Background: We sought to evaluate the safety and effectiveness of extracorporeal shockwave therapy as a therapeutic treatment for destroying Morton’s neuroma.
Methods: Twenty-five patients (25 feet) were included in the study. Indications for participation were more than 8 months of conservative care with a visual analog scale pain score of 4 or greater. The mean overall pain score on a modified visual analog scale was 6.9 preoperatively.
Results: Thirteen patients were randomized to the active group and 12 to the sham group. Two patients in the sham group were lost to follow-up. Post-treatment evaluations were performed at 1, 6, and 12 weeks by a blinded investigator (L.W.). The end point evaluation parameter was the reduction in visual analog scale score. The treatment group showed a significant difference before and after extracorporeal shockwave therapy (P < .0001). The sham group did not have a significant difference after 12 weeks (P = .1218).
Conclusions: Extracorporeal shockwave therapy is a possible alternative to surgical excision for Morton’s neuroma. (J Am Podiatr Med Assoc 99(3): 191–193, 2009)
Background: Tarsal tunnel syndrome (TTS) can be divided into proximal TTS and distal TTS (DTTS). Research on methods to differentiate these two syndromes is sparse. A simple test and treatment is described as an adjunct to assist with diagnosing and providing treatment for DTTS.
Methods: The suggested test and treatment is an injection of lidocaine mixed with dexamethasone administered into the abductor hallucis muscle at the site of entrapment of the distal branches of the tibial nerve. This treatment was studied with a retrospective medical record review in 44 patients with clinical suspicion of DTTS.
Results: The lidocaine injection test and treatment (LITT) was positive in 84% of patients. Of patients available for follow-up evaluation (35), 11% of those with a positive LITT test (four) had complete lasting symptom relief. One-quarter of patients with initial complete symptom relief at LITT administration (four of 16) maintained this level of symptom relief at follow-up. Thirty-seven percent of patients evaluated at follow-up (13 of 35) who had a positive response to the LITT experienced partial or complete symptom relief. No association was found between level of symptom relief maintenance and the immediate level of symptom relief (Fisher exact test = 0.751; P = .797). The results showed no difference in the distribution of immediate symptom relief by sex (Fisher exact test = 1.048; P = .653).
Conclusions: The LITT is a simple, safe, invasive method to help diagnose and treat DTTS, and it provides an additional method to assist with differentiating DTTS from proximal TTS. The study also provides additional evidence that DTTS has a myofascial etiology. The proposed mechanism of action of the LITT suggests a new paradigm in diagnosing muscle-related nerve entrapments that may lead to nonsurgical treatments or less invasive surgical interventions for DTTS.
Current management of foot pain requires foot orthoses (FOs) with various design features (eg, wedging, height) and specific mechanical properties (eg, hardness, volume). Development of additive manufacturing (three-dimensional [3-D] printing) raises the question of applying its technology to FO manufacturing. Recent studies have demonstrated the physical benefits of FO parts with specific mechanical properties, but none have investigated the relationship between honeycomb architecture (HcA) infilling density and Shore A hardness of thermoplastic polyurethane (TPU) used to make FOs, which is the aim of this study.
Sixteen different FO samples were made with a 3-D printer using TPU (97 Shore A), with HcA infilling density ranging from 10 to 40. The mean of two Shore A hardness measurements was used in regression analysis.
Interdurometer reproducibility was excellent (intraclass correlation coefficient, 0.91; 95% confidence interval [CI], 0.64–0.98; P < .001) and interprinter reproducibility was excellent/good (intraclass correlation coefficient, 0.84; 95% CI, 0.43–0.96; P < .001). Linear regression showed a positive significant relationship between Shore A hardness and HcA infilling density (R2 = 0.955; P < .001). Concordance between evaluator and durometer was 86.7%.
This study revealed a strong relationship between Shore A hardness and HcA infilling density of TPU parts produced by 3-D printing and highlighted excellent concordance. These results are clinically relevant because 3-D printing can cover Shore A hardness values ranging from 40 to 70, representing most FO production needs. These results could provide important data for 3-D manufacturing of FOs to match the population needs.
Low-Dye taping is commonly used to manage foot pathologies and pain. Precut one-piece QUICK TAPE was designed to facilitate taping. However, no study to date has demonstrated that QUICK TAPE offers similar support and off-loading as traditional taping.
This pilot study compared the performance of QUICK TAPE and low-Dye taping in 20 healthy participants (40 feet) with moderate-to-severe pes planus. Study participants completed arch height index (AHI), dynamic plantar assessment with a plantar pressure measurement system, and subjective rating in three conditions: barefoot, low-Dye, and QUICK TAPE. The order of test conditions was randomized for each participant, and the taping was applied to both feet based on a standard method. A generalized estimating equation with an identity link function was used to examine differences across test conditions while accounting for potential dependence in bilateral data.
Participants stood with a significantly greater AHI (P = .007) when either taping was applied compared with barefoot. Participants also demonstrated significantly different plantar loading when walking with both tapings versus barefoot. Both tapings yielded reduced force-time integral (FTI) in the medial and lateral forefoot and increased FTI under toes. Unlike previous studies, however, no lateralization of plantar pressure was observed with either taping. Participants ranked both tapings more supportive than barefoot. Most participants (77.8%) ranked low-Dye least comfortable, and 55.6% preferred QUICK TAPE over low-Dye.
Additional studies are needed to examine the clinical utility of QUICK TAPE in individuals with foot pathologies such as heel pain syndrome and metatarsalgia.
Pes cavus is a structural deformity in which the increased plantar arch can lead to greater metatarsal verticality with the consequent excess of pressure under the forefoot zone (especially the metatarsal zone), causing pain and significant loss of functional capacity. We sought to determine whether neuromuscular stretching with symmetrical rectangular biphasic currents can reduce the pressure supported by this zone.
This prospective, nonrandomized, longitudinal, analytical, and experimental controlled trial included 34 patients with pes cavus. Pedobarometric measurements were made using the footscan USB Gait Clinical System platform considering the toes and metatarsal heads, forefoot, midfoot, and hindfoot before and after performing stretching using a Med Tens 931 electrotherapy device. The measurements were repeated 7 days after the application.
With the Student t test for paired samples, we showed that there was a significant decline in metatarsal pressure (P < .001) in the zones of the first (P = .045) and third (P = .01) metatarsals and that this reduction was maintained 1 week after the plantar stretching.
Plantar stretching with symmetrical rectangular biphasic currents is effective for the prevention and treatment of pes cavus metatarsalgia caused by excessive pressure. (J Am Podiatr Med Assoc 103(3): 191–196, 2013)
Background: Of all of the lower-extremity injuries with multifactorial causes, heel pain represents the most frequent reason for visits to health-care professionals. Managing patients with heel pain can be very difficult. The purpose of this research was to identify key variables that can influence foot health in patients with heel pain.
Methods: A cross-sectional observational study was performed with 62 participants recruited from the Educational Welfare Unit of the University of Malaga, Malaga, Spain. Therapists, blinded for the study, acquired the anthropometric information and the Foot Posture Index, and participants completed the Foot Health Status Questionnaire.
Results: The most significant results reveal that there is a moderate relationship between clinical variables such as footwear and Foot Health Status Questionnaire commands such as Shoe (r = 0.515; P < .001). The most significant model domain was General Health (P < .001), with the highest determination coefficient (beta not standard = 34.05). The most significant predictable variable was body mass index (−0.110).
Conclusions: The variables that can help us manage clinical patients with heel pain are age, body mass index, footwear, and Foot Posture Index (left foot).
To our knowledge, hand dominance and side of foot disorders has not been described in the literature. We sought to evaluate whether hand dominance was associated with ipsilateral foot disorders in community-dwelling older men and women.
Data were from the Framingham Foot Study (N = 2,089, examined 2002–2008). Hand preference for writing was used to classify hand dominance. Foot disorders and side of disorders were based on validated foot examination findings. Generalized linear models with generalized estimating equations were used to estimate odds ratios and 95% confidence intervals, accounting for intraperson variability.
Left-handed people were less likely to have foot pain or any foot disorders ipsilateral but were more likely to have hallux valgus ipsilateral to the left hand. Among right-handed people, the following statistically significant increased odds of having an ipsilateral versus contralateral foot disorder were seen: 30% for Morton’s neuroma, 18% for hammer toes, 21% for lesser toe deformity, and a twofold increased odds of any foot disorder; there was a 17% decreased odds for Tailor’s bunion and an 11% decreased odds for pes cavus.
For the 2,089 study participants, certain forefoot disorders were shown to be ipsilateral and others were contralateral to the dominant hand. Future studies should examine whether the same biological mechanism that explains ipsilateral hand and foot preference may explain ipsilateral hand dominance and forefoot disorders. (J Am Podiatr Med Assoc 103(1): 16–23, 2013)
This study evaluated the clinical effectiveness and cost-effectiveness of two different types of foot orthoses used to treat plantar heel pain. Forty-eight patients were randomly assigned to receive either a functional or an accommodative orthosis. General (EuroQol) and specific (Foot Health Status Questionnaire) health-status measures were used. Data were also collected using economic questionnaires relating to National Health Service costs for podia-try, other health-service costs, and patient costs. Data were measured at baseline and at 4- and 8-week intervals. Thirty-five patients completed the study. The results demonstrated a significant decrease in foot pain and a significant increase in foot function with the functional foot orthoses over the 8-week trial. The accommodative foot orthoses demonstrated a significant reduction in foot pain only at 4 weeks. The cost-effectiveness analysis demonstrated that functional orthoses, although initially more expensive, result in a better quality of life. Use of functional orthoses resulted in an increased cost of £17.99 ($32.74) per patient, leading to an incremental cost per quality-adjusted life year of £1,650 ($3,003) for functional orthoses. (J Am Podiatr Med Assoc 94(3): 229–238, 2004)
Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts.
Methods: In this crossover randomized controlled trial, 40 participants wore custom-made orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides.
Results: For the prefab-custom group (n = 27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P = .02) and custom orthoses (P = .02) but maintained a trend toward improved economy only while wearing custom orthoses (P = .08). For the custom-prefab group (n = 13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P = .01).
Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait. (J Am Podiatr Med Assoc 98(6): 429–435, 2008)
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)