Effectiveness of a Double Air-Cushioned Shoe Compared with Physiotherapy in the Treatment of Plantar Fasciitis.

OBJECTIVE: This study was aimed at comparing the plantar fasciitis treatment effect of a double air-cushioned shoe to that of physiotherapy combined with ESWT. METHODS: Retrospective chart review of 40 patients diagnosed with plantar fasciitis was performed. Group 1 wore a double air-cushioned shoe for 2 months, and group 2 underwent physiotherapy with ESWT once/week over a 4-week period. The foot function index (FFI) score was obtained at the initial visit, 1 month, and 2 months. RESULTS: There were 25 patients in group 1 and 15 patients in group 2. The pretreatment FFI was 62.6 for group 1 and 50 for group 2. The 1-month posttreatment FFI was 45.6 for group 1 and 35.7 for group 2. The 2-month posttreatment FFI was 35 for group 1 and 43.1 for group 2. In both groups 1 and 2, follow-up FFIs were significantly improved from the initial FFI (p < 0.05) and there were no significant differences between two groups (p > 0.05). CONCLUSIONS: The double air-cushioned shoe can be considered an alternative treatment option for noninvasive treatment of early-stage plantar fasciitis.

Percutaneous endoscopic thoracic discectomy; transforaminal approach.

INTRODUCTION: Because of the increasing use of magnetic resonance imaging (MRI), thoracic soft disc herniations are being easily detected in the early stages. To avoid a high morbidity rate and other complications that are associated with the conventional approach, the authors have applied a percutaneous endoscopic technique. METHODS: From May 2001 to July 2007, fourteen patients with soft lateral or central thoracic disc herniation (TDH) underwent percutaneous endoscopic thoracic discectomy. Under local anesthesia with intravenous sedation, the authors removed the herniated disc through the thoracic intervertebral foramen after performing a foraminoplasty, which is the enlargement of the foramen by cutting the lateral and inferior part of the superior facet with a round cutter. The clinical outcome was evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). RESULTS Six patients were male and eight were female, aged 21-75 years (mean: 48.1 years). Mean follow-up period was 60.2 months (15-89 months), mean operative time was 61 min. The mean VAS improved from 6.5 to 3.0 for back pain and 5.8 to 2.5 for leg pain at the final follow-up. The mean ODI scores also improved from 58.1 before surgery to 24.5 at the final follow-up. Conversion to an open procedure was not required for any of the patients. DISCUSSION: As it has been proven to lessen the morbidity rate, this percutaneous endoscopic thoracic discectomy (PETD) technique for symptomatic soft TDH is a safe and effective method that provides a direct route to the lesion under local anesthesia.

Quantitative motor unit action potentials (QMUAP) in whiplash patients with neck and upper-limb pain.

INTRODUCTION: Needle EMG studies in patients with whiplash symptoms to document presence of neural injury, such as cervical radiculopathy, are not available. OBJECTIVE: To document presence of motor unit action potential (MUAP) parameter changes compatible with neurogenic involvement in symptomatic-limb muscles in whiplash induced acute and chronic pain states. DESIGN: Retrospective review. SETTING: Out patient quantitative electromyography (QEMG) laboratory. PARTICIPANTS: 72 consecutive patients (mean age 43.6 years) who underwent QEMG between 1/2001 - 12/2004 for electrodiagnosis of neck and upper-limb pain related to auto-accidents (mean symptom duration 15.3 months). INTERVENTIONS: QEMG with MUAP parameter analysis. MAIN OUTCOME MEASURES: Amplitude, duration, size-index (SI), percentage of polyphasic units and firing rate analysis in chosen bilateral muscles representing C3-C8 myotomes. RESULTS: No spontaneous activity noted in muscles examined. Without subsetting symptom duration, symptomatic-side: asymptomatic-side MUAP parameter comparison showed significant increase in MUAP frequency on the symptomatic-side C6-muscle (10.4 +/- 1.3 vs. 9.7 +/- 1.4, p = < 0.05), and C7 muscle (10.0 +/- 1.2 vs. 9.1 +/- 1.1, p < or = 0.01). The symptomatic-side C6-muscle also showed increased percentage of polyphasic-MUAPs (23.7 +/- 13.1 vs. 15.9 +/- 12.7, p < 0.001). Patients with acute symptom duration (< 6 months, mean duration 3.4 +/- 1.4 months, N=26), showed increased percentage of polyphasic MUAPs in the symptomatic-side C6-muscle (27.0 +/- 12.3% vs. asymptomatic 22.2 +/- 17.6%, p < or = 0.05). In patients with chronic symptom duration (> or =6 months, mean duration 22.0 +/- 17.9 months, N=46), symptomatic-side C6-muscle showed increased polyphasic MUAPs (22.2 +/- 13.2%) vs. asymptomatic (15.5 +/- 11.6%), p < or = 0.02, and higher firing rates (10.3 +/- 1.7 vs. 9.6 +/- 1.3 respectively, p < or = 0.003). CONCLUSIONS: QEMG changes suggest neural injury in symptomatic side C6 and C7 innervated muscles, even in the absence of spontaneous activity. In acute and chronic pain patients a higher percentage of polyphasic MUAPs is noted in the symptomatic side C6 muscle. In chronic pain patients higher MUAP frequencies are noted in the symptomatic side C6 muscle.

Prevention of secondary osteoporosis postmenopause in hemiplegia.

OBJECTIVES: To study secondary osteoporosis postmenopause in women with hemiplegia and to show the therapeutic effects of etidronate and how osteoporotic conditions relate to the activities of daily living (ADL). DESIGN: Eighty-one postmenopausal women with hemiplegia were admitted within 6 mo of their first cerebrovascular accident. The bone mineral density (BMD) and biochemical markers of bone turnover were measured at the time of admission. Forty women (treatment group) received a 2-wk administration of etidronate. Forty-one women (control group) were not administered etidronate. RESULTS: After completing a 3-mo rehabilitation program, BMD levels were remeasured. ADL was evaluated by FIM. The low ADL group had a larger decrease in BMD than the high ADL group. For the control group, the BMD rate of change on the paretic side of the femoral neck was -9.6%/3 mo for the low ADL group. BMD loss was reduced significantly by the administration of etidronate for the low ADL group. CONCLUSIONS: Results indicate that ADL corresponds to the progression of osteoporosis in postmenopausal women with hemiplegia and that increasing the level of ADL will reduce the progression of osteoporosis. Use of etidronate has also been proven to have a suppressive effect on the BMD decrease in women.