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. ID: 98130887 TITLE: Resectional arthroplasty: treatment for calcaneonavicular coalition. AUTHOR: Fuson S; Barrett M ADDRESS: Puget Sound Hospital, Tacoma, Washington 98032, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: In a 10-year retrospective review of one practitioner's experience with calcaneonavicular tarsal coalitions, a diagnostic procedure based on clinical and radiographic examination is described. What typically may present as heel pain, on thorough clinical examination, may be identified more specifically as midtarsal pain. Radiographically degenerative changes may be identified through computed tomography as well as magnetic resonance imaging, bone scan, and plain radiographs. Treatment modalities are based on the degree of symptomatic degenerative changes present. In early stages, steroid injection is used to diminish inflammation at the midtarsal joint. Typically, this is performed with orthotic therapy to limit the motion at the calcaneonavicular coalition. More advanced stages will require surgical intervention. Based on the degree of degeneration at the more proximal subtalar joint, arthroplasty of the calcaneonavicular coalition without interposition of the extensor digitorum brevis has produced acceptable long-term results. If the subtalar joint has advanced degeneration and there has been failure of more conservative treatments, rearfoot arthrodesis has been performed. SOURCE: J Foot Ankle Surg 1998 Jan-Feb;37(1):11-5 4
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. ID: 98129423 TITLE: Judging pain in infants: behavioural, contextual, and developmental determinants. AUTHOR: Hadjistavropoulos HD; Whitfield MF; Grunau RE Craig KD ADDRESS: Regina Health District, SK, Canada. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Caretakers intuitively use various sources of evidence when judging infant pain, but the relative importance of salient cues has received little attention. This investigation examined the predictive significance for judgements of painful discomfort in preterm and full-term neonates of behavioural (facial activity and body movement), contextual (invasiveness of the procedure), and developmental (gestational age) information. Judges viewed videotapes showing infants varying in the foregoing characteristics undergoing heel incisions for routine blood sampling purposes. Findings indicated all but the contextual information contributed uniquely to judgements of pain, with facial activity accounting for the most unique variance (35%), followed by bodily activity and gestational age, each accounting for 3% and 1% of the judgmental variance, respectively. Generally, 71% of the variance in ratings of pain could be predicted using facial activity alone, compared to 30% of the variance using bodily activity alone, 19% by relying on context alone, and 8% by referring to gestational age alone. Noteworthy was the tendency to judge early preterm infants to be experiencing less pain even though they were subjected to the same invasive procedure as the older infants. This finding also runs counter to evidence from developmental neurobiology which indicates that preterm newborns may be hypersensitive to invasive procedures. SOURCE: Pain 1997 Dec;73(3):319-24 6 NLM CIT
. ID: 98110101 TITLE: Spinal reflex pattern to foot nociceptive stimulation in standing humans. AUTHOR: Decchi B; Rossi A; Di Troia AM; Arrigucci U Spidalieri R; Zalaffi A ADDRESS: Laboratorio di Neurofisiologia, Istituto di Scienze Neurologiche dell'Universita, Siena, Italy. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Ipsi- and contralateral patterns of lower limb nociceptive reflex responses were studied in 6 normal subjects in free standing position. Once the position was stabilized, only ankle extensor muscles showed consistent tonic activity while ankle flexors and knee extensors and flexors were virtually silent. Reflex responses, elicited by painful electrical stimuli to the skin of the plantar and dorsal aspect of the foot, were recorded from ipsi- and contralate operated side (significant: peroneus longus). The persistent clinical problems as well as the functional changes indicate that the disturbed ankle joint kinematics permanently alter foot function and may subsequently support the development of arthrosis. Therefore, the Evans procedure should only be applied if anatomical reconstruction of the lateral ankle ligaments is not feasible. SOURCE: Foot Ankle Int 1997 Dec;18(12):765-71 8
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. ID: 98016825 TITLE: Seronegative spondyloarthropathy in familial Mediterranean fever. AUTHOR: Langevitz P; Pras M; Shemer J; Zemer D; Livneh A ADDRESS: Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones) 0 (Anti-Inflammatory Agents, Non-Steroidal) 0 (Antirheumatic Agents) 0 (HLA-B27 Antigen) 59-05-2 (Methotrexate) 599-79-1 (Sulfasalazine) 64-86-8 (Colchicine)
ABSTRACT
: To define a possible association between familial Mediterranean fever (FMF) and seronegative spondyloarthropathy (SNSA) and to study features of SNSA in FMF patients, we screened for the presence and manifestations of SNSA in 3,000 FMF patients attending the National Center for FMF in our institution. This population included 160 patients with chronic arthritis, most who suffered from SNSA. Patients were considered to suffer from SNSA if they had chronic arthritis, inflammatory back/neck pain, and sacroiliitis. Patients who had other diseases associated with SNSA were excluded. Eleven patients, nine men and two women, with chronic monoarthritis or oligoarthritis, grade 2 (four patients) or grades 3 to 4 (seven patients), sacroiliitis, and inflammatory back pain met the criteria for diagnosis of SNSA of FMF. These patients were rheumatoid factor (RF) and HLA-B27 negative. In seven patients, spondyloarthropathy developed while they received colchicine, and in four before colchicine. Most patients responded to treatment with nonsteroidal antiinflammatory drugs, but three required second-line agents. These findings suggest that SNSA is one of the musculoskeletal manifestations of FMF that may occur despite colchicine therapy and requires specific treatment. SOURCE: Semin Arthritis Rheum 1997 Oct;27(2):67-72
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. ID: 98035514 TITLE: The nonlinear finite element analysis and plantar pressure measurement for various shoe soles in heel region. AUTHOR: Shiang TY ADDRESS: Graduate Institute of Coaching Science, National College of Physical Education and Sports, Taoyuan, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: The most influential factor contributing to foot and shoe comfort is underfoot cushioning. The shock absorbing ability of footwear in the heel area is of particular importance in reducing the impact load during athletic activities and in therapeutic footwear prescribed for heel pain. Furthermore, foot care for foot problem patients is an important part of treatment and educational programs. Therefore, a well-designed sport shoe which can provide comfort and protection is essential. In order to design a functional shoe, biomechanics and other new technologies should be considered, and the design process should be examined in the biomechanics laboratory over and over. The design process requires too much time and effort since the entire experimental and test work can only be done after the prototype is manufactured. Therefore, this study tried to introduce the Finite Element Method (FEM) into the shoe design process by building a three-dimensional FE model with various shoe soles and loading conditions. The material properties of shoe materials were tested using an Instron Testing Machine. An in-shoe pressure insole was used to measure the plantar pressure in different ambulation conditions with various shoe constructions. The subject for this study was a healthy young male without any foot problem. The average plantar pressures obtained from approximately 50 steps in the heel region for each of the various conditions were collected. was discontinued. Further research is required to fully establish the potential of this approach in subjects with traumatic brain injury. SOURCE: Clin Rehabil 1997 Aug;11(3):220-6 13
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. ID: 97422740 TITLE: Swaddling after heel lance: age-specific effects on behavioral recovery in preterm infants. AUTHOR: Fearon I; Tranmer J; Muir DW; Hains SM Kisilevsky BS ADDRESS: Department of Psychology, Queen's University, Kingston, Ontario, Canada. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 7782-44-7 (Oxygen)
ABSTRACT
: We examined responses of preterm infants to swaddling after a heel lance. Fifteen preterm infants from two postconceptional age (PCA) groups (Group 1: n = 7, PCA < 31 wk; Group 2: n = 8, PCA > or = 31 wk) were observed for 30 minutes during blood sampling followed by routine care; blood sampling followed by swaddling; and no blood sampling and routine care. In both groups, blood sampling resulted in concurrent increases in heart rate and state of arousal, in negative facial displays, and in reductions in blood oxygensaturation. After the blood was drawn, infants less than 31 weeks PCA exhibited an immediate and spontaneous return to behavioral patterns similar to those observed during the no-blood-sample condition, regardless of treatment condition. Infants 31 weeks PCA or older exhibited protracted behavioral disturbance that was significantly reduced by the use of swaddling. We discuss the significance of these findings. SOURCE: J Dev Behav Pediatr 1997 Aug;18(4):222-32 14
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. ID: 98000166 TITLE: Magnetic resonance imaging of Achilles tendon in patients with rheumatoid arthritis. AUTHOR: Stiskal M; Preidler KW; Czembirek H; Mesaric P Steiner E; Stenzel I; Szolar DH ADDRESS: Department of Radiology KH Lainz-Vienna, Austria. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: RATIONALE AND OBJECTIVES: The authors characterize the appearance of the Achilles tendon in patients with rheumatoid arthritis and differentiate this appearance from degenerative tendinopathy in patients with chronic pain of the heel using magnetic resonance (MR) imaging. METHODS: Thirty patients with rheumatoid arthritis and 28 patients with chronic pain of the heel underwent MR imaging of the ankle and foot. Three radiologists independently assessed the MR images with respect to size, shape, and intratendinal signal characteristics of the Achilles tendon. The Achilles tendon was considered abnormal on MR imaging when intratendinous signal alterations or an anteroposterior measurement greater than 8 mm was seen. Physical examination of the Achilles tendons was accomplished in both groups. Operation confirmed the diagnosis of 13 patients in the second group with chronic pain of the heel. RESULTS: The Achilles tendon of 83% of patients with rheumatoid arthritis demonstrated various intratendinous patterns (longitudinal, reticular, nodular) of intermediate signal intensity on all pulse sequences on MR imaging. Ninety percent of patients with rheumatoid tendinopathy showed no enlargement of the anteroposterior diameter of the Achilles tendon. In addition, all patients with rheumatoid arthritis had findings compatible with an inflammation of the retrocalcaneal bursa on MR imaging, whereas none of the patients with tendinopathy associated with chronic heel pain had retrocalcaneal bursitis. All patients, however, had enlargement of the anteroposterior diameter of the Achilles tendon. Seventy-nine percent showed various intratendinous lesions of intermediate signal intensity on all pulse sequences. Twenty-one percent of patients had an enlargement of the Achilles tendon without intratendinous changes. CONCLUSIONS: Rheumatoid tendinopathy can be distinguished from degenerative tendinopathy in patients with chronic pain of the heel with MR imaging. Inflammation of the retrocalcaneal bursa and the absence of enlargement of the tendon combined with the presence of intratendinous signal alterations are characteristic findings of rheumatoid tendinopathy. SOURCE: Invest Ra is less than 1%, and the most common types are talocalcaneal and calcaneonavicular coalitions. The cause is attributed to failure of segmentation and differentiation of the primitive mesenchyme. Calcaneonavicular coalitions can be diagnosed with an oblique radiograph of the hindfoot. Most talocalcaneal coalitions require computerized tomography for diagnostic confirmation. Magnetic resonance Imaging may be useful for cartilaginous and fibrous coalitions. Casting is the usual initial treatment for the symptomatic individual. With treatment failure, in the absence of degenerative changes, resection of the coalition can be performed with good results. Isolated subtalar fusion may be performed for failed talocalcaneal resections. Failed subtalar fusions and failed calcaneonavicular resection may be treated with triple arthrodesis. SOURCE: Foot Ankle Int 1996 May;17(5):286-96
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. ID: 95167427 TITLE: Bone scintigraphy in evaluation of heel pain in Reiter's disease: compared with radiography and clinical examination. AUTHOR: Lin WY; Yeh HW; Liao SQ; Kao CH; Hsu CY; Lang JL Wang SJ ADDRESS: Department of Nuclear Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 63347-66-0 (Technetium Tc 99m Medronate)
ABSTRACT
: Tc-99m MDP bone scans were used to evaluate the heel pain (talalgia) in 38 patients with Reiter's disease, and compared with clinical examination and radiologic findings. In our work, 58% (22/38) patients presented talalgia with a total of 35 lesions. Only two lesions of clinical talalgia were missed by the bone scan. The diagnostic sensitivity was as high as 94% (33/35). However, the diagnostic sensitivity of radiography was only 69% (11/16) when the disease duration was more than one year; furthermore, it declined to 33% (4/12) when the disease duration was less than one year. Based on the bone scans, the correlation between positive scintigraphic findings and clinical talalgia was extremely good. Clinical talalgia occurred in all the 33 lesions demonstrated by bone scan. However, three lesions demonstrated by radiography were not consistent with clinical talalgia and not visualized by radioscintigraphy. Our data show that the radionuclide scan is a more sensitive indicator and has better correlation with clinical talalgia than radiography. We consider that bone scintigraphy is superior to radiography in the evaluation of heel pain in Reiter's disease. SOURCE: Scand J Rheumatol 1995;24(1):18-21 22
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. ID: 97431935 TITLE: Heel lifting as a conservative therapy for osteoarthritis of the hip: based on the rationale of Pauwels' intertrochanteric osteotomy. AUTHOR: Ohsawa S; Ueno R ADDRESS: Department of Orthopaedic Surgery, Osaka Teishin Hospital, Japan. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Patients with osteoarthritis of the hip were treated with a conservative therapy of heel lifting. Orthoses were applied on 35 hips in 33 subjects and the cases were followed for 23 months on average. Dramatic pain relief was reported, but the time required to reduce or completely relieve pain increased according to the stage of osteoarthritis. The radiological results were not satisfactory. During the follow-up, only two hips showed improvement, 22 showed no change, and 11 deteriorated. The mechanism of heel lifting in relation to the hip joint was analysed, showing that pelvic obliquity was achieved and the trunk stabilized. In conclusion this simple orthosis was effective as a palliative therapy for osteoarthritis of the hip. SOURCE: Prosthet Orthot Int 1997 Aug;21(2):153-8 23
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. ID: 97417430 TITLE: Effectiveness of oral sucrose and simulated rocking on pain response in preterm neonates. AUTHOR: Johnston CC; Horton LJ; Stevens BJ; Stremler RL ADDRESS: School of Nursing, McGill University, Montreal, Quebec, Canada. celeste@wilson.lan.mcgill.ca PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng REGISTRY NUMBERS: 57-50-1 (Sucrose)
ABSTRAC JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: The search for the cause of subcalcaneal heel pain involves a range of elements from the height of the patient's shoe heels to the presence of concomitant disease. Heel pain that interferes with daily activities, particularly when mobility is a job requirement, worries the patient and challenges the clinician. However, most patients improve with or without treatment. SOURCE: Hosp Pract (Off Ed) 1997 Sep 15;32(9):81-3, 86-8, 91-2 25
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. ID: 97420575 TITLE: Amputation and prostheses in Khartoum. AUTHOR: Mohamed IA; Ahmed ME; Ahmed AR ADDRESS: Damazine Hospital, University of Khartoum, Sudan. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: One hundred and seventy patients with major lower limb amputation (MLLA) presenting to The National Prosthetic-Orthotic Centre (NPOC) in Khartoum over a 1-year period were studied. There were 141 males and 29 females giving a M:F ratio of 4.9: 1.0, with mean age of 37 years (range 5-72 years). Forty-one patients (24%) underwent amputation of diabetic septic foot, 30 patients (17.6%) underwent amputation as a result of trauma from road traffic accidents and Madura foot, and war injuries accounted for 29 amputations (17%). One hundred and eleven patients had below knee amputation (BKA), 52 had above knee amputation (AKA) and seven patients had Syme's amputation. Diabetic amputees had higher rate of revisional surgery compared with others because of sepsis and/or flap necrosis. Stump pain was reported by amputees with excessive scarring of the stump and those with undue prominence of bony ends. There are two types of prostheses provided by the NPOC for both BKA and AKA: the peg leg and the conventional prostheses. The Syme's amputees were fitted with either simple hoof or articulated prostheses with solid ankle cushion heel (SACH). The peg leg consists of a leather lined side bearing metal socket connected to a rocker base by side steels. It is used by the country natives as it suits different weather and job conditions, particularly farming, and it can be repaired locally. The urban population use the conventional prostheses which is lighter in weight, can be put on and taken off easily and is cosmetically acceptable. However, these prostheses are more expensive and require frequent repair or replacement. The functional outcome of patient's rehabilitation with the prostheses was significantly affected by the level and indication of amputation. Those with BKA and those amputated because of trauma or Madura foot experienced better functional outcome compared with the diabetics, independent of age. 50% of patients with the AKA and 19% of those with BKA reported poor functional outcome. Surgeons should be more involved with the long-term evaluation of functional outcome in such patients, to offer help if feasible and to modify their technique for future procedures. SOURCE: J R Coll Surg Edinb 1997 Aug;42(4):248-51
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. ID: 97369655 TITLE: Does change in skin perfusion provide a good index to monitor the sympathetic response to a noxious stimulus in preterm newborns? AUTHOR: Kunzek S; Shore AC; Quinn MW ADDRESS: Department of Vascular Medicine, University of Exeter, UK. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Skin perfusion was measured using laser Doppler fluximetry (LDF) in 16 preterm babies undergoing a standardised heel prick procedure. Although there was a significant reduction in skin blood flow following the heel prick, this was variable and dependent on basal skin blood flow. This, together with loss of data due to movement artefact, makes this technique unreliable in quantifying the sympathetic response to a noxious stimulus in preterm infants. SOURCE: Early Hum Dev 1997 Sep 19;49(2):81-9
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. ID: 97297266 TITLE: Factors associated with joint pain among postmenopausal women. AUTHOR: Huang C; Wasnich RD; Lydick E; Ross PD ADDRESS: Hawaii Osteoporosis Center, Honolulu 96814, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: OBJECTIV anaesthesia was induced in 55 ASA I-III patients with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed. Intrathecal 24-h infusions consisted of bupivacaine 2 mg h-1 alone (n = 18), bupivacaine 1 mg h-1 alone (n = 18) or bupivacaine 1 mg h-1 combined with morphine 8 micrograms h-1 (n = 19). The interview after 3, 6, 12 and 24 h included assessment of pain at rest and on movement (VAS scale), occurrence of sensory and motor block and nausea/vomiting. Bupivacaine 1 mg h-1 combined with an infusion of morphine provided as good postoperative analgesia as bupivacaine 2 mg h-1, but motor block disappeared earlier (P = 0.01). Patients in the bupivacaine 1-mg h-1 group required more supplementary doses of oxycodone i.m. than the other groups (P = 0.04). Time to first oxycodone dose from the start of intrathecal infusion did not differ between groups. The frequency of nausea and vomiting was similar in all groups. In spite of this, antiemetic medication was required more often in the bupivacaine 1-mg h-1 group (possible because of opioid rescue medication). On the ward, one patient in the bupivacaine 2-mg h-1 group experienced a new increase in sensory block with concomitant hypotension. One patient in the same group had minor decubitus on the heel of the operated leg, probably because of prolonged motor block. We conclude that intrathecal infusion of a combination of bupivacaine 1 mg h-1 and morphine 8 micrograms h-1 produced adequate postoperative analgesia. Unfortunately, postoperative nausea and vomiting was a frequent disturbing adverse effect. SOURCE: Br J Anaesth 1997 Jun;78(6):666-70
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. ID: 97277963 TITLE: Assessment of acute pain in preterm infants by evaluation of facial expression and frequency domain analysis of heart rate variability. AUTHOR: Lindh V; H~akansson S; Sandman PO; Wiklund U ADDRESS: Department of Pediatrics, University Hospital, Ume~a, Sweden. vialih96@student.umu.se PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: In ten preterm infants (postconceptional age 27-35 weeks) facial expression and heart rate variability (HRV) were investigated during three situations: (a) the infant at rest in its crib or incubator, (b) provocation of the withdrawal flexor reflex by application of von Frey's hairs, and (c) lancing and squeezing for blood sampling. Video recordings of facial expressions, mixed at random, were categorised as the baby being either undisturbed, disturbed or in pain and a detailed scoring for each situation was performed. Mean heart rate (HR) was calculated and power spectral analysis was assessed on data from segments of 45-s duration from the three procedures. Flexor withdrawal did not evoke visual signs of pain or influence HRV, but caused a slight increase in HR. The lancing and squeezing of the heel evoked a facial expression of pain in all infants. The HR increased and a reduction in both total HRV and power in the low frequency band of the HRV spectrum was seen during blood sampling. The differentiation between painful and non-painful procedures was more apparent when principal component analysis of HRV was applied. SOURCE: Early Hum Dev 1997 Apr 25;48(1-2):131-42 34
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. ID: 97307899 TITLE: Milk-induced hypoalgesia in human newborns. AUTHOR: Blass EM ADDRESS: Department of Psychology, Cornell University, Ithaca, New York, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng REGISTRY NUMBERS: 0 (Analgesics)
ABSTRACT
: OBJECTIVE: To determine whether milk and its components reduce crying in newborns during and after blood collection for phenylketonuria evaluation. METHODOLOGY: Seventy-two normal newborns ingested 2 mL of milk (Similac), Ross Special Formula, fat, protein, lactose, sucrose, or water for the 2 minutes preceding blood collection via heel lance. Crying duration during and for the 3 minutes after the procedure was determined by scorers who were blind to the ingestive substance. RESULTS: Sucrose and Similac each reduced IT morphine. Naloxone (1 mg/kg) reversed morphine-produced hypoalgesia. CONCLUSION: This is the first study to demonstrate that mechanical hyperalgesia to a nonpunctate stimulus occurs after a surgical incision in the rat. This rat model of postoperative has several similarities to postoperative patients: mechanical hyperalgesia to punctate and nonpunctate stimuli, nonevoked pain, and pain behaviors inhibited by SC and IT morphine. This model also may be useful for predicting analgesia by investigational agents for postoperative pain. SOURCE: Anesthesiology 1997 May;86(5):1066-77 38
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. ID: 97292003 TITLE: Solitary painful piezogenic pedal papule. AUTHOR: Graham BS; Barrett TL ADDRESS: Department of Dermatology, Naval Medical Center, San Diego, CA 92134-5000, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng SOURCE: J Am Acad Dermatol 1997 May;36(5 Pt 1):780-1 39
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. ID: 97300955 TITLE: Painful piezogenic pedal papules: response to local electro-acupuncture. AUTHOR: Woodrow SL; Handfield-Jones S; Brereton-Smith G ADDRESS: Dermatology Department, West Suffolk Hospital, Bury St Edmunds, Suffolk, U.K. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: We report the case of a woman who had pain in both heels which was exacerbated by long periods of exercise. On examination, there were small flesh-coloured papules which appeared over the medial and lateral aspects of the heels only on weight bearing. Coincidentally, she was noted to have larger flesh-coloured papules over the anterior surface of the shins. The diagnoses of painful piezogenic pedal papules and bilateral tibialis anterior muscle herniation, respectively, were made. After many attempts to control the pain, a course of electro-acupuncture was commenced. A good subjective clinical response was achieved which has been maintained by fortnightly treatments. We discuss the prevalence, pathogenesis and treatment of painful piezogenic pedal papules. We believe that our patient is the first to have 'herniations' at both heel and shin sites and the first to have successful sustained pain relief for painful piezogenic pedal papules. SOURCE: Br J Dermatol 1997 Apr;136(4):628-30 40
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. ID: 97272408 TITLE: Heel anatomy for retrograde tibiotalocalcaneal roddings: a roentgenographic and anatomic analysis. AUTHOR: Flock TJ; Wapner KL; Hecht PJ; Ishikawa S ADDRESS: Lewiston Orthopaedic Associates, P.A., Bryden Canyon Center, Idaho 83501, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: There is an increased interest in load-sharing devices for tibiotalocalcaneal arthrodesis. Although the neurovascular anatomy of the heel has been well described, the purpose of this study is to consider heel anatomy as it relates to plantar heel incisions and to well-defined fluoroscopic landmarks to prevent complications during these procedures. Twenty lateral radiographs of normal feet while standing were evaluated by two observers. The distance from the calcaneocuboid (CC) joint to a line parallel to the center of the intramedullary canal of the tibia was calculated. In the second part of the study, 14 dissections of the arterial and neural anatomy were performed. The distances from the CC joint to structures crossing the heel proximal to the CC joint were studied. In the 20 standing radiographs, the mean distance from the CC joint to the middle of the intramedullary canal of the tibia was 2.1 cm (standard deviation, 0.55 cm). In the dissections, the only artery or nerve found to cross the plantar surface proximal to the CC joint was the nerve to the abductor digiti quinti (NAbDQ). The mean distance from the CC joint to the NAbDQ was 3.1 cm (standard deviation, 1.36 cm). Assuming reaming to 12 mm, NAbDQ would be at risk 42% of the time. We recommend careful dissection of the heel during retrograde roddings to avoid damage to NAbDQ and subsequent neurogenic heel pain. SOURCE: Foot Ankle Int 1997 Apr;18(4):233-5
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. ID: 97009512 TITLE: A functional index in myositis. AUTHOR: Josefson A; Carlsson J; R Our results strongly suggest that 1 ml of a 30% glucose solution given orally alleviates mild pain significantly and can be used for this purpose in newborns. Breast milk and 10% glucose did not have a similar effect. SOURCE: Acta Paediatr 1997 Feb;86(2):217-20 44
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. ID: 97257568 TITLE: Radiographs in heel pain [letter; comment] AUTHOR: Devitt N COMMENTS: Comment on: Bull Rheum Dis 1996 Jun;45(4):1-3 PUBLICATION TYPES: COMMENT LETTER LANGUAGE: Eng SOURCE: Bull Rheum Dis 1997 Apr;46(2):1 45
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. ID: 97255391 TITLE: A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. AUTHOR: Mata S; Esdaile JM; Chhem RK; Rosenberg E; Gore B Watts CS; Joseph L; Starr MR; Fitzcharles MA; Fortin PR ADDRESS: Department of Medicine, Montreal General Hospital, Quebec, Canada. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Diffuse idiopathic skeletal hyperostosis (DISH) is a common but little-studied disorder in the elderly that is infrequently recognized by physicians. Its prevalence in adults over 40 years of age is estimated at 3.8% for men and 2.6% for women. The present case-control study evaluated the history of pain and stiffness, radicular pain and enthesitis, physical findings on the musculoskeletal examination, and level of physical and psychologic disability in 130 persons: 56 patients with DISH, 43 control patients with spondylosis of the lumbar spine, and 31 healthy control patients. DISH patients were more likely to report a past history of upper extremity pain, medial epicondylitis of the elbow, enthesitis of the patella or heel, or dysphagia than spondylosis patients. They had more extremity and spinal stiffness and pain than healthy controls. DISH patients weighed more at a young age and their body mass index was greater at the time of the clinical evaluation than either spondylosis or healthy control patients. On musculoskeletal examination, DISH patients had a greater reduction in neck rotation and thoracic movements than either spondylosis patients or healthy controls, and had a greater reduction in lumbar movement than healthy controls. DISH patients had similar levels of spinal disability and physical disability overall, as measured by standardized indices, as spondylosis patients. No differences were found among the 3 groups of patients for the laboratory tests evaluated. DISH is clearly a distinct disorder with signs and symptoms that distinguish it from other causes of spinal complaint and from healthy individuals. It has the potential to cause major disability. Future studies need to address the natural history of DISH, pursue pathogenic mechanisms, and evaluate treatment modalities. SOURCE: Medicine (Baltimore) 1997 Mar;76(2):104-17 46
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. ID: 97241426 TITLE: Unusual presentation of calcaneal osteomyelitis. Twenty-five years after inoculation. AUTHOR: Rogoff RS; Bartis DG; Tinkle JD ADDRESS: California College of Podiatric Medicine, San Francisco, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: An unusual presentation of calcaneal osteomyelitis is described, where-by the infection remained undiagnosed for 25 years. The 36-year-old patient recently sought medical treatment for a reported ankle sprain, but the pain was recalcitrant to conservative care. Further investigation yielded a history significant for stepping on a chicken bone as a child, which entered the inferior lateral heel. Magnetic resonance imaging revealed what plain radiographs did not: a well demarcated lytic lesion in the body of the calcaneus. Intraoperative findings were consistent with an abscess of chronic osteomyelitis. The treatment included incision and drainage, antibiotic beads, and a tricortical bone graft. SOURCE: J Am Podiatr Med Assoc 1997 Mar;87(3):125-30 47
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. ID: 97234118 TITLE: Immobilizing heel pain in a runner [see comments] AUTHOR: Sack KE COMMENTS: Comment in: Hosp Pract (Off Ed) 1997 May 15;32(5):25-6 ADDRESS: Clinical Programs in Rheumatology, University of California, San Francisco, respectively, indicating that leg volume was increased under all exercise conditions. Among exercises, the swell-preventing effect of knee-bending was strongest, and that of heel-raising was weakest. Heel-raising also yielded the highest number of subjective complaints. Knee-bending, which uses the thigh and calf muscles simultaneously, was considered the most effective for suppressing lower-leg swelling and minimizing subjective complaints. SOURCE: Ind Health 1997;35(1):36-40 52
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. ID: 97064936 TITLE: Subtalar arthrodesis using interposition iliac crest bone graft after calcaneal fracture. AUTHOR: Amendola A; Lammens P ADDRESS: Division of Orthopaedic Surgery, University Hospital, University of Western Ontario, London, Canada. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Fifteen consecutive patients with hindfoot pain after calcaneal fracture underwent subtalar arthrodesis using interposition iliac crest bone graft. Outcome and correction of calcaneal collapse were assessed before and after surgery with clinical examination, visual analogue scores, and standard x-rays while weightbearing. Eleven of the 15 patients were satisfied with the procedure. There were four failures due to transverse tarsal joint arthritis, overcorrection, and reflex sympathetic dystrophy. Radiographic examination revealed restoration of heel height, with 100% union rate of the arthrodesis. The described technique allows arthrodesis and correction of calcaneal collapse after calcaneal fracture. SOURCE: Foot Ankle Int 1996 Oct;17(10):608-14 53
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. ID: 96436102 TITLE: Results of closed intra-articular calcaneal fractures treated with early mobilisation and without reduction. AUTHOR: Low CK; Lam KS; Mesenas S ADDRESS: Department of Orthopaedic Surgery, Toa Payoh Hospital, Singapore. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Between January 1987 and December 1989, a retrospective study was done of 42 patients with 56 closed intra-articular calcaneal fractures treated with no reduction and early mobilisation at the Department of Orthopaedic Surgery, Toa Payoh Hospital. There were 12 left, 16 right and 14 bilateral fractures. Using the Creighton-Nebraska Health Assessment for calcaneal fractures, 38 (67.9%) fractures were rated as excellent and good and the average follow-up period was 3.2 years. Thirty-five (83.3%) of the patients were able to work after an average interval of 4.5 months. The complications included residual pain in 34 (60.1%) fractures, heel deformity in 40 (71.4%), foot swelling in 31 (55.4%) and limitation of subtalar movement in 35 (62.5%). Early osteoarthritis of the subtalar joint was noted in 5 (8.9%) comminuted fractures and was associated with poor results. SOURCE: Ann Acad Med Singapore 1995 Nov;24(6):820-2
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. ID: 97056014 TITLE: Sever's disease and other causes of heel pain in adolescents. AUTHOR: Madden CC; Mellion MB ADDRESS: University of Nebraska Medical Center, Omaha, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Sever's disease, or apophysitis of the calcaneus, is a common but frequently undiagnosed source of heel pain in young athletes. This condition frequently occurs before or during the peak growth spurt in boys and girls, often shortly after they begin a new sport or season. Sever's disease often occurs in running and jumping sports, particularly soccer. Patients present with intermittent or continuous heel pain occurring with weight bearing. Findings include a positive squeeze test and tight heel cords. Sever's disease cannot be diagnosed radiographically. The condition usually resolves two weeks to two months after the initiation of conservative treatment, which may include rest, ice application, heel lifts, stretching and strengthening exercises, and, in more severe cases, nonsteroidal anti-inflammatory drugs. SOURCE: Am Fam Physician 1996 Nov 1;54(6):1995-2000 58
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. ID: 97066006 TITLE: Experience in a neonatal intensive care unit affects pain response. AUTHOR: Johnston CC; Stevens goals of surgery were to alleviate pain, improve function and cosmesis, remove infected bone, and prevent further infection. The surgical sites are completely healed without complications 2 years postoperatively. SOURCE: J Am Podiatr Med Assoc 1996 Apr;86(4):179-82 60
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. ID: 97090548 TITLE: Response to pain in a group of healthy term newborns: behavioral and physiological aspects. AUTHOR: Fazzi E; Bollani L; Gerola O; Scelsa B; Farinotti L ADDRESS: Department of Child Neuropsychiatry, University of Pavia, Italy. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Various reports have documented the difficulty in assessing neonatal response to painful stimuli. The aim of our study was to evaluate previously described scales for assessing pain in a group of 18 healthy term newborns selected according to Prechtl's optimality criteria and subjected to a routine metabolic screening blood test performed on the 5th day of life. Both a modified CHEOPS scale and Grunau-Craig Scale, to assess pain behavior response before, during and after a painful stimulus, revealed definite modifications in scores. Response to pain was also evaluated by measuring variations in decreases in transcutaneous oxygen pressure in all newborns during application of the stimulus and in returns to baseline or higher values upon removal of the stimulus. Our study confirms that healthy term newborns feel pain when subjected to limited painful stimuli such as the routine blood test and suggests useful and easy methodological tools to evaluate pain in the newborn. SOURCE: Funct Neurol 1996 Jan-Feb;11(1):35-43
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. ID: 96428790 TITLE: Anterior thigh compartment syndrome following prolonged tourniquet application and lateral positioning. AUTHOR: Seybold EA; Busconi BD ADDRESS: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical Center, Worcester, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: A case presentation of anterior thigh compartment syndrome following prolonged tourniquet application and lateral decubitus positioning is presented with a review of the literature regarding thigh compartment syndrome. In this case, an 18-year-old man underwent a 12-hour scapular fasciocutaneous-free flap grafting procedure for a non-healed ulcer of the medial heel. Postoperatively, the patient developed anterior thigh compartment syndrome that was delayed in diagnosis because of the epidural analgesics he received for pain control. The patient was returned to the operating room and was successfully treated by an anterior decompression fasciotomy. SOURCE: Am J Orthop 1996 Jul;25(7):493-6 63
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. ID: 96434213 TITLE: Pressure sores as a complication of patient-controlled epidural analgesia after cesarean delivery. Case report. AUTHOR: Smet IG; Heylen RJ; Vundelinckx GJ; De Jongh RF Vercauteren MP ADDRESS: Department of Anesthesiology, Sint Jansziekenhuis, Schiepse-Bos Genk, Belgium. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: BACKGROUND AND OBJECTIVES: Postoperative epidural analgesia using mixtures of bupivacaine and opioids has become common practice following abdominal surgery. Side effects such as hypotension, motor block, respiratory depression, pruritus, and urinary retention are well known. Pressure sores occurring within the first 24 hours are extremely rare. METHODS: Three parturients scheduled for cesarean delivery received for postoperative pain relief with a patient-controlled epidural analgesia, consisting of 0.11% bupivacaine, 2 micrograms/mL sufentanil, 3 micrograms/mL clonidine, and 1.25 micrograms/mL epinephrine. RESULTS: Within the first postoperative day pressure sores were observed at one heel. In one patient the coccygeal area was also affected. After discontinuation of the patient-controlled analgesia and local treatment, including application of heel pads, the pressure sores healed uneventfully. CONCLUSIONS: Pressure sores following postoperative epidural analgesia may occur even in young patients. Although bup ADDRESS: Department of Rehabilitation Medicine, Goteborg University, Sahlgrenska University Hospital, Sweden. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Clinical alignment, pain variables, common symptoms and functional activity level associated with patellofemoral pain syndrome (PFPS) were evaluated in 40 women with PFPS and 20 healthy controls. No significant difference could be found neither between the patients' most symptomatic knee and least symptomatic knee, nor between the patients and controls regarding clinical lower extremity alignment, such as Q-angle and leg-heel alignment measurements. There were no radiographic signs of malalignment. The patients were significantly more involved competitively in sports but had a significantly lower pain free activity level than the controls. Pain was associated with increased activity. It is suggested that chronic overloading and temporary overuse of the patellofemoral joint, rather than malalignment, contribute to patellofemoral pain. SOURCE: Scand J Med Sci Sports 1995 Aug;5(4):237-44 69
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. ID: 95261874 TITLE: Can topical lignocaine reduce behavioural response to heel prick? AUTHOR: Rushforth JA; Levene MI; Thorpe H; Griffiths G ADDRESS: Academic Department of Paediatrics, General Infirmary at Leeds. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng REGISTRY NUMBERS: 0 (Ointments) 137-58-6 (Lidocaine)
ABSTRACT
: In a randomised, double blind, controlled study the ability of 5% lignocaine ointment to reduce the behavioural response to heel lance in 30 healthy neonates was assessed. Five per cent lignocaine ointment applied to the heel under an occlusive dressing for one hour before heel prick did not reduce the infants' behavioural response to the heel prick procedure. SOURCE: Arch Dis Child Fetal Neonatal Ed 1995 Jan;72(1):F49-51 70
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. ID: 95261873 TITLE: Exposure to invasive procedures in neonatal intensive care unit admissions. AUTHOR: Barker DP; Rutter N ADDRESS: Department of Neonatal Medicine and Surgery, Nottingham City Hospital. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: The nature and numbers of invasive procedures were studied in 54 consecutive infants admitted to a neonatal intensive care unit. Over 3000 procedures were recorded, 74% in infants below 31 weeks of gestation. One infant (23 weeks' gestation, birth weight 560 g) underwent 488 procedures. Heel prick blood sampling was the most common procedure (56%), followed by endotracheal suction (26%) and intravenous cannula insertion (8%). Invasive procedures which would cause pain or distress to a child are frequently performed on infants admitted to the neonatal intensive care unit. A reduction in the number of procedures, modifying them, or providing adequate analgesia could relieve some of this pain and distress. SOURCE: Arch Dis Child Fetal Neonatal Ed 1995 Jan;72(1):F47-8 71
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. ID: 96285834 TITLE: Piezogenic pedal papules in two family members. AUTHOR: Gibney MD; Glaser DA ADDRESS: Division of Dermatology, Saint Louis University Health Sciences Center, Missouri, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW OF REPORTED CASES LANGUAGE: Eng
ABSTRACT
: Piezogenic pedal papules are small, occasionally painful, fat herniations that become apparent when weight is placed on the heel. Although the cause is unknown, hereditary factors may play a role. This is the second report of two family members with this condition. SOURCE: Cutis 1996 Apr;57(4):260-2 72
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. ID: 96243350 TITLE: Regional variations in skin perfusion and skin thickness may contribute to varying efficacy of topical, local anaesthetics in neonates. AUTHOR: Larsson BA; Olsson GL; Lagercrantz H; Egekvist H Bjerring P; Norman M ADDRESS: Department of Paediatric Anaesthesia and Intensive Care, Karolinska Hospital, Stockholm, Sweden. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 0 (Anesthetics, Local) 0 (Drug Combinations) 0 (EMLA) 0 (Ointments) 137-58-6 (Lidocaine) 721 on painful symptoms [VAS scale, presence of the active trigger point (TrP) in the muscle] and on g-f parameters [peaks of vertical force (F1 and F3 of Fz) and of lateral shear force (Fx)]. RESULTS: Treatment with heel lift produced a moderate, significant reduction of the spontaneous pain and of the abnormal Fx peak in the affected leg after 7 to 14 days with no further improvement afterward. Treatment with dynamic insoles caused a marked, significant reduction of the pain at 7 days, with complete resolution of the painful symptoms at 30 days and concomitant disappearance of the active TrP in the muscle. It also produced a significant and progressive reduction of the abnormal Fx peak in the affected leg starting at the 7th day and continuing until the 60th day. CONCLUSION: Both anatomical and biomechanical alterations of the dynamics of movement play a role in the painful symptoms of MPS of the peroneus longus, but the biomechanical factor is by far the more prominent. SOURCE: Clin J Pain 1996 Mar;12(1):30-7 74
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. ID: 96297334 TITLE: How effective is therapeutic ultrasound in the treatment of heel pain? AUTHOR: Crawford F; Snaith M ADDRESS: London Foot Hospital & School of Podiatric Medicine, United Kingdom. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng
ABSTRACT
: OBJECTIVES: To evaluate the therapeutic effect from ultrasound in the treatment of plantar heel pain by physiotherapists and podiatrists, and to quantify the placebo effect of this electrophysical agent. METHODS: Patients experiencing episodes of plantar heel pain were allocated randomly, at each episode, to receive either true ultrasound (machine calibrated to deliver a dose of ultrasound at 0.5 w/cm2, 3 MHz, pulsed 1:4), for eight minutes, or sham ultrasound (only the timer on the machine activated). Each episode was treated, according to randomisation, eight times. An independent observer set the equipment before obscuring the control panel with a drape. All treatments were undertaken by the same operator. Patients' pain scores were measured on a 10 cm linear analogue scale before the course of eight treatments commenced and at the end of the course, and analysed using a Wilcoxon Signed-Ranks test. RESULTS: Nineteen patients experienced episodes of heel pain (seven bilateral). Both groups showed a reduction in pain; the improvement was 30% in the treated group and 25% in the placebo group (p = 0.5). CONCLUSIONS: Therapeutic ultrasound at a dosage of 0.5 w/cm2, 3 MHz, pulsed 1:4, for eight minutes is no more effective than placebo in the treatment of plantar heel pain. SOURCE: Ann Rheum Dis 1996 Apr;55(4):265-7
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. ID: 96303060 TITLE: The medial instep plantar fasciotomy [letter; comment] AUTHOR: Amarnek DL COMMENTS: Comment on: J Foot Ankle Surg 1995 Sep-Oct;34(5):447-57; discussion 509-10 PUBLICATION TYPES: COMMENT LETTER LANGUAGE: Eng SOURCE: J Foot Ankle Surg 1996 Mar-Apr;35(2):182-3 77
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. ID: 96247176 TITLE: Capillary blood sampling: should the heel be warmed? [see comments] AUTHOR: Barker DP; Rutter N; Cappendijk VC; Willetts B COMMENTS: Comment in: Arch Dis Child Fetal Neonatal Ed 1996 Sep;75(2):F143-4 ADDRESS: Department of Neonatal Medicine and Surgery, Nottingham City Hospital. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng
ABSTRACT
: The hypothesis that capillary blood sampling is made easier by warming the heel was examined in a randomised, controlled trial of healthy newborn infants. Sampling was performed using an automated lancet with or without prior warming. The time taken to collect a standard volume of blood, the number of repeat procedures needed, and the infants' behavioural responses were measured. Eighty one procedures were studied in 57 infants. Warming produced a median rise in heel skin temperature of 4.7 degrees C. However, there were no significant differences between the warmed and unwarmed groups in any of the outcome measures. Heel skin temperature is not an important factor in capi sucrose has analgesic effects in healthy premature infants. SOURCE: Arch Dis Child Fetal Neonatal Ed 1996 Mar;74(2):F126-8
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. ID: 96266722 TITLE: Metatarsalgia [see comments] AUTHOR: Quirk R COMMENTS: Comment in: Aust Fam Physician 1996 Nov;25(11):1788 PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Metatarsalgia, or pain in the metatarsal region of the foot, is a common orthopaedic problem, but is generally less well understood than pain in the toes, ankle or heel. The cause of metatarsal pain is often less apparent than in other regions of the foot, and in many cases plain X-rays are of no help. Morton's neuroma, a common cause of severe metatarsalgia, can usually only be diagnosed from the history and clinical examination. The key to diagnosis in the metatarsal region is to have a clear knowledge of the most likely conditions. SOURCE: Aust Fam Physician 1996 Jun;25(6):863-5; 867-9 82
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. ID: 96266754 TITLE: Case management study: heel pain in the adult [see comments] AUTHOR: Hurwitz SR COMMENTS: Comment in: Bull Rheum Dis 1997 Apr;46(2):1 ADDRESS: University of Virginia Medical Center, Charlottesville, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Non-Steroidal) SOURCE: Bull Rheum Dis 1996 Jun;45(4):1-3 83
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. ID: 96257173 TITLE: Heel spur: radiation therapy for refractory pain--results with three treatment concepts. AUTHOR: Seegenschmiedt MH; Sauer R; Stecken A; Katalinic A Keilholz L ADDRESS: Department of Radiation Therapy, University Erlangen-Nurnberg, Strahlenstherapeutische Universitatsklinik, Germany. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: PURPOSE: To evaluate radiation therapy (RT) to treat refractory pain in plantar heel spur. MATERIALS AND METHODS: From 1984 to 1994, 141 patients with refractory painful plantar heel spur (170 heels, because of bilateral disease) underwent RT. Quantitative criteria were used to evaluate heel pain and ankle function prior to RT, 6-12 weeks after RT, and at last follow-up (median, 4 years). Patients were divided into three treatment groups: group A (n = 72 heels [two courses, 1.0-Gy fractions, 12-Gy total RT dose]), group B1 (n = 50 heels [one course, 0.3-Gy fractions, 3-Gy total dose]), and group B2 (n = 48 heels [one course, 0.5-Gy fractions, 5-Gy total dose]). RESULTS: At last follow-up, complete pain relief was achieved in 48 (67%) of 72 group A heels and in 71 (72%) of 98 group B heels. Statistically significant (P < .05) differences between groups were found for insufficient pain relief (< 80%) in patients in whom the response time after RT was longer than 4 weeks or in whom pain recurred during follow-up. The best results were achieved with the 5-Gy total RT dose (P < .05). Prognostic factors for complete pain relief were acute pain and short duration of pain prior to RT. The prognostic factor for insufficient pain relief was total RT dose. CONCLUSION: Refractory heel pain is effectively treated with RT, which should be considered a primary treatment approach rather than a last resort. SOURCE: Radiology 1996 Jul;200(1):271-6 84
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. ID: 96207605 TITLE: Comparison of newborn circumcision pain to calcaneal heel puncture pain: is newborn circumcision pain control clinically warranted? [see comments] AUTHOR: Holton ME COMMENTS: Comment in: J Am Osteopath Assoc 1996 May;96(5):273; discussion 274-5 COMMENTS: Comment in: J Am Osteopath Assoc 1996 May;96(5):273-4; discussion 274-5 PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: In newborns, elective male circumcision and calcaneal puncture for obtaining blood samples both cause pain. With elective male circumcision, dorsal penile nerve block (DPNB) is recommended for pain control, but no pain control is routinely recommended or used during calcaneal puncture. A prospective investigation was conducted to compare pain during elective circumcision (with and without DPNB) and calcaneal puncture to determine whether pain control should be used with the latter p ARTICLE LANGUAGE: Eng
ABSTRACT
: Although epithelial malignancies can have bone metastases, involvement of small bones is exceedingly rare, representing either first manifestation of an occult carcinoma or late disseminated disease. Small bone metastases may mimic primary skeletal diseases leading to misdiagnosis and delayed treatment. We report three cases of metastatic epithelial malignancies diagnosed by computed tomography (CT)-guided fine-needle aspiration (FNA) biopsy in two patients with lytic calcaneal lesions and a patellar lesion in a third patient; all with histologic confirmation. Case 1, a 63-year-old female, presented with heel pain. FNA and tissue biopsy of the calcaneus revealed a clear cell malignancy consistent with a renal primary. Follow-up abdominal CT scan revealed a renal lesion consistent with renal cell carcinoma. Case 2, a 37-yr-old male with squamous cell carcinoma of the esophagus, presented with foot pain. FNA and tissue biopsy of the calcaneous revealed metastatic squamous cell carcinoma. Case 3, a 52-yr-old male with a history of squamous cell carcinoma of floor of mouth, presented with knee pain and swelling. FNA and tissue biopsy of the patella revealed metastastic squamous cell carcinoma. To the best of our knowledge, this is the first complete FNA cytology report with histologic confirmation of unusual small bone metastases of the feet and patella from epithelial malignancies and shows the value of FNA cytology in establishing a correct diagnosis, and excluding primary skeletal diseases. SOURCE: Diagn Cytopathol 1995 Oct;13(3):192-5 87
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. ID: 96121292 TITLE: Efficacy of first-time steroid injection for painful heel syndrome. AUTHOR: Miller RA; McGuire M; Torres J ADDRESS: Department of Orthopaedics and Rehabilitation, University of New Mexico Hospital, Albuquerque 87106, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Steroidal) 378-44-9 (Betamethasone)
ABSTRACT
: The purpose of this study was to evaluate the results of a single injection of corticosteroids in patients with painful heel syndrome. Twenty-seven heels in 24 patients were injected with a combination of 1 ml of lidocaine and 1 ml of betamethasone (6 mg). These patients had never previously received an injection to their heels and had continued symptoms of pain after a trial of other nonoperative treatment modalities. After the injection, patients were seen and surveyed periodically for a period of 5 months to 8 months. The amount of pain relief that they obtained, the length of time this lasted, and the amount of heel pain present at the final follow-up were recorded. Based on the results of our study, we believe that a steroid injection is a reasonable adjunct in the treatment of painful heel syndrome, but that it is unlikely to provide permanent pain relief. SOURCE: Foot Ankle Int 1995 Oct;16(10):610-2 88
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. ID: 96027073 TITLE: Sucrose reduces pain reaction to heel lancing in preterm infants: a placebo-controlled, randomized and masked study. AUTHOR: Bucher HU; Duc G; Wolf M; Keel M; von Siebenthal K Moser T ADDRESS: Department Obstetrics and Gynaecology, University Hospital, Zurich, Switzerland. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng REGISTRY NUMBERS: 0 (Analgesics) 0 (Hemoglobins) 0 (Oxyhemoglobins) 57-50-1 (Sucrose) 9008-02-0 (deoxyhemoglobin)
ABSTRACT
: In term infants sucrose given by mouth has been reported to reduce duration of crying after a heel prick. This study was designed primarily to investigate the effect of sucrose administered orally immediately before heel lancing on the nociceptive reaction in preterm infants as assessed by change in heart rate and duration of crying. A secondary objective was to document changes in cerebral blood volume during acute pain. We used a randomized, masked, placebo-controlled, crossover trial in a neonatal intermediate care unit in a level 3 perinatal center. The patients studied were 16 preterm infants; birt Antigen) SOURCE: J Am Podiatr Med Assoc 1995 Oct;85(10):538-42 92
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. ID: 96027812 TITLE: Treatment of idiopathic clubfoot. A thirty-year follow-up note [see comments] AUTHOR: Cooper DM; Dietz FR COMMENTS: Comment in: J Bone Joint Surg Am 1996 Oct;78(10):1624-5 Comment in: J Bone Joint Surg Am 1996 Oct;78(10):1625-6 ADDRESS: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: We evaluated forty-five patients who had seventy-one congenital clubfeet. The average age was thirty-four years (range, twenty-five to forty-two years). Twenty-nine of these patients had been evaluated and reported on in 1980. We performed pedobarographic and electrogoniometric analyses in addition to the clinical and radiographic studies performed previously. With the use of pain and functional limitation as the outcome criteria, thirty-five (78 per cent) of the forty-five patients had an excellent or good outcome compared with eighty-two (85 per cent) of ninety-seven individuals who did not have congenital deformity of the foot. The patient's occupation, passive dorsiflexion as measured with a hand-held goniometer, the antero-posterior calcaneus-fifth metatarsal angle, the total foot pressure time integral, and the number of rapid single-limb toe-ups that could be performed were the only variables that differed significantly between the feet that had an excellent or good result and those that had a poor result (p < 0.05). A comparison of the feet that had an excellent or good outcome with those that had a poor outcome with regard to body-mass index, peak pressure under the heel, and force time integral under the metatarsal heads revealed a p value that was between 0.05 and 0.08 for each variable. The technique of treatment led to good long-term results in our patients who had clubfoot. The data suggest that a sedentary occupation and avoidance of excessive weight gain may improve the over-all long-term result. Excessive weakening of the triceps surae may predispose patients to a poor result; therefore, it is prudent to avoid overlengthening of this muscle. The outcome could not be predicted from the radiographic result. SOURCE: J Bone Joint Surg Am 1995 Oct;77(10):1477-89 93
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. ID: 96053959 TITLE: Role of plantar fascia in the load bearing capacity of the human foot. AUTHOR: Kim W; Voloshin AS ADDRESS: Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA 18015, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Plantar fascia release is an accepted and widely used surgical way to reduce heel pain, however its effect of the load bearing characteristics of the foot is not well studied. A simple biomechanical model is developed here to analyze load bearing mechanism of the foot during the stance phase of the gait cycle. Quasilinearization is used for the system identification, and all model's parameters are determined from the in vivo tests. The model is used to compare the load bearing mechanism of different pathological situations. The results of the study suggest that the plantar fascia carries as much as 14% of the total load on the foot. Its surgical release decreases dynamic loading on the ankle by only 10%. It is also found that the lowering of the arch degenerates the load bearing capacity of the foot. Thus, the plantar fascia plays an important part in the load bearing by the foot and its surgical release should be carefully considered. SOURCE: J Biomech 1995 Sep;28(9):1025-33 94
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. ID: 96027749 TITLE: Spur formation and heel pain [letter; comment] AUTHOR: Kelly A; Winson I; Wainwright A COMMENTS: Comment on: Clin Orthop 1994 Sep;(306):192-6 PUBLICATION TYPES: COMMENT LETTER LANGUAGE: Eng SOURCE: Clin Orthop 1995 Oct;(319):330 95
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. ID: 96022741 TITLE: Update on women's footwear. AUTHOR: Frey C; Smith J; Thompson F ADDRESS: Department of Orthopaedic Surgery, University of Southern California, Los Angeles 90007, USA. PUBLICA PUBLICATION TYPES: LETTER LANGUAGE: Eng
ABSTRACT
: This case report was presented because there are few published cases of a solitary lesion of primary osteoma cutis occurring in the foot. It is an unusual cause of heel pain. SOURCE: J Am Podiatr Med Assoc 1995 Jun;85(6):341-2 101
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. ID: 95324429 TITLE: Skin blood flow changes during routine nursery procedures. AUTHOR: McCulloch KM; Raju TN; Ji SA ADDRESS: Department of Pediatrics, University of Illinois at Chicago 60612, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 0 (Analgesics) 57-27-2 (Morphine)
ABSTRACT
: OBJECTIVE: The objective of this study was to establish that changes in skin blood flow could serve as an index of pain and discomfort in newborn infants. METHODS: Skin blood flow changes during intensive care procedures and during morphine administration were measured in a group of newborn infants using a laser Doppler technique. Heart rate, respiratory rate and oxygen saturation were also measured. Changes in skin blood flow and physiologic variables that occurred during procedures were analyzed and compared among procedures. RESULTS: Measurements were made during 145 procedures in 15 infants 2-32 days old with birth weights of 500-2900 g and gestational ages of 23-37 weeks. Ten of the infants were receiving mechanical ventilation. Skin blood flow increased 27-134% during lancet puncture of the heel, physical handling, standard suctioning and chest physiotherapy, and there were no changes during closed system suctioning. Skin blood flow decreased 35% by 20 min after intravenous morphine. Changes seen in heart rate, respiratory rate and oxygen saturation were generally minimal. CONCLUSIONS: We conclude that laser Doppler skin blood flow changes could be an index of neonatal pain and discomfort; even noninvasive handling procedures are associated with increases in skin blood flow; and changes in skin blood flow may be more useful than conventional physiologic variables in assessing the response to intensive care nursery procedure. SOURCE: Early Hum Dev 1995 Apr 14;41(2):147-56 102
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. ID: 95316437 TITLE: Pain-reducing properties of sucrose in human newborns. AUTHOR: Blass EM; Shah A ADDRESS: Department of Psychology, Cornell University, Ithaca, NY 14853-7601, USA. PUBLICATION TYPES: CLINICAL TRIAL CONTROLLED CLINICAL TRIAL JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 0 (Analgesics, Non-Narcotic) 0 (Endorphins) 57-50-1 (Sucrose)
ABSTRACT
: To assess the characteristics of sucrose as a pain-reducing substance, crying in 72 newborn humans during and after blood collection via heel prick was determined. In the first study infants drank 2 ml of water or 2 ml of a 0.17-0.34- or 0.51-M sucrose solution 1 min prior to blood collection. In the second experiment, a delay of 30, 60, 90, 120 or 240 s was imposed between sucrose intake and the initiation of blood collection. The dose-response function for concentration was flat. The most effective time delay was 120 s. The effectiveness of the 2-min interval accords with previous findings of endogenous opioid release caused by sucrose taste. The flat dose-response function extends findings in rats and humans that the calming and pain-reducing effects of sucrose are not influenced by either concentration or volume, suggesting that the transduction from gustatory afferent to opioid-mediated efferent is of an on-off nature and not graded. SOURCE: Chem Senses 1995 Feb;20(1):29-35 103
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. ID: 95314038 TITLE: Pain and tissue-interface pressures during spine-board immobilization. AUTHOR: Cordell WH; Nelson DR; Stroman SJ; Olinger ML Hollingsworth JC ADDRESS: Emergency Medicine and Trauma Center, Methodist Hospital of Indiana, Indianapolis, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng
ABSTRACT
: STUDY OBJECTIVES: Although spine boards are one of the main EMS means of immobilization and transportation, few studies have addressed the discomfort and potential harmful consequences of using th Jul;26(1):31-6 104
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. ID: 95308075 TITLE: Monostotic Paget's disease involving the calcaneus. Diagnostic and therapeutic problems. Two case-reports. AUTHOR: Perrot S; Menkes CJ; Job-Deslandre C; Renoux M Mortier E ADDRESS: Rheumatology Department A, Cochin Teaching Hospital, Paris, France. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng REGISTRY NUMBERS: 0 (Diphosphonates) 40391-99-9 (amidronate)
ABSTRACT
: The authors report the cases of two patients who had chronic incapacitating heel pain unresponsive to standard therapy. They were both found to have Paget's disease of the calcaneus. The diagnosis was difficult because the typical roentgenological changes required time to develop and because no other sites were involved. Local corticosteroid injections, elimination of weight-bearing, and standard analgesic therapy were ineffective. Bisphosphonate therapy (pamidronate) given as intravenous infusions ensured prompt lasting pain relief, making ambulation possible. SOURCE: Rev Rhum Engl Ed 1995 Jan;62(1):45-7 105
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. ID: 95307278 TITLE: The analgesic effect of sucrose in full term infants: a randomised controlled trial [see comments] AUTHOR: Haouari N; Levene M; Griffiths G; Wood C COMMENTS: Comment in: BMJ 1995 Sep 16;311(7007):747 Comment in: BMJ 1995 Sep 16;311(7007):747-8 ADDRESS: University Division of Paediatrics and Child Health, Leeds General Infirmary. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng REGISTRY NUMBERS: 57-50-1 (Sucrose)
ABSTRACT
: OBJECTIVE--To evaluate the effects of different sucrose concentrations on measures of neonatal pain. DESIGN--Randomised, double blind, placebo controlled trial of sterile water (control) or one of three solutions of sucrose--namely, 12.5%, 25%, and 50% wt/vol. SETTING--Postnatal ward. PATIENTS--60 healthy infants of gestational age 37-42 weeks and postnatal age 1-6 days randomised to receive 2 ml of one of the four solutions on to the tongue two minutes before heel prick sampling for serum bilirubin concentrations. MAIN OUTCOME MEASURE--Duration of crying over the first three minutes after heel prick. RESULTS--There was a significant reduction in overall crying time and heart rate after three minutes in the babies given 50% sucrose as compared with controls. This was maximal one minute after heel prick in the 50% sucrose group and became statistically significant in the 25% sucrose group at two minutes. There was a significant trend for a reduction in crying time with increasing concentrations of sucrose over the first three minutes. CONCLUSION--Concentrated sucrose solution seems to reduce crying and the autonomic effects of a painful procedure in healthy normal babies. Sucrose may be a useful and safe analgesic for minor procedures in neonates. SOURCE: BMJ 1995 Jun 10;310(6993):1498-500 106
NLM CIT
. ID: 95273112 TITLE: Non-operative treatment of thoracolumbar fractures. AUTHOR: Hartman MB; Rechtine GR; Chrin AM ADDRESS: Florida Orthopaedics, Tampa 33617, USA. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: Between 1986 and 1992, 32 thoracolumbar fractures in 32 patients were treated nonoperatively with 4-6 weeks on a rotorest bed followed by bracing with a thoracolumbosacral orthosis for a total of 3-6 months. The fractures were classified as 20 burst, six fracture dislocations, five severe compression fractures, and one gunshot wound. There were 12 multilevel fractures. Nine patients had incomplete neurological injuries and three had complete neurological injuries. The average age was 36.8 years (range 17-63) and the average follow-up was 22.3 months (range 12-60). Fifty three percent (17/32) of these had multisystem injuries including visceral trauma and long extremity fractures. There were only two complications; a deep vein thrombosis and a heel ulcer. Neither of these complications extended the patients' hospital stay. All nine of those with incomplete neurological injuries improved at least one Frankel grade. Fifteen of 24 patients who were employed ret recommended for growing Brucella. Tetracycline or doxycycline 200 mg per day for 6 weeks is the mainstay of most medical treatment schedules. Combination with streptomycin for 3 weeks or rifampicin for 6 weeks is recommended, to reduce significantly the failure and relapse rate. Spinal involvement is associated with an increased failure and relapse rate while they occurred least among those with no osteoarticular involvement. Surgical intervention to stabilize the spine and relieve neurological compression may become necessary. With the use of these various measures, the outlook for complete recovery is good. SOURCE: Baillieres Clin Rheumatol 1995 Feb;9(1):161-77 108
NLM CIT
. ID: 95244384 TITLE: Postlaminectomy pseudomeningocele. An unsuspected cause of low back pain. AUTHOR: Aldrete JA; Ghaly R ADDRESS: Center for Pain Management, Destin, FL 32541, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE LANGUAGE: Eng
ABSTRACT
: BACKGROUND AND OBJECTIVES. Patients with postlaminectomy pseudomeningoceles may present to pain management centers without having been diagnosed previously. Practitioners treating chronic low back pain need to be aware of this potential hazard. METHODS. Retrospective analyses of six such cases was made including: clinical signs and symptoms, radiological findings, and possible therapeutic modalities. RESULTS. In every case, there was a palpable fluctuating mass under the surgical scar, sensory loss in both lower extremities, and limited leg raising; moreover, heel tapping produced pain. Also, every patient had a history of long standing cigarette smoking and multiple spinal surgeries. Radiologically dural saccular or tubular structures were noted at myelograms, magnetic resonance imaging, or computed axial tomography scan, usually at the site of the surgery. In one patient with metallic devices, diagnosis was made by ultrasound. CONCLUSIONS. The need for a complete examination by the pain specialist is emphasized since instrumentation in attempts to perform invasive procedures, i.e., inserting needles in the patients, may result in unintentional puncture of the pseudomeningocele and cerebrospinal fluid leaks. The clinical features accompanying the surgical complications ought to be recognized as a warning signal. SOURCE: Reg Anesth 1995 Jan-Feb;20(1):75-9 109
NLM CIT
. ID: 95227206 TITLE: Effect of positive heel inclination on posture. AUTHOR: Franklin ME; Harris S; Cook H; Brauninger L Chenier TC ADDRESS: Department of Physical Therapy, School of Allied Health Sciences, East Carolina University, Greenville, NC 27858-4353, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGE: Eng
ABSTRACT
: Millions of women wear high heels on a daily basis; however, few studies have analyzed the changes high heels (positive heel inclination) have on posture. The purpose of this study was to determine whether positive heel inclination changed the postural alignment of the head, spine, pelvis, and knees. Fifteen female college students ((mean age = 22.7, SD = 3.7 years) had sagittal plane angles measured for the cervical spine, thoracic spine, lumbar spine, sacral spine, and knee joints in addition to anterior/posterior displacements of the head and pelvis. All variables were assessed by a Metrecom Skeletal Analysis System, a three-dimensional electrogoniometer. Six randomized trials, three at zero heel inclination and three at 5 cm positive heel inclination, were measured. Analysis of variance results indicated positive heel inclination of subjects brought about significantly lower anterior pelvic tilt, lumbar lordosis, and sacral base angles when compared with zero heel inclination (p < .01). Clinically, patients with low back pain may be affected by high heel usage because of the reduction of the normal lumbar lordosis. SOURCE: J Orthop Sports Phys Ther 1995 Feb;21(2):94-9 110
NLM CIT
. ID: 95227055 TITLE: ABC of rheumatology. Pain in the foot. AUTHOR: West SG; Woodburn J ADDRESS: School of Human and Health Sciences, University of Hudders Back to plantar fasciitis (heel spurs) home page

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