Investigation of the relationship between foot deformities and radiographic measurements of the talus and calcaneus / Investigación de la relación entre las deformidades del pie y las mediciones radiográficas del talo y del calcáneo

SUMMARY: The weight of the body is transmitted to the foot through the subtalar joint and talus. Considering the important location of the talus and calcaneus, the morphological structures of these bones may affect the biomechanics of the subtalar joint. At the same time, the morphological structure of these bones is important in some common foot deformities. We aimed to investigate whether the various measurements of the talus and calcaneus are associated with different foot deformities in this study. In this study, radiography images of 158 (72 male and 86 female) patients within the mean age of 44 years were retrospectively examined. Eleven different measurements of the talus and calcaneus were obtained from the lateral and antero-posterior radiographs of the patients. A total of 158 patient's routine clinic radiographs were retrospectively assessed, which have calcaneal spur (n=63), hallux valgus (n=32) and control group (n=63). We determined that the body height of the calcaneus, maximum width of the head of the talus, minimum anterior width of the calcaneus were significantly different between calcaneal spur group and control group. Maximum length fibular malleolar facet of the talus was significantly different between age groups. And we determined that the calcaneal index was significantly different between hallux valgus group and control groups. Also all measurements were significantly different between males and females. As a result, some measurements that significantly determine the morphology of the talus and calcaneus were found to be significant between deformity groups and control groups. We think that our study will contribute to the literature as it is the first study in which the measurements obtained from the radiographic images of the talus and calcaneus are associated with foot deformities.

El peso del cuerpo se transmite al pie a través de la articulación subtalar y el talo. Teniendo en cuenta la importante ubicación del talo y el calcáneo, las estructuras morfológicas de estos huesos pueden afectar la biomecánica de la articulación subtalar. Al mismo tiempo, la estructura morfológica de estos huesos es importante en algunas deformidades comunes del pie. Nuestro objetivo fue investigar si las diversas medidas del talo y el calcáneo están asociadas con diferentes deformidades del pie en este estudio. Se examinaron retrospectivamente imágenes radiográficas de 158 pacientes (72 hombres y 86 mujeres) con una edad promedio de 44 años. Se obtuvieron once medidas diferentes del talo y el calcáneo a partir de las radiografías lateral y anteroposterior de los pacientes. Se evaluaron retrospectivamente un total de 158 radiografías clínicas de rutina de los pacientes, los cuales tenían espolón de calcáneo (n=63), hallux valgus (n=32) y grupo control (n=63). Determinamos que la altura del cuerpo del calcáneo, el ancho máximo de la cabeza del talo, el ancho anterior mínimo del calcáneo fueron significativamente diferentes entre el grupo con espolón calcáneo y el grupo control. La longitud máxima de la faceta maleolar fíbular del talo era significativamente diferente entre los grupos de edad. También determinamos que el índice calcáneo fue significativamente diferente entre el grupo de hallux valgus y los grupos controles. Además, todas las medidas fueron significativamente diferentes entre hombres y mujeres. Como resultado, algunas medidas que determinan la morfología del talo y el calcáneo resultaron significativas entre los grupos de deformidad y los grupos controles. Estimamos que nuestro estudio contribuirá a la literatura debido a que es el primer reporte en el que las medidas obtenidas de las imágenes radiográficas del talo y el calcáneo se asocian con deformidades del pie.

Ultrasound reference values for the calcaneus of children and adolescents at moderate altitudes in Peru

Abstract Objective: a) Establish reference values for bone parameters by using the speed of sound (SOS, m/s) of broadband ultrasound attenuation (BUA, dB/MHz) and establish a bone quality index (BQI = αSOS + βBUA) for children and adolescents living in a region of moderate altitude, b) compare bone parameters with an international standard (with different ethnic, socio-economic, and lifestyle backgrounds) by using ultrasound of the calcaneus (heel bone) (QUS). Methods: A descriptive cross-sectional study was carried out with children and adolescents between the ages of 6.0 and 16.9 years old. The sample was selected randomly. A total of 1322 subjects were studied. Weight, height, and bone parameters, using ultrasound of the calcaneus, were evaluated SOS, BUA, and BQI. Body Mass Index BMI was calculated. Results: The average age of males was 11.44 ± 0.35 years old, and for females, it was 11.43 ± 0.35 years old. The students in this research showed slightly higher values of SOS, BUA, and BQI for both sexes when compared with the international reference (the 50th percentile). Percentiles were generated (P3, P10, P25, P50, P75, P90, and P97) using the LMS method [median (M), standard deviation (S), and power of the Box-Cox transformation (L)] by age and sex. Conclusion: The students living at a moderate altitude showed slightly higher values in bone parameters in relation to the international reference. This pattern depicted a population with a better state of bone health. The proposed percentiles may be used to categorize adequate to at risk bone parameters based on age and sex.

Calidad ósea en poblaciones contemporáneas. Análisis de la estructura trabecular calcánea en una muestra esqueletal / Bone Quality in Contem porary Populations. Calcaneal Trabecular Structure Analysis in a Skeletal Sample

Resumen Objetivo: La osteoporosis es una condición de relevancia a nivel epidemiológico en Argentina, así como en el resto del mundo. Si bien actualmente la herramienta diagnóstica más relevante es la densitometría ósea, los análisis radiológicos pueden aportar información, principalmente en lo referente a la calidad ósea. En ese sentido, nos proponemos evaluar la estructura trabecular calcánea de una población local. Métodos: El material para dicho estudio consistió en 91 calcáneos de esqueletos pertenecientes a una muestra esqueletal. Fueron analizados individuos adultos, de ambos sexos, mediante imágenes radiográficas, a fin de clasificar su estructura trabecular de acuerdo al índice propuesto por Jhamaria y col., en una escala de V (normal) a I (osteoporosis severa). Resultados: Las prevalencias estimadas fueron de 23,1% de osteoporosis (fases I y II), 16,5% de borderline (fase III) y 48,4% se clasificó como estructura trabecular normal (fases IV y V). En relación a la edad de los individuos, se encontró una correlación significativa negativa entre ella y la pérdida trabecular (tau-b = -0,524, p = 0,00). No se encontraron diferencias significativas en cuanto a la afección dimórfica de la patología. Discusión: La relación entre envejecimiento y osteoporosis hallada es coincidente con estudios nacionales e internacionales que reconocen una disminución en la densidad mineral ósea (DMO) y una mala calidad ósea en individuos adultos mayores. La ausencia de afección dimórfica podría deberse a la edad promedio de la muestra, sumada a la posible resistencia de la estructura esponjosa del calcáneo a los cambios generados por el déficit estrogénico en las mujeres, característica de la osteoporosis tipo I. Conclusión: Creemos que es necesario revalorizar el análisis óseo por medio de radiografías, puesto que pueden ser de utilidad tanto en la clínica como en la investigación básica, debido a la mayor disponibilidad de equipos y a que posibilitan el análisis de otras propiedades del tejido óseo.

Abstract Objective: Osteoporosis is an important condition in an epidemiologic level in Argentina as in the rest of the world. Even though nowadays the most relevant diagnostic technique is bone densitometry, radiological studies can provide useful information, mainly in relation to bone quality. For this purpose, we aim to evaluate the calcaneus trabecular structure in a contemporary local population. Methods: The sample for this study consisted of 91 calcaneus from skeletons belonging to the skeletal repository. Adult individuals from both sexes were analyzed, to classify their trabecular structure according to the index proposed by Jhamaria et al., on a scale of V (normal) to I (severe osteoporosis). Results: The estimated prevalence were 23,1% of osteoporosis (phase I and II), 16,5% of borderline (phase III) and 48,4% were classified as normal trabecular structure (phase IV and V). In relation to the age of the individuals, a significant negative correlation was found between the first and the trabecular loss (tau-b = -0.524, p = 0.00). No significant differences were found in relation to the sex prevalence of this pathology. Discussion: The association found between aging and osteoporosis matches with the results of national and international studies that recognize that a decrease in Bone Mineral Density (BMD) and a bad bone quality in older adults. Absence of differences between sexes in this condition could be due to age average of the sample, added to the possible resistance of the calcaneus spongy structure to changes generated by estrogen deficit in women, characteristic of osteoporosis type I. Conclusion: We believe that it is necessary to revalue bone analysis by radiographic means, since they can be of use both in clinic and in basic research, due to a greater equipment availability and because they allow the analysis of other properties of bone tissue.

Ultrasound of entheses in ankylosing spondylitis patients: The importance of the calcaneal and quadriceps entheses for differentiating patients from healthy individuals

OBJECTIVES: To compare the ultrasonographic findings of entheses in ankylosing spondylitis (AS) patients with those of healthy control individuals and to assess the ability of ultrasound (US) to identify aspects related to the disease. METHODS: A cross-sectional study involving 50 patients with AS and 30 healthy controls was performed. Clinical assessment included the use of a visual analog scale for pain, assessment of swelling of the enthesis, global assessments for patients and physician, use of a disease activity index, mobility and dysfunctional indices, erythrocyte sedimentation rate and clinical enthesitis index. US was performed for the following entheses by two experienced musculoskeletal radiologists: brachial triceps, distal quadriceps, proximal and distal patellar tendons, calcaneal tendon, and plantar fascia; the total and subitems of the Madrid Sonographic Enthesitis Index were used for evaluations. RESULTS: Comparison between groups showed a statistically significant difference with worse scores in AS patients, with bone erosion of the calcaneal enthesis and bone erosion and thickening of the plantar fascia. The odds ratio for thickening of the plantar fascia in the AS group was 3.47, according to logistic regression analysis. The AS group also had worse scores regarding the presence of calcification in the quadriceps enthesis, with a fivefold increased risk. CONCLUSION: US analysis showed that only entheses of the foot and quadriceps were able to differentiate AS patients from healthy individuals.

Analysis of lifestyle and bone mineralization in a population of Spanish young adults / Análisis de los estilos de vida y la mineralización ósea en una población de adultos jóvenes españoles

Abstract Objective: To analyze the environmental factors (nutritional status, levels of physical activity and nutritional habits) and their possible association with bone mass in a population of young adults. Methods: The study population consisted of 200 subjects (117 women and 83 men) aged between 18 and 25 years (mean age 20.4 years ±2.2 years). Body composition parameters were measured by an electronic balance (TANITA BC-418MA), nutritional habits were estimated by 72-h dietary recall, level of physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and bone mass was measured by ultrasonography at the calcaneus. Results: There were significant differences in bone mass values ​​according to gender (p= 0.013). Despite the fact that 70% of the subjects had a body mass index (BMI) within the normal range, 20% had overweight or obesity. 49% of the individuals had a moderate level of physical activity, although women had lower levels of physical activity than men (17.9% vs 8.4%). Most diets among young adults were hyperprotic, hyperlipidic and low-carbohydrates, with low-calcium and fiber intakes and high-phosphorus. Analysis of bone mass according to BMI showed higher values ​​as the weight category rises, with significant differences in women. Higher values ​​of bone mass were shown as the level of physical activity was higher, showing significant differences in males. Conclusion: Our results show that BMI and level of physical activity are significantly associated with bone health in a population of young adults, suggesting the relevance of promoting healthy lifestyles as a strategy for the early prevention of osteoporosis.

Resumen Objetivo: Analizar los factores ambientales (estado nutricional, nivel de actividad física y hábitos nutricionales) y su posible relación con los niveles de masa ósea en una población de adultos jóvenes. Métodos: La población de estudio estuvo constituida por 200 sujetos (117 mujeres y 83 hombres) de edades comprendidas entre 18 y 25 años (edad media 20.4 años ± 2.2 años). La composición corporal se evaluó con balanza electrónica (TANITA BC-418MA), la valoración de los hábitos nutricionales mediante Recordatorio de 72 h, el nivel de actividad física a través del Cuestionario Internacional de Actividad Física (IPAQ) y la masa ósea mediante ultrasonografía en el calcáneo. Resultados: Existen diferencias estadísticamente significativas en los valores de masa ósea en función del sexo (p= 0.013). A pesar de que el 70% de los sujetos presentaron un índice de masa corporal (IMC) dentro de los límites de la normalidad, un 20% padece sobrepeso y obesidad. El 49% de los individuos tenian un nivel moderado de actividad física, aunque las mujeres presentaron niveles más bajos de actividad física que lo varones (17.9% vs 8.4%). Las dietas mayoritarias entre los adultos jóvenes son hiperprotéicas, hiperlipídicas y bajas en hidratos de carbono, observándose una ingesta baja de calcio y fibra y alta en fósforo. El análisis de la masa ósea en función de IMC mostró valores mayores conforme asciende la categoría ponderal, existiendo diferencias significativas en mujeres. Igualmente, se muestran valores más altos de masa ósea conforme mayor es el nivel de actividad física, evidenciando diferencias significativas en los varones. Conclusión: Nuestros resultados muestran que el índice de masa corporal y el nivel de actividad física se asocian significativamente con la salud ósea en una población de adultos jóvenes, evidenciando la importancia del fomento de estilos de vida saludables como estrategia para la prevención temprana de la osteoporosis.

Levels of calcaneus bone mineral density in adults from 10 regions of China / 中华流行病学杂志

Objective: To describe the regional and population-related differences in calcaneus bone mineral density (BMD) across ten regions of China. Methods: Based on the results: from the second Re-survey of China Kadoorie Biobank project, in which 5% of the surviving participants were interviewed during 2013-2014 and 24 677 participants aged 38-87 years were included in the study. We excluded those people with missing data for BMD and important variables. Calcaneus BMD was measured using the quantitative ultrasound bone densitometer. We analyzed four indexes, including broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI), and T score. Results The average calcaneus BMDs of the present population were: BUA (109.7±12.6) dB/MHz, SOS (1 554.7±45.6) m/s, SI (88.3±18.8), T score (-0.74±1.28). Urban residents showed higher calcaneus BMD, so as in men. The calcaneus BMD decreased by age, with a larger decline seen in women. Current smokers and postmenopausal women presented lower calcaneus BMD, while in those who frequently drank milk or yogurt or being physically more active, had higher calcaneus BMD. Conclusion: Calcaneus BMD varied greatly among people from the ten regions of CKB study and among participants having different demographic characteristics, lifestyle behaviors or health conditions.

Osteotomia de alongamento da coluna lateral do calcâneo para tratamento do pé plano flexível sintomático de crianças e adolescentes: revisão sistemática / Calcaneal lateral column lengthening osteotomy for symptomatic flexible flatfoot in children and adolescents: a systematic review

RESUMO O pé plano flexível é condição frequente na criança pequena e apresenta forte tendência para correção espontânea, ou tornar-se moderado ou leve no adulto, o que não causará problemas futuros. Entretanto, em uma pequena proporção de casos a deformidade é mais grave, não melhora, o que pode levar ao comprometimento do desempenho mecânico, deformidade e, eventualmente, dor. Nestes casos o tratamento cirúrgico deve ser considerado. O objetivo desta revisão sistemática foi avaliar os resultados da literatura no tratamento do pé plano flexível sintomático da criança ou adolescente por um procedimento bastante frequente que é a osteotomia de alongamento da coluna lateral do calcâneo. Foi realizada busca sistemática eletrônica nas bases de dados PubMed, Web of Science, Cochrane, CINAHL, SciELO, SCOPUS e LILACS por artigos publicados entre março de 1975 e setembro de 2016. Após aplicação dos critérios de elegibilidade, os artigos selecionados foram avaliados quanto aos resultados clínicos, radiográficos e complicações. Dos 341 artigos encontrados nas bases de dados, apenas oito estudos foram selecionados, segundo os critérios de inclusão e exclusão, com um total de 105 pacientes e 167 pés tratados. Somente três autores realizaram estudo prospectivo, mas sem caso controle ou aleatorização. A maioria das publicações no período avaliado é composta por estudos descritivos ou série de casos (nível de evidência III ou IV), com grandes variações metodológicas, mas com alto índice de satisfação dos pacientes e cirurgiões, em relação aos resultados. Entretanto, são necessárias pesquisas com desenho prospectivo, aleatorizado, grupo controle adequado e critérios de avaliação validados.

ABSTRACT Flexible flatfoot is a common condition in small children, which shows a strong tendency to spontaneously correct with their growth or to become moderate or mild in adults, which will not cause future problems. However, in a small number of cases, this condition is more severe, does not improve spontaneously, which may cause mechanical impairment, deformity, and, eventually, pain. In such cases, surgical treatment should be considered. The aim of this systematic review was to evaluate the literature results on the treatment of the symptomatic flexible flatfoot in children or adolescents through a very frequent procedure: calcaneal lateral column lengthening osteotomy, A systematic electronic search in PubMed, Web of Science, Cochrane, CINAHL, SciELO, SCOPUS and LILACS databases was performed. We searched articles published between March 1975 and September 2016. After applying the eligibility criteria, the selected publications were evaluated in relation to their clinical and radiographic results and complications. We found 341 articles in the mentioned databases, but selected only eight studies, according to the inclusion and exclusion criteria. These studies included a total of 105 patients and 167 treated feet. Only three authors performed prospective studies, but without case-control or randomization. The majority of publications were descriptive studies or case series (level of evidence III or IV), with great methodological variations, but with a high satisfaction rate on the part of both patients and surgeons in relation to the results. However, more prospective and randomized studies are required, with adequate control groups and validated evaluation criteria.

Comparison between the gold standard DXA with calcaneal quantitative ultrasound based-strategy (QUS) to detect osteoporosis in an HIV infected cohort

ABSTRACT Introduction: Osteoporosis represents one of the most frequent comorbidity among HIV patients. The current standard method for osteoporosis diagnosis is dual-energy X-ray absorptiometry. Calcaneal quantitative ultrasound can provide information about bone quality. The aims of this study are to compare these two methods and to evaluate their ability to screen for vertebral fracture. Methods: This cross-sectional study was conducted in HIV patients attending the Clinic of Infectious and Tropical Diseases of Brescia during 2014 and who underwent lumbar/femoral dual-energy X-ray absorptiometry, vertebral fracture assessment and calcaneal quantitative ultrasound. The assessment of osteoporosis diagnostic accuracy was performed for calcaneal quantitative ultrasound and for vertebral fracture comparing them with dual-energy X-ray absorptiometry. Results: We enrolled 73 patients and almost 48% of them had osteoporosis with at least one of the method used. Vertebral fracture were present in 27.4%. Among patients with normal bone measurements, we found vertebral fracture in proportion between 10% and 30%. If we used calcaneal quantitative ultrasound method and/or X-ray as screening, the percentages of possible savable dual-energy X-ray absorptiometry ranged from 12% to 89% and misclassification rates ranged from 0 to 24.6%. A combined strategy, calcaneal quantitative ultrasound and X-Ray, identified 67% of patients with low risk of osteoporosis, but 16.4% of patients were misclassified. Conclusions: We observed that patients with osteoporosis determined by calcaneal quantitative ultrasound and/or dual-energy X-ray absorptiometry have higher probability to undergo vertebral fracture, but neither of them can be used for predicting vertebral fracture. Use of calcaneal quantitative ultrasound for screening is a reasonable alternative of dual-energy X-ray absorptiometry since our study confirm that none strategy is clearly superior, but both screen tools must be always completed with X-ray.

Calcaneus quantitative ultrasound and body composition in preschool children: physical activity consideration / Ultrasonido cuantitativo de calcáneo y composición corporal en niños preescolares: consideración de actividad física

SUMMARY: The aim of this research was to determine the difference in Calcaneus quantitative ultrasound (QUS) and body composition according to physical activity in preschool children. We recruited 296 healthy children (112 girls and 184 boys) from different kindergartens in Vojvodina, Serbia. Children were evaluated for body composition. Quantitative ultrasound (QUS) measurements of the heel were performed using the Speed of sound, Broadband Ultrasound Attenuation, Quantitative Ultrasound Index and Estimated bone mineral density for further analysis. Furthermore, children were divided into three groups according to physical activity. Apart from the differences in Body fat % and body mass, there were no significant group differences for BMI, waist circumference and abdominal skinfold (p>0.05). The ANOVA showed significant differences (p<0.05) in all QUS measurements between three different intensities of physical activity. The results show that Body Mass and Body fat % were important predictors that discriminate children according to physical activity. Moreover, the results show that beside BMI and Body fat %, all calcaneus QUS measurements showed differences according to physical activity. In conclusion, our study showed differenses in all calcaneus QUS measurements according to physical activity level.

RESUMEN: El objetivo de esta investigación fue determinar la diferencia entre el ultrasonido cuantitativo (USC) de calcáneo y la composición corporal según la actividad física en niños en edad preescolar. Se estudiaron 296 niños sanos (112 niñas y 184 niños) de diferentes jardines infantiles en Vojvodina, Serbia. Se evaluó la composición corporal de los niños. Las medidas de USC del talón se realizaron utilizando la velocidad del sonido, atenuación de ultrasonido de banda ancha, el índice de ultrasonidos cuantitativos y la densidad mineral ósea estimada para un análisis posterior. Los niños se dividieron en tres grupos según actividad física. Además de las diferencias de porcentaje de grasa corporal y masa corporal, no se observaron diferencias significativas de grupo en el índice de masa corporal (IMC), circunferencia de cintura y el pliegue abdominal (p> 0,05). El test de ANOVA mostró diferencias significativas (p <0,05) en todas las mediciones USC entre tres diferentes intensidades de actividad física. Los resultados muestran que la masa corporal y la grasa corporal fueron indicadores importantes que permiten diferenciar a los niños según la actividad física. Por otra parte, los resultados muestran que además del IMC y el porcentaje de grasa corporal, todas las mediciones de USC del calcáneo mostraron diferencias según el nivel de actividad física. En conclusion, nuestro estudio mostró diferencias en el USC de acuerdo al nivel de actividad física.

Análisis imagenológico del calcáneo aplicada a la fijación interna de fracturas a través del abordaje del seno del tarso / Imaging of the Calcaneus applied to the internal fixation of fractures by a sinus tarsi approach

Resumen: Objetivo: La técnica a través del abordaje del seno del tarso (AST), se ha convertido en una opción cada vez más popular para el tratamiento de las fracturas de calcáneo. A pesar de los buenos resultados reportados, las complicaciones relacionadas con la fijación interna no han sido analizadas aún. A través de mediciones en tomografías computadas con reconstrucción 3D (TC) hemos planteado el objetivo de realizar una descripción del calcáneo aplicada al uso de osteosíntesis en fracturas de dicho hueso. Métodos: Se obtuvieron, retrospectivamente, 24 estudios de TC de 22 pacientes consecutivos que presentaban calcáneos sanos sin antecedente de cirugía ni fractura, 18 hombres y cuatro mujeres, 14 derechos y 10 izquierdos. La edad promedio fue de 45.8 (rango: 19-79) años. Se realizaron mediciones del ancho y largo de tornillos que se necesitarían para fijar una fractura de calcáneo con un montaje predefinido. Resultados: Los resultados están enfocados en mediciones obtenidas de imágenes de TC, las cuales ayudarían al cirujano a un correcto posicionamiento, angulación y largo de los tornillos necesarios para la fijación interna de fracturas de calcáneo. Conclusión: Este estudio describe una serie de mediciones del calcáneo que resultan de utilidad para la fijación interna de fracturas de calcáneo a través del AST. Su propósito es minimizar las complicaciones derivadas del uso de osteosíntesis en estas fracturas.

Abstract: Objective: The mini-invasive technique, through a sinus tarsi approach (STA), has become an increasingly popular choice for the treatment of calcaneal fractures. However, despite the good results reported, the complications related with internal fixation have not yet been analyzed. Using 3D reconstruction CT scans, we proposed doing biometric description of the calcaneus with the purpose of performing osteosynthesis as treatment for calcaneal fractures. Methods: A total of 24 CT scans were retrospectively obtained from 22 consecutive patients with healthy calcanei and no history of surgery or fracture. They included 18 males and 4 females; 14 right and 10 left calcanei. Mean age was 45.8 (range 19-79). The width and length of the screws needed to fix a calcaneal fracture with a predefined montage were measured. Results: The results focus on biometric measurements obtained from CT scans that may help surgeons achieve proper positioning, angulation and length of the screws needed for the internal fixation of calcaneal fractures. Conclusion: This study describes a series of biometric calcaneal measurements that are useful for the internal fixation of calcaneal fractures using a sinus tarsi approach. The purpose is to minimize the complications resulting from osteosynthesis to treat these fractures.

Effects of Pilates-Interventional Program on Calcaneus-Bone Density Parameters of Adult Women / Efectos de un Programa de Intervención de Pilates Sobre Parámetros de Densidad Ósea en el Calcáneo de Mujeres Adultas

Physical exercise has a positive influence on bone tissue and therefore, is recommended in order to prevent the bone mass loss during the aging process. Similarly, normally practice of exercise potentially prevents the incidence of osteoporosis and bone fractures in adult women. In order to evaluate the differences of a Pilates-Interventional Program on parameters of bone density (right and left calcaneus) for six months, a total of 22 women (48.18±9.59) participated in the study. Bone mineral density (BMD) was estimated by the broadband ultrasonic attenuation (BUA) and the speed of sound signals (SOS), through "Sahara" sound device. The BUA showed significant difference in the right and the left leg (both, P< 0.01), the SOS of the right leg (P<0.05), whereas the BMD was not proved to be statistically significant at the end of the treatment. In conclusion, the bone mineral density by BUA increased, while the speed of sound of the right leg decreased. Thus, our findings might imply a better level of bone strength after a specific intervention focused on the Pilates method.

El ejercicio físico tiene una influencia positiva en el tejido óseo y por consiguiente, es recomendado a la hora de prevenir pérdida de masa ósea durante el envejecimiento. Igualmente, la práctica regular de ejercicio previene la osteoporosis y fractura de huesos en población adulta y mayor. Con el fin de evaluar las diferencias de parámetros en la densidad ósea (huesos calcáneos derecho e izquierdo) tras un programa de intervención Pilates de 6 meses, un total de 22 mujeres (48,18±9,59) participaron en el estudio. La densidad mineral ósea (DMO) fue estimada mediante la atenuación ultrasónica de banda ancha (AUBA) y la velocidad de las señales del sonido (VSS) a través del dispositivo de sonido "Sahara". La AUBA mostró diferencias significativas en ambos calcáneos (P<0,01), la VSS obtuvo diferencias significativas en el calcáneo derecho (P<0,5) y la DMO no mostró significancia alguna tras el programa de intervención. En conclusión, el calcáneo incrementó mediante medición AUBA mientras que VSS fue significativo en el calcáneo derecho. Nuestros resultados podrían implicar un mejor nivel de fuerza del calcáneo después de una intervención específica con Pilates.

Lifestyle and Genetic Predictors of Stiffness Index in Community-dwelling Elderly Korean Men and Women

PURPOSE: Differing lifestyle, nutritional, and genetic factors may lead to a differing stiffness index (SI) determined by quantitative ultrasound in elderly men and women. The purpose of this study was to determine SI and the gender-specific factors associated with low SI in a Korean elderly cohort. METHODS: This was a cross-sectional descriptive study identifying the gender-specific factors related to SI in 252 men and women aged 65 years and greater from local senior centers in Seoul, Korea between January and February 2009. RESULTS: The mean SI of elderly men was significantly higher than that of the women's. A multiple regression analysis reveals that age, nutritional status, and physical activity were predictive factors of lower SI in men, whereas age, alcohol consumption, educational level, and genetic polymorphism were predictive factors for elderly women. CONCLUSIONS: Low SI was common in both elderly men and women. We found gender differences in factors linked to low SI. In multiple regression analysis, nutritional status and physical activity were more important factors in men, whereas alcohol consumption, educational level, and genetic polymorphism were significant factors predicting low SI in women. Gender-specific modifiable risk factors associated with low SI should be considered when developing osteoporosis prevention programs for the elderly.

Evaluation of the normal calcaneal angles in Egyptian population

The calcaneus is the largest and strongest tarsal bone. It is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. The importance of the calcaneal angles in assessing the fractures of calcaneus and planning treatment has been highlighted. The purpose of this study was to evaluate the normal calcaneal angles in the Egyptian populations who live in Alexandria and nearby governorates and compare their values to the published data. Lateral plain radiographs of 220 normal feet and ankles of 103 males and 97 females with age ranged from 20 to 40 years, were studied retrospectively at El Hadra University Hospital, Alexandria, Arabrepublic of Egypt between June and December 2010. Three of the normal calcaneal angles [Bohler angle-Gissane's angle-calcaneal compression angle] were measured and the mean and standard deviation of each angle were calculated. The relationships between each angle and age, sex, side of the body, occupation, weight, height, and residence of examined persons was tested and compared to previous researches and international figures. The mean of Bohler angle in the Egyptian population was 30.14 +/- 4.182 ranged from 22° to 40°. The mean of Gissane's angle was 122.92 +/- 6.952 ranged from 108° to 138°, while the mean of calcaneal compression angle was 31.03 +/- 3.82 ranged from 24° to 44°. The measured calcaneal angles are not significantly related to age, sex, and side of the body, residence and occupation of the examined persons except there is significant negative correlation between the Bohler angle and the age which not reported in the previous researches and studies. The study showed that difference in the mean of the calcaneal angles from other previous studies that reinforce the importance of establishing the normal range of the calcaneal angles in a given population

Correlation of periodontal status and bone mineral density in postmenopausal women: A digital radiographic and quantitative ultrasound study.

Background: Data suggest that postmenopausal women with osteoporosis are at an increased risk for periodontal attachment loss and tooth loss; however, the extent of relationship between these two diseases is still not clear. Aim: The aim of the study was to evaluate the correlation of periodontal status and bone mineral density (BMD) in postmenopausal women. Materials and Methods: The study population included 60 postmenopausal women aged 50-60 years (mean±SD: 55.5±3.4 years). Periodontal status was examined by plaque index, bleeding index, probing depth, and clinical attachment level (CAL). Digital panoramic radiograph was taken to measure the maxillary and mandibular alveolar bone density values. Skeletal (calcaneal) BMD was measured by quantitative ultrasound technique for T-score values. The recorded data for T-score, maxillary and mandibular alveolar bone densities, and periodontal status were subjected to statistical analysis for correlation and regression procedures. Results: The results showed that mandibular alveolar (r=0.907, P<0.001) and maxillary alveolar bone density (r=0.898, P<0.001) had significant positive correlation with calcaneal T-score. Probing depth (r=-0.316, P<0.05), bleeding index (r=-0.277, P<0.05), and plaque index (r=-0.285, P<0.05) showed weak but significant negative correlation with calcaneal T-score and alveolar bone density of both the jaws, whereas CAL showed weak correlation with T-score which could not reach to a statistically significance level (r=-0.221, P>0.05). Conclusion: Calcaneal BMD was related to alveolar bone loss and, to a lesser extent, to clinical attachment loss, implicating postmenopausal bone loss as a risk indicator for periodontal disease in postmenopausal women.

Association of estrogen receptor-alpha gene polymorphism with pathogenesis of osteoporosis in Korean vegetarian men

The purpose of this study was to investigate the association between two genetic polymorphisms [PvuII and Xbal restriction fragment length polymorphisms, RFLPs] of the estrogen receptor-a [ER1] gene and the quantitative ultrasound [QUS] parameters at the calcaneus. Two hundred and sixty-six Korean vegetarian men, mean age 50.9 +/- 12.0 years [range 26-80], were studied. Polymorphisms at the ER1 gene sites and the cross-sectional associates of genetic factors with calcaneal QUS parameters including broadband ultrasound attenuation [BUA] and the speed of sound [SOS] were analyzed by RFLPs using polymerase chain reaction. The distribution of PvuII and Xbal RFLPs in the ER1 gene was as follows: PP 11.6%, Pp 47.2%, pp 41.2%, XX 1.2%, Xx 24.4% and xx 74.4%. After adjusting for potential confounding factors such as age and body mass index, two genetic polymorphisms of the ER1 gene were independently associated with BUA, SOS and stiffness index at the calcaneus of our subjects. The QUS measurements of the subjects with the xx genotype were higher than those of the subjects with an Xx genotype, while the QUS measurements of the subjects with a Pp genotype were significantly lower than those of the subjects with PP or pp genotypes [p < 0.05]. The results suggest that the PvuII and Xbal RFLPs of the ER1 gene may be genetic factors that affect QUS at the calcaneus

Benign tumors and tumor-like lesions of the calcaneum: A study of 12 cases.

Benign tumors of the calcaneum are rare. Cystic lesions such as simple bone cysts and aneurysmal bone cysts are commonly seen. Aims and Objectives: To evaluate tumors of the calcaneum, which were seen over a 12-year period. Materials and Methods: We analyzed noninfectious, noninflammatory, benign lesions of the calcaneum seen in the Orthopedic Out Patient Department from 1991 to 2003. Twelve such tumors were encountered. There were 11 males and one female and their ages varied from 18 to 53 years with a median of 31. Data was collected from the histopathology reports, radiographs, and inpatient and outpatient records. One of the coauthors reviewed the histopathologic findings of all the tumors. Results: Twelve benign lesions were seen in 12 patients. In our series, cysts predominated, with three aneurysmal bone cysts and five simple bone cysts. The other benign tumors were: one fibrous dysplasia, one vascular hamartoma, one osteoblastoma, and one chondromyxoid fibroma. The bone cysts were treated by curettage, with or without bone grafting, except for one large aneurysmal bone cyst, which was treated by excision of the calcaneum. The postoperative function in this patient was good, with modified footwear. Conclusion: The calcaneum is an uncommon site for most bone tumors, and in our series, bone cysts were the most common benign lesions. Curettage and bone grafting or the use of bone substitutes can be effectively used in the treatment of symptomatic bone cysts of the calcaneum.

Sex determination by discriminant analysis of calcaneal measurements on the lateral digital radiography / 法医学杂志

OBJECTIVE@#Five measurements of the calcaneus taken on digital radiography (DR) of adults of Han Population of Sichuan Province were selected to determine sex by multivariate discriminant analysis.@*METHODS@#Lateral radiographs of calcaneus taken from 393 subjects were collected. The samples were randomly divided into the experimental group (148 males and 186 females) and the examined group (26 males and 33 females). Five measurements were taken from the radiography. The analysis of variance (AVON) was carried out to determine if there was significant difference between the male and female. The discriminant functions were drawn by Fisher discriminant analysis. The effects of all obtained functions were evaluated with the examined samples.@*RESULTS@#There was statistically significant difference in the five measurements between the males and the females (P<0.05). Six groups of discriminant functions were obtained with an accuracy ranged from 78.4% to 88.9%. When applied on the examined samples, the sex discriminant accuracy varied from 79.7% to 86.4%.@*CONCLUSION@#These five measurements acquired from the lateral radiographs of calcaneus could be used for sex assessment during forensic identification of individuals.

Combined clinical risk indices with quantitative ultrasound calcaneus measurement for identifying osteoporosis in Thai postmenopausal women.

OBJECTIVE: To examine the diagnostic performance of clinical risk indices combined with quantitative ultrasound calcaneus measurement (QUS) for identifying osteoporosis in Thai postmenopausal women. MATERIAL AND METHOD: The present study was designed as a cross-sectional investigation in 300 Thai women, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Hologic, Bedford, MA, USA). A BMD T-scores < or = -2.5 was defined as "osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. The OSTA and KKOS score was calculated for each woman using her age and weight Women with OSTA/KKOS scores < or = -1 and > -1 were classified as "high risk" and "low risk", respectively. RESULTS: Using DXA as the gold standard, the sensitivity of QUS to identify osteoporosis was lower than the sensitivity of OSTA/KKOS (60 vs. 71/74%) but the specificity and PPV of QUS were higher than OSTA/KKOS. The sensitivity increased when using OSTA/KKOS combined with QUS to identify osteoporosis (approximately 87-89%) while the specificity, PPV and NPV were comparable with using clinical risk indices alone. The risk (odds ratio; OR) of osteoporosis when QUS T-score < or = -2.5 alone was 9.94 (95%CI: 4.74-20.87), which was higher than high risk by OSTA/KKOS alone (OR: 6.35, 95%CI: 2.99-13.47 for OSTA and 8.15, 95%CI: 3.76-17.66 for KKOS). Furthermore, individuals were classified "high risk" from OSTA/KKOS with QUS T-score < or = -2.5SD, the risk of osteoporosis was increased (OR: 43.68, 95%CI: 13.89-137.36 and OR: 60.92, 95%CI: 17.69-209.76 for OSTA and KKOS, respectively). CONCLUSION: Using the clinical risk indices combined with QUS could improve the accuracy of osteoporosis identification. This approach could be used in a primary care setting or community-based hospital where a DXA machine is not available.

Endoscopic decompression of the retro-calcaneal space rationale, surgical technique, and early results a preliminary report

The purpose of the present study was to present the technique and preliminary results with endoscopic decompression of the retro-calcaneal space. Endoscopic calcaneoplasty was performed in 10patients [7 male; 3 female]. The average age was 38 years with a range from 27 to 56 years. All patients were resistant for conservative therapy for more than 6 months. All patients showed on X-ray a Haglund spur. Patients with a cavovarus deformity were excluded. The follow-up ranged from 2 to 12 months with an average of 5.2 months. All patients showed clinical improvement and would opt for the same procedure again. Three showed a good and 7 an excellent result in the Ogilvie-Harris score. Postoperative X-ray control showed sufficient bone removal in all cases. Time for surgery lasted on average 46 minutes [range 28 - 84 minutes]. There was no intra- or postoperative complications. Endoscopic decompression of the retrocalca-neal space is an effective minimal invasive treatment option for patients with retrocalcaneal bursitis

Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS.

BACKGROUND: Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden in such patients. AIM: The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 25 years in urban women population in this region. MATERIALS AND METHODS: A hospital based study was carried out in 158 women by calculating T-scores utilizing calcaneal QUS as diagnostic tool. RESULTS: The result suggested that a substantial female population had oesteopenia and osteoporosis after the age of 45 years. The incidence of osteoporosis was (20.25%) and osteopenia (36.79%) with maximum number of both osteoporosis and osteopenic women recorded in the age group of (55-64 years). After the age of 65 years, there was an almost 100% incidence of either osteopenia or osteoporosis, indicating that it increases with age and in postmenopausal period, thereby suggesting lack of estrogenic activity might be responsible for this increasing trend. Religion, caste and diet had an influence on the outcome of osteopenic and osteoporosis score in present study, but still it has to be substantiated by conducting larger randomized clinical trials in future. CONCLUSION: A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis.