Nonoperative management of retrocalcaneal pain with AFO and stretching regimen.

BACKGROUND: Retrocalcaneal heel pain is caused by a spectrum of etiologies all resulting in the same symptom of pain at the tendon-Achilles insertion. Several studies have reported the outcomes of operative treatment, but none have reported the outcomes or success rates of nonoperative treatment. We describe a detailed treatment algorithm and report the clinical outcomes. METHODS: One hundred thirty-five patients were prescribed a treatment regimen consisting of an AFO and stretching program and were enrolled in our prospective study. One hundred three patients completed pre- and post-treatment Foot Function Indices and were included in the analysis. The effect on FFI from clinical and radiographic factors was examined. RESULTS: Of the study population, 76% had a BMI greater than 25, 80% were older than 50 years, and 75% had an exostosis on radiographs. The mean pre-treatment FFI was 48.4 and the mean post-treatment FFI was 18.6 indicating a statistically significant improvement in function of 29.8. Neither BMI nor age had a significant effect on the magnitude of improvement; though, smokers had significantly less improvement. FFI improvement in patients with an exostosis were less than those without an exostosis. Patients with an exostosis less than 1 cm had less improvement than those with an exostosis of 1 cm or more. Patients with Types I and III exostoses had significantly less improvement in FFI compared to Types II and IV. Twelve of the 103 (11.6%) were not pleased with the results of nonoperative treatment and elected to have a procedure performed. CONCLUSION: Our study is the first to report the outcome of non operatively treated retrocalcaneal heel pain and to classify retrocalcaneal exostoses. Using our treatment algorithm, we had an 88% success rate in alleviating symptoms and avoiding surgery. Our data suggests that the use of an AFO and stretching regimen may benefit patients suffering from retrocalcaneal heel pain.

[Exostoses of the external auditory canal in professional diving. A case for the German Social Accident Insurance Institution]. / Berufstaucher mit Gehörgangsexostosen. Ein Fall für die Berufsgenossenschaft.

Exostoses of the external auditory canal are often diagnosed incidentally but may also cause complications, e.g., conductive hearing loss and/or recurrent inflammations of the external ear canal due to stenosis. This paper presents current scientific data on the pathogenesis of ear canal exostoses, which obviously focus on the cold water hypothesis. We present a case of an expert opinion on occupational illness and discuss whether the legal preconditions for recognition "like an occupational disease" according to article 9(2) Social Code Book VII are met. A systematic reporting of suspected cases is recommended in order to obtain reliable data on the epidemiology and the clinical course of external auditory exostoses among individuals occupationally exposed to cold water and to enter an expert discussion on the reasonability of an inclusion in the list of occupational diseases.

A cirurgia pré-protética para Torus Palatino: relato de caso / The pre-prosthetic surgery for Palatine Torus: a case report

O torus palatino é uma alteração de desenvolvimento comum, localizada na linha média do palato duro. Sua etiologia é incerta, podendo ser associado alterações funcionais, fatores genéticos e características raciais. Sua incidência varia de acordo com grupos étnicos, idade e geralmente acomete o sexo feminino. Normalmente esse nódulo ósseo intra oral não apresenta sintomatologia dolorosa, todavia a sua remoção é freqüentemente indicada quando há trauma recorrente, interferência nos processos de fonação, deglutição, mastigação, no posicionamento normal da língua, ou para correção de deformidades ósseas que prejudiquem a adaptação de prótese...

The palatine torus is a usual developmental disturbance, located in the midline of the hard palate. Its etiology is uncertain and may be associated with functional changes, genetic factors and racial characteristics. Its incidence varies according to ethnic groups, age and usually affects females. Normally this intra-osseous oral nodule presents no painful symptoms, but its removal is often required when there is recurrent trauma, interference in the processes of speech, swallowing, chewing, in the normal positioning of the tongue, or to correct bone deformities that affect the adaptation of prosthesis...

A proposed subungual exostosis clinical classification and treatment plan.

Subungual exostosis is a slow-growing, benign outgrowth of normal bone under the nail that affects the nail unit. The most common location in the foot is the dorsal surface of the distal phalanx of the big toe. Clinically, it can appear in combination with a variety of nail disorders, masking the underlying bone condition, which is frequently unrecognized or misdiagnosed. A new classification system for these lesions is proposed on the basis of the clinical signs and symptoms present during examination and the associated disorders of the nail plate. Also, a therapeutic algorithm that describes surgical approaches to the different presentations of this disorder is presented.

Prevalencia de torus palatino y mandibular en los pacientes que asistieron a las clínicas de la Facultad de Odontología de la Universidad de Cartagena durante el período 1995-2004 / Prevalence of torus palatinus and torus mandibularis in patients attending the clinics of the Dental School, University of Cartagena, over the period 1995-2004

El estudio es de tipo descriptivo retrospectivo. La muestra fue de 368 historias clínicas que se escogieron aleatoriamente del archivo de la Facultad de Odontología. A cada historia se le diligenció un formato y una vez analizado, se obtuvieron los siguientes resultados: 1. La presencia de torus estuvo en el 61 por ciento de la muestra. 2. Estadísticamente no se encontró diferencia significativa en cuanto al sexo y a la presencia de torus (p>0.05). 3. Fue más frecuente en pacientes de tez morena. 4. En pacientes de la región atlántica 5. Con mayor frecuencia en los pacientes entre los 15 y los 25 años de edad. 6. El torus palatino fue el que más se presentó, ubicándose en tercio medio y posterior. Los torus mandibulares se encontraron en mayor proporción de manera bilateral, ubicándose en zona de premolares y contrario a lo que reporta la literatura en el estudio realizado, no se presentó ningún torus mandibular en zona de molares. Se concluye que la prevalencia de torus palatino fue mayor que la del torus mandibular. El torus se presentó con mayor frecuencia en personas de tez morena y en pacientes entre los 12 y los 25 años de edad. Torus Palatino/ Prevalencia de Torus.

[Clinical signs and diagnosis of hallux valgus]. / Klinische Untersuchung + Röntgenbild. So funktioniert die Hallux-valgus-Diagnostik.

The hallux valgus deformity (fibular deviation of the big toe) is one of the most common deformities affecting lower limbs. If the hallux crosses over the second toe, the condition may be termed hallux valgus superductus, if it moves under the second toe, the term hallux valgus subductus applies. Mechanical pressure on the pseudoexostosis results in a bunion and possibly fistulization. Hallux valgus is often combined with a splay foot. Overloading of the second to fourth metatarsal heads may cause midfoot pain. As a result of the increased load, the second to fifth toes may deform into hammer or claw toes. Therefore hallux valgus should usually not be considered in its own. Apart from the anamnesis and clinical examination, X-ray diagnosis is very important for the treatment planning. A.p. and lateral X-rays should be obtained of the entire foot in the standing patient, as also an oblique view. While the latter permits evaluation of the extent of an arthrosis of the metatarsophalangeal joint of the big toe, the lateral films allow the longitudinal arch and the stability of the first tarsometatarsal articulation to be assessed. On the a.p. film the hallux valgus angle and the intermetatarsal (rays 1/2) angle can be determined.

In vivo correlation of noncarious cervical lesions and occlusal wear.

STATEMENT OF PROBLEM: The etiology of noncarious cervical lesions is not well understood. An understanding of the etiology helps the clinician determine appropriate treatment and management strategies. Purpose This study evaluated the relationship between noncarious cervical lesions and occlusal (or incisal) wear. MATERIAL AND METHODS: Casts (n = 299) made from dental students were articulated in a semi-adjustable articulator and evaluated. Data included the presence and contour of noncarious cervical lesions (NCLs) and the presence, location, and severity of any occlusal/incisal wear facets. Also included were Angle's classification, occlusal guidance patterns, midline, presence of tori, tooth restoration, reverse articulation (crossbite), open occlusal relationship, and posterior excursive contacts where present. Following a calibration procedure, 2 evaluators made independent observations on the casts. The first evaluator recorded for each tooth in each subject: presence and severity of NCLs, presence and extent of occlusal/proximal restorations, and presence of reverse articulation and open occlusal relationship. Following the first evaluation red rope wax was placed at the cervical margins of each tooth for the purpose of blinding the second evaluator from NCL observations. The second evaluator recorded severity and location of occlusal/incisal wear, presence or absence of posterior excursive contacts, Angle's classification, occlusal guidance pattern, any midline discrepancy, and presence or absence of tori. The Spearman correlation coefficient and chi 2 tests were used to analyze the data (alpha=.05). RESULTS: There was no relationship between noncarious cervical lesions and occlusal/incisal wear. There was also no correlation between NCLs and other parameters examined. CONCLUSIONS: Under the conditions of this study, noncarious cervical lesions are not related to occlusal wear.

The prevalence of radiographically evident mandibular tori in the University of Iowa dental patients.

OBJECTIVES: To evaluate the radiographic prevalence of mandibular tori and to determine the attributes which make tori radiographically evident. METHODS: The prevalence of mandibular tori was determined from 1600 radiographic surveys of patients attending the College of Dentistry, University of Iowa, 200 for each decade of life from the first to the eighth. Dry skulls were evaluated at the National Museum of Natural History. Mandibular tori were measured, classified and radiographed to correlate the radiographic findings with the physical characteristics. RESULTS: Overall, 16.9% of the patient population had radiographically detectable mandibular tori with some cohorts within the population as high as 33%. Lobulated tori extending 4 mm or more mediolaterally were radiographically detectable. CONCLUSIONS: This study revealed one of the higher prevalence rates of mandibular tori in the literature for a population within the United States. Radiographic threshold analysis suggests that this group of Iowans has a high percentage of medium to large discretely lobulated tori.

Buccal alveolar exostoses: prevalence, characteristics, and evidence for buttressing bone formation.

BACKGROUND: Buttressing bone formation has been described as the development of thickened or exostotic buccal alveolar bone in response to heavy occlusal forces. Little supporting evidence for this model has been found in previous literature, however, and there is little seen on the prevalence or characteristics of buccal alveolar exostoses. METHODS: A sample of 416 selected teeth and investing bone in 52 modern skeletal specimens at the National Museum of Natural History were examined. Two measures of heavy occlusal function--periodontal ligament (PDL) width and occlusal attrition--were analyzed for their relationship to three parameters of buccal alveolar bone (exostoses, lipping, and overall thickness). RESULTS: Buccal alveolar bone enlargements were found in 25% of all teeth examined: 18% were expressed as marginal bony lippings and 7% as buccal exostoses. Exostoses were mainly seen around maxillary molars and bicuspids, especially in males, while lippings were seen in molars, bicuspids, and mandibular incisors, with even gender distribution. When findings were controlled for arch and tooth type, no significant correlations were found between wider PDL spaces or occlusal attrition and exostotic, lipped, or thicker alveolar bone. CONCLUSIONS: These results indicate a lack of anatomic evidence for the theory of buttressing bone formation and suggest that other factors may be of greater importance in the etiology of buccal bone enlargements. Incidentally, no correlation was found between widened PDL spaces or severe occlusal attrition and the presence of cervical loss of tooth structure, which casts doubt on the currently popular concept of abfraction.

Torus palatinus and torus mandibularis: a review of the literature.

The torus has been mentioned in the literature for about 180 years. However, little has been revealed about it until the last two decades when great advances were made in the field of genetics. Its occurrence in various ethnic groups ranges from 9 to 66 per cent. Even between similar ethnic groups living in different environments, different figures have been reported. It has been statistically proven that differences do occur between various ethnic groups and the sexes. In current thinking, the occurrence of tori is considered to be an interplay of genetic and environmental factors. The quasi-continuous genetic or threshold model seems to hold the answers to their formation. This theory proposes that the environmental factors responsible must first reach a threshold level before the genetic factors can express themselves in the individual. Hence, both genetic and environmental factors determine liability, making the system multifactorial.

A classification of palatal osseous alveolar marginal exostoses--POAMES.

The bony palates of 1,122 dentate dry human skulls were examined for Palatal Osseous Alveolar Marginal Exostoses (POAMES). Four types of POAMES were identified, namely ridges, ledges, nodular exostoses and a combination of these.

Torus mandibularis: an estimation of the degree of genetic determination.

Torus mandibularis has frustrated several attempts to make family patterns of variation fit modifications of Mendelian models. It is suggested that the quasi-continuous model of inheritance provides a rational explanation for the diverging opinions. The model implies an underlying continuous and normally distributed variable, 'liability', with a threshold value beyond which individuals will be affected. Both genetic and environmental factors determine liability, making the system multifactorial. The incidence of variable degrees of torus was examined in two groups of patients with different stresses on the jaws: one group with bruxism and one comparison group. The transformation of incidences to group means and variances of liability was demonstrated. Muscular forces during bruxism were shown to influence liability. The relative importance of environmental and genetic components of variance could, however, not be estimated directly from the entire groups, since both were mixed with regard to the genetic predisposition. To achieve materials with uniform genotypes, all individuals without torus were omitted. The estimate of the genotypic variance (VG) was obtained by subtracting the variance of the bruxism sub-group--the environmental component associated with bruxism (VEB)--from the total phenotypic variance of the comparison sub-group (VP). The estimate of the genetic determination of torus (VG/VP) turned out to be about 30%, whereas approximately 70% of the causes seemed to be attributable to environmental influence in terms of occlusal stress. Gene effects on the morphologic level are usually pleiotropic, and it is suggested that the correlation of torus mandibularis with other clinical variables might make an interesting subject for further investigation.

Dupuytren's (subungual) exostosis.

Because it may produce a bewildering array of histologic patterns, the clinical entity of subungual exostosis (Dupuytren's exostosis), is sometimes confused with chondrosarcoma. However, this lesion is a distinct entity. It begins as a reactive growth of cellular fibrous tissue and metaplastic cartilage, which undergoes enchondral ossification. The rate of growth may be exuberant, but it is limited. We present a series of 15 cases as well as a review of the literature. Postadolescents and young adults are most commonly affected, and the majority of cases (80%) occur on the dorsal-medial aspect of the great toe. Trauma, whether chronic or acute, and infection are frequent inciting factors. The radiologic picture is consistent and can be diagnostic. In more than half our cases, chondrosarcoma was suspected initially. However, if the entire clinical picture is evaluated, the histologic findings should not lead to confusion with a malignant process. This acquired exostosis is benign; local excision is curative. However, recurrence is common (53%) after incomplete excision or when the lesion has not achieved full maturation.

The prevalence of ankylosing hyperostosis in a Jerusalem population--with description of a method of grading the extent of the disease.

The prevalence of ankylosing hyperostosis in a Jewish hospital population is presented. In individuals over the age of 40 years the overall prevalence was 22.4% in males and 13.4% in females. The prevalence increased with age to a maximum of 46% in males and 30% in females over the age of 80 years. A method of grading the disease according to extent is described. The most extensive grade III is seen almost exclusively in males.

Methodological aspects of classifying low--and medium intensity of hyperostosis spongiosa orbitae.

Low- and medium expressions of hyperostosis spongiosa orbitae are occurring rather frequently compared to strong or very strong ones, yet their notation and differentiation is sometimes rather difficult. By means of original photographs of low and medium intensity degrees of this pathological trait methodological facilitation of notation is intended. This could serve as a stimulus for a more frequent incorporation of this bone condition in skeletal studies let alone minimal interobserver differences.