Heel Pad Stiffness in Plantar Heel Pain by Shear Wave Elastography.

The goal of the study was to evaluate the reliability of supersonic shear wave elastography in measuring heel pad stiffness and the change in heel pad stiffness in patients with plantar heel pain. In the reliability test involving 12 normal participants, each heel pad was tested six times in succession, and adequate reliability was reflected in the intraclass correlation coefficients (0.95, 0.93 and 0.96 for the microchambers, macrochambers and bulk heel pad, respectively). In the clinical assessment involving 20 normal participants and 16 unilateral plantar heel pain patients, diseased heel pads (86.8 ± 22.9, 36.8 ± 7.7 and 46.6 ± 10.9 kPa for the microchambers, macrochambers and bulk heel pad, respectively) were significantly stiffer than unaffected heel pads (66.8 ± 14.1, 25.2 ± 5.7, 34.2 ± 6.6 kPa) and those of normal participants (60.9 ± 11.4, 26.3 ± 6.1, 31.8 ± 6.3 kPa), suggesting that the heel pad with plantar heel pain was associated with loss of elasticity.

Reducing limping by tibial lengthening along nails in adult unilateral developmental dysplasia of the hip with high dislocation.

BACKGROUND/PURPOSE: Treatment of adult neglected developmental dysplasia of the hip (DDH) with high dislocation is still not established. The main concern of young patients is leg-length discrepancy (LLD), which leads to limping gait and impaired body image. Such patients usually ask for a minimally invasive treatment that can improve the LLD. METHODS: Between 1993 and 2003, 17 patients with neglected DDH with high dislocation (mean age, 22.8 years) were treated by tibial lengthening using the Ilizarov external fixator over an intramedullary nail. The inclusion criteria were unmarried young adults, unilateral lesion, significant limping or unsightly gait with psychologic discomfort, marked shortening > 4 cm with the block test, and benefit from a shoe-lift. Exclusion criteria were patients older than 30 years, hip pain as the chief complaint, and compensated low hip dislocation without significant limping. RESULTS: All 17 patients had eventual bone consolidation without further operation. The mean external fixation index was 14.2 day/cm. Bone formation was good in all patients with a mean consolidation index of 57.7 day/cm. At an average follow-up period of 7.8 years, the limping was much improved from a moderate or severe degree to a mild degree in all patients. No patients had equinus contracture. All patients were satisfied with their treatment results. There were two complications: transient loss of big toe extension and mild wound infection. CONCLUSION: Tibial lengthening can improve limping in adult patients with neglected DDH and high dislocation with a low morbidity. Lengthening along intramedullary nails can effectively reduce the external fixation time, improve bone formation, and prevent complications.