NLM CIT. ID: 99342937
TITLE: Foot and ankle problems in the young athlete [In Process Citation] AUTHORS: Omey ML; Micheli LJ AUTHOR AFFILIATION: Division of Sports Medicine, Children's Hospital, Boston, MA 02115, USA.
ABSTRACT: In the U.S., greater than half of boys and one quarter of girls in the 8- to 16-yr-old age range are engaged in some type of competitive, scholastic, organized sport during the school year. Children and adolescents are becoming more involved in sports at earlier ages and with higher levels of intensity. Foot and ankle problems, in particular, are the second most common musculoskeletal problem facing primary care physicians in children under 10 yr of age next to acute injury. This report focuses on foot and ankle problems, trauma, and overuse in the young athletic population. Guidelines are given for both conservative and surgical management. Specific problems addressed include pes planus, tarsal coalition, adolescent bunion, os trigonum, accessory navicular, physeal fractures, sprains, peroneal tendon subluxation, metatarsal fractures, sesamoid fractures, turf toe, stress fractures, tendonitis, osteochondritis dissecans, ankle impingement, bursitis, Haglund's deformity, sesamoiditis, plantar fasciitis, apophysitis, osteochondroses, cuboid syndrome, and reflex sympathetic dystrophy. An extensive review of the literature is performed and presented in combination with the extensive experience of a well- established sports medicine clinic at the Boston Children's Hospital. NLM PUBMED CIT. ID: 10416548 SOURCE: Med Sci Sports Exerc 1999 Jul;31(7 Suppl):S470-86 2

NLM CIT. ID: 99341732
TITLE: In-shoe pressure measurements with a viscoelastic heel orthosis [In Process Citation] AUTHORS: Hsi WL; Lai JS; Yang PY AUTHOR AFFILIATION: Department of Rehabilitation, National Taiwan University Hospital, Taipei.
ABSTRACT: OBJECTIVE: To detect the mechanical effect of a viscoelastic heel orthosis. DESIGN: Two-factor analysis of variance with interactions between the orthosis and the subjects. The number of subjects was determined by presuming the effect of the orthosis to be twice as large as the error-free standard deviation (SD) of the interactions, the step- to-step SD four times as large as the error-free SD of the interactions, type 1 error probability equal to .05, and type 2 error probability equal to .20. SETTING: A gait laboratory in a university hospital. SUBJECTS: Twenty-two consecutive patients with treated heel pain. MAIN OUTCOME MEASURES: Peak pressure (PP), pressure-time integral (PTI), and foot-to-sensor contact time (CoT) measured for five steps at 24 discrete sensors of predetermined positions in the foot with treated heel pain. RESULTS: The orthosis reduced PPs, PTIs, and CoT (p < .05) in the median midfoot and lateral midfoot; reduced PPs and PTIs (p < .05) in the posterior heel and medial midfoot; increased PP and PTI (p < .05) in the anterior part of the first metatarsal head; and increased PTI (p < .05) in the lateral part of the hallux. The ratios of the estimated step-to-step SDs to the estimated error-free SDs of the interactions of PPs, PTIs, and CoT were less than four at all the sensors. CONCLUSION: Proper design and estimation of the variations ensured that there was sufficient power to detect the effect of an a priori specified size as statistically significant: the orthosis reduced the mechanical loads in the posterior heel and the midfoot and increased the mechanical loads in the anterior part of the first metatarsal head and the lateral part of the hallux during walking. NLM PUBMED CIT. ID: 10414766 SOURCE: Arch Phys Med Rehabil 1999 Jul;80(7):805-10 3

NLM CIT. ID: 99321261
TITLE: Plantar fascia release through a transverse plantar incision [In Process Citation] AUTHORS: Brown JN; Roberts S; Taylor M; Paterson RS AUTHOR AFFILIATION: SPORTSMED.SA, Stepney, South Australia.
ABSTRACT: A transverse plantar incision for plantar fascial release was assessed for pain relief, numbness, and subsequent heel pad symptoms. Twenty- seven feet in 26 patients who underwent plantar fascia release were reviewed with a minimum follow-up of 2 years after surgery (average, 37.6 months). Comprehensive data were obtained on 25 feet (24 patients) (93% response rate). The plantar fascia origin was completely transected in all cases. This led to complete resolution of symptoms in 19 feet and residual minor symptoms in six feet. After 2 years, four patients had developed recurrent symptoms, two in the area of surgery and two on the dorsum of the foot, in association with a pes planus foot. Two patients had some continued persistence of heel pain after surgery, although significantly less pain than preoperatively.Thus, 76% of patients had complete relieve of there symptoms, 12% of patients had mild symptoms not affecting daily activities, and 12% of patients had moderate symptoms that limited some activities. No patient suffered heel pad symptoms or numbness after surgery. It is concluded that plantar fascia release through a transverse plantar incision is a successful procedure for long-term relief of symptoms which avoids unnecessary heel pad numbness and scar morbidity. The benefits of a transverse incision include greater intraoperative vision, to ensure adequate release and spur excision, and an incision parallel to the medial calcaneal branches of the tibial nerve. NLM PUBMED CIT. ID: 10395338 SOURCE: Foot Ankle Int 1999 Jun;20(6):364-7 4

NLM CIT. ID: 99318488
TITLE: Rhabdomyolysis in association with Duchenne's muscular dystrophy [In Process Citation] AUTHORS: Obata R; Yasumi Y; Suzuki A; Nakajima Y; Sato S AUTHOR AFFILIATION: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Japan.
ABSTRACT: PURPOSE: To present a case of rhabdomyolysis which developed in a child with a known history of Duchenne's muscular dystrophy, following an anesthetic which included sevoflurane. CLINICAL FEATURES: An 11 yr old boy with a known history of Duchenne's muscular dystrophy underwent anesthesia for strabismus repair. The anesthetic consisted of sevoflurane and nitrous oxide without the use of a muscle relaxant. His postoperative course was complicated by a complaint of heel pain and the development of myoglobinuria. He was treated with dantrolene sodium and discharged home after two days, without further complication. CONCLUSION: Sevoflurane anesthesia has not been shown previously to be associated with the development of acute rhabdomyolysis in a child with a history of Duchenne's muscular dystrophy. As with halothane and isoflurane, the continued use of sevoflurane in the presence of Duchenne's muscular dystrophy should be questioned. NLM PUBMED CIT. ID: 10391604 SOURCE: Can J Anaesth 1999 Jun;46(6):564-6 5

NLM CIT. ID: 99312749
TITLE: Imaging of the rearfoot. AUTHORS: Yozsa S; Lehnert B; Resnick D AUTHOR AFFILIATION: Veterans Affairs Palo Alto Health Care System, CA 94304, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The authors review various pedal conditions affecting the rearfoot, including plantar fasciitis, Achilles tendon pathology, fractures, arthritides, coalitions, and tumors. Various diagnostic imaging modalities such as routine radiography, radionuclide bone scanning, computed tomography, and magnetic resonance imaging are discussed. NLM PUBMED CIT. ID: 10384755 SOURCE: J Am Podiatr Med Assoc 1999 Jun;89(6):292-301 6

NLM CIT. ID: 99278906
TITLE: Management of heel pain syndrome with acetic acid iontophoresis. AUTHORS: Japour CJ; Vohra R; Vohra PK; Garfunkel L; Chin N AUTHOR AFFILIATION: Department of Surgery, Veterans Affairs Medical Center, Brooklyn, NY 11209, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 64-19-7 (Acetic Acid)
ABSTRACT: This study was undertaken to determine the effectiveness of acetic acid iontophoresis in the treatment of heel pain. Thirty-five patients with chronic heel pain were treated with acetic acid iontophoresis over a 4- year period. Ninety-four percent of patients had complete or substantial relief of heel pain after an average of 5.7 sessions of acetic acid iontophoresis over an average period of 2.8 weeks. Heel pain levels were rated from 0 to 10, with 10 representing the most severe pain. Heel pain prior to iontophoresis treatment received an average rating of 7.5; by the end of therapy, the average rating had decreased to 1.8. At an average follow-up time of 27 months, heel pain levels averaged 0.64, indicating continued reduction in heel pain. Ninety-four percent of participants said that they would recommend acetic acid iontophoresis to someone with similar heel pain. NLM PUBMED CIT. ID: 10349289 SOURCE: J Am Podiatr Med Assoc 1999 May;89(5):251-7 7

NLM CIT. ID: 99278903
TITLE: Orthoses in the treatment of rearfoot problems. AUTHORS: Sobel E; Levitz SJ; Caselli MA AUTHOR AFFILIATION: Division of Orthopedic Sciences, New York College of Podiatric Medicine, NY 10035, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Orthotic management is helpful in the treatment of most orthopedic conditions involving the rearfoot, including plantar fasciitis, Achilles tendon disorders, posterior tibial tendon dysfunction, flatfoot, ankle sprains, and problems associated with diabetes, arthritis, and equinus disorders. A review of the effectiveness of orthoses in the treatment of these conditions is presented here. An in- depth analysis of the orthotic management of plantar fasciitis and a critical review of foot orthoses for the pronated foot are presented. Also discussed are the rationale and effectiveness of the tension night splint in the treatment of plantar fasciitis, orthotic devices for the different stages of posterior tibial tendon dysfunction, and the various categories of orthoses for off-loading the diabetic foot. The modern ankle brace, the effectiveness of prefabricated versus prescription foot orthoses, and recent developments in the ankle-foot orthosis are also reviewed. NLM PUBMED CIT. ID: 10349286 SOURCE: J Am Podiatr Med Assoc 1999 May;89(5):220-33 8

NLM CIT. ID: 99244282
TITLE: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. AUTHORS: Pfeffer G; Bacchetti P; Deland J; Lewis A Anderson R; Davis W; Alvarez R; Brodsky J; Cooper P; Frey C Herrick R; Myerson M; Sammarco J; Janecki C; Ross S; Bowman M Smith R AUTHOR AFFILIATION: San Francisco Orthopaedic Foot and Ankle Center, Department of Orthopaedics, University of California, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device. NLM PUBMED CIT. ID: 10229276 SOURCE: Foot Ankle Int 1999 Apr;20(4):214-21 9

NLM CIT. ID: 99236494
TITLE: Plantar fasciitis and other causes of heel pain. AUTHORS: Barrett SJ; O'Malley R AUTHOR AFFILIATION: Advanced Foot Care, Spring, TX 77380, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The most common cause of heel pain is plantar fasciitis. It is usually caused by a biomechanical imbalance resulting in tension along the plantar fascia. The diagnosis is typically based on the history and the finding of localized tenderness. Treatment consists of medial arch support, anti-inflammatory medications, ice massage and stretching. Corticosteroid injections and casting may also be tried. Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed despite correction of biomechanical abnormalities. Heel pain may also have a neurologic, traumatic or systemic origin. NLM PUBMED CIT. ID: 10221305 SOURCE: Am Fam Physician 1999 Apr 15;59(8):2200-6 10

NLM CIT. ID: 99215272
TITLE: Diagnosing and treating plantar fasciitis: a conservative approach to plantar heel pain. AUTHORS: Tisdel CL; Donley BG; Sferra JJ AUTHOR AFFILIATION: Department of Orthopaedic Surgery, Cleveland Clinic, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Plantar fasciitis is the most common cause of pain at the weight- bearing surface of the heel, and may coexist with other sources of heel pain. This has led to a confusing array of treatment strategies, including surgery. We offer a simple, effective diagnostic and treatment algorithm that emphasizes nonsurgical treatment options for this often frustrating condition. NLM PUBMED CIT. ID: 10199059 SOURCE: Cleve Clin J Med 1999 Apr;66(4):231-5 11

NLM CIT. ID: 99201541
TITLE: The relationship of heel pad elasticity and plantar heel pain. AUTHORS: Turgut A; Gokturk E; Kose N; Seber S; Hazer B Gunal I AUTHOR AFFILIATION: Department of Orthopedics, Osmangazi University Hospital, Meselik, Eskisehir, Turkey. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain. This hypothesis is evaluated by this blinded observer prospective study, using an age and weight matched control population. Hindfoot lateral radiographs of 73 patients with plantar heel pain, 29 of whom had bilateral involvement (102 feet), and who ranged in age from 20 to 60 years, were studied and compared with 120 healthy subjects (240 feet). Heel pad thickness and heel pad compressibility index were not significantly different in patients with plantar heel pain than in healthy subjects matched for age and weight. In patients with unilateral heel pain, heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side. The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate. NLM PUBMED CIT. ID: 10101325 SOURCE: Clin Orthop 1999 Mar;(360):191-6 12

NLM CIT. ID: 99179271
TITLE: [Is therapy with local infiltrations feasible in primary care consultations?] VERNACULAR
TITLE: Es factible la terapia con infiltraciones locales en las consultas de atencion primaria? AUTHORS: Magana Loarte JE; Perez Franco J; Sanchez Sanchez G AUTHOR AFFILIATION: Centro de Salud La Estacion, Talavera de la Reina, Toledo. jmaganal@meditex.es PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Spa REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones) 0 (Anesthetics, Local)
ABSTRACT: OBJECTIVE: To study the feasibility of local infiltration in primary care consultations. DESIGN: Before-and-after intervention study. SETTING: Two clinics at an urban health centre. PARTICIPANTS: Patients diagnosed with pathology of tender areas and treated with corticosteroid infiltration between May 1997 and May 1998. INTERVENTION: Corticoid infiltration plus local anaesthetic. Weekly check-up. Analysis of the variables: sex, age, diagnosis, time elapsed between indication and start of treatment, subjective assessment of pain before and after treatment (VRS scale), number of infiltrations per patient, side-effects. Evaluation of overall and individual effectiveness. RESULTS: 41 patients were infiltrated. Average age was 58. Most common pathologies were: rotary joint tendinitis (48.7%), anserine bursitis (24.4%), plantar fasciitis (7.3%). Average number of infiltrations per pathology: 1.3. Mean waiting time: 3.5 days. Comparison of pain by means of VRS (range 0-5) before and after treatment used the Wilcoxon test, with a statistically significant difference and p < 0.001 (z = -5.5109). For 35 patients (85.4%), pain was solved very well (values 0 and 1 on the VRS). For 3 patients (7.3%), improvement was moderate; and for 3 (7.3%) there was no improvement. CONCLUSIONS: 1. Treatment with local infiltration of corticosteroids is effective in dealing with pain, and is an alternative to treatment with NSAIDs. 2. It is feasible in primary care, and there are many advantages if the general practitioner employs this therapeutic technique. NLM PUBMED CIT. ID: 10079554 SOURCE: Aten Primaria 1999 Jan;23(1):4-7 13

NLM CIT. ID: 99174312
TITLE: Gouty os trigonum tarsi: case report. AUTHORS: Lai PL; Yang WE; Chen WJ; Lin PY AUTHOR AFFILIATION: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Os trigonum tarsi is found in 7% of the world adult population. However, it rarely causes symptoms. The majority of patients with os trigonum tarsi are found incidentally. This condition is often found in ballet dancers, javelin throwers and soccer players. It rarely produces symptoms in normally active adul>

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NLM CIT. ID: 99171037
TITLE: [MRI of plantar fasciitis] VERNACULAR
TITLE: MR-Tomographie der Plantarfasciitis. AUTHORS: Steinborn M; Heuck A; Maier M; Schnarkowski P Scheidler J; Reiser M AUTHOR AFFILIATION: Institut fur Radiologische Diagnostik, Ludwig-Maximilians-Universitat Munchen. Marc.Steinborn@ikra.med.uni-muenchen.de PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger REGISTRY NUMBERS: 0 (Contrast Media)
ABSTRACT: PURPOSE: The purpose of this study was to determine the type and frequency of characteristic bone and soft tissue changes on MRI of patients with a clinical diagnosis of plantar fasciitis. MATERIALS AND METHODS: 28 patients with a clinical diagnosis of plantar fasciitis underwent MR imaging. Besides T1- and T2-weighted sequences, short-tau- inversion-recovery sequences were used routinely. In 27 patients T1- weighted images after intravenous contrast injection were acquired additionally. As a control group the images of 15 patients without clinical signs for plantar fasciitis were evaluated. RESULTS: In 25 of 28 cases (89%) the clinical diagnosis of plantar fasciitis was established by MR imaging. The most common finding was a peritendinous edema at the calcaneal insertion site which was found in all 25 patients. In 19 of 25 cases (76%) a bone marrow edema of the calcaneus was present. In 14 of 25 cases (56%) an intratendinous signal intensity increase of the plantar fascia could be observed which showed contrast enhancement in 12 cases. Compared to the control group (mean thickness 3.3 mm) the plantar fascia showed significant thickening in the 25 MR positive patients (mean thickness 6.72 mm). DISCUSSION: Besides thickening of the plantar fascia and intratendinous signal intensity increase with contrast enhancement to some extent, bone marrow edema of the calcaneus and peritendinous edema close to the plantar fascia are characteristic signs of plantar fasciitis on MRI. Both signs can reliably be seen on STIR sequences only. NLM PUBMED CIT. ID: 10071643 SOURCE: Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1999 Jan;170(1):41-6 15

NLM CIT. ID: 99169432
TITLE: Ultrasound guided injection of plantar fasciitis [letter; comment] AUTHORS: Quinn M; Gough A COMMENTS: Comment on: Ann Rheum Dis 1998 Jun;57(6):383-4 PUBLICATION TYPES: COMMENT LETTER REGISTRY NUMBERS: 0 (Glucocorticoids, Synthetic) NLM PUBMED CIT. ID: 10070279 SOURCE: Ann Rheum Dis 1998 Dec;57(12):749-50 16

NLM CIT. ID: 99165440
TITLE: Ultrasound of the plantar aponeurosis (fascia). AUTHORS: Gibbon WW; Long G AUTHOR AFFILIATION: Department of Radiology, The General Infirmary at Leeds, UK. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To assess the plantar aponeurosis origin (plantar fascia) using high-resolution ultrasound. DESIGN: The sonographic appearance of the plantar fascia in asymptomatic volunteers was compared with the appearance in: (1) clinical idiopathic plantar fasciitis, (2) inflammatory arthropathy without clinically active plantar fasciitis and (3) Achilles tendon or ankle ligament injury. Patients. There were 48 asymptomatic volunteers (96 heels), 190 patients with idiopathic plantar fasciitis (297 heels), 35 with rheumatoid factor negative spondyloarthropathy (70 heels), 17 with rheumatoid arthritis (34 heels), 62 with clinical Achilles tendinitis (93 heels) and 17 with instability secondary to previous ankle ligament injury (17 heels). RESULTS: Compared with the asymptomatic volunteers, the symptomatic plantar aponeurosis demonstrated significant thickening in patients with clinically unilateral (P<0.001) and bilateral (P<0.001) idiopathic plantar fasciitis as well as in patients with spondyloarthropathy (P<0.001). However, the plantar aponeurosis on the asymptomatic side in patients with unilateral idiopathic plantar fasciitis (P<0.2), rheumatoid arthritis (P<0.2) and ankle injury (P<0.1) demonstrated no significant thickening. In patients with idiopathic plantar fasciitis, abnormal plantar aponeurosis echogenicity was seen in 78% and subcalcaneal bone spurs in 24%. Peritendinous edema was present in 5% of all symptomatic heels, subcalcaneal bone erosion in 4% and intratendinous calcification in 3% of heels. Retrocalcaneal bursitis was present in 7% of patients with idiopathic plantar fasciitis, 40% with spondyloarthropathy and 19% with rheumatoid arthritis. CONCLUSION: Ultrasound allows confirmation of the clinical diagnosis in plantar fasciitis and may provide information as to its etiology. NLM PUBMED CIT. ID: 10068071 SOURCE: Skeletal Radiol 1999 Jan;28(1):21-6 17

NLM CIT. ID: 99166200
TITLE: MR imaging in sports injuries of the foot and ankle. AUTHORS: Bencardino J; Rosenberg ZS; Delfaut E AUTHOR AFFILIATION: Department of Diagnostic Radiology, Long Island Jewish Medical Center, New Hyde Park, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: MR imaging has become the diagnostic modality of choice for the evaluation of traumatic ligamentous and tendinous injures of the foot and ankle, occult bony trauma, and osteochondral lesions of the talus. This article reviews the current applications of MR imaging for the evaluation of sports-related injuries of the foot and ankle, including fractures, sprains, tendon injuries, and heel pain. NLM PUBMED CIT. ID: 10067228 SOURCE: Magn Reson Imaging Clin N Am 1999 Feb;7(1):131-49, ix 18

NLM CIT. ID: 99163265
TITLE: Long-term follow-up of heel spur surgery. A 10-year retrospective study. AUTHORS: Vohra PK; Giorgini RJ; Sobel E; Japour CJ Villalba MA; Rostkowski T AUTHOR AFFILIATION: Division of Surgery, New York College of Podiatric Medicine, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A comparative retrospective study of 48 open heel spur surgeries and 20 endoscopic plantar fasciotomies was conducted involving 59 patients over a 10-year period. There was a significant reduction in heel pain at the time of follow-up (average, 3 years) for both groups. Overall, 85% of procedures were associated with patient satisfaction with the results, and patients said that they would recommend heel spur surgery for relief of severe heel pain in 94% of cases. Factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity, are discussed. NLM PUBMED CIT. ID: 10063778 SOURCE: J Am Podiatr Med Assoc 1999 Feb;89(2):81-8 19

NLM CIT. ID: 99163263
TITLE: Heel pain in children. Diagnosis and treatment. AUTHORS: Kim CW; Shea K; Chambers HG AUTHOR AFFILIATION: Department of Orthopaedic Surgery, University of California, San Diego, Medical Center 92103-8894, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain in children is common, and its evaluation is challenging. Medical history and physical examination may be unrevealing owing to children's limited communication skills. Often, advanced laboratory and imaging studies are required to make an accurate diagnosis. The most common causes of heel pain in children are apophysitis, enthesopathy, and overuse syndromes such as tendinitis. Juvenile rheumatoid arthritis is relatively uncommon. In very active children, occult fractures must also be evaluated. Pain unrelated to activity may indicate tumors, infection, or congenital problems. In general, heel pain in children is treated nonoperatively. For fractures in particular, children are less likely than adults to receive surgical treatment. NLM PUBMED CIT. ID: 10063776 SOURCE: J Am Podiatr Med Assoc 1999 Feb;89(2):67-74 20

NLM CIT. ID: 99162762
TITLE: Ultrasonographic assessment of posterior heel pain. AUTHORS: Wang CL; Shieh JY; Wang TG; Hsieh FJ AUTHOR AFFILIATION: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: To investigate the value of ultrasonography in the diagnosis of posterior heel pain, 68 patients with normal plain x-ray findings of the posterior heel underwent ultrasonographic examination with a 10-MHz linear array probe. The findings included Achilles tendinosis (31 patients), retrocalcaneal bursitis (12), superficial Achilles bursitis (7), soft tissue mass (7), Achilles tendon rupture (4), xanthoma (3), tenosynovitis of the flexor hallucis longus tendon (2), and negative findings (2). Sixteen of these patients underwent surgery after ultrasonographic examination. The surgical diagnoses were consistent with the ultrasonographic diagnoses in all cases. With high-resolution ultrasonography, pathologic conditions of the posterior heel can be readily differentiated. NLM PUBMED CIT. ID: 10063275 SOURCE: J Formos Med Assoc 1999 Jan;98(1):56-61 21

NLM CIT. ID: 99149380
TITLE: [High energy shock wave treatment of the painful heel spur] VERNACULAR
TITLE: Hochenergetische Stosswellenbehandlung des schmerzhaften Fersensporns. AUTHORS: Perlick L; Boxberg W; Giebel G AUTHOR AFFILIATION: Abteilung fur Unfall- und Wiederherstellungschirurgie, Kreiskrankenhaus, Ludenscheid. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: Extracorporal shock wave application (ESWA) has been used in the treatment of stones located in kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of the ESWA on the treatment of soft tissue disorders. The aim of this study was to explore the effect of high energy extracorporal shock waves in patients with painful calcaneus spurs. 83 patients who underwent medicophysical treatment without benefit were treated with 3000 impulses of 0.30 mj/mm2. Follow-ups after 12 weeks and 12 months showed that 51 of 83 patients became pain-free and 20 patients improved from the treatment. The results are showing the benefit of the high energy extracorporal shock wave application in the treatment of chronic plantar fasciitis. NLM PUBMED CIT. ID: 10025241 SOURCE: Unfallchirurg 1998 Dec;101(12):914-8 22

NLM CIT. ID: 99125600
TITLE: Infectious causes of heel pain. AUTHORS: Kosinski M; Lilja E AUTHOR AFFILIATION: Division of Medical Sciences, New York College of Podiatric Medicine, NY 10035, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain is often attributed to a biomechanical etiology or sports- related injury. However, failure to recognize an infectious cause can lead to a delay in proper treatment and result in severe patient disability. This article reviews some of the more common infectious etiologies of heel pain. NLM PUBMED CIT. ID: 9926684 SOURCE: J Am Podiatr Med Assoc 1999 Jan;89(1):20-3 23

NLM CIT. ID: 99125599
TITLE: Enthesitis, arthritis, and heel pain. AUTHORS: Lehman TJ AUTHOR AFFILIATION: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Often, individuals who present with "isolated" heel pain but with normal laboratory findings are dismissed without diagnosis. However, if these patients are carefully questioned and examined, a significant proportion are found to have a spondyloarthropathy. The keys to making this diagnosis are obtaining a thorough medical history and performing a complete physical examination. The classic complaints of back pain and enthesitis in other areas are frequently not reported by patients unless specifically sought, because they are thought to be unrelated to the heel pain. NLM PUBMED CIT. ID: 9926683 SOURCE: J Am Podiatr Med Assoc 1999 Jan;89(1):18-9 24

NLM CIT. ID: 99108857
TITLE: Prognosis, course of disease, and treatment of the spondyloarthropathies. AUTHORS: Leirisalo-Repo M AUTHOR AFFILIATION: Department of Medicine, Helsinki University Central Hospital, Finland. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Prognosis in the majority of patients with acute reactive arthritis is usually good, with most patients recovering in a few months. In about 15% to 30% of such patients, the disease progresses, and spondyloarthropathy and even ankylosing spondylitis develop in the following 10 to 20 years. A recurrent attack of reactive arthritis is common in patients with chlamydia-triggered arthritis, but it is rare in patients who have had enteroarthritis. In patients with chronic spondyloarthropathy without evidence of preceding infection, the disease can progress slowly into ankylosing spondylitis. When reactive chlamydia arthritis is indicated, a prolonged course of antibiotics is needed. For other forms of reactive arthritis, solid evidence in favor of antibiotic therapy is still lacking. Presence of hip pain, decreased mobility of thoracic cervical or thoracic spine, heel pain, inflammatory gut lesions, high erythrocyte sedimentation rate, positive family history, and presence of human leukocyte antigen B27 are indicators for chronicity. Sulfasalazine might be of use in chronic arthritis and ankylosing spondylitis, especially if the patient has peripheral arthritis. NLM PUBMED CIT. ID: 9891708 SOURCE: Rheum Dis Clin North Am 1998 Nov;24(4):737-51, viii 25

NLM CIT. ID: 99095105
TITLE: Heel pain syndrome [letter; comment] AUTHORS: Skliar JD COMMENTS: Comment on: J Foot Ankle Surg 1998 Jul-Aug;37(4):267-8 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9879055 SOURCE: J Foot Ankle Surg 1998 Nov-Dec;37(6):548-9 26

NLM CIT. ID: 99087501
TITLE: Outcome study of subjects with insertional plantar fasciitis. AUTHORS: Martin RL; Irrgang JJ; Conti SF AUTHOR AFFILIATION: University of Pittsburgh, Pennsylvania, USA. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9872466 SOURCE: Foot Ankle Int 1998 Dec;19(12):803-11 27

NLM CIT. ID: 99076646
TITLE: [Essential bone cyst of the calcaneus in children. Report of three cases] VERNACULAR
TITLE: Quiste oseo esencial de calcaneo en el nino. Presentacion de tres casos. AUTHORS: Anton Rodrigalvarez LM; Ortega Medina L Cabadas Gonzalez MI; Aguilar Rodriguez L AUTHOR AFFILIATION: Unidad de Ortopedia Infantil, Hospital Clinico San Carlos, Madrid. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Spa
ABSTRACT: OBJECTIVE: The purpose of this study was to analyze the properties of essential bone cyst of the calcaneus in childhood, as well as its evolution, and differences with regard to adults. PATIENTS AND METHODS: The cases of children with a diagnosis of essential bone cyst of calcaneus in last sixteen years in the pediatric orthopedic unit of San Carlos Clinic have been reviewed. We evaluated the information regarding the clinical history and the radiological and histological date as well as the therapy result with esteroid intracavity therapy and curettage and bone grafting. The radiologic score was done following Sodergard criteria and the posttreatment follow-up with Neer's score. RESULTS: The mean age of the patients was 10.3 years. Two of the patients had recurrent heel pain for more than six months. Treatment consisted in intracavitary esteroid in two cases and curettage and bone grafting in all three cases, in two of the cases because of failure of esteroid therapy and in the other because of an atypical X-ray image. In all cases the histological stady identified the existence of a characteristic membrane conective tissue. The postsurgery follow-up a period of half four years has been satisfactory. CONCLUSIONS: The essential bone cyst of the calcaneous is exceptional localization in children, frequently symptomatic and resistant to the esteroid intracavitaria contrary to what happens with the essential bone cyst of other localizations and with the essential bone cyst of the calcaneus in the adults. The recurrent heel pain and atipical X-ray image are surgery indications. NLM PUBMED CIT. ID: 9859549 SOURCE: An Esp Pediatr 1998 Oct;49(4):364-8 28

NLM CIT. ID: 99053933
TITLE: Operative management of Haglund's deformity in the nonathlete: a retrospective study. AUTHORS: Sammarco GJ; Taylor AL AUTHOR AFFILIATION: University of Cincinnati Medical Center, Ohio, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Haglund's deformity, or "pump bump," is a common cause of posterior heel pain. Management of the condition usually consists of nonoperative therapy. This study presents a retrospective study of 65 cases (53 patients), with symptomatic Haglund's deformity in nonathletes (13 male and 40 female), who presented during a 4-year period (1989-1994). Sixty- five percent (39 heels) of these patients failed to respond to nonoperative therapy for an average of 62 weeks, (range, 4-260 weeks). This group of patients went on to operative treatment. Surgical management consisted of excision of the posterior calcaneal tuberosity through a medial longitudinal incision with debridement, reattachment of the Achilles tendon using bone anchors, and 4 weeks of postoperative immobilization. Thirty-nine patients (74%) were contacted for follow- up. The average follow-up period for these patients was 155 weeks, (range, 92-335 weeks). There were 50% excellent results, 47% good results, 3% fair results (1 patient), and no poor results. The Maryland Foot Score for operated heels was an average of 67/100 preoperative and an average of 92/100 postoperative. On unoperated heels the score was an average of 81/100 at first evaluation and an average of 86/100 at final evaluation. Complications included one recurrence of painful prominence, one wound infection, and one incisional neuroma. The outcome of these cases demonstrated that in those patients who fail nonoperative treatment, surgical treatment of Haglund's deformity produces a predictably good surgical result when performed using the technique described. NLM PUBMED CIT. ID: 9840198 SOURCE: Foot Ankle Int 1998 Nov;19(11):724-9 29

NLM CIT. ID: 99054830
TITLE: Musculoskeletal pain in primary pediatric care: analysis of 1000 consecutive general pediatric clinic visits. AUTHORS: de Inocencio J AUTHOR AFFILIATION: Centro de Salud "Benita de Avila," Insalud Area 4, Madrid, Spain. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: OBJECTIVES: 1) To determine the number of primary care clinic visits attributable to musculoskeletal pain (MSP) in children >/=3 and <15 years of age. 2) To describe the demographic characteristics of this population assessed for limb/back pain. 3) To characterize the etiology of musculoskeletal pain in an urban general pediatric clinic in Madrid, Spain. METHODS: Prospective evaluation of 1000 consecutive clinic visits to an urban general pediatric clinic. Inclusion criteria were 1) age >/=3 and <15 years and 2) musculoskeletal evaluation requested by the family or patient. All consultations related to MSP were recorded via standard protocol and data record form. RESULTS: During the study period, 61 of 1000 (6.1%; confidence interval: 4.6-7.5) clinic visits for children >/=3 and <15 years were related to MSP. Patients' age, mean +/- SD, was 9.7 +/- 3.3 years. Musculoskeletal complaints were more frequent in boys (57.4%), although there was no statistical difference. The presenting complaints included knee arthralgias in 33%; other joint (eg, ankles, wrists, elbows) arthralgias in 28%; soft tissue pain in 18%; heel pain in 8%; hip pain in 6%; and back pain in 6%. Symptoms were attributable to trauma in 30%; overuse syndromes in 28% (eg, chondromalacia patellae, mechanical plantar fasciitis, overuse muscle pain); and normal skeletal growth variants (eg, Osgood-Schlatter syndrome, hypermobility, Sever's disease) in 18% of patients. CONCLUSION: MSP represents a frequent presenting complaint in general pediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing pediatrics continuing medical education and training programs. musculoskeletal pain, limb pain, arthralgia, children, general pediatrics, pediatric primary care. NLM PUBMED CIT. ID: 9832591 SOURCE: Pediatrics 1998 Dec;102(6):E63 30

NLM CIT. ID: 99040968
TITLE: [5-years lithotripsy of plantar of plantar heel spur: experiences and results--a follow-up study after 36.9 months] VERNACULAR
TITLE: 5 Jahre Lithotripsie des plantaren Fersenspornes: Erfahrungen und Ergebnisse--eine Nachuntersuchung nach 36,9 Monaten. AUTHORS: Sistermann R; Katthagen BD AUTHOR AFFILIATION: Orthopadische Klinik, Stadtische Kliniken Dortmund, Klinikzentrum Mitte. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: INTRODUCTION: Effectivity and application as well as possible complications and side effects of extracorporeal shock wave lithotripsy of plantar heel spurs should be evaluated. METHOD: We applied extracorporeal shock wave lithotripsy (ECSL) to treat plantar fasciitis in 54 patients (period from: 3/1/1993 to 3/1/1996). 20 persons were treated with Lithostar plus (group 1) and ultrasound focussing and 34 patients (group 2) were treated by a Lithostar and X-ray focussing. RESULTS: After 6 weeks 14 (70%) of group 1 and 27 (79.4%) of group 2 were free of pain. After 36.9 months 8 (40%) of group 1 and 23 (67.6%) of group 2 were still painfree. We could not recognize any severe complications after 36.9 months. CONCLUSION: ECSL is an effective and noninvasive method of treatment. It is not the method of choice for the first treatment of plantar fasciitis but is an alternative option for operation. NLM PUBMED CIT. ID: 9823634 SOURCE: Z Orthop Ihre Grenzgeb 1998 Sep-Oct;136(5):402-6 31

NLM CIT. ID: 99040967
TITLE: [Using extracorporeal shockwave therapy in orthopedics--a meta-analysis] VERNACULAR
TITLE: Der Einsatz der extrakorporalen Stosswellentherapie in der Orthopadie-- eine Metaanalyse. AUTHORS: Heller KD; Niethard FU AUTHOR AFFILIATION: Orthopadische Universitatsklinik, Rheinisch-Westfalischen Technischen Hochschule Aachen. PUBLICATION TYPES: JOURNAL ARTICLE META-ANALYSIS LANGUAGES: Ger
ABSTRACT: AIM: Up to now ESWT is not a standard therapeutic technique in orthopaedics. The mechanisms of the induced analgesic effect or the mechanism of shock-waves in bony defects are still unknown. By metaanalysis successrates and indications for ESWT are worked out as well as adequate impulse- and energyrates according to actual state of knowledge. Aim of this study is to rate the published cases. METHOD: 105 papers referring to ESWT of the locomotor system are rated. Validation was performed for each paper according to the international accepted system of the American Association of Spine Surgery in Type A- E. Advise for therapy is taken only from high quality publications of Type A and B. This advise should regard scientific as well as economic aspects. RESULTS: 4825 cases from 55 publications and abstracts that underwent ESWT were evaluated. 24 papers with 1585 cases (33%) live up to the standards of a scientific investigation. Numerous studies exist about therapy of calcifying tendinitis, epicondylitis humeri radialis, painful heel, pseudarthrosis and other enthesiopathies. Especially the studies concerning pseudarthosis and other enthesiopathies do hardly live up to scientific standards. In calcifying tendinitis and painful heel ESWT achieves nearly the same results than the established methods. No serious complications were observed. Because of the high complication rate in operative treatment of heel spur ESWT seems to be justifiable. The techniques of ESWT, energy density levels, impulse rates and complications will be described. CONCLUSION: The advantages of ESWT are non-invasiveness and low rate of complications. Primary aim should be to evaluate adequate energy density levels and impulse rates for specific groups of indications using high quality studies according to evidence-based-medicine. Long term results need to be awaited to be able to compare ESWT with established methods. Recent inflationary use of ESWT especially in outpatient departments has no scientific indication in numerous cases as conservative methods are not used consequently. NLM PUBMED CIT. ID: 9823633 SOURCE: Z Orthop Ihre Grenzgeb 1998 Sep-Oct;136(5):390-401 32

NLM CIT. ID: 99038637
TITLE: MR imaging of benign soft-tissue masses of the foot and ankle. AUTHORS: Llauger J; Palmer J; Monill JM; Franquet T; Bague S Roson N AUTHOR AFFILIATION: Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Approximately 75% of all biopsy-proved soft-tissue masses of the foot and ankle are benign tumors or nontumoral lesions representing a variety of histologic types. In some cases, it may be difficult if not impossible to identify the lesion; however, careful analysis of the magnetic resonance (MR) imaging findings and correlation of these findings with the patient's clinical history can usually suggest a more specific diagnosis, particularly in the most common benign tumors of the foot (e.g., fibromatosis, cavernous hemangioma) and in nonneoplastic soft-tissue lesions such as Morton neuroma, ganglion cyst, and plantar fasciitis. In addition, a specific diagnosis can almost always be made in patients with pigmented villonodular synovitis (PVNS) or giant cell tumor (GCT) of the tendon sheath. The MR imaging appearance of PVNS consists of multiple synovial lesions with low or intermediate signal intensity on T1-weighted images and low signal intensity on T2-weighted and gradient-echo images. GCTs of the tendon sheath usually have areas of low signal intensity on both T1- and T2- weighted images due to the paramagnetic effect of hemosiderin. Awareness and understanding of the underlying pathologic findings in lesions of the foot and ankle aid in MR imaging interpretation. NLM PUBMED CIT. ID: 9821196 SOURCE: Radiographics 1998 Nov-Dec;18(6):1481-98 33

NLM CIT. ID: 99001584
TITLE: Unusual heel pain in a patient with primary oxalosis treated by liver- kidney transplantation [letter] AUTHORS: Javier RM; Moulin B; Durckel J; Sibilia J; Kuntz JL PUBLICATION TYPES: LETTER REGISTRY NUMBERS: 0 (Oxalates) NLM PUBMED CIT. ID: 9785405 SOURCE: Rev Rhum Engl Ed 1998 Jul-Sep;65(7-9):517-8 34

NLM CIT. ID: 98444156
TITLE: Ultrasound guided injection of recalcitrant plantar fasciitis [see comments] AUTHORS: Kane D; Greaney T; Bresnihan B; Gibney R FitzGerald O AUTHOR AFFILIATION: Department of Diagnostic Imaging, St Vincent's Hospital, Dublin, Ireland. COMMENTS: Comment in: Ann Rheum Dis 1998 Dec;57(12):749-50 PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Anesthetics, Local) 0 (Anti-Inflammatory Agents, Steroidal) 137-58-6 (Lidocaine) 76-25-5 (Triamcinolone Acetonide)
ABSTRACT: OBJECTIVE: To determine the effect of ultrasound guided injection in recalcitrant idiopathic plantar fasciitis. METHODS: Four patients with a clinical diagnosis of idiopathic plantar fasciitis, who were unresponsive to palpation guided injection with triamcinolone acetonide and local anaesthetic, underwent ultrasonographic examination of the heel. RESULTS: The following ultrasonographic features were noted:- (a) increased thickness of plantar fascia in symptomatic heels compared with asymptomatic heels, (b) loss of distinction of the distal plantar fascia borders, (c) reduced echogenicity of the plantar fascia. Ultrasound guided injection of the enlarged, hypoechoic plantar fascia resulted in complete relief in four of five heels (mean duration of follow up = 24 months) in three cases. One patient developed a recurrence of symptoms after six months. CONCLUSION: Ultrasound allows for confirmation of the clinical diagnosis and ultrasound guided injection produces a good clinical response when unguided injection is unsuccessful. The technique is quick, inexpensive, and entails no radiation exposure. NLM PUBMED CIT. ID: 9771217 SOURCE: Ann Rheum Dis 1998 Jun;57(6):383-4 35

NLM CIT. ID: 98406588
TITLE: Metastatic breast cancer presenting as heel pain. AUTHORS: Groves MJ; Stiles RG AUTHOR AFFILIATION: Northlake Regional Medical Center, Tucker, GA, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors present a case of breast cancer metastasizing to the calcaneus that was confirmed by bone biopsy. The patient's complaint of heel pain provided the initial evidence of skeletal metastasis. Metastatic spread of cancer to the hand or foot (acrometastasis) is considered rare. However, the possibility of acrometastasis should be considered in any patient with a history of cancer presenting with skeletal pain, especially if the symptoms do not respond to therapy. NLM PUBMED CIT. ID: 9735627 SOURCE: J Am Podiatr Med Assoc 1998 Aug;88(8):400-5 36

NLM CIT. ID: 98406584
TITLE: Conservative treatment of plantar fasciitis. A prospective study. AUTHORS: Lynch DM; Goforth WP; Martin JE; Odom RD; Preece CK Kotter MW AUTHOR AFFILIATION: Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Temple, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents)
ABSTRACT: 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. NLM PUBMED CIT. ID: 9735623 SOURCE: J Am Podiatr Med Assoc 1998 Aug;88(8):375-80 37

NLM CIT. ID: 98376637
TITLE: Entrapment neuropathy: the etiology of intractable chronic heel pain syndrome. AUTHORS: Hendrix CL; Jolly GP; Garbalosa JC; Blume P DosRemedios E AUTHOR AFFILIATION: New Britain General Hospital, CT 06050, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Chronic heel pain syndrome (CHPS) is a common clinical entity. The etiology of CHPS has never been completely defined and there are no clear treatment regimens in the literature. Most authors agree that nonoperative treatment is effective in most patients. However, in 5%- 10% of patients, operative intervention is required. Outcomes for these patients have been inconsistent. A series of 51 patients with intractable CHPS who were diagnosed with an entrapment of the posterior tibial nerve and its terminal branches is presented. Descriptive statistics were obtained for the demographic data and pre and postsurgical start-up and standing pain visual analog scale (VAS) scoring. Statistical testing of the VAS mean scores was performed using a paired t-test at the 0.01 level of significance. Pre- and postsurgical start-up and pre- and postsurgical standing pain VAS means were significantly different from each other (t = 19.6, p = .001 and t = 19.4, p = .001, respectively). Based on subjective and objective criteria, 96% of the patients experienced significant improvement and 90% reported completed resolution of heel pain. The presence of tarsal tunnel syndrome in all 51 patients strongly suggests entrapment neuropathy as the etiology of intractable CHPS. NLM PUBMED CIT. ID: 9710778 SOURCE: J Foot Ankle Surg 1998 Jul-Aug;37(4):273-9 38

NLM CIT. ID: 98376636
TITLE: Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. AUTHORS: Benton-Weil W; Borrelli AH; Weil LS Jr; Weil LS Sr PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A retrospective study was done to evaluate patient pain level and satisfaction after a percutaneous plantar fasciotomy. Between 1990 and 1996, 51 patients underwent percutaneous plantar fasciotomy for chronic plantar fasciitis associated with heel pain syndrome. All patients had undergone at least 6 months of conservative therapy. A questionnaire incorporating a visual analog pain scale was used to determine the effectiveness and patient satisfaction of the procedure. Of 35 patients who responded to the questionnaire, 27 were female and eight were male, ranging in age from 31 to 76 years with an average age of 47 years. Follow-up time after surgery ranged from 12 to 57 months, with an average of 34 months. Utilizing a visual analog pain scale, results showed a preoperative pain level of 8.7 (+/- 1.2) with a range of 6-10. Pain level at follow-up was 2.1 (+/- 2.7) with a range of 0-10. Eighty- three percent of the patients stated that the procedure met or exceeded their expectations. Percutaneous plantar fasciotomy is a simple and cost-effective method for surgical intervention of chronic heel pain syndrome. Complications are rare and the results compare favorably with other reported more invasive and costly techniques. NLM PUBMED CIT. ID: 9710777 SOURCE: J Foot Ankle Surg 1998 Jul-Aug;37(4):269-72 39

NLM CIT. ID: 98376635
TITLE: The heel pain syndrome [editorial] [see comments] AUTHORS: Weil LS Sr COMMENTS: Comment in: J Foot Ankle Surg 1998 Nov-Dec;37(6):548-9 PUBLICATION TYPES: EDITORIAL NLM PUBMED CIT. ID: 9710776 SOURCE: J Foot Ankle Surg 1998 Jul-Aug;37(4):267-8 40

NLM CIT. ID: 98369935
TITLE: Adaptive gait responses to plantar heel pain. AUTHORS: Levins AD; Skinner HB; Caiozzo VJ AUTHOR AFFILIATION: Department of Orthopaedic Surgery, College of Medicine, UCI Medical Center, Orange 92868, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Neuropathic foot ulcers in people with diabetes result from repetitive stress aggravated by a lack of protective sensation. Protective sensation causes individuals without this impairment to produce alterations in their gait in response to painful stimuli. This study evaluates the adaptive gait responses to pain in individuals with sensate feet. The gaits of 18 such control subjects were studied with a foot switch gait analyzer without painful stimuli. Each then had his or her gait analyzed with three successively larger painful stimuli (2, 3.3, and 4.6 mm beads) placed below the heel. This study showed that subjects compensated for the painful stimuli by reducing the single limb support duration of the affected side at bead sizes of 3.3 and 4.6 mm and by reducing the unaffected side's swing phase and single limb support as a percentage of the gait cycle at the 4.6-mm bead size only. Gait adaptations to painful stimuli may indicate another possible avenue, in addition to pressure redistribution, in the assessment of programs aimed at prevention and treatment of diabetic foot ulcers. NLM PUBMED CIT. ID: 9704312 SOURCE: J Rehabil Res Dev 1998 Jul;35(3):289-93 41

NLM CIT. ID: 98368061
TITLE: Calcaneal osteochondritis: a new overuse injury. AUTHORS: Lokiec F; Wientroub S AUTHOR AFFILIATION: Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel- Aviv Medical Center, Israel. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: This is a case report of osteochondritis of the medial plantar apophysis of the calcaneus presenting as medial plantar heel pain in a 15-year-old basketball player. The lesion was detected radiographically and by increased focal uptake on bone scan. Conservative treatment resulted in complete pain relief and normal calcaneal appearance with union of the osteochondral fragment. No recurrence was noted during 3 years of follow-up. NLM PUBMED CIT. ID: 9702679 SOURCE: J Pediatr Orthop B 1998 Jul;7(3):243-5 42

NLM CIT. ID: 98306886
TITLE: Tibial nerve entrapment and heel pain caused by a Baker's cyst [letter] AUTHORS: Willis JD; Carter PM PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 9642916 SOURCE: J Am Podiatr Med Assoc 1998 Jun;88(6):310-1 43

NLM CIT. ID: 98283767
TITLE: A new modified technique for harvest of calcaneal bone grafts in surgery on the foot and ankle [see comments] AUTHORS: Biddinger KR; Komenda GA; Schon LC; Myerson MS AUTHOR AFFILIATION: Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA. COMMENTS: Comment in: Foot Ankle Int 1999 Jan;20(1):68 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Reported sites for retrieval of cancellous bone for grafts include the iliac crest, greater trochanter, proximal tibia, and distal tibia. A new lateral technique for retrieval of cancellous bone from the calcaneus is evaluated through anatomic review, quantitative analysis, and retrospective clinical assessment. Of 22 patients managed with this technique over a 2-year period, 17 returned for an evaluation by questionnaire, physical examination, and radiographic follow-up at an average of 7 months after surgery (range, 4-16 months). Complaints/complications were minor: three had minor incisional symptoms, five had medial heel pain (3 caused by plantar fasciitis), and one had unchanged preoperative heel pain secondary to clubfoot deformity. Compared with more extensive bone-grafting procedures, this procedure offers the advantages of bone harvested under local anesthesia using a readily accessible ipsilateral extremity and producing minor complications. NLM PUBMED CIT. ID: 9622424 SOURCE: Foot Ankle Int 1998 May;19(5):322-6 44

NLM CIT. ID: 98281196
TITLE: Foot pain: specific indications for scintigraphy. AUTHORS: O'Duffy EK; Clunie GP; Gacinovic S; Edwards JC Bomanji JB; Ell PJ AUTHOR AFFILIATION: Department of Rheumatology, University College, London. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Radiopharmaceuticals) 63347-66-0 (Technetium Tc 99m Medronate)
ABSTRACT: Bone scintigraphy is requested as part of the investigation of foot pain, but its contribution to clinical management has not been comprehensively documented. Previously published data are limited; the most comprehensive series identified scintigraphic abnormalities in patients with primarily orthopaedic problems and a control group was not included (Maurice HD et al. J Bone Joint Surg 1987;69B:448 52). The aim of this study was to evaluate whether bone scintigraphy may be useful in different clinical circumstances indicated by referral request details. Regions of scintigraphic abnormality were scored and compared with clinical details drawn from case notes of 60 patients with foot pain. The commonest clinical indications for scans were: confirmation of the clinical suspicion of plantar fasciitis, documentation of the extent of inflammatory arthritis and location of focal pathology. A group of 30 asymptomatic, age- and sex-matched controls were also studied. In 14 out of 19 symptomatic feet in the plantar fasciitis group, focal uptake at the medial calcaneal tubercle was present, confirming the diagnosis. In patients with non-specific, diffuse foot pain, the bone scan identified focal abnormalities in 11 out of 14 cases, thus directing the clinician to the site of pathology. Scintigraphy also proved useful in mapping local inflammatory disease. Technetium-99m methylene diphosphonate image abnormalities occurred in the control group most commonly in the midfoot (16 regions in 13 subjects) and first metatarsophalangeal joint (19 regions in 14 subjects). NLM PUBMED CIT. ID: 9619897 SOURCE: Br J Rheumatol 1998 Apr;37(4):442-7 45

NLM CIT. ID: 98278216
TITLE: [Complications, side-effects and contraindications in the use of medium and high-energy extracorporeal shock waves in orthopedics] VERNACULAR
TITLE: Komplikationen, Nebenwirkungen und Kontraindikationen der Anwendung mittel-und hochenergetischer extrakorporaler Stosswellen im orthopadischen Bereich. AUTHORS: Sistermann R; Katthagen BD AUTHOR AFFILIATION: Orthopadische Klinik, Stadtische Kliniken Dortmund, Klinikzentrum Mitte, Dortmund. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: INTRODUCTION: Possible complications and side effects using extracorporeal shock waves for orthopaedic diseases should be evaluated. METHOD: Since 1993 we prospectively evaluated the complications and adverse effects applying extracorporeal shockwaves for orthopaedic diseases. Within three years 542 lithotripsies in 276 patients were made. 190 patients were treated because of calcifying tendinitis, 34 for epicondylitis and 52 suffering from a plantar heel spur. RESULTS: In 216 cases we could recognize small superficial hematomas, 4 hyperventilations and in 3 cases a blood pressure elevation over 200 mmHg. Two cases of high blood pressure showed data over 200 mmHg without other clinical symptoms. They were of transitory nature during therapy. In one case we had to treat a hypertension crisis within the first 3 hours after therapy. Today the application of shockwaves in the thoracic region or lung, coagulopathies or anticoagulant medicine, pregnancy and the use at nerval or vascular structures represent an absolute contraindication. When using extracorporeal shock waves for bone lithotripsy, bone tumors, bone infection or infected pseudarthrosis and the application at growth plates in children and young adults represent an absolute contraindication. CONCLUSION: In general lithotripsy has only minor complications when it is used accurate. NLM PUBMED CIT. ID: 9615982 SOURCE: Z Orthop Ihre Grenzgeb 1998 Mar-Apr;136(2):175-81 46

NLM CIT. ID: 98278215
TITLE: [Symptomatic low-energy shockwave therapy in heel pain and radiologically detected plantar heel spur] VERNACULAR
TITLE: Symptomatische niedrig-energetische Stosswellentherapie bei Fersenschmerzen und radiologisch nachweisbarem plantaren Fersensporn. AUTHORS: Krischek O; Rompe JD; Herbsthofer B; Nafe B AUTHOR AFFILIATION: Orthopadische Universitatsklinik Mainz. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGES: Ger
ABSTRACT: QUESTION: The long-term analgetic effect of low-energetic shock-wave therapy in heel spur for two different numbers of applicated impulses is investigated. METHODS: 50 patients with recalcitrant heel pain and a plantar calcaneal spur on the X-ray received in a controlled, prospective and randomized study low-energetic extracorporal shock-wave- therapy. The first group received 3 x 500 impulses and the second group 3 x 100 impulses of 0.08 mJ/mm2 with an experimental device. The follow- up was 1 1/2, 3 and by telephone after 12 months. RESULTS: There was clear improvement and relief of pain in both groups on manual pressure and while walking and an increase of the pain-free walking ability from 10 minutes before the treatment to 2 and 3 hours respectively after 12 months. We saw a significantly better results after the treatment with 3 x 500 impulses. CONCLUSION: The extracorporal shock-wave therapy is an effective treatment in refractory heel pain. An amount of at least 3 x 500 impulses in the low energetic treatment is useful. NLM PUBMED CIT. ID: 9615981 SOURCE: Z Orthop Ihre Grenzgeb 1998 Mar-Apr;136(2):169-74 47

NLM CIT. ID: 98201985
TITLE: Differences in impulse distribution in patients with plantar fasciitis. AUTHORS: Bedi HS; Love BR AUTHOR AFFILIATION: Geelong Hospital, Victoria, Australia. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The impulse distribution based upon vertical foot-floor reaction forces and time under the fore-, mid-, and hindfoot was determined using Tekscan's F-Scan system. This was compared in 40 barefoot patients with long-standing plantar fasciitis with an equal number of normal subjects. The patient group tended to load the hind- and midfoot to a lesser extent than the control group. Consequently, a greater proportionate load was borne by the forefoot. This result was highly significant for both the midfoot (P < 0.001) and forefoot (P = 0.002) comparisons. An objective biomechanical method such as this may be useful as a diagnostic aid, to identify individuals predisposed to this condition, and for evaluating the efficacy of various treatment modalities. NLM PUBMED CIT. ID: 9542986 SOURCE: Foot Ankle Int 1998 Mar;19(3):153-6 48

NLM CIT. ID: 98201984
TITLE: Biomechanical consequences of sequential plantar fascia release. AUTHORS: Murphy GA; Pneumaticos SG; Kamaric E; Noble PC Trevino SG; Baxter DE AUTHOR AFFILIATION: University of Tennessee-Campbell Clinic, Department of Orthopaedic Surgery, Memphis, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Plantar fascia release has long been a mainstay in the surgical treatment of persistent heel pain, although its effects on the biomechanics of the foot are not well understood. With the use of cadaver specimens and digitized computer programs, the changes in the medial and lateral columns of the foot and in the transverse arch were evaluated after sequential sectioning of the plantar fascia. Complete release of the plantar fascia caused a severe drop in the medial and lateral columns of the foot, compared with release of only the medial third. Equinus rotation of the calcaneus and a drop in the cuboid indicate that strain of the plantar calcaneocuboid joint capsule and ligament is a likely cause of lateral midfoot pain after complete plantar fascia release. NLM PUBMED CIT. ID: 9542985 SOURCE: Foot Ankle Int 1998 Mar;19(3):149-52 49

NLM CIT. ID: 98245350
TITLE: Management of heel pain in the inflammatory arthritides. AUTHORS: Geppert MJ; Mizel MS AUTHOR AFFILIATION: Orthopaedic & Trauma Specialists, Somersworth, NH, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Subcalcaneal pain is a common complaint presented to the orthopaedist. Excessive attention to mechanical or traumatic causes may result in an improper diagnosis if rheumatologic or systemic conditions are not considered in the differential diagnosis. Systemic conditions associated with heel pain are reviewed and a conservative treatment protocol is presented that should help to obtain a correct diagnosis and to lead to effective management of this common condition. NLM PUBMED CIT. ID: 9584371 SOURCE: Clin Orthop 1998 Apr;(349):93-9 50

NLM CIT. ID: 98238133
TITLE: I have recently taken up fast walking and have developed pain in my left foot, which my internist says in plantar fasciitis. She told me to hold off on walking for a while. Can you tell me about this condition? Is there anything else I can do to speed my recovery? PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9577272 SOURCE: Harv Womens Health Watch 1998 Apr;5(8):8 51

NLM CIT. ID: 98232947
TITLE: Flexor hallucis longus dysfunction [see comments] AUTHORS: Oloff LM; Schulhofer SD AUTHOR AFFILIATION: Sports Orthopedic and Athletic Rehabilitation Medicine Group (SOAR), Menlo Park, CA 94025, USA. COMMENTS: Comment in: J Foot Ankle Surg 1998 May-Jun;37(3):260 PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Nineteen consecutive cases of flexor hallucis longus stenosing tenosynovitis that underwent operative tenolysis from September 1994 to December 1996 were retrospectively reviewed. This is classically a disorder of ballet dancers, and to a much lesser extent, running athletes. The patients were primarily nonathletic, male, and middle- aged. The mean symptom duration was 20 months, multiple physicians had been encountered, and misdiagnosis was common. Patients presented with overlapping signs and symptoms of flexor hallucis longus tendinitis, plantar fasciitis, and tarsal tunnel syndrome. A cross-reference of patients with posteromedial ankle pain, medial arch pain, and/or a positive Tinel's sign revealed that 14 (74%) and 6 (32%) feet had two of three, or all three signs, respectively. Magnetic resonance imaging and tenography proved valuable in establishing the correct primary diagnosis. Nonoperative protocols were unsuccessful. Flexor hallucis longus tenolysis was successful in each case with a mean return to regular activity at 9 weeks. Flexor hallucis longus stenosing tenosynovitis may be more prevalent than reported and should be a diagnosis of inclusion among all patient populations who present with posterior ankle, medial arch, and/or tarsal tunnel symptoms. NLM PUBMED CIT. ID: 9571456 SOURCE: J Foot Ankle Surg 1998 Mar-Apr;37(2):101-9 52

NLM CIT. ID: 98197545
TITLE: US of the ankle: technique, anatomy, and diagnosis of pathologic conditions. AUTHORS: Fessell DP; Vanderschueren GM; Jacobson JA Ceulemans RY; Prasad A; Craig JG; Bouffard JA; Shirazi KK van Holsbeeck MT AUTHOR AFFILIATION: Department of Radiology, Henry Ford Hospital, Detroit, MI 48202, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: For specific indications, ultrasound (US) is an efficient and inexpensive alternative to magnetic resonance (MR) imaging for evaluation of the ankle. In addition to the tendons and tendon sheaths, other ankle structures demonstrated with US include the anterior joint space, retrocalcaneal bursa, ligaments, and plantar fascia. Ankle US allows detection of tenosynovitis and tendinitis, as well as partial and complete tendon tears. Joint effusions, intraarticular bodies, ganglion cysts, ligamentous tears, and plantar fasciitis can also be diagnosed. As pressure for cost containment continues, demand for US of the ankle may increase given its lower cost compared with that of MR imaging. In most cases, a focused ankle US examination can be performed more rapidly and efficiently than MR imaging. Familiarity with the technique of ankle US, normal US anatomy, and the US appearances of pathologic conditions will establish the role of US as an effective method of imaging the ankle. NLM PUBMED CIT. ID: 9536481 SOURCE: Radiographics 1998 Mar-Apr;18(2):325-40 53

NLM CIT. ID: 98181948
TITLE: A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis. AUTHORS: Basford JR; Malanga GA; Krause DA; Harmsen WS AUTHOR AFFILIATION: Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN 55905, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: OBJECTIVE: To determine whether low-intensity laser irradiation, a widespread but controversial physical therapy agent, is an effective treatment of plantar fasciitis. DESIGN: A randomized, double-blinded, placebo-controlled clinical study. SETTING: A sports medicine clinic. SUBJECTS: Thirty-two otherwise healthy individuals with plantar fasciitis of more than 1 month's duration. INTERVENTION: Dummy or active irradiation with a 30 mW .83 microm GaAlAs continuous-wave infrared (IR) diode laser three times a week for 4 weeks. MEASUREMENTS: Morning pain, pain with toe walking, tenderness to palpation, windlass test response, medication consumption, and orthotic use were evaluated immediately before the study, as well as at the midpoint and end of treatment. Subjects were also evaluated at a follow-up 1 month after their last treatment. RESULTS: No significant differences were found between the groups in any of the outcome measures either during treatment or at the 1-month follow-up. Treatment, however, was well tolerated and side effects were minimal. CONCLUSIONS: Low-intensity IR laser therapy appears safe but, at least within the parameters of this study, is not beneficial in the treatment of plantar fasciitis. NLM PUBMED CIT. ID: 9523774 SOURCE: Arch Phys Med Rehabil 1998 Mar;79(3):249-54 54

NLM CIT. ID: 98164520
TITLE: Retrospective analysis of minimal-incision, endoscopic, and open procedures for heel spur syndrome. AUTHORS: Brekke MK; Green DR AUTHOR AFFILIATION: Scripps Mercy Medical Center, San Diego, CA, USA. PUBLICATION TYPES: HISTORICAL ARTICLE JOURNAL ARTICLE
ABSTRACT: Forty-four patients with recalcitrant heel spur syndrome who underwent surgical correction (54 procedures) were studied retrospectively. The results of minimal-incision, endoscopic, and open plantar fasciotomy procedures were compared. This study focuses on patient satisfaction, pain reduction, convalescence, and postoperative problems. Although all procedure groups reported high degrees of patient satisfaction and reduction of pain, some notable differences among the three groups were observed. NLM PUBMED CIT. ID: 9503769 SOURCE: J Am Podiatr Med Assoc 1998 Feb;88(2):64-72 55

NLM CIT. ID: 98158346
TITLE: Complications of plantar fascia rupture associated with corticosteroid injection. AUTHORS: Acevedo JI; Beskin JL AUTHOR AFFILIATION: Georgia Baptist Medical Center, Atlanta, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones)
ABSTRACT: From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow- up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve. NLM PUBMED CIT. ID: 9498581 SOURCE: Foot Ankle Int 1998 Feb;19(2):91-7 56

NLM CIT. ID: 98154548
TITLE: Iontophoresis of 0.4% dexamethasone for plantar fasciitis. AUTHORS: Chandler TJ AUTHOR AFFILIATION: Lexington Clinic Sports Medicine Center, Lexington, Kentucky, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Glucocorticoids, Synthetic) 50-02-2 (Dexamethasone) NLM PUBMED CIT. ID: 9490178 SOURCE: Clin J Sport Med 1998 Jan;8(1):68 57

NLM CIT. ID: 98142459
TITLE: Plantar fasciitis. Repeated corticosteroid injections are safe. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones) NLM PUBMED CIT. ID: 9481460 SOURCE: Can Fam Physician 1998 Jan;44:45, 51 58

NLM CIT. ID: 98130887
TITLE: Resectional arthroplasty: treatment for calcaneonavicular coalition. AUTHORS: Fuson S; Barrett M AUTHOR AFFILIATION: Puget Sound Hospital, Tacoma, Washington 98032, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In a 10-year retrospective review of one practitioner's experience with calcaneonavicular tarsal coalitions, a diagnostic procedure based on clinical and radiographic examination is described. What typically may present as heel pain, on thorough clinical examination, may be identified more specifically as midtarsal pain. Radiographically degenerative changes may be identified through computed tomography as well as magnetic resonance imaging, bone scan, and plain radiographs. Treatment modalities are based on the degree of symptomatic degenerative changes present. In early stages, steroid injection is used to diminish inflammation at the midtarsal joint. Typically, this is performed with orthotic therapy to limit the motion at the calcaneonavicular coalition. More advanced stages will require surgical intervention. Based on the degree of degeneration at the more proximal subtalar joint, arthroplasty of the calcaneonavicular coalition without interposition of the extensor digitorum brevis has produced acceptable long-term results. If the subtalar joint has advanced degeneration and there has been failure of more conservative treatments, rearfoot arthrodesis has been performed. NLM PUBMED CIT. ID: 9470111 SOURCE: J Foot Ankle Surg 1998 Jan-Feb;37(1):11-5 59

NLM CIT. ID: 98126722
TITLE: Plantar fasciitis/calcaneal spur among security forces personnel. AUTHORS: Sadat-Ali M AUTHOR AFFILIATION: College of Medicine & Medical Sciences, King Faisal University, Saudi Arabia. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A prospective single survey was conducted among Security Forces personnel at the Mobile Hospital, Ministry of Interior, Makkah Al- Mukarramah, Saudi Arabia. One hundred three patients presented to the orthopedic clinic with painful heel. A control group of patients from the other clinics without painful heel was also screened. The average age was 38.81 years and 38.1 years in the patient and the control group, respectively. The mean Quetelet index of body mass in the patient group was 30.36 kg/m2 and in the control group it was 26.71 kg/m2. There was a statistically significant difference of p < 0.05 between the two groups for Quetelet index of body mass. The right side was affected in 37 patients, the left side was involved in 45 patients, and 21 patients had pain bilaterally. Seventy-one patients had spur on the calcaneum. The prevalence of painful heel attributable to plantar fasciitis/calcaneum spur was 1.18%. This study suggests that obesity is a cause and initiator of heel pain and plantar fasciitis/calcaneal spur and that improper footwear aggravates the condition. NLM PUBMED CIT. ID: 9465574 SOURCE: Mil Med 1998 Jan;163(1):56-7 60

NLM CIT. ID: 98122739
TITLE: Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. AUTHORS: Powell M; Post WR; Keener J; Wearden S AUTHOR AFFILIATION: Department of Orthopaedics, West Virginia University, Morgantown 26505, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: Chronic plantar fasciitis frustrates patients and treating physicians. Our hypothesis was that use of a dorsiflexion night splint for 1 month would effectively treat patients with recalcitrant plantar fasciitis. A 6-month randomized crossover study included 37 patients with chronic plantar fasciitis. Patients were treated with dorsiflexion night splints for 1 month. Group A wore splints for the 1st month and group B for the 2nd month. No splints were used in either group for the final 4 months of the study. No other medications, stretching, or strengthening exercises were prescribed. Eighty-eight percent of patients who completed the study improved. Eighty percent of the involved feet improved subjectively. Results of the AOFAS Ankle-Hindfoot Rating System and the Mayo Clinical Scoring System demonstrated significant improvement for both groups during the period of splint wear. Improvements were maintained at study completion. Response to splinting did not correlate with foot type, degree of obesity, or the presence of heel spur on radiographs. We believe dorsiflexion splints provide relief from the symptoms of recalcitrant plantar fasciitis in the majority of patients. NLM PUBMED CIT. ID: 9462907 SOURCE: Foot Ankle Int 1998 Jan;19(1):10-8 61

NLM CIT. ID: 98039111
TITLE: MRI of plantar fasciitis. AUTHORS: Roger B; Grenier P AUTHOR AFFILIATION: Service de Radiologie Polyvalente Diagnostique et Interventionelle, Hopital de la Pitie, 83, boulevard de l'Hopital, F-75651 Paris Cedex 13, France. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: At present, MRI is the only imaging method that can precisely visualize lesions of the superficial plantar aponeurosis, whether they be musculoaponeurositides, enthesopathies or tears, and whether they be acute or chronic, with or without complications. By its direct visualization of the lesion, MRI enables an accurate assessment of the injury to be made and thereby better orients the therapeutic strategy. NLM PUBMED CIT. ID: 9369509 SOURCE: Eur Radiol 1997;7(9):1430-5 62

NLM CIT. ID: 98059214
TITLE: An inexpensive "orthosis" for plantar fasciitis [letter; comment] AUTHORS: de Souza H; Reed L COMMENTS: Comment on: Med J Aust 1997 Jun 2;166(11):616 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9397072 SOURCE: Med J Aust 1997 Nov 3;167(9):509 63

NLM CIT. ID: 98048954
TITLE: [Heel pain and calcaneal spurs] AUTHORS: Lu H; Gu G; Zhu S AUTHOR AFFILIATION: Arthritis Clinic & Research Center, People's Hospital Beijing Medical University Beijng. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Chi
ABSTRACT: The authors of this paper have reviewed 137 X-ray films of the involved feet and followed up 30 patients all of them suffering from heel pain treated in the authors' hospital during 1980-1985, in order to find out the relationship between the length, shape and the direction of the spurs with the heel pain. We have found: (1) There are no clear relationship between heel pain and the length, shape and the direction of the calcaneal spur. (2) The plantar soft tissue of the painful foot was thickened, indicating the heel pain was due to inflammation in the plantar soft tissue. (3) Heel pain is related to the patient's age and sex. (4) The spurs still exist and grow even bigger after the syndrome disappears. NLM PUBMED CIT. ID: 9387707 SOURCE: Chung Hua Wai Ko Tsa Chih 1996 May;34(5):294-6 64

NLM CIT. ID: 98038439
TITLE: Keeping in shape: exercise fundamentals for the midlife patient. AUTHORS: Strauss E; Durand E; Blaustein A AUTHOR AFFILIATION: Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The typical physiologic effects of aging on the musculoskeletal system can be impeded with regular exercise and diet. Common orthopedic problems in sedentary midlife patients are shoulder impingement, low back pain, and plantar fasciitis. Although the responsibility for maintaining an exercise program rests with the individual, the primary care physician can play an important role as coach, cheerleader, and respected advisor. The key is to encourage patients to initiate a program of regular, moderate exercise 30 minutes a day, three times a week, and to eat a balanced, nutritious diet. The best exercise and diet regimen is one that is custom-designed to accommodate the individual patient's needs and objectives. NLM PUBMED CIT. ID: 9371105 SOURCE: Geriatrics 1997 Nov;52(11):62-3, 67-8, 73-4 passim; quiz 80 65

NLM CIT. ID: 98035514
TITLE: The nonlinear finite element analysis and plantar pressure measurement for various shoe soles in heel region. AUTHORS: Shiang TY AUTHOR AFFILIATION: Graduate Institute of Coaching Science, National College of Physical Education and Sports, Taoyuan, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The most influential factor contributing to foot and shoe comfort is underfoot cushioning. The shock absorbing ability of footwear in the heel area is of particular importance in reducing the impact load during athletic activities and in therapeutic footwear prescribed for heel pain. Furthermore, foot care for foot problem patients is an important part of treatment and educational programs. Therefore, a well- designed sport shoe which can provide comfort and protection is essential. In order to design a functional shoe, biomechanics and other new technologies should be considered, and the design process should be examined in the biomechanics laboratory over and over. The design process requires too much time and effort since the entire experimental and test work can only be done after the prototype is manufactured. Therefore, this study tried to introduce the Finite Element Method (FEM) into the shoe design process by building a three-dimensional FE model with various shoe soles and loading conditions. The material properties of shoe materials were tested using an Instron Testing Machine. An in-shoe pressure insole was used to measure the plantar pressure in different ambulation conditions with various shoe constructions. The subject for this study was a healthy young male without any foot problem. The average plantar pressures obtained from approximately 50 steps in the heel region for each of the various conditions were collected. The results showed that the mean peak plantar pressure of the running situation was significantly higher than that of the walking situation as predicted, and that the insole could provide better cushioning compared to the other shoe constructions. The stress strain relationship for shoe materials was approximated better by a second-order nonlinear curve according to the Instron test. The results of the finite element method suggested that only the second- order nonlinear stress strain curve could correctly describe the shoe material, which also confirmed a potential valuable role for FEM in designing functional shoes. NLM PUBMED CIT. ID: 9369026 SOURCE: Proc Natl Sci Counc Repub China B 1997 Oct;21(4):168-74 66

NLM CIT. ID: 98013837
TITLE: The role of bone scintigraphy and plain radiography in intractable plantar fasciitis. AUTHORS: Tudor GR; Finlay D; Allen MJ; Belton I AUTHOR AFFILIATION: Department of Radiology, Leicester Royal Infirmary NHS Trust, UK. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The objective of this study was to assess the role of bone scintigraphy and plain film radiography in intractable plantar fasciitis. The bone scintigrams, radiographs and clinical histories of 33 patients with chronic plantar fasciitis were reviewed. These patients were refractory to conservative treatments and were being considered for surgical plantar fascia release. Twenty-eight patients had increased uptake on scintigraphy at the medial calcaneal tubercle, while a plantar spur was seen in 21 patients. Seventy-five percent of patients with increased uptake had a calcaneal spur; 95% of patients with a spur had increased uptake on scintigraphy. It would appear that plantar calcaneal spurs are more prevalent in this group of patients than in the general population and, although they may not be the primary cause of pain, they may predispose to it. Scintigraphy was helpful in patients without a spur or with atypical symptoms or signs. It did not provide any further information on the group of patients with a spur. NLM PUBMED CIT. ID: 9352552 SOURCE: Nucl Med Commun 1997 Sep;18(9):853-6 67

NLM CIT. ID: 98000166
TITLE: Magnetic resonance imaging of Achilles tendon in patients with rheumatoid arthritis. AUTHORS: Stiskal M; Szolar DH; Stenzel I; Steiner E Mesaric P; Czembirek H; Preidler KW AUTHOR AFFILIATION: Department of Radiology KH Lainz-Vienna, Austria. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: RATIONALE AND OBJECTIVES: The authors characterize the appearance of the Achilles tendon in patients with rheumatoid arthritis and differentiate this appearance from degenerative tendinopathy in patients with chronic pain of the heel using magnetic resonance (MR) imaging. METHODS: Thirty patients with rheumatoid arthritis and 28 patients with chronic pain of the heel underwent MR imaging of the ankle and foot. Three radiologists independently assessed the MR images with respect to size, shape, and intratendinal signal characteristics of the Achilles tendon. The Achilles tendon was considered abnormal on MR imaging when intratendinous signal alterations or an anteroposterior measurement greater than 8 mm was seen. Physical examination of the Achilles tendons was accomplished in both groups. Operation confirmed the diagnosis of 13 patients in the second group with chronic pain of the heel. RESULTS: The Achilles tendon of 83% of patients with rheumatoid arthritis demonstrated various intratendinous patterns (longitudinal, reticular, nodular) of intermediate signal intensity on all pulse sequences on MR imaging. Ninety percent of patients with rheumatoid tendinopathy showed no enlargement of the anteroposterior diameter of the Achilles tendon. In addition, all patients with rheumatoid arthritis had findings compatible with an inflammation of the retrocalcaneal bursa on MR imaging, whereas none of the patients with tendinopathy associated with chronic heel pain had retrocalcaneal bursitis. All patients, however, had enlargement of the anteroposterior diameter of the Achilles tendon. Seventy-nine percent showed various intratendinous lesions of intermediate signal intensity on all pulse sequences. Twenty-one percent of patients had an enlargement of the Achilles tendon without intratendinous changes. CONCLUSIONS: Rheumatoid tendinopathy can be distinguished from degenerative tendinopathy in patients with chronic pain of the heel with MR imaging. Inflammation of the retrocalcaneal bursa and the absence of enlargement of the tendon combined with the presence of intratendinous signal alterations are characteristic findings of rheumatoid tendinopathy. NLM PUBMED CIT. ID: 9342119 SOURCE: Invest Radiol 1997 Oct;32(10):602-8 68

NLM CIT. ID: 97457528
TITLE: Clinical snapshot: plantar fasciitis. AUTHORS: Campbell-Giovaniello KJ AUTHOR AFFILIATION: Veterans Administration Outpatient Clinic, Redding, CA, USA. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9311337 SOURCE: Am J Nurs 1997 Sep;97(9):38-9 69

NLM CIT. ID: 97452806
TITLE: Plantar heel pain in the adult. AUTHORS: Hurwitz SH AUTHOR AFFILIATION: Department of Orthopedics, University of Virginia Health Sciences Center, Charlotiesville, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The search for the cause of subcalcaneal heel pain involves a range of elements from the height of the patient's shoe heels to the presence of concomitant disease. Heel pain that interferes with daily activities, particularly when mobility is a job requirement, worries the patient and challenges the clinician. However, most patients improve with or without treatment. NLM PUBMED CIT. ID: 9307596 SOURCE: Hosp Pract (Off Ed) 1997 Sep 15;32(9):81-3, 86-8, 91-2 70

NLM CIT. ID: 97436872
TITLE: Anatomical factors associated with overuse sports injuries. AUTHORS: Krivickas LS AUTHOR AFFILIATION: Harvard Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Overuse injuries develop when repetitive stress to bone and musculotendinous structures damages tissue at a greater rate than that at which the body can repair itself. A combination of extrinsic factors, such as training errors and environmental factors, and intrinsic or anatomical factors, such as bony alignment of the extremities, flexibility deficits and ligamentous laxity, predispose athletes to develop overuse injuries. Malalignant of the lower extremity, including excess femoral anteversion, increased Q angle, lateral tibial torsion, tibia vara, genu varum or valgum, subtalar varus and excessive pronation are frequently cited as predisposing to knee extensor mechanism overuse injuries. These and other forms of malalignment have also been implicated in iliotibial band syndrome, medial tibial stress syndrome, lower extremity stress fractures and plantar fasciitis. Muscle inflexibility aggravates and predisposes to the development of a variety of overuse injuries, especially those occurring in children and adolescents, including the traction apophysitises. Flexibility deficits may be improved by an appropriate stretching programme. Unfortunately, lower extremity malalignment is less amenable to intervention. Orthotics are often prescribed to improve lower extremity alignment. However, studies have not shown that orthotics have any effect on knee alignment and, while they can alter subtalar joint alignment, the clinical benefit of this remains unclear. Awareness of anatomical factors that may predispose to overuse injuries allows the clinician to develop individual prehabilitation programmes designed to decrease the risk of overuse injury. In addition, the clinician can advise the athlete on the importance of avoiding extrinsic factors that may also predispose to overuse injury. NLM PUBMED CIT. ID: 9291553 SOURCE: Sports Med 1997 Aug;24(2):132-46 71

NLM CIT. ID: 97395411
TITLE: Fortnightly review. Plantar fasciitis. AUTHORS: Singh D; Angel J; Bentley G; Trevino SG AUTHOR AFFILIATION: Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL NLM PUBMED CIT. ID: 9251550 SOURCE: BMJ 1997 Jul 19;315(7101):172-5 72

NLM CIT. ID: 97401231
TITLE: Infracalcaneal heel pain in the athlete. AUTHORS: Agostinelli J; Ross JA AUTHOR AFFILIATION: Orthopedics/Podiatry Services, Eglin Air Force Base, Florida, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel-spur syndrome is a condition encountered on a daily basis by those practitioners who primarily treat athletes. The authors discuss anatomy, the clinical examination, radiographic evaluation, exercise, and alternative medicines. NLM PUBMED CIT. ID: 9257037 SOURCE: Clin Podiatr Med Surg 1997 Jul;14(3):503-9 73

NLM CIT. ID: 97396647
TITLE: Treatment of plantar fasciitis with night splint and shoe modifications consisting of a steel shank and anterior rocker bottom [letter; comment] AUTHORS: Ng A COMMENTS: Comment on: Foot Ankle Int 1996 Dec;17(12):732-5 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9252820 SOURCE: Foot Ankle Int 1997 Jul;18(7):458 74

NLM CIT. ID: 97396634
TITLE: Endoscopic plantar fascia release: a cross-sectional anatomic study. AUTHORS: Reeve F; Laughlin RT; Wright DG AUTHOR AFFILIATION: Wright State University, Department of Orthopaedic Surgery, Dayton, Ohio 45409, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Endoscopic plantar fascia release is a new procedure proposed to treat heel pain and plantar fasciitis. The purpose of this study was to assess the structures at risk during plantar fascia release using this method. Ten fresh-frozen cadaver feet were divided into two groups. All specimens underwent cannula placement inferior to the plantar fascia. Five-of the specimens had plantar fascia release using the endoscopic technique. Six of the specimens were then frozen and cut in transverse, sagittal, and coronal sections to visualize the relationship between the cannula and plantar fascia and surrounding structures. Gross dissection was performed on the remaining four specimens. The amount of plantar fascia released, the relationship to the nerve to abductor digiti minimi, and the fascia of the abductor hallucis muscle were assessed. The average distance from the cannula margin to the nerve to the abductor digiti minimi was 6 mm at the medial border of the plantar fascia. The average amount of plantar fascia released was 90%. Although a complete release was attempted, the fascia to the abductor hallucis was not released in any of the specimens. The nerve to the abductor digiti minimi was not damaged in any of the specimens. On coronal sections, the nerve was closer to the cannula and plantar fascia release than previously reported. NLM PUBMED CIT. ID: 9252807 SOURCE: Foot Ankle Int 1997 Jul;18(7):398-401 75

NLM CIT. ID: 97344828
TITLE: An inexpensive "orthosis" for plantar fasciitis [letter] [see comments] AUTHORS: White AD COMMENTS: Comment in: Med J Aust 1997 Nov 3;167(9):509 PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 9201195 SOURCE: Med J Aust 1997 Jun 2;166(11):616 76

NLM CIT. ID: 97338957
TITLE: Isolated peripheral enthesitis and/or dactylitis: a subset of psoriatic arthritis. AUTHORS: Salvarani C; Cantini F; Olivieri I; Macchioni P Niccoli L; Padula A; Ferri S; Portioli I AUTHOR AFFILIATION: Unita Reumatologica, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. PUBLICATION TYPES: JOURNAL ARTICLE MULTICENTER STUDY
ABSTRACT: OBJECTIVE: To identify isolated peripheral enthesitis and/or dactylitis as a subset of psoriatic arthritis (PsA) and to define the clinical characteristics of these patients. METHODS: We examined 401 unselected patients with PsA seen in 3 Italian rheumatological centers over a 6 month period. The diagnosis of PsA was based upon the clinical experience of a rheumatologist. The clinical features of patients with PsA were assessed by clinical examination and review of the patients' charts, evaluating the presence of peripheral arthritis, spinal involvement, dactylitis, and enthesitis. A series of 483 rheumatological patients without psoriasis and spondyloarthropathy (European Spondylarthropathy Study Group criteria) seen consecutively in a one month period constituted the control group. RESULTS: 14 patients (3.5%) presented isolated episodes of peripheral enthesitis and/or dactylitis. No patient developed peripheral arthritis and/or axial involvement during the followup period (median 30 mo; range 3-72 mo). 10/14 patients (71%) presented at least one episode of finger and/or toe dactylitis. 5 of these 10 patients (50%) had additional episodes of peripheral enthesitis (Achilles tendinitis, plantar fasciitis, and posterior tibial tendinitis). Episodes of Achilles tendinitis and/or plantar fasciitis were present in 8/14 patients (57%). 3 of these 8 patients (37%) had associated peripheral enthesitis in other sites as well: lateral epicondyle, insertion of the patella tendon into the inferior pole of the patella, femoral quadriceps, and posterior tibial tendons. An additional case had posterior tibial tendinitis and 2 episodes of toe dactylitis. None of these 14 cases presented radiological evidence of sacroiliitis and only one of the 13 typed was HLA-B27 positive. 12 patients (2.4%) of the control group had episodes of peripheral enthesitis (11 plantar fasciitis and one Achilles tendinitis). No patient had episodes of dactylitis. The frequency of isolated Achilles tendinitis and/or dactylitis was significantly higher in patients with PsA compared to controls (3.5 vs 0.2%; p = 0.001). CONCLUSION: In some patients PsA can occur only with peripheral enthesitis, particularly Achilles tendinitis, and/or dactylitis. These patients may represent a subset of PsA, not defined by Moll and Wright and spondyloarthritis classification criteria, and poorly recognized in the studies on PsA. NLM PUBMED CIT. ID: 9195517 SOURCE: J Rheumatol 1997 Jun;24(6):1106-10 77

NLM CIT. ID: 97329754
TITLE: Effect of cutting the plantar fascia on mechanical properties of the foot. AUTHORS: Arangio GA; Chen C; Kim W AUTHOR AFFILIATION: Department of Surgery, Lehigh Valley Hospital, Allentown, PA, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A biomechanical model was used to calculate the loadbearing characteristics of the plantar fascia and to determine the effect of cutting the plantar fascia on the stiffness of the foot. With a load of 683 N applied to the foot, the model predicted a 17% increase in vertical displacement and a 15% increase in horizontal elongation when the plantar fascia was cut, compared with the corresponding value when the plantar fascia was intact. Plantar fasciotomy, although clinically satisfactory in cases of recalcitrant heel pain, decreases the stiffness of the foot and creates a less rigid and more deformable arch. The biomechanical model described can help to evaluate the possible outcome of such a procedure. NLM PUBMED CIT. ID: 9186224 SOURCE: Clin Orthop 1997 Jun;(339):227-31 78

NLM CIT. ID: 97376392
TITLE: Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. AUTHORS: Sollitto RJ; Plotkin EL; Klein PG; Mullin P AUTHOR AFFILIATION: Saddle Brook Surgicenter, NJ 07663, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In this paper the authors discuss plantar fascial heel pain, including its etiology and treatment. The results of a retrospective study using radiofrequency lesioning on plantar fascial heel pain are presented and discussed. Thirty-nine patients were treated with radiofrequency lesioning, and 92% of the patients experienced complete resolution of symptoms following the procedure. NLM PUBMED CIT. ID: 9232502 SOURCE: J Foot Ankle Surg 1997 May-Jun;36(3):215-9; discussion 256 79

NLM CIT. ID: 97310910
TITLE: Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. AUTHORS: Gudeman SD; Eisele SA; Heidt RS Jr; Colosimo AJ Stroupe AL AUTHOR AFFILIATION: Specialty Centers for Orthopaedic & Rehabilitative Excellence, Indianapolis, Indiana, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Steroidal) 50-02-2 (Dexamethasone)
ABSTRACT: Plantar fasciitis is a common problem in running sports. This study was undertaken to determine whether iontophoresis of dexamethasone in conjunction with other traditional modalities provides more immediate pain relief than traditional modalities alone. Forty affected feet were randomly assigned to one of two groups. Group I feet were treated with traditional modalities and placebo iontophoresis. Group II feet received the traditional modalities plus iontophoresis of dexamethasone. Both groups were treated six times over 2 weeks. The subjects' clinical course was assessed using the Maryland Foot Score. At the conclusion of treatment, Group II patients had significantly greater improvement than Group I patients (increase on Maryland Foot Score of 6.8 +/- 5.6 for Group II and 3.1 +/- 4.1 for Group I). However, at followup 1 month after completion of treatment there was no significant difference between groups (increase of 5.6 +/- 8.0 for Group I and 7.4 +/- 6.3 for Group II). These results suggest that although traditional modalities alone are ultimately effective, iontophoresis in conjunction with traditional modalities provides immediate reduction in symptoms. Based on these results, iontophoresis of dexamethasone for plantar fasciitis should be considered when more immediate results are needed (i.e., performance athletes and active patients. NLM PUBMED CIT. ID: 9167809 SOURCE: Am J Sports Med 1997 May-Jun;25(3):312-6 80

NLM CIT. ID: 97301995
TITLE: Effect of systemic and intrathecal morphine in a rat model of postoperative pain [see comments] AUTHORS: Zahn PK; Gysbers D; Brennan TJ AUTHOR AFFILIATION: Department of Anesthesia, University of Iowa, Iowa City 52242-1009, USA. COMMENTS: Comment in: Anesthesiology 1997 May;86(5):1015-7 PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Analgesics, Opioid) 57-27-2 (Morphine)
ABSTRACT: BACKGROUND: To learn more about persistent pain after an incision, a rat model for postoperative pain has been developed. To further evaluate this model, the authors examined the effect of intrathecal (IT) and subcutaneous (SC) morphine, effective for postoperative pain relief in patients, on pain behaviors immediately after surgery and 1 day after surgery. METHODS: Rats were anesthetized with halothane, and a 1-cm incision was made in the plantar aspect of the foot and closed. After recovery, the rats were placed on an elevated plastic mesh floor, and withdrawal threshold was determined using calibrated von Frey filaments (15-522 mN) applied from beneath the test cage to an area adjacent to the wound at the heel. Pain behaviors also were assessed using the response frequency to a nonpunctate mechanical stimulus and a cumulative pain score. RESULTS: Mechanical hyperalgesia and nonevoked pain behaviors were present on the day of surgery and 1 day after surgery. Administration of either SC (0.3-3.0 mg/kg) or IT (0.16-5.0 micrograms) morphine reversibly increased the withdrawal threshold. The response frequency to the nonpunctate stimulus and the nonevoked pain scores also were decreased by 3 mg/kg of SC or 5 micrograms of IT morphine. Naloxone (1 mg/kg) reversed morphine-produced hypoalgesia. CONCLUSION: This is the first study to demonstrate that mechanical hyperalgesia to a nonpunctate stimulus occurs after a surgical incision in the rat. This rat model of postoperative has several similarities to postoperative patients: mechanical hyperalgesia to punctate and nonpunctate stimuli, nonevoked pain, and pain behaviors inhibited by SC and IT morphine. This model also may be useful for predicting analgesia by investigational agents for postoperative pain. NLM PUBMED CIT. ID: 9158356 SOURCE: Anesthesiology 1997 May;86(5):1066-77 81

NLM CIT. ID: 97293753
TITLE: The painful foot, Part II: Common rearfoot deformities. AUTHORS: Van Wyngarden TM AUTHOR AFFILIATION: University of Kansas Medical Center, Kansas City, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: As with deformities of the forefoot, deformities of the rearfoot often respond well to conservative therapy. Rest and nonsteroidal anti- inflammatory medications are often used. Patients with plantar fasciitis may benefit from corticosteroid injections. Surgery may be helpful in refractory cases. Haglund's deformity is associated with pain in the area of the osseous ridge on the posterosuperior aspect of the calcaneus. The retrocalcaneal bursa may be inflamed. This disorder is diagnosed by palpation of the painful area. Conservative treatment consists of minimizing pressure over the osseous ridge. Corticosteroid injection is not advised since it may weaken the Achilles tendon. Surgical intervention consists of resection or reduction of the osseous ridge. Posterior calcaneal spur is another cause of heel pain. The spur can be visualized radiographically in the tendon insertion. Treatment is conservative, with footgear modification and nonsteroidal anti- inflammatory drug therapy. Surgery to remove the spur may be indicated if conservative measures fall to relieve the pain. Tarsal tunnel syndrome is characterized by pain and numbness from the medial malleolus to the sole of the foot. Conservative treatment includes reducing abnormal pronation with an orthosis. NLM PUBMED CIT. ID: 9149647 SOURCE: Am Fam Physician 1997 May 1;55(6):2207-12 82

NLM CIT. ID: 97281596
TITLE: Diagnostic imaging of heel pain and plantar fasciitis. AUTHORS: DiMarcangelo MT; Yu TC AUTHOR AFFILIATION: Department of Diagnostic Radiology and Nuclear Medicine, Cooper Hospital/University Medical Center, Camden, New Jersey, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain or calcaneodynia is a common clinical complaint which has a myriad of causes ranging from plantar fasciitis to stress fracture. In many instances, the etiology of the heel pain is difficult to ascertain simply on the basis of history and physical examination. Therefore, the clinician may enlist various diagnostic imaging modalities to clarify the source of pain. Of all the imaging techniques, magnetic resonance imaging (MRI) has proven its worth in the diagnosis of heel pain. This article outlines the various causes of heel pain and their associated imaging findings. NLM PUBMED CIT. ID: 9135904 SOURCE: Clin Podiatr Med Surg 1997 Apr;14(2):281-301 83

NLM CIT. ID: 97272408
TITLE: Heel anatomy for retrograde tibiotalocalcaneal roddings: a roentgenographic and anatomic analysis. AUTHORS: Flock TJ; Ishikawa S; Hecht PJ; Wapner KL AUTHOR AFFILIATION: Lewiston Orthopaedic Associates, P.A., Bryden Canyon Center, Idaho 83501, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: There is an increased interest in load-sharing devices for tibiotalocalcaneal arthrodesis. Although the neurovascular anatomy of the heel has been well described, the purpose of this study is to consider heel anatomy as it relates to plantar heel incisions and to well-defined fluoroscopic landmarks to prevent complications during these procedures. Twenty lateral radiographs of normal feet while standing were evaluated by two observers. The distance from the calcaneocuboid (CC) joint to a line parallel to the center of the intramedullary canal of the tibia was calculated. In the second part of the study, 14 dissections of the arterial and neural anatomy were performed. The distances from the CC joint to structures crossing the heel proximal to the CC joint were studied. In the 20 standing radiographs, the mean distance from the CC joint to the middle of the intramedullary canal of the tibia was 2.1 cm (standard deviation, 0.55 cm). In the dissections, the only artery or nerve found to cross the plantar surface proximal to the CC joint was the nerve to the abductor digiti quinti (NAbDQ). The mean distance from the CC joint to the NAbDQ was 3.1 cm (standard deviation, 1.36 cm). Assuming reaming to 12 mm, NAbDQ would be at risk 42% of the time. We recommend careful dissection of the heel during retrograde roddings to avoid damage to NAbDQ and subsequent neurogenic heel pain. NLM PUBMED CIT. ID: 9127114 SOURCE: Foot Ankle Int 1997 Apr;18(4):233-5 84

NLM CIT. ID: 97232439
TITLE: Plantar fasciitis: US evaluation [letter; comment] AUTHORS: Gibbon W; Long G COMMENTS: Comment on: Radiology 1996 Oct;201(1):257-9 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9122410 SOURCE: Radiology 1997 Apr;203(1):290 85

NLM CIT. ID: 97257568
TITLE: Radiographs in heel pain [letter; comment] AUTHORS: Devitt N COMMENTS: Comment on: Bull Rheum Dis 1996 Jun;45(4):1-3 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9104042 SOURCE: Bull Rheum Dis 1997 Apr;46(2):1 86

NLM CIT. ID: 97234118
TITLE: Immobilizing heel pain in a runner [see comments] AUTHORS: Sack KE AUTHOR AFFILIATION: Clinical Programs in Rheumatology, University of California, San Francisco, USA. COMMENTS: Comment in: Hosp Pract (Off Ed) 1997 May 15;32(5):25-6 PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9078986 SOURCE: Hosp Pract (Off Ed) 1997 Mar 15;32(3):243 87

NLM CIT. ID: 97266502
TITLE: [Extracorporeal shock-wave therapy. Experimental basis, clinical application] VERNACULAR
TITLE: Extrakorporale Stosswellentherapie. Experimentelle Grundlagen, klinischer Einsatz. AUTHORS: Rompe JD; Kullmer K; Vogel J; Eckardt A; Wahlmann U Eysel P; Hopf C; Kirkpatrick CJ; Burger R; Nafe B AUTHOR AFFILIATION: Orthopadische Universitatsklinik Mainz. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGES: Ger
ABSTRACT: The purpose of our studies was to investigate experimentally the dose- dependent effects of extracorporeal shock waves on tendon and bone and to unveil therapeutic possibilities in tendinopathies and pseudarthroses. In animal experiments, both positive and negative influences were exerted by shock waves, depending on the initial situation and on the power of the applied shock waves. In prospective clinical trials positive effects were found in the treatment of persistent tennis elbow, plantar fasciitis, calcifying tendinitis, and pseudarthrosis. Our data show that extracorporeal shock waves may provide analgesic, resorptive and osteo-inductive reactions with nearly no side effects. However, the high cost of apparatus and staff prevents a routine application. Extracorporeal shock waves thus remain a last alternative before the indication is made for an operative procedure. NLM PUBMED CIT. ID: 9198795 SOURCE: Orthopade 1997 Mar;26(3):215-28 88

NLM CIT. ID: 97227145
TITLE: Repetitive strain injury to the foot in elite women kendoka. AUTHORS: Nunn NR; Dyas JW; Dodd IP AUTHOR AFFILIATION: Cheltenham and Gloucester College of Higher Education, United Kingdom. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To account for the apparent high incidence of pain in the feet of elite women kendo players. METHODS: A clinical evaluation was done by a chiropractor, the women were interviewed about their kendo experience, and the conditions and frequency of training and ground reaction forces were measured on a Kistler force plate during the kendo attacking action. RESULTS: Four out the five women presented with plantar fasciitis. They had all practised for some time on wooden floors laid on concrete, for between two to four hours a week. They warmed up conscientiously but cool down was more cursory. The force plate results showed that they were hitting the floor with a mean force of four times body weight during a transient impact. CONCLUSIONS: High motivation for practice and training, hard floors, ignoring painful feet, and cursory postpractice cool down probably produced the condition. Postpractice icing and stretching were found to be most effective in the short term. In the longer term reducing the level of impact, either by training on sprung floors or changing the footwork, might reduce the incidence and intensity of the fasciitis. NLM PUBMED CIT. ID: 9132217 SOURCE: Br J Sports Med 1997 Mar;31(1):68-9 89

NLM CIT. ID: 97328875
TITLE: A prospective study of Plantar fasciitis in Harare. AUTHORS: Chigwanda PC AUTHOR AFFILIATION: Department of Surgery, University of Zimbabwe Medical School, Avondale, Harare, Zimbabwe. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Steroidal) 53-36-1 (Depo-Medrol) 83-43-2 (Methylprednisolone)
ABSTRACT: OBJECTIVES: 1. To determine the sex distribution of Plantar fasciitis in Harare. 2. To determine the presence or absence of a calcaneal spur and its role in causation and hence treatment. 3. To determine unilateral or bilateral involvement. 4. To determine the response to steroidal injection. 5. To determine the role of occupation and/or activities if any. DESIGN: Patients presenting with heel pad pain were carefully examined, the age, sex and occupation recorded. They were followed up at two weekly intervals following treatment. SETTING: This prospective study was carried out at a private surgery in a low density suburb. Most patients were referred by their general practitioners and some by patients who had been treated successfully. A few were referred from towns in and around Mashonaland Central Province. SUBJECTS: All patients had to satisfy the diagnosis of Plantar fasciitis. Those presenting with well known causes of pain in and around the heel were excluded. INTERVENTIONS: All patients had radiographs of both heels requested. The painful heels were injected in the office with 80 mg of depo-medrol plus three to four mls of plain lignocaine using the lateral approach. RESULTS: The majority of patients (90%) were female, the mean age 48.5 years. Most patients (60%) had no calcaneal spur, 64% had unilateral disease and this was predominantly left-sided. 94% had relief of their symptoms following a single injection. CONCLUSIONS: In this study there were more females treated for Plantar fasciitis, the majority responded to a single injection. The role of occupation and/or activities require further study. NLM PUBMED CIT. ID: 9185376 SOURCE: Cent Afr J Med 1997 Jan;43(1):23-5 90

NLM CIT. ID: 97162572
TITLE: Lower extremity injuries at the New York City Marathon. AUTHORS: Caselli MA; Longobardi SJ AUTHOR AFFILIATION: Department of Orthopedics, New York College of Podiatric Medicine, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The purpose of this study was to determine the type and frequency of lower extremity running injuries incurred by athletes participating in the New York City Marathon. A survey was conducted of 265 athletes presenting to medical stations for podiatric care during the 1994 New York City Marathon. The results of the survey indicated that the most common injuries occurring in marathon runners were corns, calluses, blisters, muscle cramps, acute knee and ankle injuries, plantar fasciitis, and metatarsalgia. An inverse relationship was observed between the number of miles trained per week and the number of injuries. These findings are consistent with long-term studies of running injuries. NLM PUBMED CIT. ID: 9009547 SOURCE: J Am Podiatr Med Assoc 1997 Jan;87(1):34-7 91

NLM CIT. ID: 97162568
TITLE: Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain. AUTHORS: Caselli MA; Clark N; Lazarus S; Velez Z; Venegas L AUTHOR AFFILIATION: Department of Orthopedic Sciences, New York College of Podiatric Medicine, NY, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: The effect of a magnetic foil placed in the PPT/Rx Firm Molded Insole on the relief of heel pain was determined using the foot function index. Nineteen patients wore the PPT/Rx Firm Molded Insoles with the magnetic foil for 4 weeks and 15 patients wore the same PPT/Rx Firm Molded Insole with no magnetic foil for the same time. Approximately 60% of patients in both groups reported improvement. There was also no significant difference in the improvement between the magnetic foil group and the PPT/Rx Firm Molded Insole group in their scores on the post-treatment foot function index. These results suggest that the PPT/Rx Firm Molded Insole alone was effective in treating heel pain after only 4 weeks. The magnetic foil offered no advantage over the plain insole. NLM PUBMED CIT. ID: 9009543 SOURCE: J Am Podiatr Med Assoc 1997 Jan;87(1):11-6 92

NLM CIT. ID: 97164266
TITLE: Heel pain as the inaugural manifestation of metastatic prostate cancer [letter] AUTHORS: Gisserot O; Jaureguiberry JP; Carli P; Paris JF Jaubert D; Chagnon A PUBLICATION TYPES: LETTER REVIEW REVIEW OF REPORTED CASES NLM PUBMED CIT. ID: 9010979 SOURCE: Rev Rhum Engl Ed 1996 Dec;63(11):870-1 93

NLM CIT. ID: 97129386
TITLE: Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom [see comments] AUTHORS: Mizel MS; Marymont JV; Trepman E AUTHOR AFFILIATION: Department of Orthopaedics, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. COMMENTS: Comment in: Foot Ankle Int 1997 Jul;18(7):458 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Seventy-one feet in 57 patients with plantar fasciitis were treated with the combination of a night splint and a shoe modification consisting of a steel shank and anterior rocker bottom. At average follow-up of 16 months, symptoms were resolved in 42 (59%), improved in 13 (18%), not changed in 11 (15%), and worse in 5 (7%) of the feet. No relation was found between outcome and age, gender, duration of symptoms, and bilateral involvement. The method is effective for the treatment of plantar fasciitis. NLM PUBMED CIT. ID: 8973894 SOURCE: Foot Ankle Int 1996 Dec;17(12):732-5 94

NLM CIT. ID: 97070234
TITLE: Operative treatment of subcalcaneal pain. AUTHORS: Tountas AA; Fornasier VL AUTHOR AFFILIATION: Division of Orthopaedic Surgery, Northwestern General Hospital, Toronto, Canada. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Twenty of 21 consecutive patients (21 heels) with subcalcaneal pain retractory to conservative treatment managed by resection of the proximal attachment of the plantar fascia and the heel spur, if present, were reviewed retrospectively. The results, at a mean followup of 40 months (range, 12-102 months), using a 100 point scoring system, rated excellent in 8 patients, good in 10, fair in 1, and poor in 1 (90% satisfactory outcome). Time to maximal improvement often was prolonged, yet once reached was maintained over time. The only complication encountered was 1 superficial wound infection. Radiographically it was noted that, despite complete excision, subcalcaneal exostoses often reformed and the fascial transection never did precipitate collapse of the longitudinal arch of the foot. A combination of mucoid and fibrinoid degeneration of the plantar fascia, an acceleration of an age related process, was the principal histopathologic finding. It was concluded that the subcalcaneal pain unresponsive to conservative modalities can be treated effectively by the index procedure. The radiographic and histologic findings of this study suggest that changes within the fascia, rather than the spur, are primarily responsible for the pathogenesis of the syndrome. NLM PUBMED CIT. ID: 8913160 SOURCE: Clin Orthop 1996 Nov;(332):170-8 95

NLM CIT. ID: 97056014
TITLE: Sever's disease and other causes of heel pain in adolescents. AUTHORS: Madden CC; Mellion MB AUTHOR AFFILIATION: University of Nebraska Medical Center, Omaha, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Sever's disease, or apophysitis of the calcaneus, is a common but frequently undiagnosed source of heel pain in young athletes. This condition frequently occurs before or during the peak growth spurt in boys and girls, often shortly after they begin a new sport or season. Sever's disease often occurs in running and jumping sports, particularly soccer. Patients present with intermittent or continuous heel pain occurring with weight bearing. Findings include a positive squeeze test and tight heel cords. Sever's disease cannot be diagnosed radiographically. The condition usually resolves two weeks to two months after the initiation of conservative treatment, which may include rest, ice application, heel lifts, stretching and strengthening exercises, and, in more severe cases, nonsteroidal anti-inflammatory drugs. NLM PUBMED CIT. ID: 8900359 SOURCE: Am Fam Physician 1996 Nov 1;54(6):1995-2000 96

NLM CIT. ID: 96413393
TITLE: Plantar fasciitis: sonographic evaluation [see comments] AUTHORS: Cardinal E; Chhem RK; Beauregard CG; Aubin B Pelletier M AUTHOR AFFILIATION: Department of Radiology, Saint-Luc Hospital, Montreal, Quebec, Canada. COMMENTS: Comment in: Radiology 1997 Apr;203(1):290 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: PURPOSE: To evaluate the sonographic findings of plantar fasciitis. MATERIALS AND METHODS: Both feet of 15 patients who had a clinical diagnosis of plantar fasciitis were evaluated with ultrasound (US) by using a 7.0-MHz linear-array transducer. Heel pain was unilateral in 11 patients and bilateral in four. Sagittal sonograms were obtained, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other observations included hypoechoic fascia, fiber rupture, perifascial fluid collections, and calcifications. Both feet of 15 healthy volunteers were also evaluated as a control group. RESULTS: Plantar fascia thickness was significantly increased in the heels in patients with plantar fasciitis (3.2-6.8 mm; mean, 5.2 mm +/- 1.13) compared with their asymptomatic heels (2.0-4.0 mm; mean, 2.9 mm +/- 0.70) (P < .0001) and compared with the heels of the patients in the control group (1.6-3.8 mm; mean, 2.6 mm +/- 0.48) (P < .0001). The proximal plantar fascia of 16 (84%) symptomatic heels were diffusely hypoechoic compared with none of the patients' asymptomatic heels and only one heel of a patient in the volunteer group. No fascia rupture, perifascial fluid collection, or calcifications were identified. CONCLUSION: Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. US may be a valuable noninvasive technique for the diagnosis of plantar fasciitis. NLM PUBMED CIT. ID: 8816554 SOURCE: Radiology 1996 Oct;201(1):257-9 97

NLM CIT. ID: 97041507
TITLE: Outcome of nonsurgical treatment for plantar fasciitis [published erratum appears in Foot Ankle Int 1996 Nov;17(11):722] AUTHORS: Gill LH; Kiebzak GM AUTHOR AFFILIATION: Miller Orthopaedic Clinic, Charlotte, North Carolina 28203, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis. NLM PUBMED CIT. ID: 8886778 SOURCE: Foot Ankle Int 1996 Sep;17(9):527-32 98

NLM CIT. ID: 97041506
TITLE: Surgical treatment of recalcitrant plantar fasciitis. AUTHORS: Sammarco GJ; Helfrey RB AUTHOR AFFILIATION: Center for Orthopaedic Care, Inc., Cincinnati, Ohio 45219, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Twenty-six patients (35 feet) underwent partial plantar fasciectomy with neurolysis of the nerve to the abductor digiti quinti muscle. Nonsurgical treatment for plantar fasciitis had been unsuccessful in these patients. Patients were followed after surgery for an average of 37.5 months. Six patients were male and 20 patients were female; the average age was 49 years. All patients had failed to respond to nonsurgical treatment for an average of 21.5 months. In addition to routine history and physical examination patients were evaluated before and after surgery with a subjective foot rating system, and a detailed questionnaire was used to assess post-operative functional outcome. Thirty-two patients (92%) had a satisfactory functional outcome, and three patients (8%) had an unsatisfactory result (21 excellent, 11 good, 3 fair, 0 poor). The Maryland Foot Score increased from a preoperative average of 74.8/100 points to a postoperative average of 90.6/100 points. Four patients (11%) had postoperative complications, including superficial wound infection (two patients), deep venous thrombosis (one patient), and superficial phlebitis (one patient), all of which resolved uneventfully with treatment. Ten patients (28.6%) reported some degree of heel pain after surgery. All 10 patients denied limitation in activity related to postoperative pain. The average period before return to daily activity and restricted work duty was 5.6 weeks and to full work duty without restriction was 8.7 weeks. Although the length of time for partial or complete resolution of symptoms is variable, a successful treatment outcome can be expected in most patients who are treated for recalcitrant plantar fasciitis. NLM PUBMED CIT. ID: 8886777 SOURCE: Foot Ankle Int 1996 Sep;17(9):520-6 99

NLM CIT. ID: 97040212
TITLE: Retrospective review of endoscopic plantar fasciotomy--1992 through 1994. AUTHORS: Stone PA; Davies JL AUTHOR AFFILIATION: Presbyterian/St. Luke's Podiatric Surgical Residency Program, Denver, CO, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Endoscopic plantar fasciotomy is a rewarding procedure for both patient and surgeon. A vast majority of the patients have complete or near- complete resolution of heel pain at 6 months postoperatively. The procedure, however, is not without side effects and complications. This retrospective statistical study describes the postoperative side effects and complications of endoscopic plantar fasciotomy from 1992 to 1994. The procedure has been modified in an attempt to reduce several of the more commonly reported side effects. NLM PUBMED CIT. ID: 8885603 SOURCE: J Am Podiatr Med Assoc 1996 Sep;86(9):414-20 100

NLM CIT. ID: 96378608
TITLE: Evaluation of pediatric foot problems: Part II. The hindfoot and the ankle. AUTHORS: Manusov EG; Lillegard WA; Raspa RF; Epperly TD AUTHOR AFFILIATION: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The bony development of the growing child can lead to a variety of hindfoot and ankle problems. Overuse injuries are common, often occurring in conjunction with symptomatic pes planus and plantar fasciitis. Predisposing structural differences such as Haglund's disease, os trigonum, rigid and flexible pes planus, and Sever's disease merit special attention, but treatment may require only patient education and conservative management. Sprains and fractures of growing joints, however, may have poor outcomes if ignored or missed. NLM PUBMED CIT. ID: 8784171 SOURCE: Am Fam Physician 1996 Sep 1;54(3):1012-26, 1031 101

NLM CIT. ID: 97001920
TITLE: Acute injuries and specific problems in adult athletes. AUTHORS: Barry NN; McGuire JL AUTHOR AFFILIATION: Division of Immunology and Rheumatology, Stanford University Medical Center, California, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Special considerations need to be given to specific groups of adult athletes. The most common problems and needs of female and older athletes are discussed in the first section of this article. The second section reviews the diagnosis and management of certain acute injuries most frequently encountered in adult athletes. The last section discusses the differentiation between tarsal tunnel syndrome and plantar fasciitis, chronic compartmental pressure syndrome and medial tibial stress syndrome ("shin sp