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.     

Endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal for management of painful heel syndrome

BackgroundThe pathogenesis of painful heel syndrome is multifactorial including plantar fasciitis, increased intra-osseous pressure of the os calcis, calcaneal periostitis and presence of calcaneal spur. The currently used endoscopic treatment of painful heel syndromes involves endoscopic plantar fascia release alone without addressing other pathological changes.ObjectivesTo evaluate the clinical outcome of endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal.MethodsThe study was conducted on 22 cases/24 feet with idiopathic painful heel syndrome resistant to conservative treatment. All cases were treated by plantar fasciotomy; calcaneal drilling and calcaneal spur removal using a modified cannula trocar system. Evaluation of pain was done using VAS and functional evaluation was done using the Modified Mayo Scoring System for Plantar Fasciotomy. Also patient's satisfaction was evaluated by direct questionnaire.ResultsThere was statistically significant improvement in the mean VAS from 82.81 (±7.8 std) preoperative to 6.63 (±2.75 std) and the Mayo score form 7.05 (±3.67 std) preoperative to 87.5 (±4.81 std) at 2 years follow up (P < 0.05). The satisfaction rate was 85% with no major complications.ConclusionEndoscopic plantar fascia release with calcaneal drilling and calcaneal spur removal has high success rate and patient's satisfaction rate when compared to published reports on isolated endoscopic plantar release.     

Association of serum levels of aggrecan ARGS,NITEGE fragments and radiologic knee osteoarthritis in Tunisian patients

ObjectivesProteolytic degradation of aggrecan is a hallmark of the pathology of osteoarthritis. The aim of this study was to develop enzyme-linked immunosorbent assay (ELISA) to quantify the serum levels of specific aggrecan fragments generated by aggrecanases-mediated cleavage. We investigated the relationships between these two aggrecan degradations fragments and urinary CTX-II levels.MethodsThe competitive ELISAs employ a polyclonal antibody raised against the aggrecan fragments containing two neoepitopes NITEGE³⁷³ and ³⁷⁴ARGSVI. We measured serum levels of ARGSV and NITEGE in 125 women with knee osteoarthritis (mean ± SD age of 53.6 ± 7.6 years, mean ± SD disease duration of 3.6 ± 3.8 years), and 57 women age-matched controls.ResultsAggrecan neoepitopes assays showed an intra- and inter-assay imprecision (CV) lower than 20% for both tests and good linearity. Median serum ARGSVI (by 18%; P = 0.002), and NITEGE (36.4%; P < 0.001) levels were significantly decreased in patients with knee osteoarthritis compared with controls. Minimal joint space width was negatively correlated with ARGSVI (r = –0.368, P = 0.04) and NITEGE (r = –0.274, P = 0.038) in knee osteoarthritis patients. Median urinary CTX-II levels were significantly increased by 39.5% (P = 0.001) in knee OA patients compared with controls.ConclusionMarkers of degradation aggrecan were analyzed for the first time in an African osteoarthritis population. These markers can be used to monitor aggrecanase activity in human joint disease. Their combination with CTX-II can improve clinical investigation of patients with osteoarthritis patients.     

Influência da velocidade da marcha sobre a pressão plantar em sujeitos com osteoartrite unilateral de joelho

ObjectiveChanging gait speed is a common strategy to manipulate exercise intensity during physical exercise, but may elicit higher impact forces and consequent joint loading. Here we analyzed the effects of increasing walking velocity on plantar pressure and asymmetries in elderly with knee osteoarthritis (OA). Our hypothesis was that the contralateral limb could receive higher loading compared to the OA limb in the different walking speeds tested.MethodsTwelve elderly with unilateral knee OA walked at different self‐selected speeds along a 10 m pass way stepping on an instrumented mat for measurement of plantar pressure at preferred, slow and fast gait speeds. Five steps were recorded for each speed. Plantar pressure data were compared between the speeds and legs.Resultsspeeds were significantly different between them (p < 0.05). Mean and peak plantar pressure increased when speed changed from slow to fast (p < 0.05). Velocity of the center of pressure increased and the single stance time decreased when walk speed was increased (p < 0.05). Any asymmetries were observed.ConclusionIncreasing gait speed from slow to fast in subjects with unilateral knee OA significantly affected variables of plantar pressure, but asymmetries between committed and contralateral leg were not detected.     

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.     

An evaluation of the reliability and validity of capillary refill time test

BackgroundWhile capillary refill time test (CRTT) has been commonly used as a quick and convenient clinical vascular assessment of the lower limb, the validity of this test has not been established.ObjectivesThere were three aims to this study: the first was to evaluate the reliability of CRTT, the second to investigate the premise that CRTT represents skin perfusion, and thirdly to determine whether CRTT can detect lower limb vascular disease.MethodIntra- and inter-tester reliability was evaluated for five experienced physicians who used CRTT on 10 participants. Criterion validity for measurement of skin perfusion was investigated by comparison with laser Doppler flowmetry on 49 participants, and for this same group the usefulness of detecting those persons with peripheral arterial disease and a state of impaired healing was evaluated.ResultsCRTT had reasonable intra-tester reliability (ICC = 0.72) but poorer inter-tester reliability (ICC range = 0.12–0.81). For measurement of skin perfusion, CRTT was predictive of only 38% of the variance in laser Doppler flowmetry measures (r² = 0.38, P < 0.001). Finally, CRTT was not able to discriminate between patients with and without peripheral arterial disease (z = −1.86, P = 0.062), nor could it discern between patients with and without impaired lower extremity healing (z = −0.21, P = 0.830). Laser Doppler flowmetry was also unable to predict the presence of peripheral arterial disease (t₉₆ = 0.27, P = 0.787) and impaired healing (t₉₆ = 1.95, P = 0.054).ConclusionThese results question the usefulness of capillary refill time test for assessment of vascular status in the lower limb.     

Safety and efficacy of adipose-derived mesenchymal stem cells for knee osteoarthritis: A systematic review and m-analysis

ObjectiveThis research aimed to study the safety and efficacy of adipose-derived mesenchymal stem cells (ADMSCs) for knee osteoarthritis (OA).MethodsWe used six databases to search for records and then screened them for eligibility. In both randomized and non-randomized studies, the risk of bias was assessed. The data were then retrieved and used in single-arm and double-arm analyses using Comprehensive Meta-Analysis (CMA) Version 3.0 and RevMan Version 5.3, respectively.ResultsBased on the study's inclusion criteria, we included 15 studies with a total of 463 patients. According to our single-arm analyses, there was a significant improvement in quality of life (QOL) among the three dose subgroups (high, medium, and low doses), as measured by SF-36 scores after a year of follow-up [low dose: mean (M) = ?23.99; 95% confidence interval (CI) [?31.49 to ?16.49]; P < 0.001; medium dose: M = ?15.96; 95% CI [?23.5 to ? 8.42]; P < 0.001; high dose: M = ?19.31; 95% CI [?28.02 to ?10.59], P < 0.001] and the knee injury and osteoarthritis outcome score (KOOS) QOL sub-score after six months following ADMSCs injection in the low-dose group (M = 24.9; 95% CI [4.3 to 45.6]; P < 0.05). Moreover, after three months of follow-up, we detected significant pain reduction as measured by the numeric pain rating scale (NPRS), with no significant difference between the low and medium doses (low dose: M = ?3.12; 95% CI [?5.09 to ?1.14]; P < 0.01; medium dose; M = ?2.17; 95% CI [?3.13 to ?1.21]; P < 0.001). However, after a year, the results were no longer significant. Despite finding no significant difference between them after 6 and 12 months post-treatment in the Visual Analogue scale (VAS) scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, double-arm analyses revealed significant pain reduction in the ADMSCs group over the control after 12 months as estimated by the WOMAC pain sub-score (mean difference (MD) = ?1.85, 95% CI [?3.55, ?0.15], P < 0.05). After six months, the low dosage group's knee functions and activity levels improved significantly, as determined by the WOMAC physical function and stiffness subscales (M = ?23.79; 95% CI [?38.43 to ?9.16]; P = 0.001; M = ?10.25; 95% CI [?17.31 to ?2.59]; P < 0.01, respectively), as well as the KOOS scores after a year (P < 0.01 for all KOOS subscales). In the ADMSCs injections group, there were no serious adverse effects [event rate (ER) = 0.11; 95% CI [0.03–0.3]; P = 0.001].ConclusionIn the present single-arm meta-analysis, ADMSCs were associated with significant reduction in pain and improvement in QOL and knee functions in patients with knee OA. However, double arm analyses did not confirm these positive findings, which may be returned to the small sample size of included patients. Therefore, to introduce ADMSCs into clinical practice and establish guidelines for their use, more randomized controlled clinical trials with large sample sizes and long-term follow-ups are needed.     

Acute effect of orthoses on foot orientation and perceived comfort in individuals with pes cavus during standing

BackgroundChanges in foot orientation due to orthoses and the relationship with perceived comfort are still unclear in pes cavus. The purpose of this study was to determine the acute changes of fore-foot angles due to the use of custom-made orthoses and their relationship with perceived comfort during standing.MethodsTwo photographs were taken using a color-coded camera-based system from the posterior and medial views of 20 subjects with bilateral pes cavus under barefoot and with orthoses conditions during standing. Djian–Annonier, calcaneal inclination, 1st metatarsal declination and rearfoot angles were measured and perceived comfort in the forefoot, midfoot and rearfoot was estimated using an adapted Visual Analogue Scale-type questionnaire.ResultsIn comparison with the barefoot condition, orthoses increased significantly the 1st metatarsal declination angle by 1.9° (p < 0.01), and the Djian–Annonier angle by 1.1° (p = 0.02). The calcaneal inclination angle decreased significantly by an average of 3.0° (p < 0.01). Wearing orthoses significantly improved perceived comfort in forefoot, midfoot and rearfoot when compared to barefoot condition (p < 0.01). A significant correlation was observed between variation of calcaneal inclination angle and the perceived comfort at the midfoot (r = ?0.44; p = 0.04).ConclusionFlattening of foot arch and improvement of midfoot perceived comfort in pes cavus could be attributed to the reduction of the calcaneal inclination angle in the sagittal plane by using orthoses during standing.     

Midfoot plantar pressure significantly increases during late gestation

BackgroundA rise in plantar pressure has been observed in pregnant women with foot pain. The current literature on plantar pressure in pregnancy is sparse. It has been postulated that changes in plantar pressure result from the physiological effects of pregnancy. In this study we aim to quantify the plantar pressure of women in late pregnancy.MethodsTwenty-two pregnant women undergoing a caesarean section and twenty non-pregnant women were recruited from University Hospital Coventry and Warwickshire between May to June 2007. Plantar pressure measurements were performed using an in-shoe measurement system. The control group was compared with the pregnant group at 38 weeks gestation. A selection of the pregnant group had repeat measurements at 4 months post-partum. The pre and post-partum measurements were also compared.ResultsThe pregnant group (PG) exerted a significantly higher mean midfoot pressure compared to the non-pregnant control group (CG) (PG = 115.5 kPa, CG = 95.4 kPa; p = 0.001).Post-partum (PP), there was a significant reduction in the mean and maximum midfoot pressure (mean; PG = 111.9 kPa, PP = 66.2 kPa; p < 0.001, maximum; PG = 184.0 kPa, PP = 108.3 kPa; p < 0.001).ConclusionsThe physiological changes in late pregnancy result in an increase in midfoot plantar pressure. This increase resolves post-partum.     

The role of a total contact insole in diminishing foot pressures following partial first ray amputation in diabetic patients

BackgroundIn diabetic subjects, reulcerations following first ray amputations are particularly frequent. Treatment usually includes an in-shoe intervention to reduce plantar pressure.ObjectiveTo investigate the effects of a total contact insole on the plantar pressure reduction in patients with partial first ray amputations.Material and methodsTwenty diabetic subjects (mean age 60 years, mean body mass index 27 kg/m²) with partial first ray amputation of one foot. Plantar pressure data was recorded using Matscan system (Tekscan vers. 6.34, Boston, USA) while standing and taking a step for three conditions (shoe, shoe with total contact insole, and shoe with flat insole). Plantar pressures were determined at the five metatarsal areas, mid foot area and medial and lateral heel areas.ResultsPressures diminished significantly (P < 0.05) in tested areas using the total contact insole while standing and walking. While using the flat insole, significant pressure changes were only seen while walking (P < 0.05) (P < 0.05). A highly significant change in pressures with the total contact insoles during walking in all areas except for the M1 area (P < 0.001) as compared to that of flat insole.ConclusionThe conforming total contact insole showed significant reduction in plantar pressures in patients with first ray amputation.     

Effects of differential-phase remote ischemic preconditioning intervention in laparoscopic partial nephrectomy: A single blinded,randomized controlled trial in a parallel group design

Study ObjectiveThere are two windows of protection for remote ischemic preconditioning (RIPC), an early (ERIPC) and a late-phase (LRIPC). While ERIPC has been well studied, works on LRIPC are relatively scarce, especially for the kidneys. We aimed to compare the effects of early-phase versus late-phase RIPC in patients with laparoscopic partial nephrectomy (LPN).DesignA randomized controlled studySettingThe Second Affiliated Hospital of Anhui Medical University, 1 May 2012 to 30 October 2013PatientsSixty-five ASA 1 to 2 patients scheduled for LPN were located randomly to ERIPC group, LRIPC group and CON group (control).InterventionsThree five-minute cycles of right upper limb ischaemia and reperfusion were performed after induction of anesthesia in ERIPC group. Patients in LRIPC group received similar treatment 24 h before surgery, while control patients were not subjected to preconditioning.MeasurementsSerum neutrophil gelatinase-associated lipocalin (NGAL) and serum cystatin C (CysC) were evaluated before the induction of anesthesia (0h), 2 h (2 h) and 6 h (6 h) after surgery. Unilateral glomerular filtration rates (GFR) were assessed before and after surgery to evaluate overall renal function.Main ResultsSerum NGAL and CysC were significantly lower in ERIPC and LRIPC groups at 2h post-operation (P < 0.001), 6h post-operation (P < 0.001). Additionally, The GFR were significantly lower in ERIPC and LRIPC groups than in CON group at the 3rd month after surgery (P = 0.019; P < 0.001). Moreover, compared to the ERIPC group, concentration of NGAL and CysC in LRIPC group decreased to a greater extent, while GFR and the percentage of decrement was significantly less in the LRIPC group (P = 0.016; P < 0.001).ConclusionsRegardless of early-phase or late-phase intervention, limb remote ischemic preconditioning confers protection on renal ischemia-reperfusion injury in patients with laparoscopic partial nephrectomy, and the late-phase protection is more prominent.     

Single centre experience of combat-related vascular injury in victims of Syrian conflict: Retrospective evaluation of risk factors associated with amputation

ObjectiveTo elucidate the risk factors associated with amputation in cases with combat-related vascular injury (CRVI).Material and methodsThis retrospective study included 90 cases with CRVI treated between May 2011 and July 2013. The patients were divided into group I (n = 69), in which the limb was salvaged and group II (n = 21), in which the patients received amputation.ResultsThe overall and the secondary amputation rates were 23% and 18%, respectively. There were no amputations with the MESS of nine or less, increasing proportions of amputations at 10 and 11, with a level of 12 leading to 100% amputation rate. The mortality rate was 2%. Among the 52 (58%) cases with the mangled extremity severity score (MESS) ≥ 7, the limb salvage rate was 60%. The patients in group II were more likely to have a combined artery and vein injury (p = 0.042). They were also more likely to be injured as a result of an explosion (p = 0.004). Along with the MESS (p < 0.001), the duration of ischemia (DoI) (p < 0.001) were higher in group II. The rate of bony fracture (p < 0.001) and wound infection (p = 0.011) were higher in group II. For the overall amputation, the odds ratio of the bony fracture (OR: 61.39, p = 0.011), nerve injury (OR: 136.23, p = 0.004), DoI (OR: 2.03, p = 0.003), vascular ligation (OR: 8.65, p = 0.040) and explosive device injury (OR: 10.8, p = 0.041) were significant. Although the DoI (p < 0.001) and the MESS (p = 0.004) were higher in whom a temporary vascular shunt (TVS) was applied, the utilisation of a TVS did not influence the amputation rate (p = 1.0).ConclusionsThe DoI and the variables indicating the extent of tissue disruption were the major determinants of amputation. While statistically non-significant, the benefit of the application of a TVS is non-negligible. MESS is a valid scoring system but should not be the sole foundation for deciding on amputation. Extremities which were doomed to amputation with the MESS >7 seem to benefit from revascularisation with initiation of reperfusion at once. The validity of MESS merits further investigation with regard to the determination of a new cut-off value under ever developing medical management strategies.     

Dexmedetomidine as supplement to low-dose levobupivacaine spinal anesthesia for knee arthroscopy

AimTo evaluate efficiency of dexmedetomidine compared to fentanyl as supplements to low-dose levobupivacaine spinal anesthesia in patients undergoing knee arthroscopy.Materials and methodsSixty adult patients (ASA I or II) scheduled for knee arthroscopy were randomized to receive plain levobupivacaine (4 mg) plus dexmedetomidine (3 μg) in group D or fentanyl (10 μg) in group F.ResultsDexmedetomidine shortened time to surgery (P = 0.002), time to highest sensory level (P = 0.001), and time to highest Bromage score (P < 0.001). The highest sensory level was comparable in both groups (P = 0.969), but the duration of sensory block was significantly longer in group D (P = 0.009). The highest Bromage score was 2 in both groups. This score was attained in significant higher number of patients in group D (P = 0.038) that showed better muscular relaxation (P = 0.035). At the end of surgery, a residual motor block (Bromage score 1) was observed in significant higher number of patients (P = 0.033) and time to ambulation was significantly longer in group D (P = 0.001). There was no difference in the number of patients bypassed post-anesthesia care unit (PACU) (P = 0.761) or time to hospital discharge (P = 0.357) between groups. The pain free period was more prolonged (P < 0.001), and the visual analog scale (VAS) for pain was lower at the 2nd, 4th, 6th, and 8th postoperative hours (P < 0.001, <0.001, 0.013, 0.030 respectively) in group D.ConclusionDexmedetomidine is a good alternative to fentanyl for supplementation of low-dose levobupivacaine spinal anesthesia for knee arthroscopy.     

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.     

El personal no sanitario de hospitales españoles y latinoamericanos ante la donación de vivo renal relacionada

IntroductionAncillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears.ObjectiveTo analyze the attitude toward living kidney donation (LKD) among ancillary personnel in Spanish and Latin-American hospitals and to analyze the variables that might influence such attitude.Patients and methodfrom «International Collaborative Donor Project» a random sample was taken among ancillary personnel in Spain, Mexico and Cuba hospitals. Attitude towards LKD was evaluated using a validated, anonymously filled and self-administered survey.Results951 professionals were surveyed (Spain: 277, Mexico: 632, Cuba: 42). 89% (n = 850) are in favor of related kidney donation, lowering to 31% (n = 289) in non-related donation. Of the rest, 8% (n = 78) are not in favor and the 3% (n = 23) are unsure. By country, Cubans (98%) and Mexicans (91%) are more in favour than Spanish (84%) (P = .001). The following variables are related to favourable attitude towards LKD: female sex (P = .017), university degree (P = .010), work in health services (P = .035), labour stability (P = .016), personal experience in donation and transplantation (P = .001), positive attitude toward cadaveric donation (P < .001), belief that he or she might need a transplant in the future (P < .001), positive attitude towards living liver donation (P < .001), a willingness to receive a donated living liver if needed (P < .001), having discussed the subject of organ donation and transplantation within the family (P < .001), partner's positive attitude towards the subject (P < .001), participation in voluntary type pro-social activities (P = .002) and not being concerned about possible mutilation after donation (P < .001)ConclusionsThe attitude toward living related kidney donation is favourable among ancillary personnel in Spanish and Latin-Americans hospitals. Because living donation is a better source of organs than cadaveric ones, this favourable predisposition can be used as promoting agent of living donation in order to develop it in Spanish-speaking countries.     

Perioperative axial loading computed tomography findings in varus ankle osteoarthritis: Effect of supramalleolar osteotomy on abnormal internal rotation of the talus

BackgroundWe used axial loading computed tomography (AL CT) to evaluate preoperative and postoperative talocrural joints of patients who underwent supramalleolar osteotomy (SMO) to treat varus ankle osteoarthritis.MethodsWe performed retrospective analyses of 16 patients (18 feet) who underwent SMO including fibular osteotomy. Radiographic assessment was performed with weightbearing radiographs and AL CT. Clinical outcomes were assessed based on American Orthopedic Foot & Ankle Society (AOFAS) scale, visual analog scale (VAS) for pain, and Foot and Ankle Ability Measure (FAAM).ResultsThe mean 2-year follow-up tibial-ankle surface angle, talar tilt angle, Takakura stage, and tibial-lateral surface angle were all significantly different relative to preoperative parameters (P < .05). The mean 6-month follow-up talus rotation ratio was significantly corrected compared to the preoperative value (P = .001). The mean 2-year follow-up AOFAS, VAS at gait, and FAAM scores were all significantly improved relative to preoperative measurements (P = .001).ConclusionsAbnormal internal rotation of the talus in mild to moderate varus ankle osteoarthritis found on AL CT was significantly corrected after SMO.Level of evidenceTherapeutic Level IV     

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.     

Induction of the chemokine IL-8/Kc by the articular cartilage: Possible influence on osteoarthritis

PurposeIL-8 and its murine equivalent keratinocyte chemoattractant (Kc), chemokines produced by chondrocytes, contribute to the pathophysiology of osteoarthritis. However, the mechanisms leading to their production are poorly known. We aimed to investigate whether mechanical (compression), inflammatory (IL-1β) and metabolic (visfatin) stresses may induce the release of Kc when applied on murine cartilage.MethodsMouse cartilage explants were subjected to intermittent compression for 4, 6 and 24 h. Primary cultures of immature murine articular chondrocytes were obtained by enzymatic digestion of articular cartilage from 6-days-old newborns mice. The effect of compression, IL-1β (10, 50, 100 pg/mL) and of visfatin (5 μg/mL) on the release of Kc was assessed by ELISA. IL-8 levels in conditioned media from human OA joint tissues (cartilage or synovium) were also assessed.ResultsIn comparison with non-compressed explants, loading increased Kc release of 3.2-, 1.9- and 2.0-fold at 4, 6 and 24 h respectively (P < 0.004, n = 9). IL-1β triggered an increase of Kc release by primary cultured chondrocytes of 4.1-, 15.5- and 35.2-fold at 10, 50 and 100 pg/mL of IL-1β respectively (P < 0.05, n = 4). Likewise, visfatin (5 μg/mL) induced an increase in Kc release of 56.5 ± 25.2 fold (P = 0.002, n = 6). IL-8 was released in conditioned media by synovium as well as by cartilage.ConclusionWe show for the first time that IL-8/Kc is highly responsive to mechanical, inflammatory and metabolic stresses, strengthening the hypothesis that IL-8/Kc could be added to the cytokines which may have a deleterious impact in osteoarthritis.     

The effect of eliminating leg length difference on plantar foot pressure distribution in patients wearing forefoot offloading shoe

Background and purposeElevated heel construction offloads the forefoot after surgery. However, side-to-side height difference alters limb kinetics, whereas leg-length equalizing-sole at non-operated side may have beneficial effects on foot loading. The purpose of this study was to characterize leg-length equalizing sole effect on bilateral plantar pressures when using heel-lift forefoot-offloading shoe.Materials and methodsTwenty men were tested walking. Plantar peak pressures (PP) and pressure-time integrals (PTI) in the forefoot-offloading shoe and in contralateral running shoe were compared between two conditions: one with- and the other without leg-length equalizing sole elevation at the running shoe.ResultsAdding leg-length equalizing sole to the running shoe resulted in the following changes in the forefoot-offloading shoe: increased lateral midfoot PP (8.7%, p = 0.03), increased lateral midfoot (11.3%, p = 0.05) and lateral metatarsals PTI (10.3%, p = 0.04), and decreased medial and lateral heel PTI (>5%, p = 0.02). These changes were non-significant when applying a Bonferroni correction. Changes in the running shoe were: increased medial midfoot (20.5%, p = 0.03) and decreased 2nd and lateral metatarsals PP (23%, p < 0.01). PTI increased in medial and lateral heel (>25%, p < 0.01), medial midfoot (63.2%, p < 0.01) and lateral midfoot (9.2%, p = 0.04) and decreased in 2nd and lateral metatarsals (>24.5%, p < 0.01).ConclusionLeg-length equalizing sole at contralateral running shoe in subjects wearing forefoot-offloading shoe results in lateral load shift alongside heel pressure attenuation within the forefoot-offloading shoe, which is beneficial during first month after medial forefoot surgery. Reciprocal medial load-shift in the elevated running shoe itself should yet be considered when bilateral medial forefoot pathology is present.