Síndrome de Baxter, a propósito de un caso / Baxter syndrome: a case report

El síndrome de Baxter consiste en una neuropatía por atrapamiento de la primera rama del nervio plantar lateral o calcáneo inferior que cursa con dolor, imposibilidad para la abducción del 5.° dedo y, en algunos casos, parestesias. Se presenta el caso de una paciente de 44 años diagnosticada de fascitis plantar, tratada quirúrgicamente con fasciectomía tras el fracaso del tratamiento conservador. Durante el postoperatorio presentó pérdida de la movilidad del 5.° dedo, parestesias difusas y dolor moderado con dificultad para la deambulación. Tras la realización de resonancia magnética y electromiograma es diagnosticada de síndrome de Baxter. Inició tratamiento de rehabilitación obteniendo mejoría de la alodinia a nivel de la cicatriz y adquirió marcha sin ayudas técnicas, con menor dificultad para puntillas y talones. Sin embargo mantuvo parestesias ocasionales y ausencia de movilidad del 5º dedo (AU)

Baxter syndrome is an entrapment neuropathy of the first branch of the lateral plantar nerve or inferior calcaneal nerve that causes pain, inability to abduct the fifth toe and, in some cases, paraesthesia. We report the case of a 44-year-old woman with a diagnosis of plantar fasciitis, treated surgically with fasciectomy after failure of conservative treatment. During the postoperative period, the patient showed loss of mobility of the fifth toe, moderate diffuse pain, numbness, and difficulty walking. After the performance of magnetic resonance imaging and electromyography, the patient was diagnosed with Baxter syndrome. She began rehabilitation, which improved allodynia of the scar and allowed her to walk without technical aids and with less difficulty in heel toe walking. However, there was persistence of occasional numbness and lack of mobility of the fifth toe (AU)

Pathology-designed custom molded foot orthoses.

Treating patients with custom foot orthoses for common pathologies is a rewarding experience when the proper steps are taken during foot casting and custom-orthosis prescription writing. This article describes successful methods for orthoses casting and prescription writing for custom-molded orthoses for Achilles tendonitis, pes planus, hallux limitus, plantar fasciitis/heel spurs, lateral ankle instability, metatarsalgia, and pes cavus. In addition, a summary of orthotic laboratory instructions for each pathology-designed custom orthosis is provided, which should be considered by orthotic laboratories.

Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study.

OBJECTIVE: To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. DESIGN: Random assignment to two groups of treatment with two and eight months follow-up. SETTING: The data were collected in outpatients. SUBJECTS: Forty-five subjects with a history of at least six months of heel pain were studied. INTERVENTIONS: Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 +/- 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 +/- 12.3 years). MAIN OUTCOME MEASURES: Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up. RESULTS: Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 +/-18.7; group B 53.5 +/- 20; P>0.05). In both groups there was a significant (P<0.05) increase in the Mayo Clinical Scoring System score at two months (group A 83.9 +/- 13.7; group B 80 +/- 15,8) and eight months (group A 90 +/- 10.5; group B 90.2 +/-8.7) follow-up. No significant differences were obtained comparing the Mayo Clinical Scoring System scores of the two groups at two and eight months follow-up. CONCLUSIONS: There was no difference between the two techniques of using extracorporeal shock wave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.

[Use of the electrophoresis with acetic acid in a complex treatment of heel spurs at a sanatorium].

The author studied the influence of physical factors of electrophoresis with acetic acid, massage and laseropuncture in sanatorium conditions where 28 patients with heeling spurs have been treated. The patients in a control group (n=25) received a traditional treatment - an injection of hydrocortisone in area of heeling spurs, skin rubbing with herbs (tincture with different flowers, elder-berry buds. Efficiency of a proposed medical complex was shown using clinical and radiographic data.