Calcaneal Research Articles

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.

Tarsals from the Sima de los Huesos Middle Pleistocene site (Atapuerca, Burgos, Spain).

Here, we provide a complete, updated, and illustrated inventory, as well as a comprehensive study, of the tarsals (rearfoot) recovered from the Middle Pleistocene site of Sima de los Huesos (SH, Atapuerca, Spain) in comparison to other Homo comparative samples, both extant and fossil. The minimum number of individuals (MNI) estimated from the tarsals has been established as 15, which represents 51.7% of the 29 dental individuals identified within the SH sample. Within the SH hominin foot sample, an exclusive combination of primitive or plesiomorphic and derived or autapomorphic traits can be observed when compared with other Homo individuals/populations. Other characters are shared among SH hominins and Neandertals that might represent shared derived or autapomorphic traits for this evolutionary line, and most are likely related to robusticity (e.g., rectangular-like trochlea of the talus, broad calcanei, broad naviculars, and short lateral cuneiforms). Additionally, we observed some exclusive autapomorphic traits in the SH tarsal sample (e.g., narrow head of the talus and short intermediate cuneiforms). A few exclusive traits in SH tarsal remains are even more robust than in Neandertals (e.g., broad lateral malleolar facet in talus, more projected sustentaculum tali, and broad medial cuneiform). These traits could suggest a slightly higher level of gracilization in the tarsal bones of Neandertals compared to the SH sample that is also supported by other anatomical postcranial skeleton elements. Additionally, some paleobiological inferences are made in relation to body size (stature and body mass) and some associations are proposed within the SH sample. In conclusion, the morphology of the SH tarsi confirms an evolutionary relationship of sister groups between this population and Neandertals, probably representing a morphotype similar to the Neandertal ancestors.

Knowledge and Prevalence of Plantar Fasciitis among Nurses of Selected Hospital of Kathmandu, Nepal

An uncomfortable foot ailment called plantar fasciitis is brought on by an inflammation of the plantar fascia. When this band of tissue is overworked or overextended, plantar fasciitis develops. This results in tiny rips in the fascia's fibers, particularly where it connects to the heel bone. This study set out to determine how much the nurses at the Civil Service Hospital in Kathmandu knew about plantar fasciitis and how common it was. At the Civil Service Hospital in Kathmandu, 58 nurses participated in a descriptive cross-sectional research. Data were gathered using a self-administered questionnaire and the windlass test. SPSS version 20 was used to analyze the data, which included frequency and percentage using a descriptive statistical approach. The results showed that majority of respondents (53.4%) of nurses were age group of 18 to 25 years. Maximum respondents (93.1%) had normal BMI, maximum (46.6%) had 1 to 4 years work experience and majority of respondents (74.1%) worn flats during duty hours. Out of 58 respondents (56.9%) had poor knowledge, (29.3%) satisfactory and (13.8%) had good knowledge regarding plantar fasciitis with positive prevalence of windlass test (63.80%) and (36.2%) had negative windlass test. In the present study, it is concluded that majority of the respondents had (56.9%) poor knowledge, (29.3%) satisfactory and (13.8%) had good knowledge regarding plantar fasciitis with positive prevalence of windlass test (63.80%) and (36.2%) had negative windlass test, which means majority have plantar fasciitis.

Prevalence and Association of Risk Factors for Plantar Fasciitis Among Nurses in Government Tertiary Care Hospitals of Peshawar

Background: Plantar fasciitis is a common cause of heel discomfort and pain, resulting from inflammation of the plantar fascia, a thickened fibrous aponeurosis extending from the medial calcaneal tuberosity to the metatarsal heads. It affects more than 1 million people worldwide annually, with a lifetime prevalence that may reach 10% of the general population. Despite its widespread impact, the exact incidence remains unknown. Objective: This study aimed to determine the prevalence and associated risk factors of plantar fasciitis among nurses working in government tertiary care hospitals in Peshawar. Methods: A cross-sectional survey was conducted over six months, utilizing a convenient sampling technique. A total of 332 female nurses aged 25 to 50 years with clinical duties exceeding five hours per day participated in the study. Data were collected using the Plantar Fasciitis Pain and Disability Scale and the Visual Analogue Scale (VAS) for pain intensity. Face-to-face interviews and physical assessments were conducted by trained healthcare professionals. Statistical analysis was performed using SPSS version 25.0, with descriptive statistics calculated for quantitative variables and Chi-Square tests used to examine associations between variables. Ethical approval was obtained from the Institutional Review Board, and informed consent was secured from all participants. Results: The mean age of participants was 29.8042 ± 3.67743 years. The mean total score for plantar fasciitis was 31.4096, and the mean VAS score was 1.9458. Pain occurrence per week was reported as 1-2 days by 44.0% of participants, 3-4 days by 46.7%, and 5-7 days by 9.3%. Pain was most commonly worse in the afternoon (35.8%) and interfered with walking occasionally (52.7%). High heel standing was uncomfortable for 54.5% of participants. A significant relationship was found between age and VAS scores (p=0.001), as well as between high heel usage and increased pain levels (p=0.000). Conclusion: The mean score of plantar fasciitis among the nurses was below the threshold indicating significant prevalence. However, a significant association was found between high heel usage and plantar fasciitis, suggesting that footwear choices play a critical role in the development of this condition. Ergonomic interventions promoting supportive footwear and regular breaks are recommended to mitigate the risk of plantar fasciitis among nurses.

Evaluating the association between lifestyle factors and heel bone mineral density in different inflammatory states

RationaleIt is unclear whether lifestyle factors affect bone mineral density (BMD) during different inflammatory states. ObjectiveThis study investigated the effects of coffee consumption, vitamin D (VD) intake, smoking, and alcohol consumption on heel BMD in adults with different inflammatory states. MethodsThe phenotypic data from 249,825 participants were analyzed using the UK Biobank cohort. The inflammatory status was evaluated using C-reactive protein (CRP) levels and the systemic immune-inflammation index. Linear regression analysis was used to examine the association between coffee consumption, VD, smoking, alcohol consumption, and heel BMD in adults with different inflammatory states. Linear regression models were used to analyze the interaction between inflammation and the four lifestyle factors with respect to their influence on heel BMD in adults. ResultsOur findings revealed that VD was positively associated with adult heel BMD (β = 2.41 × 10−2, SE = 5.14 × 10−3, P = 2.72 × 10−6), while alcohol consumption and smoking were negatively associated with adult heel BMD. Coffee was negatively associated with adult heel BMD in low inflammatory states (β = −1.27 × 10−2, SE = 4.79 × 10−3, P = 8.00 × 10−3), while there was no association between coffee and adult heel BMD in high inflammatory states. Overall, it was found that these four lifestyle factors interacted negatively with inflammatory states. ConclusionOur study suggests that VD is positively associated with adult heel BMD and that alcohol consumption and smoking are negatively associated with adult heel BMD. Coffee may reverse the adverse effects of inflammation on BMD when the patient is in a highly inflammatory state, thus acting as a protective agent against heel BMD in adults.

A Comparative Study of the Graston Technique and Alfredson Protocol in the Management of Achilles Tendinopathy.

The Achilles tendon, the largest and strongest tendon in the human body, is frequently injured by overuse; this condition is known as Achilles tendinopathy (AT). It serves as a link between the heel bone and the calf muscles and is necessary for motions, such as walking, sprinting, and jumping. Evidence is presented to support the efficacy of the Graston technique and Alfredson protocol for pain reduction and improvement of function and calf muscle strength. The objective of this study is to compare the efficacy of the Graston technique versus the Alfredson protocol in patients with AT. Methods and data collection: After obtaining approval from the ethical review board of the Rawalpindi Medical University, all patients fulfilling the inclusion criteria are divided into two groups, A and B, by generating random identity numbers using Microsoft Excel for allocation. Group A comprises patients who undergo treatment with the Graston technique as conventional therapy with Alfredson protocol (12-week calf muscle eccentric exercises), while those in group B follow a Graston technique with sole heel lift. Individuals in the eccentric exercises group follow an Alfredson method-based 12-week eccentric exercise plan for their leg muscles. The workouts need to be done twice a day, seven days a week for 12 weeks. The plan includes two exercises: the first done with the knee straightened to work the gastrocnemius and the second done with the knee bent to work the soleus. Three sets of 15 repetitions with no rest interval for each exercise are completed twice a day on the affected limb to yield functional improvement. The results showed that both the Alfredson protocol and the Graston technique were effective in managing AT symptoms. The study involved dividing 32 participants into two groups who received either treatment for four weeks. The main way to measure improvement was a score called the Villalta-Scanlon Achilles Tendonitis Index score. In both groups, these scores showed significant improvement (with a p-value less than 0.001, which means that the results are very statistically significant). For Group A (who received the Alfredson protocol), the average Villalta-Scanlon Achilles Tendonitis Index score before treatment was 29.25. This score increased to 31.25 at mid-treatment and 34.38 after the full four weeks of treatment. Group B (who received the Graston technique) started with an average Villalta-Scanlon Achilles Tendonitis Index score of 22.94. Their scores also increased throughout the treatment, reaching 34.94 at mid-treatment and 42.88 after four weeks. These findings provide evidence that both treatments can improve AT symptoms, with some suggestions that the Graston technique might be even more effective based on the higher average Villalta-Scanlon Achilles Tendonitis Index scores after treatment. The Graston technique shows promising results, particularly in the mid- and post-treatment phases, indicating its potential efficacy in comparison to the Alfredson protocol in the treatment of AT.

Treatment of Achilles tendon rupture in a patient with alkaptonuric ochronosis

The treatment result of a patient with spontaneous rupture of the Achilles tendon and features of diagnosing alkaptonuric ochronosis, a rare disease, are presented, providing doctors beneficial information for the prevention and/or delay of possible complications. On March 8, 2021, at about 20:50, while at his workplace, getting up from his chair from the table, patient K, 52 years old, felt a sharp pain in the lower third of his right shin and was urgently taken to the hospital. He was examined by a traumatologist and was initially diagnosed with rupture of the right Achilles tendon. His right lower limb was immobilized with a plaster splint. On March 11, 2021, he entered the military traumatology and orthopedics clinic of the Kirov Military Medical Academy for surgical treatment. Upon admission, the patient complained of pain in the right lower leg and impaired support function of the right lower limb. Based on complaints, medical history, laboratory results, and instrumental studies, subcutaneous rupture of the right Achilles tendon was diagnosed. On March 12, 2021, anchor suture of the right Achilles tendon was performed. Anesthesia — combined, access: two separate incisions on the posterior surface of the lower third of the right leg and in the area of the calcaneal tubercle, each 5 cm long, intraoperatively revealed a complete subcutaneous rupture of the right Achilles tendon. Notably, the tendon was black in color when cut. The postoperative period proceeded without complications, and postoperative wounds of linear shape in the right Achilles tendon healed by primary intention. No signs of disturbances were observed in peripheral circulation and innervation of the right lower limb. To confirm the diagnosis, a simple laboratory test was performed: a change in the color of urine during the day, after its additional alkalization. The color change is due to the polymerization of homogentisic acid, which is excreted in large quantities in the urine. To verify the diagnosis, a molecular genetic technique was performed: sequencing of the clinically significant HGD gene and encoding the enzyme homogentisate-1,2-dioxygenase, which are mutations that lead to alkaptonuria. The analysis results confirmed the presence of an amino acid substitution at the pGLy161Arg position, indicating pathogenicity. The use of simple methods of additional laboratory diagnostics and molecular genetic analysis enabled the diagnosis of alkaptonuric ochronosis. Thus, characteristic diagnostic signs were damage to the Achilles tendon in combination with the obtained anamnestic, clinical, and laboratory data of alkaptonuria.

Minimally invasive technique for acute fixation and subtalar fusion of displaced intra-articular calcaneus fractures.

Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment. We describe a reproducible, minimally invasive surgical technique for primary ORIF with subtalar fusion when the calcaneal tuberosity is amendable to cannulated screw fixation to treat these complex calcaneal fractures. Our technique offers advantages compared to other techniques in that it avoids screw traffic, allows easy bony compression of the subtalar joint, and minimizes soft tissue damage via percutaneous screw fixation. Fourteen fractured calcanei in 12 patients underwent our technique and all achieved bony union with a median time to fusion of 107.5days (range, 54-530days). Eight patients returned to work with the remaining 4 patients having an unknown work status at last follow-up, although 2 of these 4 patients resumed normal activities. Only 1 patient experienced a complication, which was an infection after achieving bony union, and was treated with successful hardware removal and our infection protocol. Overall, we conclude our surgical technique offers a successful option in the treatment of DIACFs when the calcaneal tuberosity is amendable to cannulated screw fixation.

Using the Equatorial Talar Line as a Radiographic Predictor of Sanders Type 3 and 4 Calcaneus Fractures and Lateral Wall Blowout.

To assess the equatorial talar line (ETL) as a sensitive radiographic parameter to predict Sanders type III and IV fractures and the presence of lateral wall blowout. Reliability of the ETL was assessed using the intraclass correlation coefficient (ICC) and receiver operating curve (ROC) to predict sensitivity. Using lateral ankle radiographs, raters determined whether the calcaneal tuberosity was "above" (predicting Sanders type I or II) or "below" (predicting Sanders type III or IV and lateral wall blowout). In determining the "above" or "below" location of the ETL, the calculated ICC was 1.0 for each session. As a predictor of Sanders fracture classification type, the calculated ICC was 0.93 for the first session and 0.89 for the second session for an overall ICC of 0.91. As a predictor of Sanders fracture type, ROC analysis yielded an overall sensitivity of 0.82. As a predictor of lateral wall blowout, ROC analysis yielded an overall sensitivity of 0.81. The ETL is a reproducible radiographic parameter that can be reliably used to crudely predict between Sanders type I or II (ETL is "above") and Sanders type III or IV (ETL is "below") calcaneus fractures as well as the presence of lateral wall blowout.

Views about the clinical, diagnostic and comprehensive treatment of plantar fasciitis: a review

INTRODUCTION. One of the problems in modern podiatry is plantar fasciitis. According to population studies, more than two million patients are treated for plantar fasciitis each year in the United States, 1 in 10 people will develop heel pain during their lifetime, and 1 % of visits to podiatrists are related to heel pain. Plantar fasciitis occurs in approximately 10 % of the general population, with 83 % of these patients being active working adults between the ages of 25 and 65. The high prevalence of plantar fasciitis in the population necessitates the search and development of new and effective methods for its recognition and treatment. AIM. Generalization of literature data on the mechanisms of development of plantar fasciitis, methods of diagnosis and treatment. MATERIALS AND METHODS. The databases PubMed, Scopus and the electronic scientific library eLIBRARY were searched for articles using the keywords: “plantar fasciitis”, “plantar fasciosis”, “heel pain”, “heel spur”. Search depth — 10 years. Publications related to the diagnosis and treatment of PF were selected. During the study, 40 publications were selected, the content of which, to one degree or another, corresponded to the purpose of this study. RESULTS AND DISCUSSION. Pain syndrome in the area of the heel bone is the main reason for seeking medical care in patients with plantar fasciitis. Currently, there are several approaches to the treatment of plantar fasciitis: conservative and surgical treatment. Conservative treatment is represented by methods of manual therapy, physical therapy, and physical therapy. Surgical methods include various variants of resection of the bony outgrowth of the calcaneal region and other interventions. CONCLUSION. Treatment of plantar fasciitis requires a multidisciplinary approach to treatment, as no single treatment method is universal. Conservative treatment of patients with plantar fasciitis should be comprehensive. Due to the high prevalence of plantar fasciitis in the population, the introduction of new treatment techniques and the development and use of a unified patient management tactic can improve patient outcomes and quality of life. Among other surgical methods, the use of RFD has a positive effect in patients with PF refractory to conservative therapy and is the least invasive method among surgical methods.

Genetic Prediction of Osteoporosis by Anti-Müllerian Hormone Levels and Reproductive Factors in Women: A Mendelian Randomization Study

Previous observational studies have suggested that anti-Müllerian hormone (AMH) and reproductive factors are linked to reduced bone mineral density (BMD) and an increased risk of osteoporosis (OP) in women. However, related studies are limited, and these traditional observational studies may be subject to residual confounders and reverse causation, while also lacking a more comprehensive observation of various reproductive factors. Univariate and multivariate two-sample Mendelian randomization analyses were conducted to determine the causal associations of AMH levels and six reproductive factors with BMD and OP, using the random-effects inverse-variance weighted method. Heterogeneity was assessed using Cochran’s Q-statistic, and sensitivity analyses were performed to identify causal correlations. Age at menarche (AAM) was negatively associated with total body BMD (TB-BMD) in females aged 45–60 and over 60 years, as well as with heel bone mineral density (eBMD). Conversely, age at natural menopause (ANM) was positively associated with TB-BMD in the same age ranges and with eBMD. ANM was only causally associated with self-reported OP and showed no significant correlation with definitively diagnosed OP. Neither AMH level nor other reproductive factors were significantly associated with a genetic predisposition to BMD at any age and OP. Later AAM and earlier ANM are significantly genetically causally associated with decreased BMD but not with OP. AMH levels, length of menstrual cycle, age at first birth, age at last birth, and number of live births, in terms of genetic backgrounds, are not causally related to BMD or OP.

CASE STUDY: IMPROVE BONE QUALITY AND SKELETAL MUSCLE MASS WITH A PROPER DIET AND EXERCISE FOR A PERSON AGED >60 YEARS OLD

Objective: To evaluate the effects of proper dietary and exercise practice on bone mineral quality, skelet muscle and fatty mass in a person aged > 60y. Subject & Methods: A 60 ys- old male subject, risk of osteoporosis received the daily diet 2000Kcal, Ca 1300mg, protein 1.7mg/kg.bw, vitamin D 665IU. Endurance exercise 3 times/week x 60 minutes/ session with moderate & high intensity levels; 45 minutes daily morning with moderate and light intensity, and 8 hours working at office. Heel- bone mineral density (BMD) measured by Quantitative Ultra-Sonic (QUS) instrument, skelets muscle and fat mass by Inbody 370S intrument every 6 months. The study period lasted 60 months (T60). Results: The T-score of heel bone increase from -2.4 (high risk osteoporosis) at the beginning (T0) to level of pick bone mass at T36, then maintained until T60 of intervention. The BUA (Broadband Ultrasound Attenuation), reflects the quality of the bone s’ trabecular, were also improved from 39.5dB/MHz to 108.1dB/MHz (+173.7%) from T0 to T60 respectively. The body weight, skelet-muscle & fat mass were maintained quite stable during 60 months of the study. Conclusion: A proper diet and exercise restored bone quality to pick bone mass levels, maintain skeletal muscle and body fat mass in the elderly.

Static posture weightbearing joint angle differences in patients with varus ankle osteoarthritis

BackgroundAdvanced varus ankle osteoarthritis is a debilitating disease that can present with limited physical function, severe pain, and diminished quality of life. Weightbearing computed tomography enables submillimeter 3-dimensional visualization, computational analyses, and enhanced diagnoses in reporting complex degenerative changes more accurately. Research questionThis study set to compare static posture weightbearing joint angle differences in healthy and varus ankle osteoarthritis patients (compensated and non-compensated). MethodsOur retrospective assessment included 70 individuals, 44 of whom were diagnosed with advanced varus ankle osteoarthritis, and the remaining 26 were healthy participants to serve as controls. An automatic anatomic coordinate system was applied to each patient’s 3-dimensional talus and calcaneus bone reconstructions from weightbearing computed tomography scans. Subtalar and midtarsal joint angles were calculated using Euler angles. ResultsWe report statistical differences between the healthy group and both advanced varus osteoarthritis groups for midtarsal inversion/eversion. Specifically, both osteoarthritis groups’ midtarsal joints were more inverted and plantarflexed as compared to healthy participants. Compensated and non-compensated subtalar joints were statistically different with respect to inversion/eversion. Non-compensated ankles exhibited a similar mean to healthy ankles who were both less inverted than compensated ankles. SignificanceOur study helps physicians to better understand underlying mechanisms of peritalar compensation in varus ankle osteoarthritis. Patients featuring hindfoot compensation on average had a greater subtalar joint angle indicating greater inversion than healthy and non-compensated patients.

An atlas of anatomical variants of the human calcaneus.

The usefulness of anatomical variation is determined by the knowledge of why nonmetric traits appear. Clear descriptions of the traits are a necessary task, due to the risk of confusing anatomical variants and evidence of trauma. Numerous interpretations of the appearance of calcaneal anatomical variants add to the need of an anatomical atlas of calcaneal nonmetric traits. We have analyzed a total of 886 calcanei; 559 belong to different modern and pre-Hispanic samples, and 327 bones were studied from a reference collection from Athens. In this study, we present the anatomical variations that exist on the calcaneus bone, some of which have rarely been mentioned in previous research. The standardization of methods proposed may be useful to experts working in human anatomy, physical anthropology as well as comparative morphology, due to usefulness of this information during surgery, and bioanthropology to observe and study the lifestyle of past populations.

The Occurrence of Sustentaculum Tali Displacement in Intra-articular Calcaneal Fracture and Its Effect on Operation

The Occurrence of Sustentaculum Tali Displacement in Intra-articular Calcaneal Fracture and Its Effect on Operation

HeCapsNet: An enhanced capsule network for automated heel disease diagnosis using lateral foot X‐Ray images

AbstractFoot pain, particularly caused by heel spurs and Sever's disease, significantly impacts mobility and daily activities for many people. These diseases are traditionally diagnosed by orthopedic specialists using X‐ray images of the lateral foot. In certain situations, the absence of specialists requires the adoption of AI‐based methods; however, the lack of a dataset hinders the use of AI for the preliminary diagnosis of these diseases. Therefore, this study first presents a novel dataset consisting of 3956 annotated lateral foot X‐ray images and uses the original capsule network (CapsNet) to automatically detect and classify heel bone diseases. The low accuracy of 73.99% of CapsNet due to the low extraction feature layers led us to search for a new model. For this reason, this paper also proposes a new enhanced capsule network (HeCapsNet) by adjusting the features extraction layers, adding extra convolutional layers, using “he normal” kernel initializer instead of “normal” and utilizing the “same” padding scheme to perform better with medical images. Evaluating the performance of the proposed model, higher accuracy rates are achieved, including 97.29% for balanced data, 94.19% for imbalanced data, area under the curve (AUC) of 98.69%, and a fivefold cross‐validation accuracy of 95.77%. We then compared our proposed model with state‐of‐the‐art modified CapsNet models using various datasets (MNIST, Fashion‐MNIST, CIFAR10, and brain tumor). HeCapsNet performed similarly to modified CapsNets on relatively simple non‐medical datasets such as MNIST and Fashion‐MNIST, but performed better on more complex medical datasets.

Never undescribed four - headed plantaris muscle.

The plantaris is a small muscle of the superficial posterior compartment of the leg. It originates at the lateral supracondylar line of the femur and the knee joint capsule, from where it continues distally, forming a long and slender tendon distally attached to the calcaneal tuberosity. During standard anatomical dissection four-headed plantaris muscle was found and all of its heads connected to each other as a single muscle belly passing into tendinous structure which was distally attached as a standard plantaris muscle. The first head originated from the popliteal surface of the femur. The second one was originated from distal Kaplan fiber. In turn, the third and fourth heads were proximally attached to the lateral femoral epicondyle. Knowledge about morphological variations is necessary because of its potential clinical significance, which means not only neurovascular compressions, but also surgical procedures.