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J Manipulative Physiol Ther 1994 Nov;17(9):623
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PMID: 7884337, UI: 95190421
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J Manipulative Physiol Ther 1994 Nov;17(9):621-622
PMID: 7884336, UI: 95190420
J Foot Ankle Surg 1994 Sep;33(5):475-481
Department of Podiatric Surgery, Fountain Valley Regional Hospital, CA.
A retrospective analysis of fluoroscopy-assisted plantar fasciotomy/calcaneal exostectomy is presented. The study included 34 patients whose symptoms were all improved to some degree by the procedure. On a five-point scale, the average improvement of preoperative symptoms was 3.2. There were a total of eight complications. The time it took to return to normal activities and until the pain became less than preoperatively was found to be decreased when compared with traditional methods. This technique, using a single, plantar medial, small incision should be considered as an option in the treatment of recalcitrant plantar fasciitis/heel spur syndrome.
PMID: 7849673, UI: 95152469
Am Fam Physician 1994 Aug;50(2):374-380
Washington Hospital, Pennsylvania.
Family physicians can care for most patients injured while participating in indoor racquet sports. However, patients with injuries to the eye usually require ophthalmologic referral. The most common injuries that occur in persons participating in indoor racquet sports include contusions, sprains and strains, lacerations, eye injuries, bursitis and tendinitis. Musculoskeletal injuries that merit special consideration include lateral epicondylitis, DeQuervain's tenosynovitis, wrist intersection syndrome, patellar pain syndrome, meniscal injuries, Achilles tendinitis and plantar fasciitis. The family physician plays a critical role in providing patients with information about preventive measures.
PMID: 8042573, UI: 94317600
Foot Ankle Int 1994 Jul;15(7):376-381
University of California, School of Medicine, Los Angeles.
A series of 37 patients, all with a presumptive diagnosis of plantar fascia rupture, is presented. All had had prior heel pain diagnosed as plantar fasciitis, and all had been treated with corticosteroid injection into the calcaneal origin of the fascia. One third described a sudden tearing episode in the heel, while the rest had a gradual change in symptoms. Most of the patients had relief of the original heel pain, which had been replaced by a variety of new foot problems, including dorsal and lateral midfoot pain, swelling, foot weakness, metatarsal pain, and metatarsal fracture. In all 37 patients, there was a palpable diminution in the tension of the plantar fascia on the involved side, and footprints often showed a flattening of the involved arch. Magnetic resonance imaging done on one patient showed attenuation of the plantar fascia. From these observations and data, the author concluded that plantar fascia rupture had occurred. Treatment following rupture included supportive shoes, orthoses, and time. The majority had resolution of their new symptoms, but this often took 6 to 12 months to occur. In the remainder, there were persisting symptoms. Corticosteroid injections, although helpful in the treatment of plantar fasciitis, appear to predispose to plantar fascia rupture.
PMID: 7951973, UI: 95039673
J Manipulative Physiol Ther 1994 Jun;17(5):329-334
OBJECTIVE: To report a method of radiographically assessing the presence of the posterior calcaneus subluxation involved in cases of unresponsive plantar fasciitis. Complete resolution of pain occurred following short lever manipulative procedures directed at the calcaneus. CLINICAL FEATURES: Two cases of plantar fasciitis which previously had received comprehensive podiatric treatment were referred for chiropractic assessment. Bilateral radiographs of the lateral feet were compared. The relative position of the calcaneus in relationship to the proximal head of the 5th metatarsal were compared with the less affected or asymptomatic foot. A comparative postview of the plantar fascial foot was then taken at the conclusion of treatment. Kell's line assists the clinician in measuring and comparing the calcaneus/5th metatarsal distances. INTERVENTION: Short lever (chiropractic) manipulative procedures were directed at the posteriorward calcaneus. CONCLUSION: Radiographic assessment for unresponsive plantar fasciitis assists in determining where the site of short lever manipulation be delivered in order to improve calcaneus position and release sagittal stress on the plantar fascia.
PMID: 7930967, UI: 95016315
Foot Ankle Int 1994 Mar;15(3):97-102
Southwest Orthopedic Institute, Dallas, Texas.
In order to evaluate the long-term results of patients treated conservatively for plantar heel pain, a telephone follow-up survey was conducted. After eliminating those patients with worker's compensation-related complaints and those with documented inflammatory arthritides, data on 100 patients (58 females and 42 males) were available for review. The average patients was 48 years old (range 20-85 years). The average follow-up was 47 months (24-132 months). Clinical results were classified as good (resolution of symptoms) for 82 patients, fair (continued symptoms but no limitation of activity or work) for 15 patients, and poor (continued symptoms limiting activity or changing work status) in 3 patients. The average duration of symptoms before medical attention was sought was 6.1, 18.9, and 10 months for the three groups, respectively. The three patients with poor results all had bilateral complaints, but had no other obvious risk factors predictive of their poor result. Thirty-one patients stated that, even with the understanding that surgical treatment carries significant risk, they would have seriously considered it at the time medical attention was sought; twenty-two of these patients eventually had resolution of symptoms. Although the treatment of heel pain can be frustrating due to its indolent course, a given patient with plantar fasciitis has a very good chance of complete resolution of symptoms. There is a higher risk for continued symptoms in over-weight patients, patients with bilateral symptoms, and those who have symptoms for a prolonged period before seeking medical attention.
PMID: 7951946, UI: 95039646
Baillieres Clin Rheumatol 1994 Feb;8(1):137-148
Rheumatic Disease Unit, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada.
Once the almost exclusive domain of the orthopaedic surgeon, sports injuries are now being seen with increasing frequency by other specialists, including rheumatologists. It is therefore important for rheumatologists to be able to diagnose and manage the various musculoskeletal conditions that are associated with physical activity. Soft tissue injuries are a very common cause of morbidity in both competitive and recreational athletes. Most of these conditions are provoked by muscle-tendon overload (or overuse) that is usually the result of excessive training or improper training techniques. However, despite an emerging literature on the natural history of soft tissue overuse syndromes, relatively little is known about the causes, incidence and outcome of many of these injuries. Of the methodologically robust epidemiological studies that have been done, most have focused on habitual distance runners. In this population, it has been reported that the incidence of injury can be as high as 50% or more, and that overtraining and the presence of previous injury are the most significant predictors of future injury. In other popular forms of exercise, such as walking, swimming, cycling, aerobics and racquet sports, injuries are also reported with high frequency but, to date, no prospective studies have examined actual incidences in these populations, and risk factors for injury in these activities remain speculative. Several of the more commonly occurring soft tissue injuries (such as rotator cuff tendinitis, lateral and medial epicondylitis, patellar tendinitis, the iliotibial band friction syndrome, Achilles tendinitis and plantar fasciitis) exemplify the overuse concept and are therefore highlighted in this review. The management of these, and most other, exercise-related soft tissue injuries is directed towards promptly restoring normal function and preventing re-injury.
PMID: 8149440, UI: 94199633
Magn Reson Imaging Clin N Am 1994 Feb;2(1):97-107
Musculoskeletal and Body MRI, Bridgeport MRI Center, Connecticut, USA.
Heel pain can be caused by disorders of either the plantar fascia, calcaneus, tendons, or adjacent nerves. Because these conditions can lead to pain located in a small area of the heel, a precise clinical diagnosis may be difficult. This article describes some of these various causes of heel pain and how MR imaging helps to characterize them.
PMID: 7584243, UI: 96052655
Orthopedics 1993 Oct;16(10):1153-1163
US Navy, Oakland, Calif.
PMID: 8255812, UI: 94077778
Foot Ankle 1993 Oct;14(8):465-470
Centre for Medical and Health Physics, Queensland University of Technology, Brisbane, Australia.
There is currently no objective reliable diagnostic test for plantar fasciitis inasmuch as diagnosis cannot be made on the basis of finding a heel spur on radiography (x-ray). In this single-blind observational study, ultrasonography was used to measure plantar fascia thickness in subjects with clinically suspected plantar fasciitis and in control subjects. It was concluded that the population mean plantar fascia thickness is greater for people with plantar fasciitis than for people without heel pain (P < .0005) and that the difference is clinically significant. The ultrasonic appearance of the plantar fascia in plantar fasciitis indicated inflammatory changes.
PMID: 8253440, UI: 94074956
J Formos Med Assoc 1993 Sep;92(9):845-847
Department of Orthopedic Surgery, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Schwannoma, a relatively common tumor of the nerve sheath, rarely involves the foot. A review of the literature disclosed that most reports of schwannoma of the foot were solitary tumors. There has been only one reported case of multiple schwannomas of the foot. We report a case of multiple schwannomas involving both the medial and lateral plantar nerves of the right foot. The patient had been treated for plantar fasciitis for the previous eight years. After excision of one tumor, magnetic resonance imaging (MRI) was used in the diagnosis, revealing four additional tumors. These tumors were also successfully excised and the patient's symptoms relieved. Patients with prolonged intractable pain and tenderness of the foot may require examination by MRI or sonography to search for deep tumors impinging upon the plantar nerves.
PMID: 7904871, UI: 94122613
Mil Med 1993 Jun;158(6):410-415
Royal Australian Air Force, Base Medical Flight, RAAF Edinburgh.
Lower limb injuries present the greatest source of medical problems during basic military training. These main overuse lower limb injuries, anterior compartment syndrome, stress fractures, Achilles tendinitis, plantar fasciitis, shin splints, and chondromalacia patellae, are reviewed with respect to current knowledge of rates, diagnosis, and treatment. Part 2 shall review possible etiological factors involved in the causation of these injuries.
PMID: 8361601, UI: 93368742
Sports Med 1993 May;15(5):344-352
Lexington Clinic, Sports Medicine Center, Kentucky.
Plantar fasciitis is a repetitive microtrauma overload injury of the attachment of the plantar fascia at the inferior aspect of the calcaneus. The diagnosis of plantar fasciitis is common among athletes in many sports, primarily those sports that involve running. Common treatments for plantar fasciitis, including ice, stretching, ultrasound, and shoe inserts are helpful in reducing the symptoms. However, recurrence of the problem is common. By understanding the potential biomechanical causes of this disorder it may be possible to correct the anatomical and biomechanical variables that cause plantar fasciitis and reduce the rate of recurrence as well as speed the rehabilitation process. It may also be possible to identify predisposing maladaptations that can be corrected, therefore, preventing the initial occurrence of plantar fasciitis.
PMID: 8100639, UI: 93310380
J Med Assoc Thai 1993 Feb;76(2):61-70
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Between 1976 and 1989, 160 cases of seronegative spondyloarthropathy (SNSA) were admitted to the Department of Medicine at Chulalongkorn Hospital. The prevalence of idiopathic ankylosing spondylitis (IdAS) was 52 cases (32.5%), Reiter's syndrome (RS) 68 cases (42.5%), psoriatic arthritis (PsA) 28 cases (17.5%), reactive arthritis eight cases (5.0%) and Behcet's disease four cases (2.5%). Clinical comparison of the patients with IdAS, RS and PsA showed a male predominance in IdAS (90.2%), RS (97.1%) and PsA (71.4%). There was a significant difference (p < 0.01) between IdAS and PsA, and RS and PsA. The initial articular manifestation usually occurred in the younger age group (IdAS, 22.15; RS, 22.91; and PsA, 30.86 years); however, there was a significant difference (p < 0.05) between IdAS and PsA, and RS and PsA. Initial peripheral arthritis was found in IdAS (51.9%), RS (91.2%) and PsA (92.6%); there was a significant difference (p < 0.001) between IdAS and RS, and IdAS and PsA. The symptom of back pain was found in IdAS (78.8%), RS (38.2%) and PsA (21.4%); there was a significant difference (p < 0.001) between IdAS and RS, and IdAS and PsA. During physical examination, peripheral arthritis was evident in the IdAS (42.2%), RS (88.2%) and PsA (92.2%) patients; likewise sacroiliitis was found in the IdAS (100%) RS (54.4%), and PsA (57.2%) patients. Evidence of ankylosing spondylitis was found in the IdAS (100%), RS (22.1%) and PsA (46.4%) patients. These findings show a significant difference (p < 0.001) between patients with IdAS and RS, IdAS and PsA. Other associated symptoms were similar, particularly evidence of enthesopathy (tendonitis, heel pain, plantar fasciitis), the polyarticular pattern was more common than the mono-articular pattern. Hip joint was significantly (p < 0.05) more commonly involved in patients with IdAS than in those with RS and PsA. Associated symptoms, particularly genital lesion or skin lesion, are specific symptoms for RS and PsA, respectively.
PMID: 8228701, UI: 94045328
Magn Reson Q 1992 Jun;8(2):97-115
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
Technical considerations for the magnetic resonance imaging of the foot and ankle are discussed, including the selection of the appropriate surface coil, the importance of stabilizing the anatomic region, and the principles guiding the choice of pulse sequences. The anatomy of the foot and ankle are reviewed, and the normal appearance and important variations of the different structures on magnetic resonance images are discussed. Pathology of the foot and ankle are then discussed. Topics covered include osteochondral and radiographically occult fractures, tears and inflammation of the Achilles and posterior tibial tendons, tears of the lateral collateral ligaments and sinus tarsi syndrome, primary tumors (in particular, those of the foot), synovial diseases such as pigmented villonodular synovitis, congenital abnormalities, and disorders such as tarsal tunnel syndrome and plantar fasciitis.
PMID: 1622776, UI: 92322443
J Med Assoc Thai 1992 Jun;75(6):337-340
Department of Orthopaedics Surgery and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Ten patients undergoing 12 fasciotomy by stripping the plantar fascia and superficial plantar muscles from the calcaneus have been reviewed for an average of 24.9 months after the operation. All patients failed to respond to conservative treatment by anti-inflammatory medication, heel pads and local steroid injections for a duration of 6 months to 3 years (average 15 months). There were 7 females and 3 males. Their work was of a light nature and none of them were professional athletes. The results indicated 91.6 per cent excellent, 8.4 per cent good and no failure. Complete pain relief at rest and walking was obtained in 11 of 12 for an average of 11.75 months (from 8 months to 18 months) after surgery. There was only 1 of 12 who had mild pain at walking that did not impair activity. All patients could return to their jobs about 4-6 weeks after surgery. Bloodless operation (under tourniquet control) was performed under general anaesthesia.
PMID: 1487681, UI: 93139684
Foot Ankle 1992 May;13(4):188-195
Mayo Graduate School of Medicine, Rochester, Minnesota 55905.
Thirteen consecutive patients underwent plantar fasciotomy in 16 feet for intractable plantar fasciitis and had follow-up from 4.5 to 15 years. Plantar fasciotomy was successful (good or excellent results) for 71% of the 14 feet operated on and for which follow-up data were available. However, time to full recovery was prolonged, additional treatment was frequently required, and abnormalities of foot function persisted. Flattening of the longitudinal arch occurred. Dynamic force-plate studies showed differences in peak vertical, fore-aft, and lateral-medial forces between patients and matched controls. More rapid progression of weightbearing along the longitudinal axis of the foot during stance phase in patients indicated avoidance of heel loading.
PMID: 1634150, UI: 92339957
Sports Med 1992 Feb;13(2):146-149
Department of Rehabilitation and Sports Medicine, University of Kentucky, Lexington.
Tarsal tunnel syndrome has only recently been noted to be a cause of foot and ankle pain in runners. The tarsal tunnel is located just posterior to the medial malleolus and may compress the posterior tibial nerve as it passes through it, producing numbness and paraesthesia in the foot. While the aetiology of this condition is frequently multifactorial, abnormal foot and ankle mechanics and excessive training tend to be the most commonly cited aetiological factors. Successful treatment of tarsal tunnel syndrome requires an accurate diagnosis by differentiating it from plantar fasciitis and Achilles tendinitis and then making proper biomechanical and training changes in the runner. Conservative treatment is generally successful, but occasionally surgical treatment is required to decompress the nerve.
PMID: 1561508, UI: 92221194
Radiology 1992 Jan;182(1):285
PMID: 1727300, UI: 92080721
Orthop Rev 1992 Jan;21(1):116
PMID: 1565508, UI: 92228569
J Rheumatol 1992 Jan;19(1):80-82
Department of Rehabilitation Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892.
We observed 3 patients with psoriasis who developed arthritis during treatment of psoriatic skin disease with intramuscular recombinant human gamma-interferon (IFN-gamma). Symptoms primarily involved the hands, feet, shoulders, and neck. One patient had acute plantar fasciitis. Routine laboratory studies were unrevealing. Patients presented with symptoms initially between the 10th and 12th weeks of treatment and the arthritis resolved after cessation of IFN-gamma. One patient was subsequently retreated with IFN-gamma for 4 weeks and had a temporary recurrence of arthritis with an associated rise and fall of his articular index.
PMID: 1556705, UI: 92211676
Foot Ankle 1991 Dec;12(3):135-137
Division of Foot and Ankle Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
This study reports the results of the use of molded ankle foot orthosis night splints for the treatment of recalcitrant plantar fasciitis on 14 patients with a total of 18 symptomatic feet. All patients had symptoms for greater than 1 year and had previously undergone treatment with non-steroidal anti-inflammatory medicines, cortisone injections, shoe modifications, and physical therapy without resolution. All patients were provided with custom-molded polypropylene ankle foot orthoses in 5 degrees of dorsiflexion to be used as a night splint. With continued use of nonsteroidal anti-inflammatory medication, Tuli heel cups, Spenco liners, and general stretching exercises, successful resolution occurred in 11 patients in less than 4 months. There were three failures. It is felt that the use of night splints provides a useful, cost-effective adjunct to current therapeutic regimens of plantar fasciitis.
PMID: 1791004, UI: 92165271
J Foot Surg 1991 Nov;30(6):568-570
A new, minimally traumatic endoscopic approach to plantar fasciotomy has been developed by the authors. This technique can be performed comfortably under a local anesthetic. Patients are immediately weightbearing and all returned to regular type shoes on the 3rd postoperative day. An earlier return to regular activity and work, with less pain and patient discomfort was found, as compared with traditional heel spur surgery techniques.
PMID: 1770208, UI: 92121619
J Am Podiatr Med Assoc 1991 Jul;81(7):373-378
College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, IA.
The deep fascia of the foot lies beneath the subcutaneous tissue and surrounds the intrinsic foot muscles. Depending on its location, the composition of the deep fascia varies. In some areas it is thin, while in other areas it is greatly thickened to form retinacula and the plantar aponeurosis. Selected clinical considerations that relate to the deep fascia of the foot are described. These include the following: plantar fasciitis, infection, compartment syndrome, calcaneal fracture, and neuroma.
PMID: 1941581, UI: 92045458
Am J Sports Med 1991 Jul;19(4):409-412
Orthopaedic and Sports Medicine Associates, Emerson, New Jersey 07675.
Five hundred questionnaires were distributed to long-distance runners who had used, or who were using orthotic shoe inserts for symptomatic relief of lower extremity complaints. Three hundred forty-seven (69.4%) responded (males, 71%; females, 29%). The mean age of the respondents was 36 years (range, 15 to 61). The average distance run per week was 39.6 miles (range, 5 to 98). The mean duration for use of the orthotic inserts was 23 months (range, 1 to 96). The predominant (63%) type of orthotic device used was flexible. The presumed diagnoses in the population studied were excessive pronation (31.1%), leg length discrepancy (13.5%), patellofemoral disorders (12.6%), plantar fasciitis (20.7%), Achilles tendinitis (18.5%), shin splints (7.2%), and miscellaneous (4.9%). Of the runners responding, 262 (75.5%) reported complete resolution or great improvement of their symptoms. Results of treatment with orthotic shoe inserts were independent of the diagnosis or the runner's level of participation. A high degree of overall satisfaction was demonstrated by the finding that 90% of the runners continued to use the orthotic devices even after resolution of their symptoms. Orthotic shoe inserts were most effective in the treatment of symptoms arising from biomechanical abnormalities, such as excessive pronation or leg length discrepancy. Along with other conservative measures, orthotic shoe inserts may allow the athlete to continue participation in running and avoid other treatment modalities that are more costly and time consuming, and therefore less acceptable to them.
PMID: 1897659, UI: 91377908
Radiology 1991 Jun;179(3):665-667
Department of Radiology, Yale University School of Medicine, New Haven, Conn.
The clinical presentation of plantar fasciitis may be mimicked by a number of other painful heel conditions. Thus, magnetic resonance (MR) imaging was used to develop objective morphologic criteria to establish a diagnosis of plantar fasciitis in eight patients. Sagittal T1-weighted and coronal intermediate and T2-weighted images of symptomatic and asymptomatic feet were obtained; additional sequences were used for symptomatic feet. Maximum thickness of the plantar fascia was significantly increased (P less than .0001) in patients with plantar fasciitis (sagittal, 7.40 mm +/- 1.17, and coronal, 7.56 mm +/- 1.01) compared with age- and sex-matched volunteers (sagittal, 3.22 mm +/- 0.44, and coronal, 3.44 mm +/- 0.53) and young male controls (sagittal, 3.00 mm +/- 0.8, and coronal, 3.00 mm +/- 0.0). Furthermore, nine of 10 feet with plantar fasciitis had areas of moderately increased signal intensity in the substance of the fascia. MR imaging may provide an objective assessment of the morphologic changes associated with plantar fasciitis, as well as assist in excluding other causes of heel pain.
PMID: 2027971, UI: 91227475
Clin Nucl Med 1991 May;16(5):325-328
Division of Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
Fifteen patients complaining of chronic heel pain underwent three-phase Tc-99m MDP bone scintigraphy. Ten patients demonstrated abnormal scan findings consistent with plantar fasciitis (PF) and had responded to conventional therapy. Two patients were found to have calcaneal stress fractures, and one patient demonstrated a calcaneal spur that required no treatment. The remaining two patients had normal scans and did not appear clinically to have PF. The three-phase bone scan is therefore very useful in diagnosing PF and in distinguishing it from other etiologies of the painful heel syndrome.
PMID: 2054987, UI: 91275397
Clin Orthop 1991 May;266:185-196
Department of Orthopaedic Surgery, Boston University Medical School, Massachusetts.
Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.
PMID: 2019049, UI: 91208799
Radiographics 1991 May;11(3):401-414
Department of Radiology, Yale University School of Medicine, New Haven, CT 06510.
Magnetic resonance (MR) imaging was performed in 60 patients with ankle pain who were suspected of having various soft-tissue or osseous abnormalities. Results of conventional radiographs had been normal or inconclusive. Soft-tissue disorders depicted by MR imaging included tendon and ligament tears, tendinitis, tenosynovitis, and plantar fasciitis. Osseous conditions demonstrated by MR imaging included osteochondritis dessicans, infarcts, bone bruises, stress fractures, tarsal coalition, and osteoid osteoma. The authors believe that MR imaging is useful in the assessment of a variety of painful ankle disorders.
PMID: 1852934, UI: 91305610
Am J Sports Med 1991 Jan;19(1):66-71
Lexington Clinic Sports Medicine Center, KY 40504.
Plantar fasciitis is a relatively common injury that occurs in running athletes. The disease entity is a good example of an overloaded process of the plantar fascia at its calcaneal insertion. This study was designed to examine the strength and flexibility findings in the muscles that are put on tensile load during running, and which are responsible for controlling the forces on the foot during stance and pushoff, thus modifying the overload. Three groups of athletes underwent physical examination, including checking ankle range of motion in plantar flexion and dorsiflexion. Cybex peak torque measurements were taken at 60 and 180 deg/sec. The groups were a control group of 45 athletes with no symptoms, a group that included 43 affected feet with symptomatic plantar fasciitis, and a group that included the 43 unaffected contralateral feet. Analysis of data showed dynamic range of motion deficits in 38 of 43 affected feet, static range of motion deficits in 37 of 43 affected feet, deficits in peak torque at 60 deg/sec in 41 of 43 affected feet, and deficits in peak torque at 180 deg/sec in 37 of 43 affected feet. Statistical comparison of range of motion showed that the group with symptomatic plantar fasciitis was significantly restricted compared to both control and unaffected contralateral feet groups. Statistical comparison of peak torque showed that the symptomatic plantar fasciitis group was significantly lower than both other groups at both velocities. This study documents strength and flexibility deficits in the supporting musculature of the posterior calf and foot that are affected by plantar fasciitis.
PMID: 1672577, UI: 91181679
Sports Med 1990 Nov;10(5):338-345
Department of Human Performance and Health Promotion, University of New Orleans, Louisiana.
Plantar fasciitis is a common overuse injury found in runners. The plantar fascia, which is responsible for maintaining the integrity of the longitudinal arch, becomes irritated, inflamed or torn by repetitive stresses placed upon it. Commonly cited predisposers of plantar fasciitis are excessive pronation, a flat or cavus foot, tight Achilles tendon, type of training shoes worn, and errors in the training routine. Once the plantar fascia becomes irritated a myriad of conservative measures may be used, including everything from rest, ice and elevation to steroid injections and, if all else fails, surgery. In most cases conservative treatment of one kind or another will alleviate the symptoms of plantar fasciitis. However, it is essential to determine and correct the cause of the problem in order for the runner to resume normal activity levels. Controlling anatomical/biomechanical inefficiencies of the feet, stretching and strengthening exercises for the lower extremity, proper training shoes, and reasonable training routines will alleviate the symptoms of plantar fasciitis in a large percentage of sufferers. To prevent this injury, runners should be aware of the potential overuse injury and take precautionary measures, e.g. seek a biomechanical/anatomical evaluation from a qualified practitioner. The practitioner can then offer suggestions as to the specific steps the runner should follow to prevent the injury condition.
PMID: 1979886, UI: 91088866
Aust Fam Physician 1990 Oct;19(10):1579
PMID: 2248570, UI: 91063826
Clin Podiatr Med Surg 1990 Apr;7(2):385-389
Department of Podiatric Surgery, Doctors Hospital, Columbus, Ohio.
The authors present two cases involving heel spur syndrome and plantar fasciitis. Histologic changes in the plantar fascia are compared, and changes found in chronic inflammation are discussed.
PMID: 2346891, UI: 90268359
Q J Med 1989 Dec;73(272):1167-1184
Department of Rheumatology, Westminster Hospital, London.
One hundred and twenty-three patients with human immunodeficiency virus infection have been referred to rheumatologists at our hospitals between October 1985 and April 1989 because of musculoskeletal symptoms. Thirty-four homosexual men presented with acute, peripheral, non-erosive arthritis (mean number of four joints affected) with the knees being involved in 23. Other features developing concurrently with arthritis included psoriasis, keratoderma blenorrhagica, plantar fasciitis, urethritis, conjunctivitis and anterior uveitis. Four of five patients investigated were HLA-B27-positive; none of 15 patients tested had raised titres of rheumatoid or antinuclear factors. Various infections were associated with the onset of arthritis and two patients with a recent history of diarrhoea had serological evidence of yersinia infection. No micro-organisms were identified within the joint except for HIV itself. At the time of onset of arthritis four of these individuals had the acquired immunodeficiency syndrome (AIDS); 11 were not known to be HIV-positive before testing which was performed following referral for arthritis. Six patients have since developed AIDS and four have died. In 15 individuals, including those who progressed to AIDS, joint symptoms have been severe, persistent and poorly responsive to non-steroidal anti-inflammatory drugs. In only five patients has the arthritis been known to resolve. Synovitis has also been seen in two women: in one of these HIV infection was thought to have been acquired through intravenous drug abuse. Other rheumatic lesions included myalgia/myositis, non-inflammatory peripheral arthritis, spinal pain, soft tissue lesions, arthralgia or myalgia of unknown cause and infective lesions including septic arthritis and bony infection due to histoplasmosis and atypical mycobacterial infection. It appears likely that HIV infection is a risk factor for the development of seronegative arthritis and other rheumatic lesions.
PMID: 2616738, UI: 90139453
Postgrad Med 1989 Sep 1;86(3):175-179
University of California, School of Medicine, San Francisco.
While most foot injuries heal without treatment, failure to recognize and treat some can have disastrous consequences. The exact mechanism of injury must be determined for accurate diagnosis. Many injuries, such as plantar fasciitis, "pump bump," sesamoiditis, and stress fractures, are the result of cumulative, repetitive stress rather than of an acute event. Others, such as injuries to tendons, may be chronic or acute. The foot is susceptible to numerous types of acute trauma, including sprains, fractures, dislocations, crushing, freezing, thermal injury, puncture wounds, and penetration by foreign bodies. Special care is required to minimize the danger of serious complications when treating foot injuries in diabetic patients.
PMID: 2570414, UI: 89366988
Med Sci Sports Exerc 1989 Aug;21(4):379-385
Division of Sports Medicine, University of British Columbia, Vancouver, Canada.
In order to compare the clinical presentation of overuse injuries in older and younger athletes, retrospective patient chart data were obtained from cases which had been referred to an outpatient sports medicine clinic over a 5-yr period. A total of 1,407 cases were studied comprising two populations separated by significantly (P less than 0.001) different ages: 685 "old" (mean age = 56.9 +/- 6.1 yr) and 722 "young" (mean age = 30.4 +/- 8.1 yr). Although the two subpopulations demonstrated modest differences in sport activity at the time of injury, specific diagnoses, and anatomic location of injury, many similarities existed between the groups. Running, fitness classes, and field sports were more commonly associated with injury in the younger group, while racquet sports, walking, and low intensity sports were more commonly associated with injury in the older group. The frequency of tendinitis was similar in both age groups, while metatarsalgia, plantar fasciitis, and meniscal injury were more common in the older population, and patellofemoral pain syndrome (PFPS) and stress fracture/periostitis were more common in the younger population. Anatomically, injury sites in the foot were more frequent in the older group, while injury sites in the knee were more frequent in the younger group. In the older population, the prevalence of osteoarthritis was 2.5 times higher than the frequency of osteoarthritis as the source of activity-related pain. In the older group, 85% of the diagnoses were overuse injuries known to respond to conservative treatment, 14.4% of the cases required consultative referral, and only 4.1% required surgery.
PMID: 2674589, UI: 89384078
Ann Rheum Dis 1989 Apr;48(4):351
PMID: 2712619, UI: 89227310
Phys Ther 1988 Dec;68(12):1913-1916
Department of Physical Therapy, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
This case report describes an approach for determining when fabricated orthoses might be useful in the treatment of a patient with foot-related problems. The patient is of special interest because she is an aerobics instructor, and her type of injury is relatively common. Particular emphasis in the report is placed on hypothesizing the cause of the patient's complaints and then basing treatment on that hypothesis.
PMID: 3194454, UI: 89058009
Med Sci Sports Exerc 1988 Oct;20(5):501-505
J. B. Snow Biomechanics Laboratory, Department of Health and Sport Science, Wake Forest University, Winston-Salem, NC 27109.
The purpose of this study was to determine whether a relationship exists between selected biomechanical, anthropometric, and training variables and runners afflicted with one of the following injuries: iliotibial (IT) band friction syndrome, shin splints, and plantar fasciitis. Competitive and recreational runners were divided into a non-injured control group (N = 19), an IT band friction syndrome injury group (N = 13), a shin splint injury group (N = 17), and a plantar fasciitis injury group (N = 15). Discriminant function analysis of the biomechanical data revealed two significant (P less than 0.05) discriminators between the control and shin splint groups; maximum pronation velocity and maximum pronation. Analysis of the anthropometric and training data revealed that plantar flexion range of motion was a significant (P less than 0.05) discriminator between the control and plantar fasciitis groups. In addition, analysis of the descriptive statistics (mean +/- SE) identified some non-significant (P greater than 0.05) trends between the injury and control groups: maximum pronation, total rearfoot movement, and maximum velocity of pronation were greater in the injury groups; the injury groups showed a trend toward a higher arch; dorsiflexion range of motion was less in the shin splint group; a greater percentage of injured runners had a leg length difference (greater than 0.64 cm); 20% more runners in the injury groups ran hills; and 20% more of the runners in the IT band friction syndrome group ran on crowned roads.
PMID: 3193867, UI: 89056648
Am J Sports Med 1988 May;16(3):306-307
University of Illinois College of Medicine, Chicago.
In this study, rupture of the plantar fascia was seen in five feet, of which four had had plantar fasciitis. At the time of the injury, which is an acceleration type of motion, there is severe pain in the heel followed by the development of ecchymosis in the sole and toward the heel of the foot. With conservative symptomatic care, the acute symptoms as well as the plantar fasciitis symptoms subside, generally allowing full activity in 3 to 4 weeks.
PMID: 2898217, UI: 88250524
Clin Sports Med 1988 Jan;7(1):119-126
Orthopaedic Hospital of Los Angeles, California.
An excessive amount and/or a prolonged duration of pronation is the most common mechanical cause of structural strain resulting in plantar fasciitis. Temporary relief of pain can be achieved by customary antiinflammatory drugs or therapy; long-term relief is achieved by adequate remedy of the aggravating pronation factors. A semirigid, custom-molded orthosis reduces excessive plantar fascial strain by supporting the first metatarsal bone and by controlling calcaneal position when in conjunction with a firm posterior counter shoe. A clinical environment with physician and orthotist together allows ideal evaluation and treatment of patients.
PMID: 3044618, UI: 88311134
Foot Ankle 1987 Dec;8(3):152-155
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
A curved, oblique plantar incision in the proximal aspect in the medial longitudinal arch was used to release the plantar fascia in eight feet with recalcitrant plantar fasciitis. Seven feet became pain free and the eighth was 75% improved. Normal sensation to the heel was preserved in all cases. No painful scars or neuromas of the calcaneal branch of the posterior tibial nerve developed. This approach represents a significant improvement over previously reported surgical approaches.
PMID: 3440557, UI: 88152695
Aust Fam Physician 1987 Aug;16(8):1113-1115
PMID: 3675346, UI: 88049255
Clin Sports Med 1987 Apr;6(2):291-320
Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia.
The authors discuss the clinical characteristics and treatment of such overuse injuries of the foot as plantar fasciitis, Haglund's syndrome, Jones' fracture, and tarsal navicular stress fractures. A consideration of orthotic devices is also provided.
PMID: 2891450, UI: 88080576
Med Sci Sports Exerc 1987 Feb;19(1):71-73
Ninety-one runners were studied to determine whether specific variables were indicative of runners who had suffered with plantar fasciitis either presently or formerly vs runners who had never suffered with plantar fasciitis. Each runner was asked to complete a running history, was subjected to several anatomical measurements, and was asked to run on a treadmill in both a barefoot and shoe condition at a speed of 3.35 mps (8 min mile pace). Factor coefficients were used in a discriminant function analysis which revealed that, when group membership was predicted, 63% of the runners could be correctly assigned to their group. Considering that 76% of the control group was correctly predicted, it was concluded that the predictor variables were able to correctly predict membership of the control group, but not able to correctly predict the presently or formerly injured sufferers of plantar fasciitis.
PMID: 2881184, UI: 87143672
J Bone Joint Surg [Br] 1987 Jan;69(1):38-40
We report five patients with nutritional osteomalacia who presented with the symptoms and signs of plantar fasciitis. All the patients were Asian vegetarian women. All improved with treatment of the osteomalacia, albeit slowly in two cases.
PMID: 3818730, UI: 87137786
Foot Ankle 1986 Dec;7(3):156-161
Plantar fasciitis is a common cause of pain, particularly in runners and certain other athletic groups. This syndrome must be distinguished from certain other conditions, such as the tarsal tunnel syndrome and achillodynia. Conservative therapy including rest, orthotics, heel cups, anti-inflammatory agents, and icing reduce symptoms in most patients. A few athletes may need surgery to continue running. The authors released the plantar fascia and excised areas of mucinoid degeneration in 15 athletes. Fourteen returned to full athletic activity.
PMID: 3804138, UI: 87107189
Ital J Orthop Traumatol 1986 Dec;12(4):533-535
Thirty patients presenting with the heel pain syndrome, commonly referred to as "plantar fasciitis", were studied prospectively over a two year period. The pain was associated with a calcaneal spur in 21 patients (70%). In a control series of 25 patients without heel symptoms, calcaneal spurs were present in only 4 out of 50 heels (8%). This difference is highly significant (p 0.001). Seven patients (22%) in the plantar fasciitis group complained of ipsilateral sciatica.
PMID: 3610621, UI: 87279079
Am J Sports Med 1986 Nov;14(6):481-485
A group of 182 patients with subcalcaneal pain related to sports activity was studied to determine injury types and patterns. Running/jogging produced the greatest percentage of subcalcaneal injuries, 76%. A survey was done of the specific types of heel pain, plantar fasciitis and median calcaneal neuritis. A review of each entity was given and surgical approach was detailed. Subcalcaneal surgical decision making is based on six specific tenets: correct diagnosis; approximately 12 months of conservative treatment; EMG for diagnosis and appropriate nerve blocks; thorough knowledge of the anatomy or complete review; patient understanding that surgery may not give a good enough result to allow the return to high performance athletics; and correct and appropriately directed surgery.
PMID: 3799874, UI: 87097713
Sports Med 1985 Sep;2(5):334-347
Running is the most visible expression of the continued interest in regular physical activities. Unfortunately injuries are common, primarily due to overuse, and a number of aetiological factors have been recognised. Of these, training errors can be responsible for up to 60% of injuries. The training surface, a lack of flexibility and strength, the stage of growth and development, poor footwear and abnormal biomechanical features have all been implicated in the development of running injuries. A thorough understanding of the biomechanics of running is a necessary prerequisite for individuals who treat or advise runners. Clinically, the configuration of the longitudinal arch is a valuable method of classifying feet and has direct implications on the development and management of running problems. The runner with excessively pronated feet has features which predispose him/her to injuries that most frequently occur at the medial aspect of the lower extremity: tibial stress syndrome; patellofemoral pain syndrome; and posterior tibialis tendinitis. These problems occur because of excessive motion at the subtalar joint and control of this movement can be made through the selection of appropriate footwear, plus orthotic foot control. The runner with cavus feet often has a rigid foot and concomitant problems of decreased ability to absorb the force of ground contact. These athletes have unique injuries found most commonly on the lateral aspect of the lower extremity: iliotibial band friction syndrome; peroneus tendinitis; stress fractures; trochanteric bursitis; and plantar fasciitis. Appropriate footwear advice and the use of energy-absorbing materials to help dissipate shock will benefit these individuals. Running shoes for the pronated runner should control the excessive motion. The shoes should be board-lasted, straight-lasted, have a stable heel counter, extra medial support, and a wider flare than the shoes for the cavus foot. For these athletes a slip-lasted, curve-lasted shoe with softer ethylene vinyl acetate (EVA) and a narrow flare is appropriate. Orthotic devices are useful in selected runners with demonstrated biomechanical abnormalities that contribute to the injury. Soft orthotics made of a commercial insole laminated with EVA are comfortable, easily adjusted, inexpensive, and more for-giving than the semirigid orthotics which are useful in cases where the soft orthotic does not provide adequate foot control. A review of injury data shows an alarming rise in the incidence of knee pain in runners-from 18% to 50% of injuries in 13 years.
PMID: 3850616, UI: 86018297
Foot Ankle 1985 Aug;6(1):44-46
A 71-year-old male presented with unremitting heel pain in the region of his calcaneal tuberosity. He had been previously treated with steroid injections for plantar fasciitis. Diagnostic workup revealed a calcaneal osteomyelitis which was treated with a partial calcanectomy. This case underlines the need to rule out this expected but previously unreported complication.
PMID: 4043891, UI: 86006529
Phys Ther 1984 Oct;64(10):1544
PMID: 6483984, UI: 85015165
Clin Orthop 1984 Jun;186:202-204
Ten patients were operated on for plantar fasciitis (12 heels) by stripping the plantar fascia and superficial plantar muscles from the calcaneus. All patients were refractory to conservative treatment for an average of 12.4 months prior to operation and were followed up for a minimum of 24 months after operation. Complete symptomatic relief was obtained in all patients despite the presence of massive obesity in six. Hypoesthesia of the heel, which was present in five feet after operation, may have enhanced pain relief. Three patients who were receiving workmen's compensation returned to work within 16 weeks of surgery. One deep wound infection occurred and required surgical debridement before healing could occur. Surgical treatment is efficacious in selected cases of plantar fasciitis that are refractory to conservative measures.
PMID: 6723144, UI: 84206302
Med Sci Sports Exerc 1984;16(1):60-63
The purpose of this study was to identify anatomical variables associated with plantar-fasciitis sufferers. Selected anatomical variables which were chosen for measurement were leg length, pronation of the subtalar joint, plantar and dorsiflexion ability, and arch height of the foot, as well as the variables height, weight, age, and miles run per week. The means and standard deviations revealed that leg-length inequality, pronation of the subtalar joint, and arch height were not good indicators of plantar-fasciitis sufferers. According to the discriminant-function analysis in which 64% of the subjects were assigned to the appropriate group, plantar flexion, dorsiflexion, and height were good predictors of the recovered and non-recovered sufferers, but could predict no more than 50% of the present sufferers. Therefore, a set of predictor variables was not found for the prediction of plantar-fasciitis sufferers.
PMID: 6708780, UI: 84167221
Instr Course Lect 1984;33:278-282
Plantar fasciitis is a typical repetitive-stress running injury and a difficult problem to treat. A full, nonoperative treatment program requires unusual patient cooperation and motivation. Surgical treatment is necessary in a small number of intractable cases.
PMID: 6152808, UI: 86252360
Clin Orthop 1983 Jul;177:116-121
Millions of people run in the United States, both for competitive reasons and for basic conditioning. Unfortunately, many runners develop cumulative (overload) stress syndromes, a number of which occur in the hindfoot. Among the most common are Achilles tendinitis and its associated conditions, plantar fasciitis, and tendinitis of the posterior tibial and flexor hallucis longus tendons. Most of these conditions respond well to conservative treatment, but in some instances surgery is needed. Surgery frequently can help patients who have not responded to conservative therapy to return to active and even competitive athletic lives.
PMID: 6861383, UI: 83233348
Am J Sports Med 1983 Jul;11(4):215-219
Plantar fascia release has been suggested to be of benefit for patients with symptoms of chronic unresponsive plantar fasciitis. However, results of this procedure have not been published. We performed 11 releases in 9 long-distance runners whose symptoms had been present for an average of 20 months and had not responded to nonsurgical treatment. The results of these operations were excellent in 10 feet and good in 1 foot at an average follow-up time of 25 months. Eight out of nine patients returned to desired full training at an average time of 4.5 months. Histologic examination of surgical biopsy specimens from these patients showed collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and matrix calcification. Plantar fascia release was an effective procedure for these patients.
PMID: 6614290, UI: 83306260
Foot Ankle 1983 Jan;3(4):227-237
The biomechanical evaluation of patients with painful heels has received only limited attention although the potential morbidity and disability associated with such an ailment can be severe. An objective analysis of the patient's foot function during gait can produce useful information to assess the underlying pathology. This method can also help to evaluate the efficacy of various existing treatment protocols. The impulse distribution based on foot-floor vertical reaction force and time under the hind-, mid-, and forefoot was determined in 32 normal subjects while walking in their usual street shoes. Variations related to shoe types were noted, with high heeled shoes causing the most significant deviations from normal. The same technique was applied to 13 painful heel syndrome patients. Characteristic deviations from the normal impulse distribution were noted in these patients which provided the basis for differentiating the pathological condition between the patients with painful heel pads and those with plantar fasciitis. The effectiveness of using heel cups as a therapeutic device was also assessed. Although significant gait changes were not associated with the insertion of heel cups, they did seem to shift the foot-floor impulse forward from the heel region, which made them effective in patients afflicted with localized heel pain, but not in those with plantar fasciitis.
PMID: 6832667, UI: 83159065
Can J Appl Sport Sci 1982 Mar;7(1):41-44
PMID: 7094192, UI: 82233995
Am J Sports Med 1982 Jan;10(1):6-11
This study documents changes in momentary distribution of forces under the foot, comparing barefoot gait to that with heel cups, medial arch supports, and low-dye taping. Cholesterol crystal force plate analysis and a computerized Kistler force platform were used in the study. Low-dye taping or a heel cup significantly diminished the duration of forces under the midfoot, medializing the instant center of forces. A medial arch support shifted the instant center of forces laterally, though it did not diminish the duration of forces under the arch. The relationship between these alterations of force distribution and the treatment of common runner's ailments such as plantar fasciitis, posterior tibial tendinitis, metatarsalgia, and shin splints is much clearer in the light of these results.
PMID: 7053640, UI: 82088941
Rheumatol Rehabil 1980 Nov;19(4):218-222
A painful heel syndrome (plantar fasciitis and/or Achilles tendinitis) was found in 33 among 150 patients suffering from a seronegative spondarthritis. The clinical and radiological manifestations of this syndrome were similar in the nosological entities included in the seronegative spondarthritis group. HLA-B27 antigen was found in 91% of the patients, radiological sacroliitis in 64% and an asymmetric peripheral arthritis in all cases. By contrast, Achilles tendinitis was not encountered in 220 cases of rheumatoid arthritis; plantar fasciitis was exceptional in the same cases.
PMID: 7209286, UI: 81152437
J Nucl Med 1980 Jul;21(7):633-636
We have found that Tc-99m methylene diphosphonate imaging of the heel is of diagnostic value in the "painful heel syndrome," permitting positive identification of the site of inflammation in cases where radiography is unhelpful. With this technique, tracer uptake in the heel is susceptible to quantification, allowing a serial and objective assessment of response to therapy.
PMID: 7391835, UI: 80229491
J Bone Joint Surg [Am] 1978 Jun;60(4):537-539
Symptoms resembling those of plantar fasciitis were seen in six athletes who were thought to have a partial rupture of the plantar fascia. Treatment, which included the use of crutches, anti-inflammatory agents, strapping of the arch, and ice packs, was successful in all but one patient who had a painful mass in the area of the previous rupture. After surgical excision of the painful mass and release of the fascia, he recovered. Five of the six athletes had been previously treated with repeated local injections of steroid.
PMID: 27524, UI: 78218337
Aust N Z J Surg 1978 Feb;48(1):96-98
The tarsal tunnel syndrome is a complex of symptoms affecting the foot produced by compression neuropathy of the posterior tibial nerve on the medial aspect of the ankle, within the fibrous osseous "tunnel" that has the posteromedial aspect of the tibia as its floor and the flexor retinaculum as its roof. Keck first drew attention to this entity in 1962, and was followed by Lam in the same year. Despite sporadic reports following these documentations, the clinical recognition of the syndrome is often delayed. It is still frequently misdiagnosed as acute foot strain or plantar fasciitis at its initial presentation (Kopell and Thompson, 1963; Lam, 1962, 1967). In this paper we report a case of tarsal tunnel syndrome caused by compression of the posterior tibial nerve by a ganglion at the ankle.
PMID: 276358, UI: 78210297
Ann Rheum Dis 1977 Aug;36(4):343-348
This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondylitis. On the other hand, sub-Achilles bursitis more frequently affected women with rheumatoid arthritis and rarely gave rise to severe talalgias. The simple calcaneal spur was associated with generalized osteoarthrosis and its frequency increased with age. This condition was not related to talalgias. Finally, clinical and radiological involvement of the subtalar and midtarsal joints were observed mainly in rheumatoid arthritis and occasionally caused apes valgoplanus.
PMID: 901031, UI: 77265663
J Bone Joint Surg [Am] 1975 Jul;57(5):672-673
Of 116 patients with pain in the plantar portion of the heel, nineteen proved on follow-up to have systemic disease as the etiology. Of these treated with phenylbutazone, 71 per cent showed good results and a similar percentage benefited equally from injections of cortisone derivatives. Only two patients required surgical procedures, and these were successful in both.
PMID: 1150711, UI: 75211417
Clin Orthop 1974;103:57-62
PMID: 4416727, UI: 75017106
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