Spontaneous distal rupture of the plantar fascia

Spontaneous ruptures of the plantar fascia are uncommon injuries. They typically occur at its calcaneal insertion and usually represent a complication of plantar fasciitis and local treatment with steroid injections. In contrast, distal ruptures commonly result from traumatic injuries. We describe the case of a spontaneous distal rupture of the plantar fascia in a 48‐year‐old woman with a low level of physical activity and no history of direct injury to the foot, plantar fasciitis, or steroid injections.     

应用等离子刀生物学特征完成内窥镜下跖筋膜松解术

目的:观察等离子刀在内窥镜下跖筋膜松解中的应用效果及优势。方法:选取2002-01/2005-02南京医科大学附属南京第一医院骨科收治的12例患者,跖筋膜炎7例,先天性高弓仰趾足畸形3例,马蹄内翻足2例。分别在跟骨内外侧建立两个入路,引入关节镜和等离子刀。等离子刀由内向外切开跖筋膜,直到显示跖筋膜下的疏松结缔组织或可见到拇展肌、趾短屈肌等的肌纤维。对于高弓足和马蹄内翻足,在切开处的远端用Saber等离子刀再作数个横行切开,并且用蓝钳切除掉部分跖筋膜组织,也可以用等离子刀进行汽化消融。对于跖筋膜炎,只切开跖筋膜内侧的2/3。在高弓足和马蹄内翻足的病例,同时施行截骨矫形、跟腱延长或肌腱转移等其他手术。记录手术时间并观察足跟局部反应和畸形矫正效果。结果:12例患者均成功完成手术进入结果分析。①手术时间5￣20min。②术后足底肿胀较轻,渗出少,未见皮肤的坏死和感染。③术后随访≥14个月。7例跖筋膜炎的病例,有4例疼痛完全缓解,或仅在走高低不平的路时有不适感;3例疼痛较术前有好转,但仍然有隐痛的感觉,不过能接受,不需要服用止痛药。3例高弓足的病例,术后高弓畸形明显改善,足底和趾背胼胝、疼痛消失,能穿皮鞋行走,其中有1例主诉足趾背伸肌力减弱。马蹄内翻足的病例,术后对外形的矫正都很满意。结论:等离子刀用于内窥镜下跖筋膜松解具有明显的优点:①等离子刀具有止血的作用,术后基本没有什么渗血。②创伤小,损伤反应轻,康复快。③操作简便,手术时间短。④安全性高。     

同种异体肌腱移植重建跖腱膜32例

文章对承德医学院附属医院足底跖腱膜缺损的32例患者进行回顾性病例分析,所有患者应用同种异体肌腱重建跖腱膜,以期最大限度地恢复足的外观,保留足的功能.手术分2期进行:一期完成足底创面的覆盖和修复,根据患者足底损伤的情况,20例患者应用小腿内侧皮瓣修复足底创面.其余12例患者的撕脱皮瓣进行了原位缝合,在创面完全愈合后1个月,进行2期手术.2期手术根据跖腱膜的损伤情况,26例跖腱膜完全缺失的患者应用3条同种异体肌腱进行修复,其余6例跖腱膜部分缺损的患者应用2条同种异体肌腱进行了重建,修复的同时均应用钢丝进行了辅助固定.术后6周,患者扶拐下地行功能锻炼,术后6个月抽出钢丝.32例患者未出现排斥反应,创面均1期愈合.26例术后6个月复查,患者已部分负重行走,X射线平片示足弓彤状维持良好;1年后复查,患者已完全负重行走,X射线半片示足弓形状维持良好;2年后复查,患足功能良好,外形满意,X射线平片示足弓形状维持良好.可见,应用同种异体肌腱重建跖腱膜,不损坏正常的组织结构,不涉及到肌腱粘连的问题,可以维持足的基本形态结构,保留足的功能,是一种可行术式.     

Contribution of plantar fascia to the increased forefoot pressures in diabetic patients

OBJECTIVES: Secondary to peripheral neuropathy, plantar hyperpressure is a proven risk factor for foot ulceration. But limited joint mobility (LJM) and soft tissue abnormalities may also contribute. The aim of this study was to evaluate the relationships among thickness of plantar fascia, mobility of the metatarso-phalangeal joint, and forces expressed under the metatarsal heads. RESEARCH DESIGN AND METHODS: We evaluated 61 diabetic patients: 27 without neuropathy (D group), 19 with neuropathy (DN group), and 15 with previous neuropathic foot ulceration (DNPU group). We also examined 21 control subjects (C). Ultrasound evaluation was performed with a high resolution 8- to 10-MHz linear array (Toshiba Tosbee SSA 240). The foot loading pattern was evaluated with a piezo-dynamometric platform. First metatarso-phalangeal joint mobility was assessed with a mechanic goniometer. RESULTS: Diabetic patients presented increased thickness of plantar fascia (D 2.9 +/- 1.2 mm, DN 3.0 +/- 0.8 mm, DNPU 3.1 +/- 1.0 mm, and C 2.0 +/- 0.5.mm; P < 0.05), and significantly reduced motion range at the metatarso-phalangeal joint (D 54.0 +/- 29.4 degrees, DN 54.9 +/- 17.2 degrees, DNPU 46.8 +/- 20.7 degrees, and C 100.0 +/- 10.0 degrees; P < 0.05). The evaluation of foot-floor interaction under the metatarsal heads showed increased vertical forces in DN and DNPU and increased medio-lateral forces in DNPU. An inverse correlation was found between the thickness of plantar fascia and metatarso-phalangeal joint mobility (r = -0.53). The thickness of plantar fascia was directly correlated with vertical forces under the metatarsal heads (r = 0.52). CONCLUSIONS: In diabetic patients, soft tissue involvement may contribute to the increase of vertical forces under the metatarsal heads. Changes in the structure of plantar fascia may also influence the mobility of the first metatarso-phalangeal joint.     

1例食管自发性破裂病人的护理

食管破裂在临床上不多见。但其后果极为严重 ,如不及时处理 ,几乎毫不例外地发生纵隔炎、食管胸膜瘘 ,可导致死亡[1] 。我院外科于 1999年 8月成功救治了 1例食管自发性破裂病人。现报告如下。1　病例介绍　　病人 ,男 ,2 6岁 ,主因饮酒约 5 0 0mL后腹痛 4h ,于 1999年8月 2 4日 17:0 0入院。查体 :体温 3 6.6℃、脉搏 96/min、呼吸2 0 /min、血压 16/12kPa。痛苦面容 ,心肺未见异常 ,腹平坦 ,全腹肌紧张 ,右下腹压痛阳性 ,肠鸣音弱 ,未闻及气过水声。化验 :血红蛋白 12 0 g/L、白细胞 11.6× 10 9/L、中性粒细胞 80 %、淋巴细胞 2 0 % ;X…     

Quantitative tissue parameters of Achilles tendon and plantar fascia in healthy subjects using a handheld myotonometer

Objective

The aim of the study was to examine the quantitative tissue properties of the Achilles tendon and plantar fascia using a handheld, non-invasive MyotonPRO device, in order to generate normal values and examine the biomechanical relationship of both structures.

Effects of plantar fascia stiffness on the biomechanical responses of the ankle-foot complex

BACKGROUND: The plantar fascia is one of the major stabilizing structures of the longitudinal arch of human foot, especially during midstance of the gait cycle. Knowledge of its functional biomechanics is important for establishing the biomechanical rationale behind different rehabilitation, orthotic and surgical treatment of plantar fasciitis. This study aims at quantifying the biomechanical responses of the ankle-foot complex with different plantar fascia stiffness. METHODS: A geometrical detailed three-dimensional finite element model of the human foot and ankle, incorporating geometric and contact nonlinearities was constructed by 3D reconstruction of MR images. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the plantar fascia on the stress/strain distribution of the bony, ligamentous and encapsulated soft tissue structures. FINDINGS: The results showed that decreasing the Young's modulus of plantar fascia would increase the strains of the long and short plantar and spring ligaments significantly. With zero fascia Young's modulus to simulate the plantar fascia release, there was a shift in peak von Mises stresses from the third to the second metatarsal bones and increased stresses at the plantar ligament attachment area of the cuboid bone. Decrease in arch height and midfoot pronation were predicted but did not lead to the total collapse of foot arch. INTERPRETATION: Surgical dissection of the plantar fascia may induce excessive strains or stresses in the ligamentous and bony structures. Surgical release of plantar fascia should be well-planned to minimise the effect on its structural integrity to reduce the risk of developing arch instability and subsequent painful foot syndrome.     

Ultrasound diagnosis of quadriceps tendon rupture

Quadriceps tendon ruptures are an uncommon knee injury. The diagnosis is often complicated by a limited examination secondary to edema and pain, the insensitivity of radiographs, and the unavailability of non-emergent magnetic resonance imaging. A delay in diagnosis and treatment has been shown to cause significant morbidity. A case report of bilateral quadriceps tendon rupture is presented demonstrating the utility and ease of bedside ultrasound to rapidly confirm the diagnosis.     

自发性食管破裂患者的护理

自发性食管破裂系指未能找出明确原因的食管穿孔,可发生在剧烈呕吐后,或因胸部受剧烈打击、减速性损伤等,患者因腹内压急骤增高并传递至声门,使食管腔内压力迅速上升（〉15cmH2O）,造成食管扩张而撕裂。     

Effect of Achilles tendon loading on plantar fascia tension in the standing foot

BACKGROUND: The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. METHODS: A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. FINDINGS: With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. INTERPRETATION: Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.     

The influence of athletic activity on the plantar fascia in healthy young adults

PURPOSE: Complaints deriving from the plantar fascia are relatively common in athletes. This study aimed to investigate the changes of thickness of plantar fascia via sonography in healthy young adults with different levels of activity. PATIENTS AND METHODS: One hundred ten adults with normal body mass index were separated into three groups according to activity level: sedentary (group 1, n = 50), athletic activity less than 7 hours per week (group 2, n = 30), and athletic activity 7 or more hours per week (group 3, n = 30). The thicknesses of the plantar fascia at origin and at a point 5 mm distal to origin were measured via sonography. RESULTS: The mean values of the thickness of the proximal plantar fascia (PFp) and the distal plantar fascia (PFd) in group 1 were similar to those of groups 2 and 3 (p > 0.05). The mean values of PFp and PFd were significantly higher in men than in women (p < 0.05). The mean values of PFp and PFd were similar in left and right feet (p > 0.05). There were moderate positive correlations between PFp and weight, height, and body mass index but no correlation between PFp and amount of athletic activity. CONCLUSIONS: The thickness of the plantar fascia at origin did not change with athletic activity at the amateur level.     

Effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity

BackgroundThe plantar fascia is exposed to repetitive tensile stress induced by cyclic loads associated with daily activities, such as walking and running. Due to overuse or abnormal foot alignment, insertional and distal (i.e., mid-substance) regions within the plantar fascia may exhibit microtears, which leads to plantar fasciopathy. Ultrasound shear wave elastography is an imaging technique to measure shear wave velocity propagating through biological tissues, considered herein as an index of tensile stress. This study aimed to quantify the effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity.MethodsShear wave velocity of the plantar fascia was measured in the insertional and distal regions using ultrasound shear wave elastography in sixteen healthy participants (7 males and 9 females). The measurements were performed while the toes were maintained in neutral or dorsiflexed positions.FindingsWhen considering the insertional region, there was no significant difference in shear wave velocity between neutral toe position [mean (SEM): 5.4 (0.6) m/s] and dorsiflexed toe position [5.5 (0.5) m/s] (P = 0.88; effect size = 0.05). When considering the distal region, there was a significant difference in shear wave velocity between the neutral position [7.8 (0.4) m/s] and dorsiflexed position [9.9 (0.3) m/s] (P = 0.002; effect size = 0.88). The difference in shear wave velocity between the insertional and distal regions showed a large effect size for either neutral (P = 0.010; effect size = 0.75) or dorsiflexed toe position (P = 0.003; effect size = 0.86).InterpretationIn contrast to clinical beliefs, these findings suggest that toe dorsiflexion induces non-homogeneous changes in tensile stress within the plantar fascia.