Cause Of Foot Pain Research Articles

Clinical Use of High-Resolution Ultrasonography for the Diagnosis of Type II Accessory Navicular Bone

Medial foot pain is a common complaint in rehabilitation clinics. The differential diagnoses include many musculoskeletal disorders like tendonitis and inflammation of ossicles. Posterior tibialis tendonitis is a common cause of foot pain in adults. The accessory navicular (AN) bone is occasionally observed and considered as a secondary ossification center of the navicular bone. Occasionally, posterior tibialis tendonitis and AN bone may cause acute or chronic medial foot pain with varying degrees of dysfunction. Previously, the diagnosis of an AN bone in a painful medial foot was based on clinical presentation and radiographic examinations such as plain radiography, bone scintigraphy, and magnetic resonance imaging. However, the application of soft-tissue ultrasonography for the diagnosis of posterior tibialis tendonitis associated with an AN bone has not been documented. Here, we report the case of a 60-yr-old woman with painful medial foot which had a diagnosis of posterior tibialis tendonitis associated with an AN bone by high-resolution ultrasonography.

Problemfälle bei Metatarsalgie

Metatarsalgia is characterized by pain under the metatarsal heads and is a very common cause of foot pain among adults. Symptoms can be isolated or in combination with accompanying deformities occurring in the forefoot and/or hindfoot. In the foreground of the treatment is the exhaustion of conservative forms of therapy to minimize the symptoms of local pressure increase and callus under the metatarsal heads. In addition, various surgical methods are available, such as corrective osteotomy of the metatarsal bone, soft tissue interventions and the correction of associated deformities. The indications for surgical intervention should be made with caution in order to avoid failures and complaints persisting after surgery. The most common problems are an inadequate indication for surgery, technical problems and insufficient postoperative treatment.

Osteoid osteoma of the cuboid bone: a rare cause of foot pain

Osteoid osteoma, a common bone lesion of benign nature, is more rarely seen in feet. It most commonly involves the talus yet rarely the cuboid. The atypical symptoms of foot involvement may delay the diagnosis. Differential diagnosis most commonly includes ankle sprain, monoarticular arthritis, anterior impingement syndrome, tarsal spur, osteomyelitis, stress fracture, eosinophilic granuloma. The delay in diagnosis and treatment of osteoid osteoma in the foot may be a cause of chronic foot pain. In this study, we present a 17-year-old boy with osteoid osteoma in his right cuboid bone. The patient was undiagnosed during the first year of his symptoms. After surgical removal of the tumor, his complaints were resolved. The pathological examination confirmed the diagnosis of osteoid osteoma. Osteoid osteoma is an unusual bone tumor of the foot. It should be included in the differential diagnosis of patients exhibiting foot pain. In speculative cases with no obvious radiographic findings, further imaging studies, such as CT, should be considered.

Extracorporeal Shock Wave for Chronic Proximal Plantar Fasciitis: 225 Patients with Results and Outcome Predictors

Plantar fasciitis can be a chronic and disabling cause of foot pain in the adult population. For refractory cases, extracorporeal shock wave therapy (ESWT) has been proposed as therapeutic option to avoid the morbidity of surgery. We hypothesized that the success of extracorporeal shock wave therapy in patients with chronic plantar fasciitis is affected by patient-related factors. A retrospective review of 225 patients (246 feet) who underwent consecutive ESWT treatment by a single physician at our institution between July 2002 and July 2004 was performed. Subjects were included only if they had plantar fasciitis for more than 6 months and failure to response to at least 5 conservative modalities. Patients were evaluated prospectively with health questionnaires, Roles and Maudsley scores, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores at regular intervals. Follow-up was 30.2 +/- 8.7 months post procedure. Multivariable analysis was performed to assess factors leading to successful outcomes. Success rates of 70.7% at 3 months and 77.2% at 12 months were noted in this population. Previous cortisone injections, body mass index, duration of symptoms, presence of bilateral symptoms, and plantar fascia thickness did not influence the outcome of ESWT. The presence of diabetes mellitus, psychological issues, and older age were found to negatively influence ESWT outcome. Whereas many factors have been implicated in the development of plantar fasciitis, only diabetes mellitus, psychological issues, and age were found to negatively influence ESWT outcome. 2.

Hallux Valgus With Increased Intermetatarsal Angle: Surgical Treatment With Proximal Opening Wedge Metatarsal Osteotomy

Hallux valgus is a common cause of foot pain and deformity in the adult and adolescent population, which often requires surgical treatment when nonsurgical treatments fail. When the condition is associated with an increased intermetatarsal angle, a surgical technique using a proximal first metatarsal osteotomy is often indicated. A proximal opening wedge osteotomy stabilized with a wedge and plate configuration offers a stable, reliable means to correct the increased intermetatarsal angle. This article describes a technique for surgical correction of hallux valgus with an increased metatarsal angle, using a 3-incision technique that includes: (1) a medial bunionectomy with capsular imbrication, (2) a lateral soft-tissue release, and (3) a proximal metatarsal osteotomy fixed with a 4-hole L-shaped plate with a wedge spacer.

Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630

BackgroundPosterior tibialis tendon dysfunction (PTTD) is a common cause of foot pain and dysfunction in adults. Clinical observations strongly suggest that the condition is progressive. There are currently no controlled studies evaluating the effectiveness of exercise, orthoses, or orthoses and exercise on Stage I or IIA PTTD. Our study will explore the effectiveness of an eccentric versus concentric strengthening intervention to results obtained with the use of orthoses alone. Findings from this study will guide the development of more efficacious PTTD intervention programs and contribute to enhanced function and quality of life in persons with posterior tibialis tendon dysfunction.Methods/designThis paper presents the rationale and design for a randomized clinical trial evaluating the effectiveness of a treatment regime for the non-operative management of Stage I or IIA PTTD.DiscussionWe have presented the rationale and design for an RCT evaluating the effectiveness of a treatment regimen for the non-operative management of Stage I or IIA PTTD. The results of this trial will be presented as soon as they are available.

An uncommon cause of foot pain: the cuboid insufficiency stress fracture

We report a case of bone insufficiency fracture of the cuboid in a 33-year-old female patient with many risk factors of bone insufficiency: long term steroid treatment for lupus erythematosus, renal failure, hemodialysis since 3 years and severe secondary hyperparathyroidism. Early diagnosis was established using magnetic resonance imaging (MRI), and confirmed 4 months later on radiography, showing typical line of sclerosis perpendicular to bone trabeculae. Literature review shows only few detailed cuboid stress fracture case reports: four cases in young athletes, one case complicating plantar fascia disruption and one case after plantar fasciotomy. Insufficiency fracture of the foot bones involves mainly the metatarsals, the calcaneus, the talus, whereas cuboid location seems exceedingly rare. Physiopathological characteristics of this uncommon fracture are mentioned.

Definition and classification of metatarsalgia

A comprehensive classification of metatarsalgia is proposed, including metatarsalgias caused by systemic or extraregional disease, regional diseases and biomechanical disorders. In accordance with this classification, epidemiological data about metatarsalgia and its causes are given on the basis of 878 cases of metatarsalgia observed during a 1 year office practice. Metatarsalgia is the most frequent cause of foot pain (eight times more frequent than pain elsewhere in the foot in our experience) and a thorough understanding of its multivariate etiology and pathogenesis is of utmost importance for any clinician dealing with foot disorders. This matrix, moreover, offers a tool for classifying all types of metatarsalgia, by means of an alphanumeric system, in a way useful for both analytical and clinical purposes.

Magnetic resonance imaging of the equine foot: 15 horses.

Foot pain is a common cause of equine lameness and there have been significant limitations of the methods available for the diagnosis of the causes of foot pain (radiography, nuclear scintigraphy and ultrasonography). Until recently, magnetic resonance imaging (MRI) in the horse has been limited to examination of cadaver limbs. Our purpose was to 1) describe MRI of the foot in live horses, 2) describe MRI findings in horses with foot pain in which a definitive diagnosis could not be established by alternative means and 3) correlate MRI findings with other methods of clinical investigation. The feet of 15 horses with unilateral (12) or bilateral (3), forelimb (14) or hindlimb (1) lameness associated with foot pain of previously ill-defined origin were examined using MRI. The horses were examined in right lateral recumbency under general anaesthesia, with the feet positioned in the isocentre of a flared end 1.5 Tesla GE Signa Echospeed magnet. Images were obtained in sagittal, transverse and dorsal planes using 3-dimensional (3D) T2* gradient echo (GRE), spoiled gradient echo, fat-saturated 3D T2* GRE and short inversion recovery sequences. Image acquisition took approximately 1 h. Abnormalities of the distal interphalangeal joint (DIP) cartilage and/or subchondral bone, periarticular osteophyte formation, distension of the DIP joint capsule with or without synovial proliferation, distension of the navicular bursa with or without evidence of chronic inflammation, surface and core lesions in the deep digital flexor tendon, abnormal signal within the navicular bone, evidence of mineralised fragments in the distal sesamoidean impar ligament, irregular outline of and signal in the medial cortex of the distal phalanx, and an abnormal signal on the dorsal aspect of the distal phalanx consistent with laminitis were identified. MRI permits the diagnosis of a variety of lesions involving different structures within the foot that cannot be diagnosed using other means, thus enhancing our knowledge of the causes of foot pain. With further experience it is likely that lesions involving other structures will also be identified. Long-term follow-up data is required to determine the prognosis for the injuries described.

Isolated injury of the cuboid bone.

The purpose of this study was to describe isolated injury of the cuboid bone as a potentially radiographically occult cause of foot pain. The imaging studies of 17 patients, 13 women and 4 men aged 17-79 years (average 45 years), who presented with pain over the lateral aspect of the midfoot were retrospectively reviewed. Frontal, lateral, and inversion-oblique radiographs were available for all patients. In addition, MR imaging was performed in eight patients, CT in two, conventional tomography in two, and bone scan in one. Conventional radiographs revealed cuboid fracture in seven patients. Of the remaining ten, eight underwent MR imaging which demonstrated four fractures, three bone bruises, and one stress reaction, and two had tomography, CT, and/or bone scan, all of which documented an isolated cuboid fracture. Isolated fracture of the cuboid may be radiographically occult. Other imaging modalities, particularly MR imaging, can document this injury as the source of pain.

Imaging of an unusual cause of foot pain

We report a case of foot pain and ankle stiffness developing in a patient with bilateral talo-navicular coalition and coalition of the intermediate and lateral cuneiform bones. Although radiographs showed these structural abnormalities, a technetium99mdiphosphonate bone scan provided a physiological assessment, showing areas of raised uptake due to increased metabolic activity at sites of restricted movement. A computerized tomography scan was then performed to further evaluate abnormality in these sites due to developing degenerative change.

Stress fracture of accessory navicular: a rare cause of foot pain

A case of medial foot pain caused by an apparent stress fracture of an accessory navicular is presented in a patient with a long-standing history of flat feet. Radiographs support the diagnosis. After excision of the fractured ossicle the patient was pain free.

Plantar fasciitis: detection with ultrasonography versus bone scintigraphy

Purpose: To compare ultrasonography (US) with three-phase bone scintigraphy (BS) for detection of plantar fasciitis (PF). Materials and methods: Forty-three consecutive patients with a clinical diagnosis of PF were prospectively studied with US and BS. There were 58 symptomatic feet and 28 asymptomatic feet. US positive findings for PF were thickness of the proximal plantar fascia> 3.9 mm (T) and hypoechoic fascia (H). Focal uptake at the medial calcaneus tuberosity in the early and delayed images were used as BS positive findings for PF. Receiver operating characteristic (ROC) methodology was used to analyze the results. Sensitivity, specificity, positive and negative predictive values, and accuracy in diagnosis of plantar fasciitis were calculated for both modalities. Results: The mean area under the ROC curve, indicating successful diagnosis of PF, was 81.6% for BS, 76.5% for T and 81.8% for H (P> 0.25). The sensitivities were 77.6%, 74.1% and 70.7%, respectively for BS, T, and H (P>0.39). The specificity of BS (85.7%) did not differ significantly from the specificity of H (92.9%, p=0.20). Plantar fascia thickness specificity (71.4%) was significantly lower than BS (P =0.038) and H (P =0.0000). There were no statistically significant differences between positive and negative predictive values. Also, in 10 patients (23%), other causes of foot pain were found by BS. Conclusion: US and BS demonstrate no statistically significant difference in ability to demonstrate plantar fasciitis in patients with heel pain.

Foot pain after a plantar fasciotomy: an MR analysis to determine potential causes.

The purpose of this work was to determine potential causes of foot pain in patients who have had a surgical release of the plantar fascia for treatment of fasciitis. We studied 17 patients (15 women, 2 men; age range 22-59 years, mean 40 years) with foot pain after undergoing a fasciotomy. Fourteen unilateral and three bilateral procedures accounted for the 20 ankles evaluated. Mean duration after surgery was 22 months (range 3-53 months). Each patient was instructed to localize the pain to a region of the foot; classify the pain as new onset, persistent, or recurrent; and characterize it as to the action that produced the greatest pain. T1-weighted sagittal and dual-echo T2-weighted images in the sagittal, coronal, and axial planes were obtained in a 1.5 T magnet. The MR studies were evaluated for abnormalities of the plantar fascia, perifascial soft tissues, tendons, and osseous structures. The plantar fascia appeared thick in all ankles (mean 8.0 mm, range 6-12 mm). A total of 25 symptomatic sites were assessed. An acute plantar fascia rupture explained plantar symptoms in two feet. In another 16 feet (12 with plantar heel pain and 4 with nonspecific heel pain), 6 had documentation of acute plantar fasciitis and 9 demonstrated perifascial edema. Of the latter nine feet, five demonstrated abnormalities of the posterior tibialis, peroneus longus, and peroneus brevis tendons. The pain localized to the medial arch in six feet; five feet had abnormalities of the posterior tibialis tendon and one foot demonstrated edema in the flexor digitorum brevis muscle. The pain localized to the lateral midfoot in one foot, which had a cuboid stress fracture. The cause of foot pain in patients who had a plantar fasciotomy appeared to be multifactorial. Three likely causes of pain were identified: persistent or recurrent acute plantar fasciitis, pathology related to arch instability, and structural failure from overload.

Osteochondritis of the Medial Cuneiform

Osteochondritis of tarsal cuneiforms is a rare entity, barely reported in the medical literature. To the nine cases previously reported, we add our series with four cases of bilateral lesion of the medial cuneiform. Medial cuneiform osteochondritis may be the cause of foot pain and limping in children ages 4 to 6 years. In three of our four cases, it was a casual finding in feet being studied for some other problems. Only boys were affected, with bilateral lesions and coexistent navicular injury in half of our cases. Evolution was always satisfactory, with clinical and radiologic resolution in a period ranging from 4 to 72 months, and needing only symptomatic relief.

Clinical features that distinguish tarsal tunnel syndrome from non-neuropathic causes of foot pain

Clinical features that distinguish tarsal tunnel syndrome from non-neuropathic causes of foot pain

Köhler's bone disease of the tarsal navicular.

Fourteen patients with Köhler's bone disease of the tarsal navicular in 16 feet were reviewed at an average follow-up of 31 years 6 months after diagnosis. The type and length of treatment did not affect the final outcome; however, short-leg cast immobilization did decrease the duration of symptoms. Two feet were symptomatic at the time of follow-up: one foot had a talocalcaneal coalition with degenerative changes, and the other foot had a large accessory navicular. Both of these feet were rated as having a fair result. The remaining 12 feet were classified as having a good result. Patients with Köhler's bone disease can be expected to have a normal foot at adulthood. Should the patient become symptomatic, other causes of foot pain should be investigated.

The accessory navicular — An important cause of medial foot pain

The accessory navicular is a commonly occurring accessory ossicle of the foot. In most instances this is an incidental finding. In some patients, the accessory navicular is the direct cause of foot pain. We present 10 such cases. The typical clinical picture is of a young female patient who presents with chronic or acute on chronic medial foot pain centered over the medial side of the navicular. The patient is usually physically active on her feet and localizes the pain accurately. Plain radiography reveals an accessory navicular united to the navicular by a synchondrosis (Type II). The diagnosis can be confirmed by showing increased localized uptake of isotope on a technetium 99m MDP bone scan. In some cases, the accessory navicular is mistaken for a fracture. Awareness of this accessory ossicle causing such symptoms should lead to the correct diagnosis.

Tarsal coalition: An unusual cause of foot pain—Clinical spectrum and treatment in 129 patients

Tarsal coalition is an unusual cause of foot symptoms. The abnormal fusion of tarsal bones is caused by a congenital failure of mesenchyme to differentiate and form joints in the majority of cases. Symptoms from tarsal coalition generally present in the second decade of life when the congenital coalition ossifies and becomes immobile. Patients describe pain and stiffness of the foot and reduced subtalar motion, local tenderness, and pes planus may be found on examination. In the adolescent, symptoms from tarsal coalition are readily recognized, but the diagnosis is frequently delayed in older patients. This is possibly due to physician unawareness that coalition causes foot symptoms in older patients and to overlooking the coalition on plain film radiography. Tarsal coalition has an age-related distribution. The diagnosis should be considered in the patient with chronic foot pain, subtalar stiffness with or without a pes planus deformity.

Osteochondritis of the tarsal second cuneiform bone.

Osteochondritis of the Tarsal Second Cuneiform BonesB. T. Glanville HicksB. T. Glanville HicksThe Clinic, Footscray, Victoria, AustraliaSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/0007-1285-26-304-214SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutAbstractIt is nearly half a century since the first descriptions were forthcoming of the condition now known to us as osteochondritis, or focal aseptic necrosis of the ossific centres of the skeleton. Previous article Next article FiguresReferencesRelatedDetailsCited byMRI findings of intermediate cuneiform osteochondrosis as a rare cause of foot pain in a childRadiology Case Reports, Vol. 15, No. 6Osteochondritis of Intermediate Cuneiform with Delayed Appearance Ossification Centre of Navicular Bone–A Rarity1 January 2018 | Journal of Foot and Ankle Surgery (Asia Pacific), Vol. 5, No. 2Avascular necrosis of the intermediate cuneiform bone in a childJournal of Pediatric Orthopaedics B, Vol. 22, No. 3Osteochondrosis of the Medial Cuneiform Bone in a Child4 January 2013 | Foot & Ankle Specialist, Vol. 6, No. 2An Unusual Cause of Foot Pain in a Child: Osteochondrosis of the Intermediate CuneiformThe Journal of Foot and Ankle Surgery, Vol. 48, No. 4FootOn Osteochondrosis Deformans Juvenilis Capituli Humeri Including Investigation of Intra-Osseous Vasculature in Distal Humerus4 November 2014 | Acta Orthopaedica Scandinavica, Vol. 30, No. sup38Anwendungsbeispiele Volume 26, Issue 304April 1953Pages: 161-216 © The British Institute of Radiology History Published onlineJanuary 28,2014 Metrics Download PDF