Background: The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) have been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. The objective of this study was to compare the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis through comparisons of plantar fascia thickness and pressure distribution.
Methods: Between July 2020 and September 2020, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm2 ), Group 2 (n = 25) received medium energy density (0.18 mJ/mm2), and Group 3 (n = 21) received high energy density (0.38 mJ/mm2). All groups received three sessions of ESWT with a frequency of 2,000 shocks/min at one week intervals. The patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), and plantar fascia thickness measured by ultrasonography, and plantar pressure distribution.
Results: The posttreatment VAS and FFI scores were determined to be statistically significantly lower than the pretreatment values in all three groups (p<0.001). There was no significant difference between the groups in terms of the pre and post treatment values of VAS, FFI scores, plantar fascia thickness and pressure distribution (p>0.05). No statistically significant difference was found between the groups in terms of percentage changes in all the outcome parameters (p>0.05).
Conclusions: The results of the study suggest that neither low, medium, or high levels of ESWT were superior to one another in terms of pain, foot functions, fascia thickness and pressure distribution in the treatment of plantar fasciitis.
Background: The aim of this study was to investigate the relationship between the radiographic
bone morphology of the ankle and the observed fracture type.
Methods: We retrospectively reviewed the patients who had visited our emergency department with ankle injuries between June 2012 and July 2018. All patients were treated with open reduction and internal fixation. Patients were categorized in two groups based on the fracture patterns (groups 1 and 2). Group 1 consisted of isolated lateral malleolar fractures, while group 2 comprised bimalleolar fractures. Group 1 was further divided into two groups; namely group A and B based on their classification into Weber type B and C fractures, respectively. Four radiographic parameters were measured postoperatively by standing whole-leg anteroposterior view of the ankle; talocrural angle (TCA), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), and the distance between the talar dome and distal fibula.
Results: One hundred and seventeen patients were included in group 1-A, 89 patients in group 1-B, and 168 patients in group 2. The values of TCA and MMRL were significantly higher in group 2 than in group 1. Lateral malleolar length/medial malleolar length ratio was also significantly different between the two groups. However, there were no significant differences between the groups in terms of LMRL and the distance between the tip of the distal fibula and talar process. LMLR and MMRL values between groups A and B were not significantly different (p=0.402 and p=0.592, respectively). However, there was a significant difference between the two groups in terms of TCA and the distance between the tip of the distal fibula and talar process.
Conclusions: The talocrural angle, medial malleolar relative length, and lateral malleolar length/medial malleolar length were significantly higher in patients with bimalleolar fracture than in patients with isolated lateral malleolar fractures.
Dislocation of the proximal interphalangeal (PIP) joint of the fifth toe is an uncommon injury and when diagnosed in the acute phase closed reduction is commonly an adequate treatment option. We describe a rare case of a 7-year-old patient presented with late diagnosed isolated dislocation of the PIP joint in the fifth toe. Although there are a few reported cases of late diagnosis combined fracture-dislocation of the toes in both adult and pediatric age group in the literature, belatedly diagnosed dislocation of the 5th toe without accompanying fracture in the pediatric population has not yet been reported as far as we know. This patient achieved good clinical outcomes following treatment via open reduction and internal fixation
Osteonecrosis is acknowledged as a relatively uncommon disorder caused by various factors, including autoimmune diseases, drug-induced diseases, inherited metabolic disorders, coagulation disorders, and underlying malignancies. To our knowledge, no previous research has investigated osteonecrosis stemming from extracorporeal membrane oxygenation. Herein, we report a rare case of postperipheral venoarterial extracorporeal membrane oxygenation–induced multifocal osteonecrosis in the foot and ankle that demonstrated a low serpiginous peripheral signal on T1-weighted images and a double-line sign on fat-suppressed or T2-weighted magnetic resonance images. Conservative treatment was applied, and the patient was mostly recuperated after 6 months.
Background: Onychomycosis is the most common nail disease seen in clinical practice. Medication safety, severity of disease, co-morbidities, concomitant medications, patient age, and cost are all important considerations when treating onychomycosis. Since cost may affect treatment decisions, we sought to analyze Medicaid formulary coverage of onychomycosis antifungals.
Methods: Public state Medicaid formularies were searched for coverage of FDA approved onychomycosis medications and off-label oral fluconazole. Total drug cost for a single great toenail was calculated using National Average Drug Acquisition Cost. Pearson correlation coefficients were calculated to compare coverage and cost, mycological cure rate, and complete cure rate.
Results: Oral terbinafine and off-label fluconazole were widely covered for onychomycosis treatment. There was poor coverage of oral itraconazole and topical ciclopirox, and no coverage of topical efinaconazole and tavaborole without step-edits or prior authorization. There was a significant negative correlation between medication coverage and cost (r = −0.758, p= 0.040). There was no correlation between medication coverage and mycologic (r = 0.548, p = 0.339) and complete (r = 0.768, p = 0.130) cure rates.
Conclusions: There is poor Medicaid coverage of antifungals for the treatment of onychomycosis, with step-edits and prior authorization based on cost rather than treatment safety and efficacy. We recommend involving podiatrists and dermatologists in developing criteria for insurance approval of onychomycosis treatments.
Background: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle. This pain occurs due to chronic inflammation, characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus tarsi syndrome. We sought to determine the effects of corticosteroid and local anesthetic, platelet-rich plasma, and ozone injection on the sinus tarsi syndrome.
Methods: Sixty patients diagnosed with sinus tarsi syndrome were randomly divided into three groups. Patients in the first group received corticosteroid and local anesthetic, patients in the second group received platelet-rich plasma, and patients in the third group were given ozone injections. Outcome measures were Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), Foot Function Index (FFI), and Foot-Ankle Outcome Score (FAOS). Outcome measures were evaluated by comparing pre-intervention and post-injection 1-month, 3-month, and 6-month follow-ups.
Results: At the end of the 1st month, third month, and sixth month after injection, significant improvements were observed in all three groups compared to the baseline (p < .001 for all comparisons). In the 1st and third months, the improvements in AOFAS scores were similar in Groups 1 and 3; those in Group 2 were lower (p = .001 and p = .004, respectively). In the 1st month, the improvements in FAOS scores were similar in Groups 2 and 3; those in Group 1 were higher (p < .001). During the 6-month follow-up period, there was no statistically significant difference in VAS and FFI results between all three groups (p > .05).
Conclusions: Corticosteroid and local anesthetic or platelet-rich plasma or ozone injections could provide clinically significant functional improvement for at least six months in patients with sinus tarsi syndrome.
This case describes delayed treatment of a medial talonavicular dislocation with a shear fracture of the talar head, comminuted posterior talar process fracture, and an intra-articular cuboid fracture with subtle medial displacement of the calcanealcuboid joint and the associated treatment. The injury was sustained in a 35-year-old male following a high-energy motor vehicle accident. Three weeks following the injury, delayed treatment was achieved following an attempted closed reduction under general anesthesia followed by open reduction and percutaneous kirschner wire fixation. After a 12-month follow-up the patient was able to return to work and regular activities pain free without complications. Several associated injuries have been described with isolated talonavicular dislocations. This case reviews the technique and care surrounding this injury pattern and its delayed treatment.
Background: Using high-heeled shoes in daily life affects the stability of walking, body posture, and functionality. So, the present study was aimed to determine the immediate effect of Kinesio-taping (KT) on functionality, static and dynamic balance, exercise capacity, posture in young women using high-heeled shoes.
Methods: Thirty-seven females who were used high-heeled shoes with a mean age of 20.32±1.37 years were divided into two groups: control (n:20) and study group(n:17). The study group’s both limbs were taped medially, laterally, and dorsally with KT; no application was made to the control group. Balance [Techno Body Postural Line], functionality [vertical jump and functional reach test], exercise capacity [6-min walk test], human body posture [New York Posture Rating Chart] was assessed.
Results: Use of high-heeled shoes was 8(7-9) hours/day, 5(3-5) days/week, 3(2-6.5) years in the study group versus 6(6-8) hours/day, 4(2.5-5.75) days/week for 4(2.5-5.75) years in the control group. Statistical significance in functional reach distance (cm) was found within the control (p:0.010) and study groups (p:0.005) but not between the groups (p>0.05). Stabilometric mono pedal right foot elips area (mm2; p:0.006) and perimeter (mm;p:0.009); left foot elips area (mm2;p:0.016), perimeter (mm;p:0.023) and front/backward standard deviation (p:0.018); dynamic balance area gap percentage (%; p:0.030) were significant within the study group. Posture, vertical jump distance, exercise capacity, stabilometric test results, bipedal closed-eye&opened eye results were similar within and between the groups (p>0.05).
Conclusions: Kinesio-taping has no immediate effect on exercise capacity, vertical jump function, posture, and bipedal static balance but can modulate the functional reach function, static mono pedal leg balance, and dynamic equilibrium. Further studies are recommended to investigate the additive effect of KT with high heels and after 45 minutes, 24 hours and 72 hours.
The accessory navicular bone (ANB) is one of the most common accessory ossicles of the foot. Fewer than 1% of ANBs are symptomatic, and most of the symptomatic ANBs are type II ANBs. Avascular necrosis of the type II ANB is an uncommon cause of symptomatic accessory navicular syndrome and also a rarely reported condition in the podiatric medical literature. This rare disorder must be distinguished from other painful conditions of the ANB and should be considered in differential diagnoses. We present a case of avascular necrosis of the type II ANB with sclerosis on radiographs and magnetic resonance images in a 46-year-old woman.
Background: Onychomycosis, or fungal nail infection, is the cause of 50% of onychopathies seen by podiatric physicians. This pathology is accompanied by a negative psychosocial component because of its effect on self-image, which is an essential part of social relations. Conventional pharmacologic treatment based on antifungal agents is lengthy and expensive and has a high abandonment rate and a low cure rate. Therefore, a faster and more efficient solution has been sought using laser treatment. However, studies on the efficacy of this physical method are not conclusive due to the lack of uniformity in the method used to apply the laser and an objective method to measure the results. The aim of this study was to measure the efficacy of laser treatment of onychomycosis by microbiological cure and clinical evolution using the Onychomycosis Severity Index.
Methods: A prospective study with a strictly repetitive protocol of Nd:YAG 1,064-nm laser was applied to 50 participants with onychomycosis in the first toe, following the manufacturer's instructions. The efficacy of the treatment on fungal infection was measured by microbiological culture before and after treatment. The clinical evolution of the nail dystrophy was quantitatively evaluated using the Onychomycosis Severity Index.
Results: The efficacy of Nd:YAG 1,064-nm laser in eliminating fungal infection was 30% (15 participants). However, significant improvement in nail appearance (dystrophy) was observed in 100% of patients (P < .001).
Conclusions: Laser treatment has relatively low efficacy in treating fungal infection but results in an objective improvement in the clinical appearance of the nail in 100% of patients.