[Extracorporeal shockwave therapy in symptomatic heel spurs. An overview]. / Extrakorporale Stosswellentherapie beim symptomatischen Fersensporn. Eine Ubersicht.

Extracorporeal shock wave application (ESWA) has been successfully used for years in routine clinical management of plantar fasciitis. So far no clinical trails have shown the efficiency in placebo-controlled protocols. This paper presents an overview of conservative and operative treatment modalities with respect to their efficacy. Results of a prospective randomized placebo-controlled double-blind multicenter trial to show efficiency and safety of ESWT are presented. In patients treated conservatively without success, a single shock wave application can improve the condition significantly compared with placebo treatment (p = 0.0149). The Roles and Maudsley score also showed a significant improvement between the groups, with 61.6% good or excellent results in the verum group and 39.7% in the placebo group (p = 0.0128). Therapy-related side effects (local swelling, petechia) are rare. The data presented in this study led to FDA approval in January 2002 of the shock wave device used.

Injection accuracy and clinical relief of de Quervain's tendinitis.

In a controlled, prospective, double-blind study, the incidence of accurate injection of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon compartments was defined and correlated with clinical relief of de Quervain's tendinitis. X-ray dye was included with steroid and lidocaine injections for 19 patients; dye location was immediately checked by 1 radiologist blinded to the clinical results. Dye was confirmed to be within the first dorsal compartment in 16 of 19 cases. There was relief of symptoms in 11 of 19 patients. Four of 5 patients with dye in both the APL and EPB tendon compartments, experienced relief of symptoms, while all 3 with dye in neither compartment experienced no relief. This suggests that accurate injection of steroids is required for relief of de Quervain's tendinitis. The EPB compartment was often missed (13/19 cases), possibly because it was separate or of small size and deep location. This may be a factor in failed injections, just as surgery can fail if a separate EPB compartment is not released.

Kirschner wire breakage after surgery of the lesser toes.

A retrospective review was made of all patients operated on by the two senior authors from January 1985 to January 1993 for problems with Kirschner wire breakage following forefoot surgery. Thirty-three broken K-wires in 27 patients were encountered. All of these were 0.045-inch K-wires that had been placed across the metatarsophalangeal (MTP) joint of the lesser toes. In no case was there breakage of a K-wire that was larger than 0.045 inches or that did not cross the MTP joint. The medical records and radiographs of 565 consecutive patients having fixation with 0.045-inch K-wires that crossed the MTP joints of the lesser toes were then reviewed. A total of 1002 K-wires were used with an overall failure rate of 3.2% (4.8% of the patients). All of these K-wires failed just proximal to the point of entry into the metatarsal head. No intra-articular retained fragments were noted. Twenty-five of the retained fragments were completely within the metatarsal head and shaft, and eight of these fragments pierced the cortex of the metatarsal proximally. Twenty-three patients with retained fragments were examined in follow-up and in no case could the retained fragment be palpated or directly related to postoperative symptoms. Of the three patients who complained of persistent pain, two had mild pain with persistent MTP synovitis and one had severe pain due to lateral deviation of the toe after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

The Foot in Running.

Injuries to the foot and ankle are often encountered in runners, be they highlevel competitors or recreational joggers. Many of these injuries are due to overuse syndromes and training errors; others are related to the running surface or the athlete's footwear. Only with a rational approach to diagnosis can the primary underlying cause be identified so that appropriate treatment can be prescribed. Conservative measures, which include rest, cross-training, orthotic changes, and altering training methods, are often curative. Surgery is usually indicated only after conservative measures have been exhausted. Careful preoperative planning is needed to minimize dissection, thereby optimizing the chance of a return to the preinjury activity level. Preoperative counseling of the patient is also important, so that expectations about the outcome and the rehabilitation requirements are realistic.