scholarly journals Midarch Foot Pain: Entrapment Neuropathy of the Distal Medial Plantar Nerve and Its Branches

2021 ◽  
Vol 111 (2) ◽  
Author(s):  
Stephen L. Barrett ◽  
Sara Sohani ◽  
Sequioa DuCasse ◽  
Adam Kahn ◽  
A. Lee Dellon
Keyword(s):  
Plantar Fasciitis ◽  
Clinical Results ◽  
Positive Outcomes ◽  
Foot Pain ◽  
Steroid Injections ◽  
Nerve Decompression ◽  
Intralesional Steroid ◽  
Fresh Frozen ◽  
External Neurolysis ◽  
Pain Generator

Medial forefoot pain, or midarch pain, is usually attributed to plantar fasciitis. The authors present their findings of a previously unreported nerve entrapment of the medial proper plantar digital nerve (MPPDN). Ten fresh-frozen cadaveric specimens were analyzed for anatomical variance in the nerve distribution of the MPPDN. In addition, clinical results from a retrospective review of nine patients who underwent surgical nerve decompression of the MPPDN are presented. Significant anatomical variance was found for the MPPDN in the cadaveric dissection of 10 fresh-frozen specimens. Nine patients with a clinical diagnosis of entrapment of the MPPDN all obtained excellent pain relief with surgical external neurolysis. Only one complication occurred: a hypertrophic scar formation that was successfully treated with intralesional steroid injections. The authors believe that this MPPDN entrapment is often overlooked or misdiagnosed as plantar fasciitis. Surgical peripheral nerve decompression of this nerve can provide positive outcomes for patients suffering from midarch foot pain caused by this pain generator.

Ultrasound-Guided Percutaneous Radiofrequency Lesioning When Treating Recalcitrant Plantar Fasciitis: Clinical Results

2014 ◽  
Vol 37 (01) ◽  
pp. 56-62 ◽  
Author(s):  
P. Wu ◽  
J. Lee ◽  
K. Wu ◽  
T. Wu ◽  
C. Shao ◽  
...  
Keyword(s):  
Plantar Fasciitis ◽  
Clinical Results ◽  
Ultrasound Guided

Therapeutic Effect of Superficial Cryotherapy versus Intralesional Corticosteroids injection in Alopecia Areata

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nour El-dissouki Ibrahim ◽  
Mahira Hamdy Elsayed ◽  
Ahmed Abdel-Fattah Afify
Keyword(s):  
Side Effects ◽  
Alopecia Areata ◽  
Response To Treatment ◽  
High Dose ◽  
Efficacy And Safety ◽  
Steroid Injections ◽  
Intralesional Steroid ◽  
Males And Females ◽  
Intravenous Steroids ◽  
Effects Assessment

Abstract Alopecia areata, one or more round bald patches appear suddenly, most often on the scalp. It can affect males and females at any age. It starts in childhood in about 50%, and before the age of 40 years in 80%. The exact mechanism is not yet understood. There is not yet any reliable cure for alopecia areata. Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people. Their role and efficacy are unknown. Injections of triamcinolone acetonide 2.5–10 mg/ml into patchy scalp, its efficacy is temporary. Oral and pulse intravenous steroids in high dose can lead to temporary regrowth of hair. The sensitisers diphenylcyclopropenone provoke hair growth in treated areas Now, superficial cryotheray is introduced as a possible treatment for Alopecia Areata. With minimial side effects and being less painful. So, this study clarifies the therapeutic efficacy and safety of superficial cryotherapy for treatment of patchy Alopecia areata. Aim of the study The aim of the study is to evaluate and compare the efficacy and safety of Superficial Cryotherapy and Intralesional corticosteroids in the treatment of patchy Alopecia Areata. Patients and methods study included 20 patients complaining of Alopecia Areata. 3 patches of scalp alopecia areata will be randomly subjected to either superficial cryotherapy twice monthly for 3 months (3 cycles, 2-3 seconds) or intralesional steroid injections once monthly for 3 months (triaminoclone acetonide 1:7, 1ml) or intralesional saline (1 ml). Assessment for the response to treatment will be done at one month and three month following treatment by digital photography and by phototrichogram by comparing number of Terminal, and vellus and hair thickness, Also assessment for side effects of therapy will be done. Results Patients treated with TCA showed statistically significant high response compared to patients treated with cryotherapy. Also, side effects assessment showed minimal side effects with treatment with TCA compared to cryotherapy. Conclusion TCA treatment of alopecia areata is much tolerable than treatment with cryotherapy with also better response rates.

scholarly journals Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

2015 ◽  
Vol 16 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Melih Malkoc ◽  
Ozgur Korkmaz ◽  
Adnan Kara ◽  
Ismail Oltulu ◽  
Ferhat Say
Keyword(s):  
Daily Activity ◽  
Plantar Fasciitis ◽  
Plantar Fascia ◽  
Clinical Results ◽  
Activity Score ◽  
Vas Score ◽  
Sporting Activity ◽  
Significant Difference ◽  
The Mean

ABSTRACTPlantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.We retrospectively reviewed 75 patients with heel pain. A total of 35 patients in the first group were treated with medial arch supporting insoles, and 40 patients in the second group were treated with heel pads. The patients were evaluated with the Visual Analogue Scale (VAS) and the Foot and Ankle Ability Measure (FAAM) at the first and last examinations.The mean VAS score in the first group was 8.6±1,2 (6-10); the FAAM daily activity score was 66.2±16 (41.2-95.0), and the sporting activity score was 45.4±24,4 (0.1-81) before treatment. At the last follow-up in this group, the mean VAS score was 5.3±1,5 (0-9); the FAAM daily activity score was 83,0±15,1 (55,9-100), and the sporting activity score was 73,5±26,2 (25-100). The mean VAS score in the second group was 8,6±0,9 (7-10); the FAAM daily activity score was 66.4±17 (41.4-95.2), and the sporting activity score was 45.8±24,2 (0.8-81, 3) before the treatment. At the last follow-up in this group, the mean VAS score was 5.5±1,2 (0-9); the FAAM daily activity score was 83.4±14,9 (60, 2-100), and the sporting activity score was 73.8±26 (28-100).There was no significant difference in the clinical results of both groups. The force distribution by the use of silicone heel pads and medial arch-supported silicone insoles had no effect on the clinical results of the treatment of plantar fasciitis.

The effect of in-situ decompression on ulnar nerve stability: a cadaveric study

2017 ◽  
Vol 42 (7) ◽  
pp. 715-719 ◽  
Author(s):  
B. Butler ◽  
J. Peelman ◽  
L.-Q. Zhang ◽  
M. Kwasny ◽  
D. Nagle
Keyword(s):  
Ulnar Nerve ◽  
Medial Epicondyle ◽  
Cadaveric Study ◽  
Flexion Angle ◽  
Anterior Translation ◽  
Nerve Decompression ◽  
Flexor Carpi Ulnaris ◽  
Before And After ◽  
Fresh Frozen

Ten fresh frozen right cadaver arms were placed in a motorized jig and an in-situ ulnar nerve decompression was performed in 5 mm increments distally to the flexor carpi ulnaris (FCU) aponeurosis then proximally to the intermuscular septum. The elbows were ranged 0–135° after each incremental decompression and the ulnar nerve to medial epicodyle distance was measured to assess for nerve translation/subluxation compared with baseline (prerelease) values. None of the specimens had ulnar nerve subluxation (defined as anterior translation past the medial epicondyle) even after full decompression. Furthermore, there were no statistically significant ulnar nerve translations (defined as any difference in distance from ulnar nerve to medial epicondyle before and after each decompression) for any flexion angle or extent of decompression. This study provides biomechanical evidence that in situ ulnar nerve decompression from the FCU aponeurosis to the intermuscular septum does not result in significant ulnar nerve translation or subluxation.

scholarly journals Comparison of curcumin with intralesional steroid injections in Oral Submucous Fibrosis – A randomized, open-label interventional study

2014 ◽  
Vol 4 (3) ◽  
pp. 169-173 ◽  
Author(s):  
Monu Yadav ◽  
K. Aravinda ◽  
Vasu S. Saxena ◽  
K. Srinivas ◽  
P. Ratnakar ◽  
...  
Keyword(s):  
Oral Submucous Fibrosis ◽  
Interventional Study ◽  
Open Label ◽  
Steroid Injections ◽  
Intralesional Steroid ◽  
Submucous Fibrosis

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.

The effect of intralesional steroid injections on esophageal strictures and the child as whole: A case series

2020 ◽  
Vol 55 (4) ◽  
pp. 646-650 ◽  
Author(s):  
Chantal A. ten Kate ◽  
John Vlot ◽  
Cornelius E.J. Sloots ◽  
Erica L.T. van den Akker ◽  
Rene M.H. Wijnen
Keyword(s):  
Case Series ◽  
Steroid Injections ◽  
Esophageal Strictures ◽  
Intralesional Steroid

Intralesional Steroid Injections for Recurrent Vaginal Strictures

2018 ◽  
Vol 31 (2) ◽  
pp. 206
Author(s):  
Jessica Shim ◽  
Maggie Dwiggins ◽  
Veronica Gomez-Lobo
Keyword(s):  
Steroid Injections ◽  
Intralesional Steroid

The Influence of Foot Position on Stretching of the Plantar Fascia

2007 ◽  
Vol 28 (7) ◽  
pp. 815-822 ◽  
Author(s):  
Ryan M. Flanigan ◽  
Deborah A. Nawoczenski ◽  
Linlin Chen ◽  
Hulin Wu ◽  
Benedict F. DiGiovanni
Keyword(s):  
Plantar Fasciitis ◽  
Plantar Fascia ◽  
Nonoperative Treatment ◽  
Ankle Dorsiflexion ◽  
Variable Reluctance ◽  
Mechanical Explanation ◽  
Fresh Frozen ◽  
Forefoot Varus ◽  
Foot Position ◽  
Stretching Exercises

Background A recent study found nonweightbearing stretching exercises specific to the plantar fascia to be superior to the standard program of weightbearing Achilles tendon-stretching exercises in patients with chronic plantar fasciitis. The present study used a cadaver model to demonstrate the influence of foot and ankle position on stretching of the plantar fascia. Methods Twelve fresh-frozen lower-leg specimens were tested in 15 different configurations representing various combinations of ankle and metatarsophalangeal (MTP) joint dorsiflexion, midtarsal transverse plane abduction and adduction, and forefoot varus and valgus. Measurements were recorded by a differential variable reluctance transducer (DVRT) implanted into the medial band of the plantar fascia, and primary measurement was a percent deformation of the plantar fascia (stretch) with respect to a reference position (90 degrees ankle dorsiflexion, 0 degrees midtarsal and forefoot orientation, and 0 degrees MTP dorsiflexion). Results Ankle and MTP joint dorsiflexion produced a significant increase (14.91%) in stretch compared to the position of either ankle dorsiflexion alone (9.31% increase, p < 0.001) or MTP dorsiflexion alone (7.33% increase, p < 0.01). There was no significant increase in stretch with positions of abduction or varus (2.49%, p = 0.27 and 0.55%, p = 0.79). Conclusion This study provides a mechanical explanation for enhanced outcomes in recent clinical trials using plantar fascia tissue-specific stretching exercises and lends support to the use of ankle and MTP joint dorsiflexion when employing stretching protocols for nonoperative treatment in patients with chronic proximal plantar fasciitis.

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

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