Entrapment neuropathy: the etiology of intractable chronic heel pain syndrome.

Chronic heel pain syndrome (CHPS) is a common clinical entity. The etiology of CHPS has never been completely defined and there are no clear treatment regimens in the literature. Most authors agree that nonoperative treatment is effective in most patients. However, in 5%-10% of patients, operative intervention is required. Outcomes for these patients have been inconsistent. A series of 51 patients with intractable CHPS who were diagnosed with an entrapment of the posterior tibial nerve and its terminal branches is presented. Descriptive statistics were obtained for the demographic data and pre and postsurgical start-up and standing pain visual analog scale (VAS) scoring. Statistical testing of the VAS mean scores was performed using a paired t-test at the 0.01 level of significance. Pre- and postsurgical start-up and pre- and postsurgical standing pain VAS means were significantly different from each other (t = 19.6, p = .001 and t = 19.4, p = .001, respectively). Based on subjective and objective criteria, 96% of the patients experienced significant improvement and 90% reported completed resolution of heel pain. The presence of tarsal tunnel syndrome in all 51 patients strongly suggests entrapment neuropathy as the etiology of intractable CHPS.

Foot function in diabetic patients after partial amputation.

The function of partially amputated feet in 10 patients with diabetes mellitus was studied. First-step bilateral barefoot plantar pressure distribution and three-dimensional kinematic data were collected using a Novel EMED platform and three video cameras. Analysis of the plantar pressure data revealed a significantly greater mean peak plantar pressure in the feet with transmetatarsal amputation (TMA) than in the intact feet of the same patients. The heels of the amputated feet had significantly lower mean peak plantar pressures than all the forefoot regions. A significantly greater maximum dynamic dorsiflexion range of motion was seen in the intact compared with the TMA feet. However, no difference was noted in the static dorsiflexion range of motion between the two feet and there was, therefore, a trend for the TMA feet to use less of the available range of motion. Given the altered kinematics and elevated plantar pressures noted in this study, careful postsurgical footwear management of feet with TMA would appear to be essential if ulceration is to be prevented.

The frontal plane relationship of the forefoot to the rearfoot in an asymptomatic population.

Physical therapists use biochemical orthotics to treat symptoms attributed to structural abnormalities of the feet. The purpose of this study was to determine the prevalence of forefoot varus, valgus, and neutral positions in a healthy population, and to compare forefoot positions between genders, legs, and age groups. Nonprobability sampling was used to obtain 120 healthy subjects. A repeated-measures, one-group design was used. A forefoot measuring device and a goniometer were used to measure the forefoot-rearfoot frontal plane relationship. Of the 234 measured feet, 86.67% had a varus, 8.75% had a valgus, and 4.58% had a neutral forefoot-rearfoot relationship. No significant difference in position was found between genders or legs within subjects. A certain amount of forefoot varus or valgus may be characteristic of a healthy population; however, future studies should include children and adolescents to determine if forefoot positions are acquired or congenital.