Heel Pad Research Articles

Effectiveness of joint mobilization on heel fat pad syndrome among obese patient in geriatric population

Objective. To determine the effect of joint mobilization on Heel Fat Pad Syndrome among obese geriatrics. Methods. The randomized controlled study was performed at the Saveetha Physiotherapy OPD, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India. 202 samples aged above 60 years were collected based on the criterion for inclusion and exclusion. Interventions. The experimental Group (101Subjects) was treated with Ultrasound and Joint Mobilization. The Control Group (101 Subjects) was treated with Ultrasound and conventional Exercises. The lifestyle and Balance Assessment used the Foot Function Index and Berg balance scale. A numeric Pain Rating Scale was used to measure Pain. Results. The Wilcoxon Signed Rank Test revealed a significant difference (p < 0.001) in the experimental Group between the pre-test and post-test values of NPRS, FFI, and BBS. Similarly, the Control Group showed a significant difference (p < 0.001) in the pre-test and post-test values of NPRS, FFI, and BBS. The comparison of post-test scores between the Experimental Group and the Control Group also showed a significant difference (p < 0.001), indicating significant improvements in the experimental group. As a result, the effects of Joint Mobilization on Heel Pad Syndrome minimize the symptoms of heel fat pad syndrome, Improve Foot Function and balance and reduce pain. Conclusion. The study provided evidence that ultrasound and joint mobilization used in this study show a significant reduction in pain and balance with non-specific heel pain.

Texture differences of microchambers and macrochambers in heel pads between the elderly with and without diabetes

ObjectiveThis study aims to use the texture analysis of ultrasound images to distinguish the features of microchambers (a superficial thinner layer) and macrochambers (a deep thicker layer) in heel pads between the elderly with and without diabetes, so as to preliminarily explore whether texture analysis can identify the potential injury characteristics of deep tissue under the influence of diabetes before the obvious injury signs can be detected in clinical management. MethodsUltrasound images were obtained from the right heel (dominant leg) of eleven elderly people with diabetes (DM group) and eleven elderly people without diabetes (Non-DM group). The TekScan system was used to measure the peak plantar pressure (PPP) of each participant. Six gray-level co-occurrence matrix (GLCM) features including contrast, correlation, dissimilarity, energy, entropy, homogeneity were used to quantify texture changes in microchambers and macrochambers of heel pads. ResultsSignificant differences in GLCM features (correlation, energy and entropy) of macrochambers were found between the two groups, while no significant differences in all GLCM features of microchambers were found between the two groups. No significant differences in PPP and tissue thickness in the heel region were observed between the two groups. ConclusionsIn the elderly with diabetes who showed no significant differences in PPP and plantar tissue thickness compared to those without diabetes, several texture features of ultrasound images were found to be significantly different. Our finding indicates that texture features (correlation, energy and entropy) of macrochambers could be used for early detection of soft tissue damage associated with diabetes.

A dynamic foot model for predictive simulations of human gait reveals causal relations between foot structure and whole-body mechanics.

The unique structure of the human foot is seen as a crucial adaptation for bipedalism. The foot's arched shape enables stiffening the foot to withstand high loads when pushing off, without compromising foot flexibility. Experimental studies demonstrated that manipulating foot stiffness has considerable effects on gait. In clinical practice, altered foot structure is associated with pathological gait. Yet, experimentally manipulating individual foot properties (e.g. arch height or tendon and ligament stiffness) is hard and therefore our understanding of how foot structure influences gait mechanics is still limited. Predictive simulations are a powerful tool to explore causal relationships between musculoskeletal properties and whole-body gait. However, musculoskeletal models used in three-dimensional predictive simulations assume a rigid foot arch, limiting their use for studying how foot structure influences three-dimensional gait mechanics. Here, we developed a four-segment foot model with a longitudinal arch for use in predictive simulations. We identified three properties of the ankle-foot complex that are important to capture ankle and knee kinematics, soleus activation, and ankle power of healthy adults: (1) compliant Achilles tendon, (2) stiff heel pad, (3) the ability to stiffen the foot. The latter requires sufficient arch height and contributions of plantar fascia, and intrinsic and extrinsic foot muscles. A reduced ability to stiffen the foot results in walking patterns with reduced push-off power. Simulations based on our model also captured the effects of walking with anaesthetised intrinsic foot muscles or an insole limiting arch compression. The ability to reproduce these different experiments indicates that our foot model captures the main mechanical properties of the foot. The presented four-segment foot model is a potentially powerful tool to study the relationship between foot properties and gait mechanics and energetics in health and disease.

Variable gearing at the ankle during walking in adults and young children: implications for foot development and evolution

Introduction: The human foot has evolved over the past seven million years from a relatively mobile, grasping appendage to a highly derived structure with a heel pad and longitudinal arch that can absorb shock at heel strike and weight-bearing yet also function as a powerful lever at toe-off. It has been proposed that the modern human foot evolved to allow our species to use “variable gearing” during walking and running. In this model, the gears of the human foot are defined relative to the ankle center of rotation as R, the distance from the ground reaction resultant vector, and r, the distance from the calf muscle vector. The gear ratio defines the torque generated to propel the body or stretch the triceps surae muscles. We test the hypothesis that variable gearing is associated with modern human pedal anatomy and a heel-to-toe rollover that allows a shift from “low gear” to “high gear” during stance.Methods: Using force plate and video analysis, we examined variable gearing in adults and children engaging in adult heel strike (AHS = 35), flat foot contact (FFC = 39), or initial heel contact (IHC = 26).Results and Discussion: Our hypothesis was partly supported. Although variable gearing was observed in IHC steps and was greater than in FFC steps, it was not as developed as in AHS steps. This may be related to anatomical and motor control differences between juvenile and adult feet, suggesting that adult anatomy, including a high arch, and neural control are critical for full use of variable gearing and that this feature would have evolved in later hominins around two million years ago with the appearance of a fully modern foot.

PLANTAR STRUCTURES IN RELATION TO A STRAIGHT RETROGRADE HIND FOOT (RHF) NAIL INSERTED THROUGH A MIDLINE HEEL PAD APPROACH: A CADAVERIC STUDY

BackgroundRHF nail is an important tool for simultaneous ankle and subtalar joint stabilisation +/− fusion. Straight and curved RHF nails are available to use, but both seem to endanger plantar structures, especially the lateral plantar artery and nerve and Baxter's nerve.There is a paucity of literature on the structures at risk with a straight RHF nail inserted along a line bisecting the heel pad and the second toe (after Stephenson et al). In this study, plantar structures ‘at risk’ were studied in relation to a straight nail inserted as above.MethodsRe-creating real-life conditions and strictly following the recommended surgical technique with regards to the incision and guide-wire placement, we inserted an Orthosolutions Oxbridge nail into the tibia across the ankle and subtalar joints in 6 cadaveric specimens. Tissue flaps were then raised to expose the heel plantar structures and studied their relation to the inserted nail.ResultsThe medial plantar artery and nerve were always more than 10mm away from the medial edge of the nail, while the Baxter nerve was a mean 14mm behind. The lateral plantar nerve was a mean 7mm medial to the nail, while the artery was a mean 2.3mm away with macroscopic injury in one specimen. The other structures ‘at risk’ were the plantar fascia and small foot muscles.ConclusionLateral plantar artery and nerve are the most vulnerable structures during straight RHF nailing. The risk to heel plantar structures could be mitigated by making incisions longer, blunt dissection down to bone, meticulous retraction of soft tissues and placement of the protection sleeve down to bone to prevent the entrapment of plantar structures during guide-wire placement, reaming and nail insertion.

Comparison of the effectiveness of peloid therapy and kinesiotaping in patients with unilateral plantar fasciitis: A prospective, randomized controlled study.

This study aimed to compare the efficacy of peloid therapy and kinesiotaping for unilateral plantar fasciitis (PF). In the randomized controlled study, a total of 114 patients (89 females, 25 males; mean age: 45.1±8.3 years; range, 27 to 65 years) diagnosed with unilateral PF between January 2021 and March 2023 were randomly divided into three equal groups: the peloid group (peloid therapy and home-based exercise + heel pad), the kinesiotaping group (kinesiotaping and home-based exercise + heel pad), and the control group (home-based exercise + heel pad). Peloid therapy was performed over two weeks for a total of 10 sessions. Kinesiotaping was applied four times over two weeks. Plantar fascia, calf, and Achilles stretching exercises and foot strengthening exercises were performed, and prefabricated silicone heel insoles were used daily for six weeks. Patients were evaluated three times with clinical assessment scales for pain, the Heel Tenderness Index, and the Foot and Ankle Outcome Score before treatment, at the end of treatment, and in the first month after treatment. Statistically significant improvements were observed for all parameters at the end of treatment and in the first month after treatment compared to the baseline in every group (p<0.001). No superiority was found between the groups. Peloid therapy or kinesiotaping, given as adjuncts to home-based exercise therapy and shoe insoles in patients with unilateral PF, did not result in additional benefits.

A modern approach to the treatment of scoliosis with skewed pelvic bones by correcting asymmetric mobile planovalgus deformity of the feet

Introduction. The treatment of combined pathology of posture and feet remains an urgent problem of the child population.Target. To study the effectiveness of using an individually made wedge-shaped corrective heel pad for each foot in the treatment of grade I-II scoliosis with pelvic bone distortion due to asymmetric mobile flat-valgus deformity of the feet for 3 years.Object and methods. A comparison group and a main group were formed from 39 children and adolescents aged 3 to 15 years with grade I-II scoliosis with skewed pelvic bones and mobile flat-valgus deformity of the feet; patients underwent orthopedic examination every 6 months, radiography of the spine with pelvic bones, photoplantography, measurement of the pronation angle of the calcaneus, the study of quality of life indicators.Results. There was a decrease in clinical symptoms in 54.2 % of patients of the main group with regression of the II degree of scoliosis to the I degree, the pronation angle of the calcaneal bones decreased by 4.25 ± 0.78 ° with the preservation of minimal asymmetry after 3 years, a decrease in the difference of the iliac crests by 3 .64 ± 1.59 mm and the angle of scoliotic deformity of the spine on radiographs by 5.22 ± 1.36°. Correlation analysis showed a statistically significant strong and moderate direct relationship between the pronation angle of the left calcaneus and the angle of scoliotic spinal deformity on radiographs in the 1st and 3rd years of the study, as well as with the difference in the iliac crests throughout the study. The quality of life of patients of the main group with correction of the asymmetry of foot hyperpronation improved by 15.5 %, in the comparison group by 2.9 %.Conclusions. The results of the study confirmed the effectiveness of the use of individual wedge-shaped corrective heel pads for each foot in the treatment of grade I-II scoliosis with skewed pelvic bones due to asymmetric mobile flat-valgus deformity of the feet.

Mechanical Behaviour of Plantar Adipose Tissue: From Experimental Tests to Constitutive Analysis.

Plantar adipose tissue is a connective tissue whose structural configuration changes according to the foot region (rare or forefoot) and is related to its mechanical role, providing a damping system able to adsorb foot impact and bear the body weight. Considering this, the present work aims at fully describing the plantar adipose tissue's behaviour and developing a proper constitutive formulation. Unconfined compression tests and indentation tests have been performed on samples harvested from human donors and cadavers. Experimental results provided the initial/final elastic modulus for each specimen and assessed the non-linear and time-dependent behaviour of the tissue. The different foot regions were investigated, and the main differences were observed when comparing the elastic moduli, especially the final elastic ones. It resulted in a higher level for the medial region (89 ± 77 MPa) compared to the others (from 51 ± 29 MPa for the heel pad to 11 ± 7 for the metatarsal). Finally, results have been used to define a visco-hyperelastic constitutive model, whose hyperelastic component, which describes tissue non-linear behaviour, was described using an Ogden formulation. The identified and validated tissue constitutive parameters could serve, in the early future, for the computational model of the healthy foot.

Evolution of friction couples in volume hydraulic machines due to achievements in material science and technology

The article analyses modern achievements in the field of volumetric axial and radial piston hydraulic machines for the mobile sector of application in terms of using the latest design solutions, friction pair materials and technologies. Goal. The aim is to acquaint specialists with directions for creating hydraulic machines of a modern technical level due to increased pressure and rotation frequency. Methodology. The evolution of constructive decisions regarding the selection of pairs of rolling and sliding friction and their change depending on the achievements in materials science, tribology and increasing the accuracy of machines for the finishing of friction surfaces are consistently considered. Results. It is shown that in axial-piston hydraulic machines with an inclined disk, the transition to hydrostatic piston pairs with heel pads was made, which made it possible to increase the pressure up to 52 MPa. In radial-piston high-torque multi-cycle hydraulic motors, almost all manufacturers have replaced the rolling friction piston pairs with sliding pairs due to the latest anti-friction materials and precision processing. Thus, the ratio of mass to power decreased almost 6 times. For radial-piston hydraulic transmissions with ball-pistons, a failure analysis was performed, respectively, regarding the materials used, quality and control of heat treatment. Originality and practical value. For promising high-speed hydraulic transmissions with ball-pistons, recommendations have been developed for the selection of steels and control of their manufacture on the basis of taking into account materials science tools. The work in the production of piston balls from ceramic materials are offered. The given informative and practical research results are planned to be taught to master's students in the discipline of "Design and Testing of Hydraulic Drives of Construction and Road Vehicles" at KhNAHU.

Model computation and biomechanical measurements of running shoes

The design of running shoes is mainly to reduce mechanical stress through the deformation of the viscoelastic midsole, which is usually made of ethylene vinyl acetate (EVA) foam. This study aims to analyze and compute the heel pad stresses through simulated strikes. For stresses and strains, a non-linear model and its dierential equation (Eq.1) is reported. Through repeated measure ANOVAs, analyses and comparisons of the three methods for non-linear computation are made. Then detailed numerical approximations of a dierential equation are derived using Eulers method. In addition, Dinato reported biomechanical measures results for Air (Nike), Gel (Asics), and Adiprene (Adidas). The results are compared to simulated data correspondingly. The measured stresses (peak pressure, kPa) are 242.7 40.8, 239.5 420.0, and 246.5 51.6 respectively. The computed boundary stress is 55 kPa. These show signicant associations between the simulated and measured stress.

Effects of extreme cyclic loading on the cushioning performance of human heel pads under engineering test condition.

Human heel pads commonly undergo cyclic loading during daily activities. Low cyclic loadings such as daily human walking tend to have less effect on the mechanical properties of heel pads. However, the impact of cyclic loading on cushion performance, a vital biomechanical property of heel pads, under engineering test condition remains unexplored. Herein, dynamic mechanical measurements and finite element (FE) simulations were employed to explore this phenomenon. It was found that the wavy collagen fibers in the heel pad will be straightened under cycle compression loading, which resulted in increased stiffness of the heel pad. The stiffness of the heel pads demonstrated an inclination to escalate over a span of 50,000 loading cycles, consequently resulting in a corresponding increase in peak impact force over the same loading cycles. Sustained cyclic loading has the potential to result in the fracturing of the straightened collagen fibers, this collagen breakage may diminish the stiffness of the heel pad, leading to a reduction in peak impact force. This work enhances understanding of the biomechanical functions of human heel pad and may provide potential inspirations for the innovative development of healthcare devices for foot complex.

Radiographic and functional outcome of operated closed intra-articular fractures of calcaneum: a retrospective analysis

Background: The present study aims to analyse the results of surgical outcome of the operated calcaneal fractures using either plates or cannulated cancellous screws. Recently there has been considerable shift of treatment of calcaneal fractures from conservative to operative owing to better understanding of fracture pattern. However, reduction of long-term functional outcome of such patients is always questionable and remains unanswered. Methods: A 25 fractures were operated with locking plates or cannulated screws after proper assessment. Functional assessment was done using AOFAS scoring system. Radiological outcome was assessed using restoration of Bohler and Gissane angle. Results: The results were extrapolated as excellent in 20 patients, good in 3 patient's and poor result in 2 patients. Statistical analysis revealed better outcomes in percutaneous cannulated screw fixation as compared to open plate fixation. 6 patients had to undergo implant exit of which 5 were cannulated screw backout, prominence irritating the soft tissue and 1 plate removal had to be done because of infection. None of the patients had subtalar arthritis, heel pad problems, peroneal tendinitis or implant failure. Conclusions: Surgical management in the treatment of choice for intra articular calcaneal fractures after thorough evaluation. The choice of implant depends upon the communition of fracture, soft tissue compromise, joint surface incongruity and surgical expertise. Radiological maintenance of Bohler and Gissane angle intraoperatively and at follow up is a good indicator for predicting functional outcomes score.

Clinical, Metabolic, and Radiological Risk Factors in Individuals With Plantar Heel Pain From a South Indian Population: A Cross-Sectional Observational Study.

Background One of the most common conditions seen in an orthopedic outpatient clinic is plantar heel pain (PHP). Studies analyzing various risk factors and their association with the development of PHP have been performed primarily in the Caucasian population, and no study has noted any association between the magnitude of various risk factors and their correlation to theseverity of PHP. Hence, we performed a prospective cross-sectional observational study in a select South Indian population presenting with PHP to a tertiary care center. Methods All adult patients presenting to the orthopedic OPD between July 2019 and July 2020 were screened for unilateral PHP and were included after meeting the eligibility criteria. Age, sex, body mass index (BMI), random blood sugar (RBS), uric acid, thyroid-stimulating hormone (TSH), and vitamin D3 were measured as demographic and metabolic parameters. Heel pad thickness, calcaneal spurs, and plantar fascial thickness were noted radiographically. Clinically, the wall-toe distance by weight bear lunge test of each foot was noted, and the severity was measured by the foot functional index (FFI). Results Among the 40 participants, the mean age was 44 (±10.9) years. The average BMI was 30.1 (27.02-32.95). No significant association was noted between the biochemical parameters and the occurrence of PHP. The plantar fascial thickness (PFT) and heel pad thickness (HPT) were thicker than the asymptomatic foot by 1.01 (0.60 - 1.30) mm and 0.79 (0.4-1.7) mm, respectively, which was statistically significant (p<0.001). The heel cord length was found to be reduced by 0.86 (0.6-1) cms, which was statistically significant (p<0.001). The average FFI score was 123.07 (±15.57), and the FFI score percentage in individuals was 53.5% (±6.77).None of the above risk factors showed any significant correlation to the intensity of clinical symptoms measured by FFI (p>0.05). Conclusion Participants had a high BMI and a higher percentage of females. There was a significant increase in PFT and HPT thicknessand a significant reduction in gastrocnemius flexibility when compared to the asymptomatic foot. There was no significant association between various clinical, metabolic, and radiological risk factors and the intensity of plantar fasciitis measured by FFI.

A fluoroscopic imaging-guided computational analyses to inform internal tissue loads within fat pad of the diabetic foot during gait

To accurately predict internal tissue loads for early diagnostics of diabetic foot ulcerations, a novel data-driven computational analysis was conducted. A dedicated dual fluoroscopic system was combined with a pressure mat to simultaneously characterize foot motions and soft tissue’s material properties during gait. Finite element (FE) models of the heel pad of a diabetic patient were constructed with 3D trajectories of the calcaneus applied as boundary conditions to simulate gait events. The tensile and compressive stresses occurring in the plantar tissue were computed. Predictions of the layered tissue FE model with anatomically-accurate heel pad structures (i.e., fat and skin) were compared with those of the traditional lumped tissue (i.e., homogeneous) models. The influence of different material properties (patient-specific versus generic) on internal tissue stresses was also investigated. The results showed the peak tensile stresses in the layered tissue model were predominantly found in the skin and distributed towards the circumferential regions of the heel, while peak compressive stresses in the fat tissue-bone interface were up to 51.4% lower than those seen in the lumped models. Performing FE analyses at four different phases of walking revealed that ignorance of layered tissue structures resulted in an unphysiological increase of peak-to-peak value of stress fluctuation in the fat and skin tissue components. Thus, to produce more clinical-relevant predictions, foot FE models are suggested to include layered tissue structures of the plantar tissue for an improved estimation of internal stresses in the diabetic foot in gait.

Adult Traumatic Heel Pad Avulsion Repair with Polydioxanone Suture, Sterile Buttons, and Wound Vac-Assisted Closure: A Case Report.

A 28-year-old woman with no medical history involved in a motor vehicle collision presented with deformity of the right leg and traumatic right heel pad avulsion. Radiographs demonstrated a right foot mid-tarsal fracture-dislocation, open cuboid, closed right tibia, and segmental fibula fractures. The heel pad was repaired using polydioxanone suture in a quilted technique with sterile buttons. At 1-year follow-up, the patient's heel pad was well-fixed with intact sensation and no pain. Repair of a heel pad avulsion using this novel technique is a versatile and cost-effective method that reduces concern for tissue necrosis associated with suture repair.

Pattern and Presentation of Pediatric Spoke Wheel Entrapment Injuries: Our Hospital Experience

Objective: Finding out how often and how severely kids get their feet caught in the spokes of motorcycle wheels, and what it means for treatment options. Study design: A cross-sectional study Place and Duration: This study was conducted in Ibn-e-Sina University, Muhammad Medical College and Hospital Mirpurkhas from February 2022 to February 2023. Methodology: The study included children who had sustained motorbike spoke wheel injuries after getting their feet entrapped in it. The children were assessed for the severity of the injury as well as the location of the injury. The classification of the injuries was done according to the Tscherne and Oestern classification and graded as 0, I, II, and III. Complete history of the patients was taken followed by a physical examination. After that, relevant investigations were ordered such as radiographs and laboratory investigations. Results: The total number of participants in the present study was 115. The mean age of the participants was 8.62±7.23 years. There were 85 (73.91%) male and 30 (26.09%) female. A total of 78 (67.83%) patients had their right feet injured and 37 (32.17%) patients had their left feet injured. Injury of grade 0 was documented in 17 (14.78%), grade I in 33 (28.69%), grade II in 42 (36.52%) patients, and grade III in 23 (20%) patients. The most common area to get injured in the accident was the heel pad and it was affected in 63 (54.78%) patients. Rupture of the tendon was seen in 11 (9.56%) patients. Fracture of bone was seen in 9 (7.82%) children and only 1 (0.86%) children suffered from neurovascular injury. Conclusion: Injury because of the Motorbike spoke wheel results in different patterns causing multiple levels of damage to tissues and even fractures. Nonetheless, most injuries are related to soft-tissues loss. The most commonly injured area is the heel pad. Phalanges and calcaneus were commonest injured bones. Keywords: Spoke wheel, Motorbike, Fracture, Heel pad, Tscherne and Oestern

Arterialization of plantar venous system via vein graft: A novel technique for reconstruction of heel pad degloving injuries

BackgroundPatients with heel pad degloving injury frequently develop ischemic necrosis of the area, necessitating soft-tissue reconstruction surgery. We have developed a technique for arterialization of the plantar venous system via vein graft (APV) as the primary revascularization treatment. The objective of this study was to clarify both the utility of APV for the preservation of degloved heel pads and the impact of this preservation on clinical outcomes. MethodsTen consecutive cases of degloving injury with devascularized heel pad were treated at a single trauma center from 2008 to 2018. Five cases underwent APV and five underwent conventional primary suture (PS) as the initial treatment. We evaluated the course according to the frequency of heel pad preservation, additional intervention after heel pad necrosis, post-operative complications, and outcomes using the Foot and Ankle Disability Index score (FADI) at the time of last follow-up. ResultsAmong the five cases that underwent APV, the heel pad was preserved in three cases and flap surgery was required in two cases. All cases that underwent PS developed necrosis of the heel pad, requiring skin graft in one case and flap surgery in four. One skin graft case and one free flap case after PS developed plantar ulcers. The three cases with preserved heel pads exhibited higher FADI than the seven cases that developed necrosis. ConclusionAPV showed a relatively high frequency of heel pad preservation, which otherwise was uniformly lacking. Functional outcomes were improved in cases with preserved heel pad compared to those that developed necrosis and underwent additional tissue reconstruction.

Rehabilitation Challenges in Orthotic Offloading with Dual Disability Involving Bilateral Lower Limbs with Right Transtibial Amputation for Charcot Joint, Left Neuropathic Foot of Hereditary Motor and Sensory Neuropathy Aetiology

Orthotic management of offloading neuropathic foot in hereditary motor and sensory neuropathy (HMSN) is challenging due to motor, sensory and functional deficits which may interfere with weight distribution over the foot. The challenge further becomes difficult with the involvement of the contralateral lower limb with below-knee amputation. This study is regarding challenges in offloading, weight transmission and distribution during the stance phase of gait in the case of a 35-year-old female with a left neuropathic foot due to HMSN with concomitant right transtibial amputation. The energy expenditure and cosmetic issues for the right lower limb and aiming for maximum functional conservation of the left foot, were considered by taking into account the heel pad thickness measured by musculoskeletal ultrasound, dynamic plantar pressure measured by footplate pressure measurement, the integrity of the ankle joint mobility and stability by clinical assessment, the electrophysiological status of the neuropathic foot by nerve conduction study and the weight-bearing capability of the right below-knee stump. The following management measures are planned for effective offloading with therapeutic footwear modification with silicone gel cushion heel and insole and rocker bottom outsole as an alternative to conventional weight-relieving calliper in a government tertiary care set-up, thereby conserving the foot function and morphology. This will help in planning a structured rehabilitation programme which will be beneficial in preventing future foot changes including trophic ulceration and subsequent amputation. Case follow-up after patient education and assessment of disease progression in each visit is being done. A better outcome in terms of quality of life and level of independent ambulation with concomitant bio-functionality of the left neuropathic foot was accomplished with community ambulation.

Tibiotalocalcaneal Arthrodesis with Intramedullary Fibular Strut Graft and Adjuvant Hardware Fixation.

Tibiotalocalcaneal Arthrodesis with Intramedullary Fibular Strut Graft and Adjuvant Hardware Fixation.

Ultrasonographic Assessment of Indian Patients With Plantar Fasciitis and Its Clinical Correlation: A Prospective Observational Study.

Plantar fasciitis is a debilitating clinical condition and is one of the most common causes of heel pain. The risk factors include frequent and prolonged running, obesity, a sedentary lifestyle, work-related weight bearing, and inappropriate footwear. Ultrasonography being a non-invasive, cost-effective, and easily available modality is a useful adjunct in the diagnosis. A prospective observational study was conducted among 30 patients with unilateral plantar fasciitis. The diagnosis was based on history and examination. Heel pad thickness and plantar fascia thickness were recorded using ultrasonography. The ultrasonography results showed increased plantar fascia and heel pad thickness in the affected limb with plantar fasciitis than the normal one (p<0.001). The BMI was positively correlated with the heel pad thickness (p<0.05). The receiver operating characteristic (ROC) curve showed 90% sensitivity and 60% specificity for heel pad thickness (p<0.001). Ultrasonography is a sensitive and specific tool to identify patients with plantar fasciitis.