Comparing the efficacy of exercise, internal and external shoe modification in pes planus: A clinical and pedobarographic study.

Pes planus is a condition that can cause pain along the innerfoot due to the absence or abnormal depression of the longitudinal arch. There are few studies available that compare therapy modalities used in these patients. In our study, those treated with conservative therapies - internal and external shoe modifications and pes planus exercises - were compared clinically and pedobarographyically. 60 pes planus patients were included in the study. In the first group; internal modification was performed by placing a medial longitudinal arch support inside the shoe. In the second group, external shoe modification was performed using the Thomas heel. In the third group of patients however, only an exercise program was executed. The patients' foot pain levels, functional asssessment, satisfaction and quality of life were recorded. Pedobarography was used in measuring both static and dynamic plantar pressure. Assessments were carried out at baseline and at the end of the first and third months respectively where intra- and inter- group comparisons were performed. Each group was composed of 20 subjects. While improvement in terms of foot pain, foot function index and quality of life was observed in all the study groups (p< 0.05), the most improvement was observed in the group of patients treated with internal modification (p< 0.016). This was followed by the external modification and the exercise groups respectively. No difference was observed between the internal and external modification groups in terms of patient satisfaction. Cross-sectionally; clinical assessments, pedobarographic analysis were correlated. The changes observed after static and dynamic pedobarographic studies were not significantly different between the study groups. At the end of the study it was observed that internal modification yielded the most significant clinical improvement. In the literature, there are limited publications comparing the conservative treatments with each other. In this study we aimed to compare the conservative treatments for flatfoot.

Discriminative value of tender points in fibromyalgia syndrome.

OBJECTIVE: The aim of this study is to assess the discriminative value of all tender points, alone and in combination, that are designated as criteria for fibromyalgia diagnosis by the American College of Rheumatology (ACR), by investigating the appropriate pressure magnitude that should be applied during tenderness examination. DESIGN: Cross-sectional. PATIENTS: This study was performed on 66 patients with fibromyalgia diagnosed according to ACR classification criteria and 50 control subjects. SETTING: The outpatient rheumatology clinic of a PM&R department of a university hospital. Intervention. Pressure pain threshold values were measured by a dolorimeter on nine specific point pairs in both groups and a cutoff value for discriminating positivity and negativity was calculated for each. Then the most valuable tender point pairs were assessed for discrimination of fibromyalgia syndrome using ACR criteria set as a reference standard. RESULTS: All tender points with determined pressure cutoff values were found out to significantly discriminate fibromyalgia syndrome and their area under curve values ranged from 0.779 to 0.934. Univariate logistic regression analysis revealed that lateral epicondyle and supraspinatus point pairs had the most powerful discriminative ability (odds ratio = 113.6 and 45.0, respectively). Multiple logistic regression analysis with backward stepwise method showed that lateral epicondyle and second rib point pairs were most discriminative with sensitivity and specificity rates of 87.9-94.0% and 77.3-84.0%, respectively. CONCLUSIONS: Fibromyalgia syndrome can have potential to be recognized simply by pressing fewer tender point areas but with various pressure cutoff levels identified for each tender point areas.