NLM CIT. ID: 99342937
TITLE: Foot and ankle problems in the young athlete [In Process Citation] AUTHORS: Omey ML; Micheli LJ AUTHOR AFFILIATION: Division of Sports Medicine, Children's Hospital, Boston, MA 02115, USA.
ABSTRACT: In the U.S., greater than half of boys and one quarter of girls in the 8- to 16-yr-old age range are engaged in some type of competitive, scholastic, organized sport during the school year. Children and adolescents are becoming more involved in sports at earlier ages and with higher levels of intensity. Foot and ankle problems, in particular, are the second most common musculoskeletal problem facing primary care physicians in children under 10 yr of age next to acute injury. This report focuses on foot and ankle problems, trauma, and overuse in the young athletic population. Guidelines are given for both conservative and surgical management. Specific problems addressed include pes planus, tarsal coalition, adolescent bunion, os trigonum, accessory navicular, physeal fractures, sprains, peroneal tendon subluxation, metatarsal fractures, sesamoid fractures, turf toe, stress fractures, tendonitis, osteochondritis dissecans, ankle impingement, bursitis, Haglund's deformity, sesamoiditis, plantar fasciitis, apophysitis, osteochondroses, cuboid syndrome, and reflex sympathetic dystrophy. An extensive review of the literature is performed and presented in combination with the extensive experience of a well- established sports medicine clinic at the Boston Children's Hospital. NLM PUBMED CIT. ID: 10416548 SOURCE: Med Sci Sports Exerc 1999 Jul;31(7 Suppl):S470-86 2

NLM CIT. ID: 99341732
TITLE: In-shoe pressure measurements with a viscoelastic heel orthosis [In Process Citation] AUTHORS: Hsi WL; Lai JS; Yang PY AUTHOR AFFILIATION: Department of Rehabilitation, National Taiwan University Hospital, Taipei.
ABSTRACT: OBJECTIVE: To detect the mechanical effect of a viscoelastic heel orthosis. DESIGN: Two-factor analysis of variance with interactions between the orthosis and the subjects. The number of subjects was determined by presuming the effect of the orthosis to be twice as large as the error-free standard deviation (SD) of the interactions, the step- to-step SD four times as large as the error-free SD of the interactions, type 1 error probability equal to .05, and type 2 error probability equal to .20. SETTING: A gait laboratory in a university hospital. SUBJECTS: Twenty-two consecutive patients with treated heel pain. MAIN OUTCOME MEASURES: Peak pressure (PP), pressure-time integral (PTI), and foot-to-sensor contact time (CoT) measured for five steps at 24 discrete sensors of predetermined positions in the foot with treated heel pain. RESULTS: The orthosis reduced PPs, PTIs, and CoT (p < .05) in the median midfoot and lateral midfoot; reduced PPs and PTIs (p < .05) in the posterior heel and medial midfoot; increased PP and PTI (p < .05) in the anterior part of the first metatarsal head; and increased PTI (p < .05) in the lateral part of the hallux. The ratios of the estimated step-to-step SDs to the estimated error-free SDs of the interactions of PPs, PTIs, and CoT were less than four at all the sensors. CONCLUSION: Proper design and estimation of the variations ensured that there was sufficient power to detect the effect of an a priori specified size as statistically significant: the orthosis reduced the mechanical loads in the posterior heel and the midfoot and increased the mechanical loads in the anterior part of the first metatarsal head and the lateral part of the hallux during walking. NLM PUBMED CIT. ID: 10414766 SOURCE: Arch Phys Med Rehabil 1999 Jul;80(7):805-10 3

NLM CIT. ID: 99321261
TITLE: Plantar fascia release through a transverse plantar incision [In Process Citation] AUTHORS: Brown JN; Roberts S; Taylor M; Paterson RS AUTHOR AFFILIATION: SPORTSMED.SA, Stepney, South Australia.
ABSTRACT: A transverse plantar incision for plantar fascial release was assessed for pain relief, numbness, and subsequent heel pad symptoms. Twenty- seven feet in 26 patients who underwent plantar fascia release were reviewed with a minimum follow-up of 2 years after surgery (average, 37.6 months). Comprehensive data were obtained on 25 feet (24 patients) (93% response rate). The plantar fascia origin was completely transected in all cases. This led to complete resolution of symptoms in 19 feet and residual minor symptoms in six feet. After 2 years, four patients had developed recurrent symptoms, two in the area of surgery and two on the dorsum of the foot, in association with a pes planus foot. Two patients had some continued persistence of heel pain after surgery, although significantly less pain than preoperatively.Thus, 76% of patients had complete relieve of there symptoms, 12% of patients had mild symptoms not affecting daily activities, and 12% of patients had moderate symptoms that limited some activities. No patient suffered heel pad symptoms or numbness after surgery. It is concluded that plantar fascia release through a transverse plantar incision is a successful procedure for long-term relief of symptoms which avoids unnecessary heel pad numbness and scar morbidity. The benefits of a transverse incision include greater intraoperative vision, to ensure adequate release and spur excision, and an incision parallel to the medial calcaneal branches of the tibial nerve. NLM PUBMED CIT. ID: 10395338 SOURCE: Foot Ankle Int 1999 Jun;20(6):364-7 4

NLM CIT. ID: 99318488
TITLE: Rhabdomyolysis in association with Duchenne's muscular dystrophy [In Process Citation] AUTHORS: Obata R; Yasumi Y; Suzuki A; Nakajima Y; Sato S AUTHOR AFFILIATION: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Japan.
ABSTRACT: PURPOSE: To present a case of rhabdomyolysis which developed in a child with a known history of Duchenne's muscular dystrophy, following an anesthetic which included sevoflurane. CLINICAL FEATURES: An 11 yr old boy with a known history of Duchenne's muscular dystrophy underwent anesthesia for strabismus repair. The anesthetic consisted of sevoflurane and nitrous oxide without the use of a muscle relaxant. His postoperative course was complicated by a complaint of heel pain and the development of myoglobinuria. He was treated with dantrolene sodium and discharged home after two days, without further complication. CONCLUSION: Sevoflurane anesthesia has not been shown previously to be associated with the development of acute rhabdomyolysis in a child with a history of Duchenne's muscular dystrophy. As with halothane and isoflurane, the continued use of sevoflurane in the presence of Duchenne's muscular dystrophy should be questioned. NLM PUBMED CIT. ID: 10391604 SOURCE: Can J Anaesth 1999 Jun;46(6):564-6 5

NLM CIT. ID: 99312749
TITLE: Imaging of the rearfoot. AUTHORS: Yozsa S; Lehnert B; Resnick D AUTHOR AFFILIATION: Veterans Affairs Palo Alto Health Care System, CA 94304, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The authors review various pedal conditions affecting the rearfoot, including plantar fasciitis, Achilles tendon pathology, fractures, arthritides, coalitions, and tumors. Various diagnostic imaging modalities such as routine radiography, radionuclide bone scanning, computed tomography, and magnetic resonance imaging are discussed. NLM PUBMED CIT. ID: 10384755 SOURCE: J Am Podiatr Med Assoc 1999 Jun;89(6):292-301 6

NLM CIT. ID: 99278906
TITLE: Management of heel pain syndrome with acetic acid iontophoresis. AUTHORS: Japour CJ; Vohra R; Vohra PK; Garfunkel L; Chin N AUTHOR AFFILIATION: Department of Surgery, Veterans Affairs Medical Center, Brooklyn, NY 11209, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 64-19-7 (Acetic Acid)
ABSTRACT: This study was undertaken to determine the effectiveness of acetic acid iontophoresis in the treatment of heel pain. Thirty-five patients with chronic heel pain were treated with acetic acid iontophoresis over a 4- year period. Ninety-four percent of patients had complete or substantial relief of heel pain after an average of 5.7 sessions of acetic acid iontophoresis over an average period of 2.8 weeks. Heel pain levels were rated from 0 to 10, with 10 representing the most severe pain. Heel pain prior to iontophoresis treatment received an average rating of 7.5; by the end of therapy, the average rating had decreased to 1.8. At an average follow-up time of 27 months, heel pain levels averaged 0.64, indicating continued reduction in heel pain. Ninety-four percent of participants said that they would recommend acetic acid iontophoresis to someone with similar heel pain. NLM PUBMED CIT. ID: 10349289 SOURCE: J Am Podiatr Med Assoc 1999 May;89(5):251-7 7

NLM CIT. ID: 99278903
TITLE: Orthoses in the treatment of rearfoot problems. AUTHORS: Sobel E; Levitz SJ; Caselli MA AUTHOR AFFILIATION: Division of Orthopedic Sciences, New York College of Podiatric Medicine, NY 10035, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Orthotic management is helpful in the treatment of most orthopedic conditions involving the rearfoot, including plantar fasciitis, Achilles tendon disorders, posterior tibial tendon dysfunction, flatfoot, ankle sprains, and problems associated with diabetes, arthritis, and equinus disorders. A review of the effectiveness of orthoses in the treatment of these conditions is presented here. An in- depth analysis of the orthotic management of plantar fasciitis and a critical review of foot orthoses for the pronated foot are presented. Also discussed are the rationale and effectiveness of the tension night splint in the treatment of plantar fasciitis, orthotic devices for the different stages of posterior tibial tendon dysfunction, and the various categories of orthoses for off-loading the diabetic foot. The modern ankle brace, the effectiveness of prefabricated versus prescription foot orthoses, and recent developments in the ankle-foot orthosis are also reviewed. NLM PUBMED CIT. ID: 10349286 SOURCE: J Am Podiatr Med Assoc 1999 May;89(5):220-33 8

NLM CIT. ID: 99244282
TITLE: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. AUTHORS: Pfeffer G; Bacchetti P; Deland J; Lewis A Anderson R; Davis W; Alvarez R; Brodsky J; Cooper P; Frey C Herrick R; Myerson M; Sammarco J; Janecki C; Ross S; Bowman M Smith R AUTHOR AFFILIATION: San Francisco Orthopaedic Foot and Ankle Center, Department of Orthopaedics, University of California, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device. NLM PUBMED CIT. ID: 10229276 SOURCE: Foot Ankle Int 1999 Apr;20(4):214-21 9

NLM CIT. ID: 99236494
TITLE: Plantar fasciitis and other causes of heel pain. AUTHORS: Barrett SJ; O'Malley R AUTHOR AFFILIATION: Advanced Foot Care, Spring, TX 77380, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The most common cause of heel pain is plantar fasciitis. It is usually caused by a biomechanical imbalance resulting in tension along the plantar fascia. The diagnosis is typically based on the history and the finding of localized tenderness. Treatment consists of medial arch support, anti-inflammatory medications, ice massage and stretching. Corticosteroid injections and casting may also be tried. Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed despite correction of biomechanical abnormalities. Heel pain may also have a neurologic, traumatic or systemic origin. NLM PUBMED CIT. ID: 10221305 SOURCE: Am Fam Physician 1999 Apr 15;59(8):2200-6 10

NLM CIT. ID: 99215272
TITLE: Diagnosing and treating plantar fasciitis: a conservative approach to plantar heel pain. AUTHORS: Tisdel CL; Donley BG; Sferra JJ AUTHOR AFFILIATION: Department of Orthopaedic Surgery, Cleveland Clinic, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Plantar fasciitis is the most common cause of pain at the weight- bearing surface of the heel, and may coexist with other sources of heel pain. This has led to a confusing array of treatment strategies, including surgery. We offer a simple, effective diagnostic and treatment algorithm that emphasizes nonsurgical treatment options for this often frustrating condition. NLM PUBMED CIT. ID: 10199059 SOURCE: Cleve Clin J Med 1999 Apr;66(4):231-5 11

NLM CIT. ID: 99201541
TITLE: The relationship of heel pad elasticity and plantar heel pain. AUTHORS: Turgut A; Gokturk E; Kose N; Seber S; Hazer B Gunal I AUTHOR AFFILIATION: Department of Orthopedics, Osmangazi University Hospital, Meselik, Eskisehir, Turkey. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain. This hypothesis is evaluated by this blinded observer prospective study, using an age and weight matched control population. Hindfoot lateral radiographs of 73 patients with plantar heel pain, 29 of whom had bilateral involvement (102 feet), and who ranged in age from 20 to 60 years, were studied and compared with 120 healthy subjects (240 feet). Heel pad thickness and heel pad compressibility index were not significantly different in patients with plantar heel pain than in healthy subjects matched for age and weight. In patients with unilateral heel pain, heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side. The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate. NLM PUBMED CIT. ID: 10101325 SOURCE: Clin Orthop 1999 Mar;(360):191-6 12

NLM CIT. ID: 99179271
TITLE: [Is therapy with local infiltrations feasible in primary care consultations?] VERNACULAR
TITLE: Es factible la terapia con infiltraciones locales en las consultas de atencion primaria? AUTHORS: Magana Loarte JE; Perez Franco J; Sanchez Sanchez G AUTHOR AFFILIATION: Centro de Salud La Estacion, Talavera de la Reina, Toledo. jmaganal@meditex.es PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Spa REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones) 0 (Anesthetics, Local)
ABSTRACT: OBJECTIVE: To study the feasibility of local infiltration in primary care consultations. DESIGN: Before-and-after intervention study. SETTING: Two clinics at an urban health centre. PARTICIPANTS: Patients diagnosed with pathology of tender areas and treated with corticosteroid infiltration between May 1997 and May 1998. INTERVENTION: Corticoid infiltration plus local anaesthetic. Weekly check-up. Analysis of the variables: sex, age, diagnosis, time elapsed between indication and start of treatment, subjective assessment of pain before and after treatment (VRS scale), number of infiltrations per patient, side-effects. Evaluation of overall and individual effectiveness. RESULTS: 41 patients were infiltrated. Average age was 58. Most common pathologies were: rotary joint tendinitis (48.7%), anserine bursitis (24.4%), plantar fasciitis (7.3%). Average number of infiltrations per pathology: 1.3. Mean waiting time: 3.5 days. Comparison of pain by means of VRS (range 0-5) before and after treatment used the Wilcoxon test, with a statistically significant difference and p < 0.001 (z = -5.5109). For 35 patients (85.4%), pain was solved very well (values 0 and 1 on the VRS). For 3 patients (7.3%), improvement was moderate; and for 3 (7.3%) there was no improvement. CONCLUSIONS: 1. Treatment with local infiltration of corticosteroids is effective in dealing with pain, and is an alternative to treatment with NSAIDs. 2. It is feasible in primary care, and there are many advantages if the general practitioner employs this therapeutic technique. NLM PUBMED CIT. ID: 10079554 SOURCE: Aten Primaria 1999 Jan;23(1):4-7 13

NLM CIT. ID: 99174312
TITLE: Gouty os trigonum tarsi: case report. AUTHORS: Lai PL; Yang WE; Chen WJ; Lin PY AUTHOR AFFILIATION: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Os trigonum tarsi is found in 7% of the world adult population. However, it rarely causes symptoms. The majority of patients with os trigonum tarsi are found incidentally. This condition is often found in ballet dancers, javelin throwers and soccer players. It rarely produces symptoms in normally active adults. The etiology of os trigonum syndrome is impingement of an unfused ossicle or a fractured posterior lateral tubercle of talus over the posterior rim of tibial plafond. We present a case of os trigonum syndrome in a young man. His posterior heel pain was due to tophaceous gout around the os trigonum tarsi, instead of the common pathogenesis of repeated hyperflexion of the ankle joint. Pictures of the specimen showed marked giant cell reaction which resulted in pseudotumor formation. We reviewed the clinical characteristics of os trigonum tarsi and gout and present the treatment of our patient. NLM PUBMED CIT. ID: 10074743 SOURCE: Chang Keng I Hsueh Tsa Chih 1998 Dec;21(4):509-13 14

NLM CIT. ID: 99171037
TITLE: [MRI of plantar fasciitis] VERNACULAR
TITLE: MR-Tomographie der Plantarfasciitis. AUTHORS: Steinborn M; Heuck A; Maier M; Schnarkowski P Scheidler J; Reiser M AUTHOR AFFILIATION: Institut fur Radiologische Diagnostik, Ludwig-Maximilians-Universitat Munchen. Marc.Steinborn@ikra.med.uni-muenchen.de PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger REGISTRY NUMBERS: 0 (Contrast Media)
ABSTRACT: PURPOSE: The purpose of this study was to determine the type and frequency of characteristic bone and soft tissue changes on MRI of patients with a clinical diagnosis of plantar fasciitis. MATERIALS AND METHODS: 28 patients with a clinical diagnosis of plantar fasciitis underwent MR imaging. Besides T1- and T2-weighted sequences, short-tau- inversion-recovery sequences were used routinely. In 27 patients T1- weighted images after intravenous contrast injection were acquired additionally. As a control group the images of 15 patients without clinical signs for plantar fasciitis were evaluated. RESULTS: In 25 of 28 cases (89%) the clinical diagnosis of plantar fasciitis was established by MR imaging. The most common finding was a peritendinous edema at the calcaneal insertion site which was found in all 25 patients. In 19 of 25 cases (76%) a bone marrow edema of the calcaneus was present. In 14 of 25 cases (56%) an intratendinous signal intensity increase of the plantar fascia could be observed which showed contrast enhancement in 12 cases. Compared to the control group (mean thickness 3.3 mm) the plantar fascia showed significant thickening in the 25 MR positive patients (mean thickness 6.72 mm). DISCUSSION: Besides thickening of the plantar fascia and intratendinous signal intensity increase with contrast enhancement to some extent, bone marrow edema of the calcaneus and peritendinous edema close to the plantar fascia are characteristic signs of plantar fasciitis on MRI. Both signs can reliably be seen on STIR sequences only. NLM PUBMED CIT. ID: 10071643 SOURCE: Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1999 Jan;170(1):41-6 15

NLM CIT. ID: 99169432
TITLE: Ultrasound guided injection of plantar fasciitis [letter; comment] AUTHORS: Quinn M; Gough A COMMENTS: Comment on: Ann Rheum Dis 1998 Jun;57(6):383-4 PUBLICATION TYPES: COMMENT LETTER REGISTRY NUMBERS: 0 (Glucocorticoids, Synthetic) NLM PUBMED CIT. ID: 10070279 SOURCE: Ann Rheum Dis 1998 Dec;57(12):749-50 16

NLM CIT. ID: 99165440
TITLE: Ultrasound of the plantar aponeurosis (fascia). AUTHORS: Gibbon WW; Long G AUTHOR AFFILIATION: Department of Radiology, The General Infirmary at Leeds, UK. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To assess the plantar aponeurosis origin (plantar fascia) using high-resolution ultrasound. DESIGN: The sonographic appearance of the plantar fascia in asymptomatic volunteers was compared with the appearance in: (1) clinical idiopathic plantar fasciitis, (2) inflammatory arthropathy without clinically active plantar fasciitis and (3) Achilles tendon or ankle ligament injury. Patients. There were 48 asymptomatic volunteers (96 heels), 190 patients with idiopathic plantar fasciitis (297 heels), 35 with rheumatoid factor negative spondyloarthropathy (70 heels), 17 with rheumatoid arthritis (34 heels), 62 with clinical Achilles tendinitis (93 heels) and 17 with instability secondary to previous ankle ligament injury (17 heels). RESULTS: Compared with the asymptomatic volunteers, the symptomatic plantar aponeurosis demonstrated significant thickening in patients with clinically unilateral (P<0.001) and bilateral (P<0.001) idiopathic plantar fasciitis as well as in patients with spondyloarthropathy (P<0.001). However, the plantar aponeurosis on the asymptomatic side in patients with unilateral idiopathic plantar fasciitis (P<0.2), rheumatoid arthritis (P<0.2) and ankle injury (P<0.1) demonstrated no significant thickening. In patients with idiopathic plantar fasciitis, abnormal plantar aponeurosis echogenicity was seen in 78% and subcalcaneal bone spurs in 24%. Peritendinous edema was present in 5% of all symptomatic heels, subcalcaneal bone erosion in 4% and intratendinous calcification in 3% of heels. Retrocalcaneal bursitis was present in 7% of patients with idiopathic plantar fasciitis, 40% with spondyloarthropathy and 19% with rheumatoid arthritis. CONCLUSION: Ultrasound allows confirmation of the clinical diagnosis in plantar fasciitis and may provide information as to its etiology. NLM PUBMED CIT. ID: 10068071 SOURCE: Skeletal Radiol 1999 Jan;28(1):21-6 17

NLM CIT. ID: 99166200
TITLE: MR imaging in sports injuries of the foot and ankle. AUTHORS: Bencardino J; Rosenberg ZS; Delfaut E AUTHOR AFFILIATION: Department of Diagnostic Radiology, Long Island Jewish Medical Center, New Hyde Park, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: MR imaging has become the diagnostic modality of choice for the evaluation of traumatic ligamentous and tendinous injures of the foot and ankle, occult bony trauma, and osteochondral lesions of the talus. This article reviews the current applications of MR imaging for the evaluation of sports-related injuries of the foot and ankle, including fractures, sprains, tendon injuries, and heel pain. NLM PUBMED CIT. ID: 10067228 SOURCE: Magn Reson Imaging Clin N Am 1999 Feb;7(1):131-49, ix 18

NLM CIT. ID: 99163265
TITLE: Long-term follow-up of heel spur surgery. A 10-year retrospective study. AUTHORS: Vohra PK; Giorgini RJ; Sobel E; Japour CJ Villalba MA; Rostkowski T AUTHOR AFFILIATION: Division of Surgery, New York College of Podiatric Medicine, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A comparative retrospective study of 48 open heel spur surgeries and 20 endoscopic plantar fasciotomies was conducted involving 59 patients over a 10-year period. There was a significant reduction in heel pain at the time of follow-up (average, 3 years) for both groups. Overall, 85% of procedures were associated with patient satisfaction with the results, and patients said that they would recommend heel spur surgery for relief of severe heel pain in 94% of cases. Factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity, are discussed. NLM PUBMED CIT. ID: 10063778 SOURCE: J Am Podiatr Med Assoc 1999 Feb;89(2):81-8 19

NLM CIT. ID: 99163263
TITLE: Heel pain in children. Diagnosis and treatment. AUTHORS: Kim CW; Shea K; Chambers HG AUTHOR AFFILIATION: Department of Orthopaedic Surgery, University of California, San Diego, Medical Center 92103-8894, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain in children is common, and its evaluation is challenging. Medical history and physical examination may be unrevealing owing to children's limited communication skills. Often, advanced laboratory and imaging studies are required to make an accurate diagnosis. The most common causes of heel pain in children are apophysitis, enthesopathy, and overuse syndromes such as tendinitis. Juvenile rheumatoid arthritis is relatively uncommon. In very active children, occult fractures must also be evaluated. Pain unrelated to activity may indicate tumors, infection, or congenital problems. In general, heel pain in children is treated nonoperatively. For fractures in particular, children are less likely than adults to receive surgical treatment. NLM PUBMED CIT. ID: 10063776 SOURCE: J Am Podiatr Med Assoc 1999 Feb;89(2):67-74 20

NLM CIT. ID: 99162762
TITLE: Ultrasonographic assessment of posterior heel pain. AUTHORS: Wang CL; Shieh JY; Wang TG; Hsieh FJ AUTHOR AFFILIATION: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: To investigate the value of ultrasonography in the diagnosis of posterior heel pain, 68 patients with normal plain x-ray findings of the posterior heel underwent ultrasonographic examination with a 10-MHz linear array probe. The findings included Achilles tendinosis (31 patients), retrocalcaneal bursitis (12), superficial Achilles bursitis (7), soft tissue mass (7), Achilles tendon rupture (4), xanthoma (3), tenosynovitis of the flexor hallucis longus tendon (2), and negative findings (2). Sixteen of these patients underwent surgery after ultrasonographic examination. The surgical diagnoses were consistent with the ultrasonographic diagnoses in all cases. With high-resolution ultrasonography, pathologic conditions of the posterior heel can be readily differentiated. NLM PUBMED CIT. ID: 10063275 SOURCE: J Formos Med Assoc 1999 Jan;98(1):56-61 21

NLM CIT. ID: 99149380
TITLE: [High energy shock wave treatment of the painful heel spur] VERNACULAR
TITLE: Hochenergetische Stosswellenbehandlung des schmerzhaften Fersensporns. AUTHORS: Perlick L; Boxberg W; Giebel G AUTHOR AFFILIATION: Abteilung fur Unfall- und Wiederherstellungschirurgie, Kreiskrankenhaus, Ludenscheid. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: Extracorporal shock wave application (ESWA) has been used in the treatment of stones located in kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of the ESWA on the treatment of soft tissue disorders. The aim of this study was to explore the effect of high energy extracorporal shock waves in patients with painful calcaneus spurs. 83 patients who underwent medicophysical treatment without benefit were treated with 3000 impulses of 0.30 mj/mm2. Follow-ups after 12 weeks and 12 months showed that 51 of 83 patients became pain-free and 20 patients improved from the treatment. The results are showing the benefit of the high energy extracorporal shock wave application in the treatment of chronic plantar fasciitis. NLM PUBMED CIT. ID: 10025241 SOURCE: Unfallchirurg 1998 Dec;101(12):914-8 22

NLM CIT. ID: 99125600
TITLE: Infectious causes of heel pain. AUTHORS: Kosinski M; Lilja E AUTHOR AFFILIATION: Division of Medical Sciences, New York College of Podiatric Medicine, NY 10035, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain is often attributed to a biomechanical etiology or sports- related injury. However, failure to recognize an infectious cause can lead to a delay in proper treatment and result in severe patient disability. This article reviews some of the more common infectious etiologies of heel pain. NLM PUBMED CIT. ID: 9926684 SOURCE: J Am Podiatr Med Assoc 1999 Jan;89(1):20-3 23

NLM CIT. ID: 99125599
TITLE: Enthesitis, arthritis, and heel pain. AUTHORS: Lehman TJ AUTHOR AFFILIATION: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Often, individuals who present with "isolated" heel pain but with normal laboratory findings are dismissed without diagnosis. However, if these patients are carefully questioned and examined, a significant proportion are found to have a spondyloarthropathy. The keys to making this diagnosis are obtaining a thorough medical history and performing a complete physical examination. The classic complaints of back pain and enthesitis in other areas are frequently not reported by patients unless specifically sought, because they are thought to be unrelated to the heel pain. NLM PUBMED CIT. ID: 9926683 SOURCE: J Am Podiatr Med Assoc 1999 Jan;89(1):18-9 24

NLM CIT. ID: 99108857
TITLE: Prognosis, course of disease, and treatment of the spondyloarthropathies. AUTHORS: Leirisalo-Repo M AUTHOR AFFILIATION: Department of Medicine, Helsinki University Central Hospital, Finland. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Prognosis in the majority of patients with acute reactive arthritis is usually good, with most patients recovering in a few months. In about 15% to 30% of such patients, the disease progresses, and spondyloarthropathy and even ankylosing spondylitis develop in the following 10 to 20 years. A recurrent attack of reactive arthritis is common in patients with chlamydia-triggered arthritis, but it is rare in patients who have had enteroarthritis. In patients with chronic spondyloarthropathy without evidence of preceding infection, the disease can progress slowly into ankylosing spondylitis. When reactive chlamydia arthritis is indicated, a prolonged course of antibiotics is needed. For other forms of reactive arthritis, solid evidence in favor of antibiotic therapy is still lacking. Presence of hip pain, decreased mobility of thoracic cervical or thoracic spine, heel pain, inflammatory gut lesions, high erythrocyte sedimentation rate, positive family history, and presence of human leukocyte antigen B27 are indicators for chronicity. Sulfasalazine might be of use in chronic arthritis and ankylosing spondylitis, especially if the patient has peripheral arthritis. NLM PUBMED CIT. ID: 9891708 SOURCE: Rheum Dis Clin North Am 1998 Nov;24(4):737-51, viii 25

NLM CIT. ID: 99095105
TITLE: Heel pain syndrome [letter; comment] AUTHORS: Skliar JD COMMENTS: Comment on: J Foot Ankle Surg 1998 Jul-Aug;37(4):267-8 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9879055 SOURCE: J Foot Ankle Surg 1998 Nov-Dec;37(6):548-9 26

NLM CIT. ID: 99087501
TITLE: Outcome study of subjects with insertional plantar fasciitis. AUTHORS: Martin RL; Irrgang JJ; Conti SF AUTHOR AFFILIATION: University of Pittsburgh, Pennsylvania, USA. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9872466 SOURCE: Foot Ankle Int 1998 Dec;19(12):803-11 27

NLM CIT. ID: 99076646
TITLE: [Essential bone cyst of the calcaneus in children. Report of three cases] VERNACULAR
TITLE: Quiste oseo esencial de calcaneo en el nino. Presentacion de tres casos. AUTHORS: Anton Rodrigalvarez LM; Ortega Medina L Cabadas Gonzalez MI; Aguilar Rodriguez L AUTHOR AFFILIATION: Unidad de Ortopedia Infantil, Hospital Clinico San Carlos, Madrid. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Spa
ABSTRACT: OBJECTIVE: The purpose of this study was to analyze the properties of essential bone cyst of the calcaneus in childhood, as well as its evolution, and differences with regard to adults. PATIENTS AND METHODS: The cases of children with a diagnosis of essential bone cyst of calcaneus in last sixteen years in the pediatric orthopedic unit of San Carlos Clinic have been reviewed. We evaluated the information regarding the clinical history and the radiological and histological date as well as the therapy result with esteroid intracavity therapy and curettage and bone grafting. The radiologic score was done following Sodergard criteria and the posttreatment follow-up with Neer's score. RESULTS: The mean age of the patients was 10.3 years. Two of the patients had recurrent heel pain for more than six months. Treatment consisted in intracavitary esteroid in two cases and curettage and bone grafting in all three cases, in two of the cases because of failure of esteroid therapy and in the other because of an atypical X-ray image. In all cases the histological stady identified the existence of a characteristic membrane conective tissue. The postsurgery follow-up a period of half four years has been satisfactory. CONCLUSIONS: The essential bone cyst of the calcaneous is exceptional localization in children, frequently symptomatic and resistant to the esteroid intracavitaria contrary to what happens with the essential bone cyst of other localizations and with the essential bone cyst of the calcaneus in the adults. The recurrent heel pain and atipical X-ray image are surgery indications. NLM PUBMED CIT. ID: 9859549 SOURCE: An Esp Pediatr 1998 Oct;49(4):364-8 28

NLM CIT. ID: 99053933
TITLE: Operative management of Haglund's deformity in the nonathlete: a retrospective study. AUTHORS: Sammarco GJ; Taylor AL AUTHOR AFFILIATION: University of Cincinnati Medical Center, Ohio, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Haglund's deformity, or "pump bump," is a common cause of posterior heel pain. Management of the condition usually consists of nonoperative therapy. This study presents a retrospective study of 65 cases (53 patients), with symptomatic Haglund's deformity in nonathletes (13 male and 40 female), who presented during a 4-year period (1989-1994). Sixty- five percent (39 heels) of these patients failed to respond to nonoperative therapy for an average of 62 weeks, (range, 4-260 weeks). This group of patients went on to operative treatment. Surgical management consisted of excision of the posterior calcaneal tuberosity through a medial longitudinal incision with debridement, reattachment of the Achilles tendon using bone anchors, and 4 weeks of postoperative immobilization. Thirty-nine patients (74%) were contacted for follow- up. The average follow-up period for these patients was 155 weeks, (range, 92-335 weeks). There were 50% excellent results, 47% good results, 3% fair results (1 patient), and no poor results. The Maryland Foot Score for operated heels was an average of 67/100 preoperative and an average of 92/100 postoperative. On unoperated heels the score was an average of 81/100 at first evaluation and an average of 86/100 at final evaluation. Complications included one recurrence of painful prominence, one wound infection, and one incisional neuroma. The outcome of these cases demonstrated that in those patients who fail nonoperative treatment, surgical treatment of Haglund's deformity produces a predictably good surgical result when performed using the technique described. NLM PUBMED CIT. ID: 9840198 SOURCE: Foot Ankle Int 1998 Nov;19(11):724-9 29

NLM CIT. ID: 99054830
TITLE: Musculoskeletal pain in primary pediatric care: analysis of 1000 consecutive general pediatric clinic visits. AUTHORS: de Inocencio J AUTHOR AFFILIATION: Centro de Salud "Benita de Avila," Insalud Area 4, Madrid, Spain. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: OBJECTIVES: 1) To determine the number of primary care clinic visits attributable to musculoskeletal pain (MSP) in children >/=3 and <15 years of age. 2) To describe the demographic characteristics of this population assessed for limb/back pain. 3) To characterize the etiology of musculoskeletal pain in an urban general pediatric clinic in Madrid, Spain. METHODS: Prospective evaluation of 1000 consecutive clinic visits to an urban general pediatric clinic. Inclusion criteria were 1) age >/=3 and <15 years and 2) musculoskeletal evaluation requested by the family or patient. All consultations related to MSP were recorded via standard protocol and data record form. RESULTS: During the study period, 61 of 1000 (6.1%; confidence interval: 4.6-7.5) clinic visits for children >/=3 and <15 years were related to MSP. Patients' age, mean +/- SD, was 9.7 +/- 3.3 years. Musculoskeletal complaints were more frequent in boys (57.4%), although there was no statistical difference. The presenting complaints included knee arthralgias in 33%; other joint (eg, ankles, wrists, elbows) arthralgias in 28%; soft tissue pain in 18%; heel pain in 8%; hip pain in 6%; and back pain in 6%. Symptoms were attributable to trauma in 30%; overuse syndromes in 28% (eg, chondromalacia patellae, mechanical plantar fasciitis, overuse muscle pain); and normal skeletal growth variants (eg, Osgood-Schlatter syndrome, hypermobility, Sever's disease) in 18% of patients. CONCLUSION: MSP represents a frequent presenting complaint in general pediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing pediatrics continuing medical education and training programs. musculoskeletal pain, limb pain, arthralgia, children, general pediatrics, pediatric primary care. NLM PUBMED CIT. ID: 9832591 SOURCE: Pediatrics 1998 Dec;102(6):E63 30

NLM CIT. ID: 99040968
TITLE: [5-years lithotripsy of plantar of plantar heel spur: experiences and results--a follow-up study after 36.9 months] VERNACULAR
TITLE: 5 Jahre Lithotripsie des plantaren Fersenspornes: Erfahrungen und Ergebnisse--eine Nachuntersuchung nach 36,9 Monaten. AUTHORS: Sistermann R; Katthagen BD AUTHOR AFFILIATION: Orthopadische Klinik, Stadtische Kliniken Dortmund, Klinikzentrum Mitte. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: INTRODUCTION: Effectivity and application as well as possible complications and side effects of extracorporeal shock wave lithotripsy of plantar heel spurs should be evaluated. METHOD: We applied extracorporeal shock wave lithotripsy (ECSL) to treat plantar fasciitis in 54 patients (period from: 3/1/1993 to 3/1/1996). 20 persons were treated with Lithostar plus (group 1) and ultrasound focussing and 34 patients (group 2) were treated by a Lithostar and X-ray focussing. RESULTS: After 6 weeks 14 (70%) of group 1 and 27 (79.4%) of group 2 were free of pain. After 36.9 months 8 (40%) of group 1 and 23 (67.6%) of group 2 were still painfree. We could not recognize any severe complications after 36.9 months. CONCLUSION: ECSL is an effective and noninvasive method of treatment. It is not the method of choice for the first treatment of plantar fasciitis but is an alternative option for operation. NLM PUBMED CIT. ID: 9823634 SOURCE: Z Orthop Ihre Grenzgeb 1998 Sep-Oct;136(5):402-6 31

NLM CIT. ID: 99040967
TITLE: [Using extracorporeal shockwave therapy in orthopedics--a meta-analysis] VERNACULAR
TITLE: Der Einsatz der extrakorporalen Stosswellentherapie in der Orthopadie-- eine Metaanalyse. AUTHORS: Heller KD; Niethard FU AUTHOR AFFILIATION: Orthopadische Universitatsklinik, Rheinisch-Westfalischen Technischen Hochschule Aachen. PUBLICATION TYPES: JOURNAL ARTICLE META-ANALYSIS LANGUAGES: Ger
ABSTRACT: AIM: Up to now ESWT is not a standard therapeutic technique in orthopaedics. The mechanisms of the induced analgesic effect or the mechanism of shock-waves in bony defects are still unknown. By metaanalysis successrates and indications for ESWT are worked out as well as adequate impulse- and energyrates according to actual state of knowledge. Aim of this study is to rate the published cases. METHOD: 105 papers referring to ESWT of the locomotor system are rated. Validation was performed for each paper according to the international accepted system of the American Association of Spine Surgery in Type A- E. Advise for therapy is taken only from high quality publications of Type A and B. This advise should regard scientific as well as economic aspects. RESULTS: 4825 cases from 55 publications and abstracts that underwent ESWT were evaluated. 24 papers with 1585 cases (33%) live up to the standards of a scientific investigation. Numerous studies exist about therapy of calcifying tendinitis, epicondylitis humeri radialis, painful heel, pseudarthrosis and other enthesiopathies. Especially the studies concerning pseudarthosis and other enthesiopathies do hardly live up to scientific standards. In calcifying tendinitis and painful heel ESWT achieves nearly the same results than the established methods. No serious complications were observed. Because of the high complication rate in operative treatment of heel spur ESWT seems to be justifiable. The techniques of ESWT, energy density levels, impulse rates and complications will be described. CONCLUSION: The advantages of ESWT are non-invasiveness and low rate of complications. Primary aim should be to evaluate adequate energy density levels and impulse rates for specific groups of indications using high quality studies according to evidence-based-medicine. Long term results need to be awaited to be able to compare ESWT with established methods. Recent inflationary use of ESWT especially in outpatient departments has no scientific indication in numerous cases as conservative methods are not used consequently. NLM PUBMED CIT. ID: 9823633 SOURCE: Z Orthop Ihre Grenzgeb 1998 Sep-Oct;136(5):390-401 32

NLM CIT. ID: 99038637
TITLE: MR imaging of benign soft-tissue masses of the foot and ankle. AUTHORS: Llauger J; Palmer J; Monill JM; Franquet T; Bague S Roson N AUTHOR AFFILIATION: Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Approximately 75% of all biopsy-proved soft-tissue masses of the foot and ankle are benign tumors or nontumoral lesions representing a variety of histologic types. In some cases, it may be difficult if not impossible to identify the lesion; however, careful analysis of the magnetic resonance (MR) imaging findings and correlation of these findings with the patient's clinical history can usually suggest a more specific diagnosis, particularly in the most common benign tumors of the foot (e.g., fibromatosis, cavernous hemangioma) and in nonneoplastic soft-tissue lesions such as Morton neuroma, ganglion cyst, and plantar fasciitis. In addition, a specific diagnosis can almost always be made in patients with pigmented villonodular synovitis (PVNS) or giant cell tumor (GCT) of the tendon sheath. The MR imaging appearance of PVNS consists of multiple synovial lesions with low or intermediate signal intensity on T1-weighted images and low signal intensity on T2-weighted and gradient-echo images. GCTs of the tendon sheath usually have areas of low signal intensity on both T1- and T2- weighted images due to the paramagnetic effect of hemosiderin. Awareness and understanding of the underlying pathologic findings in lesions of the foot and ankle aid in MR imaging interpretation. NLM PUBMED CIT. ID: 9821196 SOURCE: Radiographics 1998 Nov-Dec;18(6):1481-98 33

NLM CIT. ID: 99001584
TITLE: Unusual heel pain in a patient with primary oxalosis treated by liver- kidney transplantation [letter] AUTHORS: Javier RM; Moulin B; Durckel J; Sibilia J; Kuntz JL PUBLICATION TYPES: LETTER REGISTRY NUMBERS: 0 (Oxalates) NLM PUBMED CIT. ID: 9785405 SOURCE: Rev Rhum Engl Ed 1998 Jul-Sep;65(7-9):517-8 34

NLM CIT. ID: 98444156
TITLE: Ultrasound guided injection of recalcitrant plantar fasciitis [see comments] AUTHORS: Kane D; Greaney T; Bresnihan B; Gibney R FitzGerald O AUTHOR AFFILIATION: Department of Diagnostic Imaging, St Vincent's Hospital, Dublin, Ireland. COMMENTS: Comment in: Ann Rheum Dis 1998 Dec;57(12):749-50 PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Anesthetics, Local) 0 (Anti-Inflammatory Agents, Steroidal) 137-58-6 (Lidocaine) 76-25-5 (Triamcinolone Acetonide)
ABSTRACT: OBJECTIVE: To determine the effect of ultrasound guided injection in recalcitrant idiopathic plantar fasciitis. METHODS: Four patients with a clinical diagnosis of idiopathic plantar fasciitis, who were unresponsive to palpation guided injection with triamcinolone acetonide and local anaesthetic, underwent ultrasonographic examination of the heel. RESULTS: The following ultrasonographic features were noted:- (a) increased thickness of plantar fascia in symptomatic heels compared with asymptomatic heels, (b) loss of distinction of the distal plantar fascia borders, (c) reduced echogenicity of the plantar fascia. Ultrasound guided injection of the enlarged, hypoechoic plantar fascia resulted in complete relief in four of five heels (mean duration of follow up = 24 months) in three cases. One patient developed a recurrence of symptoms after six months. CONCLUSION: Ultrasound allows for confirmation of the clinical diagnosis and ultrasound guided injection produces a good clinical response when unguided injection is unsuccessful. The technique is quick, inexpensive, and entails no radiation exposure. NLM PUBMED CIT. ID: 9771217 SOURCE: Ann Rheum Dis 1998 Jun;57(6):383-4 35

NLM CIT. ID: 98406588
TITLE: Metastatic breast cancer presenting as heel pain. AUTHORS: Groves MJ; Stiles RG AUTHOR AFFILIATION: Northlake Regional Medical Center, Tucker, GA, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors present a case of breast cancer metastasizing to the calcaneus that was confirmed by bone biopsy. The patient's complaint of heel pain provided the initial evidence of skeletal metastasis. Metastatic spread of cancer to the hand or foot (acrometastasis) is considered rare. However, the possibility of acrometastasis should be considered in any patient with a history of cancer presenting with skeletal pain, especially if the symptoms do not respond to therapy. NLM PUBMED CIT. ID: 9735627 SOURCE: J Am Podiatr Med Assoc 1998 Aug;88(8):400-5 36

NLM CIT. ID: 98406584
TITLE: Conservative treatment of plantar fasciitis. A prospective study. AUTHORS: Lynch DM; Goforth WP; Martin JE; Odom RD; Preece CK Kotter MW AUTHOR AFFILIATION: Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Temple, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents)
ABSTRACT: A randomized, prospective study was conducted to compare the individual effectiveness of three types of conservative therapy in the treatment of plantar fasciitis. One hundred three subjects were randomly assigned to one of three treatment categories: anti-inflammatory, accommodative, or mechanical. Subjects were treated for 3 months, with follow-up visits at 2, 4, 6, and 12 weeks. For the 85 patients who completed the study, a statistically significant difference was noted between groups, with mechanical treatment with taping and orthoses proving to be more effective than either anti-inflammatory or accommodative modalities. NLM PUBMED CIT. ID: 9735623 SOURCE: J Am Podiatr Med Assoc 1998 Aug;88(8):375-80 37

NLM CIT. ID: 98376637
TITLE: Entrapment neuropathy: the etiology of intractable chronic heel pain syndrome. AUTHORS: Hendrix CL; Jolly GP; Garbalosa JC; Blume P DosRemedios E AUTHOR AFFILIATION: New Britain General Hospital, CT 06050, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Chronic heel pain syndrome (CHPS) is a common clinical entity. The etiology of CHPS has never been completely defined and there are no clear treatment regimens in the literature. Most authors agree that nonoperative treatment is effective in most patients. However, in 5%- 10% of patients, operative intervention is required. Outcomes for these patients have been inconsistent. A series of 51 patients with intractable CHPS who were diagnosed with an entrapment of the posterior tibial nerve and its terminal branches is presented. Descriptive statistics were obtained for the demographic data and pre and postsurgical start-up and standing pain visual analog scale (VAS) scoring. Statistical testing of the VAS mean scores was performed using a paired t-test at the 0.01 level of significance. Pre- and postsurgical start-up and pre- and postsurgical standing pain VAS means were significantly different from each other (t = 19.6, p = .001 and t = 19.4, p = .001, respectively). Based on subjective and objective criteria, 96% of the patients experienced significant improvement and 90% reported completed resolution of heel pain. The presence of tarsal tunnel syndrome in all 51 patients strongly suggests entrapment neuropathy as the etiology of intractable CHPS. NLM PUBMED CIT. ID: 9710778 SOURCE: J Foot Ankle Surg 1998 Jul-Aug;37(4):273-9 38

NLM CIT. ID: 98376636
TITLE: Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. AUTHORS: Benton-Weil W; Borrelli AH; Weil LS Jr; Weil LS Sr PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A retrospective study was done to evaluate patient pain level and satisfaction after a percutaneous plantar fasciotomy. Between 1990 and 1996, 51 patients underwent percutaneous plantar fasciotomy for chronic plantar fasciitis associated with heel pain syndrome. All patients had undergone at least 6 months of conservative therapy. A questionnaire incorporating a visual analog pain scale was used to determine the effectiveness and patient satisfaction of the procedure. Of 35 patients who responded to the questionnaire, 27 were female and eight were male, ranging in age from 31 to 76 years with an average age of 47 years. Follow-up time after surgery ranged from 12 to 57 months, with an average of 34 months. Utilizing a visual analog pain scale, results showed a preoperative pain level of 8.7 (+/- 1.2) with a range of 6-10. Pain level at follow-up was 2.1 (+/- 2.7) with a range of 0-10. Eighty- three percent of the patients stated that the procedure met or exceeded their expectations. Percutaneous plantar fasciotomy is a simple and cost-effective method for surgical intervention of chronic heel pain syndrome. Complications are rare and the results compare favorably with other reported more invasive and costly techniques. NLM PUBMED CIT. ID: 9710777 SOURCE: J Foot Ankle Surg 1998 Jul-Aug;37(4):269-72 39

NLM CIT. ID: 98376635
TITLE: The heel pain syndrome [editorial] [see comments] AUTHORS: Weil LS Sr COMMENTS: Comment in: J Foot Ankle Surg 1998 Nov-Dec;37(6):548-9 PUBLICATION TYPES: EDITORIAL NLM PUBMED CIT. ID: 9710776 SOURCE: J Foot Ankle Surg 1998 Jul-Aug;37(4):267-8 40

NLM CIT. ID: 98369935
TITLE: Adaptive gait responses to plantar heel pain. AUTHORS: Levins AD; Skinner HB; Caiozzo VJ AUTHOR AFFILIATION: Department of Orthopaedic Surgery, College of Medicine, UCI Medical Center, Orange 92868, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Neuropathic foot ulcers in people with diabetes result from repetitive stress aggravated by a lack of protective sensation. Protective sensation causes individuals without this impairment to produce alterations in their gait in response to painful stimuli. This study evaluates the adaptive gait responses to pain in individuals with sensate feet. The gaits of 18 such control subjects were studied with a foot switch gait analyzer without painful stimuli. Each then had his or her gait analyzed with three successively larger painful stimuli (2, 3.3, and 4.6 mm beads) placed below the heel. This study showed that subjects compensated for the painful stimuli by reducing the single limb support duration of the affected side at bead sizes of 3.3 and 4.6 mm and by reducing the unaffected side's swing phase and single limb support as a percentage of the gait cycle at the 4.6-mm bead size only. Gait adaptations to painful stimuli may indicate another possible avenue, in addition to pressure redistribution, in the assessment of programs aimed at prevention and treatment of diabetic foot ulcers. NLM PUBMED CIT. ID: 9704312 SOURCE: J Rehabil Res Dev 1998 Jul;35(3):289-93 41

NLM CIT. ID: 98368061
TITLE: Calcaneal osteochondritis: a new overuse injury. AUTHORS: Lokiec F; Wientroub S AUTHOR AFFILIATION: Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel- Aviv Medical Center, Israel. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: This is a case report of osteochondritis of the medial plantar apophysis of the calcaneus presenting as medial plantar heel pain in a 15-year-old basketball player. The lesion was detected radiographically and by increased focal uptake on bone scan. Conservative treatment resulted in complete pain relief and normal calcaneal appearance with union of the osteochondral fragment. No recurrence was noted during 3 years of follow-up. NLM PUBMED CIT. ID: 9702679 SOURCE: J Pediatr Orthop B 1998 Jul;7(3):243-5 42

NLM CIT. ID: 98306886
TITLE: Tibial nerve entrapment and heel pain caused by a Baker's cyst [letter] AUTHORS: Willis JD; Carter PM PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 9642916 SOURCE: J Am Podiatr Med Assoc 1998 Jun;88(6):310-1 43

NLM CIT. ID: 98283767
TITLE: A new modified technique for harvest of calcaneal bone grafts in surgery on the foot and ankle [see comments] AUTHORS: Biddinger KR; Komenda GA; Schon LC; Myerson MS AUTHOR AFFILIATION: Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA. COMMENTS: Comment in: Foot Ankle Int 1999 Jan;20(1):68 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Reported sites for retrieval of cancellous bone for grafts include the iliac crest, greater trochanter, proximal tibia, and distal tibia. A new lateral technique for retrieval of cancellous bone from the calcaneus is evaluated through anatomic review, quantitative analysis, and retrospective clinical assessment. Of 22 patients managed with this technique over a 2-year period, 17 returned for an evaluation by questionnaire, physical examination, and radiographic follow-up at an average of 7 months after surgery (range, 4-16 months). Complaints/complications were minor: three had minor incisional symptoms, five had medial heel pain (3 caused by plantar fasciitis), and one had unchanged preoperative heel pain secondary to clubfoot deformity. Compared with more extensive bone-grafting procedures, this procedure offers the advantages of bone harvested under local anesthesia using a readily accessible ipsilateral extremity and producing minor complications. NLM PUBMED CIT. ID: 9622424 SOURCE: Foot Ankle Int 1998 May;19(5):322-6 44

NLM CIT. ID: 98281196
TITLE: Foot pain: specific indications for scintigraphy. AUTHORS: O'Duffy EK; Clunie GP; Gacinovic S; Edwards JC Bomanji JB; Ell PJ AUTHOR AFFILIATION: Department of Rheumatology, University College, London. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Radiopharmaceuticals) 63347-66-0 (Technetium Tc 99m Medronate)
ABSTRACT: Bone scintigraphy is requested as part of the investigation of foot pain, but its contribution to clinical management has not been comprehensively documented. Previously published data are limited; the most comprehensive series identified scintigraphic abnormalities in patients with primarily orthopaedic problems and a control group was not included (Maurice HD et al. J Bone Joint Surg 1987;69B:448 52). The aim of this study was to evaluate whether bone scintigraphy may be useful in different clinical circumstances indicated by referral request details. Regions of scintigraphic abnormality were scored and compared with clinical details drawn from case notes of 60 patients with foot pain. The commonest clinical indications for scans were: confirmation of the clinical suspicion of plantar fasciitis, documentation of the extent of inflammatory arthritis and location of focal pathology. A group of 30 asymptomatic, age- and sex-matched controls were also studied. In 14 out of 19 symptomatic feet in the plantar fasciitis group, focal uptake at the medial calcaneal tubercle was present, confirming the diagnosis. In patients with non-specific, diffuse foot pain, the bone scan identified focal abnormalities in 11 out of 14 cases, thus directing the clinician to the site of pathology. Scintigraphy also proved useful in mapping local inflammatory disease. Technetium-99m methylene diphosphonate image abnormalities occurred in the control group most commonly in the midfoot (16 regions in 13 subjects) and first metatarsophalangeal joint (19 regions in 14 subjects). NLM PUBMED CIT. ID: 9619897 SOURCE: Br J Rheumatol 1998 Apr;37(4):442-7 45

NLM CIT. ID: 98278216
TITLE: [Complications, side-effects and contraindications in the use of medium and high-energy extracorporeal shock waves in orthopedics] VERNACULAR
TITLE: Komplikationen, Nebenwirkungen und Kontraindikationen der Anwendung mittel-und hochenergetischer extrakorporaler Stosswellen im orthopadischen Bereich. AUTHORS: Sistermann R; Katthagen BD AUTHOR AFFILIATION: Orthopadische Klinik, Stadtische Kliniken Dortmund, Klinikzentrum Mitte, Dortmund. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: INTRODUCTION: Possible complications and side effects using extracorporeal shock waves for orthopaedic diseases should be evaluated. METHOD: Since 1993 we prospectively evaluated the complications and adverse effects applying extracorporeal shockwaves for orthopaedic diseases. Within three years 542 lithotripsies in 276 patients were made. 190 patients were treated because of calcifying tendinitis, 34 for epicondylitis and 52 suffering from a plantar heel spur. RESULTS: In 216 cases we could recognize small superficial hematomas, 4 hyperventilations and in 3 cases a blood pressure elevation over 200 mmHg. Two cases of high blood pressure showed data over 200 mmHg without other clinical symptoms. They were of transitory nature during therapy. In one case we had to treat a hypertension crisis within the first 3 hours after therapy. Today the application of shockwaves in the thoracic region or lung, coagulopathies or anticoagulant medicine, pregnancy and the use at nerval or vascular structures represent an absolute contraindication. When using extracorporeal shock waves for bone lithotripsy, bone tumors, bone infection or infected pseudarthrosis and the application at growth plates in children and young adults represent an absolute contraindication. CONCLUSION: In general lithotripsy has only minor complications when it is used accurate. NLM PUBMED CIT. ID: 9615982 SOURCE: Z Orthop Ihre Grenzgeb 1998 Mar-Apr;136(2):175-81 46

NLM CIT. ID: 98278215
TITLE: [Symptomatic low-energy shockwave therapy in heel pain and radiologically detected plantar heel spur] VERNACULAR
TITLE: Symptomatische niedrig-energetische Stosswellentherapie bei Fersenschmerzen und radiologisch nachweisbarem plantaren Fersensporn. AUTHORS: Krischek O; Rompe JD; Herbsthofer B; Nafe B AUTHOR AFFILIATION: Orthopadische Universitatsklinik Mainz. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGES: Ger
ABSTRACT: QUESTION: The long-term analgetic effect of low-energetic shock-wave therapy in heel spur for two different numbers of applicated impulses is investigated. METHODS: 50 patients with recalcitrant heel pain and a plantar calcaneal spur on the X-ray received in a controlled, prospective and randomized study low-energetic extracorporal shock-wave- therapy. The first group received 3 x 500 impulses and the second group 3 x 100 impulses of 0.08 mJ/mm2 with an experimental device. The follow- up was 1 1/2, 3 and by telephone after 12 months. RESULTS: There was clear improvement and relief of pain in both groups on manual pressure and while walking and an increase of the pain-free walking ability from 10 minutes before the treatment to 2 and 3 hours respectively after 12 months. We saw a significantly better results after the treatment with 3 x 500 impulses. CONCLUSION: The extracorporal shock-wave therapy is an effective treatment in refractory heel pain. An amount of at least 3 x 500 impulses in the low energetic treatment is useful. NLM PUBMED CIT. ID: 9615981 SOURCE: Z Orthop Ihre Grenzgeb 1998 Mar-Apr;136(2):169-74 47

NLM CIT. ID: 98201985
TITLE: Differences in impulse distribution in patients with plantar fasciitis. AUTHORS: Bedi HS; Love BR AUTHOR AFFILIATION: Geelong Hospital, Victoria, Australia. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The impulse distribution based upon vertical foot-floor reaction forces and time under the fore-, mid-, and hindfoot was determined using Tekscan's F-Scan system. This was compared in 40 barefoot patients with long-standing plantar fasciitis with an equal number of normal subjects. The patient group tended to load the hind- and midfoot to a lesser extent than the control group. Consequently, a greater proportionate load was borne by the forefoot. This result was highly significant for both the midfoot (P < 0.001) and forefoot (P = 0.002) comparisons. An objective biomechanical method such as this may be useful as a diagnostic aid, to identify individuals predisposed to this condition, and for evaluating the efficacy of various treatment modalities. NLM PUBMED CIT. ID: 9542986 SOURCE: Foot Ankle Int 1998 Mar;19(3):153-6 48

NLM CIT. ID: 98201984
TITLE: Biomechanical consequences of sequential plantar fascia release. AUTHORS: Murphy GA; Pneumaticos SG; Kamaric E; Noble PC Trevino SG; Baxter DE AUTHOR AFFILIATION: University of Tennessee-Campbell Clinic, Department of Orthopaedic Surgery, Memphis, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Plantar fascia release has long been a mainstay in the surgical treatment of persistent heel pain, although its effects on the biomechanics of the foot are not well understood. With the use of cadaver specimens and digitized computer programs, the changes in the medial and lateral columns of the foot and in the transverse arch were evaluated after sequential sectioning of the plantar fascia. Complete release of the plantar fascia caused a severe drop in the medial and lateral columns of the foot, compared with release of only the medial third. Equinus rotation of the calcaneus and a drop in the cuboid indicate that strain of the plantar calcaneocuboid joint capsule and ligament is a likely cause of lateral midfoot pain after complete plantar fascia release. NLM PUBMED CIT. ID: 9542985 SOURCE: Foot Ankle Int 1998 Mar;19(3):149-52 49

NLM CIT. ID: 98245350
TITLE: Management of heel pain in the inflammatory arthritides. AUTHORS: Geppert MJ; Mizel MS AUTHOR AFFILIATION: Orthopaedic & Trauma Specialists, Somersworth, NH, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Subcalcaneal pain is a common complaint presented to the orthopaedist. Excessive attention to mechanical or traumatic causes may result in an improper diagnosis if rheumatologic or systemic conditions are not considered in the differential diagnosis. Systemic conditions associated with heel pain are reviewed and a conservative treatment protocol is presented that should help to obtain a correct diagnosis and to lead to effective management of this common condition. NLM PUBMED CIT. ID: 9584371 SOURCE: Clin Orthop 1998 Apr;(349):93-9 50

NLM CIT. ID: 98238133
TITLE: I have recently taken up fast walking and have developed pain in my left foot, which my internist says in plantar fasciitis. She told me to hold off on walking for a while. Can you tell me about this condition? Is there anything else I can do to speed my recovery? PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9577272 SOURCE: Harv Womens Health Watch 1998 Apr;5(8):8 51

NLM CIT. ID: 98232947
TITLE: Flexor hallucis longus dysfunction [see comments] AUTHORS: Oloff LM; Schulhofer SD AUTHOR AFFILIATION: Sports Orthopedic and Athletic Rehabilitation Medicine Group (SOAR), Menlo Park, CA 94025, USA. COMMENTS: Comment in: J Foot Ankle Surg 1998 May-Jun;37(3):260 PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Nineteen consecutive cases of flexor hallucis longus stenosing tenosynovitis that underwent operative tenolysis from September 1994 to December 1996 were retrospectively reviewed. This is classically a disorder of ballet dancers, and to a much lesser extent, running athletes. The patients were primarily nonathletic, male, and middle- aged. The mean symptom duration was 20 months, multiple physicians had been encountered, and misdiagnosis was common. Patients presented with overlapping signs and symptoms of flexor hallucis longus tendinitis, plantar fasciitis, and tarsal tunnel syndrome. A cross-reference of patients with posteromedial ankle pain, medial arch pain, and/or a positive Tinel's sign revealed that 14 (74%) and 6 (32%) feet had two of three, or all three signs, respectively. Magnetic resonance imaging and tenography proved valuable in establishing the correct primary diagnosis. Nonoperative protocols were unsuccessful. Flexor hallucis longus tenolysis was successful in each case with a mean return to regular activity at 9 weeks. Flexor hallucis longus stenosing tenosynovitis may be more prevalent than reported and should be a diagnosis of inclusion among all patient populations who present with posterior ankle, medial arch, and/or tarsal tunnel symptoms. NLM PUBMED CIT. ID: 9571456 SOURCE: J Foot Ankle Surg 1998 Mar-Apr;37(2):101-9 52

NLM CIT. ID: 98197545
TITLE: US of the ankle: technique, anatomy, and diagnosis of pathologic conditions. AUTHORS: Fessell DP; Vanderschueren GM; Jacobson JA Ceulemans RY; Prasad A; Craig JG; Bouffard JA; Shirazi KK van Holsbeeck MT AUTHOR AFFILIATION: Department of Radiology, Henry Ford Hospital, Detroit, MI 48202, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: For specific indications, ultrasound (US) is an efficient and inexpensive alternative to magnetic resonance (MR) imaging for evaluation of the ankle. In addition to the tendons and tendon sheaths, other ankle structures demonstrated with US include the anterior joint space, retrocalcaneal bursa, ligaments, and plantar fascia. Ankle US allows detection of tenosynovitis and tendinitis, as well as partial and complete tendon tears. Joint effusions, intraarticular bodies, ganglion cysts, ligamentous tears, and plantar fasciitis can also be diagnosed. As pressure for cost containment continues, demand for US of the ankle may increase given its lower cost compared with that of MR imaging. In most cases, a focused ankle US examination can be performed more rapidly and efficiently than MR imaging. Familiarity with the technique of ankle US, normal US anatomy, and the US appearances of pathologic conditions will establish the role of US as an effective method of imaging the ankle. NLM PUBMED CIT. ID: 9536481 SOURCE: Radiographics 1998 Mar-Apr;18(2):325-40 53

NLM CIT. ID: 98181948
TITLE: A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis. AUTHORS: Basford JR; Malanga GA; Krause DA; Harmsen WS AUTHOR AFFILIATION: Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN 55905, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: OBJECTIVE: To determine whether low-intensity laser irradiation, a widespread but controversial physical therapy agent, is an effective treatment of plantar fasciitis. DESIGN: A randomized, double-blinded, placebo-controlled clinical study. SETTING: A sports medicine clinic. SUBJECTS: Thirty-two otherwise healthy individuals with plantar fasciitis of more than 1 month's duration. INTERVENTION: Dummy or active irradiation with a 30 mW .83 microm GaAlAs continuous-wave infrared (IR) diode laser three times a week for 4 weeks. MEASUREMENTS: Morning pain, pain with toe walking, tenderness to palpation, windlass test response, medication consumption, and orthotic use were evaluated immediately before the study, as well as at the midpoint and end of treatment. Subjects were also evaluated at a follow-up 1 month after their last treatment. RESULTS: No significant differences were found between the groups in any of the outcome measures either during treatment or at the 1-month follow-up. Treatment, however, was well tolerated and side effects were minimal. CONCLUSIONS: Low-intensity IR laser therapy appears safe but, at least within the parameters of this study, is not beneficial in the treatment of plantar fasciitis. NLM PUBMED CIT. ID: 9523774 SOURCE: Arch Phys Med Rehabil 1998 Mar;79(3):249-54 54

NLM CIT. ID: 98164520
TITLE: Retrospective analysis of minimal-incision, endoscopic, and open procedures for heel spur syndrome. AUTHORS: Brekke MK; Green DR AUTHOR AFFILIATION: Scripps Mercy Medical Center, San Diego, CA, USA. PUBLICATION TYPES: HISTORICAL ARTICLE JOURNAL ARTICLE
ABSTRACT: Forty-four patients with recalcitrant heel spur syndrome who underwent surgical correction (54 procedures) were studied retrospectively. The results of minimal-incision, endoscopic, and open plantar fasciotomy procedures were compared. This study focuses on patient satisfaction, pain reduction, convalescence, and postoperative problems. Although all procedure groups reported high degrees of patient satisfaction and reduction of pain, some notable differences among the three groups were observed. NLM PUBMED CIT. ID: 9503769 SOURCE: J Am Podiatr Med Assoc 1998 Feb;88(2):64-72 55

NLM CIT. ID: 98158346
TITLE: Complications of plantar fascia rupture associated with corticosteroid injection. AUTHORS: Acevedo JI; Beskin JL AUTHOR AFFILIATION: Georgia Baptist Medical Center, Atlanta, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones)
ABSTRACT: From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow- up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve. NLM PUBMED CIT. ID: 9498581 SOURCE: Foot Ankle Int 1998 Feb;19(2):91-7 56

NLM CIT. ID: 98154548
TITLE: Iontophoresis of 0.4% dexamethasone for plantar fasciitis. AUTHORS: Chandler TJ AUTHOR AFFILIATION: Lexington Clinic Sports Medicine Center, Lexington, Kentucky, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Glucocorticoids, Synthetic) 50-02-2 (Dexamethasone) NLM PUBMED CIT. ID: 9490178 SOURCE: Clin J Sport Med 1998 Jan;8(1):68 57

NLM CIT. ID: 98142459
TITLE: Plantar fasciitis. Repeated corticosteroid injections are safe. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones) NLM PUBMED CIT. ID: 9481460 SOURCE: Can Fam Physician 1998 Jan;44:45, 51 58

NLM CIT. ID: 98130887
TITLE: Resectional arthroplasty: treatment for calcaneonavicular coalition. AUTHORS: Fuson S; Barrett M AUTHOR AFFILIATION: Puget Sound Hospital, Tacoma, Washington 98032, USA. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 9470111 SOURCE: J Foot Ankle Surg 1998 Jan-Feb;37(1):11-5 59

NLM CIT. ID: 98126722
TITLE: Plantar fasciitis/calcaneal spur among security forces personnel. AUTHORS: Sadat-Ali M AUTHOR AFFILIATION: College of Medicine & Medical Sciences, King Faisal University, Saudi Arabia. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A prospective single survey was conducted among Security Forces personnel at the Mobile Hospital, Ministry of Interior, Makkah Al- Mukarramah, Saudi Arabia. One hundred three patients presented to the orthopedic clinic with painful heel. A control group of patients from the other clinics without painful heel was also screened. The average age was 38.81 years and 38.1 years in the patient and the control group, respectively. The mean Quetelet index of body mass in the patient group was 30.36 kg/m2 and in the control group it was 26.71 kg/m2. There was a statistically significant difference of p < 0.05 between the two groups for Quetelet index of body mass. The right side was affected in 37 patients, the left side was involved in 45 patients, and 21 patients had pain bilaterally. Seventy-one patients had spur on the calcaneum. The prevalence of painful heel attributable to plantar fasciitis/calcaneum spur was 1.18%. This study suggests that obesity is a cause and initiator of heel pain and plantar fasciitis/calcaneal spur and that improper footwear aggravates the condition. NLM PUBMED CIT. ID: 9465574 SOURCE: Mil Med 1998 Jan;163(1):56-7 60

NLM CIT. ID: 98122739
TITLE: Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. AUTHORS: Powell M; Post WR; Keener J; Wearden S AUTHOR AFFILIATION: Department of Orthopaedics, West Virginia University, Morgantown 26505, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: Chronic plantar fasciitis frustrates patients and treating physicians. Our hypothesis was that use of a dorsiflexion night splint for 1 month would effectively treat patients with recalcitrant plantar fasciitis. A 6-month randomized crossover study included 37 patients with chronic plantar fasciitis. Patients were treated with dorsiflexion night splints for 1 month. Group A wore splints for the 1st month and group B for the 2nd month. No splints were used in either group for the final 4 months of the study. No other medications, stretching, or strengthening exercises were prescribed. Eighty-eight percent of patients who completed the study improved. Eighty percent of the involved feet improved subjectively. Results of the AOFAS Ankle-Hindfoot Rating System and the Mayo Clinical Scoring System demonstrated significant improvement for both groups during the period of splint wear. Improvements were maintained at study completion. Response to splinting did not correlate with foot type, degree of obesity, or the presence of heel spur on radiographs. We believe dorsiflexion splints provide relief from the symptoms of recalcitrant plantar fasciitis in the majority of patients. NLM PUBMED CIT. ID: 9462907 SOURCE: Foot Ankle Int 1998 Jan;19(1):10-8 61

NLM CIT. ID: 98039111
TITLE: MRI of plantar fasciitis. AUTHORS: Roger B; Grenier P AUTHOR AFFILIATION: Service de Radiologie Polyvalente Diagnostique et Interventionelle, Hopital de la Pitie, 83, boulevard de l'Hopital, F-75651 Paris Cedex 13, France. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: At present, MRI is the only imaging method that can precisely visualize lesions of the superficial plantar aponeurosis, whether they be musculoaponeurositides, enthesopathies or tears, and whether they be acute or chronic, with or without complications. By its direct visualization of the lesion, MRI enables an accurate assessment of the injury to be made and thereby better orients the therapeutic strategy. NLM PUBMED CIT. ID: 9369509 SOURCE: Eur Radiol 1997;7(9):1430-5 62

NLM CIT. ID: 98059214
TITLE: An inexpensive "orthosis" for plantar fasciitis [letter; comment] AUTHORS: de Souza H; Reed L COMMENTS: Comment on: Med J Aust 1997 Jun 2;166(11):616 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9397072 SOURCE: Med J Aust 1997 Nov 3;167(9):509 63

NLM CIT. ID: 98048954
TITLE: [Heel pain and calcaneal spurs] AUTHORS: Lu H; Gu G; Zhu S AUTHOR AFFILIATION: Arthritis Clinic & Research Center, People's Hospital Beijing Medical University Beijng. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Chi
ABSTRACT: The authors of this paper have reviewed 137 X-ray films of the involved feet and followed up 30 patients all of them suffering from heel pain treated in the authors' hospital during 1980-1985, in order to find out the relationship between the length, shape and the direction of the spurs with the heel pain. We have found: (1) There are no clear relationship between heel pain and the length, shape and the direction of the calcaneal spur. (2) The plantar soft tissue of the painful foot was thickened, indicating the heel pain was due to inflammation in the plantar soft tissue. (3) Heel pain is related to the patient's age and sex. (4) The spurs still exist and grow even bigger after the syndrome disappears. NLM PUBMED CIT. ID: 9387707 SOURCE: Chung Hua Wai Ko Tsa Chih 1996 May;34(5):294-6 64

NLM CIT. ID: 98038439
TITLE: Keeping in shape: exercise fundamentals for the midlife patient. AUTHORS: Strauss E; Durand E; Blaustein A AUTHOR AFFILIATION: Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The typical physiologic effects of aging on the musculoskeletal system can be impeded with regular exercise and diet. Common orthopedic problems in sedentary midlife patients are shoulder impingement, low back pain, and plantar fasciitis. Although the responsibility for maintaining an exercise program rests with the individual, the primary care physician can play an important role as coach, cheerleader, and respected advisor. The key is to encourage patients to initiate a program of regular, moderate exercise 30 minutes a day, three times a week, and to eat a balanced, nutritious diet. The best exercise and diet regimen is one that is custom-designed to accommodate the individual patient's needs and objectives. NLM PUBMED CIT. ID: 9371105 SOURCE: Geriatrics 1997 Nov;52(11):62-3, 67-8, 73-4 passim; quiz 80 65

NLM CIT. ID: 98035514
TITLE: The nonlinear finite element analysis and plantar pressure measurement for various shoe soles in heel region. AUTHORS: Shiang TY AUTHOR AFFILIATION: Graduate Institute of Coaching Science, National College of Physical Education and Sports, Taoyuan, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE
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. The results showed that the mean peak plantar pressure of the running situation was significantly higher than that of the walking situation as predicted, and that the insole could provide better cushioning compared to the other shoe constructions. The stress strain relationship for shoe materials was approximated better by a second-order nonlinear curve according to the Instron test. The results of the finite element method suggested that only the second- order nonlinear stress strain curve could correctly describe the shoe material, which also confirmed a potential valuable role for FEM in designing functional shoes. NLM PUBMED CIT. ID: 9369026 SOURCE: Proc Natl Sci Counc Repub China B 1997 Oct;21(4):168-74 66

NLM CIT. ID: 98013837
TITLE: The role of bone scintigraphy and plain radiography in intractable plantar fasciitis. AUTHORS: Tudor GR; Finlay D; Allen MJ; Belton I AUTHOR AFFILIATION: Department of Radiology, Leicester Royal Infirmary NHS Trust, UK. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The objective of this study was to assess the role of bone scintigraphy and plain film radiography in intractable plantar fasciitis. The bone scintigrams, radiographs and clinical histories of 33 patients with chronic plantar fasciitis were reviewed. These patients were refractory to conservative treatments and were being considered for surgical plantar fascia release. Twenty-eight patients had increased uptake on scintigraphy at the medial calcaneal tubercle, while a plantar spur was seen in 21 patients. Seventy-five percent of patients with increased uptake had a calcaneal spur; 95% of patients with a spur had increased uptake on scintigraphy. It would appear that plantar calcaneal spurs are more prevalent in this group of patients than in the general population and, although they may not be the primary cause of pain, they may predispose to it. Scintigraphy was helpful in patients without a spur or with atypical symptoms or signs. It did not provide any further information on the group of patients with a spur. NLM PUBMED CIT. ID: 9352552 SOURCE: Nucl Med Commun 1997 Sep;18(9):853-6 67

NLM CIT. ID: 98000166
TITLE: Magnetic resonance imaging of Achilles tendon in patients with rheumatoid arthritis. AUTHORS: Stiskal M; Szolar DH; Stenzel I; Steiner E Mesaric P; Czembirek H; Preidler KW AUTHOR AFFILIATION: Department of Radiology KH Lainz-Vienna, Austria. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 9342119 SOURCE: Invest Radiol 1997 Oct;32(10):602-8 68

NLM CIT. ID: 97457528
TITLE: Clinical snapshot: plantar fasciitis. AUTHORS: Campbell-Giovaniello KJ AUTHOR AFFILIATION: Veterans Administration Outpatient Clinic, Redding, CA, USA. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9311337 SOURCE: Am J Nurs 1997 Sep;97(9):38-9 69

NLM CIT. ID: 97452806
TITLE: Plantar heel pain in the adult. AUTHORS: Hurwitz SH AUTHOR AFFILIATION: Department of Orthopedics, University of Virginia Health Sciences Center, Charlotiesville, USA. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 9307596 SOURCE: Hosp Pract (Off Ed) 1997 Sep 15;32(9):81-3, 86-8, 91-2 70

NLM CIT. ID: 97436872
TITLE: Anatomical factors associated with overuse sports injuries. AUTHORS: Krivickas LS AUTHOR AFFILIATION: Harvard Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Overuse injuries develop when repetitive stress to bone and musculotendinous structures damages tissue at a greater rate than that at which the body can repair itself. A combination of extrinsic factors, such as training errors and environmental factors, and intrinsic or anatomical factors, such as bony alignment of the extremities, flexibility deficits and ligamentous laxity, predispose athletes to develop overuse injuries. Malalignant of the lower extremity, including excess femoral anteversion, increased Q angle, lateral tibial torsion, tibia vara, genu varum or valgum, subtalar varus and excessive pronation are frequently cited as predisposing to knee extensor mechanism overuse injuries. These and other forms of malalignment have also been implicated in iliotibial band syndrome, medial tibial stress syndrome, lower extremity stress fractures and plantar fasciitis. Muscle inflexibility aggravates and predisposes to the development of a variety of overuse injuries, especially those occurring in children and adolescents, including the traction apophysitises. Flexibility deficits may be improved by an appropriate stretching programme. Unfortunately, lower extremity malalignment is less amenable to intervention. Orthotics are often prescribed to improve lower extremity alignment. However, studies have not shown that orthotics have any effect on knee alignment and, while they can alter subtalar joint alignment, the clinical benefit of this remains unclear. Awareness of anatomical factors that may predispose to overuse injuries allows the clinician to develop individual prehabilitation programmes designed to decrease the risk of overuse injury. In addition, the clinician can advise the athlete on the importance of avoiding extrinsic factors that may also predispose to overuse injury. NLM PUBMED CIT. ID: 9291553 SOURCE: Sports Med 1997 Aug;24(2):132-46 71

NLM CIT. ID: 97395411
TITLE: Fortnightly review. Plantar fasciitis. AUTHORS: Singh D; Angel J; Bentley G; Trevino SG AUTHOR AFFILIATION: Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL NLM PUBMED CIT. ID: 9251550 SOURCE: BMJ 1997 Jul 19;315(7101):172-5 72

NLM CIT. ID: 97401231
TITLE: Infracalcaneal heel pain in the athlete. AUTHORS: Agostinelli J; Ross JA AUTHOR AFFILIATION: Orthopedics/Podiatry Services, Eglin Air Force Base, Florida, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel-spur syndrome is a condition encountered on a daily basis by those practitioners who primarily treat athletes. The authors discuss anatomy, the clinical examination, radiographic evaluation, exercise, and alternative medicines. NLM PUBMED CIT. ID: 9257037 SOURCE: Clin Podiatr Med Surg 1997 Jul;14(3):503-9 73

NLM CIT. ID: 97396647
TITLE: Treatment of plantar fasciitis with night splint and shoe modifications consisting of a steel shank and anterior rocker bottom [letter; comment] AUTHORS: Ng A COMMENTS: Comment on: Foot Ankle Int 1996 Dec;17(12):732-5 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9252820 SOURCE: Foot Ankle Int 1997 Jul;18(7):458 74

NLM CIT. ID: 97396634
TITLE: Endoscopic plantar fascia release: a cross-sectional anatomic study. AUTHORS: Reeve F; Laughlin RT; Wright DG AUTHOR AFFILIATION: Wright State University, Department of Orthopaedic Surgery, Dayton, Ohio 45409, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Endoscopic plantar fascia release is a new procedure proposed to treat heel pain and plantar fasciitis. The purpose of this study was to assess the structures at risk during plantar fascia release using this method. Ten fresh-frozen cadaver feet were divided into two groups. All specimens underwent cannula placement inferior to the plantar fascia. Five-of the specimens had plantar fascia release using the endoscopic technique. Six of the specimens were then frozen and cut in transverse, sagittal, and coronal sections to visualize the relationship between the cannula and plantar fascia and surrounding structures. Gross dissection was performed on the remaining four specimens. The amount of plantar fascia released, the relationship to the nerve to abductor digiti minimi, and the fascia of the abductor hallucis muscle were assessed. The average distance from the cannula margin to the nerve to the abductor digiti minimi was 6 mm at the medial border of the plantar fascia. The average amount of plantar fascia released was 90%. Although a complete release was attempted, the fascia to the abductor hallucis was not released in any of the specimens. The nerve to the abductor digiti minimi was not damaged in any of the specimens. On coronal sections, the nerve was closer to the cannula and plantar fascia release than previously reported. NLM PUBMED CIT. ID: 9252807 SOURCE: Foot Ankle Int 1997 Jul;18(7):398-401 75

NLM CIT. ID: 97344828
TITLE: An inexpensive "orthosis" for plantar fasciitis [letter] [see comments] AUTHORS: White AD COMMENTS: Comment in: Med J Aust 1997 Nov 3;167(9):509 PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 9201195 SOURCE: Med J Aust 1997 Jun 2;166(11):616 76

NLM CIT. ID: 97338957
TITLE: Isolated peripheral enthesitis and/or dactylitis: a subset of psoriatic arthritis. AUTHORS: Salvarani C; Cantini F; Olivieri I; Macchioni P Niccoli L; Padula A; Ferri S; Portioli I AUTHOR AFFILIATION: Unita Reumatologica, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. PUBLICATION TYPES: JOURNAL ARTICLE MULTICENTER STUDY
ABSTRACT: OBJECTIVE: To identify isolated peripheral enthesitis and/or dactylitis as a subset of psoriatic arthritis (PsA) and to define the clinical characteristics of these patients. METHODS: We examined 401 unselected patients with PsA seen in 3 Italian rheumatological centers over a 6 month period. The diagnosis of PsA was based upon the clinical experience of a rheumatologist. The clinical features of patients with PsA were assessed by clinical examination and review of the patients' charts, evaluating the presence of peripheral arthritis, spinal involvement, dactylitis, and enthesitis. A series of 483 rheumatological patients without psoriasis and spondyloarthropathy (European Spondylarthropathy Study Group criteria) seen consecutively in a one month period constituted the control group. RESULTS: 14 patients (3.5%) presented isolated episodes of peripheral enthesitis and/or dactylitis. No patient developed peripheral arthritis and/or axial involvement during the followup period (median 30 mo; range 3-72 mo). 10/14 patients (71%) presented at least one episode of finger and/or toe dactylitis. 5 of these 10 patients (50%) had additional episodes of peripheral enthesitis (Achilles tendinitis, plantar fasciitis, and posterior tibial tendinitis). Episodes of Achilles tendinitis and/or plantar fasciitis were present in 8/14 patients (57%). 3 of these 8 patients (37%) had associated peripheral enthesitis in other sites as well: lateral epicondyle, insertion of the patella tendon into the inferior pole of the patella, femoral quadriceps, and posterior tibial tendons. An additional case had posterior tibial tendinitis and 2 episodes of toe dactylitis. None of these 14 cases presented radiological evidence of sacroiliitis and only one of the 13 typed was HLA-B27 positive. 12 patients (2.4%) of the control group had episodes of peripheral enthesitis (11 plantar fasciitis and one Achilles tendinitis). No patient had episodes of dactylitis. The frequency of isolated Achilles tendinitis and/or dactylitis was significantly higher in patients with PsA compared to controls (3.5 vs 0.2%; p = 0.001). CONCLUSION: In some patients PsA can occur only with peripheral enthesitis, particularly Achilles tendinitis, and/or dactylitis. These patients may represent a subset of PsA, not defined by Moll and Wright and spondyloarthritis classification criteria, and poorly recognized in the studies on PsA. NLM PUBMED CIT. ID: 9195517 SOURCE: J Rheumatol 1997 Jun;24(6):1106-10 77

NLM CIT. ID: 97329754
TITLE: Effect of cutting the plantar fascia on mechanical properties of the foot. AUTHORS: Arangio GA; Chen C; Kim W AUTHOR AFFILIATION: Department of Surgery, Lehigh Valley Hospital, Allentown, PA, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A biomechanical model was used to calculate the loadbearing characteristics of the plantar fascia and to determine the effect of cutting the plantar fascia on the stiffness of the foot. With a load of 683 N applied to the foot, the model predicted a 17% increase in vertical displacement and a 15% increase in horizontal elongation when the plantar fascia was cut, compared with the corresponding value when the plantar fascia was intact. Plantar fasciotomy, although clinically satisfactory in cases of recalcitrant heel pain, decreases the stiffness of the foot and creates a less rigid and more deformable arch. The biomechanical model described can help to evaluate the possible outcome of such a procedure. NLM PUBMED CIT. ID: 9186224 SOURCE: Clin Orthop 1997 Jun;(339):227-31 78

NLM CIT. ID: 97376392
TITLE: Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. AUTHORS: Sollitto RJ; Plotkin EL; Klein PG; Mullin P AUTHOR AFFILIATION: Saddle Brook Surgicenter, NJ 07663, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In this paper the authors discuss plantar fascial heel pain, including its etiology and treatment. The results of a retrospective study using radiofrequency lesioning on plantar fascial heel pain are presented and discussed. Thirty-nine patients were treated with radiofrequency lesioning, and 92% of the patients experienced complete resolution of symptoms following the procedure. NLM PUBMED CIT. ID: 9232502 SOURCE: J Foot Ankle Surg 1997 May-Jun;36(3):215-9; discussion 256 79

NLM CIT. ID: 97310910
TITLE: Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. AUTHORS: Gudeman SD; Eisele SA; Heidt RS Jr; Colosimo AJ Stroupe AL AUTHOR AFFILIATION: Specialty Centers for Orthopaedic & Rehabilitative Excellence, Indianapolis, Indiana, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Steroidal) 50-02-2 (Dexamethasone)
ABSTRACT: Plantar fasciitis is a common problem in running sports. This study was undertaken to determine whether iontophoresis of dexamethasone in conjunction with other traditional modalities provides more immediate pain relief than traditional modalities alone. Forty affected feet were randomly assigned to one of two groups. Group I feet were treated with traditional modalities and placebo iontophoresis. Group II feet received the traditional modalities plus iontophoresis of dexamethasone. Both groups were treated six times over 2 weeks. The subjects' clinical course was assessed using the Maryland Foot Score. At the conclusion of treatment, Group II patients had significantly greater improvement than Group I patients (increase on Maryland Foot Score of 6.8 +/- 5.6 for Group II and 3.1 +/- 4.1 for Group I). However, at followup 1 month after completion of treatment there was no significant difference between groups (increase of 5.6 +/- 8.0 for Group I and 7.4 +/- 6.3 for Group II). These results suggest that although traditional modalities alone are ultimately effective, iontophoresis in conjunction with traditional modalities provides immediate reduction in symptoms. Based on these results, iontophoresis of dexamethasone for plantar fasciitis should be considered when more immediate results are needed (i.e., performance athletes and active patients. NLM PUBMED CIT. ID: 9167809 SOURCE: Am J Sports Med 1997 May-Jun;25(3):312-6 80

NLM CIT. ID: 97301995
TITLE: Effect of systemic and intrathecal morphine in a rat model of postoperative pain [see comments] AUTHORS: Zahn PK; Gysbers D; Brennan TJ AUTHOR AFFILIATION: Department of Anesthesia, University of Iowa, Iowa City 52242-1009, USA. COMMENTS: Comment in: Anesthesiology 1997 May;86(5):1015-7 PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Analgesics, Opioid) 57-27-2 (Morphine)
ABSTRACT: BACKGROUND: To learn more about persistent pain after an incision, a rat model for postoperative pain has been developed. To further evaluate this model, the authors examined the effect of intrathecal (IT) and subcutaneous (SC) morphine, effective for postoperative pain relief in patients, on pain behaviors immediately after surgery and 1 day after surgery. METHODS: Rats were anesthetized with halothane, and a 1-cm incision was made in the plantar aspect of the foot and closed. After recovery, the rats were placed on an elevated plastic mesh floor, and withdrawal threshold was determined using calibrated von Frey filaments (15-522 mN) applied from beneath the test cage to an area adjacent to the wound at the heel. Pain behaviors also were assessed using the response frequency to a nonpunctate mechanical stimulus and a cumulative pain score. RESULTS: Mechanical hyperalgesia and nonevoked pain behaviors were present on the day of surgery and 1 day after surgery. Administration of either SC (0.3-3.0 mg/kg) or IT (0.16-5.0 micrograms) morphine reversibly increased the withdrawal threshold. The response frequency to the nonpunctate stimulus and the nonevoked pain scores also were decreased by 3 mg/kg of SC or 5 micrograms of 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. NLM PUBMED CIT. ID: 9158356 SOURCE: Anesthesiology 1997 May;86(5):1066-77 81

NLM CIT. ID: 97293753
TITLE: The painful foot, Part II: Common rearfoot deformities. AUTHORS: Van Wyngarden TM AUTHOR AFFILIATION: University of Kansas Medical Center, Kansas City, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: As with deformities of the forefoot, deformities of the rearfoot often respond well to conservative therapy. Rest and nonsteroidal anti- inflammatory medications are often used. Patients with plantar fasciitis may benefit from corticosteroid injections. Surgery may be helpful in refractory cases. Haglund's deformity is associated with pain in the area of the osseous ridge on the posterosuperior aspect of the calcaneus. The retrocalcaneal bursa may be inflamed. This disorder is diagnosed by palpation of the painful area. Conservative treatment consists of minimizing pressure over the osseous ridge. Corticosteroid injection is not advised since it may weaken the Achilles tendon. Surgical intervention consists of resection or reduction of the osseous ridge. Posterior calcaneal spur is another cause of heel pain. The spur can be visualized radiographically in the tendon insertion. Treatment is conservative, with footgear modification and nonsteroidal anti- inflammatory drug therapy. Surgery to remove the spur may be indicated if conservative measures fall to relieve the pain. Tarsal tunnel syndrome is characterized by pain and numbness from the medial malleolus to the sole of the foot. Conservative treatment includes reducing abnormal pronation with an orthosis. NLM PUBMED CIT. ID: 9149647 SOURCE: Am Fam Physician 1997 May 1;55(6):2207-12 82

NLM CIT. ID: 97281596
TITLE: Diagnostic imaging of heel pain and plantar fasciitis. AUTHORS: DiMarcangelo MT; Yu TC AUTHOR AFFILIATION: Department of Diagnostic Radiology and Nuclear Medicine, Cooper Hospital/University Medical Center, Camden, New Jersey, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain or calcaneodynia is a common clinical complaint which has a myriad of causes ranging from plantar fasciitis to stress fracture. In many instances, the etiology of the heel pain is difficult to ascertain simply on the basis of history and physical examination. Therefore, the clinician may enlist various diagnostic imaging modalities to clarify the source of pain. Of all the imaging techniques, magnetic resonance imaging (MRI) has proven its worth in the diagnosis of heel pain. This article outlines the various causes of heel pain and their associated imaging findings. NLM PUBMED CIT. ID: 9135904 SOURCE: Clin Podiatr Med Surg 1997 Apr;14(2):281-301 83

NLM CIT. ID: 97272408
TITLE: Heel anatomy for retrograde tibiotalocalcaneal roddings: a roentgenographic and anatomic analysis. AUTHORS: Flock TJ; Ishikawa S; Hecht PJ; Wapner KL AUTHOR AFFILIATION: Lewiston Orthopaedic Associates, P.A., Bryden Canyon Center, Idaho 83501, USA. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 9127114 SOURCE: Foot Ankle Int 1997 Apr;18(4):233-5 84

NLM CIT. ID: 97232439
TITLE: Plantar fasciitis: US evaluation [letter; comment] AUTHORS: Gibbon W; Long G COMMENTS: Comment on: Radiology 1996 Oct;201(1):257-9 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9122410 SOURCE: Radiology 1997 Apr;203(1):290 85

NLM CIT. ID: 97257568
TITLE: Radiographs in heel pain [letter; comment] AUTHORS: Devitt N COMMENTS: Comment on: Bull Rheum Dis 1996 Jun;45(4):1-3 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 9104042 SOURCE: Bull Rheum Dis 1997 Apr;46(2):1 86

NLM CIT. ID: 97234118
TITLE: Immobilizing heel pain in a runner [see comments] AUTHORS: Sack KE AUTHOR AFFILIATION: Clinical Programs in Rheumatology, University of California, San Francisco, USA. COMMENTS: Comment in: Hosp Pract (Off Ed) 1997 May 15;32(5):25-6 PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 9078986 SOURCE: Hosp Pract (Off Ed) 1997 Mar 15;32(3):243 87

NLM CIT. ID: 97266502
TITLE: [Extracorporeal shock-wave therapy. Experimental basis, clinical application] VERNACULAR
TITLE: Extrakorporale Stosswellentherapie. Experimentelle Grundlagen, klinischer Einsatz. AUTHORS: Rompe JD; Kullmer K; Vogel J; Eckardt A; Wahlmann U Eysel P; Hopf C; Kirkpatrick CJ; Burger R; Nafe B AUTHOR AFFILIATION: Orthopadische Universitatsklinik Mainz. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL LANGUAGES: Ger
ABSTRACT: The purpose of our studies was to investigate experimentally the dose- dependent effects of extracorporeal shock waves on tendon and bone and to unveil therapeutic possibilities in tendinopathies and pseudarthroses. In animal experiments, both positive and negative influences were exerted by shock waves, depending on the initial situation and on the power of the applied shock waves. In prospective clinical trials positive effects were found in the treatment of persistent tennis elbow, plantar fasciitis, calcifying tendinitis, and pseudarthrosis. Our data show that extracorporeal shock waves may provide analgesic, resorptive and osteo-inductive reactions with nearly no side effects. However, the high cost of apparatus and staff prevents a routine application. Extracorporeal shock waves thus remain a last alternative before the indication is made for an operative procedure. NLM PUBMED CIT. ID: 9198795 SOURCE: Orthopade 1997 Mar;26(3):215-28 88

NLM CIT. ID: 97227145
TITLE: Repetitive strain injury to the foot in elite women kendoka. AUTHORS: Nunn NR; Dyas JW; Dodd IP AUTHOR AFFILIATION: Cheltenham and Gloucester College of Higher Education, United Kingdom. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To account for the apparent high incidence of pain in the feet of elite women kendo players. METHODS: A clinical evaluation was done by a chiropractor, the women were interviewed about their kendo experience, and the conditions and frequency of training and ground reaction forces were measured on a Kistler force plate during the kendo attacking action. RESULTS: Four out the five women presented with plantar fasciitis. They had all practised for some time on wooden floors laid on concrete, for between two to four hours a week. They warmed up conscientiously but cool down was more cursory. The force plate results showed that they were hitting the floor with a mean force of four times body weight during a transient impact. CONCLUSIONS: High motivation for practice and training, hard floors, ignoring painful feet, and cursory postpractice cool down probably produced the condition. Postpractice icing and stretching were found to be most effective in the short term. In the longer term reducing the level of impact, either by training on sprung floors or changing the footwork, might reduce the incidence and intensity of the fasciitis. NLM PUBMED CIT. ID: 9132217 SOURCE: Br J Sports Med 1997 Mar;31(1):68-9 89

NLM CIT. ID: 97328875
TITLE: A prospective study of Plantar fasciitis in Harare. AUTHORS: Chigwanda PC AUTHOR AFFILIATION: Department of Surgery, University of Zimbabwe Medical School, Avondale, Harare, Zimbabwe. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Steroidal) 53-36-1 (Depo-Medrol) 83-43-2 (Methylprednisolone)
ABSTRACT: OBJECTIVES: 1. To determine the sex distribution of Plantar fasciitis in Harare. 2. To determine the presence or absence of a calcaneal spur and its role in causation and hence treatment. 3. To determine unilateral or bilateral involvement. 4. To determine the response to steroidal injection. 5. To determine the role of occupation and/or activities if any. DESIGN: Patients presenting with heel pad pain were carefully examined, the age, sex and occupation recorded. They were followed up at two weekly intervals following treatment. SETTING: This prospective study was carried out at a private surgery in a low density suburb. Most patients were referred by their general practitioners and some by patients who had been treated successfully. A few were referred from towns in and around Mashonaland Central Province. SUBJECTS: All patients had to satisfy the diagnosis of Plantar fasciitis. Those presenting with well known causes of pain in and around the heel were excluded. INTERVENTIONS: All patients had radiographs of both heels requested. The painful heels were injected in the office with 80 mg of depo-medrol plus three to four mls of plain lignocaine using the lateral approach. RESULTS: The majority of patients (90%) were female, the mean age 48.5 years. Most patients (60%) had no calcaneal spur, 64% had unilateral disease and this was predominantly left-sided. 94% had relief of their symptoms following a single injection. CONCLUSIONS: In this study there were more females treated for Plantar fasciitis, the majority responded to a single injection. The role of occupation and/or activities require further study. NLM PUBMED CIT. ID: 9185376 SOURCE: Cent Afr J Med 1997 Jan;43(1):23-5 90

NLM CIT. ID: 97162572
TITLE: Lower extremity injuries at the New York City Marathon. AUTHORS: Caselli MA; Longobardi SJ AUTHOR AFFILIATION: Department of Orthopedics, New York College of Podiatric Medicine, New York, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The purpose of this study was to determine the type and frequency of lower extremity running injuries incurred by athletes participating in the New York City Marathon. A survey was conducted of 265 athletes presenting to medical stations for podiatric care during the 1994 New York City Marathon. The results of the survey indicated that the most common injuries occurring in marathon runners were corns, calluses, blisters, muscle cramps, acute knee and ankle injuries, plantar fasciitis, and metatarsalgia. An inverse relationship was observed between the number of miles trained per week and the number of injuries. These findings are consistent with long-term studies of running injuries. NLM PUBMED CIT. ID: 9009547 SOURCE: J Am Podiatr Med Assoc 1997 Jan;87(1):34-7 91

NLM CIT. ID: 97162568
TITLE: Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain. AUTHORS: Caselli MA; Clark N; Lazarus S; Velez Z; Venegas L AUTHOR AFFILIATION: Department of Orthopedic Sciences, New York College of Podiatric Medicine, NY, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
ABSTRACT: The effect of a magnetic foil placed in the PPT/Rx Firm Molded Insole on the relief of heel pain was determined using the foot function index. Nineteen patients wore the PPT/Rx Firm Molded Insoles with the magnetic foil for 4 weeks and 15 patients wore the same PPT/Rx Firm Molded Insole with no magnetic foil for the same time. Approximately 60% of patients in both groups reported improvement. There was also no significant difference in the improvement between the magnetic foil group and the PPT/Rx Firm Molded Insole group in their scores on the post-treatment foot function index. These results suggest that the PPT/Rx Firm Molded Insole alone was effective in treating heel pain after only 4 weeks. The magnetic foil offered no advantage over the plain insole. NLM PUBMED CIT. ID: 9009543 SOURCE: J Am Podiatr Med Assoc 1997 Jan;87(1):11-6 92

NLM CIT. ID: 97164266
TITLE: Heel pain as the inaugural manifestation of metastatic prostate cancer [letter] AUTHORS: Gisserot O; Jaureguiberry JP; Carli P; Paris JF Jaubert D; Chagnon A PUBLICATION TYPES: LETTER REVIEW REVIEW OF REPORTED CASES NLM PUBMED CIT. ID: 9010979 SOURCE: Rev Rhum Engl Ed 1996 Dec;63(11):870-1 93

NLM CIT. ID: 97129386
TITLE: Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom [see comments] AUTHORS: Mizel MS; Marymont JV; Trepman E AUTHOR AFFILIATION: Department of Orthopaedics, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. COMMENTS: Comment in: Foot Ankle Int 1997 Jul;18(7):458 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Seventy-one feet in 57 patients with plantar fasciitis were treated with the combination of a night splint and a shoe modification consisting of a steel shank and anterior rocker bottom. At average follow-up of 16 months, symptoms were resolved in 42 (59%), improved in 13 (18%), not changed in 11 (15%), and worse in 5 (7%) of the feet. No relation was found between outcome and age, gender, duration of symptoms, and bilateral involvement. The method is effective for the treatment of plantar fasciitis. NLM PUBMED CIT. ID: 8973894 SOURCE: Foot Ankle Int 1996 Dec;17(12):732-5 94

NLM CIT. ID: 97070234
TITLE: Operative treatment of subcalcaneal pain. AUTHORS: Tountas AA; Fornasier VL AUTHOR AFFILIATION: Division of Orthopaedic Surgery, Northwestern General Hospital, Toronto, Canada. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Twenty of 21 consecutive patients (21 heels) with subcalcaneal pain retractory to conservative treatment managed by resection of the proximal attachment of the plantar fascia and the heel spur, if present, were reviewed retrospectively. The results, at a mean followup of 40 months (range, 12-102 months), using a 100 point scoring system, rated excellent in 8 patients, good in 10, fair in 1, and poor in 1 (90% satisfactory outcome). Time to maximal improvement often was prolonged, yet once reached was maintained over time. The only complication encountered was 1 superficial wound infection. Radiographically it was noted that, despite complete excision, subcalcaneal exostoses often reformed and the fascial transection never did precipitate collapse of the longitudinal arch of the foot. A combination of mucoid and fibrinoid degeneration of the plantar fascia, an acceleration of an age related process, was the principal histopathologic finding. It was concluded that the subcalcaneal pain unresponsive to conservative modalities can be treated effectively by the index procedure. The radiographic and histologic findings of this study suggest that changes within the fascia, rather than the spur, are primarily responsible for the pathogenesis of the syndrome. NLM PUBMED CIT. ID: 8913160 SOURCE: Clin Orthop 1996 Nov;(332):170-8 95

NLM CIT. ID: 97056014
TITLE: Sever's disease and other causes of heel pain in adolescents. AUTHORS: Madden CC; Mellion MB AUTHOR AFFILIATION: University of Nebraska Medical Center, Omaha, USA. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 8900359 SOURCE: Am Fam Physician 1996 Nov 1;54(6):1995-2000 96

NLM CIT. ID: 96413393
TITLE: Plantar fasciitis: sonographic evaluation [see comments] AUTHORS: Cardinal E; Chhem RK; Beauregard CG; Aubin B Pelletier M AUTHOR AFFILIATION: Department of Radiology, Saint-Luc Hospital, Montreal, Quebec, Canada. COMMENTS: Comment in: Radiology 1997 Apr;203(1):290 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: PURPOSE: To evaluate the sonographic findings of plantar fasciitis. MATERIALS AND METHODS: Both feet of 15 patients who had a clinical diagnosis of plantar fasciitis were evaluated with ultrasound (US) by using a 7.0-MHz linear-array transducer. Heel pain was unilateral in 11 patients and bilateral in four. Sagittal sonograms were obtained, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other observations included hypoechoic fascia, fiber rupture, perifascial fluid collections, and calcifications. Both feet of 15 healthy volunteers were also evaluated as a control group. RESULTS: Plantar fascia thickness was significantly increased in the heels in patients with plantar fasciitis (3.2-6.8 mm; mean, 5.2 mm +/- 1.13) compared with their asymptomatic heels (2.0-4.0 mm; mean, 2.9 mm +/- 0.70) (P < .0001) and compared with the heels of the patients in the control group (1.6-3.8 mm; mean, 2.6 mm +/- 0.48) (P < .0001). The proximal plantar fascia of 16 (84%) symptomatic heels were diffusely hypoechoic compared with none of the patients' asymptomatic heels and only one heel of a patient in the volunteer group. No fascia rupture, perifascial fluid collection, or calcifications were identified. CONCLUSION: Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. US may be a valuable noninvasive technique for the diagnosis of plantar fasciitis. NLM PUBMED CIT. ID: 8816554 SOURCE: Radiology 1996 Oct;201(1):257-9 97

NLM CIT. ID: 97041507
TITLE: Outcome of nonsurgical treatment for plantar fasciitis [published erratum appears in Foot Ankle Int 1996 Nov;17(11):722] AUTHORS: Gill LH; Kiebzak GM AUTHOR AFFILIATION: Miller Orthopaedic Clinic, Charlotte, North Carolina 28203, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis. NLM PUBMED CIT. ID: 8886778 SOURCE: Foot Ankle Int 1996 Sep;17(9):527-32 98

NLM CIT. ID: 97041506
TITLE: Surgical treatment of recalcitrant plantar fasciitis. AUTHORS: Sammarco GJ; Helfrey RB AUTHOR AFFILIATION: Center for Orthopaedic Care, Inc., Cincinnati, Ohio 45219, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Twenty-six patients (35 feet) underwent partial plantar fasciectomy with neurolysis of the nerve to the abductor digiti quinti muscle. Nonsurgical treatment for plantar fasciitis had been unsuccessful in these patients. Patients were followed after surgery for an average of 37.5 months. Six patients were male and 20 patients were female; the average age was 49 years. All patients had failed to respond to nonsurgical treatment for an average of 21.5 months. In addition to routine history and physical examination patients were evaluated before and after surgery with a subjective foot rating system, and a detailed questionnaire was used to assess post-operative functional outcome. Thirty-two patients (92%) had a satisfactory functional outcome, and three patients (8%) had an unsatisfactory result (21 excellent, 11 good, 3 fair, 0 poor). The Maryland Foot Score increased from a preoperative average of 74.8/100 points to a postoperative average of 90.6/100 points. Four patients (11%) had postoperative complications, including superficial wound infection (two patients), deep venous thrombosis (one patient), and superficial phlebitis (one patient), all of which resolved uneventfully with treatment. Ten patients (28.6%) reported some degree of heel pain after surgery. All 10 patients denied limitation in activity related to postoperative pain. The average period before return to daily activity and restricted work duty was 5.6 weeks and to full work duty without restriction was 8.7 weeks. Although the length of time for partial or complete resolution of symptoms is variable, a successful treatment outcome can be expected in most patients who are treated for recalcitrant plantar fasciitis. NLM PUBMED CIT. ID: 8886777 SOURCE: Foot Ankle Int 1996 Sep;17(9):520-6 99

NLM CIT. ID: 97040212
TITLE: Retrospective review of endoscopic plantar fasciotomy--1992 through 1994. AUTHORS: Stone PA; Davies JL AUTHOR AFFILIATION: Presbyterian/St. Luke's Podiatric Surgical Residency Program, Denver, CO, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Endoscopic plantar fasciotomy is a rewarding procedure for both patient and surgeon. A vast majority of the patients have complete or near- complete resolution of heel pain at 6 months postoperatively. The procedure, however, is not without side effects and complications. This retrospective statistical study describes the postoperative side effects and complications of endoscopic plantar fasciotomy from 1992 to 1994. The procedure has been modified in an attempt to reduce several of the more commonly reported side effects. NLM PUBMED CIT. ID: 8885603 SOURCE: J Am Podiatr Med Assoc 1996 Sep;86(9):414-20 100

NLM CIT. ID: 96378608
TITLE: Evaluation of pediatric foot problems: Part II. The hindfoot and the ankle. AUTHORS: Manusov EG; Lillegard WA; Raspa RF; Epperly TD AUTHOR AFFILIATION: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The bony development of the growing child can lead to a variety of hindfoot and ankle problems. Overuse injuries are common, often occurring in conjunction with symptomatic pes planus and plantar fasciitis. Predisposing structural differences such as Haglund's disease, os trigonum, rigid and flexible pes planus, and Sever's disease merit special attention, but treatment may require only patient education and conservative management. Sprains and fractures of growing joints, however, may have poor outcomes if ignored or missed. NLM PUBMED CIT. ID: 8784171 SOURCE: Am Fam Physician 1996 Sep 1;54(3):1012-26, 1031 101

NLM CIT. ID: 97001920
TITLE: Acute injuries and specific problems in adult athletes. AUTHORS: Barry NN; McGuire JL AUTHOR AFFILIATION: Division of Immunology and Rheumatology, Stanford University Medical Center, California, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Special considerations need to be given to specific groups of adult athletes. The most common problems and needs of female and older athletes are discussed in the first section of this article. The second section reviews the diagnosis and management of certain acute injuries most frequently encountered in adult athletes. The last section discusses the differentiation between tarsal tunnel syndrome and plantar fasciitis, chronic compartmental pressure syndrome and medial tibial stress syndrome ("shin splints"), and pelvic stress fractures and osteitis pubis, some commonly encountered difficult diagnoses. NLM PUBMED CIT. ID: 8844912 SOURCE: Rheum Dis Clin North Am 1996 Aug;22(3):531-49 102

NLM CIT. ID: 96384149
TITLE: Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. AUTHORS: Batt ME; Tanji JL; Skattum N AUTHOR AFFILIATION: Department of Family Practice, University of California at Davis School of Medicine, Sacramento, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents)
ABSTRACT: OBJECTIVE: The objective of this study was to evaluate the efficacy of a tension night splint (TNS) as part of a treatment regimen for the management of plantar fasciitis. DESIGN: The design was a randomized clinical trial. SETTING: The setting was a university-based primary care sports medicine clinic in California. PATIENTS: Forty patients with plantar fasciitis entered the study (age range, 20-74 years; average age, 45.7 years). Excluded from the study were patients with other concomitant ankle or foot pathology. Thirty-two patients (21 women, 11 men) completed the study with 33 treated feet. INTERVENTION: The patients were randomized to one of two treatment groups. The control group (n = 17) received standard treatment of antiinflammatory medication (Ibuprofen), a Viscoheel sofspot heel cushion (Bauerfeind USA, Kennesaw, GA, U.S.A.) and a stretching program for the gastrocnemius and soleus muscles. The tension night split group (n = 16) received the same standard treatment protocol and additionally an office manufactured custom fitted posterior splint to be used at night. Those patients in the control group not responding to treatment after 8- 12 weeks were crossed over to the tension night splint group. Patients were reviewed every 4 weeks for symptom assessment and compliance. MAIN OUTCOME MEASURES: The main outcome measures were subjective assessment of pain (Visual analogue scale), plantar fascial tenderness, and ankle range of motion. Patients were discharged from either arm of the trial when they had resumed normal activities with minimal or no discomfort. This end point was recorded as weeks to cure. MAIN RESULTS: There was no significant difference in the demographics of the two groups (p > 0.05). In the control group, 6 of 17 were cured after an average interval of 8.8 weeks. The remaining 11 of 17 control group patients were crossed over to receive a TNS in addition to control modalities. Following cross over 8 of 11 of this group were cured after an average of 13 weeks. Three of the 11 failed to significantly respond. Of the 15 patients (16 feet) originally randomly assigned to the TNS group 16 of 16 were cured with an average treatment time of 12.5 weeks. The TNS treatment protocol was a significantly more efficacious treatment regime (p < 0.05). Thus, of 33 cases of plantar fasciitis treated in this study three failed treatment. CONCLUSION: When used in combination with a visco-elastic heel pad, stretching program and nonsteroidal anti- inflammatory drugs, the TNS is an effective treatment of plantar fasciitis. NLM PUBMED CIT. ID: 8792046 SOURCE: Clin J Sport Med 1996 Jul;6(3):158-62 103

NLM CIT. ID: 96305549
TITLE: [Radiotherapy of plantar heel spurs: indications, technique, clinical results at different dose concepts] VERNACULAR
TITLE: Radiotherapie beim plantaren Fersensporn. Indikation, Technik, klinische Ergebnisse bei unterschiedlichen Dosiskonzepten. AUTHORS: Seegenschmiedt MH; Keilholz L; Stecken A Katalinic A; Sauer R AUTHOR AFFILIATION: Strahlentherapeutische Klinik und Poliklinik, Universitat Erlangen- Nurnberg. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: BACKGROUND: In a retrospective study the efficacy of orthovoltage radiotherapy for refractory painful plantar heel spur was analyzed for 3 different radiation dose concepts. PATIENTS AND METHODS: From 1.1 1984 through 1.3.1994, 182 patients with refractory painful heel symptoms and radiologically proven plantar heel spur received radiotherapy. A total of 141 patients and 170 heels (due to double- sided symptoms) were completely documented in long-term follow-up. Clearly defined semi-quantitative criteria (9-point score) were used to analyze heel pain and ankle function prior to RT, 6 to 12 weeks post- radiation, and at last follow-up. The treatment outcome, i.e. (un)favourable response, of 3 radiation dose concepts were compared: Group A (n = 72 heels) received 12 Gy total radiation dose in 3 fractions per week and 2 series (6 x 1 Gy per series) separated by 6 weeks; group B (n = 98 heels) received 3 Gy total radiation dose in 10 fractions of 0.3 Gy (n = 50) or 5 Gy (10 x 0.5 Gy) (n = 48) with conventional fractionation in 1 series. RESULTS: Radiotherapy was very effective: at last follow-up 67% (group A) and 71% (group B) remained completely free of pain. The rate of "complete pain relief" (i.e. free of any pain symptoms) was not different between the 3 radiation concepts. However, significant differences were observed with regard to "incomplete or insufficient pain relief", i.e. a subjective pain relief of less than 80%, a delayed pain relief after more than 4 weeks or a relapse of pain symptoms in long-term follow-up. More favourable results were achieved in patients receiving 5 Gy or 12 Gy total dose, while patients with 3 Gy total dose had significantly worse results. Prognostic factors for "complete pain relief" were short duration of pain symptoms and acute pain symptoms prior to radiotherapy; with regard to "in-complete or insufficient pain relief" the total dose was found to be a prognostic parameter. CONCLUSIONS: Patients with refractory heel pain can yield a high response to radiotherapy even after failing various conventional treatments previously. Thus, radiotherapy should not be solely regarded as a last resort due to its low costs and high efficacy at low radiation doses. NLM PUBMED CIT. ID: 8693404 SOURCE: Strahlenther Onkol 1996 Jul;172(7):376-83 104

NLM CIT. ID: 96257173
TITLE: Heel spur: radiation therapy for refractory pain--results with three treatment concepts. AUTHORS: Seegenschmiedt MH; Keilholz L; Katalinic A Stecken A; Sauer R AUTHOR AFFILIATION: Department of Radiation Therapy, University Erlangen-Nurnberg, Strahlenstherapeutische Universitatsklinik, Germany. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 8657925 SOURCE: Radiology 1996 Jul;200(1):271-6 105

NLM CIT. ID: 96384622
TITLE: Diagnosis and treatment of heel pain in chronic inflammatory arthritis using ultrasound. AUTHORS: Cunnane G; Brophy DP; Gibney RG; FitzGerald O AUTHOR AFFILIATION: University Department of Rheumatology, University College Dublin, St. Vincent's Hospital, Ireland. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones)
ABSTRACT: The authors examined the role of ultrasound (US) in diagnosis and management of heel pain in chronic inflammatory arthritis. Nineteen patients underwent US examination. Eight patients (2 with previously unsuccessful nonguided injections), had 11 US-guided corticosteroid injections for treatment of retrocalcaneal bursitis (n = 6), plantar fasciitis (n = 3), and posterior tibial tenosynovitis (n = 2). US- demonstrated Achilles tendon rupture (n = 2), Achilles tendinitis (n = 8), posterior tibial tenosynovitis (n = 6), peroneus longus tenosynovitis (n = 2), retrocalcaneal bursitis (n = 13), and plantar fasciitis (n = 4). Loss of smooth bone contour (n = 13) correlated with bone erosions on plain radiographs in all but one case. Ten of 11 guided injections resulted in full resolution of heel pain. The diverse causes of heel pain are highlighted, and the ability of US to provide information with management implications is confirmed. US-guided corticosteroid injection is beneficial, especially after failure of nonguided injection. NLM PUBMED CIT. ID: 8792510 SOURCE: Semin Arthritis Rheum 1996 Jun;25(6):383-9 106

NLM CIT. ID: 96266724
TITLE: A review of subcalcaneal heel pain and plantar fasciitis. AUTHORS: Brown C AUTHOR AFFILIATION: Department of Orthopaedics, Modbury Public Hospital. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Pain beneath the heel is a common and sometimes very debilitating condition. Although usually described as plantar fasciitis' it can be caused by several different conditions. Adequate treatment is aided by determining which cause or causes of subcalcaneal pain is present in a particular patient. This article discusses the approach to the diagnosis and management of pain underneath the calcaneus. NLM PUBMED CIT. ID: 8687311 SOURCE: Aust Fam Physician 1996 Jun;25(6):875-81; 884-5 107

NLM CIT. ID: 96266754
TITLE: Case management study: heel pain in the adult [see comments] AUTHORS: Hurwitz SR AUTHOR AFFILIATION: University of Virginia Medical Center, Charlottesville, USA. COMMENTS: Comment in: Bull Rheum Dis 1997 Apr;46(2):1 PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Non-Steroidal) NLM PUBMED CIT. ID: 8680528 SOURCE: Bull Rheum Dis 1996 Jun;45(4):1-3 108

NLM CIT. ID: 96210170
TITLE: Plantar fasciitis, posterior night splints and activity during recovery [letter] AUTHORS: Weise J PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 8623714 SOURCE: Am Fam Physician 1996 May 1;53(6):1994 109

NLM CIT. ID: 96210169
TITLE: Plantar fasciitis, posterior night splints and activity during recovery [letter; comment] AUTHORS: Zamorski M COMMENTS: Comment on: Am Fam Physician 1995 Sep 1;52(3):891-8, 901-2 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 8623712 SOURCE: Am Fam Physician 1996 May 1;53(6):1993; discussion 1993-4 110

NLM CIT. ID: 96210168
TITLE: Plantar fasciitis, posterior night splints and activity during recovery [letter; comment] AUTHORS: Little RB COMMENTS: Comment on: Am Fam Physician 1995 Sep 1;52(3):891-8, 901-2 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 8623711 SOURCE: Am Fam Physician 1996 May 1;53(6):1993; discussion 1993-4 111

NLM CIT. ID: 96272448
TITLE: The diagnosis and management of plantar fasciitis. AUTHORS: Quaschnick MS AUTHOR AFFILIATION: Presentation College Lakota Campus, Eagle Butte, S.D., USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Plantar fasciitis is the most common diagnosis for pain in the inferior aspect of the heel and accounts for 10% of running injuries seen. It primarily afflicts the middle-aged and elderly populations and athletes. The diagnosis is relatively easy for the primary care provider to establish because of the typical presentation. Diagnostic studies usually are not warranted, but a careful history and physical examination are essential in identifying various predisposing anatomical, biomechanical, and environmental factors. This article addresses a wide array of conservative measures available in developing an individualized management approach based on the contributing factors identified. Because 90% or more respond to conservative measures, the primary care provider can manage the care of the majority of clients who present with plantar fasciitis. To avoid painful recurrence, measures effective in relieving symptoms need to be included in an ongoing plan of prevention. NLM PUBMED CIT. ID: 8801492 SOURCE: Nurse Pract 1996 Apr;21(4):50-4, 60-3, quiz 64-5 112

NLM CIT. ID: 96297334
TITLE: How effective is therapeutic ultrasound in the treatment of heel pain? AUTHORS: Crawford F; Snaith M AUTHOR AFFILIATION: London Foot Hospital & School of Podiatric Medicine, United Kingdom. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL
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. NLM PUBMED CIT. ID: 8733444 SOURCE: Ann Rheum Dis 1996 Apr;55(4):265-7 113

NLM CIT. ID: 97021190
TITLE: Magnetic resonance imaging in the evaluation of heel pain. AUTHORS: Hall RL; Erickson SJ; Shereff MJ; Johnson JE Kneeland JB AUTHOR AFFILIATION: Division of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: This study demonstrates magnetic resonance findings in 16 patients (25 heels) with heel pain. Sixteen of 25 (64%) studies demonstrated abnormalities which could be related to the etiology of their heel pain. Eleven of 16 abnormal scans demonstrated thickening of the plantar aponeurosis with associated fibrosis (7 of 11), and a tear of the flexor digitorum brevis (1 of 11). One study demonstrated changes in the heel pad consistent with fluid. The other four abnormal studies demonstrated changes thought to be consistent with bilateral fibrous calcaneonavicular coalitions, subtalar arthrosis and tenosynovitis of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons. NLM PUBMED CIT. ID: 8867550 SOURCE: Orthopedics 1996 Mar;19(3):225-9 114

NLM CIT. ID: 96303061
TITLE: A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome [letter; comment] AUTHORS: Wander DS COMMENTS: Comment on: J Foot Ankle Surg 1995 May-Jun;34(3):305-11 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 8722893 SOURCE: J Foot Ankle Surg 1996 Mar-Apr;35(2):183-4 115

NLM CIT. ID: 96417197
TITLE: Estimation of sex on the basis of radiographs of the calcaneus. AUTHORS: Riepert T; Drechsler T; Schild H; Nafe B; Mattern R AUTHOR AFFILIATION: Institut fur Rechtsmedizin der Johannes Gutenberg-Universitat, Mainz, Germany. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Lateral and anteroposterior radiographs of the ankles of 800 Central Europeans aged 20 to 79 were analyzed with regard to sexual dimorphism. All the distances, but not the angles, of the calcaneus were much larger in males than in females. Approximately 80% of the study sample could be sexed correctly by classifying all specimens greater than 86.0 mm in length as male and those less than 86.0 mm as female. The prevalence of os tibiale externum was 8.0 and 2.6% and the prevalence of plantar heel spur was 16.3 and 6.5% (increasing with age) for males and females, respectively, being significantly more frequent in females. On the other hand, the bone island frequencies were 9.1% in males and 4.8% in females. Our study suggests that radiographs of the ankle are a convenient, rapid, cheap and non-invasive means for estimating sex. NLM PUBMED CIT. ID: 8819988 SOURCE: Forensic Sci Int 1996 Feb 9;77(3):133-40 116

NLM CIT. ID: 97076598
TITLE: Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study. AUTHORS: Rompe JD; Hopf C; Nafe B; Burger R AUTHOR AFFILIATION: Department of Orthopaedics, University Hospital, Mainz, Germany. PUBLICATION TYPES: CLINICAL TRIAL CONTROLLED CLINICAL TRIAL JOURNAL ARTICLE
ABSTRACT: The aim of this prospective single-blind pilot study was to explore the pain-alleviating effect of low-energy extracorporeal shock wave therapy (ESWT) in painful heel associated with inferior calcaneal spurs. Thirty patients who suffered from persistent symptoms for more than 12 months qualified for low-energy ESWT and were assigned at random to two groups, real or simulated ESWT. Before beginning the treatment, any other therapy was stopped for a period of 6 weeks. The shock waves were applied by a experimental device allowing exact localization through an integrated fluoroscopy unit. Patients were treated three times at weekly intervals. Each time 1000 impulses of 0.06 mJ/mm2 were given around the heel spur. Follow-ups were done after 3, 6, 12 and 24 weeks. Patients of the placebo group who did not improve at the 6-week follow- up were then offered ESWT therapy and were checked at 3, 6, 12 and 24 weeks after the last treatment. Whereas we noticed no significant differences between the groups before ESWT, there was a significant alleviation of pain and improvement of function at all follow-ups in the treatment group. NLM PUBMED CIT. ID: 9063856 SOURCE: Arch Orthop Trauma Surg 1996;115(2):75-9 117

NLM CIT. ID: 96418501
TITLE: Chronic plantar heel pain: treatment with a short leg walking cast. AUTHORS: Tisdel CL; Harper MC AUTHOR AFFILIATION: Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Ohio 44195, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The efficacy of a short leg walking cast in the treatment of chronic plantar heel pain was assessed for 32 patients with 37 involved extremities treated over a 2-year period. All patients had failed numerous other treatment modalities and had been symptomatic for an average of 1 year. Long-term follow-up for 24 patients with 28 involved extremities revealed complete resolution of pain for 7 extremities (25%), improvement for 17 (61%), and no improvement for 4 (14%). Ten (42%) patients were completely satisfied with cast treatment, 3 (12%) were satisfied with reservations, and 11 (46%) were dissatisfied. Casting appears to be a reasonable option for patients with recalcitrant heel pain and should be offered before surgical intervention. NLM PUBMED CIT. ID: 8821286 SOURCE: Foot Ankle Int 1996 Jan;17(1):41-2 118

NLM CIT. ID: 96075447
TITLE: Scintigraphic localisation of steroid injection site in plantar fasciitis. AUTHORS: Dasgupta B; Bowles J AUTHOR AFFILIATION: Southend Health Care Trust, Westcliff-on-Sea, Essex, UK. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Steroids) 63347-66-0 (Technetium Tc 99m Medronate)
ABSTRACT: Plantar fasciitis is a common cause of heel pain. We evaluated scintigraphic localisation of the inflammatory focus in 15 patients with this condition. Technetium-labelled bone scans precisely localised abnormal discrete areas of tracer uptake in 12 (80%) of patients in the medial and posterior aspect below the inferior surface of the calcaneum. Steroid injection at the inflammatory site abolished local tenderness and reduced pain in all 12. Our findings support an injection approach through the medial heel border posterior to the point of heel tenderness. Technetium scintigraphy may be a useful investigation to localise the steroid injection site in resistant cases of plantar fasciitis. NLM PUBMED CIT. ID: 7475824 SOURCE: Lancet 1995 Nov 25;346(8987):1400-1 119

NLM CIT. ID: 96127492
TITLE: Unusual small bone metastases from epithelial malignancies: diagnosis by fine-needle aspiration cytology with histologic confirmation. AUTHORS: Singh HK; Silverman JF; Ballance WA Jr; Park HK AUTHOR AFFILIATION: Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, NC 27858-4534, USA. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 8575276 SOURCE: Diagn Cytopathol 1995 Oct;13(3):192-5 120

NLM CIT. ID: 96121292
TITLE: Efficacy of first-time steroid injection for painful heel syndrome. AUTHORS: Miller RA; Torres J; McGuire M AUTHOR AFFILIATION: Department of Orthopaedics and Rehabilitation, University of New Mexico Hospital, Albuquerque 87106, USA. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE 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. NLM PUBMED CIT. ID: 8574371 SOURCE: Foot Ankle Int 1995 Oct;16(10):610-2 121

NLM CIT. ID: 96027749
TITLE: Spur formation and heel pain [letter; comment] AUTHORS: Kelly A; Wainwright A; Winson I COMMENTS: Comment on: Clin Orthop 1994 Sep;(306):192-6 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 7554647 SOURCE: Clin Orthop 1995 Oct;(319):330 122

NLM CIT. ID: 96052315
TITLE: Misdiagnosed recalcitrant heel pain associated with HLA-B27 antigen. AUTHORS: Scherer PR; Gordon D; Kashanian A; Belvill A AUTHOR AFFILIATION: Department of Biomechanics, California College of Podiatric Medicine, San Francisco, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (HLA-B27 Antigen) NLM PUBMED CIT. ID: 7473086 SOURCE: J Am Podiatr Med Assoc 1995 Oct;85(10):538-42 123

NLM CIT. ID: 96139705
TITLE: The medial instep plantar fasciotomy [see comments] AUTHORS: Perelman GK; Figura MA; Sandberg NS AUTHOR AFFILIATION: Deaconess Medical Center West Campus, St. Louis, Missouri, USA. COMMENTS: Comment in: J Foot Ankle Surg 1996 Mar-Apr;35(2):182-3 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A review of the anatomy, etiology, and conservative and surgical treatments of plantar fasciitis are presented and a simple surgical technique is introduced. The medial instep plantar fasciotomy was performed by the authors on 50 feet previously untreated by surgery (41 patients). The follow-up results (average length of time to follow-up was 11.3 months) revealed that 82.6% of the patients experienced at least 90% pain relief and 97.8% experienced at least 80% pain relief. Overall, 91.3% of the patients related at least 80% satisfaction with the results of the surgery and all but one of the patients stated that they would recommend and/or have the procedure performed again if the need arose. Complications arising from the instep procedure were limited, and the most frequent complaint was scar formation. Stress was placed on exhausting conservative measures before attempting surgical correction, and the average patient utilized five different modalities of conservative treatment over an average period of 13 months. Postoperatively, patients were encouraged to continue, or begin using, orthotics/arch supports to avoid problems such as arch pain. NLM PUBMED CIT. ID: 8590879 SOURCE: J Foot Ankle Surg 1995 Sep-Oct;34(5):447-57; discussion 509-10 124

NLM CIT. ID: 96098454
TITLE: An anatomic analysis of endoscopic plantar fascia release. AUTHORS: Hawkins BJ; Langermen RJ Jr; Gibbons T; Calhoun JH AUTHOR AFFILIATION: Central States Orthopedic Specialists, Tulsa, Oklahoma 74136, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Eighteen fresh-frozen cadaver foot specimens underwent release of the plantar fascia via a newly described endoscopic technique. A 75% release was attempted on each specimen in order to represent a partial fascial release. Each specimen was then dissected to assess the success of the procedure. Five separate measurements were recorded evaluating the reproducibility of the procedure, adequacy of the release considering accepted etiologies for chronic heel pain, and the possibility of damage to local structures. Partial release was noted to be possible, but controlling the exact percentage of the incision was difficult. The release averaged 82% of the width of the fascia, with a range of 53% to 100%. There was no damage in any specimen to the first branch of the lateral plantar nerve, the structure considered most at risk during the procedure. Release of the deep fascia of the abductor hallucis muscle was not possible with this approach. NLM PUBMED CIT. ID: 8563923 SOURCE: Foot Ankle Int 1995 Sep;16(9):552-8 125

NLM CIT. ID: 95381953
TITLE: Use of posterior night splints in the treatment of plantar fasciitis [see comments] AUTHORS: Ryan J AUTHOR AFFILIATION: Department of Family Medicine, University of Wisconsin Medical School, Madison 53715, USA. COMMENTS: Comment in: Am Fam Physician 1996 May 1;53(6):1993; discussion 1993-4 PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Plantar fasciitis is a frequent cause of heel pain in athletes, as well as in persons who are not involved in sports. Stretching, strengthening, correction of training errors and orthotics are essential components in any treatment program. For patients who do not respond to these interventions, posterior night splints can obviate the need for invasive therapies such as corticosteroid injections and surgery. NLM PUBMED CIT. ID: 7653427 SOURCE: Am Fam Physician 1995 Sep 1;52(3):891-8, 901-2 126

NLM CIT. ID: 96053959
TITLE: Role of plantar fascia in the load bearing capacity of the human foot. AUTHORS: Kim W; Voloshin AS AUTHOR AFFILIATION: Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA 18015, USA. PUBLICATION TYPES: JOURNAL ARTICLE
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. NLM PUBMED CIT. ID: 7559672 SOURCE: J Biomech 1995 Sep;28(9):1025-33 127

NLM CIT. ID: 95326050
TITLE: Primary osteoma cutis [letter] AUTHORS: Klein MD PUBLICATION TYPES: LETTER
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. NLM PUBMED CIT. ID: 7602510 SOURCE: J Am Podiatr Med Assoc 1995 Jun;85(6):341-2 128

NLM CIT. ID: 96023658
TITLE: A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome [see comments] AUTHORS: Tomczak RL; Haverstock BD AUTHOR AFFILIATION: College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa, USA. COMMENTS: Comment in: J Foot Ankle Surg 1996 Mar-Apr;35(2):183-4 PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The authors review the etiologies and treatments of plantar fasciitis or heel spur syndrome. They offer results of a retrospective study. Comparison of the return to work time after surgery for this condition, examinations of the effects of patient age at the time of surgery, gender, duration of pain prior to surgery, and type of surgical procedure, either endoscopic plantar fasciotomy or open plantar fasciotomy with heel spur resection, is provided. NLM PUBMED CIT. ID: 7550197 SOURCE: J Foot Ankle Surg 1995 May-Jun;34(3):305-11 129

NLM CIT. ID: 95258913
TITLE: [The radiotherapy treatment of painful calcaneal spurs] VERNACULAR
TITLE: Strahlentherapeutische Behandlung des schmerzhaften Fersenbeinsporns. AUTHORS: Schafer U; Micke O; Glashorster M; Rube C; Prott FJ Willich N AUTHOR AFFILIATION: Klinik und Poliklinik fur Strahlentherapie-Radioonkologie, Westfalische Wilhelms-Universitat Munster. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger REGISTRY NUMBERS: 0 (Cesium Radioisotopes) 0 (Cobalt Radioisotopes)
ABSTRACT: PURPOSE: Many patients attend orthopedic departments complaining of pain on the plantar aspect of the calcaneum. The symptoms may subside spontaneously, but often persist. Treatment is usually by local injection of a corticosteroid, orthopedic devices or other standard treatment. If these methods fail, X-ray treatment may be considered. The efficacy of radiotherapy of the calcaneal spur was evaluated. PATIENTS AND METHODS: From April 1981 through December 1991, 18 patients with painful heel were irradiated mostly with the caesium or telecobalt unit, usually with a dose of 4 times 0.5 Gy. Among these patients, 12 could be followed up during a prolonged period on the basis of questionnaires. RESULTS: According to the categories of v. Pannewitz 17% of the patients were pain-free by the end of the treatment course, 22% showed marked improvement, 33% showed improvement and in 28% the pain was not influenced. Over an average of 41.5 months 58% of the patients reported freedom from pain. CONCLUSIONS: Low-dose radiotherapy appears to relieve the painful heel syndrome in a high proportion of patients. The overall treatment risk appears to be very small. The mechanism of low-dose radiotherapy is unknown. NLM PUBMED CIT. ID: 7740407 SOURCE: Strahlenther Onkol 1995 Apr;171(4):202-6 130

NLM CIT. ID: 95182390
TITLE: Heel spur surgery. Another new approach. AUTHORS: Licopantis DP AUTHOR AFFILIATION: American Board of Podiatric Surgery, New City, NY. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 7877105 SOURCE: J Am Podiatr Med Assoc 1995 Feb;85(2):100-3 131

NLM CIT. ID: 95141102
TITLE: Metastatic breast carcinoma to the os calcis presenting as heel pain. AUTHORS: Freedman DM; Henderson RC AUTHOR AFFILIATION: Department of Orthopaedics, University of North Carolina, Chapel Hill. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: A 47-year-old woman who had been treated for breast carcinoma 11 years previously developed significant heel pain of unclear etiology, which ultimately proved to be metastatic adenocarcinoma. A low index of suspicion and falsely negative plain radiographs contributed to a delay in diagnosis. No other osseous metastases besides those to the foot were identifiable at the time of diagnosis. Breast carcinoma is one of the most common malignancies and frequently metastasizes to bone. Despite this, metastases to the hands or feet (acrometastases) have been identified in only a few cases. It is likely that acrometastases are more common than reported but unrecognized. NLM PUBMED CIT. ID: 7839171 SOURCE: South Med J 1995 Feb;88(2):232-4 132

NLM CIT. ID: 95167427
TITLE: Bone scintigraphy in evaluation of heel pain in Reiter's disease: compared with radiography and clinical examination. AUTHORS: Lin WY; Wang SJ; Lang JL; Hsu CY; Kao CH; Liao SQ Yeh HW AUTHOR AFFILIATION: Department of Nuclear Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE 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. NLM PUBMED CIT. ID: 7863272 SOURCE: Scand J Rheumatol 1995;24(1):18-21 133

NLM CIT. ID: 95165366
TITLE: [Magnetic resonance imaging of lesions of the superficial plantar fasciitis] VERNACULAR
TITLE: Imagerie par resonance magnetique des lesions de l'aponevrose plantaire superficielle. AUTHORS: Helie O; Dubayle P; Boyer B; Pharaboz C AUTHOR AFFILIATION: Service de Radiologie, HIA Begin, Saint-Mande. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Fre
ABSTRACT: MRI is an efficient imaging modality to establish the diagnosis of plantar fascia tear and plantar fasciitis. MRI allow to differentiate recent rupture from scar and fasciitis. NLM PUBMED CIT. ID: 7861367 SOURCE: J Radiol 1995 Jan;76(1):37-41 134

NLM CIT. ID: 95308075
TITLE: Monostotic Paget's disease involving the calcaneus. Diagnostic and therapeutic problems. Two case-reports. AUTHORS: Perrot S; Mortier E; Renoux M; Job-Deslandre C Menkes CJ AUTHOR AFFILIATION: Rheumatology Department A, Cochin Teaching Hospital, Paris, France. PUBLICATION TYPES: JOURNAL ARTICLE 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. NLM PUBMED CIT. ID: 7788323 SOURCE: Rev Rhum Engl Ed 1995 Jan;62(1):45-7 135

NLM CIT. ID: 95299444
TITLE: Endoscopic heel anatomy: analysis of 200 fresh frozen specimens. AUTHORS: Barrett SL; Day SV; Pignetti TT; Egly BR PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors radiographed and dissected 200 fresh frozen cadaveric specimens selected randomly from the general United States population. A 21% incidence of inferior calcaneal exostosis formation was identified. Of those specimens identified as having an inferior calcaneal exostosis, there was a 52.4% incidence of heel spurs that were in the plantar fascia and a 47.6% incidence of heel spurs that were identified superior to the plantar fascia. After dissection of the specimens, the mean width and thickness of the medial, central and lateral bands of the plantar fascia, and the width of the medial and lateral subcutaneous fat were calculated. The presence of an inferior calcaneal bursa was identified in one specimen, and the presence of a heel neuroma was identified in 0 specimens of the 200 examined. The results of this study will assist the practitioner in performing the endoscopic plantar fasciotomy by providing the surgeon with quantitative averages of fascial dimensions. By knowing these fascial measurements, the practitioner will be aided intraoperatively in determining what level of fasciotomy to perform. This could help obviate some of the postoperative biomechanical sequelae that can occur with total releases, and immediate postoperative excessive ambulation by the patient. This study may help to gain insight into the true etiology of heel spur syndrome/plantar fasciitis. NLM PUBMED CIT. ID: 7780393 SOURCE: J Foot Ankle Surg 1995 Jan-Feb;34(1):51-6 136

NLM CIT. ID: 95299439
TITLE: The role of endoscopy in treatment of stenosing posterior tibial tenosynovitis. AUTHORS: Wertheimer SJ; Weber CA; Loder BG; Calderone DR Frascone ST AUTHOR AFFILIATION: Department of Podiatric Surgery, St. John Hospital-Macomb Center, Harrison Township, Michigan, USA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Some foot and ankle pathologic conditions can be treated by an endoscopic approach. Its effectiveness has been reported in the treatment of plantar fasciitis. The authors have used an endoscopic approach in the treatment of posterior tibial tenosynovitis resistant to nonsurgical treatment. A review of the pathology, terminology and the diagnosis of tenosynovitis is provided. The case report demonstrates a technique using an endoscope to incise the posterior tibial tendon sheath. NLM PUBMED CIT. ID: 7780388 SOURCE: J Foot Ankle Surg 1995 Jan-Feb;34(1):15-22 137

NLM CIT. ID: 95156228
TITLE: Plantar fascial release. AUTHORS: White DL PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW LITERATURE
ABSTRACT: The author reviews the literature for the possible etiology and the conservative and surgical treatment alternatives for mechanically induced plantar heel pain. A long-term retrospective study on a plantar fascial release surgery performed on patients with recalcitrant plantar heel pain, all of whom were unresponsive to conservative therapy, is presented. NLM PUBMED CIT. ID: 7853155 SOURCE: J Am Podiatr Med Assoc 1994 Dec;84(12):607-13 138

NLM CIT. ID: 95190421
TITLE: A comparative radiologic examination for unresponsive plantar fasciitis [letter; comment] AUTHORS: Subotnick SI COMMENTS: Comment on: J Manipulative Physiol Ther 1994 Jun;17(5):329-34 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 7884337 SOURCE: J Manipulative Physiol Ther 1994 Nov-Dec;17(9):623; discussion 623-4 139

NLM CIT. ID: 95190420
TITLE: A comparative radiologic examination for unresponsive plantar fasciitis [letter; comment] AUTHORS: Brantingham J; Snyder WR COMMENTS: Comment on: J Manipulative Physiol Ther 1994 Jun;17(5):329-34 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 7884336 SOURCE: J Manipulative Physiol Ther 1994 Nov-Dec;17(9):621-2; discussion 623-4 140

NLM CIT. ID: 95162400
TITLE: Heel pain: diagnosis and management. AUTHORS: Campbell P; Lawton JO AUTHOR AFFILIATION: Department of Orthopaedic Surgery, Leeds General Infirmary. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Chronic non-traumatic heel pain is not an uncommon symptom in patients presenting to GP, orthopaedic or rheumatological clinics. A full history and examination will provide a diagnosis in most cases. Rarer causes need to be excluded in certain patients. This article outlines the differential diagnosis and discusses the more common causes. NLM PUBMED CIT. ID: 7858827 SOURCE: Br J Hosp Med 1994 Oct 19-Nov 1;52(8):380-5 141

NLM CIT. ID: 95135577
TITLE: Painful heel syndrome: results of nonoperative treatment. AUTHORS: Davis PF; Severud E; Baxter DE AUTHOR AFFILIATION: Moline Orthopedic Associates, Ltd., Illinois. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: One hundred five patients (70% female and 30% male; average age, 48 years) with 132 symptomatic heels were treated according to a standard nonoperative protocol and then reviewed at an average follow-up of 29 months. The treatment protocol consisted of nonsteroidal anti- inflammatory medications, relative rest, viscoelastic polymer heel cushions, Achilles tendon stretching exercises, and, occasionally, injections. Obesity, lifestyle (athletic versus sedentary), sex, and presence or size of heel spur did not influence the treatment outcome. Ninety-four patients (89.5%) had resolution of heel pain within 10.9 months. Six patients (5.7%) continued to have significant pain, but did not elect to have operative treatment, and five patients (4.8%) elected to have surgical intervention. Despite attention to the outcome of surgical treatment for heel pain in the current literature, initial treatment for heel pain is nonoperative. The treatment protocol used in this study was successful for 89.5% of the patients. NLM PUBMED CIT. ID: 7834059 SOURCE: Foot Ankle Int 1994 Oct;15(10):531-5 142

NLM CIT. ID: 95112224
TITLE: Nerve entrapment causing heel pain. AUTHORS: Johnston MR AUTHOR AFFILIATION: University of Texas Health Science Center at San Antonio. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Subcalcaneal heel pain is one of the most common foot ailments, yet the exact etiology is still controversial. Much attention and evidence have recently been presented implicating nerve entrapment as a causative factor for pain. Careful evaluation is needed to discern a nerve entrapment from other possible causes of heel pain. The majority of heel pain cases respond to thoughtful, conservative care; however, this care may take several weeks to months. In the few instances that surgery is necessary, the available reports show good to excellent results in most cases. NLM PUBMED CIT. ID: 7812907 SOURCE: Clin Podiatr Med Surg 1994 Oct;11(4):617-24 143

NLM CIT. ID: 95103597
TITLE: The heel in sport. AUTHORS: Baxter DE AUTHOR AFFILIATION: Department of Orthopaedics, Baylor College of Medicine, Houston, Texas. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The various causes of posterior and inferior heel pain in the athlete have been presented. Various examples of athletes who have had the various problems and discussed their outcome have been discussed. This article primarily has tried to educate the reader as to the different types of heel pain and has stressed the need for conservative care. Ninety-five percent of patients who have inferior heel pain will recover with appropriate conservative care. Therefore, surgery should be done only after conservative care has been exhausted and adequate time has passed. NLM PUBMED CIT. ID: 7805100 SOURCE: Clin Sports Med 1994 Oct;13(4):683-93 144

NLM CIT. ID: 94365090
TITLE: Plantar heel pain [letter; comment] AUTHORS: Howells RJ COMMENTS: Comment on: J Bone Joint Surg Br 1994 Jan;76(1):140-2 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 8083288 SOURCE: J Bone Joint Surg Br 1994 Sep;76(5):850 145

NLM CIT. ID: 94349686
TITLE: The relationship of pes planus and calcaneal spur to plantar heel pain [see comments] AUTHORS: Prichasuk S; Subhadrabandhu T AUTHOR AFFILIATION: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medicine, Bangkok, Thailand. COMMENTS: Comment in: Clin Orthop 1995 Oct;(319):330 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A prospective study of pes planus by using calcaneal pitch and calcaneal spur was carried out in 82 patients with plantar heel pain and in 400 normal subjects. The mean normal calcaneal pitch was 20.54 degrees. The mean calcaneal pitch in patients with plantar heel pain was 15.99 degrees, which was significantly lower than in normal subjects. The incidence of calcaneal spur in normal subjects and in patients with plantar heel pain was 15.5% percent (62 of 400) and 65.9% (54 of 82), respectively. Again, this was a highly significant difference. Excessive weight gain, aging, and gender may be important factors effecting the lowering of the pitch and the increasing of spur formation. These factors could lead to the development of plantar heel pain. NLM PUBMED CIT. ID: 8070194 SOURCE: Clin Orthop 1994 Sep;(306):192-6 146

NLM CIT. ID: 95152469
TITLE: Fluoroscopy-assisted plantar fasciotomy and calcaneal exostectomy: a retrospective study and comparison of surgical techniques. AUTHORS: Graves RH 3rd; Levin DR; Giacopelli J; White PR Russell RD AUTHOR AFFILIATION: Department of Podiatric Surgery, Fountain Valley Regional Hospital, CA. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 7849673 SOURCE: J Foot Ankle Surg 1994 Sep-Oct;33(5):475-81 147

NLM CIT. ID: 94317600
TITLE: Indoor racquet sports injuries. AUTHORS: Silko GJ; Cullen PT AUTHOR AFFILIATION: Washington Hospital, Pennsylvania. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Non-Steroidal)
ABSTRACT: 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. NLM PUBMED CIT. ID: 8042573 SOURCE: Am Fam Physician 1994 Aug;50(2):374-80, 383-4 148

NLM CIT. ID: 95042098
TITLE: Endoscopic plantar fasciotomy. AUTHORS: Barrett SL AUTHOR AFFILIATION: Endoscopic Foot Specialists, The Woodlands, Texas. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW LITERATURE
ABSTRACT: Endoscopic plantar fasciotomy (EPF) is an efficacious, minimally invasive procedure for the surgical intervention of heel spur syndrome/plantar fasciitis. Because of the minimal trauma involved with the technique, patients are able to return to full activity much quicker than with traditional "open" heel spur surgery techniques. The EPF procedure is not difficult to perform but requires extreme precision to ensure a successful result and to avoid iatrogenic complications. The author strongly encourages proper training with cadaveric specimens before using this technique with patients to ensure the highest standard of care. As with all surgical techniques, there are inherent complications; these complications are usually biomechanical in nature and can be reduced greatly by proper surgical techniques. NLM PUBMED CIT. ID: 7954212 SOURCE: Clin Podiatr Med Surg 1994 Jul;11(3):469-81 149

NLM CIT. ID: 95039673
TITLE: Plantar fascia rupture associated with corticosteroid injection. AUTHORS: Sellman JR AUTHOR AFFILIATION: University of California, School of Medicine, Los Angeles. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones)
ABSTRACT: 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. NLM PUBMED CIT. ID: 7951973 SOURCE: Foot Ankle Int 1994 Jul;15(7):376-81 150

NLM CIT. ID: 95038697
TITLE: Fatigue perturbation of the os calcis. AUTHORS: Smith SD; Young-Paden B; Smith SB; Ellis WN AUTHOR AFFILIATION: Department of Podiatric Surgery, Tustin Hospital and Medical Center, California. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: This paper represents a philosophical shift in thinking. The authors propose that heel spur syndrome is not a primary soft tissue injury (i.e., enthesiopathy with concomitant bruising of the bursae and fat pad, and eventually the formation of a traction spur by the pull of the plantar fascia), but rather a primary bone injury. A microtrabecular stress failure (fatigue perturbation) of the os calcis occurs with secondary soft tissue involvement such as enthesiopathy, periostitis, myositis, bursitis, and finally the formation of a buttress callous (bone spur) to stabilize a microcortical crack. This study describes four stages in a progressive, sequential, pattern of fatigue failure of the os calcis. Clinical symptoms for each stage, along with supporting data such as x-rays, bone scans, and MRIs will be presented, as well as a suggested treatment plan for the chronic resistant cases. NLM PUBMED CIT. ID: 7951194 SOURCE: J Foot Ankle Surg 1994 Jul-Aug;33(4):402-10 151

NLM CIT. ID: 95016315
TITLE: A comparative radiologic examination for unresponsive plantar fasciitis [see comments] AUTHORS: Kell PM COMMENTS: Comment in: J Manipulative Physiol Ther 1994 Nov-Dec;17(9):621-2; discussion 623-4 Comment in: J Manipulative Physiol Ther 1994 Nov-Dec;17(9):623; discussion 623-4 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 7930967 SOURCE: J Manipulative Physiol Ther 1994 Jun;17(5):329-34 152

NLM CIT. ID: 94362654
TITLE: Endoscopic plantar fasciotomy versus traditional heel spur surgery [letter; comment] AUTHORS: Wander DS COMMENTS: Comment on: J Foot Ankle Surg 1993 Nov-Dec;32(6):595-603 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 8081343 SOURCE: J Foot Ankle Surg 1994 May-Jun;33(3):322 153

NLM CIT. ID: 94349658
TITLE: An unexpected, benign cause of increased muscular uptake at bone scintigraphy. AUTHORS: Lafforgue P; Siles S; Daumen-Legre V; Acquaviva PC AUTHOR AFFILIATION: Service de Rhumatologie, C.H.U. la Timone, Marseille, France. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 63347-66-0 (Technetium Tc 99m Medronate)
ABSTRACT: Bone scintigraphy was performed in a healthy 30-year-old man because of post-traumatic heel pain. The scintigraphy displayed a bilateral increased uptake of 99mTc-MDP in the pectoral muscles and triceps brachii. Further extensive investigations including muscle biopsy were normal and excluded diagnoses such as polymyositis, myositis ossificans or amyloidosis. The abnormalities were in fact explained by physical exercise performed a few hours prior to the radionuclide scan. This was confirmed by the absence of these changes on a second bone scan performed 3 months later. This case shows that muscle exercise should be kept in mind as a cause of skeletal muscle uptake of bone-seeking agents, with the view to avoid unnecessary investigations. NLM PUBMED CIT. ID: 8070166 SOURCE: Clin Exp Rheumatol 1994 May-Jun;12(3):309-11 154

NLM CIT. ID: 94288699
TITLE: Heel pain. AUTHORS: Gibbon WW; Cassar-Pullicino VN AUTHOR AFFILIATION: Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 8017990 SOURCE: Ann Rheum Dis 1994 May;53(5):344-8 155

NLM CIT. ID: 94315541
TITLE: Simple bone cyst of the calcaneus. A case report and literature review. AUTHORS: Smith SB; Shane HS AUTHOR AFFILIATION: Department of Podiatric Surgery, Monrovia Community Hospital, CA 91017. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW OF REPORTED CASES
ABSTRACT: The authors presented a case report of a patient presenting with heel pain symptoms and physical findings similar to those associated with a heel spur syndrome. With a standard x-ray, the presence of a simple bone cyst was evident. Although mainly reported in tubular bones, steroid injection therapy has been successful and appears to be replacing surgical curettage and packing as the preferred choice of treatment in many cases. As more reports of the successful eradication of simple bone cysts of the calcaneus with steroid injections are reported, greater confidence for using it as a treatment choice for this particular lesion may be gained. The surgical approach in the patient presented here was chosen because of factors that the authors believe increased the likelihood of a pathologic fracture, such as size and extent of the lesion, history of progressive pain, and activity level of the patient. The larger body weight and the resulting stress of the patient more likely to present with a calcaneal cyst may also be factors to consider. NLM PUBMED CIT. ID: 8040810 SOURCE: J Am Podiatr Med Assoc 1994 Mar;84(3):127-30 156

NLM CIT. ID: 94290480
TITLE: New treatment for chronic heel pain [letter] AUTHORS: Weil LS PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 8019546 SOURCE: J Foot Ankle Surg 1994 Mar-Apr;33(2):216-9 157

NLM CIT. ID: 94290479
TITLE: Endoscopic plantar fasciotomy vs. traditional heel spur surgery [letter; comment] AUTHORS: Barrett SL; Day SV COMMENTS: Comment on: J Foot Ankle Surg 1993 Nov-Dec;32(6):595-603 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 8019545 SOURCE: J Foot Ankle Surg 1994 Mar-Apr;33(2):214-6 158

NLM CIT. ID: 95039646
TITLE: Conservative treatment of plantar heel pain: long-term follow-up. AUTHORS: Wolgin M; Cook C; Graham C; Mauldin D AUTHOR AFFILIATION: Southwest Orthopedic Institute, Dallas, Texas. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 7951946 SOURCE: Foot Ankle Int 1994 Mar;15(3):97-102 159

NLM CIT. ID: 94205354
TITLE: Poor results after resection for Haglund's heel. Analysis of 35 heels in 23 patients after 3 years. AUTHORS: Nesse E; Finsen V AUTHOR AFFILIATION: Department of Orthopedics, University Hospital, Trondheim, Norway. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: We reviewed 23 patients 3 (1-6) years after resection of the calcaneus for 35 Haglund's heels. 19 heels had been treated with a small resection and 16 with a large resection. The effect on the heel pain was independent of the size of the resection, but stiffness and ankle pain were more frequently associated with large than small resections. At follow-up persistent heel pain was found in 12 heels and additional various late complaints in 22. The overall clinical outcome was good in 20 heels, satisfactory in 10 and poor in 5 heels. NLM PUBMED CIT. ID: 8154272 SOURCE: Acta Orthop Scand 1994 Feb;65(1):107-9 160

NLM CIT. ID: 94199633
TITLE: Exercise and soft tissue injury. AUTHORS: Hart LE AUTHOR AFFILIATION: Rheumatic Disease Unit, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 8149440 SOURCE: Baillieres Clin Rheumatol 1994 Feb;8(1):137-48 161

NLM CIT. ID: 96052655
TITLE: Magnetic resonance imaging of plantar fasciitis and other causes of heel pain. AUTHORS: Kier R AUTHOR AFFILIATION: Musculoskeletal and Body MRI, Bridgeport MRI Center, Connecticut, USA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 7584243 SOURCE: Magn Reson Imaging Clin N Am 1994 Feb;2(1):97-107 162

NLM CIT. ID: 94132104
TITLE: The heel pad in plantar heel pain [see comments] AUTHORS: Prichasuk S AUTHOR AFFILIATION: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand. COMMENTS: Comment in: J Bone Joint Surg Br 1994 Sep;76(5):850 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A study of heel-pad thickness and compressibility using lateral radiographs, loaded and unloaded by body-weight, was carried out on 70 patients with plantar heel pain and 200 normal subjects. The heel-pad thickness and the compressibility index (resistance to compression) were greater in the patients than in normal subjects and significantly increased with age. In normal subjects, the thickness was greater in males than in females, but there was no significant difference in the compressibility. Increased weight led to an increase in heel-pad thickness and compressibility index. The body mass index was greater in patients with plantar heel pain than in normal subjects and 40% of the patients were considered to be overweight. Increase in the compressibility index indicates loss of elasticity and an increased tendency to develop plantar heel pain. NLM PUBMED CIT. ID: 8300659 SOURCE: J Bone Joint Surg Br 1994 Jan;76(1):140-2 163

NLM CIT. ID: 94119546
TITLE: Subcalcaneal heel pain. AUTHORS: Karr SD AUTHOR AFFILIATION: Orthopaedics Northeast Foot and Ankle Center, Fort Wayne, Indiana. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, MULTICASE
ABSTRACT: Subcalcaneal heel pain is a very common presenting complaint. Careful evaluation is necessary to guide treatment decisions. By far, most subcalcaneal heel pain resolves with appropriate conservative treatment over a period of weeks to months. Occasionally, when surgery is necessary, the goal of the procedure is adequate decompression in the area of the origin of the plantar fascia and medial calcaneal tubercle. NLM PUBMED CIT. ID: 8290225 SOURCE: Orthop Clin North Am 1994 Jan;25(1):161-75 164

NLM CIT. ID: 94214405
TITLE: A surgical approach to a vascular malformation in the plantar medial foot. AUTHORS: Bernard EB; Cicchinelli LD; Poindexter JM Jr AUTHOR AFFILIATION: Department of Podiatric Surgery, Northlake Regional Medical Center, Tucker, Georgia. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Vascular malformations are infrequent findings in the foot, especially the plantar medial foot. Deeper vascular malformations may be more difficult to diagnose due to the depth and oblique course of the medial neurovascular structures into plantar aspect of the foot. The authors present an interesting case report of a vascular anomaly mimicking a heel spur syndrome and describe a surgical approach for the resection of this type of lesion with a 10-month follow-up. NLM PUBMED CIT. ID: 8161991 SOURCE: J Foot Ankle Surg 1994 Jan-Feb;33(1):37-42 165

NLM CIT. ID: 94157033
TITLE: Unicameral bone cyst of the calcaneus in children. AUTHORS: Moreau G; Letts M AUTHOR AFFILIATION: Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW OF REPORTED CASES
ABSTRACT: The calcaneus is an uncommon site for a unicameral bone cyst. However, because of the concentration of forces through the heel, such cysts are usually symptomatic and require treatment. Because of the lack of attention paid to calcaneal unicameral bone cysts, as well as the controversy concerning their appropriate treatment and ultimate outcome, a retrospective study of our experience was undertaken. Over a 15-year period, we treated six children with calcaneal unicameral bone cysts. The diagnosis was confirmed pathologically at the time of treatment for all six. The most common presenting complaint was heel pain upon weight-bearing, secondary to microfracturing of the cyst. Although conservative treatment, which entailed casting and sponge fillers in the shoes, was attempted for most patients, none responded to this form of management. One child had three separate injections of methylprednisolone acetate without any radiographic or clinical change in the cyst, which ultimately required curettage and bone grafting. Bone grafting with either autogenous or allograft bone was successful in eradicating the cyst in all six patients, with no symptoms of recurrence at an average follow-up of 4 years. No resultant treatment complications were encountered. Unicameral bone cysts of the calcaneus, when symptomatic, respond well to curettage and bone grafting, and this type of treatment is recommended. NLM PUBMED CIT. ID: 8113358 SOURCE: J Pediatr Orthop 1994 Jan-Feb;14(1):101-4 166

NLM CIT. ID: 94177167
TITLE: Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study [see comments] AUTHORS: Kinley S; Frascone S; Calderone D; Wertheimer SJ Squire MA; Wiseman FA AUTHOR AFFILIATION: Department of Podiatric Surgery, St. John Hospital-Macomb Center, Mount Clemens, Michigan. COMMENTS: Comment in: J Foot Ankle Surg 1994 Mar-Apr;33(2):214-6 Comment in: J Foot Ankle Surg 1994 May-Jun;33(3):322 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A comparative study of endoscopic plantar fasciotomy versus traditional type heel spur surgery has been performed involving 76 patients and 92 procedures. Sixty-six of those procedures consisted of endoscopic fasciotomy, whereas 26 involved traditional type surgery. Those patients in which the endoscopic fasciotomy was performed had significantly less postoperative pain, returned to regular activities 4 weeks earlier, and had fewer complications postoperatively than those patients involving traditional heel spur surgery. An overview of the surgical technique involving endoscopic fasciotomies is presented, as well as factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity. NLM PUBMED CIT. ID: 8130790 SOURCE: J Foot Ankle Surg 1993 Nov-Dec;32(6):595-603 167

NLM CIT. ID: 94077778
TITLE: Plantar fasciitis. AUTHORS: DeMaio M; Paine R; Mangine RE; Drez D Jr AUTHOR AFFILIATION: US Navy, Oakland, Calif. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL REGISTRY NUMBERS: 0 (Anti-Inflammatory Agents, Non-Steroidal) NLM PUBMED CIT. ID: 8255812 SOURCE: Orthopedics 1993 Oct;16(10):1153-63 168

NLM CIT. ID: 94074956
TITLE: Ultrasound diagnosis of plantar fasciitis. AUTHORS: Wall JR; Harkness MA; Crawford A AUTHOR AFFILIATION: Centre for Medical and Health Physics, Queensland University of Technology, Brisbane, Australia. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 8253440 SOURCE: Foot Ankle 1993 Oct;14(8):465-70 169

NLM CIT. ID: 94122613
TITLE: Multiple schwannomas of the foot: report of a case. AUTHORS: Ko JY; Wang JW; Wan YL; Chen WJ AUTHOR AFFILIATION: Department of Orthopedic Surgery, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 7904871 SOURCE: J Formos Med Assoc 1993 Sep;92(9):845-7 170

NLM CIT. ID: 93373200
TITLE: Computer-generated orthoses. A review. AUTHORS: Grumbine N PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: It is obvious with the various casting techniques used in the study that the ease with which individuals adjust to the fashionette orthotic makes it a desirable device. It is tolerated well with higher-heeled shoes and shoes that are used more for fashion purposes. Future studies need to assess the degree of control compared with the type of deformity and the type of symptoms the patient has. These types of devices may be sufficient to minimize stress on a given deformity, such as a neuroma, but may not be sufficient enough to eliminate the need for the removal of the neuroma. Recurrence of the neuroma after it has been resected and the patient prescribed a fashionette orthosis also needs to be assessed. A neuroma is one example of a type of deformity that needs to be controlled and evaluated with regard to cause and response to orthotic therapy. Abnormal tylomas and pressure lesions need to be assessed on a symptomatic basis for their control with the different types of devices and the pathomechanic causing the pressure. This study indicates that milled orthoses are tolerated better than pressed orthoses. Milled orthoses require less adjustment and the adjustment is tolerated better, regardless of the casting position. The degree of position control had some variations. When comparing the pressed and the milled functional orthoses, there is a more rapid adjustment with the milled type of orthoses. This suggests that possibly the milled orthoses have less alteration in shape and loss of contour from the direct milling and the digitizing process compared with the pressing techniques. The long-term effect of pressing compared with milled orthotics was not assessed during this study with regard to fluid distortion of the polypropylene over time. The fluid nature has a tendency to suffer a loss of contour and progressive loss of function. The milled process theoretically has less change in the contour with the passage of time, although this needs to be assessed in further studies. Possibly, the fluid nature of the orthosis can be assessed by determining how soon the symptoms return between adjustments. Posting surfaces tend to wear over a period of time and distort with the fluid nature. The posting can break down from the type of material from which it is made. A model of assessment for future studies may be to check the duration of when heel spur types of symptoms or postural complex types of symptoms, such as knee pain or lower back pain, recur.(ABSTRACT TRUNCATED AT 400 WORDS) NLM PUBMED CIT. ID: 8364842 SOURCE: Clin Podiatr Med Surg 1993 Jul;10(3):377-91 171

NLM CIT. ID: 93355611
TITLE: Palmar digital neurectomy in horses. 57 cases (1984-1990). AUTHORS: Jackman BR; Baxter GM; Doran RE; Allen D; Parks AH AUTHOR AFFILIATION: Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The medical records of 57 horses that had palmar digital neurectomy performed between 1984 and 1990 were reviewed. Neurectomies were performed either by transection and electrocoagulation (47 horses) or by the guillotine technique (10 horses). Middle-aged geldings, Quarter Horses, and Thoroughbreds were significantly over-represented when compared with the hospital population. Horses used as hunter/jumpers also appeared to be over-represented. Complications occurred in 17 (34%) of the 50 horses for which follow-up information was obtained. Recurrence of heel pain was the most common complication (14 horses). Palpable painful neuromas were detected in three horses. One year after neurectomy, 74% of the horses were sound; this decreased to 63% after 2 years. NLM PUBMED CIT. ID: 8351810 SOURCE: Vet Surg 1993 Jul-Aug;22(4):285-8 172

NLM CIT. ID: 93368742
TITLE: A review of lower limb overuse injuries during basic military training. Part 1: Types of overuse injuries. AUTHORS: Ross J AUTHOR AFFILIATION: Royal Australian Air Force, Base Medical Flight, RAAF Edinburgh. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 8361601 SOURCE: Mil Med 1993 Jun;158(6):410-5 173

NLM CIT. ID: 93294736
TITLE: Transverse plantar incision for heel spur surgery. Four-year follow-up survey of 35 patients. AUTHORS: Self TC; Kunz RE; Young G AUTHOR AFFILIATION: Doxey-Hatch Medical Center/Veterans Affairs Medical Center, Salt Lake City, UT 84148. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A transverse plantar incisional approach was used on 35 patients who underwent heel spur surgery from 1982 through 1990. Ten bilateral procedures were performed on a total of 45 feet. A medial approach was used for five of the bilateral surgeries. The average age of the patient was 47 years, and the average follow-up period was 49 months. Of the 34 plantar approach cases in which complete data were obtained, 94% showed either good or excellent results. The authors illustrate a technique using a transverse plantar incision as an alternative to the medial approach for heel spur surgery. NLM PUBMED CIT. ID: 8515372 SOURCE: J Am Podiatr Med Assoc 1993 May;83(5):259-62 174

NLM CIT. ID: 93338420
TITLE: Endoscopic plantar fasciotomy: two portal endoscopic surgical techniques--clinical results of 65 procedures. AUTHORS: Barrett SL; Day SV AUTHOR AFFILIATION: Specialized Foot Centre, Spring, Texas. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors have developed two endoscopic techniques that, in their opinion, are minimally traumatic and achieve superior clinical results when compared with traditional types of heel spur surgery. From the original development of the one-portal system for endoscopic plantar fasciotomy, a two-portal system has been developed (patent pending) that provides significant advantages over the one-portal system. Postoperative morbidity was decreased with both endoscopic techniques when compared with traditional types of open heel spur surgery. Both groups of patients returned to normal activity sooner than would patients who have had their heel spur syndrome/plantar fasciitis treated with open, traditional surgery. NLM PUBMED CIT. ID: 8339077 SOURCE: J Foot Ankle Surg 1993 May-Jun;32(3):248-56 175

NLM CIT. ID: 94221039
TITLE: [Involvement of the foot in reactive arthritis. A retrospective study of 105 cases] VERNACULAR
TITLE: L'atteinte du pied dans les arthrites reactionnelles. Etude retrospective de 105 cas. AUTHORS: Calmels C; Eulry F; Lechevalier D; Dubost JJ Ristori JM; Sauvezie B; Bussiere JL AUTHOR AFFILIATION: Service de Rhumatologie, Hopital G. Montpied, CHRU, Clermont-Ferrand. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Fre
ABSTRACT: The foot is among the sites most often affected in spondyloarthropathies, whose diagnostic criteria include heel pain and sausage-like swelling of the toes. Few studies have systematically analyzed foot manifestations in reactive arthritides. We retrospectively reviewed 143 patients fulfilling Amor's criteria. One hundred five patients (73%) exhibited inflammatory involvement of one (n = 47) or both feet. In 8 cases no other articular sites were affected. Heel pain was reported by 36% of patients (52/143), within the first six months in half the cases. Both heels were painful in 26 patients. Heel pain was plantar in 36 cases, posterior in 7 cases, and bipolar in 4 cases. Roentgenographic calcaneal changes were found in 54 cases overall but in only 31 of the patients with heel pain. Sixteen patients had asymptomatic calcaneitis. Seventeen patients had involvement of the transverse tarsal joint, usually with no other affected joints. Involvement of the subtalar joint was rare (6 cases). Metatarsophalangeal manifestations were found in 44% of patients (64/143) and were symmetrical in 17 cases; 17 patients had changes of the great toe suggestive of gout. Interphalangeal arthritis was seen in 22% (32/143) of cases; in half these cases the first two rays were affected and sausage-like digital swelling was seen in 28 patients (20%). Permanent roentgenological damage was uncommon. NLM PUBMED CIT. ID: 8167638 SOURCE: Rev Rhum Ed Fr 1993 May;60(5):324-9 176

NLM CIT. ID: 93310380
TITLE: A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. AUTHORS: Chandler TJ; Kibler WB AUTHOR AFFILIATION: Lexington Clinic, Sports Medicine Center, Kentucky. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 8100639 SOURCE: Sports Med 1993 May;15(5):344-52 177

NLM CIT. ID: 93223594
TITLE: [Analgetic irradiation of degenerative-inflammatory skeletal diseases. Benefits and risks] VERNACULAR
TITLE: Analgetische Bestrahlung degenerativentzundlicher Skeletterkrankungen. Nutzen und Risiko. AUTHORS: Sautter-Bihl ML; Liebermeister E; Scheurig H Heinze HG AUTHOR AFFILIATION: Klinik fur Strahlentherapie und Nuklearmedizin, Stadtisches Klinikum Karlsruhe. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: Between 1980 and 1991, ionizing radiation was applied for analgesic purposes to 181 patients (97 men, 84 women, mean age 54 [29-81] years) with degenerative-inflammatory skeletal disease. The long-term effects were evaluated by questionnaire. Radiation of 2.5 to 6.0 Gy achieved lasting pain relief in 21 of 30 patients (70%) with arthritis of the shoulder or humeroscapular periarthritis, 15 of 21 (71%) with arthritis of the hip, in 12 of 15 (80%) with heel spurs or Achilles tendon bursitis and 10 of 11 (91%) with epicondylitis. Pain relief lasted for longer than two years in 41 of the 77 patients (53%). There were no side effects at the stated dosage. According to dose measurements the theoretical risk of malignant tumour induction is 20-40/million radiated patients and thus four orders of magnitude below the spontaneous malignant tumour incidence rate. The genetic risk is even lower. Ionizing radiation of degenerative-inflammatory diseases is thus an effective form of treatment with few side effects. NLM PUBMED CIT. ID: 8467752 SOURCE: Dtsch Med Wochenschr 1993 Apr 8;118(14):493-8 178

NLM CIT. ID: 93259532
TITLE: Heel pain syndrome: electrodiagnostic support for nerve entrapment. AUTHORS: Schon LC; Glennon TP; Baxter DE AUTHOR AFFILIATION: Foot and Ankle Center, Union Memorial Hospital, Baltimore, Maryland 21218. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A local entrapment neuropathy has been proposed as one of the etiologies of heel pain, but it has never been documented by electrodiagnostic studies. Primary symptoms in patients suspected of having a neurologic basis for their heel pain include neuritic medial heel pain and radiation either proximally or distally. On physical examination, all patients in our series had reproduction of their symptomatology with palpation over the proximal aspect of the abductor hallucis and/or the origin of the plantar fascia from the medial tubercle of the calcaneus. Twenty-seven patients (20 women and seven men; average age 49) with these clinical characteristics were examined by electromyography and motor/sensory/mixed nerve conduction studies. Bilateral heel signs and symptoms were present in 11 patients. Ten of the patients had a significant history of back pain with referral to the legs. In 23 of the 38 symptomatic heels, abnormalities were identified in the lateral and/or the medial plantar nerves. The number of abnormal values per heel ranged from one to four, with a mean of 2.1. The most common finding was involvement of the medial nerve (57%). Thirty percent of the heels had isolated findings in the lateral plantar nerve and 13% had abnormalities in both plantar nerves. Two patients had electrophysiologic evidence of active S1 radiculopathy, with ipsilateral evidence of plantar nerve entrapment suggesting a "double crush" syndrome. The results of this study support the presence of abnormalities of plantar nerve function in a selected group of patients with neuritic heel pain. NLM PUBMED CIT. ID: 8491426 SOURCE: Foot Ankle 1993 Mar-Apr;14(3):129-35 179

NLM CIT. ID: 94045328
TITLE: Clinical comparison of patients with ankylosing spondylitis, Reiter's syndrome and psoriatic arthritis. AUTHORS: Deesomchok U; Tumrasvin T AUTHOR AFFILIATION: Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 8228701 SOURCE: J Med Assoc Thai 1993 Feb;76(2):61-70 180

NLM CIT. ID: 93137178
TITLE: Aggressive osteoblastoma of the calcaneus. AUTHORS: Miyayama H; Sakamoto K; Ide M; Ise K; Hirota K Yasunaga T; Ishihara A AUTHOR AFFILIATION: Division of Clinical Pathology, Kumamoto Municipal Hospital, Japan. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW OF REPORTED CASES
ABSTRACT: Aggressive osteoblastoma of the left calcaneus in 29-year-old Japanese woman is reported. Her initial symptom was heel pain while walking. This was a primary calcaneal tumor, initially diagnosed as a benign osteoblastoma. After a 5-year follow-up (from the initial curettage), there was local recurrence. The histologic findings of aggressive osteoblastoma were confirmed after right lower leg amputation. The recurrent tumor was mildly aggressive to the talocalcanean joint and the retrocalcaneal area, without distant metastasis. The characteristics of the primary and recurrent tumors were examined by the radiologic, histologic, and electron microscopic procedures. Although there are questions about aggressive osteoblastoma, the authors believe that there are osteoblastic tumors of borderline malignancy between benign osteoblastoma and low-grade osteosarcoma. The current case was an example compatible with an aggressive osteoblastoma with the proposed name of Dorfman classification Group 4. NLM PUBMED CIT. ID: 8422627 SOURCE: Cancer 1993 Jan 15;71(2):346-53 181

NLM CIT. ID: 93161217
TITLE: Heel pain in the older patient. AUTHORS: Black JR; Bernard JM; Williams LA AUTHOR AFFILIATION: J. A. Haley Veterans Hospital, Tampa, Florida. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Older Americans are the fastest growing segment of the US population. For this group, mobility is a significant factor in individual well- being. Heel pain is primarily a symptom found in adults, and like most health problems, increased age has a compounding effect on most disease processes. If heel pain becomes the cause of immobility in an older patient, significant consequences may arise. The true prevalence of heel pain in older individuals is not known precisely. The frequency may lie between 12.5% and 15% on the basis of reports in the literature. The scientific basis of these figures, however, is open to question. No one method of organizing heel pain according to a causative agent or condition is accepted universally. A review of the literature, however, reveals that most reporters ultimately include the same elements in whatever schema they use. In general terms, management of heel pain, regardless of the cause, can be organized according to noninvasive to invasive treatment methods. The authors have found the categories of mechanical, pharmacologic, and surgical to be useful. Selection of a therapeutic method is based on the patient's specific physical circumstance and social situation. NLM PUBMED CIT. ID: 8431831 SOURCE: Clin Podiatr Med Surg 1993 Jan;10(1):113-9 182

NLM CIT. ID: 93124390
TITLE: Heel spur surgery. A transverse plantar approach. AUTHORS: Boike AM; Snyder AJ; Roberto PD; Tabbert WG AUTHOR AFFILIATION: Department of Podiatric Surgery, Ohio College of Podiatric Medicine, Cleveland. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 8419629 SOURCE: J Am Podiatr Med Assoc 1993 Jan;83(1):39-42 183

NLM CIT. ID: 93122687
TITLE: Calcaneal fracture after cortical bone removal. AUTHORS: Manoli A 2d; Harper MC; Fitzgibbons TC; McKernan DJ AUTHOR AFFILIATION: Wayne State University, Hutzel Hospital, Detroit, Michigan 48201. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Four patients developed calcaneal fractures while walking, soon after bone removal from the undersurface of the calcaneus. Heel spur or osteomyelitic bone removal can lead to this complication. NLM PUBMED CIT. ID: 1478582 SOURCE: Foot Ankle 1992 Nov-Dec;13(9):523-5 184

NLM CIT. ID: 92324695
TITLE: Investigations into the fat pads of the sole of the foot: heel pressure studies. AUTHORS: Jahss MH; Kummer F; Michelson JD AUTHOR AFFILIATION: Foot Service, Hospital for Joint Diseases-Orthopaedic Institute, New York, New York. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The fat pads of the heel have a structure that is optimized for load bearing. In various diseases and aging, the load-carrying ability of the heel pad is clinically impaired. The loading pattern was examined in subjects having normal heel pads and those with atrophic heel pads, both with and without clinical symptoms. Normal heel pads showed a broad region of high pressure, which accounted for a high percentage of the total load transmission. In contrast, the atrophic heels showed a high but narrow peak pressure. However, most of the load was transmitted over a large area of low pressure. There was no difference between symptomatic and asymptomatic heels. The mechanical behavior of the fat pad is discussed with particular reference to the anatomic structure of the pads. Pad thickness and septal integrity are both important to the mechanical characteristics of the fat pad. The load- bearing patterns observed are discussed in terms of the mechanical components influencing fat pad resilience. These results have direct relevance to understanding the pathophysiology of heel pain secondary to degeneration of the fat pad. NLM PUBMED CIT. ID: 1624185 SOURCE: Foot Ankle 1992 Jun;13(5):227-32 185

NLM CIT. ID: 92322443
TITLE: Magnetic resonance imaging of the foot and ankle. AUTHORS: Kneeland JB; Dalinka MK AUTHOR AFFILIATION: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 1622776 SOURCE: Magn Reson Q 1992 Jun;8(2):97-115 186

NLM CIT. ID: 92289106
TITLE: Treatment of chronic heel pain by surgical release of the first branch of the lateral plantar nerve. AUTHORS: Baxter DE; Pfeffer GB AUTHOR AFFILIATION: Baylor College of Medicine, Department of Orthopaedics, Houston, Texas. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Sixty-nine heels (53 patients) with chronic heel pain had a surgical release of the first branch of the lateral plantar nerve. The average duration of heel-pain symptoms was 23 months (range, six months to eight years). No patient had less than six months of conservative treatment before surgery. The average duration of preoperative conservative treatment was 14 months. Forty-four patients (83%) had taken nonsteroidal antiinflammatory agents. Sixty-three heels (91%) had used heel cups and/or orthoses. Fifty-nine heels (86%) had received one or more injections of a steroid preparation. Thirty-four heels had developed pain initially during a sports activity. Postoperatively, 61 heels (89%) had excellent or good results; 57 heels (83%) had complete resolution of pain. The average follow-up period was 49 months. In general, heel pain resolves with conservative treatment. In recalcitrant cases, however, entrapment of the first branch lateral plantar nerve should be suspected. Surgical release of this nerve can be expected to provide excellent relief of pain and facilitate return to normal activity. NLM PUBMED CIT. ID: 1600660 SOURCE: Clin Orthop 1992 Jun;(279):229-36 187

NLM CIT. ID: 93139684
TITLE: Operative treatment of plantar fasciitis. AUTHORS: Kulthanan T AUTHOR AFFILIATION: Department of Orthopaedics Surgery and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 1487681 SOURCE: J Med Assoc Thai 1992 Jun;75(6):337-40 188

NLM CIT. ID: 92339957
TITLE: Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. AUTHORS: Daly PJ; Kitaoka HB; Chao EY AUTHOR AFFILIATION: Mayo Graduate School of Medicine, Rochester, Minnesota 55905. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 1634150 SOURCE: Foot Ankle 1992 May;13(4):188-95 189

NLM CIT. ID: 92288083
TITLE: Successful treatment of Paecilomyces varioti infection in a patient with chronic granulomatous disease and a review of Paecilomyces species infections [see comments] AUTHORS: Williamson PR; Kwon-Chung KJ; Gallin JI AUTHOR AFFILIATION: Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892. COMMENTS: Comment in: Clin Infect Dis 1992 Sep;15(3):552-3 PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW OF REPORTED CASES REGISTRY NUMBERS: 0 (Antifungal Agents) 1397-89-3 (Amphotericin B) 65277-42-1 (Ketoconazole) 82115-62-6 (Interferon Type II) 84625-61-6 (Itraconazole)
ABSTRACT: An 8-year-old boy who had chronic granulomatous disease developed a soft tissue infection of the right heel after riding on a motor scooter. Infection was insidious, and minor heel pain and fevers occurred only on the day interferon-gamma was injected. Soft tissue biopsy showed hyphal elements, and Paecilomyces varioti grew in culture. The infection was treated with amphotericin B for 7 weeks (total dose, 40 mg/kg) followed by 1 year of therapy with itraconazole (100 mg twice daily). Complete cure was achieved during the follow-up period of 10 months. NLM PUBMED CIT. ID: 1318085 SOURCE: Clin Infect Dis 1992 May;14(5):1023-6 190

NLM CIT. ID: 92256123
TITLE: Foot and ankle pain resulting from rheumatic conditions. AUTHORS: Jahss MH AUTHOR AFFILIATION: Mt. Sinai School of Medicine, New York, New York. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Pain in the foot and ankle is most frequently secondary to static and degenerative changes, eg, corns, hammer toes, bunions, anterior metatarsalgia, and heel pain. A second common group consists of rheumatologic disorders that encompass immune and hereditary factors. This group includes rheumatoid arthritis, the often underdiagnosed seronegative spondyloarthropathies, and, less commonly, crystalline deposit disorders and diffuse connective tissue diseases. Both the physician and the public need a heightened awareness of the existence and presence of these disorders, which may be devastating, eg, psoriatic arthritis and tenosynovitis. To these groups, we now must add Lyme disease and acquired immunodeficiency syndrome. The advances in testing, including immunologic and nuclear imaging (eg, magnetic resonance imaging), have permitted more rapid and specific diagnosis with earlier treatment. NLM PUBMED CIT. ID: 1581152 SOURCE: Curr Opin Rheumatol 1992 Apr;4(2):233-40 191

NLM CIT. ID: 92355901
TITLE: Myositis ossificans: pedal manifestations. AUTHORS: Kaminsky SL; Corcoran D; Chubb WF; Pulla RJ AUTHOR AFFILIATION: Loyola University Medical Center, Maywood, Illinois. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Myositis ossificans traumatica is a benign muscular lesion that is frequently reported in the orthopedic literature, but is not commonly found in the foot. This case report discusses myositis ossificans occurring in the foot. It is most likely subsequent to a heel spur injection received by the patient. NLM PUBMED CIT. ID: 1645005 SOURCE: J Foot Surg 1992 Mar-Apr;31(2):173-81 192

NLM CIT. ID: 92355899
TITLE: Retrospective analysis of calcaneal spur removal and complete fascial release for the treatment of chronic heel pain. AUTHORS: Gormley J; Kuwada GT PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Doctors Gormley and Kuwada investigate the pathology of chronic heel pain secondary to soft tissue and osseous inflammatory conditions. Pertinent literature review regarding success following fascial release as well as bone spur removal is provided. Ninety-four patients are reported having sustained spur removal with fascia resection according to the authors' technique. They report a 95% success rate postoperatively. NLM PUBMED CIT. ID: 1645003 SOURCE: J Foot Surg 1992 Mar-Apr;31(2):166-9 193

NLM CIT. ID: 92221194
TITLE: Tarsal tunnel syndrome in runners. AUTHORS: Jackson DL; Haglund BL AUTHOR AFFILIATION: Department of Rehabilitation and Sports Medicine, University of Kentucky, Lexington. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 1561508 SOURCE: Sports Med 1992 Feb;13(2):146-9 194

NLM CIT. ID: 92080721
TITLE: Plantar fasciitis: US imaging [letter; comment] AUTHORS: Gibbon WW COMMENTS: Comment on: Radiology 1991 Jun;179(3):665-7 PUBLICATION TYPES: COMMENT LETTER NLM PUBMED CIT. ID: 1727300 SOURCE: Radiology 1992 Jan;182(1):285 195

NLM CIT. ID: 92228569
TITLE: Plantar fasciitis [letter] AUTHORS: Boyd HS PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 1565508 SOURCE: Orthop Rev 1992 Jan;21(1):116 196

NLM CIT. ID: 92211676
TITLE: Arthritis in patients with psoriasis treated with gamma-interferon. AUTHORS: O'Connell PG; Gerber LH; Digiovanna JJ; Peck GL AUTHOR AFFILIATION: Department of Rehabilitation Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 82115-62-6 (Interferon Type II)
ABSTRACT: 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. NLM PUBMED CIT. ID: 1556705 SOURCE: J Rheumatol 1992 Jan;19(1):80-2 197

NLM CIT. ID: 92291788
TITLE: Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. AUTHORS: Buckley RE; Meek RN AUTHOR AFFILIATION: Department of Orthopaedics, University of British Columbia, Vancouver, Canada. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Seventeen displaced intraarticular calcaneal fractures treated operatively were matched with 17 nonoperatively treated displaced intraarticular calcaneal fractures among Workers' Compensation Board patients. Matching criteria included type of fracture, age, year of injury, and occupation. After follow-up averaging 6.3 years and 5.4 years, respectively, no significant differences existed between the two groups in heel pain, subtalar motion, and return to work. However, in those fractures treated operatively, the overall clinical result was better when an anatomic reduction of the subtalar joint was achieved. NLM PUBMED CIT. ID: 1534837 SOURCE: J Orthop Trauma 1992;6(2):216-22 198

NLM CIT. ID: 92165271
TITLE: The use of night splints for treatment of recalcitrant plantar fasciitis. AUTHORS: Wapner KL; Sharkey PF AUTHOR AFFILIATION: Division of Foot and Ankle Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 1791004 SOURCE: Foot Ankle 1991 Dec;12(3):135-7 199

NLM CIT. ID: 92121619
TITLE: Endoscopic plantar fasciotomy for chronic plantar fasciitis/heel spur syndrome: surgical technique--early clinical results. AUTHORS: Barrett SL; Day SV PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 1770208 SOURCE: J Foot Surg 1991 Nov-Dec;30(6):568-70 200

NLM CIT. ID: 92066977
TITLE: [Symptoms in area of the Achilles tendon. Etiology and therapeutic considerations] VERNACULAR
TITLE: Beschwerden im Achillessehnenbereich. Atiologien und therapeutische Uberlegungen. AUTHORS: Biedert R AUTHOR AFFILIATION: Abteilung Sporttraumatologie, Eidgenossischen Sportschule Magglingen. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: A number of pathologic conditions can produce posterior heel pain, making it difficult to distinguish the exact cause. Only a careful physical examination allows the probable diagnosis, which is the first and most important step in a successful therapy. Pathologically, the Achilles tendon itself may be inflamed secondary to degeneration owing to a decreased blood supply or the result of a partial rupture. The inflammation can also be accompanied by microtears or calcium deposits. In most cases the tendon sheath and the mesotenon are also involved (tenosynovitis). The retrocalcaneal bursa located between the posterior angle of the os calcis and the Achilles tendon may become inflamed and hypertrophic. It is frequently associated with a prominent superior tuberosity of the os calcis. In a few cases there was also an irritation of the bursa between the Achilles tendon and the skin caused by ill-fitting shoes. Over a 3-year period, 102 patients who engaged in different sports were treated for problems in the Achilles tendon area and retrospectively reviewed with a follow up of 18.8 months. Most of them were runners (48%), followed by soccer players (15.7%) and tennis players (5.9%). The mean age was 36 years. In the vast majority of patients (n = 70, 68.6%) nonoperative treatment was successful. In this group there were 45 cases (65%) with postural abnormalities and excessive pronation requiring correction by means of orthotic appliances. In 19 patients (27%) the problems were caused by a muscular imbalance, and in 15 cases (21%) wrong training methods with overuse had caused the inflammation.(ABSTRACT TRUNCATED AT 250 WORDS) NLM PUBMED CIT. ID: 1957182 SOURCE: Unfallchirurg 1991 Oct;94(10):531-7 201

NLM CIT. ID: 92029092
TITLE: The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy [see comments] AUTHORS: Dougados M; van der Linden S; Juhlin R; Huitfeldt B Amor B; Calin A; Cats A; Dijkmans B; Olivieri I; Pasero G et al AUTHOR AFFILIATION: Rene Descartes University, Hopital Cochin, Paris, France. COMMENTS: Comment in: Arthritis Rheum 1991 Oct;34(10):1218-30 PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE MULTICENTER STUDY
ABSTRACT: Classification criteria for most of the disorders belonging to the spondylarthropathy group already exist. However, the spectrum of spondylarthropathy is wider than the sum of these disorders suggests. Seronegative oligoarthritis, dactylitis or polyarthritis of the lower extremities, heel pain due to enthesitis, and other undifferentiated cases of spondylarthropathy have been ignored in epidemiologic studies because of the inadequacy of existing criteria. In order to define classification criteria that also encompass patients with undifferentiated spondylarthropathy, we studied 403 patients with all forms of spondylarthropathy and 674 control patients with other rheumatic diseases. The diagnoses were based on the local clinical expert's opinion. The 403 patients included 168 with ankylosing spondylitis, 68 with psoriatic arthritis, 41 with reactive arthritis, 17 with inflammatory bowel disease and arthritis, and 109 with unclassified spondylarthropathy. Based on statistical analysis and clinical reasoning, we propose the following classification criteria for spondylarthropathy: inflammatory spinal pain or synovitis (asymmetric or predominantly in the lower limbs), together with at least 1 of the following: positive family history, psoriasis, inflammatory bowel disease, urethritis, or acute diarrhea, alternating buttock pain, enthesopathy, or sacroiliitis as determined from radiography of the pelvic region. These criteria resulted in a sensitivity of 87% and a specificity of 87%. The proposed classification criteria are easy to apply in clinical practice and performed well in all 7 participating centers. However, we regard them as preliminary until they have been further evaluated in other settings. NLM PUBMED CIT. ID: 1930310 SOURCE: Arthritis Rheum 1991 Oct;34(10):1218-27 202

NLM CIT. ID: 92031300
TITLE: Hematogenous calcaneal osteomyelitis in children. AUTHORS: Winiker H; Scharli AF AUTHOR AFFILIATION: Department of Pediatric Surgery, Childrens' Hospital of Lucerne. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Antibiotics)
ABSTRACT: Heel pain is a frequent complaint in children due to intensive school and leisure-time sports. Heel pain accompanied by inflammatory signs has to be considered as osteomyelitis until the opposite is proven. From 1980 to 1989, twenty children were treated for acute or subacute osteomyelitis of the calcaneus (OMC) at the Department of Pediatric Surgery of the Children's Hospital of Lucerne. The schema of investigation comprising laboratory work-up, x-rays, scintiscanning and aspiration of the focus makes quick and accurate diagnosis possible. Exogenous osteitis of the newborn and calcaneal apophysitis in children must be differentiated; this is a prime consideration. Treatment includes surgical interventions (curettage, drainage) and long-term antibiotics. The course of the disease can be shortened, complications become avoidable and the rate of recurrence is diminished. NLM PUBMED CIT. ID: 1931840 SOURCE: Eur J Pediatr Surg 1991 Aug;1(4):216-20 203

NLM CIT. ID: 92014783
TITLE: TL-61 versus Rohadur orthoses in heel spur syndrome. AUTHORS: Ferguson H; Raskowsky M; Blake RL; Denton JA AUTHOR AFFILIATION: Center for Sports Medicine, Saint Francis Memorial Hospital, San Francisco, CA 94109. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors present the subjective responses of 40 patients with heel spur syndrome or plantar fascitis to orthotic treatment. Twenty patients had Rohadur orthoses and 20 patients had TL-61 orthoses. These data show no difference in the response to or problems created by either TL-61 or Rohadur orthoses. The authors recommend TL-61 as one alternative to Rohadur, now that that latter is unavailable. NLM PUBMED CIT. ID: 1920106 SOURCE: J Am Podiatr Med Assoc 1991 Aug;81(8):439-42 204

NLM CIT. ID: 92045458
TITLE: Deep fascia of the foot. Anatomical and clinical considerations. AUTHORS: Mitchell IR; Meyer C; Krueger WA AUTHOR AFFILIATION: College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, IA. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 1941581 SOURCE: J Am Podiatr Med Assoc 1991 Jul;81(7):373-8 205

NLM CIT. ID: 91377908
TITLE: Effectiveness of orthotic shoe inserts in the long-distance runner. AUTHORS: Gross ML; Davlin LB; Evanski PM AUTHOR AFFILIATION: Orthopaedic and Sports Medicine Associates, Emerson, New Jersey 07675. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 1897659 SOURCE: Am J Sports Med 1991 Jul-Aug;19(4):409-12 206

NLM CIT. ID: 91227475
TITLE: Plantar fasciitis: MR imaging [see comments] AUTHORS: Berkowitz JF; Kier R; Rudicel S AUTHOR AFFILIATION: Department of Radiology, Yale University School of Medicine, New Haven, Conn. COMMENTS: Comment in: Radiology 1992 Jan;182(1):285 PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2027971 SOURCE: Radiology 1991 Jun;179(3):665-7 207

NLM CIT. ID: 91275397
TITLE: Evaluation of plantar fasciitis by three-phase bone scintigraphy. AUTHORS: Intenzo CM; Wapner KL; Park CH; Kim SM AUTHOR AFFILIATION: Division of Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 63347-66-0 (Technetium Tc 99m Medronate)
ABSTRACT: 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. NLM PUBMED CIT. ID: 2054987 SOURCE: Clin Nucl Med 1991 May;16(5):325-8 208

NLM CIT. ID: 91208799
TITLE: Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. AUTHORS: Schepsis AA; Leach RE; Gorzyca J AUTHOR AFFILIATION: Department of Orthopaedic Surgery, Boston University Medical School, Massachusetts. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2019049 SOURCE: Clin Orthop 1991 May;(266):185-96 209

NLM CIT. ID: 91305610
TITLE: MR appearance of painful conditions of the ankle. AUTHORS: Kier R; McCarthy S; Dietz MJ; Rudicel S AUTHOR AFFILIATION: Department of Radiology, Yale University School of Medicine, New Haven, CT 06510. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 1852934 SOURCE: Radiographics 1991 May;11(3):401-14 210

NLM CIT. ID: 91324630
TITLE: Endoscopic plantar fasciotomy: preliminary study with cadaveric specimens. AUTHORS: Barrett SL; Day SV; Brown MG PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors have developed an endoscopic approach to a plantar fasciotomy. This technique would minimize the surgical trauma that is normally induced with a conventional type of heel spur surgery. The authors believe that this new technique will provide an earlier return to normal ambulation, less loss of work, and earlier, overall increased patient comfort. NLM PUBMED CIT. ID: 1865071 SOURCE: J Foot Surg 1991 Mar-Apr;30(2):170-2 211

NLM CIT. ID: 91155052
TITLE: Heel spur syndrome. Pathomechanics and nonsurgical treatment. Biomechanics Graduate Research Group for 1988. AUTHORS: Scherer PR AUTHOR AFFILIATION: Department of Biomechanics, California College of Podiatric Medicine, San Francisco 94115. PUBLICATION TYPES: CLINICAL TRIAL JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: In this study, the authors review the multitude of suspected etiologies of heel spur syndrome, propose a new pathomechanical theory, and apply a treatment plan to 84 patients with 133 painful heels. The study investigates whether there is a common foot type to the syndrome and whether factors such as sex, age, occupation, and weight influence incidence or treatment. A subgroup is established, consisting of subjects who only received mechanical treatment, to determine if a change in foot position can relieve symptoms. NLM PUBMED CIT. ID: 1999801 SOURCE: J Am Podiatr Med Assoc 1991 Feb;81(2):68-72 212

NLM CIT. ID: 91272132
TITLE: A new radiologic measurement for the diagnosis of Haglund's deformity. AUTHORS: Chauveaux D; Liet P; Le Huec JC; Midy D AUTHOR AFFILIATION: Service d'Orthopedie-Traumatologie, CHU Pellegrin, Bordeaux, France. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors describe a new method of radiologic measurement of "Haglund's deformity", based on a radiologic study of 31 feet operated for posterior heel pain and more especially for calcaneal tendinopathies related to deformity of the calcaneus, and on a series of 60 asymptomatic feet. This angular approach requires a lateral weight-bearing view and proved positive in 85% of symptomatic feet, with only 14% of false-positives in the control group. It thus proves markedly superior to previously described radiologic formulations, since it allows not only for the size and site of the deformity of the posterosuperior part of the calcaneus but also for the angle of verticalization of the latter. NLM PUBMED CIT. ID: 2053043 SOURCE: Surg Radiol Anat 1991;13(1):39-44 213

NLM CIT. ID: 91198988
TITLE: Calcaneal decompression for heel pain. AUTHORS: Baerg RH AUTHOR AFFILIATION: VA Medical Center, Loma Linda, California. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The causes and treatments for heel pain can vary significantly and, many times, can present a challenging problem for both conservative and operative care. This article describes the most common cause of heel pain, with a focus on the use and proper application of the calcaneal decompression procedure. A review of the literature, anatomic considerations, mechanism of action, surgical technique, and case presentations are offered. NLM PUBMED CIT. ID: 2015529 SOURCE: Clin Podiatr Med Surg 1991 Jan;8(1):197-202 214

NLM CIT. ID: 91198987
TITLE: Surgical management of recalcitrant heel pain. AUTHORS: Jacoby RP; Wolfe LC AUTHOR AFFILIATION: Valley Foot Surgeons, Ltd., Phoenix, Arizona. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: A minimal incision approach to the treatment of heel spur syndrome has been presented. This procedure is indicated when the surgeon thinks that conservative modalities have failed to alleviate heel pain. Knowledge of anatomic structures is imperative. NLM PUBMED CIT. ID: 2015528 SOURCE: Clin Podiatr Med Surg 1991 Jan;8(1):187-95 215

NLM CIT. ID: 91198986
TITLE: Minimal incision surgical approach to mechanical heel pain. AUTHORS: Hepford CA AUTHOR AFFILIATION: Colmery-O'Neil Veterans Administration Hospital, Topeka, Kansas. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A brief discussion of the specifics of mechanical heel pain, the causes, the preoperative criteria, the proper regional block anesthesia, and the revised method of surgical intervention by minimal trauma approach are related. Postoperative management with presentation of case history radiographs and a discussion about results and complications complete the relating of this 17-year experience. NLM PUBMED CIT. ID: 2015527 SOURCE: Clin Podiatr Med Surg 1991 Jan;8(1):167-85 216

NLM CIT. ID: 91198985
TITLE: Differential diagnosis and treatment of heel pain. AUTHORS: Dailey JM AUTHOR AFFILIATION: Juvenile Diabetes Foundation, North Bethesda, Maryland. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain caused by heel spur syndrome is a common finding in the podiatric community. It can be baffling and frustrating to the podiatric physician when its rectification becomes conservatively prolonged. This article helps the podiatric physician realize that heel pain may be present whether there is a spur or not and helps give a basic understanding of the systemic disorders that can be involved with heel pain. NLM PUBMED CIT. ID: 2015526 SOURCE: Clin Podiatr Med Surg 1991 Jan;8(1):153-66 217

NLM CIT. ID: 91161877
TITLE: Soft tissue calcifications induced by local corticosteroid injection. AUTHORS: Conti RJ; Shinder M AUTHOR AFFILIATION: Department of Podiatric Surgery Metropolitan Hospital, Philadelphia, Pennsylvania. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 5611-51-8 (triamcinolone hexacetonide) 76-25-5 (Triamcinolone Acetonide)
ABSTRACT: The authors discuss soft tissue calcifications as a possible effect of local corticosteroid therapy. The literature will be reviewed and a case report will be presented, which illustrates soft tissue calcifications in the heel of a patient who received multiple injections of triamcinolone hexacetonide, for heel spur syndrome. The accumulation of insoluable steroid acts as a foreign body and induced a chronic granulomatous inflammatory process, with subsequent dystrophic calcification. NLM PUBMED CIT. ID: 2002185 SOURCE: J Foot Surg 1991 Jan-Feb;30(1):34-7 218

NLM CIT. ID: 91181679
TITLE: Functional biomechanical deficits in running athletes with plantar fasciitis. AUTHORS: Kibler WB; Goldberg C; Chandler TJ AUTHOR AFFILIATION: Lexington Clinic Sports Medicine Center, KY 40504. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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.(ABSTRACT TRUNCATED AT 250 WORDS) NLM PUBMED CIT. ID: 1672577 SOURCE: Am J Sports Med 1991 Jan-Feb;19(1):66-71 219

NLM CIT. ID: 91116519
TITLE: Improvements in the design of viscoelastic heel orthoses. A clinical study. AUTHORS: Levitz SJ; Dykyj D AUTHOR AFFILIATION: Department of Orthopedics, New York College of Podiatric Medicine, NY 10035. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A heel orthosis combining the principles of weight redistribution and shock attenuation was dispensed to 30 subjects with heel pain. Relief or cessation of pain occurred in 73% of the cases. The factor most clearly and significantly associated with the effectiveness of the orthosis was a lesser degree of overweight. Within this prescriptive guideline, such a device has the potential of becoming a cost-effective and time-efficient way of treating heel pain of mechanical origin. NLM PUBMED CIT. ID: 2277336 SOURCE: J Am Podiatr Med Assoc 1990 Dec;80(12):653-6 220

NLM CIT. ID: 91110268
TITLE: The aging foot. AUTHORS: Osterman HM; Stuck RM PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In the aging patient changes that compromise mobility may occur in the feet. Common foot pathologies are heel pain, metatarsalgia, hammertoes and clawtoes, bunions, hallux rigidus, corns and calluses, nail pathologies, arthritis, and neuropathies. To educate patients and families, nurses must be familiar with these conditions and their prevention, conservative treatment, surgical procedures, nursing interventions, and patient education. NLM PUBMED CIT. ID: 2274343 SOURCE: Orthop Nurs 1990 Nov-Dec;9(6):43-7, 76 221

NLM CIT. ID: 91088866
TITLE: Plantar fasciitis in runners. Treatment and prevention. AUTHORS: Warren BL AUTHOR AFFILIATION: Department of Human Performance and Health Promotion, University of New Orleans, Louisiana. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL REGISTRY NUMBERS: 50-78-2 (Aspirin)
ABSTRACT: 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. NLM PUBMED CIT. ID: 1979886 SOURCE: Sports Med 1990 Nov;10(5):338-45 222

NLM CIT. ID: 91047417
TITLE: [Tenosynovial giant cell tumor in the differential diagnosis of painful heel] VERNACULAR
TITLE: Der tenosynoviale Riesenzelltumor in der Differentialdiagnose bei Fersenschmerz. AUTHORS: Sager M; Kissling R; Zynamon A; Zollinger H AUTHOR AFFILIATION: Orthopadische Universitatsklinik Balgrist, Abteilung fur Physikalische Medizin und Rheumatologie, Zurich. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL LANGUAGES: Ger
ABSTRACT: Based on a case report regarding a patient with a tenosynovial tumor in the calcaneal spur area, we present a compilation of the differential diagnoses in the event of heel pain. The diagnostic procedure is dealt with peripherally. As to the various therapeutic possibilities, we refer to the literature. NLM PUBMED CIT. ID: 2237042 SOURCE: Schweiz Rundsch Med Prax 1990 Oct 2;79(40):1175-9 223

NLM CIT. ID: 91068014
TITLE: A wider spectrum of spondyloarthropathies. AUTHORS: Khan MA; van der Linden SM AUTHOR AFFILIATION: Department of Medicine, Case Western Reserve University, Cleveland, OH. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: As in other diseases of undetermined etiology, the diagnosis of ankylosing spondylitis (AS) and related spondyloarthropathies (SpA) is based on clinical and roentgenographic features. The current criteria for diagnosis of some of these diseases are too restricted, and do not recognize the existence of a much wider disease spectrum. For example, radiographically detected sacroiliitis is extremely frequent in AS, but may not be an obligate manifestation, especially in early or atypical forms of the disease. Arthritis involving the axial skeleton, including the sacroiliac joints, can be present in some patients without evidence of erosive disease roentgenographically. The disease spectrum of Reiter's syndrome has also been broadened considerably, and "incomplete" forms of Reiter's syndrome are observed much more commonly than the classical triad of arthritis, conjunctivitis, and urethritis. The term "B27-associated reactive arthritis" has been used in recent years to refer to SpA following enteric or urogenital infections, and the disease spectrum includes the clinical picture of typical Reiter's syndrome. The clinical spectrum of psoriatic SpA has been better clarified. Some of the less well defined B27-associated clinical syndromes include seronegative oligoarthritis, polyarthritis, or dactylitis ("sausagelike" toes) of the lower extremities, and heel pain caused by calcaneal (and tarsal) periostitis. These and other undifferentiated SpA have been ignored in previous epidemiological studies because of the inadequacy of the existing classification criteria. The European Spondylarthropathy Study Group (ESSG) has completed a study aimed at developing preliminary classification criteria for the whole group of SpA patients, with the specific intention of encompassing patients with undifferentiated SpA. NLM PUBMED CIT. ID: 2251505 SOURCE: Semin Arthritis Rheum 1990 Oct;20(2):107-13 224

NLM CIT. ID: 91063826
TITLE: Patient education. Plantar fasciitis. AUTHORS: Murtagh J PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 2248570 SOURCE: Aust Fam Physician 1990 Oct;19(10):1579 225

NLM CIT. ID: 91193160
TITLE: Pattern of rheumatic diseases in south India. V. Ankylosing spondylitis. A clinical and radiological study. AUTHORS: Achuthan K; Porkodi R; Ramakrishnan S Krishnamurthy V; Madhavan R; Parthiban M; Chandrasekaran AN AUTHOR AFFILIATION: Department of Rheumatology, Madras Medical College. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: One hundred and two patients from South India with primary ankylosing spondylitis (AS) were analysed clinically and radiologically. The mean age of onset was 26 years, with a male to female ratio of 16:1. Eleven patients presented as juvenile ankylosing spondylitis. The mode of presentation of AS included axial involvement in 59, peripheral arthritis in 38, heel pain in 18 and acute anterior uveitis (AAU) in 11. The overall incidence of extra axial features was high (90 patients). These included subjects with peripheral arthritis (49), heel pain (35), AAU (14), rib pain (11), aortic regurgitation (8), apical pulmonary fibrosis (5), mitral regurgitation (2) and conduction defects (2). Peripheral arthritis was characteristically asymmetrical and oligo articular, and involved lower limb joints. No renal involvement was noticed. Radiologically, bilateral sacroilitis was seen in 80% of cases. NLM PUBMED CIT. ID: 2084081 SOURCE: J Assoc Physicians India 1990 Oct;38(10):774-6 226

NLM CIT. ID: 91048376
TITLE: [Therapy-resistant heel pain--an indication for surgery in sports traumatology] VERNACULAR
TITLE: Der therapieresistente Fersenschmerz--eine Operationsindikation der Sporttraumatologie. AUTHORS: Riel KA; Bernett P AUTHOR AFFILIATION: Klinik und Poliklinik fur Sportverletzungen, Techn. Universitat Munchen, Klinikum r.d. Isar. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain. NLM PUBMED CIT. ID: 2237738 SOURCE: Sportverletz Sportschaden 1990 Sep;4(3):121-4 227

NLM CIT. ID: 90268359
TITLE: Chronic plantar fascial inflammation and fibrosis. AUTHORS: LeMelle DP; Kisilewicz P; Janis LR AUTHOR AFFILIATION: Department of Podiatric Surgery, Doctors Hospital, Columbus, Ohio. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2346891 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):385-9 228

NLM CIT. ID: 90268347
TITLE: Heel pain. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 2346888 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):203-404 229

NLM CIT. ID: 90268357
TITLE: Seronegative arthritis as a cause of heel pain. AUTHORS: Turlik MA AUTHOR AFFILIATION: Department of Podiatric Orthopedics, Ohio College of Podiatric Medicine, Cleveland. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL REGISTRY NUMBERS: 0 (HLA-B27 Antigen)
ABSTRACT: Seronegative disease as a cause of heel pain is not nearly as common as mechanically induced heel pain. Recognizing the clinical findings, however, will help in distinguishing this from more common forms of heel pain. NLM PUBMED CIT. ID: 2189542 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):369-75 230

NLM CIT. ID: 90268354
TITLE: Tumors of the heel. AUTHORS: Berlin SJ; Mirkin GS; Tubridy SP AUTHOR AFFILIATION: Bon Secours Hospital, Baltimore, Maryland. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: We have attempted to show a correlation between heel pain and tumors and tumor-like conditions. The anatomy and size of the calcaneus predisposes it to increased incidence of trauma. Furthermore, the increased vascularity of the heel versus other areas of the foot may contribute to a higher incidence of both local and metastatic tumors. Most tumors and tumor-like conditions initially present with pain as the patient's primary complaint. Therefore, any complaint of heel pain must be thoroughly evaluated and treated. Accordingly, when biopsy or excision is necessary, the surgeon must plan his approach while considering the unique position and anatomic properties of the calcaneus. NLM PUBMED CIT. ID: 2189540 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):307-21 231

NLM CIT. ID: 90268352
TITLE: Neuromas of the heel. AUTHORS: Davidson MR; Copoloff JA AUTHOR AFFILIATION: California College of Podiatric Medicine, San Francisco. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Often overlooked in the differential diagnosis of heel pain is neuroma of the medial calcaneal branch of the posterior tibial nerve. Heel neuroma is an important disorder of the foot that has been misdiagnosed by physicians since the early 1900s as heel spur syndrome. The authors show how heel pain rarely has anything to do with calcaneal exostosis, but instead could be related to heel neuroma. NLM PUBMED CIT. ID: 2189538 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):271-88 232

NLM CIT. ID: 90268351
TITLE: Inferior heel spur surgery. AUTHORS: Schwartz NH AUTHOR AFFILIATION: Ohio College of Podiatric Medicine, Cleveland. PUBLICATION TYPES: HISTORICAL ARTICLE JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: In most instances, pure mechanical heel spur surgery can and should be avoided. The proper diagnosis is extremely important because many different disorders can cause inferior heel pain like that of a mechanical cause. Described throughout the literature are many surgical approaches and techniques for this problem. Personal preference and experience dictates the choice. In some isolated cases, a specifically designed procedure may be necessary. Postoperative care is as important as the surgical procedure itself because recovery usually takes quite a long time. NLM PUBMED CIT. ID: 2189537 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):261-70 233

NLM CIT. ID: 90268350
TITLE: History and mechanical control of heel spur pain. AUTHORS: Bergmann JN AUTHOR AFFILIATION: Northwestern University, Evanston. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: The symptom of heel pain from heel spur syndrome has both a cause (abnormal pronation) and an effect (inflammation at the heel spur area). I believe that heel spur syndrome cause and effect can best be treated mechanically by a two-stage approach. This two-stage approach uses a different orthotic for each stage. The first stage is to prescribe an orthotic to alleviate the cause through control of abnormal pronation by posting or wedging, and also to alleviate the effect by local accommodation and shock absorption of the inflamed area. The second stage of mechanical treatment is begun after the effect (local inflammation) has subsided. This second stage consists of treatment with a rigid functional orthotic to treat only the cause. This orthotic is more durable and controlling and will therefore maintain the patient and prevent abnormal pronation from occurring. Thus, the cause of pain at the heel spur area will be eliminated. Orthotics can be a great adjunct to treatment of heel spur syndrome. But, as is the case with any other method you use to treat your patients, orthotics are only as good as the theories on which you base them. There are a variety of excellent materials and computerized methods being used today for fabrication of orthotic devices, but they are only as effective as the knowledge on which you base them. If you do not understand the etiology of the mechanical problem and do not observe what treatment is successful and the reasons behind this success, the orthotic you prescribe is not going to have a high level of success, regardless of new materials or technology. You will be like the laboratory technician who can fabricate an orthotic, but cannot predict, with any level of confidence, whether it will alleviate the mechanical problem. NLM PUBMED CIT. ID: 2189536 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):243-59 234

NLM CIT. ID: 90268349
TITLE: The heel in systemic disease. AUTHORS: Lichniak JE AUTHOR AFFILIATION: Department of Podiatric Orthopedics, Ohio College of Podiatric Medicine, Cleveland. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Heel pain is most commonly the result of mechanical abnormality in foot structure or function. Systemic disease, however, may also affect the heel, resulting in pain, deformity, or both of the rearfoot. This article discusses and reviews notable systemic conditions, exclusive of the seronegative spondyloarthropathies, which may produce subjective or objective heel findings. Specific conditions discussed are rheumatoid arthritis, crystal deposition arthropathies, osteoporosis, diffuse idiopathic skeletal hyperostosis, diabetes mellitus, hypertrophic osteoarthropathy, Paget's disease, hyperlipidemia, sarcoidosis, sickle cell anemia, and acromegaly and their effects on the heel. NLM PUBMED CIT. ID: 2189535 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):225-41 235

NLM CIT. ID: 90268348
TITLE: The role of intrinsic musculature in the formation of inferior calcaneal exostoses. AUTHORS: Forman WM; Green MA AUTHOR AFFILIATION: Division of Podiatric Medicine, Mt. Sinai Medical Center, Cleveland, Ohio. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: Review of the anatomy contributing to calcaneal spur formation is provided. Freshly amputated limbs, used because they are not subject to the effects of the preservatives that effect cadaveric limbs, are the basis for the study the authors report. An alternative theory to the cause of heel spurs is presented based on that study. NLM PUBMED CIT. ID: 2189534 SOURCE: Clin Podiatr Med Surg 1990 Apr;7(2):217-23 236

NLM CIT. ID: 90237969
TITLE: Medial calcaneal nerve. An anatomical study. AUTHORS: Didia BC; Horsefall AU AUTHOR AFFILIATION: Department of Anatomy, College of Health Sciences, University of Port Harcourt, Nigeria. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors studied the medial calcaneal nerve of the human foot to determine its precise origin and to establish in detail its course and distribution. Its origin and distribution were compared to those of the inferior calcaneal nerve, and the importance of the nerve in the diagnosis of heel pain was reviewed. The authors concluded that the medial calcaneal nerve occurs in all subjects. Its origin is variable, arising from either the tibial nerve or the lateral plantar nerve after the bifurcation of the former. It innervates the flexor retinaculum and the skin of the heel pad. Therefore, it is clinically a source of pain perception in the heel. NLM PUBMED CIT. ID: 2332828 SOURCE: J Am Podiatr Med Assoc 1990 Mar;80(3):115-9 237

NLM CIT. ID: 90139453
TITLE: Rheumatological lesions in individuals with human immunodeficiency virus infection. AUTHORS: Rowe IF; Forster SM; Seifert MH; Youle MS Hawkins DA; Lawrence AG; Keat AC AUTHOR AFFILIATION: Department of Rheumatology, Westminster Hospital, London. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2616738 SOURCE: Q J Med 1989 Dec;73(272):1167-84 238

NLM CIT. ID: 90016174
TITLE: Chronic heel pain. Treatment rationale. AUTHORS: Baxter DE; Pfeffer GB; Thigpen M AUTHOR AFFILIATION: University of Texas Health Science Center, Houston. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Chronic heel pain needs a treatment rationale. Most heel pain responds to conservative treatment. When surgery is done, the surgeon must be aware of the anatomy and especially the nerves about the heel that can cause pain. The author's experience is presented. NLM PUBMED CIT. ID: 2797751 SOURCE: Orthop Clin North Am 1989 Oct;20(4):563-9 239

NLM CIT. ID: 89366988
TITLE: Common injuries of the foot. Often more than 'just a sprain'. AUTHORS: Coughlin RR AUTHOR AFFILIATION: University of California, School of Medicine, San Francisco. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2570414 SOURCE: Postgrad Med 1989 Sep 1;86(3):175-9, 182, 185 240

NLM CIT. ID: 89384078
TITLE: Musculoskeletal injuries associated with physical activity in older adults. AUTHORS: Matheson GO; Macintyre JG; Taunton JE; Clement DB Lloyd-Smith R AUTHOR AFFILIATION: Division of Sports Medicine, University of British Columbia, Vancouver, Canada. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW LITERATURE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2674589 SOURCE: Med Sci Sports Exerc 1989 Aug;21(4):379-85 241

NLM CIT. ID: 89342206
TITLE: Recalcitrant heel pain. Traumatic fibrosis versus heel neuroma. AUTHORS: Beito SB; Krych SM; Harkless LB PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In 1977, Davidson et al wrote an article entitled "Heel Neuroma." Since that time there has been a strong debate on whether the heel neuroma actually exists. The authors present a study of 14 patients presenting with recalcitrant heel pain. Each patient underwent surgical excision of a plantar heel mass. Two patients had bilateral procedures. Preoperative findings are compared with postoperative results. All of the patients experienced at least 75% relief, and the overall satisfaction rate was 79%. NLM PUBMED CIT. ID: 2760835 SOURCE: J Am Podiatr Med Assoc 1989 Jul;79(7):336-9 242

NLM CIT. ID: 89337384
TITLE: The rheumatoid heel: its relationship to other disorders in the rheumatoid foot. AUTHORS: Bouysset M; Tebib J; Weil G; Noel E; Colson F Llorca G; Lejeune E; Bouvier M AUTHOR AFFILIATION: Department of Rheumatology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Minerals)
ABSTRACT: Four-hundred and eight rheumatoid feet are studied. The percentage of talalgia is 3.7%; for inferior exostosis it is 29.6%, and 30.8% for posterior exostosis. Posterior demineralisation is present in 12%, whereas for bony erosion it is 8.1%. Plantar spurs are very closely associated to flattened feet (p less than 0.0001). Likewise a very noticeable statistical association is noted between postero-superior calcaneitis and tarsal arthritis (p less than 0.0001), and calcaneitis was more frequent among marked valgus (p less than 0.001). These results are compared with findings of other works. Therapeutic consequences are evoked. NLM PUBMED CIT. ID: 2758768 SOURCE: Clin Rheumatol 1989 Jun;8(2):208-14 243

NLM CIT. ID: 89277097
TITLE: Heel pain and body weight. AUTHORS: Hill JJ Jr; Cutting PJ AUTHOR AFFILIATION: Department of Orthopedics, Eisenhower Army Medical Center, Fort Gordon, Georgia. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Body weight has been implicated as a factor in plantar heel pain. In this study, a statistically significant correlation between heel pain and increased body weight is documented in a series of consecutive plantar heel pain patients. NLM PUBMED CIT. ID: 2731839 SOURCE: Foot Ankle 1989 Apr;9(5):254-6 244

NLM CIT. ID: 89227310
TITLE: Laterality and incidence of adhesive capsulitis of the shoulder and plantar fasciitis among rural Saudis in the Jeddah zone [letter] AUTHORS: Agunwa WC PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 2712619 SOURCE: Ann Rheum Dis 1989 Apr;48(4):351 245

NLM CIT. ID: 89279675
TITLE: A rational approach to the management of heel pain. A protocol proposal. AUTHORS: Meltzer EF PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 2732916 SOURCE: J Am Podiatr Med Assoc 1989 Feb;79(2):89-92 246

NLM CIT. ID: 89058009
TITLE: Management of a patient with a diagnosis of bilateral plantar fasciitis and Achilles tendinitis. A case report. AUTHORS: Riddle DL; Freeman DB AUTHOR AFFILIATION: Department of Physical Therapy, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 3194454 SOURCE: Phys Ther 1988 Dec;68(12):1913-6 247

NLM CIT. ID: 88339137
TITLE: Heel pain in sarcoidosis. AUTHORS: Shaw RA; Holt PA; Stevens MB AUTHOR AFFILIATION: Johns Hopkins Medical Institutions, Good Samaritan Hospital, Baltimore, Maryland. PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 3421578 SOURCE: Ann Intern Med 1988 Oct 15;109(8):675-7 248

NLM CIT. ID: 89165046
TITLE: [Reiter's syndrome: considerations on the frequency and mid-term course of its juvenile form] VERNACULAR
TITLE: Sindrome de Reiter: consideraciones sobre la frecuencia y la evolucion a medio plazo de su forma juvenil. AUTHORS: Lopez Longo FJ; Monteagudo Saez I; Cobeta Garcia JC Prados Bueno R; de Inocencio Arocena J; Maroto Alvaro E Garcia Fernandez EJ AUTHOR AFFILIATION: Seccion de Reumatologia y Servicio de Pediatria II, Hospital General Gregorio Maranon, Madrid. PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Spa REGISTRY NUMBERS: 0 (HLA-B Antigens)
ABSTRACT: Reiter's Syndrome (RS) is not common in children and adolescents. From 1982 to 1987 we have seen 13 pediatric patients (8 male and 5 female) with clinical manifestations that characterized RS. Age of onset was 13 years. Clinical findings have been arthritis (100%) involving the knee and ankle joints, heel pain (84%), lumbosacral pain (38%). One to three weeks before joint involvement, six patients (46%) complained of urethritis, 5 (38%) had enteritis and two patients had both. 46% of the patients had HLA-B27 antigen. Radiologic findings were sacroileitis in five patients and calcaneal spurs. All patients were treated with non- steroidal antiinflammatory therapy and, in general, there was a clinical remission in 1-3 months. Nevertheless, after 4 years of follow up, 2 patients had acute relapsing arthritis and 4 had chronic arthropathy. Three patients have developed secondary ankylosing spondylitis. RS is not all that infrequent in pediatric patients with joint involvements if one looks for urethritis, enteritis, eye involvement and cutaneous manifestations. The clinical course is favorable, but there might be some chronic or relapsing cases. Some patients can developed secondary ankylosing spondylitis. For that reason a prolonged follow up of these patients is necessary. NLM PUBMED CIT. ID: 3232876 SOURCE: An Esp Pediatr 1988 Oct;29(4):298-301 249

NLM CIT. ID: 89138206
TITLE: Painful heel syndrome: radiographic and treatment assessment. AUTHORS: Amis J; Jennings L; Graham D; Graham CE AUTHOR AFFILIATION: University of Cincinnati College of Medicine, Ohio. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: From July 1980 to January 1986, 170 patients who had unilateral heel pain were examined, x-ray filmed, and treated in a similar fashion. Radiographs of painful and nonpainful heels were measured. There was a statistically significant increased thickness of the heel fat pad and subfascial area compared with that of the control subject (the nonpainful side). A tightness of the Achilles tendon and a new sign, which the authors are designating as the "saddle" sign, were other prominent features. A treatment program of stretching exercises and walking seemed to be effective in relief of symptoms. NLM PUBMED CIT. ID: 3224903 SOURCE: Foot Ankle 1988 Oct;9(2):91-5 250

NLM CIT. ID: 89056648
TITLE: Etiologic factors associated with selected running injuries. AUTHORS: Messier SP; Pittala KA AUTHOR AFFILIATION: J. B. Snow Biomechanics Laboratory, Department of Health and Sport Science, Wake Forest University, Winston-Salem, NC 27109. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 3193867 SOURCE: Med Sci Sports Exerc 1988 Oct;20(5):501-5 251

NLM CIT. ID: 89011440
TITLE: Heel spur surgery [letter] AUTHORS: Rosenblum DM PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 3171968 SOURCE: J Am Podiatr Med Assoc 1988 Sep;78(9):486 252

NLM CIT. ID: 88250524
TITLE: Spontaneous rupture of the plantar fascia. AUTHORS: Ahstrom JP Jr AUTHOR AFFILIATION: University of Illinois College of Medicine, Chicago. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2898217 SOURCE: Am J Sports Med 1988 May-Jun;16(3):306-7 253

NLM CIT. ID: 88286418
TITLE: A new use of instrumentation in fluoroscopy controlled heel spur surgery. AUTHORS: Shmokler RL; Bravo AA; Lynch FR; Newman LM PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 3397874 SOURCE: J Am Podiatr Med Assoc 1988 Apr;78(4):194-7 254

NLM CIT. ID: 88311134
TITLE: Plantar fasciitis. Mechanics and pathomechanics of treatment. AUTHORS: Kwong PK; Kay D; Voner RT; White MW AUTHOR AFFILIATION: Orthopaedic Hospital of Los Angeles, California. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 3044618 SOURCE: Clin Sports Med 1988 Jan;7(1):119-26 255

NLM CIT. ID: 88078723
TITLE: Heel pain in sarcoidosis--is sarcoid a cause of spondarthropathy? [letter] AUTHORS: Ott H; Van Linthoudt D PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 3690142 SOURCE: Br J Rheumatol 1987 Dec;26(6):468 256

NLM CIT. ID: 88152695
TITLE: Proximal medial longitudinal arch incision for plantar fascia release. AUTHORS: Ward WG; Clippinger FW AUTHOR AFFILIATION: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 3440557 SOURCE: Foot Ankle 1987 Dec;8(3):152-5 257

NLM CIT. ID: 88060255
TITLE: Foot complaints attributed to heel pain [editorial] AUTHORS: Reinherz RP; Gastwirth CM PUBLICATION TYPES: EDITORIAL NLM PUBMED CIT. ID: 3680863 SOURCE: J Foot Surg 1987 Sep-Oct;26(5):369-70 258

NLM CIT. ID: 88049255
TITLE: Plantar fasciitis. AUTHORS: Harbison S PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 3675346 SOURCE: Aust Fam Physician 1987 Aug;16(8):1113-5 259

NLM CIT. ID: 88021471
TITLE: Surgical management of Achilles tendinitis. AUTHORS: Schepsis AA; Leach RE AUTHOR AFFILIATION: Department of Orthopedic Surgery, University Hospital of Boston University Medical Center, Massachusetts 02118. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Inflammation of the Achilles tendon and its contiguous structures is one of the most common overuse problems seen in runners. There are actually several etiologies. Involvement of the tendon itself is secondary to areas of mucinoid or fibrotic degeneration, or may be a result of a partial rupture. The sheath (or mesotenon) may also become chronically inflammed. Retrocalcaneal bursitis seems to be a separate entity with hypertrophy and fibrosis of the bursa usually occurring in conjunction with a prominent posterior superior angle of the os calcis. The vast majority of patients can be successfully treated nonoperatively; however, there is a group of patients who are refractory to nonoperative management who would like to continue running, particularly if they are competitive. A retrospective review of 45 surgical cases in 37 patients was performed. All but two of these patients were competitive long-distance runners. There were 24 cases of Achilles tendinitis and/or tenosynovitis, 14 cases with retrocalcaneal bursitis, and 7 with a combination of both. Mean followup was 3 years (range, 1 1/2 to 8 years). Overall there were 87% satisfactory results. Ninety-two percent of the patients with involvement with the tendon and/or sheath had a satisfactory outcome as compared with 71% of patients with retrocalcaneal bursitis. Passive dorsiflexion in the 29 unilateral cases improved from a mean of 17 degrees preoperatively to a mean of 25 degrees postoperatively. We feel that surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed. NLM PUBMED CIT. ID: 3661810 SOURCE: Am J Sports Med 1987 Jul-Aug;15(4):308-15 260

NLM CIT. ID: 87284005
TITLE: Persistent heel pain twenty years after calcaneal fracture and triple arthrodesis relieved by lateral decompression. AUTHORS: Connolly JF PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Heel pain after a fractured calcaneus is frequently due to lateral impingement. This can be worsened by triple arthrodesis, which diminishes the height of the talus and calcaneus. Resection of the distal fibula can relieve such persistent heel pain and should be considered before arthrodesis. NLM PUBMED CIT. ID: 3612859 SOURCE: J Trauma 1987 Jul;27(7):809-10 261

NLM CIT. ID: 87277831
TITLE: Imaging study of the painful heel syndrome. AUTHORS: Williams PL; Smibert JG; Cox R; Mitchell R Klenerman L PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Diphosphonates) 50-23-7 (Hydrocortisone) 52997-55-4 (technetium Tc 99m diphosphonate) 7440-26-8 (Technetium)
ABSTRACT: A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45 degrees medial oblique radiographs of both feet. Of the 52 painful heels 31 (59.6%) showed increased uptake of tracer at the calcaneum. Patients with scans showing increased uptake tended to have more severe heel pain and responded more frequently to a local hydrocortisone injection. On plain x-ray, 39 of 52 painful heels (75%) and 24 of the 38 opposite nonpainful heels (63%) showed plantar spurs, compared with five of 63 (7.9%) heels in 59 age- and sex-matched controls. No evidence of stress fractures was seen. NLM PUBMED CIT. ID: 3609986 SOURCE: Foot Ankle 1987 Jun;7(6):345-9 262

NLM CIT. ID: 87281337
TITLE: Postoperative fracture of os calcis and treatment. AUTHORS: Donohue T; Sorkin B; Kanat IO PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The occurrence of fracture of the calcaneus after heel spur surgery can be a devastating complication requiring prompt treatment and strict patient compliance during the postoperative course. The literature contains little information regarding this type of injury. Several factors must be considered in assessing the etiology of the fracture, including injuries incurred, surgical procedures performed, and axial forces that have been applied to the calcaneus. NLM PUBMED CIT. ID: 3611627 SOURCE: J Foot Surg 1987 May-Jun;26(3):261-5 263

NLM CIT. ID: 88080576
TITLE: Overuse injuries in sport: the foot. AUTHORS: Torg JS; Pavlov H; Torg E AUTHOR AFFILIATION: Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia. PUBLICATION TYPES: JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
ABSTRACT: 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. NLM PUBMED CIT. ID: 2891450 SOURCE: Clin Sports Med 1987 Apr;6(2):291-320 264

NLM CIT. ID: 87233862
TITLE: [Ankylosing spondylitis with juvenile onset. Study of 62 cases] VERNACULAR
TITLE: Les spondylarthrites ankylosantes a debut juvenile. Etude de 62 observations. AUTHORS: Job-Deslandre C; Menkes CJ; Godran A; Amor B PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Fre REGISTRY NUMBERS: 0 (HLA Antigens) 0 (HLA-B27 Antigen)
ABSTRACT: The study of 338 files of patients hospitalized for ankylosing spondylarthritis between 1977 and 1985, has enabled to select 52 cases (15 p. cent) of juvenile forms (onset before the age of 16). An additional 10 cases followed in pediatric clinic are included. The male predominance is definite (88.7 p. cent); the onset is late (mean age: 11.6 +/- 3.2 years) and, most of the time, at the level of a peripheral joint (79 p. cent). The evolution, studied with a mean follow-up of 11.2 +/- 4.8 years, is usually manifested by bouts of peripheral and/or axial arthritis (82.2 p. cent). Joint involvement predominates in the lower extremities: knees (23 cases) and feet (21 cases). The late appearance of spinal and/or sacro-iliac joint involvement explains the late diagnosis (5.6 +/- 4.8 years). Visceral involvement is less frequent (12 cases of eye involvement). The functional prognosis is dominated by a severe involvement of the coxo-femoral joints (46.6 p. cent). Heel pain with posterior and/or inferior talus erosions (15 cases) are, because of their frequency, interesting for making the diagnosis. The total functional prognosis is relatively good: Steinbrocker stage 0-1 for 26 patients (44 p. cent). A bilateral arthroplasty was performed in 9 patients with an excellent result in 7 cases. NLM PUBMED CIT. ID: 3495861 SOURCE: Rev Rhum Mal Osteoartic 1987 Mar;54(3):209-12 265

NLM CIT. ID: 87143672
TITLE: Predicting plantar fasciitis in runners. AUTHORS: Warren BL; Jones CJ PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 2881184 SOURCE: Med Sci Sports Exerc 1987 Feb;19(1):71-3 266

NLM CIT. ID: 87137786
TITLE: Nutritional osteomalacia presenting with plantar fasciitis. AUTHORS: Paice EW; Hoffbrand BI PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 3818730 SOURCE: J Bone Joint Surg [Br] 1987 Jan;69(1):38-40 267

NLM CIT. ID: 87117802
TITLE: Conservative management of metatarsal and heel pain in the adult foot. AUTHORS: D'Ambrosia RD PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The Louisiana State University (LSU) Affiliated Hospitals foot clinic has had good success in the treatment of metatarsal and heel pain using the following five modalities. Muscle strengthening and muscle stretching of the intrinsic muscles and the muscles about the ankle joint, especially the gastrocnemius-soleus complex. Contrast baths in the acute condition to decrease the edema and inflammatory process. Nonsteroidal agents with the acute condition to decrease the inflammatory response. Shoe modifications. Orthotic devices. Orthotic devices seem to be the most useful in the treatment of both conditions. It has been found necessary to prescribe orthotics in almost all cases of chronic problems to institute permanent relief. Opposition remains to multiple steroid injections into either area, although there is no great objection to one or possibly two injections into a particular area to decrease the inflammatory process. It has been observed that a general worsening of the condition occurs from multiple injections. After repeated steroid injections one sets the stage for increased atrophy of the fat pad, which results in a more prominent bony surface and increased pain. Cases have been documented on many occasions showing indented areas over the heel or metatarsals or complete loss of the metatarsal fat pad of patients who have received multiple injections of steroids. NLM PUBMED CIT. ID: 3809011 SOURCE: Orthopedics 1987 Jan;10(1):137-42 268

NLM CIT. ID: 87083908
TITLE: Prevention and management of calcaneal apophysitis in children: an overuse syndrome. AUTHORS: Micheli LJ; Ireland ML PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Calcaneal apophysitis (Sever disease) is a common cause of heel pain, particularly in the athletically active child. Eighty-five children (137 heels) with calcaneal apophysitis were reviewed. Both heels were affected in 52 (61%) patients. The most common associated foot condition was pronation, occurring in 16 patients. Sixty-eight patients complained that pain was made worse by a specific sport, with soccer leading the list. All patients were treated with a physical therapy program of lower extremity stretching, especially of the heel cords, and ankle dorsiflexion strengthening. Soft Plastizote orthotics or heel cups were used in 98% of patients. Proper athletic shoewear was advised. All patients improved and were able to return to their sport of choice 2 months after the diagnosis. There were two recurrences. NLM PUBMED CIT. ID: 3793908 SOURCE: J Pediatr Orthop 1987 Jan-Feb;7(1):34-8 269

NLM CIT. ID: 87107189
TITLE: Results of surgery in athletes with plantar fasciitis. AUTHORS: Leach RE; Seavey MS; Salter DK PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 3804138 SOURCE: Foot Ankle 1986 Dec;7(3):156-61 270

NLM CIT. ID: 87279079
TITLE: Plantar fasciitis. AUTHORS: Onuba O; Ireland J PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 3610621 SOURCE: Ital J Orthop Traumatol 1986 Dec;12(4):533-5 271

NLM CIT. ID: 87097713
TITLE: Surgical decisions in athletes' subcalcaneal pain. AUTHORS: Lutter LD PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 3799874 SOURCE: Am J Sports Med 1986 Nov-Dec;14(6):481-5 272

NLM CIT. ID: 87051208
TITLE: The management of heel pain in the athlete. AUTHORS: Contompasis JP PUBLICATION TYPES: HISTORICAL ARTICLE JOURNAL ARTICLE
ABSTRACT: Heel pain in the athlete can be the result of several factors, including anatomic variations, biomechanical faults, poor habits, and training errors. Common sites of heel pain are inferior and posterior to the calcaneus. Before any treatment program is begun, thorough evaluation and accurate diagnosis are required. The more correct the diagnosis, the greater the chance of instituting a successful treatment regimen. NLM PUBMED CIT. ID: 2946397 SOURCE: Clin Podiatr Med Surg 1986 Oct;3(4):705-11 273

NLM CIT. ID: 87008670
TITLE: Xeroradiography in the diagnosis of the Haglund syndrome. AUTHORS: Burhenne LJ; Connell DG PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Xeroradiography is the radiographic method of choice for assessment of soft tissues and calcaneal detail in patients suffering from a painful swelling localized in the heel. The radiographic triad of retrocalcaneal bursitis, superficial tendo Achillis bursitis, and Achilles tendon thickening, in the presence of an intact posterior superior calcaneal margin, are readily evaluated with xeroradiography. The Haglund syndrome is a painful inflammation involving the two bursae which surround the Achilles tendon. It is associated with a prominent posterior superior calcaneal margin. Of the two objective measurements devised to assess this prominence, neither the posterior calcaneal angle of Philip and Fowler of greater than 75 degrees nor the parallel pitch line (PPL) has proved to be a reliable index. In the present study, we evaluated four patients with heel pain and swelling as well as 100 control patients. The findings suggest that the prominence of the posterior calcaneal angle should be assessed relative to the known normal range rather than by comparison to a single fixed angulation which is arbitrarily designated as being abnormal. NLM PUBMED CIT. ID: 2944889 SOURCE: Can Assoc Radiol J 1986 Sep;37(3):157-60 274

NLM CIT. ID: 86279400
TITLE: A new instrumentation for heel spur resection. AUTHORS: Keating SE PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Numerous procedures are available for resecting an inferior calcaneal exostosis (heel spur) when conservative management of the condition fails. A study was conducted with Sheridan Park Hospital patients by using the Kazanjian nasal forceps for spur removal. This procedure minimizes soft tissue destruction, bone pain, and iatrogenic calcaneal fractures. NLM PUBMED CIT. ID: 3734333 SOURCE: J Foot Surg 1986 Jul-Aug;25(4):301-3 275

NLM CIT. ID: 86088607
TITLE: A retrospective study of 195 patients with heel pain. AUTHORS: Shikoff MD; Figura MA; Postar SE PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 3510294 SOURCE: J Am Podiatr Med Assoc 1986 Feb;76(2):71-5 276

NLM CIT. ID: 88102826
TITLE: The first branch of the lateral plantar nerve and heel pain. AUTHORS: Rondhuis JJ; Huson A AUTHOR AFFILIATION: Department of Anatomy and Embryology, Leiden University, The Netherlands. PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The course and ramification pattern of the lateral plantar nerve was studied in serial sections from 4 fetal feet and in dissections from 34 adult feet with special reference to the so called first branch. This branch was found in all of the observed fetal and adult specimen. From its originating point the nerve runs immediately distally to the medial process of the calcaneal tuberosity in a lateral direction to the proximal part of the abductor digiti minimi muscle. During its course the FB gives two branches. One of them penetrates sometimes the insertion of the quadratus plantae muscle, whereas in adult feet it always sends fibres to the periosteum around the medial process of the calcaneal tuberosity and the long plantar ligament. The other innervates the flexor digitorum brevis muscle. The site of a possible entrapment is located between the abductor hallucis muscle and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the long plantar ligament as well as motor fibres for the quadratus plantae, flexor digitorum brevis and abductor digiti minimi muscles, which may explain the characteristic pain complaints of the heel pain syndrome. The occurrence of a stiff fascia perforated by the nerve branch or a bursa around the insertion of the plantar aponeurosis as has been described by several authors and which was put forward as a possible aetiological factor could not be confirmed in our material. NLM PUBMED CIT. ID: 3425404 SOURCE: Acta Morphol Neerl Scand 1986;24(4):269-79 277

NLM CIT. ID: 86086961
TITLE: Application and assessment of microfibrillar collagen hemostat in heel spur surgery: a preliminary study. AUTHORS: Malofsky H; Lopez AL PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 9007-34-5 (Collagen)
ABSTRACT: Microfibrillar collagen is described. The method of application and use on the exposed surface of cancellous bone encountered in heel spur surgery, herein defined as a resection of the inferior calcaneal exostosis with plantar fasciotomy, is discussed. Microfibrillar collagen's chief effect on cancellous bone is rapid, dramatic cessation of bone bleeding. It was assessed in terms of its effect on postoperative pain, quantitative subcutaneous hematoma formation, and edema. Although patients initially experienced increased discomfort during the first 24 hr. postoperatively, their edema, subcutaneous hematoma formation, and, more dramatically, need for narcotic analgesics was significantly reduced in the microfibrillar patient group when compared to patients having the same surgical procedures without the microfibrillar collagen intraoperatively. There were no postoperative complications encountered after the use of microfibrillar collagen in any of the 23 cases. NLM PUBMED CIT. ID: 4078239 SOURCE: J Foot Surg 1985 Nov-Dec;24(6):445-7 278

NLM CIT. ID: 86036798
TITLE: Calcaneal decompression for chronic heel pain. AUTHORS: Jay RM; Davis BA; Schoenhaus HD; Beckett D PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 4057065 SOURCE: J Am Podiatr Med Assoc 1985 Oct;75(10):535-7 279

NLM CIT. ID: 86018297
TITLE: Running shoes, orthotics, and injuries. AUTHORS: McKenzie DC; Clement DB; Taunton JE PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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.(ABSTRACT TRUNCATED AT 400 WORDS) NLM PUBMED CIT. ID: 3850616 SOURCE: Sports Med 1985 Sep-Oct;2(5):334-47 280

NLM CIT. ID: 86006529
TITLE: Calcaneal osteomyelitis following steroid injection: a case report. AUTHORS: Gidumal R; Evanski P PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 53-06-5 (Cortisone)
ABSTRACT: 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. NLM PUBMED CIT. ID: 4043891 SOURCE: Foot Ankle 1985 Aug;6(1):44-6 281

NLM CIT. ID: 85264323
TITLE: A retrospective analysis of heel pain. AUTHORS: O'Brien D; Martin WJ PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 4020666 SOURCE: J Am Podiatr Med Assoc 1985 Aug;75(8):416-8 282

NLM CIT. ID: 85283303
TITLE: Early ambulation after minimal incision surgery for calcaneal spurs. AUTHORS: Polisner RI PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: We feel that surgical intervention for heel spurs must be used with caution after a strong program of conservative measures is tried. We have learned that it is helpful to inform patients of the complexity of heel pain and that, even with surgery, their discomfort may continue for some time. We also have always advised patients that being overweight increases their pain. In light of this study, we will probably make stronger statements on the importance of losing excess weight. When people can maintain a desirable weight, heel spur syndrome surgery can produce uniformly good results. The key is in the careful selection of cases. NLM PUBMED CIT. ID: 4028491 SOURCE: Clin Podiatry 1985 Jul;2(3):497-502 283

NLM CIT. ID: 85236994
TITLE: Management of the heel spur (syndrome). AUTHORS: Rosenfeld S PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 4026941 SOURCE: J Am Podiatr Med Assoc 1985 Jun;75(6):315-6 284

NLM CIT. ID: 86009433
TITLE: Postoperative heel spur pain [editorial] AUTHORS: Reinherz RP; Gaswirth CM PUBLICATION TYPES: EDITORIAL NLM PUBMED CIT. ID: 4045105 SOURCE: J Foot Surg 1985 May-Jun;24(3):159-60 285

NLM CIT. ID: 85236985
TITLE: Fractures of the calcaneus secondary to heel spur surgery. An analysis and case report. AUTHORS: Hoffman SJ; Thul JR PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 4009459 SOURCE: J Am Podiatr Med Assoc 1985 May;75(5):267-71 286

NLM CIT. ID: 85292923
TITLE: Enthesopathy of the heels in juvenile onset seronegative B-27 positive spondyloarthropathy. AUTHORS: Gerster JC; Piccinin P PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Adrenal Cortex Hormones) 0 (HLA Antigens) 0 (HLA-B27 Antigen)
ABSTRACT: Severe heel enthesopathy was diagnosed in 4 of 18 cases of juvenile onset seronegative spondyloarthropathy. The plantar fascia was affected in each case, whereas the insertion of the Achilles tendon was involved in only one case. All were males over the age of 8 at the onset of arthropathy; HLA-B27 was present in each patient. Mild heel pain was found in 4 other patients. The prognosis was poor in patients with severe talalgia but better in patients with mild or no talalgia. When compared with the adult onset spondyloarthropathy, the incidence of severe heel pain was almost the same. No cases of Achilles tendon thickening were found in the juvenile patients. NLM PUBMED CIT. ID: 3875722 SOURCE: J Rheumatol 1985 Apr;12(2):310-4 287

NLM CIT. ID: 85178060
TITLE: Clinical study of Thai patients with ankylosing spondylitis. AUTHORS: Deesomchok U; Tumrasvin T PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (HLA Antigens) 0 (HLA-B27 Antigen)
ABSTRACT: Sixty-one Thai patients with ankylosing spondylitis (AS), diagnosed in accordance with Rome and New York criteria for AS, were studied. The cases includes idiopathic AS (46 cases), Reiter's syndrome AS (8 cases) and psoriatic spondylitis (7 cases). The vast majority of patients were male (Male:Female = 11.2:1), and in over three-fourths the age of onset was between 10 and 39. Low back pain and peripheral arthritis as the initial manifestations were observed in 78.68 and 55.73% of patients respectively. Peripheral arthritis was evident during the course of illness in 72.13% of cases, oligoarticular arthritis being predominant (68.97%). Heel pain, tendonitis and plantar pain were noted in 19.67, 4.92 and 3.28% respectively. Most patients had lumbosacral and thoracic spine involvements, and only 49.18% showed involvement of the cervical spine. Bilateral sacroiliitis was noted in 98.36%. Uveitis was evident in 11.47% while evidence of aortic insufficiency was noted in 3.28%. An association with HLA-B27 was encountered in 91.07% of all cases. In general, the clinical features of AS in Thai patients are similar to those reported elsewhere, but an association with inflammatory bowel disease and Behcet's disease are notably absent. NLM PUBMED CIT. ID: 3157530 SOURCE: Clin Rheumatol 1985 Mar;4(1):76-82 288

NLM CIT. ID: 85139396
TITLE: Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease). AUTHORS: Heneghan MA; Wallace T PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result from post- traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with a normal Achilles tendon and superficial soft tissue contour, and intact cortex of the underlying os calcis. NLM PUBMED CIT. ID: 3975103 SOURCE: Pediatr Radiol 1985;15(2):119-22 289

NLM CIT. ID: 85015165
TITLE: Role of soft orthosis in treating plantar fasciitis. Suggestion from the field. AUTHORS: Goulet MJ PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 6483984 SOURCE: Phys Ther 1984 Oct;64(10):1544 290

NLM CIT. ID: 85004973
TITLE: Heel pain--operative results. AUTHORS: Baxter DE; Thigpen CM PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In 6 years through 1982, the authors performed 34 operative cases in 26 patients with recalcitrant heel pain. The operative procedure involves an isolated neurolysis of the mixed nerve supplying the abductor digiti quinti muscle as it passes beneath the abductor hallucis muscle and beneath the medial ridge of the calcaneus. The deep fascia of the abductor hallucis muscle is released routinely, and an impinging heel spur or tight plantar fascia is partially removed or released if it is causing entrapment of the nerve. The biomechanical pathogenesis of heel pain in relation to pes planus and pes cavus predisposing to an entrapment neuropathy is described, and the anatomy of the heel in relation to the nerve distribution is clarified and well illustrated. Of the 34 operated heels, 32 had good results and two had poor results. Heel pain can cause total disability in the working population and may jeopardize one's employment or professional athletic career. The authors believe operative treatment has a place in the care of recalcitrant heel pain and that an entrapment neuropathy is an etiological factor in heel pain. NLM PUBMED CIT. ID: 6479759 SOURCE: Foot Ankle 1984 Jul-Aug;5(1):16-25 291

NLM CIT. ID: 84206302
TITLE: Surgical treatment of plantar fasciitis. AUTHORS: Lester DK; Buchanan JR PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 6723144 SOURCE: Clin Orthop 1984 Jun;(186):202-4 292

NLM CIT. ID: 84255821
TITLE: Ankylosing spondylitis in North India: a clinical and immunogenetic study. AUTHORS: Prakash S; Mehra NK; Bhargava S; Vaidya MC Malaviya AN PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (HLA Antigens) 0 (HLA-B27 Antigen)
ABSTRACT: Fifty-one North Indian patients with ankylosing spondylitis (AS) are described with mean age of onset 21.2 years and male to female ratio of 16:1. AS began with peripheral arthritis in 47%, low back pain in 41%, acute anterior uveitis in 10%, and heel pain in 2% of the patients. 76% of 51 patients had one of the extra-axial features of AS: peripheral arthritis (61%), heel pain (24%), anterior uveitis (22%), urethritis (12%), kidney disease (10%), mucosal ulcerations (6%), aortic incompetence (4%), and apical pulmonary fibrosis (4%). A majority (71%) of the patients with peripheral arthritis had mono- or oligoarthritis affecting mainly the lower limb joints. Two patients had coexistent rheumatoid arthritis also. HLA-B27 antigen was detected in 48 (94%) of 51 patients compared with 7 (6%) of 118 controls (relative risk 254; Fisher's exact p = 3.49(-29]. On comparing patients with juvenile onset AS and patients with adult onset disease we found peripheral arthritis to be more frequent at the beginning and during the course of disease in the former. NLM PUBMED CIT. ID: 6611138 SOURCE: Ann Rheum Dis 1984 Jun;43(3):381-5 293

NLM CIT. ID: 84177594
TITLE: Aspiration of the retrocalcaneal bursa. AUTHORS: Canoso JJ; Wohlgethan JR; Newberg AH; Goldsmith MR PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Mucins) GRANT/CONTRACT ID: AM-20613/AM/NIADDK
ABSTRACT: We aspirated the retrocalcaneal bursa in cadavers to determine the characteristics of bursal fluid. A small amount of clear, viscous fluid was constantly present in the bursa. Leucocyte count was low, and the mucin clot test was good. With the same technique we aspirated the retrocalcaneal bursae of 4 patients. Three had Reiter's syndrome; the bursal fluid was inflammatory, and symptoms promptly resolved after local corticosteroid injection. The fourth patient presented with heel pain; intracellular, positively birefringent crystals were present in the aspirate, consistent with the diagnosis of pseudogout. NLM PUBMED CIT. ID: 6712303 SOURCE: Ann Rheum Dis 1984 Apr;43(2):308-12 294

NLM CIT. ID: 84254321
TITLE: Chronic calcaneal pain in athletes: entrapment of the calcaneal nerve? AUTHORS: Henricson AS; Westlin NE PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In 11 heels in 10 athletes with chronic heel pain unrelieved by conservative therapy, the symptoms and physical findings caused a suspicion of entrapment of the calcaneal branches of the tibial nerve. The nerves were, therefore, surgically decompressed. No macroscopic signs of compression of the nerves were noted, but an entrapment of the anterior calcaneal branch could occur where the nerve passes between the tight and rigid edge of the deep fascia of the abductor hallucis and the medial edge of the os calcis. Followup of 58 months after surgery revealed that 10 of the 11 heels were asymptomatic and the patients had resumed athlete participation after an average of 5 weeks. NLM PUBMED CIT. ID: 6742290 SOURCE: Am J Sports Med 1984 Mar-Apr;12(2):152-4 295

NLM CIT. ID: 84167221
TITLE: Anatomical factors associated with predicting plantar fasciitis in long- distance runners. AUTHORS: Warren BL PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 6708780 SOURCE: Med Sci Sports Exerc 1984;16(1):60-3 296

NLM CIT. ID: 84151420
TITLE: Partial calcaneal ostectomy for retrocalcaneal bursitis. AUTHORS: Jones DC; James SL PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Heel pain in runners is very common. Retrocalcaneal bursitis may be disabling to the competitive runner. When conservative treatment fails, surgery (partial calcaneal ostectomy) may be indicated. Ten patients underwent partial calcaneal ostectomies at our clinic and returned to their desired level of activity within 6 months. When the surgeon adheres to the surgical principles outlined in this article, the results are uniformly good. NLM PUBMED CIT. ID: 6703183 SOURCE: Am J Sports Med 1984 Jan-Feb;12(1):72-3 297

NLM CIT. ID: 86252360
TITLE: Plantar fasciitis. AUTHORS: McBryde AM Jr PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 6152808 SOURCE: Instr Course Lect 1984;33:278-82 298

NLM CIT. ID: 84148757
TITLE: [Reactive arthritis--clinical aspects and course] VERNACULAR
TITLE: Die reaktive Arthritis--Klinik und Verlauf. AUTHORS: Kruger K; Schattenkirchner M PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ger
ABSTRACT: Post-enteritis reactive arthritis-mainly caused by Yersinia enterocolitica-has succeeded rheumatic fever as the most frequent postinfection arthritis in Northern and Central Europe. Aetiologically important are infective diseases-produced by "arthritogenic" bacteria-- as a trigger, and genetic predisposition, indicated by a high incidence of HLA-B27 (80%). Over a period of 5 years 51 cases of post-enteritis reactive arthritis were diagnosed in our clinic; the patients--after the first examination--were followed up for several years. The typical clinical findings initially were an asymmetric oligoarthritis, mainly affecting knees, ankles and toes. Transitory low-back pain and heel pain were the most important concomitant findings. Transient liver involvement was indicated by pathological laboratory tests in 12 cases. Acute primary disease was determined at latest within one year (average duration 6.5 months). In the follow-up period 7 patients developed symptoms of a chronic seronegative spondylarthritis. Thus, post- enteritis reactive arthritis may often represent the first manifestation of a chronic disease of the seronegative spondylarthritis group, e.g. Reiter's syndrome. NLM PUBMED CIT. ID: 6670283 SOURCE: Wien Klin Wochenschr 1983 Dec 23;95(24):884-9 299

NLM CIT. ID: 84078682
TITLE: HLA B27 related 'unclassifiable' seronegative spondyloarthropathies. AUTHORS: Prakash S; Mehra NK; Bhargava S; Malaviya AN PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (HLA Antigens) 0 (HLA-B27 Antigen) 9009-79-4 (Rheumatoid Factor)
ABSTRACT: Twenty-five patients (22 males and 3 females) are described who had 'unclassifiable' seronegative peripheral arthritis affecting mainly the large joints of the lower limbs with other typical features of spondyloarthropathies such as heel pain, low back pain, and mucosal ulcers. But their disorders could not be diagnosed as any specific spondyloarthropathy such as ankylosing spondylitis, Reiter's disease, etc. The mean age of onset of disease was 21.4 years and 60% of them had mono- or oligoarthritis; 60% had arthritis of only lower limb joints. Knee, ankle, and hip joints were most commonly involved, often asymmetrically (mean degree of asymmetry = 0.28). Minimal radiographic sacroiliitis was present in 4 patients, though 13 had low back pain. HLA B27 antigen was detected in 21 (84%) of these patients and only 5.9% of 118 controls (relative risk 83). In addition to these 25 patients there were 4 others whose only symptom was severe bilateral heel pain: 3 of them were positive for HLA B27. NLM PUBMED CIT. ID: 6606400 SOURCE: Ann Rheum Dis 1983 Dec;42(6):640-3 300

NLM CIT. ID: 84121042
TITLE: [Clinical aspects of reactive arthritis caused by Chlamydia] VERNACULAR
TITLE: Aspects cliniques des arthrites reactionnelles a Chlamydia. AUTHORS: Doury P; Eulry F; Pattin S PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Fre REGISTRY NUMBERS: 0 (HLA Antigens) 0 (HLA-B27 Antigen)
ABSTRACT: The authors compare a multicentered study of chlamydial reactive arthritis with their own personal series of 99 cases consisting of 58 cases of chlamydial reactive arthritis and 41 cases of non-chlamydial reactive arthritis. In the group with chlamydial reactive arthritis, mono-arthritis is more frequent and involvement of the knees, hands, wrists, the sausage appearance of the fingers and toes and heel pain are rarer than in non-chlamydial reactive arthritis. However, the genetic predisposition, in particular the presence of the HLA-B27 antigen, has an essential influence on the clinical features of reactive arthritis. NLM PUBMED CIT. ID: 6607500 SOURCE: Rev Rhum Mal Osteoartic 1983 Nov;50(11):753-7 301

NLM CIT. ID: 83305437
TITLE: Heel pain in athletes [letter] AUTHORS: Griffin ER 3d PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 6613800 SOURCE: Am Fam Physician 1983 Sep;28(3):23, 26 302

NLM CIT. ID: 83233348
TITLE: Pathologic hindfoot conditions in the athlete. AUTHORS: Leach RE; DiIorio E; Harney RA PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 6861383 SOURCE: Clin Orthop 1983 Jul-Aug;(177):116-21 303

NLM CIT. ID: 83306260
TITLE: Plantar fascia release for chronic plantar fasciitis in runners. AUTHORS: Snider MP; Clancy WG; McBeath AA PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Eng
ABSTRACT: 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. NLM PUBMED CIT. ID: 6614290 SOURCE: Am J Sports Med 1983 Jul-Aug;11(4):215-9 304

NLM CIT. ID: 83235980
TITLE: Bilateral tarsal tunnel syndrome caused by varicosities. AUTHORS: Gould N; Alvarez R PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The authors present a case report of bilateral tarsal tunnel syndrome occurring in a 39-year-old, slightly overweight female with a long history of varicose veins of her legs. Symptomatology suggestive of tarsal tunnel syndrome was present over the left heel. Vein stripping was done on both legs. When the burning discomfort at the inner aspect of the left heel continued in spite of the strippings, she presented at our Foot Clinic. Surgery on the left heel revealed varicosities overlying the medial and lateral plantar nerves near their origin, and removal of these resulted in prompt relief of her complaints. Nine months later and 10 months following the venous stripping of her right leg, medial right heel pain, burning, paresthesias, and a positive Tinel sign appeared over the inner aspect of her right heel. There was prompt subsidence of these complaints when again varicosities were found and removed. NLM PUBMED CIT. ID: 6862332 SOURCE: Foot Ankle 1983 Mar-Apr;3(5):290-2 305

NLM CIT. ID: 83187351
TITLE: Prevalence of non-painful heel spur and its relation to postural foot position. AUTHORS: Shama SS; Kominsky SJ; Lemont H PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 6841882 SOURCE: J Am Podiatry Assoc 1983 Mar;73(3):122-3 306

NLM CIT. ID: 83159065
TITLE: Objective technique for evaluating painful heel syndrome and its treatment. AUTHORS: Katoh Y; Chao EY; Morrey BF; Laughman RK PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 6832667 SOURCE: Foot Ankle 1983 Jan-Feb;3(4):227-37 307

NLM CIT. ID: 84008988
TITLE: Calcaneal heel spurs: etiology, treatment, and a new surgical approach. AUTHORS: Michetti ML; Jacobs SA PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The primary symptom of heel spurs is pain in the plantar surface of the heel. The authors illustrate a new approach to heel surgery--a plantar midline incision, which permits good exposure so the surgeon can visualize the soft tissue masses and eliminates postoperative paresthesias. NLM PUBMED CIT. ID: 6619521 SOURCE: J Foot Surg 1983 Fall;22(3):234-9 308

NLM CIT. ID: 84146260
TITLE: Reiter's disease in northern India. A clinical and immunogenetic study. AUTHORS: Prakash S; Mehra NK; Bhargava S; Malaviya AN PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (HLA Antigens) 0 (HLA-B27 Antigen) 9009-79-4 (Rheumatoid Factor)
ABSTRACT: Thirty-six patients fulfilling the criteria for Reiter's disease were studied (29 men and 7 women; 4:1). The mean age of onset was 23.8 years; in 75% of patients the onset was in the second and third decades. Clinical manifestations included low back pain and stiffness (69%), non specific urethritis (53%), heel pain (44%), radiographic sacroiliitis (42%), conjunctivitis (39%), dysentery and diarrhoea (33%), mucosal ulcerations (17%) kidney disease (14%), anterior uveitis (19%), and keratoderma blennorrhagicum (8%). Peripheral arthritis was mono or oligoarthritis in 58% of patients, mainly affecting the large joints of lower extremities, and it was often asymmetric (mean degree of asymmetry = 0.37). HLA-B27 antigen was detected in 83% of 36 patients compared with 5.9% of 118 controls (relative risk 79, corrected Fisher's P = 7.719E-18). NLM PUBMED CIT. ID: 6422532 SOURCE: Rheumatol Int 1983;3(3):101-4 309

NLM CIT. ID: 82270737
TITLE: Podiatric Surgery: the need for a second opinion. AUTHORS: Finkel ML; McCarthy EG; Miller D PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: A second-opinion podiatry program, designed to contain costs and enhance the quality of care, was established in the greater New York City area by the Building Service Employees' Health Fund. All nonemergency foot surgery recommended by a podiatrist that cost over $100 was included in this program. Of the 363 individuals who had a second opinion, 82 per cent were confirmed for surgery; however, the confirmation rate among those seeing a podiatrist serving as consultant was 94.3 per cent, while the confirmation rate of those seeing an orthopedists serving as consultant was 49.5 per cent. For every condition, the podiatrists overwhelmingly confirmed the need for surgery. Conversely, the orthopedists were more conservative in their recommendations regarding surgery. The program's cost was $311,813. If a second opinion consultation wasn't required for removal of corns or ingrown toenails, the total would be much less. It seems sensible (economically and medically) to encourage or require a consultation with an orthopedist for conditions such as bunions, hammertoes and heel spurs, and not to require a second opinion consultation for superficial podiatric conditions such as corns and ingrown toenails, which are treated predominantly by the podiatrist. NLM PUBMED CIT. ID: 7109754 SOURCE: Med Care 1982 Aug;20(8):862-70 310

NLM CIT. ID: 82234490
TITLE: Posterior heel pain associated with a calcaneal step and Achilles tendon calcification. AUTHORS: Fiamengo SA; Warren RF; Marshall JL; Vigorita VT Hersh A PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Factors are examined which may be associated with chronic posterior heel pain of nonrheumatologic and nonmetabolic etiology. The charts of patients in whom Haglund's disease retrocalcaneal bursitis, or "pump bumps" was diagnosed during the period from 1963-1978 at The Hospital for Special Surgery, were reviewed. Nineteen patients met the criteria of symptomatic patients. The radiographs in 12 of these patients were available for review. These cases and 104 control cases were evaluated for the presence of calcaneal spurs, Achilles tendon calcifications and a posterior calcaneal step. In addition, Fowler-Philip measurements were obtained from the radiographs and compared with Fowler and Philip's results. Although the Fowler-Philip angles of the two groups were not significantly different (p greater than 0.05), the symptomatic heels had a significantly longer horizontal calcaneal length (p less than 0.05). The incidences of Achilles tendon calcification (p = 0.004) and of a posterior calcaneal step (p less than 0.001) were higher in patients who had chronic posterior heel pain as compared to a control population. An increased horizontal length of the calcaneus and the presence of a posterior calcaneal step appeared to cause chronic posterior heel pain and degenerative lesions of the Achilles tendon. Although a posterosuperior calcaneal prominence is theoretically important, it was not in this series. A posterior calcaneal step may alter the tension within the tendon, resulting in microscopic tendon injury, decreased vascularity and loss of strength, with subsequent calcification or rupture. NLM PUBMED CIT. ID: 7094464 SOURCE: Clin Orthop 1982 Jul;(167):203-11 311

NLM CIT. ID: 82222982
TITLE: The Haglund syndrome: initial and differential diagnosis. AUTHORS: Pavlov H; Heneghan MA; Hersh A; Goldman AB Vigorita V PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Haglund syndrome is a common cause of posterior heel pain, characterized clinically by a painful soft-tissue swelling at the level of the achilles tendon insertion. On the lateral heel radiograph the syndrome is characterized by a prominent calcaneal bursal projection, retrocalcaneal bursitis, thickening of the Achilles tendon, and a convexity of the superficial soft tissues at the level of the Achilles tendon insertion, a "pump-bump." An objective method for evaluating prominence of the bursal projection is measurement using the parallel pitch lines. This measurement helps to identify patients with Haglund syndrome and patients predisposed to develop this condition, and also to differentiate local causes of posterior heel pain from systemic causes. The parallel pitch line measurement was determined in 10 symptomatic feet and 78 control feet and the results were analyzed statistically. NLM PUBMED CIT. ID: 7089270 SOURCE: Radiology 1982 Jul;144(1):83-8 312

NLM CIT. ID: 83028877
TITLE: An office-based orthotic system in treatment of the arthritic foot. AUTHORS: Glass MK; Karno ML; Sella EJ; Zeleznik R PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Patients with inflammatory arthritic disease of the feet invariably require conservative office management. The simplest method of obtaining relief has been to use commercially available extra-depth shoes combined with custommade, removable, closed-celled polyethylene foam arch supports. These supports are soft, light, and can be accurately adjusted to each patient's pathology. The technique and modifications used for relieving the commonest problems, such as anterior metatarsalgia and plantar heel pain, are discussed. NLM PUBMED CIT. ID: 6182074 SOURCE: Foot Ankle 1982 Jul-Aug;3(1):37-40 313

NLM CIT. ID: 82240369
TITLE: Hypertrophic osteoarthropathy: differential diagnosis in heel pain. AUTHORS: Bartee SL; Gudas CJ PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 7096879 SOURCE: J Am Podiatry Assoc 1982 May;72(5):256-60 314

NLM CIT. ID: 82145047
TITLE: HLA-B27-associated spondyloarthritis and enthesopathy in childhood: clinical, pathologic, and radiographic observations in 58 patients. AUTHORS: Jacobs JC; Berdon WE; Johnston AD PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (HLA Antigens) 0 (HLA-B27 Antigen)
ABSTRACT: HLA-B27 typing of all arthritic children helped to identify and focus attention on a subset whose disease was pathogenetically related to and demonstrated clinical features of ankylosing spondylitis and Reiter syndrome, but only rarely fulfilled current diagnostic criteria for those disorders (spondyloarthritis). In contrast to other forms of childhood arthritis, enthesopathy (inflammation at the sites of attachment of ligaments and tendons to bone) was a prominent feature in 75%; a family history of similar arthritis was obtained from 60%; boys were more frequently affected (2:1); urethritis, acute iritis, conjunctivitis, or keratoderma blennorrhagicum occurred at some time in 42%; and the initial attack followed an unexplained febrile illness, known dysentery or urethritis, or severe musculoskeletal trauma in 41%. The arthritis was generally pauciarticular, asymmetric, and primarily in the feet and large joints of the lower extremities. Distinctive radiographic features included periostitis, severe osteopenia, calcaneal erosions, and heel spurs; three of 58 had rapid destruction of a single joint. Only ten patients (all boys) were found to have radiographic sacroiliitis after an average of five years of disease, and only three had the Reiter triad. The lifetime risk of sacroiliitis and spinal ankylosis can only be determined by long-term follow-up of such prospectively identified groups of spondyloarthritic children. NLM PUBMED CIT. ID: 6977633 SOURCE: J Pediatr 1982 Apr;100(4):521-8 315

NLM CIT. ID: 82233995
TITLE: Plantar fasciitis in runners. AUTHORS: Taunton JE; Clement DB; McNicol K PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 7094192 SOURCE: Can J Appl Sport Sci 1982 Mar;7(1):41-4 316

NLM CIT. ID: 82088941
TITLE: Gait analysis. Alterations in support phase forces using supportive devices. AUTHORS: Scranton PE Jr; Pedegana LR; Whitesel JP PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 7053640 SOURCE: Am J Sports Med 1982 Jan-Feb;10(1):6-11 317

NLM CIT. ID: 82088932
TITLE: The heel pad. AUTHORS: Miller WE PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: In an attempt to gain insight into the etiology of heel pain, the heel pad was studied via dissection. The dynamic action of the heel pad as well as varying stimuli interpreted as pain were examined in view of their integral relationship to body functions. It is believed that the major role played by the heel pad has to do with pressure, and the larger number of nerve endings present to respond to pressure suggests that these are also the nerve endings responsible for the sensation of pain. NLM PUBMED CIT. ID: 7053632 SOURCE: Am J Sports Med 1982 Jan-Feb;10(1):19-21 318

NLM CIT. ID: 82002992
TITLE: Hypophosphatemic rickets in an adolescent cured by excision of a nonossifying fibroma. AUTHORS: Asnes RS; Berdon WE; Bassett CA PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Phosphates)
ABSTRACT: An adolescent girl complaining of chronic heel pain was found to have acquired hypophosphatemic rickets and a nonossifying fibroma of the femur. The hypophosphatemic rickets was completely corrected by surgical excision of the bone lesion. This case represents another example of tumor-induced osteomalacia. NLM PUBMED CIT. ID: 7273574 SOURCE: Clin Pediatr (Phila) 1981 Oct;20(10):646-8 319

NLM CIT. ID: 82048897
TITLE: Calcaneal epiphysitis in adolescent athletes. AUTHORS: McKenzie DC; Taunton JE; Clement DB; Smart GW McNicol KL PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Twenty cases of calcaneal epiphysitis are reviewed. Six females and fourteen males presented with the complaint of heel pain which was bilateral in 80% of the cases. All patients were active in running- related sports. The mean age was 11.2 years (9-14) and symptoms had been present, on the average, for 5.5 months. Physical examination placed particular emphasis on the alignment of the leg and foot. Clinically the pain was localized to the insertion of the achilles tendon to the calcaneal epiphysis. Biomechanical evaluation revealed marked genu varus - 6 cases; forefoot varus - 10 cases. Treatment consisted of modified rest and ice massage - all cases; new shoes with medial support and rigid heel counters - 10 cases; heel lifts - 6 cases; soft orthotics - 15 cases; and semiflexible sporthotics - 2 cases. Response to the treatment was generally good with 75% of patients having a reduction in symptoms in 1 month and 95% by 3 months. NLM PUBMED CIT. ID: 7296746 SOURCE: Can J Appl Sport Sci 1981 Sep;6(3):123-5 320

NLM CIT. ID: 81143234
TITLE: Entrapment neuropathy of muscle branch of lateral plantar nerve: a cause of heel pain. AUTHORS: Przylucki H; Jones CL PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 7204858 SOURCE: J Am Podiatry Assoc 1981 Mar;71(3):119-24 321

NLM CIT. ID: 81152437
TITLE: Plantar fasciitis and Achilles tendinitis among 150 cases of seronegative spondarthritis. AUTHORS: Gerster JC PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (HLA Antigens)
ABSTRACT: 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. NLM PUBMED CIT. ID: 7209286 SOURCE: Rheumatol Rehabil 1980 Nov;19(4):218-22 322

NLM CIT. ID: 80229491
TITLE: Quantitative scintigraphy in diagnosis and management of plantar fasciitis (calcaneal periostitis): concise communication. AUTHORS: Sewell JR; Black CM; Chapman AH; Statham J Hughes GR; Lavender JP PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 0 (Diphosphonates) 7440-26-8 (Technetium)
ABSTRACT: 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. NLM PUBMED CIT. ID: 7391835 SOURCE: J Nucl Med 1980 Jul;21(7):633-6 323

NLM CIT. ID: 82071807
TITLE: [Talalgia and calcaneal spurs: classification and etiopathogenetic theories] VERNACULAR
TITLE: Talagie e sproni calcaneari: inquadramento nosografico ed ipotesi eziopatogenetiche. AUTHORS: Baccarani G; Battaglia L PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Ita NLM PUBMED CIT. ID: 7307676 SOURCE: Chir Organi Mov 1980 May-Jun;66(3):365-9 324

NLM CIT. ID: 80197238
TITLE: The use of heel posting orthotic techniques for relief of heel pain. AUTHORS: Marr SJ; Pod FA PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: The case history is reported of a 56 year old male patient with heel pain. The treatment consisted of the design of a cushioned accomodative orthotic with high density rubber cushioning (Rubazote). The Podiatrist and technician combined to fabricate an orthotic device which relieved the heel pain. The orthotic was fabricated form heavy rubazote in order to cushion the heel strike. An assessment of the gait pattern and subsequent adjustment to the foot-ankle complex resulted in a satisfactory treatment. NLM PUBMED CIT. ID: 7377930 SOURCE: Arch Orthop Trauma Surg 1980;96(1):73-4 325

NLM CIT. ID: 80095108
TITLE: Biomechanical heel pain: a case study. Treatment by use of Birkenstock sandals. AUTHORS: Weiner BE; Ross AS; Bogdan RJ PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 521595 SOURCE: J Am Podiatry Assoc 1979 Dec;69(12):723-6 326

NLM CIT. ID: 79071092
TITLE: The absence of back pain in classical ankylosing spondylitis. AUTHORS: Hochberg MC; Borenstein DG; Arnett FC PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Despite the early description of painless spinal ankylosis, the existence of a clinical subset of ankylosing spondylitis with silent axial disease has largely been overlooked. Of 45 patients who met Rome diagnostic criteria for ankylosing spondylitis, five denied ever having back pain either as an initial symptom or during the subsequent course of their illness. All had decreased lumbar spine motion and bilateral radiographic sacroiliitis of at least grade III severity. Chest expansion was decreased in four, and radiographic involvement of the cervical and lumbar spine was observed in three and two patients, respectively. There were no differences observed in sex or race distribution, or frequencies of peripheral arthritis, heel pain, acute uveitis, genito-urinary infection or HLA-B27 positivity when these patients were compared with the remaining patients with back pain. These patients support the existence of a "latent" form of ankylosing spondylitis with silent axial disease. NLM PUBMED CIT. ID: 152820 SOURCE: Johns Hopkins Med J 1978 Dec;143(6):181-3 327

NLM CIT. ID: 79044273
TITLE: Stress fractures in the calcaneus of a child. A case report. AUTHORS: Buchanan J; Greer RB 3d PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: An 11-year-old girl with splastic quadriplegia, and immobilization atrophy developed a stress fracture of the calcaneus, are rare cause of heel pain in children. There was complete remission of symptoms with healing of the fracture. NLM PUBMED CIT. ID: 709919 SOURCE: Clin Orthop 1978 Sep;(135):119-20 328

NLM CIT. ID: 79084745
TITLE: Medial plantar neurapraxia (jogger's foot): report of 3 cases. AUTHORS: Rask MR PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Entrapment of the medial plantar nerve in the longitudinal arch causes burning heel pain, aching in the arch, and deficient sensation in the sole of the foot behind the great toe. Long distance valgus running may cause such a disorder in a jogger and the condition usually responds to conservative measures which include a change in running posture of the foot, anti-inflammatory medications, and proper footwear. The name "jogger's foot" is selected for this clinical syndrome. NLM PUBMED CIT. ID: 729244 SOURCE: Clin Orthop 1978 Jul-Aug;(134):193-5 329

NLM CIT. ID: 78218337
TITLE: Rupture of the plantar fascia in athletes. AUTHORS: Leach R; Jones R; Silva T PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 27524 SOURCE: J Bone Joint Surg [Am] 1978 Jun;60(4):537-9 330

NLM CIT. ID: 78171342
TITLE: Heel pain. AUTHORS: Sorrells RB PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 148455 SOURCE: J Ark Med Soc 1978 May;74(12):494-7 331

NLM CIT. ID: 78111660
TITLE: Management of heel pain [letter] PUBLICATION TYPES: LETTER NLM PUBMED CIT. ID: 628062 SOURCE: JAMA 1978 Mar 20;239(12):1131-2 332

NLM CIT. ID: 78210297
TITLE: A ganglion causing the tarsal tunnel syndrome: report of a case. AUTHORS: Pho RW; Rasjid C PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 276358 SOURCE: Aust N Z J Surg 1978 Feb;48(1):96-8 333

NLM CIT. ID: 80007350
TITLE: Pivotal resection of heel spurs in sports medicine: a case study and presentation. AUTHORS: Borovoy M; Hertzberg N PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Using the cresentic pivotal saw for resecting a heel spur in a new method whereby a plantar heel spur can be removed in toto with no irregular osseous margins remaining. Consequently, less trauma to the calcaneus occurs and the process of postoperative recovery is enhanced. This technique is new to the literature. Presently, we are developing a more sophisticated blade. NLM PUBMED CIT. ID: 755072 SOURCE: J Foot Surg 1978 Winter;17(4):162-4 334

NLM CIT. ID: 78220541
TITLE: Talalgia. A review of 30 severe cases. AUTHORS: Gerster JC; Saudan Y; Fallet GH PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Seronegative spondyloarthritides (Reiter's syndrome, ankylosing spondylitis, or psoriatic arthritis) was diagnosed in 24 of 30 patients with severe heel pain. Most of the patients were carriers of the antigen HLA B27. Talalgia was frequently the first symptom of disease. Heel surgery is contra-indicated during the inflammation phase, since it may cause local aggravation and risk of ankylosis of the talocalcaneal articulation. Other causes of heel pain include tendon chondrocalcinosis, local tuberculous infection, and nodular tendinitis caused by a partial rupture of the tendon. On the other hand, severe talagia was rarely found in rheumatoid arthritis, and no case was related to the presence of tophi or xanthomas of the Achilles tendon. NLM PUBMED CIT. ID: 671439 SOURCE: J Rheumatol 1978 Summer;5(2):210-6 335

NLM CIT. ID: 78045675
TITLE: Unilateral heel pain in a file clerk. AUTHORS: Layfer LF; Jones JV PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 21862 SOURCE: IMJ Ill Med J 1977 Nov;152(5):445-6 336

NLM CIT. ID: 77265663
TITLE: The painful heel. Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthrosis. AUTHORS: Gerster JC; Vischer TL; Bennani A; Fallet GH PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 901031 SOURCE: Ann Rheum Dis 1977 Aug;36(4):343-8 337

NLM CIT. ID: 76230671
TITLE: Diffuse skeletal abnormalities in Forestier disease. AUTHORS: Utsinger PD; Resnick D; Shapiro R PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Forestier disease, or ankylosing hyperostosis, is a common disorder of middle-aged and elderly persons. Characteristic clinical and radiographic features enable the physician to distinguish between this disease and ankylosing spondylitis. The principal clinical features include aching spinal stiffness with relative preservation of function and minimal evidence of spinal immobility. Many patients have elbow and heel pain and dysphagia. Typical radiographic findings are ligament ossification, para-articular osteophytosis, and bone production at sites of tendon and ligment attachment in spinal and extraspinal locations. The extraspinal roentgenographic manifestations are so characteristic that when present, they allow the diagnosis of spinal ankylosing hyperostosis to be suggested, even in the absence of axial radiographs. NLM PUBMED CIT. ID: 938166 SOURCE: Arch Intern Med 1976 Jul;136(7):763-8 338

NLM CIT. ID: 76154902
TITLE: [Heel pain as a symptom in rheumatic diseases] VERNACULAR
TITLE: Haelsmerter som symptom ved reumatiske sjukdomar AUTHORS: Hidle I PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Nor NLM PUBMED CIT. ID: 1258013 SOURCE: Tidsskr Nor Laegeforen 1976 Mar 20;96(8):504-5 339

NLM CIT. ID: 76086350
TITLE: Incomplete Reiter's syndrome: discriminating features and HL-A W27 in diagnosis. AUTHORS: Arnett FC; McClusky OE; Schacter BZ; Lordon RE PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: Reiter's syndrome (nonspecific urethritis, conjunctivitis, and arthritis) may present with arthritis alone. There are, however, other discriminating clinical features that contribute to diagnosis. Additionally, the presence of HL-A W27 provides a new diagnostic aid. Thirteen patients were studied and support the validity of the concept of incomplete Reiter's syndrome. Peripheral arthritis was the presenting complaint in all, and none had urethritis or conjunctivitis. The majority were young white men. The arthritis was oligoarticular and asymmetric with lower extremity involvement predominantly. Heel pain was a prominent symptom in 10, with periostitis of other sites in 5, and "sausage digits" in 8. Mucocutaneous lesions occurred in 1 and significant weight loss in 6. Only 2 had sacro-illiitis. Chronicity has characterized the course in 12. HL-A W27 was present in 12 of 13. Additional data suggest that Reiter's syndrome may be one of the most common forms of inflammatory arthritis in young men. NLM PUBMED CIT. ID: 946058 SOURCE: Ann Intern Med 1976 Jan;84(1):8-12 340

NLM CIT. ID: 75211417
TITLE: Plantar fasciitis. The painful heel syndrome. AUTHORS: Furey JG PUBLICATION TYPES: JOURNAL ARTICLE
ABSTRACT: 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. NLM PUBMED CIT. ID: 1150711 SOURCE: J Bone Joint Surg [Am] 1975 Jul;57(5):672-3 341

NLM CIT. ID: 75017106
TITLE: Treatment of plantar fasciitis and calcaneal spurs with the UC-BL shoe insert. AUTHORS: Campbell JW; Inman VT PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 4416727 SOURCE: Clin Orthop 1974;0(103):57-62 342

NLM CIT. ID: 71188749
TITLE: Heel spur and heel spur syndrome. AUTHORS: Rothbart BA PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 5575707 SOURCE: J Am Podiatry Assoc 1971 May;61(5):186-9 343

NLM CIT. ID: 70129408
TITLE: Osteotripsy for heel spur. AUTHORS: Mercado OA PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 5416880 SOURCE: J Am Podiatry Assoc 1970 Feb;60(2):76-9 344

NLM CIT. ID: 70036800
TITLE: [A comparative study of the effectiveness of radiotherapy in calcaneal spurs] VERNACULAR
TITLE: Sravnitel'noe izuchenie effektivnosti rentgenoterapii pri piatochnykh shporakh. AUTHORS: Dubovyi ED; Vinarov IV; Voloshina LF; Gol'dberg EB Dubinskaia EB; Dubovaia TE; Ukaz EB PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Rus NLM PUBMED CIT. ID: 5620303 SOURCE: Ortop Travmatol Protez 1967 Feb;28(2):17-20 345

NLM CIT. ID: 68285896
TITLE: Heel pain. AUTHORS: Tanz SS PUBLICATION TYPES: JOURNAL ARTICLE NLM PUBMED CIT. ID: 4968586 SOURCE: Clin Orthop 1963;28:169-78