Comparing effectiveness of polydeoxyribonucleotide injection and corticosteroid injection in plantar fasciitis treatment: A prospective randomized clinical study

BackgroundThis study aimed to compare the efficacy and safety of polydeoxyribonucleotide (PDRN) injection and corticosteroid injection for plantar fasciitis.MethodsThis study included 44 patients with plantar fasciitis, randomly allocated to the PDRN and corticosteroid groups. Evaluation using the visual analogue scale (VAS) pain score and Manchester-Oxford foot questionnaire (MOXFQ) was conducted at baseline, 1, 2, 6 weeks and 6 months. The thickness and echogenicity of the plantar fascia in ultrasonography and complications were recorded.ResultsCorticosteroid injection elicited more pain relief than did PDRN injection at 2 (p = 0.010) and 6 weeks (p = 0.016); however, it showed no superiority at 6 months (p = 0.523). MOXFQ showed similar outcomes. The thickness and echogenicity did not differ between groups and no complications were reported in either group.ConclusionsWe demonstrated that PDRN injection could be an effective and safe option for plantar fasciitis and was comparable to corticosteroid injection after 6 months follow up.Level of evidenceII, comparative study.     

Extracorporeal shock wave therapy versus other therapeutic methods for chronic plantar fasciitis

BackgroundTo conduct a meta-analysis comparing the efficacy of general ESWT with that of other therapies and to assess its effectiveness in chronic plantar fasciitis.MethodsA literature search was performed in PubMed, Embase, Web of Science and the Cochrane Library for information from the earliest date of data collection to March 2018. Studies comparing the benefits and risks of extracorporeal shock wave therapy with those of other therapies for chronic plantar fasciitis were included. Statistical heterogeneity was quantitatively evaluated by a X² test with the significance set as P < 0.10 or I² > 50%.ResultsThirteen trials consisting of 1,185 patients were included (637 patients were treated with ESWT; 548 patients, with OT). The results showed that patients treated with ESWT had increased success or improvement rates, an increased modified Roles & Maudsley (RM) score, a reduction of pain scales, reduced return to work time, and fewer complications than patients treated with other therapy methods (P < 0.1).ConclusionsCompared with patients who received other therapies for chronic plantar fasciitis, patients treated with ESWT responded better, had less complications and showed a clear difference in efficacy between ESWT and other therapy in chronic plantar fasciitis.Level of Evidence: Level IV, therapeutic study.     

Rearfoot eversion has indirect effects on plantar fascia tension by changing the amount of arch collapse

BackgroundRearfoot eversion motion and arch height are believed to contribute to increased tension on the plantar fascia and arch collapse during gait but the specifics of these relationships are not clear.ObjectiveTo examine the relationships among static arch height, rearfoot eversion, dynamic arch height, and plantar fascia tension.Methods28 healthy males participated. After static arch height was measured, the subjects were asked to run at 4.5 m/s while frontal plane rearfoot motion, dynamic arch height, and ground reaction forces were collected. The relationships among variables were examined with bivariate correlations and path analysis.ResultsThe results indicated a high correlation between dynamic arch height and static arch height (r = 0.642), plantar fascia tension (r = ?0.797), and maximum rearfoot eversion motion during gait (r = ?0.518). The path analysis model without the direct rearfoot eversion effect explained 81.2% of the variance in plantar fascia tension, while the model with the direct rearfoot eversion effect explained 82.1% of the variance in plantar fascia tension.DiscussionIncluding the indirect effect of maximum rearfoot eversion motion on plantar fascia tension through control of dynamic arch height is the model that best explains the interrelationships of these foot characteristics.ConclusionThe amount of maximum rearfoot eversion motion itself is not a good predictor of plantar fascia tension, however, together with the arch height, maximum rearfoot eversion motion is a good predictor because it has a pronounced indirect effect on plantar fascia tension.     

The treatment of intractable plantar fasciitis with platelet-rich plasma injection

BackgroundWhilst most cases of plantar fasciitis can be settled with existing conservative treatment, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue problems.ObjectiveEvaluate the effectiveness of platelet rich plasma (PRP) in chronic cases of plantar fasciitis.Patients and methodsPatients with plantar fasciitis not responded to a minimum of 1 year standard conservative management were offered PRP therapy. Injections were performed in theatre as a day case. Roles–Maudsley (RM) scores, Visual Analogue Scores (VAS), AOFAS scores and ‘would have injection again’ were collated pre-operatively, three and six months.ResultsProspective data was collected of 50 heels (44 patients). At six month review, RM score improved from mean 4 to 2 (p < 0.001), VAS improved from 7.7 to 4.2 (p < 0.001) and AOFAS improved from 60.6 to 81.9 (p < 0.001). 28 patients (64%) were very satisfied and would have the injection again.No complications were reported.ConclusionIn these chronic cases, PRP produce an efficacy rate, approaching 2 out of every 3. The procedure was safe with no reported complications. The authors feel PRP may have some role in treatment, and merits further study with a prospective randomised trial.     

Magnetic resonance imaging findings of chronic plantar fasciitis before and after extracorporeal shock wave therapy

IntroductionThe objective of this study is to examine the relationships between treatment outcome and changes in magnetic resonance (MR) imaging findings after extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis.MethodsThe subjects were 23 feet of 23 patients of refractory plantar fasciitis. The mean age was 53.7 years. The thickness of the plantar fascia (PF) and findings of a high-signal intensity area (HSIA) inside the PF, edema around the PF, and bone marrow edema (BME) of the calcaneus were investigated on MR images. The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and a visual analogue scale (VAS) were used. Correlations between an improvement in symptoms and one in the MRI findings were analyzed.ResultsThe mean thickness of the PF was 4.4 ± 1.6 mm before ESWT and 4.6 ± 1.8 mm six months after ESWT. After ESWT, there was a decrease in the numbers of feet showing HSIA inside the PF from 15 to 6, in edema around the PF from 16 to 2, and in BME of the calcaneus from 11 to 4. Clinical outcomes improved with ESWT from 70.3 ± 5.5 to 88.6 ± 9.1 points (JSSF), 74.1 ± 25.3 to 28.5 ± 24.4 points (VAS), respectively. Improvements in symptoms according to the JSSF and VAS scores and improvement in edema around the PF on MR images showed a significant correlation.ConclusionsEdema around the PF improved significantly in association with an improvement in symptoms after ESWT.     

Results after gastrocnemius recession in 73 patients

BackgroundVery few studies describe the clinical results and complications following the surgical procedure of gastrocnemius recession.PurposeTo survey the patient reported outcomes in patients operated with gastrocnemius recession as single procedure for various foot conditions.Material and methods93 patients operated with gastrocnemius recession as single procedure between 2006 and 2011 were detected in the database. 73 patients responded to the invitation for study participation. Questionnaires containing patient reported satisfaction, complications, plantar flexion power and visual analog pain score were used for evaluation of the postoperative result.Results45/73 (62%) patients reported a good or excellent result. 8/73 (11%) patients reported a significant postoperative complication. 16/73 (22%) patients noted reduced or severely reduced plantar flexion power after surgery. VAS pain score significantly decreased from 7.0 before surgery to 1.8 (p =0.015) after surgery for patients with plantar fasciitis (n =18) and from 5.6 to 2.3 (p < 0.01) for patients with metatarsalgia (n = 28).ConclusionPatients treated with gastrocnemius recession for plantar fasciitis demonstrated good clinical results. The complication rate was higher than reported by others.     

Plantar fasciitis and the calcaneal spur: Fact or fiction?

BackgroundPlantar fasciitis is a common diagnosis in patients presenting with heel pain. The presence of co-existing calcaneal spurs has often been reported but confusion exists as to whether it is a casual or significant association.MethodsThe lateral heel radiographs of nineteen patients with a diagnosis of plantar fasciitis and nineteen comparison subjects with a lateral ankle ligament sprain matched for age and sex, were reviewed independently by two observers. Objective measurements of calcaneal spur length and a subjective grading of spur size were recorded.ResultsThere was a significantly higher prevalence of calcaneal spurs in the cases than the comparison group (89% versus 32%; McNemar chi-square = 9.09, df = 2, p = 0.00257). There was good inter- and intra-observer agreement.ConclusionThe current study has demonstrated a significant association between plantar fasciitis and calcaneal spur formation. Further research is warranted to assess whether the association is causal.     

Extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized controlled trial

BackgroundThis study aimed at estimating the extent to which a combination therapy of extracorporeal shockwave therapy (ESWT) with usual care (exercise and orthotic support) improve functional ability in the patient with plantar fasciitis when compared to usual care alone.MethodsParticipants with plantar fasciitis were randomly allocated into two groups: ESWT (n = 23), and control (n = 21). All participants received home exercise program with orthotic support. In addition, ESWT group received 2000 shock waves with 0.02 mJ/mm² for three sessions. Functional outcomes were measured by function subscale of American orthopedic foot and ankle society (AOFAS-F) score and 12 minutes walking test including walking speed, cadence. The scores were recorded at baseline, third week and third month after the treatment. Analysis was performed using repeated measures ANOVA, and an intention to treat approach using multiple imputations.ResultsResults showed that there was a significant improvement in AOFAS-F total score and walking speed over three months in both groups (p < 0.001, p = 0.04 respectively); improvements in AOFAS-F were particularly in activity limitation (p = 0.001), walking distance (p = 0.02) and walking surface (p = 0.02). Groups were comparable with each other for both walking speed and AOFAS-F in any assessment time (p > 0.05). However, groups performed differently in cadence where there was an increase in cadence in ESWT group whereas a decline in control at the third month (p = 0.07).ConclusionThe results revealed that ESWT did not have an additive benefit over usual care to improve foot function and walking performance in patient with plantar fasciitis over three months post-treatment.     

Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences

ObjectiveImaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups.DesignSonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA).ResultsICCs _{(3, 3)} for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls.ConclusionThe results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.     

Effect of different orthotic concepts as first line treatment of plantar fasciitis

BackgroundEvaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis.MethodsProspective, randomized head-to-head trial in 30 adults (21 women, 9 men) with plantar fasciitis without any anatomic alterations. Three different prefabricated orthotics were tested (thin, non supportive orthotic (NO); soft supportive foam orthotic (FO); foam covered rigid self-supporting plastic orthotic (PO)). The follow up was 3 weeks. Main outcome measures were maximum and average pain (VAS), duration of pain per day, walking distance and subjective comfort.ResultsThere was no significant effect of NO on maximal pain and average pain. FO and PO had a significant effect on pain levels (p < 0.05) whereas PO was superior concerning pain reduction and the time until the onset of effect (p < 0.05).ConclusionsPO are superior regarding pain reduction and pain free time when compared to FO. NO did not demonstrate a significant effect in the test setup used.     

Plantar fasciitis: A randomized comparative study of platelet rich plasma and low dose radiation in sportspersons

BackgroundPlantar Fasciitis makes up about 15% of patients requiring professional care due to foot symptoms. The treatment methods are numerous with none proving to be clearly superior to others. We aimed to compare two common treatment methods in search of the best treatment.MethodAll consecutive sportspersons presenting to our OPD with clinical diagnosis of plantar fasciitis underwent treatment consisting of stretching exercises, activity modification, and NSAID’s for 6 months. First 40 patients who did not respond to the treatment were divided randomly into two groups of 20 patients each, Group A (Platelet rich plasma − PRP) and Group B (low dose radiation − LDR). At the time of final follow-up (6 months) the mean improvement in the pain score (Visual-Analogue-Scale), American Orthopaedic Foot and Ankle Score (AOFAS) and Plantar fascia thickness on ultrasound were compared.ResultSignificant improvement in all 3 parameters was noted at the time of final follow up within both groups. When compared to each other, the difference in outcome of both these Groups on the given 3 parameters came out to be insignificant (p > 0.05).ConclusionPRP is as good as LDR in patients with chronic recalcitrant plantar fasciitis not responding to physical therapy.     

Can static foot posture measurements predict regional plantar surface area?

BackgroundThe intent of this study was to determine if the use of a single or combination of static foot posture measurements can be used to predict rearfoot, midfoot, and forefoot plantar surface area in individuals with pronated or normal foot types.MethodsTwelve foot measurements were collected on 52 individuals (mean age 25.8 years) with the change in midfoot width used to place subjects in a pronated or normal foot mobility group. Dynamic plantar contact area was collected during walking with a pressure sensor platform. The 12 measures were entered into a stepwise regression analysis to determine the optimal set of measures associated with regional plantar surface area.ResultsA two variable model was found to describe the relationship between the foot measurements and forefoot plantar contact area (r² = 0.79, p < 0.0001). A four variable model was found to describe the relationship between the foot measurements and midfoot plantar contact area (r² = 0.85, p < 0.0001) in those individuals with a 1.26 cm or greater change in midfoot width.ConclusionsThe results indicate that clinicians can use a combination of simple, reliable and time efficient foot measures to explain 79% and 85% of the plantar surface area in the forefoot and midfoot, respectively.     

The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain

BackgroundPsychological variables, including catastrophic thoughts and kinesiophobia, are common in people with chronic musculoskeletal pain and are associated with pain and function. However, the role of each factor has not been evaluated in people with plantar heel pain (plantar fasciitis).MethodsThirty-six participants diagnosed with plantar heel pain were recruited. Main outcome measures included the Pain Catastrophising Scale, Tampa Scale of Kinesiophobia, the Foot Health Status Questionnaire and a Visual Analogue Scale. Hierarchical regression models were developed to evaluate the association between each psychological variable with variations in foot pain, first step pain and foot function.ResultsIn a full model with age, sex and BMI, kinesiophobia contributed to 21% of the variability in foot function and was a significant predictor in this model (Beta = −0.49, P = 0.006). In a separate model, catastrophising explained 39% of the variability in foot function and was a significant predictor in this model (Beta = −0.65, P < 0.001). Finally, pain catastrophising accounted for 18% of the variability in first step pain and was a significant predictor in a model that also included age, sex and BMI (Beta = 0.44, P = 0.008).ConclusionsAfter controlling for age, sex and BMI, kinesiophobia and catastrophising were significantly associated with foot function, while catastrophising was associated with first step pain in people with plantar heel pain. In addition to addressing biological factors in the management of plantar heel pain, clinicians should consider the potential role of pain catastrophising and kinesiophobia in this population.     

Does the minimally invasive complete plantar fasciotomy result in deformity of the Plantar arch? A prospective study

BackgroundComplete plantar fasciotomy has been associated with changes in foot loading, leading to medial longitudinal arch collapse. The purpose of this study is to analyse our clinical experience with percutaneous complete plantar fasciotomy and quantify the possible changes in foot loading measured by the calcaneal pitch angle.MethodsA prospective case series study with patients operated between 2005–2012 was conducted, where AOFAS, Maryland Foot Score (MFS), VAS and radiological calcaneal pitch (CP) were recorded. Postoperative data were collected, where the surgeon evaluated the presence of complications, and an independent investigator performed radiological and scale evaluations follow-up: AOFAS, MFS, VAS and Benton-Weil questionnaire.ResultsA total of 60 patients, 62 feet, with a mean follow-up of 57 months (range 13–107) were studied. The MFS increased a mean of 21 points (p = .001), the AOFAS score a mean of 25 points (p = .001), and the VAS decreased a mean of 8.89 points (p = .001). A total of fifty-seven feet (91.9%) were pain-free at the end of follow-up. The mean CP dropped from 20.2° (range 11–34) preoperatively to 19.3° (range 11–34) at the end of follow-up (p = .05). In 25 feet (40.3%) there were no changes in the calcaneus pitch angle, in 21 feet dropped 1° (33.9%), in 11 dropped 2° (17.8%), 3 feet 3° (4.8%) and 2 feet (3.2%) 4°. Postoperative complications were noted in 4 feet (6.4%), with lateral column pain. The surgery meets the expectations of all patients.ConclusionsPercutaneous total fascia release is safe and does not produce a significant drop in arch height based on the radiological finding. Lack of success after surgery may be explained by other pathologies that might appear like plantar fasciitis. Further studies with gait analysis after total plantar fascia release in patients are needed.     

Clinical and imaging effects of corticosteroids and platelet-rich plasma for the treatment of chronic plantar fasciitis: A comparative non randomized prospective study

The purpose is to compare the effectiveness and imaging changes (US and MRI) between PRP and corticoids injections for the treatment of chronic plantar fasciitis, using clinical results evaluated by the visual analogue scale (VAS), the AOFAS clinical rating system and the modified Roles and Maudsley score, and using imaging results (US and MRI). Our hypothesis is that PRP infiltrations are a more effective therapeutic method than infiltrations with corticosteroids. A single-centre, non randomized, prospective study of 40 consecutive patients (40 feet) with plantar fasciitis who had not responded to conservative treatment for at least 6 months was undertaken. The first 20 consecutive patients (group A) were treated with two local injections of 4 ml of a PRP concentrate. The second group of 20 patients (group B) were injected with 4 ml of 40 mg methylprednisolone. Clinical results were evaluated using a visual analogue scale (VAS), the AOFAS clinical rating system and the modified Roles and Maudsley score, with a mean follow-up of 33 months. Imaging results were evaluated by plantar US after 3 and 6 months, and MRI after 6 months. There were no complications arising from the treatment. In group A (PRP), the VAS changed from 8.25 to 1.85 and the AOFAS from 47.05 to 92.10. In group B (methylprednisolone), the VAS changed from 7.7 to 5.30 points and from 50.85 to 49.75 on the AOFAS. In the imaging tests, the thickness of the fascia in group A changed from 7.90 mm to 4.82 mm over 3 months following the injection, maintaining this thickness in the biannual controls. In group B the change was from 8.05 mm to 6.13 mm over 3 months, increasing to 6.9 mm after 6 months. The other inflammatory signs improved in all cases, especially in group A. The treatment of chronic plantar fasciitis by two injections of PRP is a safe, more efficient and long-lasting method than corticoid injections.     

An evaluation of the long-term effects of total plantar fasciotomy—A preliminary study

BackgroundPlantar fascia release for chronic plantar fasciitis has given excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential post-operative problems, commonly weakness of the medial longitudinal arch (MLA) and pain in the lateral midfoot.MethodsEight total plantar fasciotomy patients (five bilateral and three unilateral) were evaluated subjectively and objectively with regards to surgical outcome and biomechanical change. The centre of pressure (COP) and loading of the foot were measured using the F Scan mobile system and COM’nalysis software. In addition, five control subjects were evaluated with the F Scan. The reading for one foot of one of the control subjects was discarded due to a biomechanical abnormality.ResultsThe results of this study were that the COP of the foot in post-total plantar fasciotomy subjects was significantly laterally deviated throughout the propulsive phase of gait compared to that of control subjects (p < 0.05). There was no significant difference in plantar pressure at the rearfoot or the first metatarsophangeal joint (MTPJt) between the post-operative and control groups (p > 0.05). Six of the eight of the post-operative patients (11 feet) considered the procedure to be successful in resolving their symptoms.ConclusionTotal plantar fasciotomy may result in changes to the COP of the foot. It could be extrapolated from this data, in conjunction with subjective visual clinical observations of gait, that supination of the foot could occur post-operatively rather than the pronatory state secondary to a collapsed arch that, collectively, the results of cadaver studies have suggested. The conclusions drawn from this pilot study are to some extent speculative, as the measurements were only made post-operatively and a small number of subjects were studied. Further research is required in this area.     

El hemograma como factor predictivo de déficit de hierro y/o transfusión en paciente pendiente de artroplastia

IntroductionAnemia and iron deficiency predispose to an increased risk of transfusion with a consequent increase in morbidity and mortality. The study analyzes whether blood cell count parameters in addition to detecting anemia can predict iron deficiency and/or transfusional risk in patients undergoing mostly to scheduled primary hip and knee arthroplasty.ObjectiveTo analyze how blood cell count parameters predict iron deficiency and/or transfusional risk in patients undergoing programmed arthroplasty.Material and methodsThe analytical and transfusion results of 522 patients undergoing arthroplasty have been prospectively collected between 2013 and 2019 and the discriminative and predictive capacity of the basic parameters of the red cells have been analyzed; hemoglobin (Hb), mean cell volume, mean cell hemoglobin (HCM) and red blood cell distribution width (RDW) for the identification of presurgical iron deficiency and postsurgical transfusion.ResultsAnaemia was detected in 6.6%, “suboptim” Hb (<13 g/dL) in 14.5% and iron deficiency in 32.4%. Anemia detects only 13.8% of ID.After logistic regression analysis, the multivariate model significantly related Hb (p = .004), mean corpuscular hemoglobin (MCH) (p = .026), and the red cell distribution width (RDW) (p = .001) with ID; but mean corpuscular volume (MCV) is not significant.Hb, age and transferrin saturation index have been the only risk factors for transfusional risk of the parameters analyzed.ConclusionsThe hemogram contains parameters that correlate with iron deficiency, however, mean cell volume, so widely used for the orientation of iron deficiency, is not valid as a discriminator of iron deficiency in this group of patients.Low Hb and transferrin saturation index are modifiable predictors for transfusion risk.     

Investigation of the relationship between the thickness of the plantar calcaneonavicular ligament and plantar fascia in patients with plantar fasciitis

BackgroundAlthough patients with plantar fasciitis show spring ligament laxity, the thickness of the spring ligament in patients with plantar fasciitis remains unclear. This study aimed to elucidate the morphological characteristics of the spring ligament in patients with plantar fasciitis based on an ultrasound imaging system (US).MethodsThirty feet of 30 patients (painful group) diagnosed with plantar fasciitis at our hospital and thirty feet of 30 healthy volunteers (healthy group) without plantar pain were investigated. The thicknesses of both the spring ligament and plantar fascia were assessed via a US statistical comparison of the spring ligament and plantar fascia thickness between the painful and healthy groups. This was performed using Welch’s t-test, and the significance level was set at p < 0.01. In addition, Pearson’s correlation coefficient was calculated to assess the correlation between the spring ligament and plantar fascia thickness in the two groups, and the significance level was set at p < 0.01.ResultsThe spring ligament thickness in the painful group was significantly lower than that in the healthy group (p < 0.001). The thickness of the plantar fascia in the painful group was significantly greater than that in the healthy group (p = 0.03). In addition, the correlation between the spring ligament and plantar fascia thickness was moderately negative (r = −0.42, p = 0.001). The thicker the plantar fascia in the subjects, the thinner was the spring ligament.ConclusionsThe thickness of the spring ligament in patients with plantar fasciitis decreased. The thinning of the spring ligament was negatively correlated with the thickening of the plantar fascia as per the US evaluation. Based on the spring ligament thinning determined via US evaluation, interventions such as insoles from an early stage could prevent the onset of plantar fasciitis.     

Calcaneal spurs: Examining etiology using prehistoric skeletal remains to understand present day heel pain

BackgroundCalcanei are the most common sites for bony spurs. Although calcaneal enthesophytes have been extensively researched, many unknowns remain. Whether biological factors, such as age, weight and genetics, play a greater role in calcaneal spur etiology than activity is still unknown.ObjectivesThe current study examines 121 adults from a prehistoric hunter-gatherer population to aid in understanding bony spur etiology.MethodsCalcaneal spurs are scored as present or absent on the dorsal or plantar side; they are analyzed in regards to their relationships with age, sex, osteoarthritis, cortical index, femoral head breadth and muscle markers.ResultsDorsal and plantar spurs frequencies increase with age (chi-squares = 16.90, 7.268, Ps < 0.05, respectively). Dorsal spurs were more frequent than plantar spurs (chi-square = 38.000; P < 0.0001). There is a positive relationship with calcaneal spurs and upper limb and lower limb osteoarthritis (chi-squares = 5.587, 7.640, Ps < 0.05, respectively).ConclusionsThe data presented support that dorsal spurs are in part the result of activities, but plantar spurs may be a more modern phenomena resulting from long periods of standing and excess weight.     

The analgesic efficacy of continuous fascia iliaca block vs. continuous psoas compartment block after hip surgery: A comparative study

BackgroundBoth psoas compartment block and fascia iliaca compartment block have been shown to be reliable blocks for postoperative pain relief for procedures involving the hip joint. This study evaluated the efficacy of continuous psoas compartment block with continuous fascia iliaca block for postoperative analgesia after hip surgery.MethodsIn randomized blinded study Forty, ASA I–III patients aged 30–75 years, with BMI less than 40, scheduled for hip surgery, were divided to one of two groups. Group P: continuous psoas compartment block (n = 18) and group F: continuous fascia iliaca block (n = 19). Standard general anesthesia was induced after finishing the block technique. After recovery 30 ml of 0.125% levobupivacaine was injected through the catheter to all patients. Postoperative 24 h meperidine consumption, patient satisfaction, visual analogue scale pain scores at (1, 6, 12, 18, and 24 h) postoperative, postoperative hemodynamics (HR and MAp), evidence of sensory and motor blockades, and incidence of adverse effects were recorded.ResultsThere was no significant difference between the two groups in 24 h postoperative meperidine requirements, postoperative VAS, patient satisfaction, postoperative hemodynamics, and distribution of sensory and motor block of (femoral, lateral femoral cutaneous, and obturator nerves). The epidural anesthesia occurred in two patients in psoas group (11%).ConclusionBoth continuous fascia iliaca block and continuous psoas compartment block were comparable in providing safe and effective analgesia after hip surgery.