Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain / 中国骨伤

OBJECTIVE@#To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain.@*METHODS@#The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability.@*RESULTS@#The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05).@*CONCLUSION@#Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

Investigation of the relationship between foot deformities and radiographic measurements of the talus and calcaneus / Investigación de la relación entre las deformidades del pie y las mediciones radiográficas del talo y del calcáneo

SUMMARY: The weight of the body is transmitted to the foot through the subtalar joint and talus. Considering the important location of the talus and calcaneus, the morphological structures of these bones may affect the biomechanics of the subtalar joint. At the same time, the morphological structure of these bones is important in some common foot deformities. We aimed to investigate whether the various measurements of the talus and calcaneus are associated with different foot deformities in this study. In this study, radiography images of 158 (72 male and 86 female) patients within the mean age of 44 years were retrospectively examined. Eleven different measurements of the talus and calcaneus were obtained from the lateral and antero-posterior radiographs of the patients. A total of 158 patient's routine clinic radiographs were retrospectively assessed, which have calcaneal spur (n=63), hallux valgus (n=32) and control group (n=63). We determined that the body height of the calcaneus, maximum width of the head of the talus, minimum anterior width of the calcaneus were significantly different between calcaneal spur group and control group. Maximum length fibular malleolar facet of the talus was significantly different between age groups. And we determined that the calcaneal index was significantly different between hallux valgus group and control groups. Also all measurements were significantly different between males and females. As a result, some measurements that significantly determine the morphology of the talus and calcaneus were found to be significant between deformity groups and control groups. We think that our study will contribute to the literature as it is the first study in which the measurements obtained from the radiographic images of the talus and calcaneus are associated with foot deformities.

El peso del cuerpo se transmite al pie a través de la articulación subtalar y el talo. Teniendo en cuenta la importante ubicación del talo y el calcáneo, las estructuras morfológicas de estos huesos pueden afectar la biomecánica de la articulación subtalar. Al mismo tiempo, la estructura morfológica de estos huesos es importante en algunas deformidades comunes del pie. Nuestro objetivo fue investigar si las diversas medidas del talo y el calcáneo están asociadas con diferentes deformidades del pie en este estudio. Se examinaron retrospectivamente imágenes radiográficas de 158 pacientes (72 hombres y 86 mujeres) con una edad promedio de 44 años. Se obtuvieron once medidas diferentes del talo y el calcáneo a partir de las radiografías lateral y anteroposterior de los pacientes. Se evaluaron retrospectivamente un total de 158 radiografías clínicas de rutina de los pacientes, los cuales tenían espolón de calcáneo (n=63), hallux valgus (n=32) y grupo control (n=63). Determinamos que la altura del cuerpo del calcáneo, el ancho máximo de la cabeza del talo, el ancho anterior mínimo del calcáneo fueron significativamente diferentes entre el grupo con espolón calcáneo y el grupo control. La longitud máxima de la faceta maleolar fíbular del talo era significativamente diferente entre los grupos de edad. También determinamos que el índice calcáneo fue significativamente diferente entre el grupo de hallux valgus y los grupos controles. Además, todas las medidas fueron significativamente diferentes entre hombres y mujeres. Como resultado, algunas medidas que determinan la morfología del talo y el calcáneo resultaron significativas entre los grupos de deformidad y los grupos controles. Estimamos que nuestro estudio contribuirá a la literatura debido a que es el primer reporte en el que las medidas obtenidas de las imágenes radiográficas del talo y el calcáneo se asocian con deformidades del pie.

Prevalencia y biometría del espolón calcáneo en la población chilena: estudio radiológico / Prevalence and biometry of the calcaneal spur in the Chilean population: radiological study

RESUMEN: El dolor en la región calcánea del pie afecta aproximadamente a un tercio de los adultos mayores de 65 años. Asimismo, una gran cantidad de sujetos que consultan por esta condición, revelan hallazgos radiológicos de un crecimiento anormal en el hueso calcáneo, en su cara plantar, en forma de gancho denominado espolón calcáneo (EC). El objetivo del presente estudio fue relacionar la prevalencia y biometría de los EC en individuos chilenos según sexo y edad. Se realizó un estudio radiológico de tipo descriptivo-correlacional donde se revisaron al azar 400 radiografías de pies en proyección lateral de 200 sujetos chilenos entre 15 y 90 años. El análisis de los 200 exámenes radiográficos mostró que en 135 (67,5 %) de ellos presentaban EC de manera unilateral o bilateral. La presencia de al menos un EC era mayor en las mujeres 104 (52 %) que en los hombres 31 (15,5 %). Sin embargo, esta diferencia no es estadísticamente significativa p= 0,621. La edad promedio de los sujetos que presentaron EC era de 60,4 años, ampliamente superior a quien no lo presentaba (43,5 años), siendo esta diferencia estadísticamente significativa P<0,05. Se puede concluir una prevalencia del 67,5 % de EC en la población de estudio, mayor en las mujeres y directamente relacionada con la edad. Esta información podría ser de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.

SUMMARY: Pain in the talar region of the foot affects approximately one third of people over 65 years of age. Likewise, a large number of patients who consult for this condition reveal radiological findings of an abnormal growth of the hook-shaped calcaneus called a calcaneal spur (CS). The objective of the present study was to relate the prevalence and biometrics of CS in Chilean individuals according to sex and age. A descriptive-correlational radiological study was carried out where 400 lateral projection radiographs of the feet of 200 Chilean patients between 15 and 90 years of age were randomly reviewed. The analysis of the 200 people examined showed that 135 (67.5%) presented CS unilaterally or bilaterally. The presence of at least one CS is greater in the female sex 104 (52%) than in the male sex 31 (15.5%), however, this difference is not statistically significant p = 0.621. The average age of the people who presented CS is 60.43 years, much higher than those who do not present (43.51 years), this difference being statistically significant P = Sig. It can be concluded a prevalence of 67.5% of CS in the study population, higher in the female sex and directly related to age. This information will be of great morphological and medical value due to the little existing literature on this matter in Chilean individuals.

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.

Utilidad de la Ozonoterapia en el tratamiento de la enfermedad de Sever / Effectiveness of ozone therapy in the treatment of Sever's disease

Introducción: la enfermedad de Sever es causa frecuente de talalgia en niños. Objetivo: evaluar la utilidad de la Ozonoterapia en el tratamiento de la enfermedad de Sever en niños de 7-18 años atendidos en el Hospital Provincial Pediátrico Docente "Pepe Portilla" de Pinar del Río, de julio 2017 a julio 2018. Métodos: se ha realizado investigación descriptiva longitudinal y prospectiva, a 46 niños, que asistieron a consulta de Medicina Natural y Tradicional con enfermedad de Sever recidivante. Se les aplicó Ozono terapéutico, por la vía rectal, mediante el equipo OZOMED mini. En el procesamiento se utilizaron herramientas descriptivas como tablas de frecuencias y cálculo porcentual. Resultados: el grupo de edad de 7 a 12 años fue el más representado y el sexo masculino sobre el femenino, el calcáneo valgo fue la deformidad podálica que más se presentó. Se encontró actividad física alta en el 73.9 % de los niños y la mitad eran sobrepesos u obesos. Para la cuarta semana total de casos se encontraban aliviados, no hubo recaídas. No se presentaron efectos indeseables durante la aplicación de la Ozonoterapia. Conclusiones: la Ozonoterapia es una modalidad terapéutica útil en el tratamiento de la enfermedad de Sever.

Introduction: Sever's disease is a common cause of thalalgia in children. Objective: to evaluate the effectiveness of the Ozone Therapy in the treatment of Sever's disease in children from 7-18 years old attended at Pepe Portilla Pediatric Provincial Teaching Hospital, Pinar del Rio province, during July 2017 to July 2018. Methods: longitudinal and prospective descriptive research was conducted to 46 children, who attended Natural and Traditional Medicine service with relapsed of Sever's disease. Therapeutic ozone was applied to them through the rectal route, and by means of the OZOMED mini-equipment. Descriptive tools such as frequency tables and percentage calculation were used throughout the process. Results: the age group from 7 to 12 years old was the most represented and male sex prevailed over the female, the calcaneus valgus was the most frequent foot deformity. High physical activity prevailed in the 73.9% of children and half of them were overweight or obese. By the fourth week of treatment, the total of cases were relieved, without relapses. No undesirable effects during the application of ozone therapy were observed. Conclusions: ozone therapy is a useful therapeutic modality in the treatment of Sever's disease.

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.

Relationship of the Shape of Subacromial Spur and Rotator Cuff Partial Thickness Tear

BACKGROUND: The present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur. METHODS: Totally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani's type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur. RESULTS: Of the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur. CONCLUSIONS: The heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.

Golpe del espolón calcáneo complementado con electroacupuntura / Calcaneal spur shockwave complemented with electroacupuncture

El síntoma más importante del espolón calcáneo es el dolor, que se agrava con la carga estando el paciente parado o caminando; localizado en la zona del talón y de rara irra­diación. Se hace presentación de caso: mujer de 47 años de edad, sobrepeso, larga estancia de pie laborando en una cafetería, con espolón calcáneo y la descripción técnica de un único golpe en región plantar, complementado con electroacupuntura por su efecto analgésico y antiinflamatorio. La técnica se aplica por personal calificado y especializado de salud pública(AU)

The most important symptom of the calcaneal spur is pain, which worsening with the weight charge as the patients is standing up or walking; located in the heel area and of rare irradiation. Case presentation: women of 47 years of age, overweight, long time standing up as she works in a cafeteria, with a calcaneal spur and the technical description of an only plantar region shockwave, complemented with electroacupuncture for its analgesic and anti-inflammatory effect. The technique was applied by the qualified and specialized public health personal(AU)

Efectividad de la terapia Su-Jok en pacientes con dolor por espolón calcáneo / Effectiveness of the Su-Jok therapy in patients with pain due to heel spur

Se realizó una intervención terapéutica en 128 pacientes con dolor por espolón calcáneo, seleccionados aleatoriamente, quienes fueron tratados en el Departamento de Rehabilitación del Hospital General Docente "Orlando Pantoja Tamayo" en el municipio de Contramaestre, de la provincia de Santiago de Cuba, de enero del 2014 a abril del 2015, con vistas a evaluar la efectividad de la terapia Su-Jok. Se conformaron 2 grupos: uno de control, que recibió tratamiento convencional, y otro de estudio, en el cual se aplicó la terapia Su-Jok. Luego de efectuado el análisis estadístico mediante las pruebas de hipótesis de homogeneidad de la Χ² y de diferencias de medias (ambas técnicas con un error permisible de 5 %), pudo concluirse que la terapia Su Jok es efectiva para aliviar el dolor por espolón calcáneo, por lo que se recomendó promoverla para ello debido a su fácil empleo y bajo costo.

A therapeutic intervention was carried out in 128 randomly selected patients with pain due to heel spur, who were treated in the Rehabilitation Department of "Orlando Pantoja Tamayo" Teaching General Hospital in Contramaestre municipality, Santiago de Cuba province, from January, 2014 to April, 2015, with the aim of evaluating the effectiveness of the Su-Jok therapy. Two groups were formed: a control group which received conventional treatment, and a study group, in which the Su-Jok therapy was applied. After the statistical analysis was carried out by means of the homogeneity and hypothesis tests of homogeneity of Χ2 and the means differences (both techniques with a permissible error of 5%), it could be concluded that the Su-Jok therapy is effective to mitigate the pain due to heel spur, so it was recommended to promote it taking into account its easy use and low cost.

Fractura de calcáneo como complicación de tratamiento percutáneo de fascitis plantar: Reporte de un caso / Calcaneus fracture as a complication of the percutaneous treatment of plantar fasciitis: Case report

La fascitis plantar, una entidad patológica autolimitante, es una causa común de dolor en el talón en pacientes adultos. El tratamiento quirúrgico está indicado cuando el paciente recibe tratamiento conservador bien vigilado sin obtener mejoría de síntomas entre 4-6 meses. Entre las complicaciones de las técnicas percutáneas se citan: infecciones, persistencia de dolor, lesiones neurológicas, entre otras. Nosotros reportamos un paciente con fractura de calcáneo posterior a fasciotomía plantar percutánea y resección de espolón calcáneo. Se hizo una revisión y discusión de la literatura.

Plantar fasciitis, a self-limiting pathologic entity, is a common cause of heel pain in adult patients. Surgical treatment is indicated when the patient does not improve after receiving conservative treatment for 4-6 months with proper surveillance. The complications of percutaneous techniques include: infection, persistent pain, and neurologic injuries, among others. We report the case of a patient with calcaneus fracture following percutaneous plantar fasciotomy and resection of a calcaneal spur. We conducted a review and discussion of the literature.

High heel shoes; outcome of wearing in young generation: a cross sectional study

Outcome of wearing high heel shoes in young generation: A Cross Sectional Study. Introduction/ High heels increase the heel height, thus increasing the pressure under the metatarsal head in forefoot, they push the center of mass of the body forward taking the hips and spine out of alignment moreover the altered posture of walking 1-5 in high heels places excessive forces on the inside of the knee joint. All these factors contribute in causing deleterious pathologic deformities. The studies carried out previously were more focused on the adult population furthermore there isn't much work done to investigate the effect of heels in Pakistan therefore, this was a non-invasive study the purpose of which was to evaluate these complications particularly targeting the medical students of medical colleges, Karachi. A total of 220 respondents aged between 15 to 25 years were selected as potential respondents meeting the criteria for selection. A convenience based randomized sampling method was adopted, where the participants were required to fill questionnaires and give their demographic details. They were inquired about the presence of any co morbidities which was an essential part of the exclusion criteria. They were also inquired about their usage of high heel shoes, their size, duration and frequency of usage, and if they had been causing any complications such as bunions, heel spur, callosities or pain in soles, calf or back. The data obtained was analyzed through SPSS and the graphs of frequency for all the complications were computed. After analyzing the 220 participants it was found that 7.7% were males while 92.3% were females, and 61.8% were found to be within 21 to 23 years of age. After the analyses of data for the complications it was found that out of the total participants 18.8% experience foot swelling, 19.4% blisters, 16.4% foot numbness, 12.3% foot callosities, 2.8% heel spur, and 3.7% experience bunions. From this study conducted on the students of medical college it was found that wearing high heel shoes is not associated with any significant complications among most of the students

Riesgo de lesiones quirúrgicas en la fasciotomía plantar percutánea: estudio anatómico en cadáveres frescos / Risk of surgical lesions in percutaneous plantar fasciotomy: anatomical study in fresh cadavers

Introducción: La fascitis plantar es una patología frecuente, cuyo tratamiento es conservador, aunque en los casos sin respuesta se realiza cirugía. El objetivo del presente trabajo fue determinar el riesgo de lesionar los elementos nobles en la cirugía percutánea y establecer una zona de seguridad. Materiales y métodos: En 11 piezas cadavéricas frescas, se realizó la fasciotomía percutánea según la técnica de De Prado y se evaluó la relación con los elementos nobles, la lesión o no de estos y la distancia entre la sección del bisturí y las estructuras vasculonerviosas. Resultados: No se evidenciaron daños en los nervios y vasos del retropié. El promedio de distancia entre el corte y el nervio plantar lateral fue de 16 mm, y entre el corte y el nervio digiti quinti, de 10,7 mm. No hubo lesiones vasculares. Conclusiones: Este estudio demuestra el bajo riesgo de lesión neurovascular durante la práctica de la fasciotomía plantar percutánea cuando se trabaja en contacto con el calcáneo.

Background: Plantar fasciitis is a common condition. In cases of non-response to conservative treatment, surgery is performed. The aim of the study was to determine the risk of injury to noble structures in percutaneous surgery, and to define a safety zone. Methods: In 11 fresh cadavers, percutaneous fasciotomy was performed according to the De Prado technique, and later evaluated with regards to injury to noble structures, and distance between the knife and neurovascular structures. Results: There was no evidence of any damage to hind-foot nerves and vessels. The average distance between the incision and the lateral plantaris nerve was 16 mm, and between the incision and the digiti Quinti nerve 10.7 mm. There were no vascular lesions. Conclusions: The study demonstrates the low risk of neurovascular injury during the practice of percutaneous plantar fasciotomy, when working in contact with the calcaneus.

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.

Biomechanical Factors Associated with Plantar Fasciitis in Non-obese Patients / 대한스포츠의학회지

The purpose of this study was to identify the biomechanical factors that correlate with plantar fasciitis in non-obese patients whose body mass index were below 25 kg/m2. The subjects were non-obese patients who were diagnosed as plantar fasciitis by clinical appearance, physical examination, and ultrasonographic findings (n=48), and non-obese control persons without clinical diagnosis of plantar fasciitis (n=30). The two groups were compared on fat pad thickness, ankle dorsiflexion range of motion (ROM), resting calcaneal stance position (RCSP), incidence of calcaneal spur, and calcaneal pitch. The results showed that, there were statistically significant differences between two groups in ankle dorsiflexion ROM, RCSP, and calcaneal pitch (p<0.05). Multiple logistic regression analysis showed ankle dorsiflexion ROM and RCSP strongly correlated with presence of plantar fasciitis as independent predictors (p<0.05). In conclusion, reduced ankle dorsiflexion ROM and negative RCSP (valgus tendency in rear foot) may be the biomechanical factors associated with plantar fasciitis in non-obese patients.

Cirugía percutánea en fascitis plantar y espolón calcáneo / Percutaneous surgery plantar fascitis and heel spur

Se realizó un estudio prospectivo tipo serie clínica donde se avaluá la evolución de 12 pacientes (24 pies) quienes presentaban talalgia crónica por fascitis plantar con presencia de espolón calcáneo y fueron tratados con fasciotomía plantar percutánea. La mayoría de los pacientes son femeninos (90 por ciento) y la edad promedio es 40,5 años. Tiempo de seguimiento 12 meses. El resultado final fue valorado por escala análoga visual (EAV) para cuantificar dolor, opinión de paciente y reintegro a actividades habituales. El procedimiento estadístico se hizo con el programa SSPS 12,0 donde se calcularon medidas de tendencias central y de dispersión. El análisis inferencial se realizó con comparación de medidas a través de prueba T student y con la prueba no paramétrica Chi cuadrado. Se reportó 90 por ciento de resultados satisfactorios. La cirugía percutánea del pie en fascitis plantar con espolón calcáneo es un método sencillo y eficaz. Mejora el tiempo quirúrgico y logra el reintegro precoz del paciente a sus actividades habituales.

We realized a trial study where was evaluated 12 pacients (24 foots), 9 women and 3 male, who presented pain heel asociated with plantar fascitis and sprus and were realizaed fasciotomy percutaneus surgery to determine the efectiveness. The results was evaluated with analog visual scale (VAS) both the pain and the daily activities. The SSPS 12,0 statist program was utlized. The inferencial study was done with T student test and Chi square. Most patients were female (90 percent), mean age 40,5 years old. The follow up was twele months. The points in VAS to pain descending to 8,5 to 1,5. Pain was significantly lower at every assessment point as compare to preoperative values (P<0.05). Was reported90 percent of satisfactory results. The fasciotomy percutaneus surgery is a safe, efective and single procedure to treatment the pain heel for plantar Fascitis and calcaneal spurs. Those patients had significantly less postoperative pain and returned to regular activities early.

Study of the morphology of heel spur and clinical significance: base on three-dimensional computed tomography / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the characteristic morphology of heel spur, and to investigate the relationship of heel spur and plantar heel pain.</p><p><b>METHODS</b>From June 2005 to April 2009, 210 cases (254 feet) with heel spur (according to Denis Pain Scale) were divided into cases group 1 (P2, n = 46), 2 (P3, n = 44), 3 (P4, n = 42), 4 (P5, n = 36) and controls group (P1, n = 42). Three-dimensional reconstruction of heel spur was performed in all groups using volume rendering based on multi-slice CT data by Super Image orthopedics edition 1.0. The characteristic morphology of heel spur was observed and the data were measured and analyzed, involving the width of basilar part, the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur.</p><p><b>RESULTS</b>Parts of cases groups displayed coarse arcuate edge and undersurface with one or more little heel spurs adhere to heel spur, of which the numbers were greater than controls group, especially in cases group 4. No significant difference of the width of basilar part of heel spur was found among 5 groups (F = 2.32, P > 0.05). However, obvious difference was found in the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur (F = 8.23, 6.82, 5.87, P < 0.05). Compared with the controls group, the angle between heel spur and planta pedis of cases groups had higher degrees, but the difference of the other data presented irregular.</p><p><b>CONCLUSIONS</b>The characteristic morphology of heel spur varies in patients associated with plantar heel pain. No correlation is found between the severity and the morphological data, including the width of basilar part, the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur.</p>

Clínica del dolor en la atención primaria de salud / Pain Clinic in the primary health care

Se realizó un estudio descriptivo y transversal para organizar la consulta denominada Clínica del dolor -- con un algoritmo general de conducta a seguir -- y determinar qué se obtuvo con la aplicación de bloqueos terapéuticos para tratar manifestaciones dolorosas en pacientes del área de salud del Policlínico Universitario Josué País García de Santiago de Cuba, desde mayo del 2007 hasta abril del 2008. El principal resultado, independientemente de las variables analizadas (sexo, edades, ocupación y otras), fue que 85,5 por ciento de los integrantes de la casuística recibieron el alta con valoración de satisfactoria. Se recomendó introducir estas ventajosas técnicas y generalizarlas en la atención primaria de salud.

A descriptive and cross-sectional study was carried out to organize the consultation denominated Pain Clinic --with a general algorithm of behavior to follow-- and to determine what was obtained with the application of therapeutic blockades to treat painful manifestations in patients of the health area of the Josué País García University Polyclinic in Santiago de Cuba, from May, 2007 to April, 2008. The main result, independently of the analyzed variables (sex, ages, occupation and others), was that the 85,5 per cent members of the case material were discharged with satisfactory evaluation. It was recommended to introduce these advantageous techniques and generalize them in the primary health care.

Comparative trial of the foot pressure patterns between corrective orthotics,formthotics, bone spur pads and flat insoles in patients with chronic plantar fasciitis

<p><b>INTRODUCTION</b>The objective of the study is to compare the efficacy of fl at insoles, bone spur pads, pre-fabricated orthotics and customised orthotics in reducing plantar contact pressure of subjects with plantar fasciitis.</p><p><b>MATERIALS AND METHODS</b>This is a controlled non-blinded comparative study conducted in a tertiary medical institute. Thirty subjects with unilateral plantar fasciitis between the ages of 20 and 65 years were recruited at the sports medicine clinic. The contact pressures and pressure distribution patterns in both feet for each subject were measured with sensor pressure mats while standing. Repeat measurements were made with the subjects wearing shoes, fl at insoles, bone spur heel pads, pre-fabricated insoles and customised orthotics on both feet. The asymptomatic side was used as the control. Contact pressure measurements of the symptomatic and asymptomatic feet and power ratio of the pressure distribution pattern of the rearfoot were then compared.</p><p><b>RESULTS</b>Contact pressure was higher on the asymptomatic side due to unequal distribution of weight. Bone spur heel pads were ineffective in reducing rearfoot pressure while formthotics and customised orthotics reduced peak rearfoot pressures significantly. The power ratio of the rearfoot region decreased with the use of formthotics and customised orthotics.</p><p><b>CONCLUSION</b>Pre-fabricated orthotics and customised orthotics reduced rearfoot peak forces on both sides while bone spurs heel pad increase rearfoot peak pressures. Pre-fabricated and customised orthotics are useful in distributing pressure uniformly over the rearfoot region.</p>

Terapia por ondas de choque: uma opção terapêutica na fascite plantar / Shock wave therapy in plantar fasciitis

A terapia por ondas de choque vem sendo cada vez mais utilizadanas doenças do sistema músculo esquelético, principalmente nos casos de fascite plantar. É usada há mais de 10 anos moldada nas práticas urológicas (litotripsia). Já foram realizados mais de 12 milhões de tratamentos sem complicações. Ondas de choque sãoondas mecânicas transmitidas ao corpo por um aplicador acoplado na região acometida. Existem três formas de geração de ondas de choque: eletromagnética, eletrodo-hidráulica e piezoelétrica. Todos os tipos de ondas de choque têm sido utilizados no tratamento da fascite plantar e mostram bons resultados. Atualmente vem sendoutilizada onda de choque radial (gerador pneumático), menos invasiva e com resultados terapêuticos semelhantes às demais.

Th e shock wave therapy (SWT) had been largely used in muscular,bone and joint diseases and a special indication is plantar fasciitis. It is based on the urological practice (lithotripsy). More than twelve million applications of SWT had been done, without complications. SWT are mechanical waves transmitted from a special applicator, directly on the region to be treated. Th ere are diff erent generation forms of shock waves: electromagnetic, electrohydraulic and piezoelectric. All types of shock wave have been usedin the treatment of fasciitis plantar, with good results. More recently, it has been used radial shock waves, less invasive and with similar results, when compared to the other types of SWT.