scholarly journals Comparison of Calcaneal Subchondral Injection of Calcium Phosphate and Plantar Fasciotomy vs Plantar Fasciotomy Alone for Refractory Infracalcaneal Heel Pain

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110505
Author(s):  
Michael Matthews ◽  
Erin Klein ◽  
Zachary Hulst ◽  
Neathie Patel ◽  
Lowell Weil ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Heel Pain ◽  
Mean Difference ◽  
Fisher Exact Test ◽  
Level Of Evidence ◽  
Exact Test ◽  
Symptom Profile ◽  
Phosphate Injection ◽  
Plantar Fasciotomy

Background: Treatment of chronic refractory heel pain has evolved to consider calcaneal structural fatigue as a component of the symptom profile. While concomitant calcium phosphate injection has become a method of addressing the accompanying calcaneal bone marrow edema (BME) frequently seen in this population, there is no literature supporting its use compared to traditional fasciotomy. Methods: Consecutive patients with symptoms of refractory infracalcaneal heel pain and calcaneal BME were treated in our practice by either surgical fasciotomy (n = 33) or fasciotomy plus calcium phosphate injection (n = 31) between 2014 and 2019. Outcomes were retrospectively assessed via Foot and Ankle Outcome Scores (FAOS), return to activity, and complication rate. Results: Sixty-four patients (64 feet) were included with a mean age of 50.3 ± 12.9 years and mean follow-up of 23.2 ± 22.3 months. No differences were observed between groups preoperatively. Significant improvements in 4 of 5 FAOS subscales were observed postoperatively in both groups ( P < .05 for all, paired t test). However, patients undergoing concomitant calcium phosphate injection reported significantly better scores for both activities of daily living (ADL; mean difference +10.2; 95% confidence interval [CI] 0.07-20.2) and foot-specific QOL (mean difference +21.9, 95% CI 7.0-36.6) at final follow-up compared with those undergoing plantar fasciotomy alone. All patients returned to their desired level of activity, and the frequency of complications did not differ between groups ( P > .05, Fisher exact test). Conclusion: In patients presenting with recalcitrant infracalcaneal heel pain accompanied by calcaneal BME, calcium phosphate injection into the calcaneus, when combined with plantar fasciotomy, was safe and more effective than traditional plantar fasciotomy alone. Level of Evidence: Level III, retrospective comparative study.

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

2019 ◽  
Vol 41 (2) ◽  
pp. 187-192
Author(s):  
Ricardo E. Colberg ◽  
Monte Ketchum ◽  
Avani Javer ◽  
Monika Drogosz ◽  
Melissa Gomez ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Plantar Fasciitis ◽  
Case Series ◽  
Successful Outcome ◽  
Oral Steroid ◽  
Tarsal Tunnel ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Rapid Point-Of-Care Serology and Clinical History Assessment Increase Protection Provided by RT-PCR Screening: A Pilot Study Involving Three Nursing Homes in Brescia, a Hotspot of Lombardy

2021 ◽  
Vol 9 ◽  
Author(s):  
Antonella Savio ◽  
Stefano Calza ◽  
Gianbattista Guerrini ◽  
Valentina Romano ◽  
Eleonora Marchina
Keyword(s):  
Nursing Homes ◽  
Close Contact ◽  
Fisher Exact Test ◽  
Rt Pcr ◽  
Positive Serology ◽  
Serological Screening ◽  
Pcr Screening ◽  
Exact Test ◽  
Viral Spread

Background: COVID-19 outbursts have been registered worldwide within care homes with asymptomatic transmission combined with shortage/inaccuracy of diagnostic tests undermining the efforts at containment of the disease. Nursing facilities in Lombardy (Italy) were left with no, or limited, access to testing for 8 weeks after the outbreak of COVID-19.Methods: This study includes 246 residents and 286 workers of three different nursing homes in Brescia-Lombardy. Clinical questionnaires and rapid serology tests were devised to integrate the data of the first available RT-PCR screening. Follow-up serology after 60-days was performed on 67 of 86 workers with positive serology or clinically suspicious.Findings: Thirty-seven residents and 18 workers had previous positive RT-PCR. Thorough screening disclosed two additional RT-PCR-positive workers. Serology screening revealed antibodies in 59 residents and 48 workers, including 32/37 residents and all workers previously positive at RT-PCR. Follow up serology disclosed antibodies in two additional workers with recent symptoms at the time of screening. The professionals in close contact with residents had more infections (47/226–20.79% vs. 1/60–1.66%; p = 0.00013 Fisher exact-test). A suspicious clinical score was present in 44/64 residents and in 41/50 workers who tested positive with either method with totally asymptomatic disease more frequent among residents 28.1 vs. 10.0% (p = 0.019 Fisher exact-test).Interpretation: Based on the available RT-PCR ± results at the time of symptoms/contacts, our integrated clinical and serological screening demonstrated sensitivity 89% and specificity 87%. This multimodal assessment proved extremely useful in understanding the viral spread in nursing homes, in defining its stage and in implementing protective measures. Rapid serology tests demonstrated efficient and particularly suited for older people less able to move/cooperate.

NF2 and Spinal Tumors

2006 ◽  
Vol 5 (2) ◽  
pp. 179 ◽  
Author(s):  
Dilys M. Parry
Keyword(s):  
Spinal Tumor ◽  
Spinal Tumors ◽  
Fisher Exact Test ◽  
Radiological Progression ◽  
Intramedullary Tumors ◽  
Exact Test ◽  
Extramedullary Tumor ◽  
Clinical Records ◽  
And Behavior

Object The authors conducted a study to examine the incidence, classification, and progression of spinal tumors in patients with neu-rofibromatosis Type 2 (NF2) treated at a single center, and to examine relationships with the known mutational subtypes of NF2. Methods They performed a retrospective review of clinical records, neuroimaging studies, and genetic data obtained in 61 patients with NF2. Forty-one (67%) of 61 patients harbored one or more spinal tumors. Thirty-four patients had undergone serial spinal magnetic resonance imaging during a mean follow-up period of 52 months (range 10–103 months; median 53 months). In 16 patients there were multiple extramedullary tumors smaller than 5 mm, which did not progress. Fourteen patients harbored at least one extramedullary tumor that was greater than 5 mm; of these, radiological progression was demonstrated or spinal tumor excision was performed during the follow-up period in eight cases (57%). Eleven patients harbored intramedullary cord tumors in addition to small and large extramedullary tumors, three (27%) of which exhibited radiological progression. In cases in which genotypes were known, protein-truncating mutations were significantly more likely to be associated with the presence of spinal tumors than in other types (p = 0.03, Fisher exact test). No associations between clinical behavior of spinal tumors and genotype, however, could be demonstrated. Conclusions Spinal tumors in cases involving NF2 are heterogeneous in type, distribution, and behavior but larger-size tumors are more likely to progress significantly. Intramedullary tumors usually accompany multiple extramedullary tumors. In the authors' experience subtyping of the NF2 mutation has not yet influenced management. Protein-truncating mutations are associated with an increased prevalence of spinal tumors.

Five-year follow-up results of instep plantar fasciotomy for chronic heel pain

2000 ◽  
Vol 39 (4) ◽  
pp. 218-223 ◽  
Author(s):  
Kirk E. Woelffer ◽  
Michael A. Figura ◽  
Neil S. Sandberg ◽  
Neil S. Snyder
Keyword(s):  
Heel Pain ◽  
Plantar Fasciotomy

Intramuscular versus ultrasound-guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis: a randomised, double-blind, controlled study

2016 ◽  
Vol 76 (4) ◽  
pp. 666-672 ◽  
Author(s):  
Mads Ammitzbøll-Danielsen ◽  
Mikkel Østergaard ◽  
Viktoria Fana ◽  
Daniel Glinatsi ◽  
Uffe Møller Døhn ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Isotonic Saline ◽  
Group Versus ◽  
Controlled Study ◽  
Fisher Exact Test ◽  
Double Blind ◽  
Exact Test ◽  
Patient Reported ◽  
Registration Number

ObjectiveThe aim of this study was to compare the efficacy of intramuscular versus ultrasound (US)-guided intratenosynovial glucocorticoid injection in providing disease control after 2, 4 and 12 weeks in patients with rheumatoid arthritis(RA) with tenosynovitis.MethodsFifty patients with RA and tenosynovitis were randomised into two double-blind groups: (A) ‘intramuscular group’, receiving intramuscular injection of betamethasone and US-guided intratenosynovial isotonic saline injection and (B) ‘intratenosynovial group’ receiving saline intramuscularly and US-guided intratenosynovial betamethasone injection. All patients were in stable disease-modifying anti-rheumatic drug treatment prior to and during the study. Patients were excluded, and considered non-responders, if any treatments were altered during the follow-up period. ‘US tenosynovitis remission’, defined as US tenosynovitis grey-scale score ≤1 and colour Doppler score=0, was assessed at week 4 (primary outcome), and weeks 2 and 12, using non-responder imputation for missing data.ResultsUS tenosynovitis remission at week 4 was achieved in 25% (6/24) in the ‘intramuscular group’ versus 64% (16/25) in the ‘intratenosynovial group’, that is, a difference of −39 percentage point (pp) (CI −65pp to −13pp), Fisher exact test p=0.001. Corresponding values for the ‘intramuscular group’ versus the ‘intratenosynovial group’ at 2 and 12 weeks were 21% (5/24) versus 48% (13/25), that is, a difference of −27pp (CI −53pp to −2pp), p=0.072 and 8% (2/24) versus 44% (11/25), that is, difference of −36pp (−58pp to −13pp), p=0.003. Most US, clinical and patient-reported scores improved more in the ‘intratenosynovial group’ at all follow-up visits.ConclusionsIn this randomised double-blind clinical trial, patients with RA and tenosynovitis responded significantly better to US-guided intratenosynovial glucocorticoid injection than to intramuscular glucocorticoid injection, both at 4 and 12 weeks follow-up.Trial registration numberEudraCT nr: 2013-003486-34.

Low Range of Ankle Dorsiflexion Predisposes for Patellar Tendinopathy in Junior Elite Basketball Players

2011 ◽  
Vol 39 (12) ◽  
pp. 2626-2633 ◽  
Author(s):  
Ludvig J. Backman ◽  
Patrik Danielson
Keyword(s):  
Ankle Dorsiflexion ◽  
Mean Difference ◽  
Patellar Tendinopathy ◽  
Ankle Sprains ◽  
Basketball Players ◽  
Level Of Evidence ◽  
Preventive Actions ◽  
Potential Risk Factors ◽  
History Of

Background: Patellar tendinopathy (PT) is one of the most common reasons for sport-induced pain of the knee. Low ankle dorsiflexion range might predispose for PT because of load-bearing compensation in the patellar tendon. Purpose: The purpose of this 1-year prospective study was to analyze if a low ankle dorsiflexion range increases the risk of developing PT for basketball players. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Ninety junior elite basketball players were examined for different characteristics and potential risk factors for PT, including ankle dorsiflexion range in the dominant and nondominant leg. Data were collected over a 1-year period and follow-up, including reexamination, was made at the end of the year. Results: Seventy-five players met the inclusion criteria. At the follow-up, 12 players (16.0%) had developed unilateral PT. These players were found to have had a significantly lower mean ankle dorsiflexion range at baseline than the healthy players, with a mean difference of −4.7° ( P = .038) for the dominant limb and −5.1° ( P = .024) for the nondominant limb. Complementary statistical analysis showed that players with dorsiflexion range less than 36.5° had a risk of 18.5% to 29.4% of developing PT within a year, as compared with 1.8% to 2.1% for players with dorsiflexion range greater than 36.5°. Limbs with a history of 2 or more ankle sprains had a slightly less mean ankle dorsiflexion range compared to those with 0 or 1 sprain (mean difference, −1.5° to −2.5°), although this was only statistically significant for nondominant legs. Conclusion: This study clearly shows that low ankle dorsiflexion range is a risk factor for developing PT in basketball players. In the studied material, an ankle dorsiflexion range of 36.5° was found to be the most appropriate cutoff point for prognostic screening. This might be useful information in identifying at-risk individuals in basketball teams and enabling preventive actions. A history of ankle sprains might contribute to reduced ankle dorsiflexion range.

scholarly journals Migraine as a risk factor associated with hypertensive disorders of pregnancy

2014 ◽  
pp. 33-38
Author(s):  
Gabriel Braga Diégues Serva ◽  
Leonardo Santos Calvacanti Guerra ◽  
Vilneide Maria Santos Braga Diégues Serva ◽  
Waldmiro Antônio Diégues Serva ◽  
Marcela Patrícia Macêdo Belo ◽  
...  
Keyword(s):  
Fisher Exact Test ◽  
Hypertensive Disorders Of Pregnancy ◽  
Significance Level ◽  
Exact Test ◽  
Factors Associated ◽  
Follow Up Study ◽  
Hypertensive Disorders ◽  
Pregnancy And Postpartum ◽  
Hypertensive Disorders In Pregnancy

Objectives: To identify if the presence of migraine before pregnancy predisposes to hypertensive disorders of pregnancy. Methods: Observational study undertaken from a database of a follow-up study, composed of women consecutively assisted, at the first postnatal week, at IMIP. Its objective was to evaluate the course of migraine during pregnancy and postpartum in women with migraine before pregnancy. The Fisher exact test was used considering the significance level of less than 5%. Results: Of the 686 women, 38.8% were migraine sufferers before pregnancy. 14.3% referred hypertensive disorders of pregnancy. The presence of migraine before pregnancy and to have been submitted to a cesarean section (p<0.001) were factors associated with the presence of hypertensive disorders in pregnancy. Conclusion: Migraine before pregnancy is an associated factor to hypertensive disorders of pregnancy. The diagnosis of migraine should always be taken into consideration during antenatal care, for the prevention of complications.

Usage trends of minimally absorbed vaginal estrogens in breast cancer patients versus patients with non-breast malignancies

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10620-10620
Author(s):  
M. Castiel ◽  
S. Masakhalia ◽  
M. Krychman ◽  
B. Stier ◽  
A. Amsterdam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fisher Exact Test ◽  
Breast Cancer Patients ◽  
Exact Test ◽  
Age Related ◽  
Computerized System ◽  
Breast Malignancies

10620 Background: To determine if differences exist in the use of minimally absorbed vaginal estrogens in a breast cancer population versus one with non-breast malignancies. Methods: A retrospective review of all patients with documented malignancy who were prescribed vaginal 17-β-estradiol tablets (Vagifem, Novo-Disc, Princeton, New Jersey) through the General Gynecology Service from July 1, 2003 to June 30, 2004. Data were accessed from the pharmacy health information computerized system. All patients complained of dyspareunia, and examination was consistent with vaginal atrophy. Comparison between groups was performed using the Fisher Exact Test and t-test. Results: 152 patients were identified_81 patients with breast cancer diagnoses and 71 with non-breast malignancies. There was no difference in the mean age of patients in either group, 56.9 vs. 55.1 years. (p = 0.30). Overall, 60 of the 152 patients refilled their prescriptions through the time of last follow-up. There was no difference in the proportion of breast versus non-breast cancer patients who continued vaginal estradiol, 39.5% (32/81) versus 39.4% (28/71) respectively. When the cohorts were stratified by age ≤ 50 or >50 at the time of initial consultation, 79% (11/14) of breast cancer patients age ≤ 50 years refilled their prescriptions at follow-up compared to 31.3% (21/67) of patients >50 (p = 0.002). In women with non-breast malignancies there was no age-related difference in the proportion who obtained refills: 35% (7/20) ≤ 50 years versus 41.2 % (21/51) >50 years (p = 0.79). Conclusions: Minimally absorbed vaginal estrogens appear to be viewed favorably amongst the younger breast cancer patient population. The older breast cancer population does not appear to continue vaginal estradiol use long-term. This may be due to differences in relationship status, interval from menopause to diagnosis, prior exposure to estrogen, or relief of symptoms with alternative therapies. These findings are different than those observed for similar patients with non-breast malignancies. Further studies looking at the use of minimally absorbed vaginal estrogens are needed to further evaluate the usage trends in differing patient populations. No significant financial relationships to disclose.

Equivalent Knee Injury and Osteoarthritis Outcome Scores 12 and 24 Months After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register

2017 ◽  
Vol 45 (9) ◽  
pp. 2085-2091 ◽  
Author(s):  
Kristian Samuelsson ◽  
Robert A. Magnussen ◽  
Eduard Alentorn-Geli ◽  
Ferid Krupic ◽  
Kurt P. Spindler ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cohort Study ◽  
Acl Reconstruction ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Mean Difference ◽  
Level Of Evidence ◽  
Knee Ligament ◽  
Anterior Cruciate

Background: It is not clear whether Knee injury and Osteoarthritis Outcome Score (KOOS) results will be different 1 or 2 years after anterior cruciate ligament (ACL) reconstruction. Purpose: To investigate within individual patients enrolled in the Swedish National Knee Ligament Register whether there is equivalence between KOOS at 1 and 2 years after primary ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: This cohort study was based on data from the Swedish National Knee Ligament Register during the period January 1, 2005, through December 31, 2013. The longitudinal KOOS values for each individual at the 1- and 2-year follow-up evaluations were assessed through the two one-sided test (TOST) procedure with an acceptance criterion of 4. Subset analysis was performed with patients classified by sex, age, graft type, and type of injury (meniscal and/or cartilage injury). Results: A total of 23,952 patients were eligible for analysis after exclusion criteria were applied (10,116 women, 42.2%; 13,836 men, 57.8%). The largest age group was between 16 and 20 years of age (n = 6599; 27.6%). The most common ACL graft was hamstring tendon (n = 22,504; 94.0%), of which the combination of semitendinosus and gracilis was the most common. A total of 7119 patients reported on the KOOS Pain domain at both 1- and 2-year follow-ups, with a mean difference of 0.21 (13.1 SD, 0.16 SE [90% CI, −0.05 to 0.46], P < .001). The same results were found for the other KOOS subscales: symptoms (mean difference −0.54, 14.1 SD, 0.17 SE [90% CI, −0.81 to −0.26], P < .001), activities of daily living (mean difference 0.45, 10.8 SD, 0.13 SE [90% CI, 0.24 to 0.66], P < .001), sports and recreation (mean difference −0.35, 22.7 SD, 0.27 SE [90% CI, −0.79 to 0.09], P < .001), quality of life (mean difference −0.92, 20.0 SD, 0.24 SE [90% CI, −1.31 to −0.53], P < .001), and the combined KOOS-4 score (mean difference −0.41, 14.5 SD, 0.17 SE [90% CI, −0.70 to −0.13], P < .001). Analyses within specific subsets of patients showed equivalent results between the 2 follow-up evaluations. Conclusion: Equivalent results within patients were found in KOOS values at 1- and 2-year follow-ups after ACL reconstruction. The finding was consistent across all KOOS subscales and for all evaluated subsets of patients. This result implies that there is no additional value in capturing both 1- and 2-year KOOS outcomes after ACL reconstruction. However, these findings of equivalence at 1- and 2-year endpoints do not alleviate the need for longer follow-up periods.

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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