examined. Patients were grouped into 10 year age ranges (20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years and over 70 years). The incidences of plantar heel spur, dorsal heel spur, and both were evaluated according to age, sex and side relations. Plantar or dorsal heel spurs were detected in 32.6 % (326 patients) of the patients. The incidences of plantar heel spur, dorsal heel spur, plantar and dorsal heel spur were 26.0 %, 16.9 %, and 10.3 % respectively. According to sex, the incidence of plantar heel spur was higher in women in all age groups. Although the incidence of dorsal heel spur was higher in men in the 6th decade, it was more common in women in other age groups. The incidence of plantar heel spur was 2.615 times higher in the right foot and 2.810 times higher in the left foot in women. As the age increased, the risk of plantar heel spur increased 1.060 times in the right foot and 1.061 times in the left foot. The incidence of dorsal heel spur was 1.510 times higher in the right foot and 1.715 times higher in the left foot in women. As the age increased, the incidence of dorsal heel spur increased in both feet and this increase was 1.055 times in both feet.

RESUMEN: El espolón calcáneo es una protuberancia osteofítica de más de 2 mm que se encuentra por delante de la tuberosidad del calcáneo. El espolón calcáneo puede ser de dos tipos: espolón calcáneo plantar y espolón calcáneo dorsal. El objetivo de este estudio fue evaluar la relación entre la incidencia de espolón calcáneo con la edad, el sexo y el lado. Se examinaron un total de 2000 radiografías bilaterales de 1000 pacientes (518 hombres y 482 mujeres) de 20 a 93 años de edad que fueron solicitadas en el hospital estatal de Terme, Samsun, Turquía debido a un traumatismo. Los pacientes se agruparon en rangos de edad de 10 años (20-29 años; 30-39 años; 40-49 años; 50-59 años; 60-69 años y mayores de 70 años). Las incidencias de espolón calcáneo plantar, espolón calcáneo dorsal y ambos se evaluaron de acuerdo con la edad, el sexo y lados. Se detectaron espolones calcáneos plantares o dorsales en el 32,6 % (326 pacientes) de los pacientes. Las incidencias de espolón calcáneo plantar, espolón calcáneo dorsal, espolón calcáneo plantar y dorsal fueron del 26 %, 16,9 % y 10,3 %, respectivamente. Según el sexo, la incidencia de espolón calcáneo plantar fue mayor en mujeres en todos los grupos de edad. Aunque la incidencia del espolón calcáneo dorsal fue mayor en hombres en la sexta década, era más común en mujeres en otros grupos de edad. La incidencia de espolón calcáneo plantar fue 2,6 veces mayor en el pie derecho y 2,8 veces mayor en el pie izquierdo en mujeres. A medida que aumentaba la edad, el riesgo de espolón calcáneo plantar aumentaba 1,06 veces en el pie derecho y 1,061 veces en el pie izquierdo. La incidencia de espolón calcáneo dorsal fue 1,510 veces mayor en el pie derecho y 1,715 veces mayor en el pie izquierdo en mujeres. A medida que aumentaba la edad, la incidencia de espolón calcáneo dorsal aumentaba en ambos pies y este aumento era de 1,055 veces en ambos pies.

Computer assisted design of lobulated perforator flap based on descending branch of lateral circumflex femoral artery in reconstruction of heel defects / 中华显微外科杂志

Objective:To investigate the feasibility and clinical effect of the computer assisted design of the lobulated perforator flap based on the descending branch of lateral circumflex femoral artery(d-LCFA) to reconstruct the soft tissue defects of heel.Methods:From October 2014 to November 2016, a computer assisted virtual technology was used to simulate the process of pre-operative design, isolation, and harvest of d-LCFA perforating flaps. This method was used to guide the design and harvest of the flap of d-LCFA in the repair of large-area soft tissue defects of the heel in all of the 5 patients. One patient received a combine flap of the d-LCFA flap and the perforating branch of the inferior abdominal artery flap(DIEPF). Heel appearance and function were reconstructed in phase I together with the repair of the defect. Donor site was directly sutured. The recovery effect was followed-up in the clinic.Results:The 3D visualised model of the vessels in the donor area for quadriceps artery was successfully established in all 5 patients, and the design and removal of the perforating flap were successfully guided. All the 10 flaps survived successfully in 5 patients, except 1 patient had a backflow disorder at the distal end of the inferior epigastric artery perforator flap, with partial necrosis and II grafting. After 6 to 12 months of follow-up(mean, 8.7 months), the flap showed good in colour and texture, with satisfactory heel appearance. The donor site was left with a linear scar.Conclusion:Computer assisted design technology can effectively help in the design of the polyfoliate perforator flap pedicled with d-LCFA, using this technique to assist the design and repair of large area soft tissue defect of heel could reconstruct the shape of heel in phase I and restore the function of the heel to the maximum extent.

Morphometric analysis of calcaneal (heel) spurs in ancient and modern Anatolian populations / Análisis morfométrico de los espolones calcáneos en poblaciones de Anatolia antiguas y modernas

SUMMARY: Heel spurs are the bony protrusion seen especially on the dorsal and plantar face of the calcaneus bone at the attachment site of the muscles. It was aimed herein to obtain data about the life styles, daily lives, and especially the socioeconomic structures of modern and ancient Anatolian populations by evaluating the prevalence, location, age, and gender differences of heel spurs on the calcaneus and comparing these findings between the populations. Herein, the 251 calcaneus bones of 137 skeletons, which had been previously analyzed paleodemographically and dated to the Middle Ages, and 68 calcaneus bones belonging to a modern population, whose gender was unknown but lived in Anatolia, were examined in terms of heel spurs. In the current study, the presence of dorsal, plantar, or both dorsal/plantar heel spurs on these in 251 calcaneus bones was 43.9 %, 11.1 %, and 10.3 %, respectively. The presence of dorsal, plantar, or both dorsal/plantar heel spurs was determined as 22 %, 3 %, and 1.5 %, respectively, among the 68 calcaneus bones belonging to the modern population. When a comparison was made of the current study with studies in the literature on modern and prehistoric populations, a higher prevalence of heel spurs was found in prehistoric samples than in modern populations. It is our belief that this situation may have derived from the heavy labor force, environmental, or sociocultural differences in ancient Anatolian populations, insufficiency of vital materials due to inadequate industrial conditions, and the solution of anatomical disruption. In addition, the findings determined herein will guide the development of future and industrial studies on the foot and foot structure.

RESUMEN: Los espolones del talón son la protuberancia ósea que se ve especialmente en la cara dorsal y plantar del hueso calcáneo en el sitio de inserción de los músculos. El objetivo de este trabajo consistió en obtener datos sobre los estilos de vida, la vida cotidiana y, especialmente, las características socioeconómicas de las poblaciones anatolias modernas y antiguas mediante la evaluación de la prevalencia, la ubicación, la edad y las diferencias de sexo de los espolones calcáneos y comparar estos hallazgos entre los poblaciones. La muestra consistió en 251 calcáneos correspondientes a 137 esqueletos, que habían sido previamente analizados paleodemográficamente y fechados en la Edad Media; también se incluyeron 68 calcáneos pertenecientes a una población moderna de Anatolia, sin distinción de sexo. De la muestra de 251 calcáneos, se encontraron espolones calcáneos dorsales, plantares y dorsales/plantares, en el 43,9%, 11,1 % y 10,3 %, respectivamente. La presencia de espolones calcáneos dorsales, plantares y dorsales/plantares se determinó en el 22%, 3% y 1,5%, respectivamente, entre los 68 calcáneos pertenecientes a la población moderna. Cuando se realizó una comparación del estudio actual con la literatu- ra sobre poblaciones modernas y prehistóricas, se encontró una mayor prevalencia de espolones calcáneos en muestras prehistóricas que en poblaciones modernas. Creemos que esta situación puede haberse derivado a la gran fuerza de trabajo, y las diferencias ambientales o socioculturales en las antiguas poblaciones de Anatolia, la insuficiencia de materiales vitales debido a las condiciones industriales inadecuadas produjo la alteración anatómica. Además, los hallazgos aquí determinados guiarán el desarrollo de estudios futuros e industriales sobre la estructura del pie.

A clinical study on reconstruction of small and medium sized defects of tendo Achilles and heel regions with fascio cutaneous flaps

Background: Soft tissue defects of tendo Achillis and heel regions are difficult to reconstruct because of less vascularity and limited mobility of the skin. Most of these defects result from trauma, infection and excision of malignancy. Well vascularized tissues with sensation are needed to cover these defects as these regions are more prone for repeated friction and weight bearing. Aim was to study the versatility and applications of various flaps in the reconstruction of soft tissue defects of tendo Achillis and heel regionsMethods: This retrospective study was conducted in the Department of Plastic and Reconstructive Surgery, Thanjavur Medical College, Tamil Nadu, India from 2015-2019. About 22 patients with soft tissue defects of tendo Achillis and heel regions were studied. The aetiology of the defect, size of the defect and the outcome of treatment with various flaps were evaluated.Results: Of the 22 patients 20 patients were males and 2 patients were females. The age group ranged from 12 years to 68 years. Most of the defects were due to road traffic accidents. The soft tissue defects were classified into small, medium and large sized defects based on the area of the defects. Reverse sural artery flap extended lateral calcaneal artery flap, posterior tibial artery perforator flap and lateral supra malleolar flap were the various flaps used to cover these defects.Conclusions: Fascio cutaneous flaps play a major role in the reconstruction of tendo Achillis exposed defects and heel defects. Long term follow-up with physiotherapy is essential to achieve excellent function of tendo Achillis.

Cord blood spot thyroid stimulating hormone for screening of congenital hypothyroidism

Background: Congenital hypothyroidism is one of the most common causes of mental retardation in pediatric age group. Screening for congenital hypothyroidism is one of most cost effective tools to prevent mental retardation among the general population. Umblical cord TSH estimation remains an easily available option for screening of congenital hypothyroidism. Aims and objectives was to estimate correlation between TSH obtained from cord blood TSH and heel prick TSH at 3rd day of life using blood spot. To estimate the predictability to rule out congenital hypothyroidism using cord blood spot TSH and to determine whether cord blood TSH can be advocated to screen congenital hypothyroidism.Methods: Prospective study conducted in department of Neonatology, IOG, Egmore after obtaining consent from parents. The study was carried out in two phases. First phase, to establish correlation between cord blood spot TSH and heel prick TSH and to establish median cutoff point of TSH .Second phase, to establish cord blood spot TSH as screening method.Results: The birth weights ranged between 2.5 to 4.3 kg. TSH values ranged from 2.0-33.3mlU/L. The mean value was 16.45mlU/L. A cutoff value of 20mlU/L was used for recall testing of complete thyroid profile (T3, T4 and TSH). Thirty six infants were recalled for repeating complete thyroid profile.Conclusions: Congenital hypothyroidism (CH) is the one of the most common preventable causes of mental retardation which can be detected by measuring cord blood TSH .Cord blood TSH can be advocated in national public health program as a routine so that all babies can be tested before discharge thereby minimising interventions for the baby.

Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap / 中国修复重建外科杂志

Objective: To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap. Methods: Between March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained. Results: The origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements ( P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%. Conclusion: The digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.

Dolor plantar calcáneo. Experiencias y opciones de tratamiento / Calcaneal plantar pain. Experiences and treatment options

La talalgia se define como la percepción de dolor localizado en el talón que anatómicamente corresponde al hueso calcáneo y a las partes blandas colaterales, constituye la causa más frecuente de consulta a los especialistas en pie y tobillo, identificando dos zonas de aparición del dolor, el dolor plantar y el dolor posterior, los que están directamente relacionados con la inervación de esa zona del pie, realizamos un análisis general para evaluar las opciones iniciales de tratamiento y las indicaciones fisioterapéuticas exponiendo nuestra opinión y experiencias(AU)

Talalgia is defined as the perception of localized pain in the heel that anatomically corresponds to the calcaneus bone and collateral soft tissue, is the most frequent cause of consultation with foot and ankle specialists, identifying two areas of pain appearance, pain plantar and subsequent pain, which are directly related to the innervation of that area of the foot, we perform a general analysis to evaluate the initial treatment options and physiotherapeutic indications exposing our opinion and experiences(AU)

Comparison of lcp and intramedullary nail osteosynthesis in calcaneal fractures / Comparação entre placa de osteossíntese e haste intramedular em fratura do calcâneo

ABSTRACT Objective: This study compared groups of patients with calcaneal fractures of Sanders types II and III. One group was treated with ORIF using an LCP (plate), while the second was treated with a minimally invasive method using a C-Nail. Methods: The study included 217 patients in the ORIF group and 19 patients in the minimally invasive nail osteosynthesis group. Results: In the LCP group, the outcomes were excellent for 35.7% of the patients; good, 38.9%; satisfactory, 19.7%; and poor, 5.7%. In the C-Nail group, the outcomes were excellent for 36.9% of the patients; good; 31.6%; satisfactory, 21%; and poor, 10.2%. The mean values of the restoration of Böhler's angle from post-injury were 6.8° to 32.3° in the LCP group and 7.1° to 33.3° in the C-Nail group. After 12 months, there was only a minimal decrease in Böhler's angle to 29.2° in both the LCP and C-Nail groups. Conclusion: The outcomes obtained with C-Nail fixation are statistically identical to those obtained with LCP fixation. We conclude that osteosynthesis with a C-Nail is suitable as the first-choice treatment for Sanders types II and III fractures. Level of evidence IV, retrospective observational study.

RESUMO Objetivo: Comparar grupos de pacientes com fratura intra-articular do calcâneo tipos II e III de Sanders. Métodos: Estudo retrospectivo que incluiu 217 pacientes no grupo tratado por redução aberta e fixação interna com placa de compressão (Grupo PC) e 19 pacientes que seguiram um método minimamente invasivo com C-Nail. Resultados: No Grupo PC, os resultados foram excelentes em 35,7%, bons em 38,9%, satisfatórios em 19,17% e ruins em 5,7%. Os resultados registados no grupo que recebeu implante de unha foram excelentes em 36,9%, bons em 31,6%, satisfatórios em 21% e ruins em 10,2% Os valores médios do restauro do ângulo de Böhler desde o pós-ferimento variaram entre 6,8° e 32,3°, no Grupo PC, e entre 7,1° e 33,3°, no grupo tratado com C-Nail. Ao fim de 12 meses, apenas se observou redução mínima do ângulo de Böhler para 29,2° nos dois grupos. Conclusão: Os resultados do método recentemente introduzido de osteossíntese minimamente invasiva com C-Nail são estatisticamente idênticos aos obtidos pela redução aberta e fixação interna com placa de compressão. Assim, o novo tipo de osteossíntese com C-Nail é adequado como primeira escolha em fraturas do tipo Sanders II e III. Nível de evidência IV, Estudo retrospectivo de observação.

Assessment Of Plantar Fasciitis Among Adults Having Higher Body Mass Index And Glucose Intolerance In A Medical Institute Of Raipur

Introduction: Plantar fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin on the calcaneus. PF is reported to be the most common cause of inferior heel pain in diabetic and non diabetic patient population. Calcaneal spurs (CS) have commonly been implicated as a risk factor for PF. To this purpose we have evaluated the frequency of Calcaneal spur (CS) in obese patients with Type-2 diabetes. Method: Study was designed as a cross sectional Analytical study . Male and female study subjects who were Obese (BMI ≥30 kg/m2), Having Diagnosed type 2 diabetes & above the age of 18 years, with a history of plantar heel tenderness and/or pain were included in the study Information was analysed by using the Microsoft Excel and SPSS . Chi square test was used for analysis. Results:Atotal of 65 obese diabetic patients were included into the study. The mean age of the patients was 54±5.8 years. There were 25 males and 40 females. The median duration of diabetes was 4.2 years (1-10 years). The mean HbA1c was 8.4±0.9. 78% were having plantar fasciitis. Conclusion: Poor diabetes control Peripheral Neuropathy seems to be the main reasons Existence seems to be in a relationship with diabetic complications; therefore, obese diabetic patients may be more prone to these complications. Therefore, weight reduction should be encouraged in these patients

A Cross-Sectional Study Determining Pain in Lower Back and Calf Muscles among Females Due to High Heel Shoe Wear

To determine pain in lower back and calf muscles among females due to high heels shoe wear. Methodology: A sample size of 87 females working women and students were recruited on the basis of the purposive sampling technique. Participants were requested to wear 5 cm stiletto high heels and they were asked to walk on treadmill at the pace of 4km/hr for 20 minutes. Modified McGill Questionnaire for pain measurement was used as a tool before and after test data collection. Results: In this study observation of muscular pain was significant in lower limb and lower back muscles due to high heels i.e. 29.6% and 24.7% respectively. Conclusion: Back and lower limbs musculature pain contribute only 8.6% whereas, only back pain had been observed in 9.9%. Paired sample t-test was used to determine pain before and after test was significant with p-value 0.000.

A Morphometric Correlational Study Of Placenta And Umbilical Cord With Fetus

Background: The placenta is a dynamic organ to maintain the fetal homeostasis by performing a wide range ofphysiological functions. It undergoes various changes in terms of shape, size, surface area and structure duringpregnancy to support growth of the fetus. The efficiency in transfer of nutrients and oxygen through the placentais the primary determinant of birth weight.Detailed study of placenta gives a wide scope of knowledge on fetalgrowth. This study has attempted to find the correlation between umbilical cord length with birthweight and fetallength along with the correlation between other placental parameters and fetal parameters.Materials and methods: The placentas required for this study were collected from the labor room. After thoroughinspection of the placenta, shape and presence of any anomalies were noted and then the size of the placenta,which includes weight, thickness and diameter were measured. The length of the umbilical cord was measuredwith a tape calibrated in centimeters from cut end to placental end and also from cut end to fetal end. Summationof these two values gave the total length of the umbilical cord. The fetal parameters like birth weight wasmeasured by using a digital weighing machine, while the crown-heel length was measured with the help of aninfantometer.Results: 35% of placentas are round shape and 65% are of oval shape. Mean ± SD of placenta weight is 458±49.5gm,umbilical cord length is 56.2 ± 3.2cm, birth weight is 2.4 ± 0.4kg and crown-heel length is 45.8 ± 4.2cm.Conclusion: A significant relation was found between placenta size and birth weight. A non-significant relationwas found between umbilical cord length and birth weight along with umbilical cord length and crown heellength.

A Case of Tender Calcinosis Cutis of an Infant Following a Single Heel Stick / 대한피부과학회지

No abstract available.

Repair of soft tissue defect around posterior calcaneal region combined with Achilles tendon defect by the thin-layer free anterolateral thigh flap with iliotibial band / 中华显微外科杂志

Objective To investigate the clinical effect of thin-layer free anterolateral thigh flap with iliotibial tract for reconstruction of heel soft tissue and Achilles tendon defect.Methods From January,2017 to December,2017,11 cases of heel soft tissue and Achilles tendon defect were repaired by thin-layer free anterolateral thigh flap with iliotibial tract.There were 5 cases with tibia/fibula fracture,3 cases with ankle fracture and 1 case with calcaneal fracture.The area of soft tissue defect was 6.5 cm×10.0 cm-8.0 cm×13.0 cm,and the length of Achilles tendon defect was 5.5-11.5 cm.All wounds were treated with debridement and negative pressure sealing drainage technique at first stage.After 6 days,the soft tissue defect around posterior calcaneal region combined with Achilles tendon defect were repaired by the thin-layer free anterolateral thigh flap with iliotibial tract.Reasonable rehabilitation training was established after operation.Results The flaps survived in 11 cases and the donor region healed in one stage.The patients were followed-up for 8 to 20 (mean,15.74) months by outpatient review,calling or WeChat.Slightly bloated in appearance in 2 cases,and were thinned by orthopedic operation 1 year later.The other flaps were well shaped and moderately thick.At the last follow-up,the flaps were soft in texture and elastic.The sensory recovery of the flap was good,and the two-point discriminant perception in the posterior region of the heel was 3.0-5.0(mean,4.11) mm.Thompson's sign was negative,double or one-foot heel lift test was negative,and there was no recurrence of Achilles tendon rupture or skin ulceration in the heel region.The range of motion (ROM) of affected side was (23.1 1±1.17)°of extension and (43.67±1.06)°of flexion,and the ROM of normal side was (23.79±1.03)°of extension and (44.03±0.94)°of flexion.There was no statistical difference between them (P＞0.05).Postoperative follow-up was conducted according to the Thermann's function evaluation system,the evaluated result was excellent in 8 cases,good in 2 cases,and receivability in 1 case.Conclusion It is a reliable and effective method to repair heel soft tissue and Achilles tendon defect by thin-layer free anterolateral thigh flap with iliotibial tract.And this method can better restore foot ankle shape and function.

Repair of lateral calcaneal wound with the lateral supramalleolar flap pedicled with the end perforator of peroneal artery / 中华显微外科杂志

To explore the method and effect of repairing the soft tissue defect of the lateral heel with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery. Methods From May, 2015 to February, 2018, 16 cases of lateral calcaneal soft tissue defect were repaired with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery.All wounds were treated with one-stage dilata-tion and VSD to control infection. In cases of chronic calcaneal bone infection, the bone defect formed after extensive resection of infected bone was temporarily filled with antibiotic bone cement. The area of soft tissue defect on the lat-eral heel was 3.0 cm×2.0 cm-8.0 cm×5.0 cm, and the area of flaps was 3.5 cm×2.5 cm-8.5 cm×5.5 cm. The small donor area of the flap was sutured directly, and the larger area was repaired by skin grafting. Patients with chronic calcaneal bone infection underwent bone cement removal and autogenous bone transplantation after inducing mem-brane formation 6 to 8 weeks after flap transplantation. All cases were followed-up, including 7 cases outpatient fol-low-up and 9 telephone follow-up. Results All the 16 flaps survived smoothly. The donor and recipient areas of the flaps healed primarily. All cases were followed-up for 3 to 13 months. The flaps had good shape, no swelling, similar color to heel skin and no pigmentation.Ankle flexion and extension were not restricted.Four cases with chron-ic osteomyelitis of calcaneus healed well after second-stage bone grafting, with an average healing time of 8.5 months. Conclusion The retrograde lateral supramalleolar flap with the end perforator of peroneal artery is an ideal method for repairing the soft tissue defect on the lateral heel with simple operation and reliable blood supply.

Using the posterior tibial artery and peroneal artery perforator flaps to repair heel wounds: 18 cases report / 中华显微外科杂志

To investigate the clinical efficacy of using the posterior tibial artery and peroneal artery perforator flaps to repair the heel wounds. Methods From January, 2011 to May, 2018, heel soft tissue de-fect caused by trauma in 18 cases were treated by posterior tibial artery and peroneal artery perforator flaps respec-tively. The posterior tibial artery perforator flap was used in 11 cases, and the peroneal artery perforator flap was used in 7 cases. The area of flaps ranged from 5.0 cm×3.0 cm to 11.0 cm×9.0 cm. The length of the vascular pedicle was from 10.0 cm to 16.0 cm.After operation, the patients were followed-up regularly.The time of wound healing, appear-ance and texture of the flap, and function of ankle joint were observed. Results After the operation, 13 flaps sur-vived uneventfully. The wound achieved primary healing. Partial necrosis occurred in the distal of posterior tibial artery perforator flap in 2 cases, and repaired by skin graft 1 or 2 months later.Marginal necrosis occurred in posterior tibial artery perforator flap in 2 cases and in peroneal artery perforator flap in 1 case. And scar healing occurred in these 3 cases finally.All the 18 patients were followed-up for 3 to 60 months, with an average of 10 months. Fracture healing time was from 3-6 months, with an average of 4 months. Flap was soft with satisfied appearance in 16 cases. Obvious scar formation occurred in 2 cases. There was no obvious scar contracture in donor sites. There was no obvi-ous limitation of the flexion and extension function of the ankle joint in 18 cases. According to the American Or-thopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, there was excellent in 16 cases, and good in 2 cases. Conclusion As for the characteristics of the heel wound, it is a simple and practical method to use leg perforator flap to repair.The flap is based on a long vascular pedicle.And the clinical effect is satisfied.

Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

Clinical effects of heel lateral flap in repair of skin and soft tissue defects at posterior heel region / 中华烧伤杂志

Objective@#To explore the clinical effects of heel lateral flap in repair of skin and soft tissue defects at posterior heel region.@*Methods@#From September 2007 to April 2016, 24 patients (17 males and 7 females, aged 16-70 years) with skin and soft tissue defects at posterior heel region were admitted to our department. The size of skin and soft tissue defects after debridement ranged from 3.0 cm×2.0 cm to 5.0 cm×4.0 cm. The defects were repaired with heel lateral flaps, with size ranging from 3.5 cm×2.5 cm to 6.0 cm×5.0 cm. The flaps were transferred to the donor sites through the loose subcutaneous tunnel. The donor site was repaired by full-thickness skin graft collected from inguinal region. The survival of flaps and the follow-up of patients were observed.@*Results@#All flaps of 24 patients survived successfully. The recipient sites and donor sites were all healed. The patients all had follow-up of 6 to 24 months. At the last follow-up, the flaps were in good shape, with nearly normal color and soft texture. There were 6 cases of grade S3 sensation and 16 cases of grade S3+ sensation. The distance of two-point discrimination of flaps ranged from 6 to 11 mm. The lateral foot skin grafts healed well, and the skin of the lateral foot was numb in the range of 4.0 cm×2.0 cm to 9.0 cm×3.0 cm.@*Conclusions@#Heel lateral flap can not only repair the skin and soft tissue defects in the posterior region, but also reconstruct the sensory function of the posterior region. It is an ideal method to repair the skin and soft tissue defects in the posterior region.

A Subcalcaneal Bursitis Developed after Execessive Walking Exercise

Plantar heel pain is a common clinical problem in foot and ankle clinics. Typically, several conditions such as plantar fasciitis, fat pad atrophy, and calcaneal fracture may lead to plantar heel pain. However, subcalcaneal bursitis occurred between plantar fascia and plantar fat pad has rarely been described as a cause of plantar heel pain. To our knowledge, subcalcaneal bursitis has been reported only once, but there was no mention of preceding factors. We firstly present a case of subcalcaneal bursitis occurred after excessive walking exercise known as “Nordic walking” and successfully managed with conservative treatments that relieve impact on plantar heel.