Search Results
Background: Sever’s disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series.
Methods: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever’s disease. This information was then reviewed to present what is actually known about this condition.
Results: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition.
Conclusion: The level of evidence for most of what we purport to know about Sever’s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment. (J Am Podiatr Med Assoc 98(3): 212–223, 2008)
Background:
We sought to develop a standardized protocol for ultrasound (US) measurements of plantar fascia (PF) width and cross-sectional area (CSA), which may serve as additional outcome variables during US examinations of both healthy asymptomatic PF and in plantar fasciopathy and determine its interrater and intrarater reliability.
Methods:
Ten healthy individuals (20 feet) were enrolled. Participants were assessed twice by two raters each to determine intrarater and interrater reliability. For each foot, three transverse scans of the central bundle of the PF were taken at its insertion at the medial calcaneal tubercle, identified in real time on the plantar surface of the foot, using a fine wire technique. Reliability was determined using intraclass correlation coefficients (ICC), standard errors of measurement (SEM), and limits of agreement (LOA) expressed as percentages of the mean. Reliability of PF width and CSA measurements was determined using PF width and CSA measurements from one sonogram measured once and the mean of three measurements from three sonograms each measured once.
Results:
Ultrasound measurements of PF width and CSA showed a mean of 18.6 ± 2.0 mm and 69.20 ± 13.6 mm2 respectively. Intra-reliability within both raters showed an ICC > 0.84 for width and ICC > 0.92 for CSA as well as a SEM% and LOA% < 10% for both width and CSA. Inter-rater reliability showed an ICC of 0.82 for width and 0.87 for CSA as well as a SEM% and LOA% < 10% for width and a SEM% < 10% and LOA% < 20% for CSA. Relative and absolute reliability within and between raters were higher when using the mean of three sonographs compared to one sonograph.
Conclusions:
Using this novel technique, PF CSA and width may be determined reliably using measurements from one sonogram or the mean of three sonograms. Measurement of PF CSA and width in addition to already established thickness and echogenicity measurements provides additional information on structural properties of the PF for clinicians and researchers in healthy and pathologic PF.
Non-calcified tissues, including tendons, ligaments, adipose tissue and cartilage, are not visible, for any practical purposes, with conventional X-ray imaging. Therefore, any pathological changes in these tissues generally necessitate detection through magnetic resonance imaging or ultrasound technology. Until recently the development of an X-ray imaging technique that could detect both bone and soft tissues seemed unrealistic. However, the introduction of diffraction enhanced X-ray imaging (DEI) which is capable of rendering images with absorption, refraction and scatter rejection qualities has allowed detection of specific soft tissues based on small differences in tissue densities. Here we show for the first time that DEI allows high contrast imaging of soft tissues, including ligaments, tendons and adipose tissue, of the human foot and ankle. (J Am Podiatr Med Assoc 94(3): 315–322, 2004)
Giant cell tumor of tendon sheath is infrequently documented in the foot and even less near the ankle. This case report involves such a tumor of the flexor hallucis longus tendon presenting at the posterior ankle. Diagnosis was aided by magnetic resonance imaging, and treatment consisted of complete surgical excision. Pathologic examination verified the diagnosis of giant cell tumor of tendon sheath, and follow-up magnetic resonance imaging revealed no remnants or recurrence of tumor 1 year after surgery. (J Am Podiatr Med Assoc 101(2): 187–189, 2011)
Sural nerve impingement is frequently reported and often arises from localized trauma but much less understood are its mechanical etiologies. This case report describes the effects of local traction on the lateral calcaneal branch of the sural nerve. The association is confirmed anatomically and symptoms are alleviated with a heel lift. (J Am Podiatr Med Assoc 102(1): 75–77, 2012)
Evaluating Iatrogenic Complications of the Total-Contact Cast
An 8-Year Retrospective Review at Cleveland Clinic
Background: Total-contact casting is an effective method to treat various pathologic abnormalities in patients with diabetic neuropathy, but its use is frequently associated with iatrogenic complications.
Methods: The largest retrospective review to date of iatrogenic complications of total-contact casts was conducted over an 8-year period at Cleveland Clinic.
Results: In the past 8 years, 23% of patients developed complications, and the most common complication was a new heel ulcer formation. Of these complications, 92.1% resolved, 6.4% were lost to follow-up, and 1.4% resulted in a partial foot amputation. Mean cast duration was 10.3 days for patients who developed a total-contact cast iatrogenic complication. The most common indication for the use of a total-contact cast was a neuropathic foot ulceration.
Conclusions: The results of this study support the use of total-contact casting in the insensate patient with diabetes. However, adequate staff training in total-contact cast application is recommended to reduce complications.
Master Techniques in Orthopaedic Surgery: The Foot and Ankle. 3rd Ed. Edited by Harold B. Kitaoka, MD. 803 pages. Lippincott Williams & Wilkins, Philadelphia, PA, 2013. $237.79.
Background: We investigate kinematic adaptation and muscle activities in the trunk and lower extremities of healthy subjects during treadmill walking in negative-heeled sports shoes versus normal sports shoes.
Methods: Thirteen healthy female university students participated in the study. We analyzed sagittal-movement kinematics and electromyographic findings from the erector spinae, rectus abdominus, rectus femoris, biceps femoris, tibialis anterior, and lateral gastrocnemius muscles of the dominant side in two shod conditions.
Results: Negative-heeled gait is characterized by faster cadence, shorter stride length, increased maximal extension angles in the trunk and hip, increased flexion angle in the knee, larger dorsiflexion in the stance phase, and a larger range of motion of the ankle joint. Negative-heeled gait resulted in a significantly larger integrated electromyographic value, a longer duration of electromyographic activity, and a higher mean amplitude of electromyographic activity in the tibialis anterior, lateral gastrocnemius, and biceps femoris muscles.
Conclusions: Negative-heeled gait compared with normal gait places a higher physiologic demand on the tibialis anterior, lateral gastrocnemius, and biceps femoris muscles when walking on a level surface. Thus, negative-heeled shoes could be of value if used in an exercise rehabilitation or training program where inclined walking is not available owing to a flat terrain. (J Am Podiatr Med Assoc 97(6): 447–456, 2007)
