Heel Cushion Research Articles

Gait Analysis of the Hemophilic Ankle With Silicone Heel Cushion

Shock absorption becomes very important in damaged joints with destroyed cartilage and progressive muscular imbalance as occurs in hemarthropathy. The effects of silicone heel cushioning on the ankle motion of hemophilic patients in different stages of hemarthropathy of the ankle joints was measured using an ultrasound motion analysis system. It is concluded that silicone heel cushioning has no influence on ankles in the late stage of hemarthropathy. Silicone heel cushioning will lead to uncontrolled changes of the ankle joint in the early hemarthropathic ankle, involving the tibiotalar and the subtalar joints. The angular velocity of the ankle is increased producing higher acceleration at the ankle joint. The higher angle acceleration is related to higher joint loading uncontrolled by the muscles. The resulting uncoordinated motion can cause ligamentous overloading, strains, and a higher probability of joint bleeding. Therefore, silicone heel cushioning or other shock absorbing devices that return the energy immediately to the foot are not useful for prevention and treatment of chronic hemophilic synovitis and may cause additional deterioration of the joint.

Outcome of nonsurgical treatment for plantar fasciitis.

Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis.

Plantar Fasciitis

The objective of this study was to evaluate the efficacy of a tension night splint (TNS) as part of a treatment regimen for the management of plantar fasciitis. The design was a randomized clinical trial. The setting was a university-based primary care sports medicine clinic in California. Forty patients with plantar fasciitis entered the study (age range, 20-74 years; average age, 45.7 years). Excluded from the study were patients with other concomitant ankle or foot pathology. Thirty-two patients (21 women, 11 men) completed the study with 33 treated feet. The patients were randomized to one of two treatment groups. The control group (n = 17) received standard treatment of antiinflammatory medication (Ibuprofen), a Viscoheel sofspot heel cushion (Bauerfeind USA, Kennesaw, GA, U.S.A.) and a stretching program for the gastrocnemius and soleus muscles. The tension night split group (n = 16) received the same standard treatment protocol and additionally an office manufactured custom fitted posterior splint to be used at night. Those patients in the control group not responding to treatment after 8-12 weeks were crossed over to the tension night splint group. Patients were reviewed every 4 weeks for symptom assessment and compliance. The main outcome measures were subjective assessment of pain (Visual analogue scale), plantar fascial tenderness, and ankle range of motion. Patients were discharged from either arm of the trial when they had resumed normal activities with minimal or no discomfort. This end point was recorded as weeks to cure. There was no significant difference in the demographics of the two groups (p > 0.05). In the control group, 6 of 17 were cured after an average interval of 8.8 weeks. The remaining 11 of 17 control group patients were crossed over to receive a TNS in addition to control modalities. Following cross over 8 of 11 of this group were cured after an average of 13 weeks. Three of the 11 failed to significantly respond. Of the 15 patients (16 feet) originally randomly assigned to the TNS group 16 of 16 were cured with an average treatment time of 12.5 weeks. The TNS treatment protocol was a significantly more efficacious treatment regime (p < 0.05). Thus, of 33 cases of plantar fasciitis treated in this study three failed treatment. When used in combination with a visco-elastic heel pad, stretching program and nonsteroidal anti-inflammatory drugs, the TNS is an effective treatment of plantar fasciitis.

Perceived Differences in Running and Walking Shoes

Designers rely heavily on the past sales history of a particular shoe when attempting to make decisions regarding shoe characteristics of future shoes. Cushioning devices made of air, “super” gases, energy return rubber, and gel's have become popular. However, the question that needs to be asked is whether these devices are truly functional or whether they are primarily of aesthetic value. Shoe qualities such as cushioning, comfort, stability, shock absorption, and energy return play an important role during athletic activity. It is also known that the above mentioned characteristics have significant interactions with each other. Hence it is important to know the relevance of these interactions when designing shoes for a particular activity. The primary goal of this study was to investigate the interaction and relevance of shoe properties during running and walking. Four specially fabricated shoes were used in the study. The results indicate the following: • Heel cushioning and shock absorption play an important role in the overall cushioning of a midsole. • Runners perceive shoe-heel cushioning somewhat differently from those who use shoes for walking. • Heel cushioning during running seems to be influenced by shock absorption, stability and possibly rebound. • Heel cushioning during walking seems to be influenced by shock absorption and possibly rebound. Hence a good running shoe can in most cases satisfy the biomechanical needs during walking.

Human elasticity

The elasticity of the Achilles tendon and of the arch of the foot saves energy in running, enabling us to bounce along like rubber balls. Also the elastic compliance of the heel cushions impacts with the ground.

Painful heel syndrome: results of nonoperative treatment.

One hundred five patients (70% female and 30% male; average age, 48 years) with 132 symptomatic heels were treated according to a standard nonoperative protocol and then reviewed at an average follow-up of 29 months. The treatment protocol consisted of nonsteroidal anti-inflammatory medications, relative rest, viscoelastic polymer heel cushions, Achilles tendon stretching exercises, and, occasionally, injections. Obesity, lifestyle (athletic versus sedentary), sex, and presence or size of heel spur did not influence the treatment outcome. Ninety-four patients (89.5%) had resolution of heel pain within 10.9 months. Six patients (5.7%) continued to have significant pain, but did not elect to have operative treatment, and five patients (4.8%) elected to have surgical intervention. Despite attention to the outcome of surgical treatment for heel pain in the current literature, initial treatment for heel pain is nonoperative. The treatment protocol used in this study was successful for 89.5% of the patients.

Balance in lower limb child amputees.

Postural stability of five unilateral above-knee amputee children was measured when wearing the SACH and the experimental Child Amputee Prosthetic Project (CAPP) prosthetic foot. Excursions of the centre of pressure of the supportive forces were recorded via force platform during sustained weight-shifting forward, backward, left, right, and during normal standing. Visual proprioception effects on upright stance were also demonstrated with these child amputees. Total base of support did not differ for the two types of prosthetic feet, but the functional base of support for SACH foot was significantly larger than CAPP. Fluctuations of centre of pressure about a mean position in normal standing were less when children used CAPP foot. Focusing on a static target had no effect on postural stability in either anterior-posterior or lateral direction for CAPP foot conditions, but lack of visual target had a deleterious effect on lateral stability when SACH foot was worn. Balance is one of the most difficult problems for a lower limb amputee (Hellebrandt et al, 1950; Moncur, 1969; Murdoch, 1969). The absence of part or all of a lower limb reduces the amount of proprioceptive information about the surfaces on which the foot is resting and the precise location of the prosthetic limb. While limited data have been reported on the balance and stability characteristics of adult amputees (Fernie and Holliday, 1978; Hellebrandt et al, 1950), information about balance of child amputees is almost non-existent. We have found only one report of the postural stability characteristics of a child amputee; Shambes and Waterland (1970) studied an 11-year-old quadrilateral amputee who had congenital Lisfranc amputations of both lower limbs, long above-elbow amputation of the left upper limb, and medium below-elbow amputation of the right upper limb. The purpose of this study was to detail the postural stability characteristics for lower limb child amputees. In addition, the conventional SACH prosthetic foot was compared with the experimental Child Amputee Prosthetic Project (CAPP) foot for various postural tasks. The SACH foot (Fig. la) is usually constructed with a moulded polyurethane material which incorporates a heel cushion to allow some compression of the heel during heel strike in walking to simulate plantar flexion of a normal foot. The CAPP foot (Fig. lb) is an experimental prosthesis undergoing development at the UCLA Child Amputee Prosthetic Project. It is designed to provide more knee stability during early stance phase during walking and also to respond to torsional loads occurring in the stance phase of walking. The heel projection of the CAPP foot is non-weight bearing and deflects upward at heelstrike. With the ground reaction forces shifted more anteriorly on the supporting foot there is an expected increase in dynamic knee stability during the stance phase of walking. While additional research is being conducted on the dynamic characteristics of the CAPP foot, the present study provides some preliminary information about the postural stability of child amputees using the experimental CAPP foot, as well as providing a comparison with the conventional SACH foot.

Heel cushion on operating table.

Heel cushion on operating table.

Heel Cushion for Use on the Operatingtable

Heel Cushion for Use on the Operatingtable

Heel Cushion for Use on the Operating-table

Heel Cushion for Use on the Operating-table

Points from Letters: Heel Cushion for Use on Operating-table

Points from Letters: Heel Cushion for Use on Operating-table

Heel cushion for use on the operating-table.

Heel cushion for use on the operating-table.