Development of a foot and ankle strengthening program for the treatment of plantar heel pain: a Delphi consensus study.

BACKGROUND: People with plantar heel pain (PHP) have reduced foot and ankle muscle function, strength and size, which is frequently treated by muscle strengthening exercises. However, there has been little investigation of what exercises are used and there is no sound evidence base to guide practice. This study aimed to develop a consensus-driven progressive muscle strengthening program for PHP. METHODS: Thirty-eight experts were invited to participate in the study over three rounds. Round 1 was an open-ended questionnaire that provided the core characteristics of progressive strengthening programs designed for three different adult patient types with PHP (younger athletic, overweight middle-aged, older), which were presented as vignettes. In Round 2, experts indicated their agreement to the proposed exercises and training variables. In Round 3, experts were presented with amendments to the exercises based on responses from Round 2 and indicated their agreement to those changes. Consensus was achieved when > 70% of experts agreed. RESULTS: Two experts were ineligible and 12 declined, leaving 24 (67%) who participated in Round 1. Eighteen (75%) completed all three rounds. From Round 1, progressive strengthening programs were developed for the three vignettes, which included 10 different exercises and three training variables (sets / repetitions, weight, and frequency). In Round 2, 68% (n = 17) of exercises and 96% (n = 72) of training variables reached consensus. In Round 3, only exercise changes were presented and 100% of exercises reached consensus. CONCLUSIONS: This study provides three progressive strengthening programs agreed to by experts that can be used in future clinical trials to determine the effectiveness of muscle strengthening for PHP. In addition, clinicians could use the programs as part of a rehabilitation strategy with the caveat that they may change as more research is conducted.

Muscle Function and Muscle Size Differences in People With and Without Plantar Heel Pain: A Systematic Review.

BACKGROUND: Plantar heel pain is a common condition, but little is known about the relationship between muscle strength and plantar heel pain. OBJECTIVES: To review the evidence relating to muscle strength in those with and without plantar heel pain. METHODS: We systematically reviewed the literature by searching key databases. Included studies assessed muscle strength (or endurance or size as proxies) in those with and without plantar heel pain. A modified Downs-Black quality index was used to assess study quality and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to evaluate the strength of the evidence. Meta-analysis was performed where possible. RESULTS: Seven studies met the eligibility criteria. Hallux plantar flexion, lesser toe plantar flexion, ankle dorsiflexion, ankle inversion, and ankle eversion strength values were reduced in those with heel pain compared to those without; however, there was inconsistency in the findings between studies. No difference was found in calf muscle endurance between those with and without plantar heel pain (standardized mean difference, 0.01; 95% confidence interval: -0.56, 0.59). Generally, foot muscle volume was smaller in people with plantar heel pain compared to those without. The quality of individual studies was generally high (score range, 11-16/17 on the modified Downs-Black quality index); however, the GRADE ratings suggest the strength of this evidence to be very low. CONCLUSION: People with plantar heel pain have reduced strength and volume of the foot muscles, but there is no discernible difference in calf muscle endurance. These findings should be interpreted with respect to the very low GRADE ratings and are likely to change with further research. Accordingly, the role of muscle strength in plantar heel pain is worthy of further investigation. J Orthop Sports Phys Ther 2019;49(12):925-933. Epub 9 Oct 2019. doi:10.2519/jospt.2019.8588.

An Existential Perspective on Death Anxiety, Retirement, and Related Research Problems.

Aspects of existentialism relevant to existence and death anxiety (DA) are discussed. Included are the "thrownness" of existence, being-with-others, the motivational influence of inevitable death, the search for meaning, making the most of existence by taking responsibility for one's own life, and coping with existential isolation. The attempted separation of DA from object anxiety is a significant difficulty. The correlations among age, gender, and DA are variable. Personality and role-oriented problems in the transition to retirement are discussed along with Erikson's notion of "generativity" as an expression of the energy and purpose of mid-life. Furthermore, methodological and linguistic problems in DA research are considered. The article suggests qualitative methodologies as an interpersonal means of exploring DA within the contexts of psychotherapy and counselling.

Commentary on retirement, identity, and Erikson's developmental stage model.

ABSTRACTThe coincidence of retirement and aging, experienced in the later stages of life, can trigger a recurrence of the bipolar tensions of earlier stages described in Erikson's model of personality development. The model provides a means for retirees to understand the ground from which their present identity has developed and how the psychodynamics of previous life stages can be reactivated by the onset of retirement and aging. Stages of the model are illustrated by experiences within the context of retirement. The utility of Erikson's model is suggested as a means of enhancing self-awareness, self-understanding, and adjustment to retirement.

Creep as a mechanism for sealing amalgams.

Dental amalgam seals itself over time. The reduction of microleakage in amalgam restorations has been explained by corrosion products filling in the interface gap between amalgam and tooth structure in order to seal the restoration interface. This concept has been widely accepted; yet, curiously, there is little research supporting this theory. The creep mechanism may be a plausible alternative to explaining why microleakage is reduced over time in amalgam restorations. Amalgam restorations are confined to the fixed space of the cavity preparation; expansion of the amalgam through internal phase changes in this confined area must be relieved. The resultant creep-expansion of the amalgam restoration fills in the tooth/amalgam interface gap. Once the interfacial gap is filled and amalgam has made intimate contact with the cavity wall, the dental amalgam slides along the tooth preparation plane as predicted by classic metallurgical studies. The results of the creep of amalgam have been observed clinically as the extrusion of amalgam from the cavity preparation. This explanation for amalgam sealing the tooth/amalgam gap fits many clinical observations and certain research data.

Amalgam: dead or alive?

UNLABELLED: The use of dental amalgam is on the decline, yet its many advantages, including the contrast in colour with the tooth, increase the possibility that the patient's dentition will last a lifetime. CLINICAL RELEVANCE: Dental amalgam is still a viable restorative material. A recipe for the placing of better amalgam restorations along with clinical restorations of 30-year longevity using these techniques is presented.

Six-year clinical evaluation of bonded and pin-retained complex amalgam restorations.

This clinical study compared the performance of complex amalgam restorations retained with self-threading pins or bonded with a filled, 4-META-based resin. Sixty amalgam restorations (28 pin-retained and 32 bonded), each replacing at least one cusp, were placed. Self-threading stainless steel pins (Coltene-Whaledent) were used in the pin-retained group. A filled, 4-META-based bonding resin (Amalgambond Plus with HPA powder) was used in the bonded group. For both groups, any retention form remaining after removal of an old restoration was left in place but not enhanced. At six years, 11 restorations had failed; eight of which were pin-retained and three bonded. Using Fisher's exact test to compare the groups at six years, there was no significant difference in failure rate, marginal adaptation, marginal discoloration, secondary caries, tooth sensitivity or tooth vitality. At six years, there was no difference in the performance of pin-retained amalgam restorations and bonded amalgam restorations.

A history of dental amalgam.

OBJECTIVES: Silver amalgam alloy has been used as a dental restorative material since the beginnings of restorative dentistry. It rose as an easily manipulated and low cost material in comparison to other restorative techniques of the time, but it had poor dimensional stability and clinical behavior. Successive research led to the standardization of both its composition and some aspects of its mechanical properties, which have contributed to its widespread acceptance. Nevertheless, the risk of environmental toxicity generated by mercury and its poor esthetics have given rise to the search for alternative and more promising materials. This article endeavors to give a brief historical description of the main events which have led to development of modern silver amalgam alloys. SIGNIFICANCE: It is concluded that extensive knowledge of the use of silver amalgam alloy has made it the most widely used restorative material for the posterior oral cavity. However, in recent years its preponderance has been brought into question even though some innovative ideas have been suggested which could help improve this material in the future.

Case report of a 40-year, five surface complex amalgam restoration.

Reports of longevity for multi-surface amalgam restoration have been limited. This paper reports a case where a five-surface complex amalgam restoration has been followed and documented for 40 years. The pictorial series will help to identify some of the factors a dentist should consider before replacing the restoration.

¿Es actualmente la extensión por prevención un concepto válido? / Is currently the extension for prevention a valid concept?

Se analizan y discuten los diferentes conceptos de extensión por prevención de la preparación que se han desarrollado desde 1881 hasta 1999. La introducción de nuevos conocimientos en diversas áreas de la odontología hicieron que los postulados de Black en ese particular se cuestinaran tanto en la enseñanza como en la práctica clínica

Amálgama dental: história e controvérsias / Dental amalgama: history and controversies

Os AA fazem uma descriçäo atualizada sobre o momento atual do amálgama, relacionando seus aspectos históricos e controvérsias

Amálgama dentário, mercúrio e sua toxidade / Dental amalgam, mercury and its toxicity

A liberaçäo do mercúrio pela restauraçäo de amálgama é menor do que as quantidades ingeridas na dieta. Níveis de mercúrio nos dentistas säo mais altos do que na populaçäo em geral, mas dentistas säo saudáveis e näo tem doenças raras ou mortes prematuras. Amálgamas säo anti-estéticos e seräo trocados por restauraçöes estéticas, mas näo vamos trocar amálgama prematuramente e por razöes erradas