Heel Pain—Operative Results

Baxter, Donald E.; Thigpen, C. Mark

doi:10.1177/107110078400500103

Cited by 238 publications

(89 citation statements)

References 14 publications

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“…Although plantar fasciitis may resolve after a few weeks, in some patients symptoms may become chronic. The best management of chronic plantar fasciitis is not entirely agreed upon and a variety of conservative approaches as well as more invasive treatments has been suggested (13)(14)(15)(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Sonographic Evaluation of the Plantar Fascia in Asymptomatic Subjects

Gadalla

Kichouh²,

Boulet³

et al. 2014

Journal of the Belgian Society of Radiology

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Plantar fasciitis is a low-grade inflammation of the plantar fascia and perifascial tissues. It is a common cause of heel pain and usually affects middle-aged women, as well as younger, predominantly male, runners (1). The condition is likely related to repeated strain, leading to microtears and inflammation. Imaging is commonly used to confirm the diagnosis, and exclude other causes of posterior heel pain (2).Although MR imaging may be used to diagnose plantar fasciitis, many authors suggest ultrasound is an accurate, simple, and noninvasive technique to diagnose the condition. Previous investigators have reported that the most important diagnostic findings in plantar fasciitis are thickening and hypoechogenicity, and occasionally fluid collections adjacent to the fascia. Wall et al. (3) suggest that a plantar fascia thickness greater than 4 mm is consistent with plantar fasciitis. This value has been used as a reference value in several studies (4-6).To our knowledge, there are no data about the ultrasound appearance of the plantar fascia in asymptomatic subjects. Hence, it is not known if certain commonly used ultrasound criteria of plantar fasciitis might be seen in such a population. If so, this may entail the risk of attributing the patients' symptoms to a reference point where the plantar fascia crossed the anterior aspect of the inferior border of the calcaneus. The measurement points are indicated in the figures by calipers (Figs. 1-3). The plantar fascia was evaluated for echogenicity. It was only considered hypoechoic if its echogenicity was markedly decreased with respect to the subcutaneous heel fat. The plantar fascia was also assessed for presence of calcification defined as markedly hyperechoic foci, with or without acoustic shadowing, vascularity with Doppler, tear, and fluid adjacent to the fascia. The saved images were reviewed by 2 investigators. Statistical analysis was performed using a t-test (independent samples) (IBM SPSS Statistics 20, Armonk, NY). The significance threshold was set at p = 0.05. ResultsA total of 62 plantar fascias in 31 subjects (14 men, 17 women), aged from 17 to 79 years (mean age, 45 years) were evaluated ( Fig. 1-3). The results are shown in Tables I and II. The mean thickness of the plantar fascia in men was 3.7 mm (range, 2.5-7 mm), and in women 3.5 mm (range, 1.7-5.1 mm). There was no statistically significant difference between the thickness of the fascia in men and women (p = 0.21). There was no significant difference between the right and the left foot (p = 0.64).The thickness of the plantar fascia was greater than 4 mm in 4 men plantar fasciitis while other abnormalities may be overlooked and not further investigated. Therefore we decided to evaluate the plantar fascia in asymptomatic subjects with high resolution ultrasound. Materials and methodsInstitutional Review Board approval for our study was obtained and consent from the asymptomatic subjects. They were interviewed to confirm they had not been symptomatic at the sole of the foot. Other exclusion cr...

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Section: Discussionmentioning

confidence: 99%

Sonographic Evaluation of the Plantar Fascia in Asymptomatic Subjects

Gadalla

Kichouh²,

Boulet³

et al. 2014

Journal of the Belgian Society of Radiology

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“…This condition was considered to be rare. In the 1980's the identification of the lateral plantar nerve and its branches by Baxter and colleagues confirmed that the nerve could be entrapped at other sites [4]. In these individuals where the lateral plantar nerve or the calcaneal branch of the lateral plantar nerve is affected, patients can present with heel pain.…”

Section: Introductionmentioning

confidence: 83%

Tarsal Tunnel Syndrome—A New Way to Diagnose an Old Problem

O’Brien¹,

Byrden²

2017

WJNS

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Tarsal Tunnel Syndrome [TTS] is the most common lower limb focal neuropathy but it has a poor pick up rate in most Electrodiagnostic (EXD) Laboratories. There is no gold standard for assessing TTS. The tibial nerve has a complex branching system with 4 main branches and 9 different patterns of division. This study evaluated potential TTS with a similar and extensive assessment of the tibial nerve. The protocol involved 2 tibial motor studies to the Adductor Hallucis Longus (AH) and Adductor Digiti Quinti (ADQ) muscles, assessing amplitudes and distal latencies; medial plantar, lateral plantar and calcaneal sensory studies assessing amplitudes and distal latencies. A needle EMG to the tibial innervated AH and ADQ muscles was also performed. This protocol evaluated 12 different parameters which significantly increased the diagnostic yield. TTS has a low pick up rate using current standard assessment methods accounting for between 0.5% and 0.6% of positive cases referred to electrodiagnostic laboratories. This study had a pick up rate of 3.3% with 40 positive cases identified out of a population of 1210 patients referred to an electrodiagnostic laboratory in a calendar year. A combination of positive findings was observed. There were on average 4.3 positive parameters. The calcaneal sensory study and the needle EMG to the distal AH and ADQ muscles were the most sensitive tests. These 3 tests are not routinely performed in most labs. Of the 40 cases of TTS over 80% had a history of either prior injury or surgery to affected lower limb. This study suggests that this 12 parameter assessment will increase diagnostic sensitivity.

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“…Tedavide; uzunlamasına ark destekleyici ortezlerden, alçıya ve cerrahi tedavilere kadar çeşitli seçenekler mevcuttur. [17] Sedanter kişilerde konservatif yöntemler daha yoğun olarak tercih edilmektedir. Atletlerde ise tedavi yaklaşımları farklılık arz eder.…”

Section: Tedavi̇unclassified