Calcaneal Research Articles

Proteome-wide Mendelian randomization provides novel insights into the pathogenesis and druggable targets of osteoporosis

BackgroundWith the aging population, the prevalence and impact of osteoporosis are expected to rise, and existing anti-osteoporosis agents have limitations due to adverse events. This study aims to discover novel drug targets for osteoporosis.MethodsThe protein data were obtained from the latest proteome-wide association studies (PWAS) including 54, 219 participants. The osteoporosis data were extracted from a GWAS meta-analysis, characterized by heel bone mineral density (HBMD) comprising 426,824 individuals. Mendelian randomization (MR) was the primary approach used to establish genetic causality between specific traits. Summary-data-based MR (SMR), colocalization analysis, heterogeneity test, and external validation were applied to ensure the findings were reliable. The underlying mechanisms behind these causal associations were investigated by additional analyses. Finally, the druggability of the identified proteins was assessed.ResultsAfter Bonferroni correction, a total of 84 proteins were found to have a genetic association with osteoporosis. With strong colocalization evidence, proteins such as ACHE, HS6ST1, LRIG1, and LRRC37A2 were found to negatively influence HBMD, whereas CELSR2, CPE, FN1, FOXO1, and FSHB exhibited a positive association with HBMD. No significant heterogeneity was found. Additionally, CELSR2, FN1, FSHB, HS6ST1, LRIG1, and LRRC37A2 were replicated in the external validation. The effect of FSHB on HBMD was more pronounced in females compared to males. Interestingly, ACHE, LRIG1, FN1, and FOXO1 were observed to partially act on HBMD through BMI. Phewas analysis indicated that CPE and FOXO1 did not have genetic associations with any phenotypes other than osteoporosis. FN1 was highlighted as the most significant protein by protein-protein interaction network analysis.ConclusionIn conclusion, this study offers valuable insights into the role of specific proteins in the development of osteoporosis, and underscores potential therapeutic targets. Future studies should emphasize exploring these causal relationships and elucidating their underlying mechanisms.

Anatomy of the Achilles tendon-Apictorial review.

The Achilles tendon (AT) is the strongest tendon of the human body. The knowledge of AT anatomy is abasic prerequisite for the successful treatment of acute and chronic lesions. The structure of the AT results from acomplicated fusion of three parts: the tendons of the medial and lateral gastrocnemius and the soleus muscles. From proximal to distal, the tendon fibers twist in along spiral into aroughly 90° internal rotation. The tendon is narrowest approximately 5-7 cm above its calcaneal insertion and from there it expands again. The topography of the footprints of the individual AT components reflects the tendon origins. The anterior (deep) AT fibers insert into the middle third of the posterior aspect of the calcaneal tuberosity, the posterior (superficial) fibers pass over the calcaneal tuberosity and fuse with the plantar aponeurosis. Adeep calcaneal bursa is interposed between the calcaneal tuberosity and the AT anterior surface. The AT has no synovial sheath but is covered along its entire length with asliding connective tissue, the paratenon which is, however, absent on its anterior surface. The AT is supplied by the posterior tibial artery (PTA) and the peroneal artery (PA). Motor innervation of the triceps surae muscle is provided by fibers of the tibial nerve which also gives off sensitive fibers for the AT. Sensitive innervation is also provided via the sural nerve. The sural nerve crosses the AT approximately 11 cm proximal to the calcaneal tuberosity. The forces acting on the AT during exercise may be up to 12 times the body weight. Physiological stretching of AT collagen fibers ranges between 2% and 4% of its length. Stretching of the tendon over 4% results in microscopic failure and stretching beyond 8% in macroscopic failure.

Morphological characteristics of talocalcaneal coalitions: Anatomical observation, finite element analysis and clinical application

BackgroundThe intricate anatomical structure of talocalcaneal coalitions (TCCs) presents significant challenges for clinicians in both diagnosis and treatment. This study aimed to investigate the anatomy, imaging characteristics, and biomechanical properties of TCCs, providing essential references for contemporary clinical diagnosis, treatment, scientific research, and education regarding TCCs. MethodsThe morphologies of TCCs were examined and classified in intact dry osseous specimens from 131 Asian adults. The imaging characteristics of TCCs were summarized by carefully observing the X-rays and CT scans. Additionally, finite element models of TCCs were established and validated, allowing for the simulation and analysis of stress and strain. ResultsThe TCCs were primarily located in the region between the posterior end of sustentaculum tali (ST), the medial port of the tarsal canal, and the medial edge of the posterior talar articular surface (PTF). In comparison to specimens with cartilage and ligament connections, the medial tubercle of osseous connections exhibited significant inward and downward protrusion, while the ST was longer and thicker. Statistically significant differences were noted in the widths of the calcaneus and talus, as well as in the thickness and length of the ST (P < 0.05). CT imaging provided an accurate determination of TCCs’ locations, while X-rays revealed the presence of the “C sign” and “duck beak sign” in all osseous connection specimens. Finite element model analysis indicated that stress was primarily concentrated at the osseous connection, which also reduced displacement of the subtalar joint. ConclusionsThe comprehension of the precise location, anatomical morphological characteristics, imaging features and finite element mechanical properties of TCCs is instrumental in enhancing the diagnosis and treatment of TCCs.

Exploring the Link Between Calcaneal Apophysis Maturation and Heel Pain in Youth Baseball Players.

Calcaneal apophysitis is the most common cause of heel pain in children and adolescents. However, the relationship between skeletal maturity and heel pain in the specific youth cohort is unclear. To clarify the relationship between the maturity stages of the calcaneal apophysis and heel pain in youth baseball players. Cross-sectional study; Level of evidence, 3. A total of 336 youth male baseball players participated in this study. Ultrasound scanning of the calcaneal apophysis was performed along the longitudinal line connecting the middle of the Achilles tendon, the middle of the calcaneus, and the second toe, between the proximal calcaneal edge and the medial calcaneal tubercle. The authors classified the maturity of the calcaneal apophysis into 5 stages, from nonpresence of the apophysis (stage 1) to complete fusion (stage 5). The diagnosis of heel pain was based on subjective report of feeling pain on the squeeze test. The relationship between the maturity stages and physical characteristics was investigated using 1-way analysis of variance or the Kruskal-Wallis test, and the relationship between the maturity stages and heel pain was investigated using the chi-square test. Of the 336 players, 49 had heel pain, for a prevalence of 14.6%. Eighteen (5.4%) players had unilateral heel pain, and 31 (9.2%) players had bilateral heel pain. There were no significant differences in the maturity stages of the calcaneal apophysis between the players with no heel pain and those with heel pain. However, no players had heel pain during stage 5, when the calcaneus had completed its maturation. The prevalence of heel pain was 14.6% in Japanese youth male baseball players. There was no relationship between the maturity stages of the calcaneal apophysis and heel pain. Heel pain that could be associated with calcaneal apophysitis did not occur during stage 5, when maturation of the calcaneal apophysis was complete.

Effects of FGF21 overexpression in osteoporosis and bone mineral density: a two-sample, mediating Mendelian analysis.

Fibroblast growth factor 21 (FGF21) is a secreted protein that regulates body metabolism. In recent years, many observational studies have found that FGF21 is closely related to bone mineral density and osteoporosis, but the causal relationship between them is still unclear. Therefore, this study used two-sample, mediated Mendelian randomization (MR) analysis to explore the causal relationship between FGF21 and osteoporosis and bone mineral density. We conducted a two-sample, mediator MR Analysis using genetic data from publicly available genome-wide association studies (GWAS) that included genetic variants in the inflammatory cytokine FGF21, and Total body bone mineral density, Heel bone mineral density, Forearm bone mineral density, Femoral neck bone mineral density, osteoporosis. The main analysis method used was inverse variance weighting (IVW) to investigate the causal relationship between exposure and outcome. In addition, weighted median, simple median method, weighted median method and MR-Egger regression were used to supplement the explanation, and sensitivity analysis was performed to evaluate the reliability of the results. MR Results showed that FGF21 overexpression reduced bone mineral density: Total body bone mineral density (OR=0.920, 95%CI: 0.876-0.966), P=0.001), Heel bone mineral density (OR=0.971, 95%CI (0.949-0.993); P=0.01), Forearm bone mineral density (OR=0.882, 95%CI(0.799-0.973); P=0.012), Femoral neck bone mineral density (OR=0.952, 95%CI(0.908-0.998), P=0.039); In addition, it also increased the risk of osteoporosis (OR=1.003, 95%CI (1.001-1.005), P=0.004). Sensitivity analysis supported the reliability of these results. The effect of FGF21 overexpression on osteoporosis may be mediated by type 2 diabetes mellitus and basal metabolic rate, with mediating effects of 14.96% and 12.21%, respectively. Our study suggests that the overexpression of FGF21 may lead to a decrease in bone mineral density and increase the risk of osteoporosis, and the effect of FGF21 on osteoporosis may be mediated through type 2 diabetes and basal metabolic rate. This study can provide a reference for analyzing the potential mechanism of osteoporosis and is of great significance for the prevention and treatment of osteoporosis.

Somatic Structure and Ultrasound Parameters of the Calcaneus Bone in Combat Sports Athletes in Relation to Vitamin D3 Levels.

Background/Objectives: Physical activity is widely recognized for its beneficial effects on bone density during adolescence, which could lead to enhanced bone density in later life, thus acting as a health-promoting activity with long-lasting implications. However, not all studies are conclusive regarding the type, intensity, duration, and frequency of the most effective physical activities. This study focuses on combat sports athletes and examines the relationship between their somatic build and heel bone parameters using ultrasound (USG) and their vitamin D3 levels. Methods: The study included 40 male athletes specializing in various combat sports. The measurements of body height, body mass, skinfold thickness, and bone widths at multiple sites were performed to estimate the somatic build. The USG parameters of the heel bone and the blood levels of vitamin D3 were also recorded. Statistical significance was determined using one-way ANOVA, with differences among sports disciplines also examined. Results: The study found significant differences in the body composition and USG bone parameters among athletes from different combat sports (p ≤ 0.05). The calcaneus stiffness index (SI) and speed of sound (SOS) were significantly higher in athletes with normal vitamin D3 levels compared to those with below-normal levels (p = 0.0015 and p = 0.001, respectively). These findings suggest that vitamin D3 may influence bone stiffness and density. Conclusions: The study underscores the importance of maintaining adequate vitamin D3 levels to support bone mineralization in athletes, particularly those training indoors with limited exposure to sunlight. It also highlights the potential of using USG as a non-invasive method to assess bone health, aiding in the optimization of training programs to prevent injuries and improve performance.

Prevalence, causes, and treatment of plantar fasciitis in young females of a medical college

BackgroundPlantar fasciitis, a common musculoskeletal disorder, is characterized by inflammation of the plantar fascia, a thick band of tissue that connects the heel bone to the toes. The plantar fascia plays a crucial role in supporting the arch of the foot and absorbing shock during movement. Factors such as excessive physical activity, improper footwear, and biomechanical abnormalities are recognized contributors to the development of plantar fasciitis. However, the prevalence and underlying causes may vary across different demographic groups, necessitating targeted investigations.ObjectiveThis study aims to investigate the prevalence, causes and treatment of plantar fasciitis in young female students (18–30) of a medical college in Pakistan and explore potential associations with high-heel footwear.MethodologyIn this study, a cross-sectional survey was carried out, engaging 100 young females from a medical college. Employing a structured questionnaire, we assessed a spectrum of parameters, including heel pain symptoms, footwear habits, and available treatment options. The diagnostic precision of the Windlass test, specific to plantar fasciitis, was incorporated. Rigorous data analysis, utilizing SPSS, centered on discerning associations between the nuances of high-heel wear (considering types and duration) and the reported symptoms. This methodological framework ensures a comprehensive and precise exploration of the prevalence, causes, and treatment of plantar fasciitis in our targeted demographic.ResultsAll the participants were female, and the total number was 100, of which 66% felt pain in the heel when they wore high heels. Out of this 66%, only 6% are diagnosed with plantar fasciitis. The rest of the 60% have pain in the heel due to different causes such as heel spurs, stress fractures, etc. 2% of people receive treatment with steroid injections, and 12% are treated with ice.ConclusionWe conclude that the prevalence of plantar fasciitis is high in females wearing high heels. This study reveals that an increase in the total duration of wearing high heels with hard soles increases the symptoms of plantar fasciitis. Plantar fasciitis can be prevented by education and applying ergonomics and could be treated by steroids and the ice method, according to medical practitioners.

The combined talus and sustentaculum fracture: A case series

BackgroundThe sustentaculum tali is a biomechanically important stabilizer of the hindfoot and contributes to articular congruency of the subtalar joint. Sustentaculum injury associated with a talus fracture has been described infrequently and treatment of this combined injury varies. The purpose of this study was to describe and evaluate the outcomes of the combined talus and sustentaculum fracture. MethodsRetrospective chart and radiographic review was performed on all talus fractures (n = 436) requiring operative fixation over a 21-year period at a single Level-1 trauma center. All talus fractures with sustentaculum fractures were included. Statistical analysis was performed using Chi-squared and Fishers exact tests where appropriate. ResultsSustentaculum fractures occurred in 6.2 % (n = 27) of patients with talus fractures. Average follow-up was 14 months; 18.5 % were open fractures, 88.8 % were from high-energy mechanisms, and 44.4 % were polytraumas. Diagnosis of the sustentaculum fracture was missed on presenting radiographs in 69.2 % (n = 18). The most common associated talus fracture was a talar neck fracture (40.7 %) and the majority (73.7 %) were Hawkins II. Overall, 40.7 % (n = 11) of the sustentaculum fractures were treated with independent fixation and 7.4 % (n = 2) were treated with acute subtalar arthrodesis. Subtalar post-traumatic osteoarthritis (PTOA) at final follow-up was seen in 23.1 % of combined injuries. Independent sustentaculum fixation did not influence the rate of PTOA or re-operation (p = 0.92, p = 0.91, respectively). ConclusionTalar fractures have an associated sustentaculum fracture in approximately 6 % of cases, especially with Hawkins II fracture-dislocations. Over two-thirds of the associated sustentaculum fractures were missed on presenting radiographs, reiterating the need for heightened awareness and consideration of advanced imaging for all talus fractures. The rate of PTOA following these combined injuries at mean follow-up of 24 months does not exceed established rates after isolated talus fractures. Further research is required to determine the optimal management of the sustentaculum in these combined injuries. Level of evidenceIV

Systemic administration of Resolvin D1 reduces cancer-induced bone pain in mice: Lack of sex dependency in pain development and analgesia.

Bone cancer produces severe pain that is treated with opioids, but serious side effects limit opioid utilization. There is therefore a need to develop effective and safe non-opioid alternatives. The lipid mediator, Resolvin D1 (RvD1), could be a prospective candidate for cancer pain treatment. To assess RvD1 and other potential candidates, appropriate animal models that recapitulate clinical features must be used. Although several preclinical models of cancer pain have been developed, the influence of sex on the development of cancer pain and the effectiveness of RvD1 have not been studied. Using a mouse model of fibrosarcoma growth in and around the calcaneus bone, we demonstrated that the mechanical hyperalgesia in the tumor-bearing hind paw develops independently of sex, except that it developed a little sooner in female mice. A single intravenous injection of RvD1 (0.001-10 μg/kg) decreased hyperalgesia in both sexes with similar potency (ED50 = 0.0015 μg/kg) and efficacy. Repeated daily administration of 10 μg/kg RvD1 prolonged the analgesic effect and completely abolished hyperalgesia. This was also independent of sex. In this preclinical mouse model of bone cancer pain, the development of pain and the analgesic effectiveness of RvD1 are not influenced by sex.

The effect of screw insertion configuration of Sinus Tarsi plate on biomechanical performance using finite element analysis

Sinus Tarsi plates are used as implants for minimally invasive surgery of calcaneus bone fractures. This study evaluated the screw fixation patterns of Sinus Tarsi plates for optimal biomechanical performance. Six three-dimensional (3D) finite element models with different positional screws were evaluated for calcaneus fracture stabilization using Sinus Tarsi plates with 5, 6, and 7 holes. Walking stance conditions as heel strike, midstance, and push-off phases were used to compare loading. Results indicated that the equivalent (EQV) stress exhibited in the implant was higher than in the surrounding bone, with the highest value during the push-off phase. The maximum EQV stress or risk of failure decreased when an insertion screw was placed in the anterior bone using a 7-hole plate, and the most stable strain result at the fracture bone site was recorded for a Sinus Tarsi plate with 7 holes (TT 7-1). The screw insertion pattern and configuration of the Sinus Tarsi plate impacted the biomechanical performance of the calcaneal fracture.

The Effect of Biomechanical and Viscoelastic Properties of Gastrocnemius (Lateral-Medial) Muscle and Achilles Tendon on Jumping Performance in Professional Soccer Players

Anaerobic performance (vertical jumps) is an important indicator in determining athletic performance in soccer. The aim of this study was to investigate the effects of biomechanical and viscoelastic properties of lateral and medial gastrocnemius (LG&amp;amp;MG) muscle and achilles tendon (AT) on jumping performance of professional soccer players. A total of 21 male professional soccer players with a mean age of 18.19±0.40 years, a mean height of 180.48±6.25 cm, a mean body weight of 70.71±7.82 kg, and a mean BMI of 21.66±1.65 kg/m₂ were included in this study. LG and MG muscle, as well as AT biomechanical and viscoelastic properties were evaluated with Myoton Pro device. Measurements were performed in the prone position of the soccer players, LG and MG at 50° plantar flexion, and AT at 0° (neutral position) at an angle of 4 cm above the calcaneal tubercle. Counter movement jump (CMJ) were recorded with the high-speed camera in the validated My Jump 2 application. A significant correlation was observed between the LG (F) tension value and CMJ (P) value and between the MG (R&amp;amp;C) values and the CMJ (F&amp;amp;P) value of professional soccer players (p&amp;lt;0.05). There was no significant relationship between AT values and CMJ values (p&amp;gt;0.05). It should not be forgotten that training coaches on this subject and applying this information to soccer players by conscious coaches will bring about increases in the athletic performance of soccer players, and all these performance characteristics can be achieved with planned and programmed training.

An Explorative Anatomical Study on Inter-Individual Variation of the Tibial Nerve and Landmarks for Perineural Anesthesia in Horses.

Perineural anesthesia of the tibial nerve can be performed ultrasound-guided or blindly, with the latter still being commonly used in equine practice due to practical constraints, despite its lower accuracy and hence, common failure to achieve desensitization. This may be associated with anatomical variations or inadequate landmarks for injection. To examine the course of the tibial nerve, document potential anatomical variations, and determine optimal landmarks for perineural injection, dissection was conducted along the medial aspect of the tibia in 10 paired cadaver hindlimbs. No anatomical variations of the tibial nerve were observed. Mean tibial nerve thickness was 6 ± 1 mm. The junction with the plantar nerves was located at a maximum of 85 mm and the junction with the medial cutaneous branch was at a maximum of 150 mm proximal to the proximal aspect of the calcaneal tubercle. The mean distance of the tibial nerve to the cranial border of the superficial digital flexor was 11 ± 6 mm. In conclusion, problems with perineural anesthesia of the tibial nerve cannot simply be attributed to anatomical variations. The thickness of the nerve and the amount of perineural tissue may present specific challenges for achieving adequate desensitization. Our results support the generally recommended site for tibial nerve perineural injection at 100 mm proximal to the calcaneal tubercle and 11 mm cranial to the superficial digital flexor.

A RANDOMIZED COMPARATIVE CLINICAL STUDY TO EVALUATE THE AN-ALGESIC EFFECT OF JALOUKAVACHARANA AND SIRAVYADHA IN VA-TAKANTAKA WITH SPECIAL REFERENCE TO CALCANEAL SPUR

Vatakantaka (Calcaneal spur) is one among Vataja Nanatmaja Vyadhi. Kantavath Vedana (pricking pain) in Padatala Pradesha of Khudapradesha (Heel region) is a prominent characteristic feature, which is caused by Vishamampade (walking on irregular surfaces), Atishrama (excessive exertion over the heel) etc. This can be correlated to a Calcaneal Spur, which is a calcium deposit causing a bony protrusion on the underside of the heel bone, often frequently associated with plantar fasciitis; treatment includes Raktavasechana (bloodletting), Erandataila Pana, Agnikarma (cauterisation) and Samanya Vatavyadhi Chikitsha (general line of management). Jaloukavacharana (leech therapy) is a type of Ashastrakrita Raktamokshanopaya which is indicated in Avagadha Avastha (deeply situated), Grathita Avastha (complicated structures) of Doshas and by the word Sarvani Sarveva in all condition wherever Raktavasechana is indicated. At present, Jaloukavacharana (leech therapy) is taken. The study comprises 40 patients of Vatakantaka (Calcaneal spur). These patients were randomly selected based on inclusion and exclusion criteria. The duration of the study is 21 days. After evaluating therapy, it was observed that Jaloukavacharana provided better analgesic relief to the patients of vatakantaka (Calcaneal spur).

Dynamic ultrasound assessment for insertional achilles tendinopathy: the COcco-RIcci (CORI) sign.

To describe a novel, dynamic ultrasound assessment of the Achilles tendon at the calcaneal insertion taking advantage of the effusion within the deep retrocalcaneal bursa as a natural contrast agent. Positioning the ultrasound transducer in a longitudinal plane over the Achilles tendon at the calcaneal insertion, manual compression of the deep retrocalcaneal bursa can be performed using the other hand. Dynamically shifting the anechoic effusion from the proximal to the distal compartment of the bursa, the undersurface of the Achilles tendon is lifted from the underlying cortical bone of the superior facet of the calcaneal tuberosity. Pushing the anechoic effusion from the bursal cavity toward the undersurface of the Achilles tendon, an eventual focal injury of its deep fibers can be visualized dynamically during the maneuver as a "black crescent" within the tendon-i.e., the COcco-RIcci (CORI) sign. Otherwise, the gliding of the posteroinferior wedge of the Kager's fat pad inside the tendon-bone interface can be observed in normal conditions. The CORI sign is a novel sonographic sign to further enhance the diagnostic accuracy of dynamic ultrasound imaging in patients with insertional Achilles tendinopathy especially to detect focal injury involving the deep fibers of the tendon.

The Micromechanical Environment of the Impinged Achilles Tendon.

Although tendon predominantly experiences longitudinal tensile forces, transverse forces due to impingement from bone are implicated in both physiological and pathophysiological processes. However, prior studies have not characterized the micromechanical strain environment in the context of tendon impingement. To address this knowledge gap, mouse hindlimb explants are imaged on a multiphoton microscope, and image stacks of the same population of tendon cells are obtained in the Achilles tendon before and after dorsiflexion-induced impingement by the heel bone. Based on the acquired images, multiaxial strains are measured at the extracellular matrix (ECM), pericellular matrix (PCM), and cell scales. Impingement generated substantial transverse compression at the matrix-scale, which led to longitudinal stretching of cells, increased cell aspect ratio, and enormous volumetric compression of the PCM. These experimental results are corroborated by a finite elementmodel, which further demonstrated that impingement produces high cell surface stresses and strains that greatly exceed those brought about by longitudinal tension. Moreover, in both experiments and simulations, impingement-generated microscale stresses and strains are highly dependent on initial cell-cell gap spacing. Identifying factors that influence the microscale strain environment generated by impingement could contribute to a more mechanistic understanding of impingement-induced tendinopathies.

Potential association of rheumatic diseases with bone mineral density and fractures: a bi-directional mendelian randomization study

BackgroundPrevious studies have implicated rheumatoid arthritis as an independent risk factor for bone density loss. However, whether there is a causal relationship between rheumatic diseases and bone mineral density (BMD) and fractures is still controversial. We employed a bidirectional Mendelian analysis to explore the causal relationship between rheumatic diseases and BMD or fractures.MethodsThe rheumatic diseases instrumental variables (IVs) were obtained from a large Genome-wide association study (GWAS) meta-analysis dataset of European descent. Analyses were performed for the three rheumatic diseases: ankylosing spondylitis (AS) (n = 22,647 cases, 99,962 single nucleotide polymorphisms [SNPs]), rheumatoid arthritis (RA) (n = 58,284 cases, 13,108,512 SNPs), and systemic lupus erythematosus (SLE) (n = 14,267 cases, 7,071,163 SNPs). Two-sample Mendelian randomization (MR) analyses were carried out by using R language TwoSampleMR version 0.5.7. The inverse-variance weighted (IVW), MR-Egger, and weighted median methods were used to analyze the causal relationship between rheumatic diseases and BMD or fracture.ResultsThe MR results revealed that there was absence of evidence for causal effect of AS on BMD or fracture. However, there is a positive causal relationship of RA with fracture of femur (95% CI = 1.0001 to 1.077, p = 0.046), and RA and fracture of forearm (95% CI = 1.015 to 1.064, p = 0.001). SLE had positive causal links for fracture of forearm (95% CI = 1.004 to 1.051, p = 0.020). Additionally, increasing in heel bone mineral density (Heel-BMD) and total bone mineral density (Total-BMD) can lead to a reduced risk of AS without heterogeneity or pleiotropic effects. The results were stable and reliable. There was absence of evidence for causal effect of fracture on RA (95% CI = 0.929 to 1.106, p = 0.759), and fracture on SLE (95% CI = 0.793 to 1.589, p = 0.516).ConclusionsRA and SLE are risk factors for fractures. On the other hand, BMD increasing can reduce risk of AS. Our results indicate that rheumatic diseases may lead to an increased risk of fractures, while increased BMD may lead to a reduced risk of rheumatic diseases. These findings provide insight into the risk of BMD and AS, identifying a potential predictor of AS risk as a reduction in BMD.

Comparison between the effect of Steroid Injection, Prolotherapy Local Injection and Extracorporal Shock Wave Therapy in Treatment of Symptomatic Calcaneal Spur

Abstract Background Calcaneal spurs are common cause of heel pain occurring anywhere along the calcaneal tuberosity and most frequently found at the insertion of the plantar fascia. They are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. Objective To compare the effectiveness of dextrose prolotherapy injection, corticosteroid injection and extracorporal shockwave in symptomatic calcaneal spur, based on clinical and functional outcome measures. Patients and Methods This study was conducted on forty-five patients diagnosed with symptomatic calcaneal spur (plantar fasciitis) for more than 6 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the foot using visual analogue scale (VAS score) and foot function index (FFI). Results Eight weeks after treatment, the pain score by VAS was significantly improved at ESWT group mostly, less extent at prolotherapy group and least at corticosteroid group. Also the percentage of improvement in ESWT group was found higher than the other groups indicating the long term analgesic effect of ESWT. Eight weeks after treatment, the FFI subscales (pain, disability and activity limitation)and total FFI score significantly improved mostly at ESWT group, less extent at prolotherapy group and least at corticosteroid group indicating the long term beneficial effect of ESWT on the function in patients with chronic PF. Conclusion Although ESWT, dextrose prolotherapy injection, and local corticosteroid injection were all effective in the treatment of symptomatic calcaneal spur during 8weeks of follow-up but, ESWT was superior to all other modalities in its effect on pain intensity and function during daily life activities at long term follow up.

Management of Isolated Bilateral Sustentaculum Tali of Calcaneum Fracture with Long-term Follow-up: A Case Report

Management of Isolated Bilateral Sustentaculum Tali of Calcaneum Fracture with Long-term Follow-up: A Case Report

Prediction of carcass weight using the morphometry of ankle bones in hair goats.

Morphologic measurements such as body lenght, wither height, heart girth, chest width, body leght, cannon-bone circumference is used to predict carcass weight. For this purpose, estimating carcass weight with measurements of key bones such as ankle bones, which play a significant role in the balance distribution of body weight, seems possible. The aim of this study is to create new regression models for effective carcass weight estimation by using the morphometric data of the talus and calcaneus bones of hair goats. Study materials consisted of talus and calcaneus bones obtained from abattoir products of hair goat kids (12-18 months old, 20 female and 20 male) and adult hair goats (36-48 months old, 20 female and 20 male). Morphometric measurements of the talus and calcaneus of each animal were taken by a digital caliper. Using the morphometric measurements, an index and a factor were calculated for each bone. Regression analysis and correlations were examined in IBM SPSS 21 programme. As a result, statistical analysis of GLc, GLt, Bd, Calfactor and Talfactor were statistically significant on predicting carcass weight. Specific anatomical structures, such as certain bone measurements, such as talus and calnaneus could serve as indicators of growth performance and also carcass weight performance. In addition new anatomical factors and indices may be produced and new regression methods may be applied with these new parameters to predict carcass weight.

MedCapsNet: A modified Densenet201 model integrated with capsule network for heel disease detection and classification

Conditions affecting the heel bone, such as heel spurs and sever's disease, pose significant challenges to patients' daily activities. While orthopedic and traumatology doctors rely on foot X-rays for diagnosis, there is a need for more AI-based detection and classification of these conditions. Therefore, this study addresses this need by proposing MedcapsNet, a novel hybrid capsule model combining modified DenseNet201 with a capsule network, designed to accurately detect and classify heel bone diseases utilizing lateral heel x-ray foot images. We conducted a comprehensive series of experiments on the proposed hybrid architecture with several datasets, including the Heel dataset, Breast BreaKHis v1, HAM10000 skin cancer dataset, and Jun Cheng Brain MRI dataset. The first experiment evaluates the proposed model for heel diseases, while the other experiments evaluate the model on a range of medical datasets to demonstrate its performance over existing studies. On the heel dataset, MedCapsNet achieves an accuracy of 96.38%, AUC of 98.35% without data augmentation, cross-validation accuracy of 95.69%, and AUC of 98.87%. The proposed model, despite employing a fixed architecture and hyperparameters, outperformed other models across four distinct datasets, including MRI, X-ray, and microscopic images with various diseases. This is notable because different types of medical image datasets typically require different architectures and hyperparameters to achieve optimal performance.