The Conundrum of Calcaneal Spurs

2013 ◽  
Vol 7 (2) ◽  
pp. 95-101 ◽  
Author(s):  
Paul J. Moroney ◽  
Barry J. O’Neill ◽  
Khalid Khan-Bhambro ◽  
Shay J. O’Flanagan ◽  
Peter Keogh ◽  
...  
Keyword(s):  
Plantar Fasciitis ◽  
Incidental Finding ◽  
Radiographic Finding ◽  
Heel Pain ◽  
Control Group ◽  
X Rays ◽  
Foot Pain ◽  
Level Of Evidence ◽  
Associated Conditions ◽  
And Control

Background: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. Methods: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). Results: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. Conclusion: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. Clinical relevance: We have demonstrated the relevance of a radiographic finding once considered irrelevant. Level of Evidence: Prognostic, Level III: Case-control study

scholarly journals A Randomised-Controlled Clinical Study Examining the Effect of High-Intensity Laser Therapy (HILT) on the Management of Painful Calcaneal Spur with Plantar Fasciitis

2021 ◽  
Vol 10 (21) ◽  
pp. 4891
Author(s):  
Piotr Tkocz ◽  
Tomasz Matusz ◽  
Łukasz Kosowski ◽  
Karolina Walewicz ◽  
Łukasz Argier ◽  
...  
Keyword(s):  
Pain Management ◽  
High Intensity ◽  
Plantar Fasciitis ◽  
Heel Pain ◽  
The Other ◽  
Control Group ◽  
Study Group ◽  
Calcaneal Spur ◽  
High Intensity Laser ◽  
Intensity Laser

Calcaneal spur and plantar fasciitis are the most common causes of plantar heel pain. There are many effective physical modalities for treating this musculoskeletal disorder. So far, the are no clear recommendations confirming the clinical utility of high-intensity laser therapy (HILT) in the management of painful calcaneal spur with plantar fasciitis. This study aimed to evaluate the effectiveness of HILT in pain management in patients with calcaneal spur and plantar fasciitis. A group of 65 patients was assessed for eligibility based on the CONSORT guidelines. This study was prospectively registered in the Australian New Zealand Clinical Trial Registry platform (registration number ACTRN12618000744257, 3 May 2018). The main eligibility criteria were: cancer, pregnancy, electronic and metal implants, acute infections, impaired blood coagulation, cardiac arrhythmias, taking analgesic or anti-inflammatory medications, non-experience of heel pain, or presence of other painful foot conditions. Finally, 60 patients were randomly assigned into two groups: study group (n = 30, mean age 59.9 ± 10.1), treated with HILT (7 W, 149.9 J/cm2, 1064 nm, 4496 J, 12 min), and placebo-controlled group (n = 30, mean age 60.4 ± 11.9), treated with sham HILT therapy. Both groups received ultrasound treatments (0.8 W/cm2, 1 MHz frequency, 100% load factor, 5 min). Treatment procedures were performed once a day, five times per week for three weeks (total of 15 treatment sessions). Study outcomes focused on pain intensity and were assessed before (M1) and after (M2) the treatment as well as after 4 (M3) and 12 (M4) weeks using the Visual Analogue Scale (VAS) and the Laitinen Pain Scale (LPS). According to VAS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.5 pts, M1 and M3 by 3.7 pts, and M1 and M4 by 3.2 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease (p < 0.001) between M1 and M2 by 3.0 pts, M1 and M3 by 3.4 pts, and M1 and M4 by 3.2 pts. According to LPS, a statistically significant decrease in the study group was observed between M1 and M2 by 3.9 pts, M1 and M3 by 4.2 pts, and M1 and M4 by 4.0 pts (p < 0.001). On the other hand, the control group showed a statistically significant decrease between M1 and M2 by 3.2 pts (p = 0.002), M1 and M3 by 4.0 pts (p < 0.001), and M1 and M4 by 3.9 pts (p < 0.001). However, there were no statistically significant differences between the groups in VAS and LPS (p > 0.05). In conclusion, the HILT does not appear to be more effective in pain management of patients with calcaneal spurs and plantar fasciitis than the conservative standard physiotherapeutic procedures.

scholarly journals Sonographic Evaluation of Plantar Fasciitis and its Relation to Body Mass Index and Heel Pad Thickness

2020 ◽  
Vol 9 (2) ◽  
pp. 32-39
Author(s):  
Prashant Khatiwada ◽  
Dinesh Chataut ◽  
Kamal Subedi
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Plantar Fasciitis ◽  
Plantar Fascia ◽  
Skin Surface ◽  
Control Group ◽  
Heel Pad ◽  
And Control ◽  
Calcaneal Tuberosity ◽  
Symptomatic Side

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT). Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity. Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p <0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p <0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels). Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

The Association between Diagnosis of Plantar Fasciitis and Windlass Test Results

2003 ◽  
Vol 24 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Denise De Garceau ◽  
Danielle Dean ◽  
Susan Mais Requejo ◽  
David B. Thordarson
Keyword(s):  
Plantar Fasciitis ◽  
The Other ◽  
High Rate ◽  
Control Group ◽  
Test Results ◽  
Foot Pain ◽  
Positive Test Result ◽  
Pain Group ◽  
Test Result ◽  
Low Rate

Twenty-two patients with plantar fasciitis, 23 patients with other types of foot pain, and 30 patients in a control group were evaluated with the Windlass test performed in a weightbearing and non-weightbearing position. In the non-weightbearing test, the first MP joint was maximally dorsiflexed with the ankle stabilized. The weightbearing test was performed with the toes hanging off the edge of a stool and dorsiflexion of the first MP was performed. Seven of the 22 patients in the plantar fasciitis group had a positive weightbearing Windlass test (31.8%), while only three had a positive test result in a non-weightbearing position (13.6%). None of the patients in the other foot pain group or control group had pain in the weightbearing and non-weightbearing positions. Despite its high rate of specificity, the low rate of sensitivity of the Windlass test may limit its usefulness in the clinical evaluation in patients with plantar fasciitis.

scholarly journals VYC-25L Hyaluronic Acid Injectable Gel Is Safe and Effective for Long-Term Restoration and Creation of Volume of the Lower Face

2020 ◽  
Vol 40 (9) ◽  
pp. NP499-NP510 ◽  
Author(s):  
Patricia Ogilvie ◽  
Laurence Benouaiche ◽  
Wolfgang G Philipp-Dormston ◽  
Lakhdar Belhaouari ◽  
Frodo Gaymans ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Well Being ◽  
Controlled Study ◽  
Control Group ◽  
Level Of Evidence ◽  
Lower Face ◽  
Repeat Treatment ◽  
Acid Gel ◽  
Surgical Treatments ◽  
And Control

Abstract Background Juvéderm Volux (VYC-25L; Allergan plc) is an injectable hyaluronic acid gel designed to restore and create facial volume. Objective The aim of this study was to evaluate the safety and effectiveness of Volux for chin retrusion over 18 months and after repeat treatment. Methods This prospective, single-blind, controlled study enrolled subjects aged ≥18 years with chin retrusion (glabella-subnasale-pogonion facial angle 145°-165°). Subjects were randomized (3:1) to Volux at study onset or 3 months later (control group), and could receive a single repeat treatment during months 18 to 24. Assessments included mean facial-angle change from baseline, Global Aesthetic Improvement Scale (GAIS) responder rates (improved/much improved), improvements in 3 subject-reported FACE-Q scales, and safety. Results Of 132 enrolled subjects, 119 received initial Volux treatment and 89 received repeat treatment. Mean changes (95% confidence interval) in glabella-subnasale-pogonion angle from baseline for treatment and control groups, respectively, were: 1.15° (0.75°, 1.56°) and 1.16° (0.57°, 1.75°) at month 18, and 3.14° (2.68°, 3.61°) and 2.72° (1.78°, 3.66°) 1 month after repeat treatment. Investigators rated 52.5%/60.0% of treated/control subjects at month 18 and 96.9%/100% after retreatment as GAIS responders; subject-reported rates were 62.0%/64.0% and 93.8%/100%. Durable improvements in Satisfaction with Chin, Satisfaction with Lower Face and Jawline, and Psychological Well-Being were reported in 82.1%, 78.2%, and 60.3% of subjects, respectively, at month 18, and 92.3%, 93.8%, and 67.7% of subjects after retreatment. The safety profile was as expected. Conclusions Volux injectable gel is a safe, effective, and durable alternative to surgical treatments for increasing chin projection and jaw volume, and results in high patient satisfaction. Level of Evidence: 2

scholarly journals Evaluation of von Willebrand factor in COPD patients

2014 ◽  
Vol 40 (4) ◽  
pp. 373-379 ◽  
Author(s):  
Thiago Prudente Bártholo ◽  
Cláudia Henrique da Costa ◽  
Rogério Rufino
Keyword(s):  
Von Willebrand Factor ◽  
Medical Research Council ◽  
Control Group ◽  
X Rays ◽  
Copd Patients ◽  
Never Smokers ◽  
Von Willebrand ◽  
And Control ◽  
Willebrand Factor ◽  
Selection Phase

OBJECTIVE: To compare the absolute serum von Willebrand factor (vWF) levels and relative serum vWF activity in patients with clinically stable COPD, smokers without airway obstruction, and healthy never-smokers. METHODS: The study included 57 subjects, in three groups: COPD (n = 36); smoker (n = 12); and control (n = 9). During the selection phase, all participants underwent chest X-rays, spirometry, and blood testing. Absolute serum vWF levels and relative serum vWF activity were obtained by turbidimetry and ELISA, respectively. The modified Medical Research Council scale (cut-off score = 2) was used in order to classify COPD patients as symptomatic or mildly symptomatic/asymptomatic. RESULTS: Absolute vWF levels were significantly lower in the control group than in the smoker and COPD groups: 989 ± 436 pg/mL vs. 2,220 ± 746 pg/mL (p < 0.001) and 1,865 ± 592 pg/mL (p < 0.01). Relative serum vWF activity was significantly higher in the COPD group than in the smoker group (136.7 ± 46.0% vs. 92.8 ± 34.0%; p < 0.05), as well as being significantly higher in the symptomatic COPD subgroup than in the mildly symptomatic/asymptomatic COPD subgroup (154 ± 48% vs. 119 ± 8%; p < 0.05). In all three groups, there was a negative correlation between FEV1 (% of predicted) and relative serum vWF activity (r2 = −0.13; p = 0.009). CONCLUSIONS: Our results suggest that increases in vWF levels and activity contribute to the persistence of systemic inflammation, as well as increasing cardiovascular risk, in COPD patients.

Efficacy of Electro-Acupuncture in Chronic Plantar Fasciitis: A Randomized Controlled Trial

2012 ◽  
Vol 40 (06) ◽  
pp. 1167-1176 ◽  
Author(s):  
Wipoo Kumnerddee ◽  
Nitsara Pattapong
Keyword(s):  
Success Rate ◽  
Plantar Fasciitis ◽  
Controlled Trial ◽  
Acupuncture Group ◽  
Control Group ◽  
Success Rates ◽  
End Of Treatment ◽  
Foot Function ◽  
And Control

The aim of the study was to investigate the efficacy of electro-acupuncture coupled with conventional treatments and compare it with the efficacy of conventional treatments alone in patients with chronic plantar fasciitis. Thirty patients with chronic refractory plantar fasciitis were randomly assigned to two groups. Subjects in the control group received five weeks of conventional treatments, including stretching exercise, shoe modification and rescue analgesics. Subjects in the acupuncture group received the same treatments plus ten sessions of electro-acupuncture twice weekly. Endpoints included a success rate determined by a minimum of a 50% decrease in Visual Analog Scale (VAS) and Foot Function Index (FFI). At the end of treatment, VAS decreased significantly from 6.00 ± 1.69 to 1.89 ± 1.59 and from 6.27 ± 2.34 to 5.40 ± 2.26 in the acupuncture and control groups, respectively. FFI decreased significantly only in the acupuncture group (p < 0.05). Subjects in the acupuncture group obtained higher success rates than those in control group (80% and 13.3%, respectively). FFI in the acupuncture group was better than those in the control group (p < 0.001). At the sixth week follow-up, subjects in the acupuncture group showed a better FFI and success rate for pain during the day than those in the control group (p < 0.05). Electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone. The effects lasted for at least six weeks.

scholarly journals ONE-YEAR RESULTS OF BRACING FOR PATELLO-FEMORAL OSTEOARTHRITIS. PROSPECTIVE RANDOMIZED STUDY

2021 ◽  
Vol 29 (3) ◽  
pp. 127-131
Author(s):  
MATHEUS GARCIA LOPES MERINO ◽  
VICTOR MORALE ◽  
GUILHERME PEREIRA OCAMPOS ◽  
MARIA CÂNDIDA MIRANDA LUZO ◽  
OLAVO PIRES DE CAMARGO ◽  
...  
Keyword(s):  
Randomized Study ◽  
Control Group ◽  
Study Group ◽  
X Rays ◽  
Long Term Effects ◽  
Level Of Evidence ◽  
Timed Up And Go ◽  
Anthropometric Measures ◽  
One Year

ABSTRACT Objective: To compare the long-term effects of a brace designed to stabilize the patellofemoral (PF) joint in comparison to a standard neoprene sleeve for the knee with patellar hole in patients with patellofemoral osteoarthritis (PFOA). Methods: 38 patients with PFOA and comorbidities received either a functional PF brace (Study Group, SG) or a neoprene sleeve for the knee (Control Group, CG). Both groups received clinical treatment to OA and comorbidities according to a program from the institution. Patients were evaluated with Western Ontario and MacMaster (WOMAC) and Lequesne questionnaires, 30-second chair stand test (30CST), Timed Up and Go (TUG), anthropometric measures and self-reported physical activity in minutes/week at inclusion, one, three and twelve months after placing the brace. X-Rays were taken to measure the angles. Results: At one year there was more abandonment in the CG without differences in weight and body mass index between groups during the study. The SG maintained improvements in Lequesne and WOMAC total and subsets during the year, whereas the CG returned to baseline values for pain, function and total (p < 0.01). TUG and 30CST results were always better in the study group without any clinically important improvement in both groups. Conclusion: Long-term use of functional brace added to self-management program improves pain and function in patients with PFOA. Level of Evidence II, Lesser quality RCT (eg, < 80% followup, no blinding, or improper randomization).

Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study

2020 ◽  
Vol 48 (14) ◽  
pp. 3472-3477
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Christopher A. Colasanti ◽  
John P. Scanlon ◽  
Mohamed Gaafar ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Control Group ◽  
Control Groups ◽  
Level Of Evidence ◽  
Significant Difference ◽  
And Control

Background: Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes. Purpose: To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability–Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated. Results: The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups ( P > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; P > .99) or return at the same/higher level (68.2% vs 72.7%; P = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; P = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant ( P = .32). Conclusion: After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.

Radiographic Analysis of Feet With and Without Morton’s Neuroma

2016 ◽  
Vol 38 (3) ◽  
pp. 310-317 ◽  
Author(s):  
Reza Naraghi ◽  
Alexandra Bremner ◽  
Linda Slack-Smith ◽  
Alan Bryant
Keyword(s):  
Control Group ◽  
Morton’S Neuroma ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
Control Subjects ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
Angular Measurements ◽  
Morton's Neuroma ◽  
And Control

Background: The aim of this research was to investigate the association of various structural measurements of the forefoot with Morton’s neuroma (MN). Methods: Weightbearing anteroposterior and lateral foot radiographs of subjects attending the University of Western Australia (UWA) Podiatry Clinic and the first author’s private practice were included in this study. A single assessor measured the following angles: lateral intermetatarsal angle (LIMA), intermetatarsal angle (IMA), hallux valgus angle (HVA), digital divergence between the second and third digits (DD23), digital divergence between the third and fourth digits (DD34) and relative metatarsal lengths of the first to fifth metatarsals (Met1-5), and the effect of MN size as measured by ultrasonograph on digital divergence. Intratester reliability of all radiographic measurements was assessed on all radiographic measurements. The study included 101 subjects, of whom 69 were diagnosed with MN and 32 were control subjects without MN. The mean (± standard deviation) age of MN subjects was 52 (±15) years and for control subjects, 48 (±12) years. Results: When comparing all feet, there were no significant differences in the LIMA, HVA, IMA, digital divergence angles and the relative metatarsal distances between subjects with MN and control subjects. No relationship between MN size and digital divergence was found in either foot, or in either neuroma location. Conclusion: We were unable to demonstrate any relationship in this study between radiographic metatarsal length and angular measurements in a symptomatic MN group compared to a control group. In addition, we did not find any correlation between the size of MN as measured from ultrasonographic images and radiographic evidence of digital divergence. Level of Evidence: Level III, case control study.

Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis

2020 ◽  
pp. 107110072095514
Author(s):  
Christopher J. Pearce ◽  
Dexter Seow ◽  
Bernard P. Lau
Keyword(s):  
Plantar Fasciitis ◽  
Case Series ◽  
Heel Pain ◽  
Level Of Evidence ◽  
Data Points ◽  
The Mean ◽  
The Difference ◽  
Night Splint ◽  
Gastrocnemius Tightness

Background: It is known that there is an association between gastrocnemius tightness and plantar fasciitis, but this has never been quantified. The purpose of the study was to determine the correlation between gastrocnemius tightness and the severity of heel pain in plantar fasciitis. Methods: Thirty-three patients were prescribed physiotherapist-directed gastrocnemius stretching exercises, a Strassburg Sock or night splint, and silicone heel insoles as required. Outcome measures included (1) gastrocnemius tightness, (2) 100-mm visual analog scale (VAS) for pain on the first steps in the morning, and (3) 100-mm VAS for the worst pain felt during the previous week. Gastrocnemius tightness was measured by the difference in maximal ankle dorsiflexion between knee bent and straight with a goniometer. Results: The mean gastrocnemius tightness was 22 degrees at baseline compared with 9 degrees at the final follow-up ( P < .01). A reduction in VAS for pain on the first steps in the morning and VAS for the worst pain felt during the previous week from baseline to final follow-up was observed ( P < .01). Correlation analysis of 105 data points between gastrocnemius tightness and VAS for pain on the first steps in the morning was R = 0.757 ( P < .001), and between gastrocnemius tightness and VAS for the worst pain felt during the previous week was R = 0.781 ( P < .001). Conclusion: The study observed a strong, statistically significant correlation between gastrocnemius tightness and the severity of heel pain in plantar fasciitis. Level of Evidence: Level IV, case series.

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