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.     

Diagnosis of heel pain

Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.     

Biomechanical stress analysis of the main soft tissues associated with the development of adult acquired flatfoot deformity

BackgroundAdult acquired flatfoot deformity (AAFD) is traditionally related to a tibialis posterior tendon deficiency. In the intermediate stages, treatments are commonly focused on reinforcing this tissue, but sometimes the deformation appears again over time, necessitating the use of more aggressive options. Tissue stress cannot be consistently evaluated through traditional experimental trials. Computational foot modeling extends knowledge of the disease and could help guide the clinical decisions. This study analyzes the biomechanical stress of the main tissues related to AAFD and their capacity to support the plantar arch.MethodsA FE foot model was reconstructed. All the bones, cartilages and tissues related to AAFD were included, respecting their biomechanical characteristics. The biomechanical tissue stress was quantified. The capacity of each soft tissue to support the plantar arch was measured, following clinical criteria.FindingsBiomechanical stress of the tibialis posterior tendon is considerably superior to both the plantar fascia and spring ligament stress. However, it cannot maintain the plantar arch by itself. Both the tibialis posterior tendon and spring ligament act in reducing the hindfoot pronation, while the plantar fascia is the main tissue that prevents arch elongation. The Achilles tendon action increases the plantar tissue stress.InterpretationThe tibialis posterior tendon stress increases when the spring ligament or the fascia plantar fails. These findings are consistent with the theory that regards the tibialis posterior tendon as a secondary actor because it cannot support the plantar arch and claudicates when the hindfoot has rotated around the talonavicular joint.     

多针内固定治疗跟骨骨折的有限元及临床分析

背景：选择恰当的治疗方法能明显改善跟骨关节内骨折患者的预后。目的：旨在分析跟骨骨折多针内固定和钢板内固定两种方法的固定效果,评价2种内固定方式的临床疗效。方法：①CT扫描正常男性右侧跟骨,建立完整跟骨三维有限元模型,模拟SandersⅡ型跟骨骨折,模拟跟骨骨折钢板和多针两种内固定后受到跟腱载荷的工况,对比研究钢板功能位0°、多针功能位0°组、多针跖屈30°组2种内固定3种分组模型的应力分布、骨折线相对位移和内固定最大主应力。②回顾性研究59例SandersⅡ型跟骨骨折,其中36例患足行切开复位多针内固定,23例患足行切开复位钢板内固定,采用Maryland足部评分系统评价跟骨骨折钢板和多针两种内固定后的临床疗效,并分析固定后软组织并发症。结果与结论：①有限元分析中加载足踝静止状态跟腱最大载荷160N,3组模型内固定的最大主应力值均小于内固定屈服强度225MPa。3组模型跟骨骨折线的相对移位均小于跟骨关节内骨折手术指征的骨折线分离或移位≥1mm的标准。连续加载1~1000N载荷的工况,3组模型内固定失效时对应的跟腱载荷均大于160N。模型的应力分布显示,多针与钢板内固定都均匀分布了应力。②临床研究结果显示SandersⅡ型骨折多针固定组优良率83%,钢板固定组优良率78%,两组固定后疗效差异无显著性意义（P〉0.05）,但多针固定组固定后软组织并发症发生率低于钢板固定组（P〈0.05）。     

Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading?

BACKGROUND: The diabetic foot often undergoes abnormal plantar pressures, changing in walking strategy, ulcerative processes. The present study focuses on the effects that diabetes-induced alterations of Achilles tendon, plantar fascia and first metatarso-phalangeal joint-both anatomical and functional-may have on foot loading. METHODS: Sixty-one diabetic patients, with or without neuropathy, and 21 healthy volunteers were recruited. Thickness of Achilles tendon and plantar fascia was measured by ultrasound. Flexion-extension of the first metatarso-phalangeal joint was measured passively. Main biomechanic parameters of foot-floor interaction during gait were acquired and related to the above measurements. FINDINGS: Plantar fascia and Achilles tendon were significantly (P<0.05) thicker in diabetics than in controls; mean values (SD) for controls, diabetics without and with neuropathy were 2.0 mm (0.5), 2.9 mm (1.2) and 3.0 mm (0.8) for plantar fascia, respectively, and 4.0 mm (0.5), 4.6 mm (1.0) and 4.9 mm (1.7) for Achilles tendon, respectively. Flexion-extension of the first metatarso-phalangeal joint was significantly (P<0.05) smaller in diabetics than in controls; mean values (SD) for controls, diabetics without and with neuropathy were 100.0 degrees (10.0), 54.0 degrees (29.4) and 54.9 degrees (17.2), respectively. The increase in the vertical force under the metatarsals was strongly related (R=0.83, explained variance=70.1%) to the changes in the three above parameters. INTERPRETATION: Thickening of plantar fascia and Achilles tendon in diabetics, more evident in the presence of neuropathy, concurs to develop a rigid foot, which poorly absorbs shock during landing (performs the physiological impact force absorption during landing). More generally, an overall alteration of the foot-ankle complex motion likely occurs throughout the whole gait cycle, which partly explains the abnormal loading under the forefoot.     

北方汉族健康人群膝、踝关节软骨、肌腱超声测值及相关因素

目的 采用超声测量北方汉族健康人群膝、踝关节软骨、肌腱厚度，并提出参考值范围。方法 采用肌肉骨骼超声（MSUS）测量373名北方汉族健康人膝、踝关节软骨、肌腱结构，并分析相关因素。结果 男性股骨髁软骨、距骨软骨、髌韧带及跟腱厚度均大于女性（P均<0.01）。年龄、体质量指数（BMI）是女性足底筋膜增厚的影响因素（P均<0.05），BMI是女性跟腱增厚的影响因素（P<0.05）。年龄、BMI及锻炼频率是男性足底筋膜增厚的影响因素（P均<0.05）。BMI及锻炼频率是男性跟腱增厚的影响因素（P均<0.05）。低BMI是男性股骨髁软骨外侧厚度的影响因素（P<0.05）。结论 MSUS所测膝踝软骨和肌腱参考值范围可为发现异常及病变提供依据；性别、年龄及BMI均影响北方汉族健康人股骨髁软骨、跟腱及足底筋膜厚度。     

Sonography of chronic Achilles tendinopathy: a case-control study

PURPOSE: To describe the sonographic appearance of Achilles tendon in normal subjects and patients with chronic Achilles tendinopathy with the aim of establishing diagnostic sonographic criteria for Achilles tendinopathy. METHODS: A prospective, cross-sectional, case-control sonographic study of the Achilles tendon was undertaken. Thirty tendons in 21 patients and 100 tendons in 50 control subjects were selected. Sonographic assessment included tendon thickness, echogenicity, fibrillar pattern, and presence of calcifications. Power Doppler imaging was used to assess tendon vascularity. Paratendinous structures and plantar fascia were also examined. RESULTS: Tendinopathic tendons were larger than normal tendons in both cross-sectional area and antero-posterior diameter. Hypoechoic areas within the tendon were more commonly seen in patients. Disruption of fibrillar pattern, increase in tendon vascularity, increased Kager's fat pad echogenicity, and paratenon thickening were solely seen in patients. Fluid in the retrocalcaneal bursa and calcaneal bony abnormalities were seen in both groups without a significant difference. CONCLUSION: Achilles tendinopathy results in enlargement, particularly of the mid- and distal portions of the tendon, disruption of fibrillar pattern, and increase in tendon vascularity. Additional signs are increased Kager's fat pad echogenicity and paratenon thickening. Tendon calcification, changes in retrocalcaneal bursae, and calcaneal contour are not specific for Achilles tendinopathy.     

微创小切口与L形切口复位内固定术治疗跟骨骨折的临床效果比较

目的探讨微创小切口与L形切口复位内固定术治疗跟骨骨折的临床效果。方法将52例跟骨骨折患者按手术方式分为观察组(微创小切口复位内固定术)和对照组(L形切口复位内固定术),各26例。比较两组的围术期指标、跟骨及踝-后足功能恢复及并发症发生率。结果观察组的各项围术期指标均优于对照组(P<0.05)。术后,两组的Gissane角、Bohler角及跟骨长度均增大,跟骨宽度均减小(P<0.05),但组间比较,差异无统计学意义(P>0.05)。观察组术后的疼痛评分高于对照组(P<0.05);两组术后的功能和自主活动、最大步行距离、步行困难度评分无显著差异(P>0.05)。观察组的术后并发症总发生率低于对照组(P<0.05)。结论微创小切口与L形切口复位内固定术均能有效促进跟骨骨折患者跟骨及踝-后足功能恢复,但采用微创小切口复位内固定术的患者术后恢复快,疼痛程度及并发症发生率低。     

Is Real-Time Ultrasound Reliably Able to Determine Kager's Fat Pad Motion during Walking?

The distal calcaneal wedge of the Kager's fat pad (KFP) has the mechanical role of lubricating the region between the Achilles tendon and calcaneus during ankle movements. The purpose of this study was to determine the reliability of real-time ultrasound (RTUS) in visualizing the motion of the KFP during walking in adults. Recordings obtained using RTUS (13-MHz linear array transducer, IOE 323, MyLab 70, Esoate, Genoa, Italy) of the Achilles enthesis region (N = 52) of 47 participants (ranging from 21–79 years in age) while walking on a motorised treadmill at their preferred speed were analysed by three blinded assessors. Motion of the KFP was rated on a 4-point Likert scale (normal to absent). There was good agreement (κ [95% confidence interval] = 0.646 [0.643–0.649]) among the three examiners, with very good agreement (0.823 [0.818–0.828]) when classifying the motion as normal. There was a poor correlation between the motion of the calcaneal wedge and participants’ age (0.23–0.32). RTUS provides an adjunct to routine clinical examination to determine if there is normal motion of the calcaneal wedge during walking. This may be of benefit in patients with posterior heel pain for whom abnormal KFP motion is implicated.     

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.

Mechanical muscle and tendon properties of the plantar flexors are altered even in highly functional children with spastic cerebral palsy

BackgroundRecent ultrasound studies found increased passive muscle stiffness and no difference in tendon stiffness in highly impaired children and young adults with cerebral palsy. However, it is not known if muscle and tendon mechanical properties are already altered in highly functional children with cerebral palsy. Therefore, the purpose of this study was to compare the mechanical and material properties of the plantar flexors in highly functional children with cerebral palsy and typically developing children.MethodsBesides strength measurements, ultrasonography was used to assess gastrocnemius medialis and Achilles tendon elongation and stiffness, Achilles tendon stress, strain, and Young's modulus in twelve children with cerebral palsy (GMFCS levels I and II) and twelve typically developing peers during passive dorsiflexion rotations as well as maximum voluntary contractions.FindingsDespite no difference in ankle joint stiffness (P > 0.05) between groups, passive but not active Achilles tendon stiffness was significantly decreased (− 39%) and a tendency of increased passive muscle stiffness was observed even in highly functional children with cerebral palsy. However, material properties of the tendon were not altered. Maximum voluntary contraction showed reduced plantar flexor strength (− 48%) in the cerebral palsy group.InterpretationEven in children with mild spastic cerebral palsy, muscle and tendon mechanical properties are altered. However, it appears that the Achilles tendon stiffness is different only when low forces act on the tendon during passive movements. Although maximum voluntary force is already decreased, forces acting on the Achilles tendon during activity appear to be sufficient to maintain typical material properties.     

跖腱膜起点的解剖及超声影像学研究

目的 研究跖腱膜起点的确切部位及其与跟骨骨刺的关系.方法 对14只足标本行解剖观察、X线摄片,3只胎儿足行组织学切片,20例成人正常足和52例跖腱膜炎足行超声观察.结果 ①足标本解剖观察:跖腱膜位于跟骨结节内侧突的跖侧,但与其不相联系,向后附着于跟骨结节跖面,其附着处不是一个点而是一个面.再向后与后方跟腱来源的腱性组织在跟骨结节后下方相互移行融合,包被整个跟骨结节跖后面并紧密地附着于其上.②胎儿足跟部组织学观察:跖腱膜和跟腱呈强嗜酸性带状物,两者在跟骨结节的跖侧和后侧相连续(移行),无明显分界,并紧密地附着于跟骨上.③超声观察:正常跖腱膜呈厚度一致、均质的薄层带状强回声,其起始部附着于整个跟骨结节跖侧,并与后方跟腱来源的腱膜相连续,两者无明显分界.跖腱膜炎时,整个跟骨结节跖侧均可见增厚的跖腱膜.跟骨骨刺并不发生于跖腱膜内.结论 跖腱膜起始于整个跟骨结节跖侧面.跟骨骨刺发生于足内在肌如趾短屈肌起点处,不在跖腱膜内.     

非止点性跟腱病患者的肌骨超声显像特征

  目的  分析非止点性跟腱病患者肌骨超声显像特征。  方法  收集2020年11月~2022年4月共60例患者82足跟腱超声结果,将其分为健康对照组(A组,15例30足)和非止点性跟腱病组(B组,45例52足),应用肌骨超声和彩色多普勒血流显像观察并分析比较各组:(1)跟骨后结节上2 cm处跟腱厚度; (2)跟腱止点上2 cm处跟腱横截面积; (3)跟骨上缘上1 cm处Kager脂肪垫前后径; (4)跟骨后滑囊积液检出率; (5)跟腱内血流信号检出率。总结归纳非止点性跟腱病的超声显像特征。  结果  (1) 跟骨后结节上2 cm处跟腱厚度:A组小于B组(0.43±0.06 cm vs 0.55±0.17 cm,P < 0.05);(2)跟腱止点上2 cm处跟腱横截面积:A组小于B组(0.52±0.11 cm2 vs 0.74±0.23 cm2,P < 0.05);(3)跟骨上缘上1 cm处Kager脂肪垫前后径:A组小于B组(1.01±0.21 cm vs1.49±0.26 cm,P < 0.05);(4)跟骨后滑囊积液检出率:A组未检出,B组38.46%,差异有统计学意义(P < 0.05);(5)跟腱内血流信号检出率:A组未检出,B组51.92%,差异有统计学意义(P < 0.05)。  结论  非止点性跟腱病超声显像特征为跟腱厚度增厚,跟腱横截面积增大,跟腱前Kager脂肪垫前后径增宽,跟骨后滑囊积液产生或增加,以及跟腱内部血管增生。      

Diagnosing heel pain in adults

Heel pain is a common condition in adults that may cause significant discomfort and disability. A variety of soft tissue, osseous, and systemic disorders can cause heel pain. Narrowing the differential diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain. The most common cause of heel pain in adults is plantar fasciitis. Patients with plantar fasciitis report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting. Tenderness at the calcaneal tuberosity usually is apparent on examination and is increased with passive dorsiflexion of the toes. Tendonitis also may cause heel pain. Achilles tendonitis is associated with posterior heel pain. Bursae adjacent to the Achilles tendon insertion may become inflamed and cause pain. Calcaneal stress fractures are more likely to occur in athletes who participate in sports that require running and jumping. Patients with plantar heel pain accompanied by tingling, burning, or numbness may have tarsal tunnel syndrome. Heel pad atrophy may present with diffuse plantar heel pain, especially in patients who are older and obese. Less common causes of heel pain, which should be considered when symptoms are prolonged or unexplained, include osteomyelitis, bony abnormalities (such as calcaneal stress fracture), or tumor. Heel pain rarely is a presenting symptom in patients with systemic illnesses, but the latter may be a factor in persons with bilateral heel pain, pain in other joints, or known inflammatory arthritis conditions.     

Peroneus Longus overload caused by soft tissue deficiencies associated with early adult acquired flatfoot: A finite element analysis

BackgroundPeroneus Longus tendinopathy has been related to overload from cavus and ankle instability. The etiology of isolated Peroneus Longus tendon synovitis has not been elucidated. Loss of foot arch integrity as a cause of isolated Peroneus Longus overload is difficult to establish using cadaver modeling. Our objective was to analyze Peroneus Longus stress changes in pathological scenarios related to flatfoot development.MethodsA three-dimensional finite element foot model which included the foot bones and main soft tissues that maintain the arch was used. Simulations were performed in midstance of gait. Tendon's maximum principal stress and von Mises were calculated in scenarios where the plantar fascia, spring ligament and the posterior tibial tendon were weakened.FindingsDecreasing plantar fascia stiffness thus weakening arch integrity increases Peroneus Longus stresses by over three times. Additional failure of tissues that support arch, such as the spring ligament and tibialis posterior tendon further overloads this tendon. The absence of Peroneus Longus also affects stresses in tissues that maintain the arch. Stress concentrations increase in the plantar component of the Peroneus Longus.InterpretationResults offer an explanation into isolated Peroneus Longus overload synovitis. Recognition of failing medial arch structures that occur in early acquired flatfoot as a cause of Peroneus Longus overload could help in its treatment. We caution the practice of transfer of peroneus brevis to longus in surgical treatment of flatfoot as it may further overload an overloaded tendon and focus should be on restoration of arch stability to offload stresses within it.     

实时剪切波弹性成像技术评估跟腱急性闭合性损伤

目的 探讨采用实时剪切波弹性成像（SWE）技术根据跟腱硬度评价急性跟腱闭合性损伤的临床价值。方法 对49例跟腱急性闭合性损伤患者行高频超声及实时SWE检查，获得患侧和健侧跟腱的杨氏模量值和剪切波速度（SWV），比较完全断裂跟腱、不完全断裂跟腱与正常侧跟腱的差异。结果 经手术证实跟腱完全断裂患者36例，高频超声均诊断正确；经MRI证实，跟腱不完全断裂13例，其中超声正确诊断10例，漏诊3例。跟腱完全断裂组、跟腱部分断裂组和正常跟腱组跟腱杨氏模量值分别为（130.02±24.64） kPa、（281.08±84.36） kPa和（546.51±48.52） kPa，SWV分别为（6.23±1.04） m/s、（9.05±0.97） m/s和（14.33±1.41） m/s，3组间总体差异和两两比较差异均有统计学意义（P均<0.05）。结论 超声弹性成像可以作为高频超声诊断跟腱急性闭合性损伤的有效补充。     

The Diagnostic Accuracy of Böhler’s Angle in Fractures of the Calcaneus

Background

Böhler's historical tuber-joint angle of the calcaneus has been used since 1931. Surprisingly, there is a paucity of literature on its use.

Objectives

To confirm the normal range for Böhler's angle and determine the angle with the highest accuracy in the diagnosis of calcaneal fractures.

Methods

A retrospective cohort study was performed. The study cohort comprised 424 patients spanning a 5-year period from April 2005 to March 2010. Böhler's angle was measured by two independent observers on lateral x-ray study using the digital angle tool from the Picture Archival and Communication System. Data were analyzed using Stata 8 statistical software package.

Results

The mean Böhler's angle in patients without calcaneal fracture was 29.4°. In this group there was no difference in Böhler's angle between male and female patients, left and right feet, or across age. In those patients with calcaneal fractures, a Böhler's angle below 25° was moderately predictive of calcaneal fracture (sensitivity = 100%, specificity = 82%), an angle below 23° was highly predictive of calcaneal fracture (sensitivity = 100%, specificity = 89%), and an angle below 21° was strongly suggestive of calcaneal fracture (sensitivity = 99%, specificity = 99%). A Böhler's angle of ≤ 20° had the highest diagnostic accuracy.

Conclusion

A Böhler's angle of 20° or less is highly accurate in determining the presence or absence of calcaneal fracture. Böhler’s angle serves as a useful screening tool in fracture diagnosis.     

跗骨窦入路自制跟骨钢板联合空心钉内固定治疗SanderⅡ型跟骨骨折疗效观察

目的观察跗骨窦入路自制跟骨钢板联合空心钉内固定治疗SanderⅡ型跟骨骨折的疗效。方法15例SanderⅡ型跟骨骨折采取跗骨窦切口、自制跟骨钢板联合空心钉内固定治疗,观察其疗效。结果15例跟骨骨折全部骨性愈合,术后跟骨B?hler角、Gissane角、跟骨高度、跟骨宽度较术前均得到明显改善,关节面复位良好,踝关节功能根据AOFAS踝-后足评分,优11例,良3例,可I例,差0例。结论跗骨窦切口自制跟骨钢板联合空心钉内固定治疗SanderI型跟骨骨折,具有创伤小、操作简便、感染率低、固定可靠等优点,值得在临床推广使用。     

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.     

Mitek Anchor系统锚钉置入辅助加固修复急性闭合性跟腱断裂:2年同一机构12例资料回顾

12例急性闭合性跟腱断裂患者采用改良Kessler法修补跟腱,后用Mitek Anchor钉各1枚置于跟腱内外侧跟骨内,采用Bunnell方法将尾线由远向近穿经跟腱断端,加固缝合后的跟腱.随访伤口愈合情况、负重行走时间、足跟部疼痛和跟腱再断裂情况,采用Arner-Lindholm方法评价踝关节功能.修补后未见切口感染或者皮肤坏死病例.12例患者锚钉置入辅助加固修补跟腱后随访14～25个月,平均17个月.无足跟部疼痛和再断裂发生,根据Arner-Lindholm踝关节功能评定标准,优4例,良8例.结果提示,采用Mitek Anchor系统辅助加固治疗急性闭合性跟腱断裂,跟腱修补后可早期负重,降低了跟腱再断裂发生率,是一种理想的治疗方法.