RESUMO
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.
Assuntos
Tendão do Calcâneo , Calcanhar , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Tendinopatia , Humanos , Tendão do Calcâneo/fisiopatologia , Tendinopatia/terapia , Tendinopatia/fisiopatologia , Pessoa de Meia-Idade , Adulto , Masculino , Feminino , Idoso , Calcanhar/fisiopatologia , Adulto Jovem , Resultado do Tratamento , Adolescente , Fenômenos Biomecânicos , Fatores de Tempo , Terapia por Exercício/métodosRESUMO
BACKGROUND: Haglund exostosis-related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists. METHODS: Fifteen patients (15 feet) with Haglund exostosis-related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed. RESULTS: Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as "helped" or "helped a lot" (Global Treatment Outcome). CONCLUSION: In this relatively small cohort, we found that patients treated for Haglund exostosis-related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up. LEVEL OF EVIDENCE: Level II, observational prospective cohort study.
Assuntos
Calcâneo , Marcha , Calcanhar , Força Muscular , Osteotomia , Humanos , Osteotomia/métodos , Calcâneo/cirurgia , Calcâneo/fisiopatologia , Força Muscular/fisiologia , Marcha/fisiologia , Masculino , Calcanhar/cirurgia , Calcanhar/fisiopatologia , Feminino , Adulto , Análise da Marcha , Adulto Jovem , Estudos Prospectivos , Pessoa de Meia-Idade , Exostose/cirurgia , Exostose/fisiopatologiaRESUMO
The aim of this study was to compare the effects of dry needling (DN) and extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis (PF). The study included 55 patients with PF. The patients were randomly divided into 2 groups. The DN group applied 3 sessions of DN to the myofascial trigger points in the lower limb muscles. The ESWT group applied 3 sessions of ESWT to the plantar fascia. For clinical evaluation, we used a visual analog scale (VAS) (first step, rest, activity) and Foot Function Index (FFI) (pain, disability, activity). Assessments were done baseline, post-treatment first week, and fourth week. Maximum pain-free standing time (Max PfST) and maximum pain-free walking distance (Max PfWD) were recorded at baseline and post-treatment fourth week. In this study, we found significant improvement in VAS, FFI, Max PfST, and Max PfWD in both groups (p < .01). VAS-activity baseline-forth week change was significantly superior in the DN group compared to the ESWT group (p = .023). FFI-disability baseline-fourth week change was significantly superior in the DN group compared to the ESWT group (p = .048). There was no significant difference in other treatment-related changes between the groups (p > .05). However, VAS-rest baseline-fourth week change and FFI-pain baseline-fourth week change trended towards statistical significance between groups ((p = .056), (p = .052) respectively). This study showed that DN may be a good alternative treatment for patients with PF, with effects similar to or even superior to ESWT.
Assuntos
Agulhamento Seco , Tratamento por Ondas de Choque Extracorpóreas , Fasciíte Plantar , Síndromes da Dor Miofascial , Medição da Dor , Humanos , Fasciíte Plantar/terapia , Feminino , Masculino , Tratamento por Ondas de Choque Extracorpóreas/métodos , Agulhamento Seco/métodos , Pessoa de Meia-Idade , Adulto , Síndromes da Dor Miofascial/terapia , Resultado do Tratamento , Calcanhar/fisiopatologiaRESUMO
OBJECTIVE: To compare clinical assessment findings between elite athletic populations with and without a clinical diagnosis of posterior ankle impingement syndrome (PAIS). DESIGN: Cross-sectional case-control study. SETTING: Elite ballet and sport. PARTICIPANTS: Ten male and female professional ballet dancers and athletes with a clinical diagnosis of PAIS and were matched for age, sex, and activity to 10 professional ballet dancers and athletes without PAIS. INDEPENDENT VARIABLES: Posterior ankle pain on body chart and a positive ankle plantarflexion pain provocation test. MAIN OUTCOME MEASURES: Single-leg heel raise (SLHR) endurance test, range of motion testing for weight-bearing ankle dorsiflexion, passive ankle plantarflexion, and first metatarsophalangeal joint dorsiflexion, and Beighton score for generalized joint hypermobility. Participants also completed the Cumberland Ankle Instability Tool (CAIT) questionnaire. RESULTS: The group with PAIS achieved significantly fewer repetitions on SLHR capacity testing ( P = 0.02) and were more symptomatic for perceived ankle instability according to CAIT scores ( P = 0.004). CONCLUSIONS: Single-leg heel raise endurance capacity was lower, and perceived ankle instability was greater in participants with PAIS. The management of this presentation in elite dancers and athletes should include the assessment and management of functional deficits.
Assuntos
Articulação do Tornozelo , Dança , Instabilidade Articular , Amplitude de Movimento Articular , Humanos , Masculino , Dança/fisiologia , Feminino , Instabilidade Articular/fisiopatologia , Estudos Transversais , Estudos de Casos e Controles , Articulação do Tornozelo/fisiopatologia , Adulto Jovem , Adulto , Calcanhar/fisiopatologia , Atletas , Traumatismos do Tornozelo/fisiopatologia , Resistência Física/fisiologia , AdolescenteRESUMO
BACKGROUND: Gait retraining using haptic biofeedback medially shifts the center of pressure (COP) while walking in orthopedic populations. However, the ideal sensor location needed to effectively shift COP medially has not been identified in people with chronic ankle instability (CAI). RESEARCH QUESTIONS: Can a heel sensor location feasibly be employed in people with CAI without negatively altering kinematics? Does a heel sensor placement relative to the 5th metatarsal head (5MH) impact COP location while walking in people with CAI? METHODS: In this exploratory crossover study, 10 participants with CAI walked on a treadmill with vibration feedback for 10â¯minutes with a plantar pressure sensor under the heel and 5MH. Separate 2×2 repeated measures analyses of covariances (rmANCOVAs) were used to compare the averaged COP location and 3-D lower extremity kinematics from the first 10% of stance before and after training and between sensor locations. Baseline measures served as covariates to adjust for baseline differences. RESULTS: Feedback triggered by a heel sensor resulted in 40% of participants avoiding a heel strike. There were no significant main effects or interactions between time and sensor location on COP location when controlling for baseline COP (p>0.05). However, with the 5MH placement, participants displayed less ankle internal rotation(IR) (5MH/Heel: -4.12±0.00º/ -6.43±0.62º), less forefoot abduction (-4.29±0.00º/ -5.14±1.01º), more knee flexion (3.40±0.32º/ 0.14±0.57º), less knee external rotation (-10.95±0.00º/-11.24±1.48º), less hip extension (-0.20±0.00º/-1.42±1.05º), and less hip external rotation (3.12±0.00º/3.75±1.98º). SIGNIFICANCE: A 5MH location may be more feasible based on difficulties maintaining heel strike when the sensor was under the heel. While no sensor location was statistically better at changing the COP, the 5MH location decreased proximal transverse plane motions making participants' gait more like controls. Individual response variations support comprehensive lower extremity assessments and the need to identify responder profiles using sensory feedback in people with CAI.
Assuntos
Articulação do Tornozelo , Marcha , Instabilidade Articular , Pressão , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Feminino , Marcha/fisiologia , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Adulto , Adulto Jovem , Estudos Cross-Over , Calcanhar/fisiopatologia , Biorretroalimentação Psicológica , Doença Crônica , Retroalimentação Sensorial/fisiologiaRESUMO
Chronic plantar heel pain (CPHP) is associated with calcaneal bone spurs, but its associations with other calcaneal bone features are unknown. This study therefore aimed to determine associations between having CPHP and bone density and microarchitecture of the calcaneus. We assessed 220 participants with CPHP and 100 age- and sex-matched population-based controls. Trabecular bone density, thickness, separation and number, BV/TV, and cortical density, thickness and area were measured using a Scanco Xtreme1 HR-pQCT scanner at a plantar and mid-calcaneal site. Clinical, physical activity and disease history data were also collected. Associations with bone outcomes were assessed using multivariable linear regression adjusting for age, sex, physical activity, BMI and ankle plantarflexor strength. We assessed for potential effect modification of CPHP on these covariates using interaction terms. There were univariable associations at the plantar calcaneus where higher trabecular bone density, BV/TV and thickness and lower trabecular separation were associated with CPHP. In multivariable models, having CPHP was not independently associated with any bone outcome, but modified associations of BMI and ankle plantarflexor strength with mid-calcaneal and plantar bone outcomes respectively. Beneficial associations of BMI with mid-calcaneal trabecular density (BMI-case interaction standardised X/unstandardised Y beta -10.8(mgHA/cm3) (se 4.6), thickness -0.002(mm) (se 0.001) and BV/TV -0.009(%) (se 0.004) were reduced in people with CPHP. Beneficial associations of ankle plantarflexor strength with plantar trabecular density (ankle plantarflexor strength -case interaction -11.9(mgHA/cm3) (se 4.4)), thickness -0.003(mm) (se 0.001), separation -0.003(mm) (se 0.001) and BV/TV -0.010(%) (se 0.004) were also reduced. CPHP may have consequences for calcaneal bone density and microarchitecture by modifying associations of BMI and ankle plantarflexor strength with calcaneal bone outcomes. The reasons for these case-control differences are uncertain but could include a bone response to entheseal stress, altered loading habits and/or pain mechanisms. Confirmation with longitudinal study is required.
Assuntos
Tornozelo/fisiopatologia , Índice de Massa Corporal , Densidade Óssea , Calcâneo/fisiopatologia , Fasciíte Plantar/fisiopatologia , Calcanhar/fisiopatologia , Força Muscular , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain. DESIGN: Case-control. METHODS: We investigated associations by comparing 220 participants with chronic (more than 3 months in duration) plantar heel pain to 100 age- and sex-matched controls, who were recruited randomly from the electoral roll. Exposures measured were waist girth, body mass index, body composition, clinical measures of foot and leg function, physical activity via accelerometry, depression and pain catastrophizing, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analyzed using multivariable conditional logistic regression. RESULTS: Waist girth (centimeters) (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.03, 1.09), ankle plantar flexor strength (kilograms) (OR = 0.98; 95% CI: 0.97, 0.99), pain at multiple sites (pain at 1 other site: OR = 2.76; 95% CI: 1.29, 5.91; pain at 4 or more other sites: OR = 10.45; 95% CI: 3.66, 29.81), and pain catastrophizing status (none, some, or catastrophizer) (some: OR = 2.91; 95% CI: 1.33, 6.37; catastrophizer: OR = 6.79; 95% CI: 1.91, 24.11) were independently associated with chronic plantar heel pain. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension range of motion, depression, and body mass index. There were no significant associations with physical activity or body composition (bioelectrical impedance analysis). CONCLUSION: Waist girth, ankle plantar flexor strength, multisite pain, and pain catastrophizing, but not foot-specific factors, were independently associated with chronic plantar heel pain. Of these 4 factors, 3 (waist girth, multisite pain, and pain catastrophizing) were central or systemic associations. J Orthop Sports Phys Ther 2021;51(9):449-458. Epub 7 May 2021. doi:10.2519/jospt.2021.10018.
Assuntos
Pesos e Medidas Corporais , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Calcanhar/lesões , Calcanhar/fisiopatologia , Acelerometria , Adulto , Idoso , Estudos de Casos e Controles , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologiaRESUMO
BACKGROUND: Plantar heel pain (PHP) accounts for 11-15% of foot symptoms requiring professional care in adults. Recovery is variable, with no robust prognostic guides for sufferers, clinicians or researchers. Therefore, we aimed to determine the validity, reliability and feasibility of questionnaire, clinical and biomechanical measures selected to generate a prognostic model in a subsequent cohort study. METHODS: Thirty-six people (19 females & 17 males; 20-63 years) were recruited with equal numbers in each of three groups: people with PHP (PwPHP), other foot pain (PwOP) and healthy (H) controls. Eighteen people performed a questionnaire battery twice in a randomised order to determine online and face-to-face agreement. The remaining 18 completed the online questionnaire once, plus clinical measurements including strength and range of motion, mid-foot mobility, palpation and ultrasound assessment of plantar fascia. Nine of the same people underwent biomechanical assessment in the form of a graded loaded challenge augmenting walking with added external weight and amended step length on two occasions. Outcome measures were (1) feasibility of the data collection procedure, measurement time and other feedback; (2) establishing equivalence to usual procedures for the questionnaire battery; known-group validity for clinical and imaging measures; and initial validation and reliability of biomechanical measures. RESULTS: There were no systematic differences between online and face-to-face administration of questionnaires (p-values all > .05) nor an administration order effect (d = - 0.31-0.25). Questionnaire reliability was good or excellent (ICC2,1_absolute)(ICC 0.86-0.99), except for two subscales. Full completion of the survey took 29 ± 14 min. Clinically, PwPHP had significantly less ankle-dorsiflexion and hip internal-rotation compared to healthy controls [mean (±SD) for PwPHP-PwOP-H = 14°(±6)-18°(±8)-28°(±10); 43°(±4)- 45°(±9)-57°(±12) respectively; p < .02 for both]. Plantar fascia thickness was significantly higher in PwPHP (3.6(0.4) mm vs 2.9(0.4) mm, p = .01) than the other groups. The graded loading challenge demonstrated progressively increasing ground reaction forces. CONCLUSION: Online questionnaire administration was valid therefore facilitating large cohort recruitment and being relevant to remote service evaluation and research. The physical and ultrasound examination revealed the expected differences between groups, while the graded loaded challenge progressively increases load and warrants future research. Clinician and researchers can be confident about these methodological approaches and the cohort study, from which useful clinical tools should result, is feasible. LEVEL OF EVIDENCE: IV.
Assuntos
Fasciíte Plantar/diagnóstico , Avaliação de Resultados em Cuidados de Saúde/normas , Medicina Física e Reabilitação/normas , Inquéritos e Questionários/normas , Adulto , Fenômenos Biomecânicos , Estudos de Coortes , Fasciíte Plantar/fisiopatologia , Estudos de Viabilidade , Feminino , Calcanhar/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Física e Reabilitação/métodos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects. MATERIALS AND METHODS: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week. RESULTS: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days. CONCLUSION: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days.
Assuntos
Acessibilidade Arquitetônica/normas , Calcanhar/fisiopatologia , Higiene da Pele/normas , Creme para a Pele/normas , Acessibilidade Arquitetônica/instrumentação , Acessibilidade Arquitetônica/métodos , Feminino , Voluntários Saudáveis/estatística & dados numéricos , Humanos , Masculino , Higiene da Pele/métodos , Higiene da Pele/estatística & dados numéricos , Creme para a Pele/uso terapêutico , Água/metabolismo , Adulto JovemRESUMO
BACKGROUND: Dravet Syndrome (DS) is a developmental and epileptic encephalopathy characterized by severe drug-resistant seizures and associated with cognitive and motor impairments. Walking problems are frequently observed. As the foot plays a key role during walking, compromised foot function can be a feature of deviant gait. AIM: To investigate foot function in DS by characterizing foot-floor contact patterns using pedobarography. METHODS: A total of 31 children and adults were included in the DS group (aged 5.2-32.8 years, 17 female, 174 steps) and 30 in the control group (aged 6.0-32.9, 16 female, 180 steps). The foot-floor contact pattern was evaluated based on progression, length and smoothness (spectral arc length) of the center of pressure (CoP). Linear mixed models were used to identify differences between non-heel strikes and heel strikes and between the DS and control group. RESULTS: Fifteen participants with DS showed inconsistency in the type of foot-floor contact (heel strikes and non-heel strikes). Heel strikes of participants with DS had significantly reduced time of CoP under the hindfoot and increased time under the midfoot region compared to the control group. Significant time and age effects were detected. CONCLUSIONS AND IMPLICATIONS: Deviant foot-floor contact patterns were observed in DS. Possible gait immaturity and instability as well as implications for interventions are discussed.
Assuntos
Epilepsias Mioclônicas/fisiopatologia , Pé/fisiopatologia , Marcha/fisiologia , Calcanhar/fisiopatologia , Caminhada/normas , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Flatfoot is a common foot deformity, which could contribute to running injuries such as medial tibial stress syndrome. Intrafoot kinematics of flatfoot during walking have often been documented using multisegment foot models. However, the intrafoot kinematics of flatfoot during running remains unclear, despite the possible relationship between flatfoot and running injuries. We aimed to clarify rearfoot, midfoot, and forefoot kinematics when running in participants with normal foot and flatfoot. Participants with the normal foot (n = 14) and flatfoot (n = 14) were asked to runover-ground at their preferred speed. Three-dimensional kinematics of the rearfoot, midfoot, and forefoot during running were calculated based on the Rizzoli foot model. A two-sample t-test of statistical parametric mapping was performed to determine differences between normal foot and flatfoot in time histories of intrafoot kinematics during running. No differences were found between groups in characteristics and spatiotemporal parameters. In the frontal rearfoot angle, a significantly increased eversion from 24% to 100% (p < .001) was observed in the flatfoot compared to the normal foot. At the midfoot angle, a significantly increased eversion from 0% to 4% (p < .049) and 21% to 100% (p < .001) was observed in the flatfoot compared to the normal foot. At the forefoot angle, a significantly increased inversion from 6% to 17% (p < .047) was observed in the flatfoot compared to the normal foot. These findings may be useful to explain why flatfoot could contribute to running injuries such as medial tibial stress syndrome.
Assuntos
Pé Chato/fisiopatologia , Antepé Humano/fisiopatologia , Calcanhar/fisiopatologia , Corrida/fisiologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Humanos , Masculino , Corrida/lesões , Adulto JovemRESUMO
OBJECTIVES: To investigate if self-reported pain with single leg heel raise (SLHR) or single leg hop (SLH) are concurrently valid to assess midportion (MPAT) or insertional Achilles tendinopathy (IAT) symptom severity, compared to the VISA-A. Additionally, if SLHR or SLH pain accounts for VISA-A variability, and if they are associated with psychological factors. PARTICIPANTS: 60 men with MPAT, 26 men with IAT. MAIN OUTCOMES: Participants rated SLHR and SLH pain on a numerical rating scale (0 = none, 10 = worst). We investigated relationships between loading task pain, VISA-A, VISA-A constructs, and psychological outcomes (Pearson's correlation coefficients). Linear regression determined best model accounting for VISA-A variability. RESULTS: In MPAT, load tests shared fair-negative relationship with VISA-A, and VISA-A function. In IAT, SLHR had moderately strong-negative relationship with VISA-A, and pain and function constructs, and SLH shared fair-negative relationship with VISA-A, and pain and function constructs. Relationships were negligible between load tests and VISA-A activity in both conditions, and VISA-A pain in MPAT. In IAT, there was fair-positive relationship between pain catastrophising and load tests. Remaining psychological outcome relationships were negligible. Best model accounting for VISA-A included SLH in MPAT, and SLHR in IAT. CONCLUSIONS: Despite VISA-A and selected VISA-A construct associations, self-reported SLHR and SLH pain appears to provide distinct information.
Assuntos
Tendão do Calcâneo/fisiopatologia , Calcanhar/fisiopatologia , Perna (Membro)/fisiopatologia , Dor/epidemiologia , Tendinopatia/fisiopatologia , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Teste de Esforço/métodos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Medição da Dor , Autorrelato , Índice de Gravidade de Doença , Tendinopatia/epidemiologiaRESUMO
BACKGROUND: Intraoperative site application of vancomycin powder has been found to be beneficial in foot and ankle surgery among diabetic patients undergoing elective procedures. However, there are concerns for risks such as selection of multidrug-resistant bacteria, local tissue irritation, and increased wound complications. The clinical utility of intraoperative site vancomycin powder application in infected diabetic foot ulcer surgery is unknown. We aimed to report the clinical outcomes of partial or total calcanectomy for diabetic heel ulcer (DHU) and determine if intraoperative site application of vancomycin powder placement at the time of wound closure leads to improved clinical outcomes. METHODS: A current procedural terminology query (CPT 28120: partial excision bone; talus or calcaneus) was run that identified 35 patients representing 38 calcanectomies performed secondary to infected DHU with calcaneal osteomyelitis. An initial group of 25 patients did not receive intraoperative site vancomycin powder, whereas the following 13 cases received intraoperative site vancomycin powder. Demographics, clinical characteristics, comorbidities, operative complications, unexpected return to the operating room (RTOR), and revision amputations were recorded for each patient. Average follow-up was 26.1 (6.5-51.6) months. RESULTS: There was a significantly higher rate of RTOR among the vancomycin powder cohort (VANC) relative to the no-vancomycin cohort (No-VANC) (84.6% vs 36.0%, P = .038). Of the 13 VANC patients, 3 healed the wound and did not require RTOR, 2 underwent below-knee amputation (BKA), 2 received irrigation and debridement (I&D), and 6 underwent revision or total calcanectomies. Of the 25 No-VANC patients, 17 healed the wound, 4 underwent BKAs, 1 received an I&D, and 2 required revision or total calcanectomy. There was a trend toward increased rates of revision calcanectomy and BKA among the VANC cohort, but this was not statistically significant (61.5% vs 28.0%, P = .079). CONCLUSION: Partial or total calcanectomies for the management of infected DHU resulted in an overall healing rate of 50.0%, unplanned RTOR and revision calcanectomy rate of 39.5%, and a limb salvage rate of 82.6%. We found no clinical benefit with the intraoperative site application of vancomycin powder. LEVEL OF EVIDENCE: Level III, retrospective case control study.
Assuntos
Calcâneo/cirurgia , Pé Diabético/cirurgia , Calcanhar/cirurgia , Osteomielite/cirurgia , Vancomicina/administração & dosagem , Amputação Cirúrgica , Estudos de Casos e Controles , Diabetes Mellitus/patologia , Pé Diabético/complicações , Calcanhar/fisiopatologia , Humanos , Salvamento de Membro , Osteomielite/complicações , Pós , Reoperação , Estudos Retrospectivos , Vancomicina/farmacologia , Cicatrização/fisiologiaRESUMO
BACKGROUND: Midfoot and ankle movement dysfunction in people with diabetes mellitus and peripheral neuropathy (DMPN) is associated with midfoot deformity and increased plantar pressures during gait. If midfoot and ankle motion during heel rise and push-off of gait have similar mechanics, heel rise performance could be a clinically feasible way to identify abnormal midfoot and ankle function during gait. RESEARCH QUESTION: Is midfoot and ankle joint motion during a heel rise associated with midfoot and ankle motion at push-off during gait in people with DMPN? METHODS: Sixty adults with DMPN completed double-limb heel rise, single-limb heel rise, and walking. A modified Oxford multi-segment foot model (forefoot, hindfoot, shank) was used to analyze midfoot (forefoot on hindfoot) and ankle (hindfoot on shank) sagittal angle during heel rise and gait. Pearson correlation was used to test the relationship between heel rise and gait kinematic variables (n = 60). Additionally, we classified 60 participants into two subgroups based on midfoot and ankle position at peak heel rise: midfoot and ankle dorsiflexed (dorsiflexed; n = 23) and midfoot and ankle plantarflexed (plantarflexed; n = 20). Movement trajectories of midfoot and ankle motion during single-limb heel rise and gait of the subgroups were examined. RESULTS: Peak double-limb heel rise and gait midfoot and ankle angles were significantly correlated (r = 0.49 and r = 0.40, respectively). Peak single-limb heel rise and gait midfoot and ankle angles were significantly correlated (r = 0.63 and r = 0.54, respectively). The dorsiflexed subgroup, identified by heel rise performance showed greater midfoot and ankle dorsiflexion during gait compared to the plantarflexed subgroup (mean difference between subgroups: midfoot 3°, ankle 3°). SIGNIFICANCE: People with DMPN who fail to plantarflex the midfoot and ankle during heel rise have difficulty plantarflexing the midfoot and ankle during gait. Utilizing a heel rise task may help identify midfoot and ankle dysfunction associated with gait in people with DMPN.
Assuntos
Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Neuropatias Diabéticas/fisiopatologia , Pé/fisiopatologia , Marcha/fisiologia , Calcanhar/fisiopatologia , Caminhada/fisiologia , Idoso , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: This study compared the effectiveness of soft vs hard orthotics in treating heel pain and plantar fasciitis in adults. It also compared the level of function after orthotic use, cost, and number of visits for orthotics and explored whether age was a factor in orthotic effectiveness. DESIGN: Randomized controlled trial. Before randomization, patients were stratified by age (younger vs older adults) in blocks of 4 to ensure that there were an equal number of participants in each group (soft vs hard orthotics). SETTING: An orthotic clinic in a community-based hospital and a private orthotic clinic. PARTICIPANTS: The participants were adults aged 18 years or older (N=44) with heel pain and plantar fasciitis. INTERVENTION: Participants received hard or soft customized orthotics. MAIN OUTCOME MEASURES: Participants rated their pain intensity and pain interference before and after orthotic use using subscales from the Brief Pain Inventory. Function was similarly measured using the Late Life Function and Disability Instrument: Function component. Analyses of age, cost, and number of visits were also compared. RESULTS: There was a reduction in pain intensity (P=.010) and pain interference (P<.001) but no change in function over time (P=.333), and no difference between the groups who received hard vs soft orthotics. Age had no effect on orthotic effectiveness. Soft orthotics were less expensive (P<.0001) and required fewer visits for fabrication (P<.0001). CONCLUSION: Both soft and hard orthotics provided effective pain relief, but soft orthotics are less expensive.
Assuntos
Desenho de Equipamento , Fasciíte Plantar/fisiopatologia , Fasciíte Plantar/terapia , Órtoses do Pé/economia , Calcanhar/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Medição da DorRESUMO
OBJECTIVES: To (i) report the mid-term outcomes of subtalar arthroereisis using Talar-Fit implant for the treatment of flexible flatfoot patients; (ii) compare clinical and radiographic outcomes between arthroereisis with and without adjunctive operative procedures to investigate the effects of adjuncts on the outcomes; and (iii) analyze the risk factors associated with sinus tarsi pain, which is the most common postoperative complication of arthroereisis. METHODS: Thirty-one flexible flatfoot children and adolescents (46 feet) treated with subtalar arthroereisis using Talar-Fit implant from June 2014 to May 2019 were retrospectively analyzed. The feet were divided into four treatment groups: (i) arthroereisis alone, (ii) arthroereisis with gastrocnemius recession, (iii) arthroereisis with Kidner procedure, and (iv) arthroereisis with gastrocnemius recession and Kidner procedure. Clinical function was evaluated based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score. The following angles were measured for radiographic evaluation: talar-first metatarsal angle, calcaneal pitch angle, and talar declination angle on the lateral view; and talar-first metatarsal angle, talocalcaneal angle, and anteroposterior talonavicular coverage angle on the anteroposterior (AP) view. The paired Student's t-test was used to compare the pre- and postoperative angular measurements and AOFAS scores. The Wilcoxon rank-sum test was undertaken to determine the outcome differences among four treatment groups. Multivariate logistic regression analysis was used to analyze risk factors for sinus tarsi pain. P value <0.05 is considered statistically significant. RESULTS: The mean follow-up of the feet was 32.8 months (range, 10-71 months). The mean AOFAS score significantly improved from 55.5 ± 14.5 preoperatively to 86.3 ± 9.9 (P < 0.001). Comparison of radiographic outcomes showed that the lateral talar-first metatarsal angle decreased by a mean of 19.1° ± 11.9° (P < 0.001), the calcaneal pitch angle increased by a mean of 5.4° ± 3.4° (P < 0.001), the talar declination angle decreased by a mean of 14.8° ± 9.9° (P < 0.001), the AP talar-first metatarsal angle decreased by a mean of 15.6° ± 10.3° (P < 0.001), the AP talocalcaneal angle decreased by a mean of 7.2° ± 8.3° (P = 0.001), and the AP talonavicular coverage angle decreased by a mean of 20.4° ± 9.0° (P < 0.001). There were no statistically significant differences with regard to AOFAS score and all angle measurements on both the AP and lateral views among the four treatment groups. There was one dislocation case caused by a fall 6 weeks after surgery, which was treated nonoperatively. The incidence of sinus tarsi pain was 13% and logistic regression analysis indicated that patients with a longer distance from the tail end of the implant to the lateral calcaneal wall had 38.8% greater odds of developing sinus tarsi pain. CONCLUSIONS: The mid-term clinical and radiographic results were satisfactory in patients who underwent the subtalar arthroereisis procedure using Talar-Fit implant, alone or in combination with other adjuncts, for the treatment of flexible flatfoot.
Assuntos
Pé Chato/cirurgia , Calcanhar/fisiopatologia , Dor Pós-Operatória/etiologia , Procedimentos de Cirurgia Plástica/métodos , Próteses e Implantes , Articulação Talocalcânea/cirurgia , Adolescente , Adulto , Criança , Feminino , Pé Chato/diagnóstico por imagem , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Fatores de Risco , Articulação Talocalcânea/diagnóstico por imagem , Inquéritos e Questionários , Tálus/anormalidades , Adulto JovemRESUMO
BACKGROUND: Foot pain experienced by long-distance runners could be relieved by functional insoles which aim at evenly distributing the plantar pressure. RESEARCH QUESTION: We hypothesised that an individually moulded insole with medial arch support would reduce the impact and loading under the heel and metatarsal regions. METHODS: Twelve male recreational runners ran on a treadmill at 10â¯km/h for 1â¯hour with flat insoles and medial arch supported insoles. A pressure insole system (Novel Pedar, Germany) was used to obtain the peak pressure, peak force, time normalised pressure-time integrals, and the percentage of the total force-time integrals under 10 regions. RESULTS: Medial arch supported insoles reduced the peak force under the heel (medial: -15.3%, pâ¯=â¯0.001; lateral: -19.2%, pâ¯=â¯0.037) during the initial run, and reduced peak pressure under the heel (medial: -13.3%, pâ¯=â¯0.005; lateral: -9.9%, pâ¯=â¯0.006), and peak force under the medial heel (-17.8%, pâ¯=â¯0.006) after the run. The percentage of the total force-time integrals under the heel was reduced (medial: -23.8%, pâ¯=â¯0.004; lateral: -13.6%, pâ¯=â¯0.022) after the run. No significant difference was found under the metatarsal regions. There is shift of load from the metatarsal regions to the medial mid-foot as indicated by the change of the percentage of total force-time integrals. SIGNIFICANCE: Medial arch supported insoles were effective in reducing the impact and loading under the heel region in prolonged running on a treadmill. LEVEL OF EVIDENCE: Controlled laboratory study, Level V.
Assuntos
Calcanhar/fisiopatologia , Corrida/fisiologia , Adulto , Órtoses do Pé , Humanos , Masculino , Pressão , Sapatos , Fatores de TempoRESUMO
Chronic venous disease manifested as ulcers in the lower limb is a highly prevalent pathology in our population. Antiseptics and dressings designed to improve epithelialization are often used to cure the ulcer during outpatient therapy. Despite careful management, sometimes ulcers do not respond to treatment. In this report, we discuss the antiseptic and potentially immunomodulatory effects of the amniotic membrane as a biological dressing for the treatment of venous ulcers refractory to conventional therapy.