Plantar Fasciitis as a Potential Early Indicator of Elevated Cardiovascular Disease Risk.

Background Plantar fasciitis is characterized by heel pain and is often associated with extended periods of walking or standing, improper footwear, and biomechanical imbalances. This condition primarily affects the bottom of the foot, particularly the area where the heel meets the arch. Despite its prevalence, the potential systemic effects, especially the relationship with cardiovascular disease (CVD) risk factors, require further illumination. This study explores the association between chronic plantar fasciitis and elevated C-reactive protein (CRP) levels in individuals with cardiovascular risk factors. Methods A cross-sectional study of 400 patients with foot or ankle pain was initially assessed clinically and with ultrasound or MRI scans. After excluding those with confounding factors for elevated CRP, 295 patients with concurrent diabetes, hypertension, or dyslipidemia were analyzed. We investigated the correlation between plantar fasciitis and elevated CRP levels, defined as >1 mg/L, in the context of cardiovascular risk assessment. Results The study indicated that nearly half of the patients suffering from foot or ankle pain were diagnosed with plantar fasciitis, accounting for 47.8% of cases. A statistically significant association was observed between plantar fasciitis and elevated CRP levels (p=0.035). Furthermore, a substantial correlation was found between high BMI and plantar fasciitis, but no gender-specific disparity was noted. Elevated CRP levels were significantly associated with diabetes, hypertension, and dyslipidemia. Discussion A definitive cause-and-effect relationship between plantar fasciitis and systemic inflammation has not been established; our study suggests that chronic plantar fasciitis may be more than a localized condition and could be indicative of systemic inflammation, which is known to be a factor in atherosclerosis and CVD. The observed correlation between increased CRP levels and plantar fasciitis suggests that plantar fasciitis might be a clinical indicator of systemic inflammation and could improve the assessment of CVD risk. Conclusions Elevated levels of CRP, associated with chronic plantar fasciitis, suggest a link to systemic inflammation, which could elevate the risk of CVD. Identifying plantar fasciitis as a marker for systemic inflammation in patients with CVD risk factors, including diabetes, hypertension, and dyslipidemia, underscores the importance of thorough cardiovascular evaluations in individuals with persistent heel pain. Further longitudinal and interventional research is essential to substantiate these preliminary findings and understand their impact on CVD risk management and treatment.

Changes in functional characteristics of heel fat pad with age.

BACKGROUND: This study aimed to investigate age-related changes in the heel fat pad's microchamber and macrochamber layers, particularly focusing on load-induced alterations. Understanding these changes is crucial for elucidating age-related differences in foot mechanics and their potential implications for mobility and comfort. METHODS: Fifty-five healthy individuals were divided into three age groups: young adults (≤29 years), middle-aged adults (30-44 years), and elderly individuals (≥45 years). Ultrasonic imaging was utilized to measure the thickness of the heel fat pad's microchamber and macrochamber layers under varying load conditions. Thickness, percentage changes, and ratios of load-induced thickness changes were calculated to assess age-related differences. FINDINGS: Under no-load conditions, both microchamber and macrochamber layers of the heel fat pad were significantly thicker in middle-aged and elderly individuals than in young adults. When load was applied middle-aged and elderly participants exhibited smaller changes in the macrochamber layer and larger changes in the microchamber layer compared to young adults. INTERPRETATION: Our findings suggest that age influences the structural characteristics and response of the heel fat pad to mechanical loading. Thicker heel fat pad layers in middle-aged and elderly individuals under no-load conditions may reflect age-related changes in fat distribution or composition. Moreover, differences in load-induced thickness changes indicate altered mechanical properties with age, potentially affecting shock absorption and overall foot function. Understanding these age-related variations can help develop interventions aimed at preserving foot health and mobility across the lifespan.

Outcomes in Patients with Heel Ulcerations that Underwent Below the Knee Amputations versus Vertical Contour Calcanectomy: Importance of Selection Criteria.

The aim of the study was to compare preoperative factors and postoperative outcomes in patients with heel ulcerations that primarily had a transtibial (below the knee) amputation (N=38) versus vertical contour calcanectomy (n=62). The groups had no statistical difference between their Charlson Comorbidity Index Score, a prognostic score of ten-year survival in patients with multiple comorbidities. The odds of primary closure was 21.1 times higher in patients that underwent below knee amputation compared to patients that underwent vertical contour calcanectomy [OR 21.1 (95% CI 3.89-114.21)]. The odds of positive soft tissue culture at time of closure were 17.1 times higher for patients that underwent vertical contour calcanectomy [OR 17.1 (95% CI 5.40-54.16)]. The odds of a patent posterior tibial artery was 3.3 times higher for patients that underwent vertical contour calcanectomy [OR 3.3 (95% 1.09-10.09)]. The secondary aim of the study was to evaluate preoperative factors and postoperative outcomes in patients with failed vertical contour calcanectomy, defined as needing a below knee amputation. The odds of vertical contour calcanectomy failure was 13.7 times higher in male patients [OR 13.7 (95% CI 1.80-107.60)]. Vertical contour calcanectomy failure was 5.7 times higher in patients with renal disease [OR 5.7 (95% CI 1.10-30.30)], and vertical contour calcanectomy failure was 16.1 times higher for patients who needed additional surgery post closure [OR 16.1 (95% CI 1.40-183.20)].

Simultaneous effect of oxygen impurity and flow rate of purge gas on adsorption capacity of and heel buildup on activated carbon during cyclic adsorption-desorption of VOC.

Irreversible adsorption, or heel buildup, negatively impacts activated carbon performance and shortens its lifetime. This study elucidates the interconnections between flow rate and the oxygen impurity of desorption purge gas with heel buildup on beaded activated carbon (BAC). Nine thermal desorption scenarios were explored, varying nitrogen purge gas oxygen impurity levels (<5 ppmv, 10,000 ppmv, 210,000 ppm (21 %)) and flow rates (0.1, 1, 10 SLPM or 1 %, 10 %, 100 % of adsorption flow rate) during thermal desorption. Results reveal that increasing purge gas flow rate improves adsorption capacity recovery and mitigates adverse effects of purge gas oxygen impurity. Cumulative heel increased with higher purge gas oxygen impurity and lower flow rates. In the least effective regeneration scenario (0.1 SLPM N2, 21 % O2), a 32.8 wt% cumulative heel formed on BAC after five cycles, while the best-case scenario (10 SLPM N2, <5 ppmv O2) resulted in only 0.3 wt%. Comparing the pore size distributions of virgin and used BAC shows that heel initially forms in narrow micropores (<8.5Å) and later engages mesopores. Thermogravimetric analysis (TGA) showed that oxygen impurity creates high boiling point and/or strongly bound heel species. TGA confirmed that higher purge gas flow rates reduce heel amounts but encourage chemisorbed heel formation in oxygen's presence. These findings can guide optimization of regeneration conditions, enhancing activated carbon's long-term performance in cyclic adsorption processes.

Heel pain in young athletes - not always Sever's Disease: A Narrative Review.

Heel pain is a prevalent issue in young athletes, often arising from overuse and increased sporting demands. While Sever's Disease is the predominant cause, various other entities, including stress-related injuries and pathologies like tumors and bone lesions, contribute to this condition. The complex hind foot anatomy, encompassing ossicles, physis, and soft tissues, may lead to heel pain. This study aims to provide physicians with a clinically oriented narrative review of adolescent heel pain, supported by illustrative cases. CONCLUSION: This study aims to offer physicians a comprehensive understanding of the concepts surrounding heel pain in adolescents. By presenting clinically relevant information and illustrated cases, it seeks to enhance medical practitioners' ability to diagnose and manage heel pain effectively in this specific demographic.

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

Rationale: It is unclear whether lifestyle factors affect bone mineral density (BMD) during different inflammatory states. Objective: This study investigated the effects of coffee consumption, vitamin D (VD) intake, smoking, and alcohol consumption on heel BMD in adults with different inflammatory states. Methods: The 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. Results: Our findings revealed that VD was positively associated with adult heel BMD (ß = 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 (ß = -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. Conclusion: Our 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.

Comparative assessment of heel rise detection for consistent gait phase separation.

Background: Accurate identification of gait events is crucial to reliable gait analysis. Heel rise, a key event marking the transition from mid-stance to terminal stance, poses challenges in precise detection due to its gradual nature. This leads to variability in accuracy across studies utilizing diverse measuring techniques. Research question: How do different HR detection methods compare when assessed against the underlying heel motion pattern and visual detection across varying speed, footwear conditions, and individuals? Methods: Leveraging data from over 10,000 strides in diverse scenarios with 15 healthy subjects, we evaluated methods based on measurements from optical motion capture (OMC), force plates, and shank-mounted inertial measurement units (IMUs). The evaluation of these methods included an assessment of their precision and consistency with the heel marker's motion pattern and agreement with visually detected heel rise. Results: OMC-based heel rise detection methods, utilizing the heel marker's vertical acceleration and jerk, consistently identified the same point in the heel motion pattern, outperforming velocity-based methods and our new position-based method resembling traditional footswitch-based heel rise detection. Variability in velocity and position-based methods derives from subtle heel rise variations after mid-stance, exhibiting individual differences. Our proposed IMU-based methods show promise by closely matching OMC-based accuracy. Significance: The results have significant implications for gait analysis, providing insights into heel rise event detection's complexities. Accurate HR identification is crucial for gait phase separation, and our findings, especially with the robust heel marker's jerk-based method, enhance precision and consistency across walking conditions. Moreover, our successful development and validation of IMU-based algorithm offer cost-effective and mobile alternative for HR detection, expanding their potential use in comprehensive gait analysis.

Analgesic utility of automatic lancing device for heel prick in neonates: a systematic review and meta-analysis.

Background: This systematic review and meta-analysis assessed the benefits of an automatic lancing device compared with a manual lancet or a hypodermic needle in neonates. Materials & methods: We followed the Cochrane Handbook methodology, used the RoB-2 tool for risk of bias assessment, RevMan 4.1 for meta-analysis and GRADE framework for certainty assessment. We searched the databases and gray literature on 15 November 2023. Results: Six eligible studies enrolling 539 neonates were included. An automatic lancing device reduced pain scores during and after heel prick, sampling time and the need for repeat puncture. The certainty of evidence was very low to moderate. Conclusion: An automatic lancing device is preferred for heel pricks in neonates, given less pain and higher efficiency.PROSPERO registration number: CRD42023483189.

What is this article about? The heel prick is a common painful procedure in neonates. It is performed either with a hypodermic needle or a lancet (manual or automatic lancing device). Few studies have shown that an automatic lancing device, with depth regulation, causes less pain. We reviewed the available literature to assess the benefits and harms of different sampling methods.What were the results? We found six studies comparing these interventions for heel prick in neonates. There was a significant reduction in pain score, sampling time and need for repeated pricks when using an automatic lancing device.What do the results of the study mean? The automatic lancing device causes less pain (safer) and reduces the time required for sampling and repeated pricks (more effective) when used for heel pricks in neonates.

The Association of Infant Birth Sizes and Anemia under Five Years Old: A Population-Based Prospective Cohort Study in China.

Infant birth sizes are vital clinical parameters to predict poor growth and micronutrient deficiency in early life. However, their effects on childhood anemia remain unclear. We aimed to explore the associations between birth weight, crown-heel length, and head circumference with anemia in early childhood, as well as potential modification factors. This population-based prospective cohort study included 204,556 participants with singleton live births delivered at gestational ages of 28-42 weeks. A logistic regression model was used to estimate the associations of the measures of infant birth size and their Z-score with anemia under five years old. There were 26,802 (13.10%) children under five years old who were diagnosed has having anemia. Compared with children who did not have anemia, children who had anemia had a lower birth weight and smaller head circumference and a longer crown-heel length (all p-values < 0.05). After adjusting for confounders, not only birth weight (ß coefficient, -0.008; 95% CI, -0.011--0.004; p < 0.001) and head circumference (ß coefficient, -0.004; 95% CI, -0.007--0.001; p = 0.009), but also the related Z-scores were negatively associated with childhood anemia, while the trends for crown-heel length were the opposite. We further found significant interactions of folic acid use and maternal occupation with infant birth sizes. In conclusion, infants having abnormal sizes at birth are significantly associated with the risk for childhood anemia, which can be modified by folic acid use during pregnancy and maternal occupation.

Posterior Tibial Artery Blood Flow Velocity Is Increased in Patients with Plantar Heel Pain.

Background/Objectives: This study aimed to investigate the relationship between posterior tibial artery blood flow velocity and plantar heel pain (PHP). Methods: The PHP group comprised patients diagnosed with plantar fasciitis with plantar heel pain during gait, and the control group comprised healthy participants without plantar heel pain. The peak systolic velocity of the posterior tibial artery was measured using ultrasonography; it was measured three times on each side, and the mean value was calculated. Receiver operating characteristic curve analysis was performed to calculate the peak systolic velocity cutoff value for plantar heel pain. Results: 23 patients (age 58.0 ± 16.5 years; 13 males and 10 females) and 23 healthy participants (age 51.3 ± 17.3 years; 10 males and 13 females) formed the PHP and control groups, respectively. Peak systolic velocity on the affected side was significantly greater in the PHP group (44.1 ± 13.1 cm/s) than in the control group (32.7 ± 5.9 cm/s). No significant difference was observed between the left and right sides in the PHP (7.1 ± 9.8 cm/s) and control (3.7 ± 3.0 cm/s) groups. A cutoff value of 38.2 cm/s was observed on the affected side. Conclusions: We quantified the increase in posterior tibial artery blood flow velocity in patients with plantar heel pain. Peak systolic velocity measurements can aid in quantitatively evaluating these patients. This study was registered as a clinical trial (UMIN000046875) on 1 October 2021.

A randomised crossover trial on the effects of foot starting position on calf raise test outcomes: Position does matter.

BACKGROUND: This randomised crossover study with repeated measures examined the influence of the three most common foot starting positions used in conducting the calf raise test (CRT) on test outcomes. This study also accounted for the potential influence of gender, age, body mass index (BMI), and level of physical activity on test outcomes. METHODS: Forty-nine healthy individuals (59 % female, 21 ± 4 years) performed single-leg calf raise repetitions in a human movement laboratory in three randomised foot starting positions: flat, 10° incline, and step. The validated Calf Raise application was used to track the vertical displacement of a marker placed on the foot using computer vision. The application extracted the following CRT outcomes from the vertical displacement curve: number of repetitions, peak vertical height, total vertical displacement, and total positive work. Data were analysed using mixed-effects models and stepwise regression. RESULTS: There was a significant main effect (P < 0.001) of foot starting position on all outcomes, with all paired comparisons being statistically significant (P ≤ 0.023). Repetitions, total vertical displacement, and total positive work were greatest in flat and lowest in step, whereas peak vertical height was greatest in incline and lowest in step. Gender (P = 0.021; males>females) and BMI (P = 0.002; lower BMI>higher BMI) significantly influenced the number of repetitions. Gender (P < 0.001; males>females) also influenced total positive work. Age and physical activity levels did not significantly influence CRT outcomes. CONCLUSIONS: CRT foot starting position mattered and significantly affected all CRT outcomes. CRT foot starting position needs consideration when contrasting data in research and practice.

Plantar pressure reduction in the heel region through self-adjusting insoles with a heel cup in standard and individualized rocker shoes.

BACKGROUND: Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed. METHODS: In-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole. FINDINGS: Generalized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe. INTERPRETATION: The new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.

Ultrasound imaging and shear wave elastography for the differential diagnosis of heel pain: a comparative cross-sectional study.

PURPOSE: In correlation with magnetic resonance imaging (MRI), this study attempts to assess the effectiveness of the diagnostic of ultrasonography (US) features and shear wave elastography (SWE) in determining the different causes of heel pain. MATERIALS AND METHODS: 55 heels with a mean age of 38.33 ± 10.8 were included in the study (10 control cases and 41 cases, 4 of which had bilateral heel pain). There were 23 female cases (56.1%) and 18 male cases (43.95%). Examinations using shear wave elastography (SWE) and ultrasound (US) were done in different positions. MRI and the obtained data were correlated. RESULTS: When used to diagnose different heel pain causes, ultrasound demonstrated great sensitivity and specificity. SWE demonstrated a good correlation with MRI findings and enhanced the ultrasound's diagnostic precision in identifying plantar fasciitis early on (increased accuracy from 88.9 to 93.33% with 100% sensitivity and 83.3% specificity) and Achilles tendinopathy (increased accuracy from 88.9 to 97.8 with 94.7% sensitivity and 100% specificity). CONCLUSION: In summary, we concluded that heel pain can be efficiently examined by both ultrasound (US) and shear wave elastography (SWE) with the former being used as the primary effective tool and the latter being done to increase diagnostic accuracy. We also concluded that SWE improved the ultrasound's diagnostic precision in identifying patients with early plantar fasciitis and Achilles tendinopathy and showed a robust relationship with clinical outcomes, enhancing patient evaluation and follow-up.

Comparison of Platelet-Rich Plasma and Corticosteroid Injections for Chronic Plantar Fasciitis: A Randomized Controlled Trial.

BACKGROUND: Plantar fasciitis is a common and debilitating foot condition, with varying treatment options and inconsistent outcomes. The objective of this study was to assess and compare the effectiveness of autologous platelet-rich plasma (PRP) injections and corticosteroid injections in treating persistent plantar fasciitis. METHODS: In this study, a total of 70 patients suffering from chronic plantar fasciitis were randomly divided into two groups, i.e., one receiving PRP injections (n=35) and the other receiving corticosteroid injections (n=35). The visual analog scale (VAS) was used to assess pain outcomes, while the American Orthopaedic Foot and Ankle Society (AOFAS) score was used to assess functional status. Patients were assessed before the injection and then followed up at 15 days, one month, three months, and six months after the injection. RESULTS: The baseline VAS and AOFAS scores were similar between the two groups. However, the PRP group showed significantly greater improvements in VAS and AOFAS scores compared to the corticosteroid group at the one-month, three-month, and six-month follow-ups (p<0.05). The PRP group had a higher proportion of patients with mild or moderate pain and better functional outcomes at later time points. CONCLUSIONS: Autologous PRP injections are superior to corticosteroid injections in terms of long-term pain alleviation and functional improvement for patients suffering from chronic plantar fasciitis. Platelet-rich plasma should be regarded as a feasible therapeutic choice for this condition, especially in individuals who have not shown improvement with conservative treatment.

End-stage ankle arthritis alters dynamic stability during gait as measured by margin of stability between limbs and compared to healthy controls.

OBJECTIVE: This study aimed to assess dynamic stability in individuals with end-stage ankle arthritis compared to healthy controls by evaluating the margin of stability (MoS) during gait. DESIGN: A cohort of 50 participants with end-stage ankle arthritis (AA) and 50 matched healthy controls (HC) were analyzed from an IRB approved database. Kinematic data were collected using an eight-camera motion analysis system, and MoS was calculated based on the extrapolated center of mass (XCoM) and the base of support (BoS). Statistical analysis was performed using a linear mixed effects model with gait speed as a covariate. RESULTS: The analysis revealed a significant interaction between the group (AA vs. HC) and limb (arthritic vs. non-arthritic) at heel-strike and midstance. The non-arthritic limb demonstrated a significantly smaller AP MoS during heel-strike compared to the arthritic limb and either of the limbs of the HC group (p < 0.001). The arthritic limb demonstrated a significantly greater ML MoS during midstance compared to the non-arthritic limb and either of the limbs of the HC group (p < 0.001). AA group had significant slower gait speed (p < 0.001), smaller step length (p = 0.015) and smaller locomotor rehabilitation index (p < 0.001) than HC. CONCLUSION: Individuals with end-stage ankle arthritis exhibit altered dynamic stability during gait, with a significantly smaller AP MoS on the non-arthritic limb at heel-strike and greater ML MoS on the arthritic limb at midstance compared to healthy controls. Our results suggest that individuals with ankle arthritis are less stable when navigating single limb support of the arthritic limb. Further research should further examine the associations with fall risk in patients with ankle arthritis and evaluate the effectiveness of therapeutic interventions targeting these factors.

Anatomical Variations of the Medial Plantar Artery Flap: A Cadaveric Study With Clinical Applications.

The medial plantar artery flap (MPAF) presents both unique value as well as significant challenges. As the plantar foot has specific anatomy, the use of the MPAF to recreate this highly specialized area may provide improvements in durability and rates of limb salvage. The purpose of this study is to establish the anatomic course of the branching patterns of the medial plantar artery (MPA) and provide a foundation for MPA flap nomenclature as it is related to design and elevation. Thirty-seven fresh frozen cadaver feet were used for dissection: 20 right and 17 left sided limbs. Anatomic measurements recorded included: branching pattern of the MPA, bifurcation distance of the superficial branch (SB) and deep branch (DB) from the origin of the MPA, distance from the MPA origin to the anterior colliculus of the medial malleolus, and the distance from the SB and the DB to the navicular tuberosity. The MPA was found to bifurcate into SB and DB in 30 (81%) specimens; 6 (16%) specimens had only a SB, whereas 1 (3%) specimen had only a DB, which had not been previously described. The distance from the anterior colliculus to the MPA was 3.0 cm, MPA to the distal bifurcation was 2.9 cm, and navicular tuberosity to the SB and DB was 2.2 cm and 1.3 cm, respectively. Minimizing the complexity of the dissection with the use of more reliable landmarks and a deeper understanding of the anatomy may reduce complications and allow for more reproducible outcomes when utilizing the MPAF.

Efficacy of heel lifts for mid-portion Achilles tendinopathy (the LIFT trial): study protocol for a randomised controlled trial.

BACKGROUND: Mid-portion Achilles tendinopathy is a common condition, characterised by localised Achilles tendon load-related pain and dysfunction. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. Heel lifts have also been advocated as a treatment for Achilles tendinopathy, but the efficacy and mechanism of action of this intervention is unclear. This proposal describes a randomised controlled trial comparing the effectiveness of heel lifts versus sham heel lifts for reducing pain associated with mid-portion Achilles tendinopathy, with an embedded biomechanical analysis. METHODS: One hundred and eight men and women aged 18 to 65 years with mid-portion Achilles tendinopathy (who satisfy the inclusion and exclusion criteria) will be recruited. Participants will be randomised, using the website Sealed Envelope, to either a control group (sham heel lifts) or an experimental group (heel lifts). Both groups will be provided with education regarding acceptable pain levels to ensure all participants receive some form of treatment. The participants will be instructed to use their allocated intervention for at least 8 h every day for 12 weeks. The primary outcome measure will be pain intensity (numerical rating scale) at its worst over the previous week. The secondary outcome measures will be additional measures of Achilles tendon pain and disability, participant-perceived global ratings of change, function, level of physical activity and health-related quality of life. Data will be collected at baseline and the primary endpoint (week 12). Data will be analysed using the intention-to-treat principle. In addition, the acute kinetic and kinematic effects of the interventions will be examined at baseline in a subpopulation of the participants (n = 40) while walking and running using three-dimensional motion analysis. DISCUSSION: The LIFT trial (efficacy of heeL lIfts For mid-portion Achilles Tendinopathy) will be the first randomised trial to compare the efficacy of heel lifts to a sham intervention in reducing pain and disability in people with Achilles tendinopathy. The biomechanical analysis will provide useful insights into the mechanism of action of heel lifts. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12623000627651 . Registered 7 June 2023.

Effects of automatic heel lancet on invasiveness in neonates: A systematic review and meta-analysis.

AIM: We conducted a meta-analysis comparing the invasiveness of automatic lancet devices, which can collect adequate amount of blood at shallow puncture depths, with conventional manual lance devices (lancet or needle) to statistically identify less invasive instruments for neonatal heel lance. METHODS: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Ichushi databases for studies comparing the invasiveness between automatic lancet and manual lancet or needle in term and preterm neonates in neonatal intensive care unit. RESULTS: This review included 9 out of 449 searched articles, with 673 neonates. Automatic lancet had significantly lower pain scores (standardised mean difference: -2.0, 95% confidence interval: -3.3 to -0.7), heart rate (mean difference: -8.0, 95% confidence interval: -13.8 to -2.1), cry duration (mean difference: -21.5, 95% confidence interval: -32.5 to -10.4), number of punctures (mean difference: -0.6, 95% confidence interval: -1.1 to -0.2), and duration of procedures (mean difference: -37.7, 95% confidence interval: -75.2 to -0.2) than manual lancet or needle. Furthermore, peripheral oxygen saturation was significantly higher in automatic lancet than in manual lancet or needle (mean difference: 4.5, 95% confidence interval: 0.5-8.5). CONCLUSION: Automatic heel lancet devices were less invasive than manual heel lance devices (lancet or needle).

Long-term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair.

PURPOSE: The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term. METHODS: This cohort study consisted of 181 ATR-repaired patients, from two large randomized clinical trials, who attended a 3-year follow-up evaluation. Patients were postoperatively randomized to two different weight-bearing interventions compared with immobilization in a below-knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional- and patient-reported outcomes were evaluated by the validated heel-rise test and self-reported questionnaire, Achilles tendon Total Rupture Score (ATRS). RESULTS: In total, 76 out of 181 (42%) patients exhibited a DVT at the 2- or 6-week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel-rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT. CONCLUSIONS: DVT during immobilization affects patients' long-term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age. LEVEL OF EVIDENCE: Level Ⅲ.

The Therapeutic Efficacy of Ankle Mobilization and Advance Physiotherapy in Alleviating Heel Spur and Plantar Fasciitis: A Case Report.

Plantar fasciitis arises from progressive damage of the plantar fascia, which originates at the medial calcaneal tuberosity and associated perifascial tissues. The plantar fascia is made up of three segments that grow from the calcaneus and serve a crucial role in appropriate foot biomechanics. The plantar fascia itself is vital in supporting the arch and absorbing trauma. The heel spur is one of the most prevalent causes of foot discomfort. It is important to determine the most effective technique of therapy based on the emergence of pain at each step of the day. This case report describes the thorough rehabilitation of a 42-year-old mesomorphic female, a yoga instructor, and a recreational runner who presented with heel spur and plantar fasciitis symptoms. In addition to traditional therapy, the patient received advanced physical therapy with an emphasis on Mulligan joint mobilization to lessen discomfort and increase range of motion. The objective was to evaluate the effect of this intervention on several outcome measures, such as the visual analogue scale, balance test, foot functional scale, range of motion, and lower extremity functional scale. Targeted exercises and treatments were incorporated into the comprehensive rehabilitation plan to enhance foot function. The patient received the enhanced physiotherapy intervention well. The outcome measure showed notable gains. This case contributes greatly to our knowledge of the best physiotherapy treatments for those with plantar fasciitis and heel spurs.