Mean Plantar Research Articles

Cannulated screws versus nitinol staple for tarsometatarsal fusion: A cadaveric biomechanical comparison model

BackgroundThe objective of this study was to evaluate the biomechanical stability of a medially placed nitinol staple compared to two crossed-screws in the first TMT-1 joint fusion in a cadaveric cyclic loading model. MethodsSeven matched pairs (N = 7) of lower limb cadaveric specimens were utilized. TMT-1 joints from each donor were fixed with a medially placed nitinol staple or dorsally placed two 3.5 mm partially threaded cannulated crossed-screws. Specimens were tested in a 4-point bending setting with increasing cyclic forces. ResultsThe mean plantar gapping was not significantly different between the two groups at any loading stage below 200 N. Specimens fixed with a nitinol staple failed at a mean load of 305 ± 57 N. Conversely, those fixed with crossed-screws failed at 373 ± 86 N. (P = .09). ConclusionThere was no statistical difference between a medially placed nitinol staple and dorsally placed crossed-screws in failure loads and plantar gapping under cyclic loads at the TMT-1 joint, however, the staple fixation was much more variable. Level of evidenceLevel V, basic science study, biomechanics

Distal osteotomy of the first metatarsal bone for the correction of hallux valgus: comparison of the sagittal stability of two percutaneous techniques—a cadaveric study

BackgroundDistal first metatarsal osteotomy is used to correct mild or moderate hallux valgus (HV). We designed a cadaveric study to compare the resistance to axial load between two percutaneous distal first metatarsal osteotomies: Bösch osteotomy and percutaneous chevron. The first aim of this study was to develop a systematic technique for measuring the sagittal displacement on lateral foot X-rays. Our second objective was to measure the resistance to axial load for both of these osteotomies.MethodsTen pairs of freshly frozen cadaveric feet were randomly assigned to one of the two techniques investigated. Pre- and post-operative lateral X-rays were obtained. After surgery, the feet were placed under progressive axial loads up to 60 kg. Metaphyseo-diaphyseal angle (MDA) and the distance between bone fragments were measured, and the differences between the two techniques were statistically assessed.ResultsThe MDA decreased in both surgical techniques. The mean plantar tilt was −6.90 degrees (SD = 10.251) for chevron osteotomy and −5.34 degrees (SD = 16.621) for Bösch osteotomy. There was no significant difference between the techniques (p = 0.41).Regarding the distance between the bone fragments, the Bösch osteotomy produced more plantar displacement than the chevron osteotomy, which was statistically significant for the 10 and 20 kg loads (p = 0.031 and 0.04, respectively). At loads ≥ 30 kg, the bone fragment distance did not differ significantly between the techniques (p = 0.114).ConclusionsAlthough the chevron technique confers higher stability regarding fragment displacement during axial loading, both techniques increase the plantar angulation of the metatarsal head.Level of evidenceCadaveric study. Level V.

Effect of Age and BMI on Sonographic Findings of Plantar Fascia

Biomechanical dysfunction of the foot is most common cause of plantar fascia disorder and obesity and increasing age are well-known risk factors. Due to being inexpensive and quick, ultrasound imaging techniques are considered the modality of choice to assess plantar fascia. The aim of this study was to investigate the effect of age and body mass index (BMI) on sonographic findings of plantar fascia in normal population. Ultrasonography was used to measure the plantar fascia thickness of 148 healthy adults (54 males, 36.5% and 94 females, 63.5%) during a period of one year. The age, BMI, and walking distance of each participant were recorded and statistically analyzed. The mean plantar fascia thicknesses at 0.5, 1.0, and 2.0 cm distal to the insertion of the plantar fascia were 1.76 ± 0.32 mm, 2.50 ± 0.50 mm and 2.11 ± 0.41 mm respectively. The mean plantar fascia thickness for individuals ≥45 years and BMI ≥25 were significantly higher (p < .001) compared to individuals <45 years and BMI <25. In a normal population, the thickness of the plantar fascia determined by ultrasound measurement was less than 3 mm. We recommend using the position 1.0 cm distal to the calcaneal insertion of the plantar fascia as the reference point for diagnosing plantar fasciitis. The thickness of plantar fascia was significantly increased with age and BMI whereas gender, walking activity, exercise and running did not seem to affect the plantar fascia thickness.

Perfusion, Stance and Plantar Pressure Asymmetries on the Human Foot in the Absence of Disease—A Pilot Study

Physiological perfusion asymmetries in the lower limb are known, although poorly understood, as are asymmetries reported in plantar pressure and stance. This preliminary study aims to explore potential relationships between perfusion and pressure variables in humans. A convenience sample of eight healthy individuals (25.25 ± 5.37 years old) of both sexes, was selected. Chosen variables were perfusion, plantar pressure, and stance. Perfusion was measured in both feet by laser Doppler flowmetry (LDF) and polarized light spectroscopy (PSp), and plantar pressure and stance obtained by a pressure plate. These were measured in baseline (Phase I) in a repeated squatting (Phase II), and in recovery (Phase III). A 95% confidence interval was adopted. Intraindividual significant perfusion asymmetries between both feet were detected by LDF in Phase I. These disappeared in Phase II and returned in Phase III. PSp did not detect any asymmetries. Plantar pressure was also asymmetric and differently distributed along both feet with no statistical significance except in the hindfoot. Significant correlations were found between BMI and mean Plantar Pressure in Phase I and Phase III, and an inverse correlation between LDF perfusion and Plantar Pressure in Phase I. These results seem to suggest an interesting direction for exploration and study of these asymmetries in the absence of disease.

Early Results of a Novel Intramedullary Fixation Device for Proximal Fifth Metatarsal Fractures

Category:Midfoot/Forefoot; Sports; TraumaIntroduction/Purpose:Proximal fifth metatarsal fractures are commonly treated surgically due to their poor healing capacity. While intramedullary screws may be the most popular operative treatment choice, newer fixation methods continue to develop that offer fracture compression in addition to maintenance of length, alignment and rotation. We present a case-series utilizing a novel intramedullary fixation device for proximal fifth metatarsal fractures. To our knowledge, no other study in the literature has assessed the safety and efficacy of this novel fixation methodMethods:A retrospective analysis was performed for 16 patients with proximal fifth metatarsal fractures who underwent fixation with the same novel intramedullary device. Patient charts were reviewed for fracture union, plantar fracture gapping, time to weightbearing, refracture, perioperative complications, and secondary surgeries.Results:Sixteen patients with an average age of 43.3 years old underwent fixation with this novel device from 2015 to 2020. Mean follow-up was 32.4 weeks. Fifteen of the 16 patients achieved radiographic union at a mean of 8.9 weeks. One patient suffered a non-union. Mean time to full weight-bearing in, and out of, a walking boot was 6.4 and 9.8 weeks, respectively, for healed fractures. Mean plantar fracture gap improved from 1.22 mm to 0.88 mm following surgery. There were zero infections, refractures or hardware complications. Three patients suffered iatrogenic distal diaphyseal fracture during implant insertion, however postoperative progression to weightbearing was not altered in these patients relative to the remainder of the cohort.Conclusion:To our knowledge, this is the first report of early results for this novel intramedullary device. Excellent union rates, acceptable time to weight bearing, and a low complication profile can be achieved. Additionally, plantar fracture gapping, which has been shown to delay time to union, was improved using this novel implant. Based on our early findings, we propose a viable treatment option that is safe and effective for proximal fifth metatarsal fracture stabilization.

Sonographic Evaluation of the Heel Pad Thickness in Diabetics in Nigeria.

Diabetes mellitus is a chronic disease process affecting millions of people worldwide. Its prevalence is forecasted to reach a value of 7.7% by 2030. It carries severe morbidities and even mortality. Hyperglycemia and increased formation of advanced glycosylation end products causes the majority of soft tissue changes seen among diabetics. The effects are observed particularly in the heel pad and plantar fascia where thinning or thickening, fibre disorganization, calcification and hypoechoic foci are among the changes seen. This cross-sectional descriptive study was carried out at the Department of Radiology, OAUTHC, Ile Ife, Osun state, Southwest Nigeria. 40 years old and above subjects with Type 2 diabetes mellitus were recruited from the diabetic clinic of the institution and Ultrasound evaluation of the heel fat pad and plantar fascia were subsequently performed for those who met the criteria using ultrasound machine equipped with a 7.5- 12.0 MHz high frequency linear array transducer. The mean heel pad thickness on the right feet was greater than that of the left in the study subjects. There was statistical significant difference in the heel fat pad thickness of diabetic subjects and the control group, in both feet. (P=0.000). The heel pad thickness is higher in diabetic subject than in non-diabetic control subjects. However, there was no statistical significant difference in the right and left heel fat pad thickness of the participants of this study (P value 0.6062). Only HPT was a statistically significant predictor of foot ulcers among other variables after binary regression was computed. Using Spearman's rank correlation to test the relationship between the BMI of diabetic subjects and mean heel pad thickness, it revealed a moderate positive correlation, with good statistically significance (Spearman's rho = 0.4397, P=0.0000). The relationship between the BMI of diabetic subjects and mean plantar fascia thickness showed a weak positive correlation, with good statistical significance (Spearman's rho = 0.2635, P=0.0008). The duration of diabetes mellitus did not determine the heel pad thickness and plantar fascia thickness. The findings in the study suggested that history of foot ulcer in the diabetic predispose them to have reduce HPT and further foot ulcers. Sonographic measurement of heel pad thickness can therefore be an additional imaging modality to evaluate and be used in the management of the diabetic patients' feet.

Evaluation of plantar fasciitis improvement after shock wave therapy in calcaneal spur patients by musculoskeletal ultrasonography

BackgroundPlantar fasciitis due to calcaneal spur is a common cause of heel pain and functional disability, and its management presents a huge challenge for clinicians which results sometimes in unpleasant clinical outcomes. The efficacy of extracorporeal shock wave therapy (ESWT) as an alternative therapeutic option to surgical management after failure of conservative treatment has been addressed. Our aim was to evaluate the efficacy of ESWT in the treatment of plantar fasciitis in calcaneal spur patients using ultrasonography.ResultsThe mean plantar fascia (PF) thickness was statistically significantly higher in the calcaneal spur patient group (5.66 ± 1.14 mm) than in the healthy control group (2.40 ± 0.35 mm), (P = 0.001). Significant PF thickness reduction, visual analog scale (VAS), and Roles and Maudsley score (RMS) improvement were observed (P < 0.001) after 4 sessions of ESWT.ConclusionPF thickness increases significantly in calcaneal spur patients and responds to treatment. ESWT decreases the thickness of the PF and improves pain and function significantly.

The influence of a rocking-motion device built into classic cross-country roller-ski bindings on biomechanical, physiological and performance outcomes

This study aimed to determine whether the recently developed Flow Motion Technology® roller-ski prototype could improve indicators of performance during sub-maximal and maximal cross-country roller skiing. Thirteen national and international cross-country skiers completed 2 experimental trials: 1 with Flow Motion Technology® activated, allowing a rocking motion between the foot and ski binding, and 1 with the foot fixed in a traditional manner. Each trial included 2 sub-maximal bouts using the diagonal-stride and double-poling sub-techniques, as well as a double-poling maximal velocity test and a diagonal-stride 6-min time trial. There were no differences in performance between Flow Motion Technology® and traditional roller skiing during the maximal velocity test or the time trial. However, reductions in mean plantar force during sub-maximal diagonal stride (p = 0.011) and ankle range of motion during sub-maximal (p = 0.010) and maximal (p = 0.041) diagonal stride were observed with Flow Motion Technology® versus traditional roller skiing. This, together with a reduced minimum horizontal distance of the hips in front of the ankles during sub-maximal double poling (p = 0.001), indicated impaired technique with Flow Motion Technology®, which may have contributed to the trend for reduced gross efficiency during double poling with Flow Motion Technology® (pη2 = 0.214). Significant physiological differences included a reduced sub-maximal double poling respiratory exchange ratio (p = 0.03) and a greater maximal heart rate during the time trial (p = 0.014) with Flow Motion Technology®. We conclude that the application of Flow Motion Technology® requires further examination before use in training and competition.

Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis.

Background:Magnetic resonance imaging (MRI) has been used as a diagnostic and prognostic instrument to evaluate the results of conservative treatment for plantar fasciitis. However, there are scarce data available relative to changes in the plantar fascia after operative treatment. The primary objective of this study is to evaluate the imaging changes in patients with recalcitrant plantar fasciitis treated operatively by means of proximal medial gastrocnemius release.Methods:Thirteen patients with recalcitrant plantar fasciitis were studied with MRI preoperatively and 1 year after operative treatment. Quantitative (plantar fascia thickness) and qualitative variables (hyperintensity in the plantar fascia, insertional calcaneus bone edema, a plantar fascia tear, and the presence of perifascial collections) were assessed by 2 musculoskeletal radiologists. Clinical results were also measured with American Orthopaedic Ankle & Society (AOFAS), visual analog scale (VAS) pain, and 36-Item Short Form Health Survey (SF-36) scales.Results:The mean plantar fascia thickness was 6.59 mm preoperatively and 6.37 mm postoperatively (P = .972). No statistically significant differences were found in any of the qualitative variables on comparing the pre- and postoperative periods. Patients reported clinical improvements in pain VAS, AOFAS measurement, and the physical subdomains of the SF-36 scale.Conclusion:Quantitative and qualitative variables assessed for the plantar fascia on MRI did not show any significant change after medial gastrocnemius release despite clear clinical improvement.Level of Evidence:Level II, perspective cohort study.

Comparison of Plantar Pressures Between Upright and Recumbent Stationary Bicycles

The F-Scan system by Tekscan was used to compare plantar pressures at 4 locations during 30-second bouts of exercise between upright and recumbent exercise bicycles. A 2-tailed t test was used to compare the pressures at each anatomic location between each biking method for each participant. Statistical analysis demonstrated a significant difference in mean plantar pressures at the hallux, fifth metatarsal head, and the heel. The recumbent bicycle produced higher average pressures at the hallux and first metatarsal head, and the upright bicycle produced higher average pressures at the fifth metatarsal head and the heel.

Correlation between ankle-brachial index and thermography measurements in patients with peripheral arterial disease.

To correlate the ankle-brachial index and photographic thermography findings in patients with peripheral arterial disease. Photographic thermography was performed at the foot level, and ankle-brachial index was measured in 72 lower limbs of 53 patients with peripheral arterial disease who were divided into calcified artery, patients with an ankle-brachial index greater than 1.4; and non-calcified artery classified as asymptomatic, mild, moderate, and severe on the basis of peripheral arterial disease severity. Fisher's exact test was used for categorical data, and Wilcoxon test was used for numerical data. Spearman's correlation analysis showed a strong correlation (R = 0.7) between the ankle-brachial index and the mean plantar temperature in patients without lower limb artery calcification. Linear regression yielded the predictor equation Y = 3.296 × X + 29.75, wherein ankle-brachial index (X) can be predicted on the basis of temperature values. Spearman's correlation test showed no significance (p = 0.2174) in patients with arterial calcification. Kruskal-Wallis test with post hoc analysis using Dunn's test for multiple comparisons showed that the mean plantar temperature was lower in patients with arterial calcification. Photographic thermography findings show a strong correlation with ankle-brachial index in patients with non-calcified arteries.

Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study.

Autologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series. A hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12week follow-up. USG measurement of plantar fascia thickness was done at pre-injection and at 12weeks follow-up. All patients were observed for 12weeks. The mean age was 39years (range 20-55years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12week respectively and difference was significant (p < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12weeks respectively which was significant (p < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3mm which was significantly (p < 0.001) reduced to 3.9 ± 0.3mm at 12weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with p-value adjustment were also significant. The short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.

Acute osteomyelitis of the distal fibula in children: Treatment options and long-term follow-up

IntroductionAcute osteomyelitis of the distal fibula is a rare disease in children and is characterized by special features compared with other sites. The objective of this study was to report the functional outcome at long-term follow-up. MethodsWe reviewed retrospectively, between January 2000 and December 2010, all cases of acute osteomyelitis of the distal fibula. Epidemiological and bacteriological data as well as therapy and outcome factors were analyzed. At the last follow-up, functional outcome was studied based on ankle motion, growth disturbance, and radiological sequelae. ResultsSeven cases of acute osteomyelitis of the distal fibula were found. The mean age was patients was 7.71 years and the sex ratio was 2.5. The portal of entry of the pathogen was a skin injury in 57% of cases. Staphylococcusaureus was identified in 71% of cases. The mean duration of antibiotic therapy was 33.2 days. At a mean of 12.85 years of follow-up, no growth disturbance was found. The mean plantar and dorsal flexion was 41° and 27.7°, respectively. The mean postoperative American Orthopedics Foot and Ankle score (AOFAS) was 96.71 points. ConclusionAcute osteomyelitis of the distal fibula in children is scarce and rarely reported in the literature. It occurs more often in boys at an average age of 7 years. Local symptoms are usually more obvious than general symptoms. Surgical debridement of the subperiosteal abscess without bone trepanation seems to lead to a satisfactory outcome. Level of evidenceLevel IV – case series. IRBSahloul Hospital Human Research Ethics Committee.

Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet

BackgroundThe objective of this study was to explore the relationships between claw toe deformity, peripheral neuropathy, intrinsic muscle volume, and plantar aponeurosis thickness using computed tomography (CT) images of diabetic feet in a cross-sectional analysis.MethodsForty randomly-selected subjects with type 2 diabetes were selected for each of the following four groups (n = 10 per group): 1) peripheral neuropathy with claw toes, 2) peripheral neuropathy without claw toes, 3) non-neuropathic with claw toes, and 4) non-neuropathic without claw toes. The intrinsic muscles of the foot were segmented from processed CT images. Plantar aponeurosis thickness was measured in the reformatted sagittal plane at 20% of the distance from the most inferior point of the calcaneus to the most inferior point of the second metatarsal. Five measurement sites in the medial-lateral direction were utilized to fully characterize the plantar aponeurosis thickness. A linear mixed-effects analysis on the effects of peripheral neuropathy and claw toe deformity on plantar aponeurosis thickness and intrinsic muscle volume was performed.ResultsSubjects with concurrent neuropathy and claw toes had thicker mean plantar aponeurosis (p < 0.006) and may have had less mean intrinsic muscle volume (p = 0.083) than the other 3 groups. The effects of neuropathy and claw toes on aponeurosis thickness were synergistic rather than additive. A similar pattern may exist for intrinsic muscle volume, but results were not as conclusive. A negative correlation was observed between plantar aponeurosis thickness and intrinsic muscle volume (R2 = 0.323, p < 0.001).ConclusionsSubjects with concurrent neuropathy and claw toe deformity were associated with the smallest intrinsic foot muscle volumes and the thickest plantar aponeuroses. Intrinsic muscle atrophy and plantar aponeurosis thickening may be related to the development of claw toes in the presence of neuropathy.

Infrared thermography for monitoring severity and treatment of diabetic foot infections.

Monitoring of diabetic foot infections is largely based on clinical assessment, which is limited by moderate reliability. We conducted a prospective study to explore monitoring of thermal asymmetry (difference between mean plantar temperature of the affected and unaffected foot) for the assessment of severity of diabetic foot infections. In patients with moderate or severe diabetic foot infections (International Working Group on the Diabetic Foot infection-grades 3 or 4) we measured thermal asymmetry with an advanced infrared thermography setup during the first 4–5 days of in-hospital treatment, in addition to clinical assessments and tests of serum inflammatory markers (white blood cell counts and C-reactive protein levels). We assessed the change in thermal asymmetry from baseline to final assessment, and investigated its association with infection-grades and serum inflammatory markers. In seven included patients, thermal asymmetry decreased from median 1.8°C (range: −0.6 to 8.4) at baseline to 1.5°C (range: −0.1 to 5.1) at final assessment (P = 0.515). In three patients who improved to infection-grade 2, thermal asymmetry at baseline (median 1.6°C (range: −0.6 to 1.6)) and final assessment (1.5°C (range: 0.4 to 5.1)) remained similar (P = 0.302). In four patients who did not improve to infection-grade 2, thermal asymmetry decreased from median 4.3°C (range: 1.8 to 8.4) to 1.9°C (range: −0.1 to 4.4; P = 0.221). No correlations were found between thermal asymmetry and infection-grades (r = −0.347; P = 0.445), CRP-levels (r = 0.321; P = 0.482) or WBC (r = −0.250; P = 0.589) during the first 4–5 days of hospitalization. Based on these explorative findings we suggest that infrared thermography is of no value for monitoring diabetic foot infections during in-hospital treatment.

Association between the levels of physical activity and plantar pressure in 6-14-year-old children.

BackgroundThe main purpose of the study was to determine whether lower levels of physical activity were associated with higher plantar pressure generated under each foot.MethodsIn this cross-sectional study, we recruited 641 children aged 6–14 years (agemean ± SD = 9.7 ± 2.4 years; heightmean ± SD = 143.6 ± 15.3 cm, weightmean ± SD = 37.6 ± 13.4 kg; body-mass indexmean ± SD = 17.6 ± 3.2 kg/m2; 44.2% girls). We used EMED –XL pressure platform to measure force time integral, pressure-time integral, contact-time and contact area, peak plantar pressure and mean plantar pressure of the right and the left foot during the gait analysis. The level of physical activity was measured by using The Physical Activity Questionnaire for Older Children (PAQ–C). The associations were calculated by using generalized estimating equations with linear regression models.ResultsLower levels of physical activity were associated with higher force- and pressure-time integrals, longer contact time and higher peak and mean plantar pressures in both feet.ConclusionOur study shows that the level of physical activity is strongly and inversely associated with plantar pressure in a sample of 6–14 year olds.

Sonographic Evaluation of Plantar Fasciitis and its Relation to Body Mass Index and Heel Pad Thickness

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT).&#x0D; Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity.&#x0D; Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p &lt;0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p &lt;0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels).&#x0D; Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

A comparative prospective study of platelet rich plasma vs. corticosteroid injection in plantar fasciitis

Objective: To compare the relative effectiveness of intralesional Steroid versus Platelet- Rich Plasma injection among 80 patients in plantar fasciitis.Methods: A total number of 80 patients with plantar fasciitis were divided into 2 groups (Group A and B). Group A with 30 patients received intralesional Platelet Rich Plasma (PRP) and Group B received intralesional methyl prednisolone acetate injection. Pre and post intervention Visual Analogue Score (VAS), Foot and Ankle Ability Measure (FAAM) score and PF (plantar fascia) thickness for assessment of pain relief in two groups were recorded at 6 months.Results: The mean VAS scores for heel pain measured after 6 months of treatment were 1.460+0.6911in PRP group and 3.024+0.9572in steroid group. The decrease in mean VAS score in both the groups was statistically significant when compared with pre-treatment values (8.38+0.6820in PRP group and 8.44+0.6021in steroid group). The mean FAAM score measured after 6 months of treatment increased in both the groups (83.43±5.661in PRP group and 69.12±5.795 in steroid group)when compared with pre-treatment value (29.97±5.997in PRP group and 31.68±6.297 in steroid group)and it was statistically significant.There was 35.90% reduction in mean plantar fascia thickness in PRP group and 28.67% reduction in Steroid groupas compared to baseline values after 6 month of injection.Conclusion: Intralesional injection of both the PRP and steroid are effective and safe modalities of treatment for plantar fasciitis. Steroid is better for short term treatment of plantar fasciitis but in long term follow up platelet rich plasma therapy is better than steroid. Both the treatment methods have caused significant reduction in PF(Plantar fascia) thickness.

Assessment of Outcomes of a Metatarsal Bone Ostectomy for Chronic Plantar Ulcers: A Preliminary Study.

Clinical management of chronic plantar ulcers is a difficult issue in medical practice. Pressure overloading is a problem that needs to be resolved. Herein, we report a surgical method to reduce plantar pressure: a dorsal approach to a metatarsal ostectomy. From March 2011 to October 2016, 16 patients suffering from chronic plantar ulcers underwent ostectomy procedures at Taipei Wan-Fang Municipal Hospital (Taipei Medical University). A bone segment about 0.5 to 1 cm long was removed via a dorsal foot approach. The plantar wound was treated with debridement only or was simultaneously covered with a skin graft. In total, 16 patients with an average age of 57.81 (SD, 11.6) years (12 males and 4 females) were included; 15 patients (93.75%) had a diagnosis of type 2 diabetes for a mean of 20.66 years (range, 5-30 years). The mean glycated hemoglobin was 9.14 g/dL (range, 5.2-13.2 g/dL). The mean plantar wound size was 5.72 cm. Four patients (25%) needed to receive a skin graft with a mean skin graft size of 8.13 cm. The mean follow-up time was 15.2 months. The plantar wounds completely healed in 14 patients (87.5%) in an average of 2.14 months. No plantar ulcer was complicated with recurrence, but transfer ulcers developed in 2 patients (12.5%) at an average of 7.5 months postoperatively. Metatarsal ostectomy surgery via a dorsal foot approach is an efficient way to reduce pressure overloading of chronic plantar wounds. Our study provides an alternative method to treat this difficult problem with a high wound healing rate and less recurrence.

Distribuição da pressão plantar e morfologia do pé de crianças com paralisia cerebral e crianças com desenvolvimento típico

RESUMO A paralisia cerebral (PC) é caracterizada por desordens de movimento e postura, que causam limitações na execução de atividades facilmente desempenhadas por crianças com desenvolvimento típico (DT). Este estudo objetivou comparar a distribuição da pressão plantar e a morfologia do pé entre crianças com PC e DT, utilizando uma pesquisa analítica observacional transversal do tipo comparativa, com 32 crianças entre 6 e 11 anos, pareadas por sexo e idade e distribuídas em grupo estudo (GE) e grupo controle (GC). A distribuição plantar foi avaliada por meio do sistema de baropodometria eletrônica Footwork e o tipo de pé classificado pelo índice de Chippaux-Smirak. O GE obteve maior descarga de peso no sentido anterior e menor no sentido posterior (p=0,02), além de menores valores das pressões médias dos pés direito (p=0,00) e esquerdo (p=0,01) em relação ao GC. A maioria das crianças apresentou o mesmo tipo de pé bilateralmente, com prevalência de pés planos no GE e cavos no GC. Crianças com PC espástica, que apresentaram o desempenho locomotor preservado ou com alguma disfunção, revelaram antepulsão corporal, menores pressões plantares médias e prevalência do pé plano, em comparação às crianças com DT.