Fascitis eosinofílica. A propósito de un caso / Eosinophilic fasciitis. Apropos of a case

La fascitis eosinofílica es un síndrome esclerodermiforme poco frecuente y de etiología desconocida que afecta predominantemente a las extremidades. Se han barajado varias hipótesis sobre su etiología y en algunos casos se ha descrito antecedente traumático. Presentamos un caso de una paciente de 54 años que tras presentar traumatismo sobre las rodillas inicia un cuadro de mialgias, induración cutánea y retracción progresiva de diversas articulaciones iniciado en los miembros inferiores y posteriormente en los miembros superiores y en el tronco. Realizamos el seguimiento de la paciente, mostrando su manejo desde el punto de vista rehabilitador y evolución. La paciente mejoró tanto sus balances articulares como la marcha y el dolor. La fascitis eosinofílica es una enfermedad infrecuente en la que debemos realizar el diagnóstico diferencial con otros síndromes esclerodermiformes. La rehabilitación puede ayudar a reducir y evitar el progreso de las contracturas (AU)

Eosinophilic fasciitis is a rare scleroderma syndrome of unknown cause that predominantly affects the extremities. Several hypotheses have been proposed to explain its etiology and there have been reports of some patients with a history of trauma. We present the case of a 54-year-old woman who, after a knee injury, developed myalgia, progressive skin induration and retraction of various joints, starting in the lower limbs and spreading to the upper limbs and trunk. We describe the rehabilitation management and outcome of this patient. The patient showed improvement in both balance, joint pain, and gait. Eosinophilic fasciitis is a rare disease that requires a differential diagnosis with other scleroderma syndromes. Rehabilitation can help reduce and prevent progression of contractures (AU)

Nodular fasciitis of the finger and hand: case report.

Nodular fasciitis rarely arises in the hand. We describe 4 cases that were histologically diagnosed as nodular fasciitis on biopsy specimens arising in the hands. The masses of 2 patients were excised due to rapid growth. Both of these patients had no recurrence. The other 2 patients were followed without surgical excision, and the masses partially regressed without functional impairment.

[Functional assessment and rehabilitation of eosinophilic fasciitis]. / Intérêt du bilan fonctionnel et de la rééducation dans la fasciite à éosinophile.

PURPOSE: To evaluate functional assessment and rehabilitation in eosinophilic fasciitis. METHOD: Description of a clinical case of eosinophilic fasciitis, including the evolution of functional assessment after treatment with corticotherapy and rehabilitation. CASE REPORT: Our case was a 33-year-old patient with major walking disability and pain in the left calf. Biological examination and imaging, including nuclear magnetic resonance and bone scintigraphy, showed inflammation of the adipose and muscular tissues of the posterior area of the leg. Cutaneomuscular biopsy confirmed the diagnosis of eosinophilic fasciitis. Corticotherapy was then instituted in parallel with rehabilitation to limit deficiencies and disability function. DISCUSSION-CONCLUSION: Functional assessment used as indicating objective could, in partnership with follow-up of the biological inflammatory syndrome, lead to decreased use of corticoids in iosinophilic fasciitis. Moreover, supplemental rehabilitation could limit deficiencies and the functional disability resulting from the fasciitis.

Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis.

We describe the design of a new cost-effective, comfortable orthotic designed to treat heel pain associated with plantar fasciitis. The heel pad is fabricated from a 4 degrees Sorbothane medial wedge with a customized insertion of low-density Plastazote. The orthotic is medium-density Plastazote reinforced with cork in the medial longitudinal arch. One pair of orthotics takes less than 1 hour to make. Pilot data were collected retrospectively to evaluate the efficacy of the orthotic for reducing pain. Ten clients at a hand and foot orthotic clinic with a mean age of 71+/-9.1 years and with unilateral or bilateral heel pain associated with plantar fasciitis were provided with customized heel pads and soft, molded orthotics at their initial visit. Pain levels were recorded with verbal and Likert-type scales. After 5 weeks of heel pad and orthotic use, all patients showed a reduction in pain, with the overall reduction being highly significant (P

Actualización de la enfermedad de Dupuytren / Up-dating of Dupuytren´s disease

La enfermedad de Dupuytren es una afección muy frecuente en nuestra práctica diaria y que, en su evolución natural, puede originar severos grados de discapacidad manual, fundamentalmente en el último estadio de la vida laboral de muchos trabajadores. Se subestima su importancia a pesar de los buenos resultados que se obtienen actualmente con los tratamientos quirúrgicos. Transcurrido más de un siglo desde su primera descripción y tras los numerosos trabajos realizados, todavía no conocemos la causa que lo produce y parte de su etiopatogenia; su diagnóstico es clínico y el tratamiento rehabilitador postquirúrgico, muchas veces infravalorado, es imprescindible para obtener un buen resultado funcional. (AU)

Iliotibial band Z-lengthening.

Iliotibial band friction syndrome (ITBFS) is a common overuse injury reported to afflict 1.6% to 12% of runners. It results from an inflammatory response secondary to excessive friction that occurs between the lateral femoral epicondyle and the iliotibial band. Initial treatments include rest, anti-inflammatory medication, modalities (ice or heat), stretching, physical therapy, and possibly a cortisone injection. In recalcitrant cases of ITBFS, surgery has been advocated. This report describes a surgical technique of Z-lengthening of the iliotibial band in patients presenting with lateral knee pain localized to the iliotibial band at the lateral femoral epicondyle and Gerdy's tubercle who failed all nonoperative efforts.

Rehabilitación y tratamiento ortopodológico en rotura de la fascia plantar. Caso clínico

Presentamos en este trabajo un caso clínico en el que una excesiva terapia con infiltraciones de corticoides y un tratamiento ortopodológico no satisfactorio, unido a práctica deportiva excesiva, provocan que una fascitis plantar recurrente desemboque en la rotura parcial de la misma con la consecuente impotencia funcional. Planteamos así, después de un exhaustivo estudio biomecánico, un tratamiento ortopodológico personalizado junto con electroterapia como elemento coadyuvante, y siempre en coordinación con el trabajo del fisioterapeuta en aquellas alteraciones músculo-tendinosas que sin duda tienden a cronificar la patología. (AU)

The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis.

STUDY DESIGN: Single-group, pre-, and postintervention repeated measures design. OBJECTIVE: To determine the impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. BACKGROUND: Few studies have examined the efficacy of foot orthotics for plantar fasciitis, and no single study has yet examined the effects of semirigid foot orthotics on an established quality-of-life instrument. METHODS AND MEASURES: Eight men and 7 women (mean ages 44.7 +/- 9.0 years) who reported having plantar fasciitis symptoms for an average of 21.3 +/- 23.7 months participated in the study. Subjects were timed for a 100-m walk at a self-selected speed, then they rated the pain they experienced during the walk using a 10-cm visual analog scale. Subjects also completed the pain and disability subsections of the Foot Function Index questionnaire. All measures were acquired before the fabrication of custom semirigid foot orthotics and 12 to 17 days following onset of foot orthotic use. RESULTS: Postorthotic 100-m walk times were not significantly different (t = 0.39, P = 0.70) than preorthotic values. Postorthotic pain ratings (mean = 0.7 +/- 0.7) for the 100-m walk were significantly less than (Wilcoxon t = 1, P < 0.005) preorthotic pain ratings (mean = 3.0 +/- 1.7). Postorthotic Foot Function Index pain subsection ratings (Wilcoxon t = 0, P < 0.005) were significantly less than preorthotic ratings, demonstrating a 66% reduction in pain ratings. Postorthotic Foot Function Index disability subsection ratings (Wilcoxon t = 0, P < 0.005) were significantly less than preorthotic ratings, demonstrating a 75% reduction in disability ratings. CONCLUSION: Custom semirigid foot orthotics may significantly reduce pain experienced during walking and may reduce more global measures of pain and disability for patients with chronic plantar fasciitis.

Rehabilitation of plantar fasciitis.

Rehabilitation of plantar fasciitis can be a lengthy and sometimes difficult process. The patient and the practitioner can become discouraged by slow progress. It is of benefit to the patient and practitioner to be able to follow a logical approach in the rehabilitation plan. No one modality of treatment for this condition has been shown to be effective in all instances. It is best to choose several complementary treatment modalities in the rehabilitation of this difficult condition.

Treatment of plantar fasciitis.

Plantar fasciitis is a common cause of heel pain in adults. The disorder classically presents with pain that is particularly severe with the first few steps taken in the morning. In general, plantar fasciitis is a self-limited condition. However, symptoms usually resolve more quickly when the interval between the onset of symptoms and the onset of treatment is shorter. Many treatment options exist, including rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints, anti-inflammatory agents and surgery. Usually, plantar fasciitis can be treated successfully by tailoring treatment to an individual's risk factors and preferences.

Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection.

OBJECTIVE: To investigate the efficacy of ultrasound-guided steroid injection for the treatment of proximal plantar fasciitis and to evaluate mechanical properties of the heel pad after steroid injection. DESIGN: Proximal plantar fascia and heel pad were assessed with a 10-MHz linear array ultrasound transducer. Pain intensity was quantified with a tenderness threshold (TT) and visual analog scale (VAS). The transducer was incorporated into a specially designed device to measure mechanical properties of the heel pad. Evaluations were performed before injection and at 2 weeks and 3 months after injection. SETTING: An outpatient clinic of a tertiary care center. PATIENTS: Fourteen consecutive patients with unilateral proximal plantar fasciitis. INTERVENTION: Ultrasound-guided injection of 7 mg betamethasone and 0.5 mL of 1% lidocaine into the inflamed proximal plantar fascia. MAIN OUTCOME MEASURES: VAS, TT, heel pad and plantar fascia thickness, and echogenicity of the proximal plantar fascia on sonogram were assessed. Mechanical properties included unloaded heel pad thickness, compressibility index, and energy dissipation ratio. RESULTS: Both VAS score +/- standard deviation (SD; 5.43 +/- 2.03, 1.39 +/- 2.19, 0.57 +/- 1.40 at the 3 measurements, respectively) and TT +/- SD (5.05 +/- 1.42, 9.34 +/- 1.84, 9.93 +/- 1.98 kg/cm2 at the 3 measurements, respectively) improved significantly (p < .001) after steroid injection. The mean thickness of the plantar fascia was greater in the symptomatic side than in the asymptomatic side before treatment (0.58 +/- 0.13 cm vs 0.40 +/- 0.11 cm, p < .001). The thickness had decreased significantly 3 months after injection (0.46 +/- 0.12 cm at 2 weeks, 0.42 +/- 0.10 cm at 3 months, p < .001). The hypoechogenicity at the proximal plantar fascia disappeared after steroid injection (p < .001). Mechanical properties of the heel pad did not change 3 months after steroid injection (p > .05). CONCLUSION: Ultrasound offers an objective measurement of the therapeutic effect on proximal plantar fasciitis. Accurate steroid injection under ultrasound guidance can effectively treat proximal plantar fasciitis without significant deterioration of the mechanical properties of the heel pads.

Defective running shoes as a contributing factor in plantar fasciitis in a triathlete.

STUDY DESIGN: Case study of a patient who developed plantar fasciitis after completing a triathlon. OBJECTIVES: To describe the factors contributing to the injury, describe the rehabilitation process, including the analysis of defective athletic shoe construction, and report the clinical outcome. BACKGROUND: Plantar fasciitis has been found to be a common overuse injury in runners. Studies that describe causative factors of this syndrome have not documented the possible influence of faulty athletic shoe construction on the symptoms of plantar fasciitis. METHODS AND MEASURES: The patient was a 40-year-old male triathlete who was followed up for an initial evaluation and at weekly intervals up to discharge 4 weeks after injury and at 1 month following discharge. Perceived heel pain, ankle strength, and range of motion were the primary outcome measures. Shoe construction was evaluated to assess the integrity of shoe manufacture and wear of materials by visual inspection of how shoe parts were glued together, if shoe parts were assembled with proper relationship to each other, if the shoe sole was level when resting on a level surface, and if the sole allowed unstable motion. RESULTS: The patient appeared to have a classic case of plantar fasciitis with a primary symptom of heel pain at the calcaneal origin of the plantar fascia. On initial evaluation, right heel pain was a 9 of 10, plantar flexion strength was a 3+/5, and ankle dorsiflexion motion was 10 degrees. One month after discharge, perceived heel pain was 0, plantar flexion strength was 5/5, and dorsiflexion motion was 15 degrees and equal to the uninvolved extremity. The right running shoe construction deficit was a heel counter that was glued into the shoe at an inward leaning angle, resulting in a greater medial tilt of the heel counter compared with the left shoe. The patient was taught how to examine the integrity of shoe manufacture and purchased a new pair of sound running shoes. CONCLUSIONS: A running shoe manufacturing defect was found that possibly contributed to the development of plantar fasciitis. Assessing athletic shoe construction may prevent lower extremity overuse injuries.

Plantar fasciitis: etiology and treatment.

Plantar fasciitis is a common pathological condition of the foot and can often be a challenge for clinicians to successfully treat. The purpose of this article is to present and discuss selected literature on the etiology and clinical outcome of treating plantar fasciitis. Surgical and nonsurgical techniques have been used in the treatment of plantar fasciitis. Nonsurgical management for the treatment of the symptoms and discomfort associated with plantar fasciitis can be classified into 3 broad categories: reducing pain and inflammation, reducing tissue stress to a tolerable level, and restoring muscle strength and flexibility of involved tissues. Each of these treatments has demonstrated some level of effectiveness in alleviating the symptoms of plantar fasciitis. Previous studies have grouped all forms of nonsurgical therapy together. It is, therefore, difficult to determine if one type of treatment is more effective compared with another. Until such research is available, the clinician would be wise to include treatments from all 3 categories.

Keeping in shape: exercise fundamentals for the midlife patient.

The typical physiologic effects of aging on the musculoskeletal system can be impeded with regular exercise and diet. Common orthopedic problems in sedentary midlife patients are shoulder impingement, low back pain, and plantar fasciitis. Although the responsibility for maintaining an exercise program rests with the individual, the primary care physician can play an important role as coach, cheerleader, and respected advisor. The key is to encourage patients to initiate a program of regular, moderate exercise 30 minutes a day, three times a week, and to eat a balanced, nutritious diet. The best exercise and diet regimen is one that is custom-designed to accommodate the individual patient's needs and objectives.

Rehabilitation of eosinophilic fasciitis. A case report.

Eosinophilic fasciitis (EF), first described in 1974, is characterized by the sudden onset of painful swelling with induration of the soft tissues and peripheral eosinophilia, often after an episode of intense physical exertion. It rapidly progresses to joint contractures because of inflammation and fibrosis of the fascia. Of the 200 cases reported in the medical literature, most have responded positively to a prolonged course of oral prednisone. Although complete recovery is possible, more frequently signs and symptoms of EF persist. There were no detailed descriptions found in the literature of any rehabilitative interventions in this disease. This case study describes the methods used in a successful, comprehensive rehabilitation treatment of a 21-yr-old man admitted to the Palo Alto VA Medical Center rehabilitation program 8 mo after the onset of symptoms. Previous medication therapy included prednisone and methotrexate. The patient underwent 2 mo of inpatient rehabilitation, which consisted of upper and lower extremity nerve blocks, serial splinting, application of physical modalities, massage, stretching and strengthening exercises and interdisciplinary pain management. Significant improvement was made in the range of motion in all extremities, strength, hand function, level of pain, gait and endurance. Aggressive therapy did not increase eosinophilia. In fact the eosinophil count returned to normal by the time of discharge. A detailed review of the patient's rehabilitation program is presented.

Rehabilitation of the foot and ankle.

The foot and ankle are frequently injured in athletic activities. In addition to acute injuries such as ankle sprains and fractures, a variety of overuse injuries are seen. A thorough knowledge of the mechanism of injury and the course of the healing process is essential for the comprehensive rehabilitation of such injuries. Recovery progresses through several phases. If selected appropriately, modalities and therapeutic exercise can work together to facilitate the healing process at each phase. Many injuries could be averted by preventive exercise, judicious use of taping and bracing, and recognition and correction of biomechanical faults.

Sports medicine. 3. Lower extremity injuries.

This self-directed learning module highlights new advances in sports-related injuries of the lower extremity. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains sections on injuries of the hip and thigh, knee and leg, and ankle and foot. The most common injuries are primarily addressed, while less common injuries are more briefly discussed. New advances that are covered in this section include closed kinetic chain strengthening exercises and recent advances in rehabilitation after anterior cruciate ligament reconstruction.

Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature.

Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.