Background: One of the common causes of posterior ankle pain is posterior ankle impingement syndrome (PAIS). Many studies about PAIS have been conducted on special groups such as athletes, dancers, and football players, whereas there has been no previous study of a non-athletic population. This study aimed to evaluate the causes and treatment methods of this syndrome in the non-athletic population and compare it with the athletic population.
Methods: A retrospective review was done and 28 of 46 patients (60.9%) recovered from two-staged conservative therapy. 18 of 46 patients (39.1%) who did not benefit from conservative treatment for three months, hindfoot endoscopy was applied. Patient data, including sex, age, occupation, and sports activity level, were recorded. The Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and Tegner score were recorded. Patient satisfaction was assessed with a 4-point Likert scale. All complications were recorded.
Results: The mean follow-up period was 27.4 months. At the final follow-up examination, the AOFAS hindfoot score had significantly improved from 66.4 to 96.8 (p<0.001). The Tegner activity score improved significantly from 4.6 to 8.8 (p<0.001). The VAS score was 6.4 and increased to 0.9 (p<0.001). Using the 4-point Likert Scale for patient satisfaction, 13 (72.2%) stated that the surgical procedure was excellent, and 4 (27.8%) stated it as good. The mean time to return to work was 4.2 weeks. As complications, only sural nerve dysesthesia was seen in 2 patients(11.1%).
Conclusions: This study can be considered of value as the first study to have evaluated PAIS in the non-athletic population. Conservative treatment showed good results as nearly two-thirds of the patients recovered. Hindfoot endoscopy applied to cases not responding to conservative therapy is a successful treatment with low complication rates.
A randomized, prospective study was conducted to compare the individual effectiveness of three types of conservative therapy in the treatment of plantar fasciitis. One hundred three subjects were randomly assigned to one of three treatment categories: anti-inflammatory, accommodative, or mechanical. Subjects were treated for 3 months, with follow-up visits at 2, 4, 6, and 12 weeks. For the 85 patients who completed the study, a statistically significant difference was noted between groups, with mechanical treatment with taping and orthoses proving to be more effective than either anti-inflammatory or accommodative modalities.
Fracture of an ossified Achilles tendon is a rare clinical entity. Reossification after removal of the bony fragment was reported in only one case previously. In this study, we present a 49-year-old man with a reossified Achilles tendon after the removal of a fractured and ossified Achilles tendon. Treatment of an ossified or fractured Achilles tendon should be selected on a patient-by-patient basis. Surgical treatment can be used when conservative treatment has failed. The possibility of reossification after surgical treatment, especially in patients with risk factors, should be kept in mind, and the patient should be informed about this possibility.
Verrucous skin lesions on the feet of diabetic patients in conjunction with a neuropathic foot ulcer is an uncommon incident. Currently, there are approximately 20 reported cases in the literature. Herein we report two cases of verrucous lesions superimposing a chronic diabetic ulcer. Patients failed several conservative treatments, and several biopsies were performed with inconclusive results, suggesting possible underlying verrucous carcinoma. Given the possibility of underlying malignancy, both patients were treated with wide excision, and both were negative for malignancy, thus confirming verrucous skin lesions on the feet in diabetic neuropathy. We also summarize the current literature on verrucous skin lesions on the feet in diabetic neuropathy.
Background: Plantar fasciitis is a common cause of heel pain. Conservative treatment is often effective, but in many cases, invasive procedures may be required. Local corticosteroid injection is the most frequently used invasive technique and can be given under ultrasound (USG) or palpation guidance. We sought to compare the outcome of local corticosteroid injection by USG and palpation guidance in plantar fasciitis.
Methods: This was a prospective randomized study of patients who presented with heel pain between July 2015 and November 2016 and were screened for plantar fasciitis by USG. Patients with confirmed plantar fasciitis were managed conservatively for 4 weeks. The 60 consecutive patients not responding to the conservative treatment were randomized into two groups. Group A (n = 30) received a corticosteroid injection under USG guidance. Group B (n = 30) received a corticosteroid injection under palpation guidance. Patients were followed up at 3 and 6 weeks. We compared the visual analog scale score, plantar fascia thickness, and heel pad thickness in both groups.
Results: There was significant pain relief in both groups after 3 and 6 weeks of local corticosteroid injection, with greater relief noted in the USG-guided group. There was a significant decrement in plantar fascia thickness in both groups after 3 and 6 weeks; however, a greater decrement was observed in the USG-guided group. Neither group showed a significant difference in heel pad thickness after 3 and 6 weeks.
Conclusions: Ultrasound-guided injection provided better pain relief and a greater reduction in plantar fascia thickness than palpation-guided injection.
Many treatment options for plantar fasciitis currently exist, some with great success in pain relief. The objective of our study was to compare the use of intralesional steroids with platelet-rich plasma (PRP), using pain scales and functional evaluation, in patients with plantar fasciitis who did not respond to conservative treatment.
A controlled, randomized, blinded clinical assay was performed. Patients were assigned to one of the two groups by selecting a sealed envelope. The steroid treatment group received 8 mg of dexamethasone plus 2 mL of lidocaine as a local anesthetic. The PRP treatment group received 3 mL of PRP activated with 0.45 mL of 10% calcium gluconate. All of the patients were evaluated at the beginning of the study, and at 2, 4, 8, 12, and 16 weeks post-treatment with the Visual Analog Scale (VAS), Foot and Ankle Disability Index (FADI), and American Orthopedic Foot and Ankle Society (AOFAS) scale.
The right foot was the most frequently affected foot (63%). The average age of the patients was 44.8 years (range, 24–61 years). All scales used (VAS, FADI and AOFAS) showed that the difference was not statistically significant between the two groups.
We can conclude that the use of PRP is an effective treatment method for patients with plantar fasciitis who do not respond to conservative treatment because PRP demonstrates an efficacy equal to that of steroids. However, the cost and the time for preparation the PRP are two of the disadvantages of this treatment.
An isolated medial cuneiform fracture is a rarely encountered injury of the foot. We present a case of an isolated medial cuneiform fracture in a patient after sustaining a fall from a 15-foot height. Treatment consisted of primary arthrodesis of the first tarsometatarsal joint due to a high degree of comminution and intra-articular pain. When radiographs are inconclusive and the index of suspicion remains high for a lesser tarsus fracture, computed tomography is recommended. In patients with minimal displacement, conservative treatment is usually successful in achieving osseous fusion. When the fracture is displaced, intra-articular, or comminuted, surgical intervention, including open reduction with internal fixation and primary arthrodesis, should be considered.
Interdigital nerve decompression with relocation was performed on 82 feet in 78 patients. The primary indication for surgery was chronic neuritic symptoms that did not resolve with conservative treatment. All but four patients (95%) achieved complete resolution of preoperative symptoms within an average of 7 days following surgery, with full sensation restored at an average of 5 weeks. All of the patients could tolerate a shoe with a wide toe box within 8 days postoperatively. Interdigital nerve decompression with relocation provides for rapid resolution of neuritic symptoms and early return to normal activities. It is also a relatively easy surgical technique. As such, nerve decompression with relocation should be the procedure of choice for the treatment of Morton’s neuroma or interdigital nerve compression syndrome. (J Am Podiatr Med Assoc 93(3): 190-194, 2003)