Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary.

Introduction: A new regional anaesthetic technique, coined the pericapsular nerve group (PENG) block, targets the anterior hip capsule by blocking the articular branches of the femoral nerve and accessory obturator nerve. In this study, we evaluated: (1) patient outcomes; (2) postoperative pain scores; and (3) postoperative opioid consumption in total hip arthroplasty (THA) patients who received a PENG block in comparison to a control group. Methods: A retrospective chart review was performed for patients who underwent primary THA and met criteria at a single institution ( n = 48), with an additional cohort of patients collected as controls ( n = 48). Postoperative pain scores were measured by obtaining the cumulative visual analogue scores (VAS) at 12-hour intervals until the 48-hour benchmark. All administered opioids were collected from postoperative day (POD) 0 to POD2 and converted to morphine milligram equivalents (MME). Results: In the PENG group, length of stay was significantly shorter ( p  < 0.001) and the initial postoperative distance walked was significantly farther ( p = 0.001). The PENG group consistently demonstrated significantly lower mean cumulative pain scores until the 48-hour mark ( p  < 0.001 for all). Patients receiving the PENG block also experienced a significantly longer therapeutic window before requiring their first opioid ( p  < 0.002). The PENG group required significantly less opioid MMEs on POD1, POD2, and cumulatively over the entire stay ( p  < 0.022 for all). Conclusions: Our findings suggest that the PENG block has the potential of impacting THA recovery pathways and contributing to cost savings. Thus, its use further supports the transition to the outpatient setting and drives us towards achieving value-driven healthcare.

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Periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA) are serious orthopaedic complications that pose marked burdens to both patients and health care systems. At our institution, two-stage exchange with a temporary short antibiotic cement-coated intramedullary nail was utilized for the treatment of repeat PJIs in a series of compromised patients with considerable bone loss. This study reports on (1) success rates, (2) functional and pain outcomes, (3) and complications for patients receiving a temporary short intramedullary nail for the treatment of PJI. Our institutional database was queried for all repeat knee PJI patients between March 1st, 2009 and February 28th, 2015. Patients with type II/III Anderson Orthopaedic Research Institute (AORI) bone defects who underwent two-stage exchange arthroplasty with a short antibiotic-coated intramedullary nail were included for analysis (n = 31). Treatment success was determined using the Delphi-based consensus definition of a successfully treated PJI: infection eradication (healed wound with no recurrence of infection by the same organism), no further surgical intervention for infection after reimplantation, and no PJI-related mortality. A paired t-test was performed to assess for continuous variables. A total of 26 patients went on to reimplantation, while 5 patients retained the intramedullary nail. Overall treatment success was 74.2%. Range of motion significantly decreased postoperatively (102.1 vs. 87.3 degrees; p < 0.001), while Knee Society Scores (function) significantly increased (55.6 vs. 77.7, p < 0.001). A majority of patients were full weight-bearing immediately following surgery (38.7%). Treating poor health status patients with PJI of the knee can be difficult after multiple revisions. With a success rate similar to conventional methods, our results demonstrate that two-stage exchange with a temporary short intramedullary nail may be a desirable treatment option for patients with bony defects wishing to avoid amputation or permanent arthrodesis. However, this method does not outperform other treatment modalities, and may not be suitable for all patients. Patient expectations and health status should be carefully assessed to determine if this procedure is appropriate in this complex patient population.

Captain Tuckej'a Voyage to the Con^o. 8 MEMOIR I. microscope, and found to his surprise, that the anterior portion of the animal had changed its form, and on the fourth day it had acquired the appearance represented Plate I. fig. 1, 6, so that together with the other individuals he had taken, it seemed to have experienced a complete metamorphosis ; under this new form, the dorsal spine had disappeared, the front spine had become comparatively small, the antennae were rendered conspicuous, the feet and eyes were apparently more developed, and the tail had changed from forked to spatulate, fringed by a row of thirteen short spines. It will readily occur to the reader, that observations made in this way, upon aquatic animals at once so minute and so transparent, require the greatest cane and circumspection to insure any positive result; from much experience, the author is led to suppose, that Slabber lost his Zoeas in changing the sea water, and that the new form came from the added portion, a circumstance rendered more probable, by his having met with both these types at the same season of the year. It was during the spring of 1822, that the author to his great surprise, first met with Zoeas in the harbour of Cove, and that in considerable abundance ; the year following at the same season, one of considerable size occurred, amongst a great number of smaller ones, and jvidging it full grown, (PlatcII. fig.l, 2,) and a fit subject to keep for the purpose of witnessing the metamorphosis observed by Slabber, it was daily supplied with fresh sea water in the most careful manner, from May 14, until the 15th June, when it died in the act of changing its skin, and of passing into a new form, but one by no means similar to that expected, as appears evidently by its disengaged members (fig. 11.) which are changed in number, as well as in form, and now, correspond with those of the Decapoda, (Crabs, &c.) viz. five pair, the anterior of them furnished with a large claAv or pincer : the metamorphosis not having been completed, prevented any knowledge ON ZOEA, 8^c. 9 being-acquired of its general form, enough however lias been gained to shew, that the distinctive characters of Zoea, and of Slabbers changed Zoea, were entirely lost, that the members, from being natatory and cleft (as shall shortly be shown,) become simple, and adapted to crawling only. * The French have adopted the term Zoe for these atiiinals, whicli, as more simple, and better suited to the genius of our own language than the Latin, may be jjsed in familiar discourse without any impropriety. * ']'he peculiar stntctiire of tlio linili"5, l)ciiie sululividtxl into two, rcuders ucccssary this uiiauiliorizcd ajpliccitiwi) of fairs.