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 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.

Analysis of characteristics of acupuncture diagnosis and treatment based on literature / 国际中医中药杂志

Objective To explore the characteristics of diagnosis and treatment of acupuncture and moxibustion for heel pain.Methods We searched the literatures related to heel pain treated by acupuncture and moxibustion in CNKI,WFPD,VIE CBM,PubMed and Embase,then summarized the intervene measures related to acupuncture and moxibustion,clinical characteristics of syndrome differentiation and acupuncture points selection method,frequency,treatment course,treatment effect,follow-up outcomes and safety.Results A total of 47 articles are included in the acupuncture treatment of heel pain commonly used measures like small needling knife,acupuncture,acupoint injection,electro-acupuncture,fire needling,warm needling and moxibustion.The percentage of article involved in treating heel pain by small needling knife was 55.32％ (26/47) and 21.28％ (10/47) by acupuncture.The percentage of articles involved in acupuncture points selection method by differentiation of disease was 93.62％ (44/47).The main acupuncture points in the 47 articles was ashi acpoint (68.09％,32/47).The therapy frequency and treatment courses varied from the differences of the acupuncture and moxibustion methods.For small needling knife,the percentage of treating frequency of one time was 36.17％ (17/47) and evaluating the curative effect after one treatment was 40.43％ (19/47).For acupuncture,the percentage of treating frequency of once a day was 17.02％ (8/47) and 23.40％ (ll/47).The effective rate showed a lot of variation from 69.56％-100％ vary by intervene measures.The follow-up rate was not high,only 27.66％ (13/47).There was only one literature referring to the adverse reaction.Conclusions The literatures review showed that the small needling knife was the most frequent method,followed by acupuncture.Acupuncture points selection by disease differentiation is the common method.The main acupuncture points applied in heel pain is ashi acupoint.Evaluating the effect after one treatment was common used for small needling knife.Once a day and ten times a therapy course were the common treatment frequency and treatment course for the remaining intervene measures.Acupuncture and moxibustion could show immediate and probable long-term positive effect for heel pain without no severe adverse reactions.

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.

Plantar Fascitis: A Concise Review

plantar fasciitis is not uncommon condition affecting Indian population and chief complaint is heel pain while walking.it is estimated that 10-15% population requires medical treatment. Recurrence is also very common despite of treatment. This article includes etiology,knowledge of mechanism,diagnosis,current available treatmen

Biomechanical Study of Personalized Buffer Insoles for Heel Pain / 医用生物力学

Objective To study the effect from personalized insoles with different structural heel pads on plantar stress concentration of patients with heel pain. Methods Base on statistics and finite element analysis method, the finite element model of foot and personalized insoles for patient with heel pain were established. The effects from different insoles on stress of soft tissues and plantar fascia were simulated. Results The internal stress of plantar soft tissues was higher than that of plantar epidermis, and the stress of the third plantar fascia was the highest. During barefoot standing, the internal peak stress of plantar soft tissues was 1.34 times of plantar epidermis, and the stress of the third plantar fascia was 1.50 MPa. The result of orthogonal experiment showed that the optimized insole model could reduce the internal peak stress of plantar soft tissues by 51%, meanwhile relieve the stress of the third plantar fascia by 11.3%. Conclusions The optimum scheme of personalized buffer insole is the design of vertical ellipse and honeycomb groove. Such structure can assist the absorption or buffering of concussion from calcaneal fat pad, and relieve the plantar stress concentration and tension of the plantar fascia. This study is helpful to understand plantar stress distributions of patients with heel pain, which is of great significance to the study of pathology and prevention of heel pain.

The Mechanism of Occurrence and Rehabilitation of Heel Pain Based on Finite Element Method / 医用生物力学

Objective To investigate the mechanism of occurrence and rehabilitation of heel pain, so as to provide a theoretical basis for the effectiveness of heel pain treatment. Methods The CT and MRI data acquired from feet and knees of patients with heel pain were reconstructed to establish the bone-muscle composite finite element model. Based on the established model, the effect of calf muscle contracture on biomechanical properties of the foot and ankle was simulated by using the finite element method . Results When the calf muscles produce upward lifting power, plantar pressure was transferred from the heel area to the forefoot area, and there was no significant difference in pressure distribution by different combination schemes of muscle forces. The strain of the plantar fascia was increased, with stress concentration on the calcaneus surface. Under 240 N force, the peak stress at the Achilles tendon attachment position and the calcaneus nodules was up to 10.82 MPa and 11.2 MPa, respectively. Conclusions The stress concentration in calf muscles and Achilles led to the changes in biomechanics of the ankle, which resulted in heel pain. The method of improving the overall biomechanical environment by releasing concentrated stress to restore the position of the bones and joints of the ankle joint is the mechanism for rehabilitation of heel pain.

Biomechanical analysis of plantar pressure of heel pain based on 3D knee-ankle-foot finite element model / 医用生物力学

Objective To investigate the effects of insole parameter changes on biomechanical mechanism of heel pain by finite element methods.Methods The 3D finite element model of foot,crus bones,gastrocnemius muscle and knee joint was reconstructed based on CT images.The plantar pressure distribution and peak pressure were calculated by changing the shape,thickness and hardness of the insole.Results The distribution of plantar pressure calculated by the finite element model was generally consistent with that measured by the pressure plate,and the values were very close.Compared with the barefoot standing,the peak pressure of the heel was decreased by 20.5％,59.2％ and 38.4％,and that of the metatarsal head was decreased by 9.9％,18.1％ and 46.7％,with flat insole,half-contact insole and full-contact insole,respectively.For patients with heel pain,the pressure peak of the heel and the metatarsal head at plantar surface decreased with the conventional thickness of insole increasing and the hardness of insole decreasing.Conclusions The changes in insole parameters have a significant influence on the plantar pressure distribution.Finite element analysis can contribute to discovering the etiology and pathology of heel pain,so as to provide the theoretical basis for clinical treatment.

Arthroscopic debridement combined with microfracture for chronic enthesiopathy of achilles tendon / 中华骨科杂志

Objective To evaluate the efficacy of arthroscopic debridement combined with microfracture on management of chronic enthesiopathy of Achilles tendon.Methods Fifteen cases of chronic enthesiopathy of Achilles tendon were enrolled in this study from January 2013 to January 2016.There were 11 males and 4 females,with an average age of 55.5±8.9 years.Five were in left side,and 10 in right side.All the patients failed to recover after conservative treatments for 18 months to 10 years.Pathological tissue was eliminated by blade.Then microfracture was made.Arthroscopic awls (1.5 or 2 mm in diameter) were used for making multiple holes at the footprint of achilles tendon.These holes were made far enough (3-4 mm) apart so they do not break into each other.Fat droplets and bleeding from the marrow cavity were seen when the appropriate depth (approximately 5 to 10 mm) has been reached.The patients were evaluated preoperatively and postoperatively using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and visual analogue scale (VAS) scores.Results Average operation time and length of stay were 30.6± 15.4 min and 6.2±2.8 d,respectively.Postoperative incisions were Ⅰ stage healing for all patients.There were no perioperative and postoperative complications related to the procedure,such as rupture of achilles tendon,blood vessel and nerve injury.No infection and recurrence was found in all cases.All patients were followed up for an average time of 13.5 months.No rupture of achilles tendon or relapsing symptom was found.Average VAS scores before surgery,6 month after surgery and at the lattest follow-up were 7.3± 1.6,2.4± 1.3,and 2.3± 1.3,respectively.Average AOFAS Ankle-Hindfoot scores were 38.5± 7.8,92.9±6.9,and 91.6±7.1,respectively.Average postoperative VAS scores and AOFAS Ankle-Hindfoot scores were significantly improved compared with those before surgery.There was no statistically significant difference among all check point after operation in VAS scores and AOFAS Ankle-Hindfoot scores.At the latest follow-up,all patients were satisfied with the degree of painful relief.According to AOFAS Ankle-Hindfoot scores,overall excellent and good rate was 93.3％ (excellent in 10 cases,good in 4 cases,and fair in 1 case).Conclusion Clinical results of arthroscopic debridement combined with microfracture for treatment of chronic enthesiopathy of Achilles tendon are good.This technique is easy and safe to perform.

Biomechanical analysis of plantar pressure of heel pain based on 3D knee-ankle-foot finite element model / 医用生物力学

Objective To investigate the effects of insole parameter changes on biomechanical mechanism of heel pain by finite element methods. Methods The 3D finite element model of foot, crus bones, gastrocnemius muscle and knee joint was reconstructed based on CT images. The plantar pressure distribution and peak pressure were calculated by changing the shape, thickness and hardness of the insole. Results The distribution of plantar pressure calculated by the finite element model was generally consistent with that measured by the pressure plate, and the values were very close. Compared with the barefoot standing, the peak pressure of the heel was decreased by 20.5%, 59.2% and 38.4%, and that of the metatarsal head was decreased by 9.9%, 18.1% and 46.7%, with flat insole, half-contact insole and full-contact insole, respectively. For patients with heel pain, the pressure peak of the heel and the metatarsal head at plantar surface decreased with the conventional thickness of insole increasing and the hardness of insole decreasing. Conclusions The changes in insole parameters have a significant influence on the plantar pressure distribution. Finite element analysis can contribute to discovering the etiology and pathology of heel pain, so as to provide the theoretical basis for clinical treatment.

Does Painful Heels in Ankylosing Spondylitis Demonstrate Distinctive Features on Plain Radiographs: A Study of 104 Cases

OBJECTIVE: To investigate simple radiographic findings on painful heels in ankylosing spondylitis (AS). Heel radiography in most studies was from AS patients' non-painful heel. METHODS: Seventy AS patients (34 bilateral cases) with heel pain at the time digital radiographs were taken were studied. Standing lateral views (104 radiographs) of the heel were reviewed. Associations between radiologic abnormalities and disease duration and among various abnormal findings were analyzed. RESULTS: Ninety-six (93.4%) had radiographic abnormalities (82.7% in soft tissues/61.5% in bone). Abnormalities of bone only were observed in 9.6%, of the soft tissues only in 30.8%, and of both were 51.9%. These included Kager's triangle's blurring (77.9%), posterior soft tissue swellings near the Achilles tendon insertion (65.4%), obliterations of the retrocalcaneal recess (65.4%), erosions of the superior pole of the posterior calcaneus (31.7%), subplantar irregular spurs (20.2%), posterior traction spurs (16.3%), subplantar erosions (14.4%) and cortical thickenings of the inferior calcaneal body (5.8%). There was a significant association between swelling in the posterior soft tissue and obliteration of the retrocalcaneal recess (p<0.001). CONCLUSION: Digital radiography in AS is useful for observing not only bony lesions but also soft tissue abnormalities of the heel, particularly of the posterior heel. For assessing the symptomatic enthesitis of the Achilles, this simple and quick diagnostic tool is valuable when examining for soft tissues' alterations of the posterior heel.

Effects of gastrocnemius muscle force on foot biomechanics based on the finite element analysis / 医用生物力学

Objective To investigate the effects of gastrocnemius muscle forces on biomechanical mechanism of heel pain. Methods The finite element model of the foot including foot bone, soft tissues, ligaments and plantar fascia was reconstructed based foot CT images by Mimics software. The gastrocnemius force applied on the foot was 40%-90% of half-body weight（320 N） with increment of 5% of half-body weight（16 N）. The plantar surface pressure distribution and peak pressure as well as the plantar fascia stress were calculated. Results The plantar surface pressure distribution was mainly concentrated on the heel and metatarsal head. With the increase of gastrocnemius force, the peak plantar pressure at the heel decreased, while the peak pressure at the front of the foot decreased at first and then increased, which reached the minimum value with the load of 224 N. The plantar fascia stress increased with the gastrocnemius force increasing. Conclusions Gastrocnemius force applied on the foot has a significant influence on the plantar pressure distribution. Finite element analysis can contribute to understanding etiology and pathology of foot diseases, predicting the biomechanical results of the treatment and provide theoretical reference for treatments.

The Diagnosis and Treatment of Plantar Fasciitis / 대한족부족관절학회지

Plantar fasciitis is the most common cause of heel pain. The diagnosis of plantar fasciitis is primarily based on the presentation of symptoms and physical examination. Patients usually complain of heel pain at the medial calcaneal tubercle when taking their first step in the morning or when walking after resting. Diagnostic imaging is rarely required for the initial diagnosis of plantar fasciitis; however, it can be used for differential diagnosis. Conservative treatments, such as stretching, rest, ice massage, oral analgesics, foot orthotics, use of night splint, and corticosteroid injection, may be effective. The majority of patients report improvement with conservative treatments, and those who show no response from conservative treatments for a duration of six months or longer can consider extracorporeal shock wave therapy or surgery.

Plantar fasciitis - an update.

Plantar fasciitis is one of the most common causes of inferior heel pain managed by many physical therapists in variety of clinical settings and wildly treated conservatively. It is usually caused by a biomechanical imbalance resulting in tension along the plantar fascia. It is estimated that 11% to 15% of all foot complaints requiring medical attention can be attributed to this condition. The patient typically presents with inferior heel pain on weight bearing. Pain associated with plantar fasciitis may be throbbing, searing, or piercing, especially with the first few steps in the morning or after periods of inactivity. This article present on overview of the current knowledge on plantar fasciitis and focuses on biomechanics, etiology, diagnosis and treatment strategies, conservative treatment including the physical therapy management are discussed. This information should assist health care practitioners who treat patients with this disorder.

Observations on the Efficacy of Warm Needling plus Chinese Herb Fumigation in Treating Plantar Fasciitis / 上海针灸杂志

ObjectiveTo investigate the clinicalefficacy of warm needling plus Chinese herb fumigation in treating plantar fasciitis.MethodSixty-one patients with plantar fasciitis were randomly allocated to a treatment group of 31 cases and a control group of 30 cases. The treatment group receivedwarm needling plus Chinese herb fumigation and the control group, warm needling alone.ResultThe total efficacy rate and the cure rate were 100.0% and 61.3%, respectively, in the treatment group and 96.7%and 40.0%, respectively, in the control group. There was no statistically significant difference in the total efficacy rate between the two groups (P>0.05), but the cure rate was significantly higher in the treatment group than in the control group and there was a statistically significant difference between the two groups (P<0.05). There was a statistically significant pre-/post-treatment difference in the VAS score in the two groups (P<0.01), indicating that both the groups had a good analgesic effect. There was a statistically significant post-treatment difference in the VAS score between the treatment and control groups (P<0.01), indicating that theanalgesic effect was better in the treatment group than in the control group.ConclusionThe efficacy of warm needling plus Chinese herb fumigation is better than that of warm needling alone in treating plantar fasciitis.

The effectiveness of corticosteroid injection in the treatment of plantar fasciitis

Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

Plantar fasciitis: corticosteroid injection versus chiropractic therapy.

The diagnosis of plantar fasciitis is usually clinical and rarely needs to be investigated further. The patient complains of pain in the medial side of the heel, most noticeable with initial steps after a period of inactivity and usually lessens with increasing level of activity during the day, but will tend to worsen toward the end of the day. Symptoms may become worse following prolonged weight bearing, and often precipitated by increase in weight bearing activities. Paresthesia is uncommon. It is usually unilateral, but up to 30% of cases have a bilateral presentation. In our study patients who received chiropractic therapy were treated by rest, heat, ice pack, non-steroidal anti-inflammatory drugs (NSAIDS), heel pads, magnetic insole, night splints, walking cast, taping, ultrasound, plantar and Achilles stretching for a period of 6 weeks scheduled accordingly. Patients receiving corticosteroid injection were administered 80mg methyl prednisolone locally at the heel. Each patient received 3 doses of methyl prednisolone injections on 1st day, 2nd week, and 4th week. The results with corticosteroid injection were better when analyzed with numeric rating scale over a period of 6 weeks.

Clinical Observation of Chinese Herbal Fumigation plus Mulberry Stick Beating for Heel Pain / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of Chinese herbal fumigation plus beating with mulberry stick in treating heel pain. Methods: Sixty patients with heel pain were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by Chinese herbal fumigation plus beating with mulberry stick, and the control group was by orally taking Diclofenac Sodium Sustained Release Tablets plus external use of She Xiang Zhen Tong Gao (Moschus Analgesic Plaster). After one treatment course, the visual analogue scale (VAS) was used to observe the change of pain, and the clinical efficacies were also evaluated. Results: After intervention, the improvement of VAS score in the treatment group was more significant than that in the control group (P Conclusion:Chinese herbal fumigation plus beating with mulberry stick can produce a higher clinical efficacy than orally taking Diclofenac Sodium Sustained Release Tablets in treating heel pain.

Immediate Clinical and Biomechanical Effects of Low-dye Taping in Patients with Plantar Heel Pain / 대한스포츠의학회지

Plantar heel pain is common musculoskeletal disorder of the foot related to sports activity. Treatment of the plantar heel pain is usually conservative including low-dye (LD) taping. We evaluated the immediate clinical and biomechanical effect of LD taping. 19 patients who had plantar heel pain with fat pad tenderness or tenderness on plantar fascia insertion area participated in this study. We assessed plantar pressure change with foot pressure analysis system, fat pad depth changes with ultrasonography, pain improvement with visual analogue scale before and after LD taping. Patient treated with LD taping showed the decrease in maximum peak pressure and pressure time integral, and there was not a significant difference between pre and post maximal velocity, average velocity, distance of center of pressure. Fat pad depth increase (mean 1.67 mm, p<0.05) and pain improvement (mean 1.91 on visual analog scale, p<0.05). LD taping restrict midtarsal joint, correct hindfoot pronation, and provide fat pad depth increase and pain improvement, immediately.

Clinical Characteristics of the Causes of Plantar Heel Pain

OBJECTIVE: The objectives of this study were to investigate the causes of plantar heel pain and find differences in the clinical features of plantar fasciitis (PF) and fat pad atrophy (FPA), which are common causes of plantar heel pain, for use in differential diagnosis. METHOD: This retrospective study analyzed the medical records of 250 patients with plantar heel pain at the Foot Clinic of Rehabilitation Medicine at Bundang Jesaeng General Hospital from January to September, 2008. RESULTS: The subjects used in this study were 114 men and 136 women patients with a mean age of 43.8 years and mean heel pain duration of 13.3 months. Causes of plantar heel pain were PF (53.2%), FPA (14.8%), pes cavus (10.4%), PF with FPA (9.2%), pes planus (4.8%), plantar fibromatosis (4.4%), plantar fascia rupture (1.6%), neuropathy (0.8%), and small shoe syndrome (0.8%). PF and FPA were most frequently diagnosed. First-step pain in the morning, and tenderness on medial calcaneal tuberosity correlated with PF. FPA mainly involved bilateral pain, pain at night, and pain that was aggravated by standing. Heel cord tightness was the most common biomechanical abnormality of the foot. Heel spur was frequently seen in X-rays of patients with PF. CONCLUSION: Plantar heel pain can be provoked by PF, FPA, and other causes. Patients with PF or FPA typically show different characteristics in clinical features. Plantar heel pain requires differential diagnosis for appropriate treatment.