Proximal Plantar Intrinsic Tendinopathy: Anatomical and Biomechanical Considerations in Plantar Heel Pain.

Plantar heel pain is often managed through podiatric and physical therapy interventions. Numerous differential diagnoses may be implicated in patients presenting with plantar heel pain; however, symptoms are often attributed to plantar fasciitis. Abductor hallucis, flexor digitorum brevis, and quadratus plantae share proximal anatomic attachment sites and mechanical function with the plantar fascia. Although these plantar intrinsic muscles each perform isolated digital actions based on fiber orientation and attachment sites, they function collectively to resist depression of the lateral and medial longitudinal arches of the foot. Overuse injury is the primary contributing factor in tendinopathy. The close anatomic proximity and mechanical function of these muscles relative to the plantar fascia suggests potential for proximal plantar intrinsic tendinopathy as a result of repetitive loading during gait and other weightbearing activities. To date, this diagnosis has not been proposed in the scientific literature. Future studies should seek to confirm or refute the existence of proximal plantar intrinsic tendinopathic changes in patients with acute and chronic plantar heel pain through diagnostic imaging studies, analysis of lactate concentration in pathologic versus nonpathologic tendons, and response to specific podiatric and physical therapy interventions germane to tendinopathy of these muscles.

Lessons from the dead: the experiences of undergraduates working with cadavers.

Dissection of a human cadaver is a time-honored tradition for teaching anatomy in medical education. However, in recent years, for a variety of reasons, including costs and ethical concerns, some medical programs have ceased cadaver dissection in exchange for virtual dissection of cadavers in cyberspace. Past research suggests that students find work on a cadaver to be distressing, but also rewarding. This study analyzed journal entries from 21 undergraduate students working with a cadaver in a gross anatomy course. An empirical, phenomenological analysis of the data identified 19 common themes among the participant's journal entries. In addition, the analysis disclosed how participants usually felt a need to justify the act of dissection. Finally, the analysis identified how students differed in the varied ways they coped with the ambiguous status of the cadaver, which was sometimes viewed as a deceased person while at other times experienced as a fascinating machine. Based on the findings, the researchers offer recommendations for helping students to better cope with the experience of cadaver dissection and to use the experience pedagogically to better prepare students for the stress of the medical world, especially issues surrounding death and dying.