ABSTRACT
Resumen: Introducción: la fascitis o fasciosis plantar es una causa de dolor en el pie, en la cual frecuentemente se encuentran casos resistentes al tratamiento conservador. La cirugía queda reservada para los pacientes que no han respondido a tratamientos conservadores, ondas de choque o infiltraciones con corticosteroides. El objetivo de este trabajo es realizar una revisión sistemática de la literatura disponible y describir una técnica para el tratamiento de la fascitis o fasciosis plantar consistente en el rasgado longitudinal de la aponeurosis plantar asistido con ecografía. Material y métodos: se realizó una búsqueda sistemática de publicaciones previas sobre la tenotomía longitudinal en el tratamiento de la fascitis plantar. Se incluyeron los encabezados de temas médicos o MeSH (Medical subjects headings por sus siglas en inglés), en inglés: Curettage, Tenotomy y Plantar Fasciitis. La búsqueda electrónica incluyó las bases de datos de PubMed, Embase, Cochrane central register of controlled trials, Trip database y National Institute for Health and Care Excellence (NICE por sus siglas en inglés). Se realizó una descripción detallada de la técnica con la intención de que pueda ser reproducida. Conclusión: la tenotomía longitudinal representa una alternativa para el tratamiento de la fascitis plantar. Se basa en la extrapolación del conocimiento en el territorio Aquíleo con una base fisiopatológica de respaldo. Se trata de una técnica no invasiva que se puede realizar de forma ambulatoria y que permitiría la rápida incorporación del paciente a sus actividades. La tenotomía longitudinal podría evitar al paciente someterse a cirugías de mayor envergadura.
Abstract: Introduction: plantar fasciitis or fasciosis is a cause of foot pain with cases resistant to conservative treatment. Surgery is reserved for patients who have not responded to conservative treatment, shock waves, or corticosteroid injections. The aim of this publications is to carry out a systematic review of the available literature and to describe a specific technique for the treatment of plantar fasciosis consisting of the longitudinal tearing of the plantar aponeurosis assisted with ultrasound. Material and methods: a systematic search was carried out for previous publications on longitudinal tenotomy in the treatment of plantar fasciitis. The Medical Subject Headings (MeSH) terms «Curettage¼, «Tenotomy¼ and «Plantar Fasciitis¼ were included. The electronic search included PubMed, Embase, Cochrane central register of controlled trials, Trip database, and National Institute for Health and Care Excellence (NICE) databases. A detailed description of the technique was included with the intention that it can be reproduced. Conclusion: longitudinal tenotomy represents an alternative for the treatment of plantar fasciitis. It is based on the extrapolation of knowledge in the Achilles tendon territory with a supporting pathophysiological basis. It is a non-invasive technique that can be performed on an outpatient basis and that would allow the rapid incorporation of the patient to their activities. Longitudinal tenotomy would prevent the patient from undergoing major surgeries.
ABSTRACT
INTRODUCTION: plantar fasciitis or fasciosis is a cause of foot pain with cases resistant to conservative treatment. Surgery is reserved for patients who have not responded to conservative treatment, shock waves, or corticosteroid injections. The aim of this publications is to carry out a systematic review of the available literature and to describe a specific technique for the treatment of plantar fasciosis consisting of the longitudinal tearing of the plantar aponeurosis assisted with ultrasound. MATERIAL AND METHODS: a systematic search was carried out for previous publications on longitudinal tenotomy in the treatment of plantar fasciitis. The Medical Subject Headings (MeSH) terms "Curettage", "Tenotomy" and "Plantar Fasciitis" were included. The electronic search included PubMed, Embase, Cochrane central register of controlled trials, Trip database, and National Institute for Health and Care Excellence (NICE) databases. A detailed description of the technique was included with the intention that it can be reproduced. CONCLUSION: longitudinal tenotomy represents an alternative for the treatment of plantar fasciitis. It is based on the extrapolation of knowledge in the Achilles tendon territory with a supporting pathophysiological basis. It is a non-invasive technique that can be performed on an outpatient basis and that would allow the rapid incorporation of the patient to their activities. Longitudinal tenotomy would prevent the patient from undergoing major surgeries.
INTRODUCCIÓN: la fascitis o fasciosis plantar es una causa de dolor en el pie, en la cual frecuentemente se encuentran casos resistentes al tratamiento conservador. La cirugía queda reservada para los pacientes que no han respondido a tratamientos conservadores, ondas de choque o infiltraciones con corticosteroides. El objetivo de este trabajo es realizar una revisión sistemática de la literatura disponible y describir una técnica para el tratamiento de la fascitis o fasciosis plantar consistente en el rasgado longitudinal de la aponeurosis plantar asistido con ecografía. MATERIAL Y MÉTODOS: se realizó una búsqueda sistemática de publicaciones previas sobre la tenotomía longitudinal en el tratamiento de la fascitis plantar. Se incluyeron los encabezados de temas médicos o MeSH (Medical subjects headings por sus siglas en inglés), en inglés: Curettage, Tenotomy y Plantar Fasciitis. La búsqueda electrónica incluyó las bases de datos de PubMed, Embase, Cochrane central register of controlled trials, Trip database y National Institute for Health and Care Excellence (NICE por sus siglas en inglés). Se realizó una descripción detallada de la técnica con la intención de que pueda ser reproducida. CONCLUSIÓN: la tenotomía longitudinal representa una alternativa para el tratamiento de la fascitis plantar. Se basa en la extrapolación del conocimiento en el territorio Aquíleo con una base fisiopatológica de respaldo. Se trata de una técnica no invasiva que se puede realizar de forma ambulatoria y que permitiría la rápida incorporación del paciente a sus actividades. La tenotomía longitudinal podría evitar al paciente someterse a cirugías de mayor envergadura.
Subject(s)
Fasciitis, Plantar , Humans , Fasciitis, Plantar/surgery , Ultrasonography , Foot , Pain , Ultrasonography, Interventional , Treatment OutcomeABSTRACT
BACKGROUND: Current evidence shows that anaesthetic digital block with epinephrine is safe in surgical selected patients. There are no controlled studies that have examined the efficacy of local anaesthesia with vasoconstrictor in chemical matricectomy without using tourniquet to control bleeding. OBJECTIVES: A controlled, prospective and randomized study was conducted to examine primarily the rate of recurrence after segmental phenolization matricectomy with anaesthetic digital block with epinephrine vs. tourniquet. As secondary aims, duration of anaesthetic effect, post-operative bleeding and pain were analysed in both groups. METHODS: Forty-four healthy subjects with ingrown hallux nails (70 toes) were enrolled. A total of 34 toes were anaesthetized with a solution of 2% mepivacaine with (1 : 100,000) epinephrine and operated without tourniquet (experimental group) vs. 36 toes anesthetized with a solution of 2% mepivacaine without epinephrine and operated with tourniquet (control group). RESULTS: There was no statistically significant difference in recurrence rates (P = 0.478). Post-operative bleeding was significantly higher in the group with anaesthetic digital block without vasoconstrictor and with tourniquet (P = 0.001). Anaesthetic effect was higher in the group with anaesthetic digital block with vasoconstrictor and without tourniquet (P = 0.001). No post-operative complications occurred in any of the treatment groups. CONCLUSIONS: The use of local anaesthetic with vasoconstrictor to perform chemical matricectomy likely to be an effective procedure to reduce the disadvantages of using digital tourniquet (post-operative bleeding and lower anaesthetic effect) without increasing the risk of recurrence. The addition of epinephrine may reduce the need for a tourniquet and produce better and longer perioperative pain control.
Subject(s)
Epinephrine/therapeutic use , Hemostasis, Surgical/methods , Nails, Ingrown/surgery , Nerve Block/methods , Postoperative Hemorrhage/prevention & control , Tourniquets , Vasoconstrictor Agents/therapeutic use , Adolescent , Adult , Blood Loss, Surgical/prevention & control , Child , Female , Humans , Male , Mepivacaine , Prospective Studies , Recurrence , Toes , Young AdultABSTRACT
Single cell activity recorded in the subthalamic nucleus (STN) of Parkinson's patients and the effect of tremor, passive and voluntary movement upon the same cells are described. Three types of cells were distinguished by the pattern of discharge: tonic, phasic and rhythmic. They all demonstrated high mean firing rates (65, 59 and 69 Hz, respectively). Simultaneous recordings of muscle activity and tremor helped in defining cell activity. The implantation of the definitive stimulating electrode in the patients was based on the number of STN cells related to tremor, active and passive movements (mean = 68%) along the track chosen. Cells were related to tremor (n = 21; 11%), modified the discharge with differences in the amplitude of tremor (n = 4), and changed the rate and pattern when tremor stopped spontaneously or artificially (n = 6). Movement-related cells (n = 97; 51%) showed a cyclic activity correlated with phases of the movement, or modified the firing rate along the performance of the movement. Tremor and movement-related cells (n = 11; 6%) revealed an interesting sensory-motor integrative function.