足底筋膜的超声弹性图

目的通过超声弹性图对比不同年龄段正常人及足底筋膜炎病人的足底筋膜的硬度。材料与方法试验得到了医院研究伦理委员会的许可,并获得所有受试者的知情同意。研究使用彩色编码的超声弹性图对40名健康受试者及13例足底筋膜炎病人(筋膜炎组)的双脚进行检查。健康受     

Spontaneous rupture of the plantar fascia

In this study, rupture of the plantar fascia was seen in five feet, of which four had had plantar fasciitis. At the time of the injury, which is an acceleration type of motion, there is severe pain in the heel followed by the development of ecchymosis in the sole and toward the heel of the foot. With conservative symptomatic care, the acute symptoms as well as the plantar fasciitis symptoms subside, generally allowing full activity in 3 to 4 weeks.     

MR imaging of abnormalities of the plantar fascia

Foot pain and disability may curtail the performance of simple routine tasks, work-related duties, and athletic activities. Disorders of the plantar fascia are commonly encountered in the diagnostic evaluation of subcalcaneal heel pain. The approach to imaging the ankle and foot has undergone significant amendment with the introduction of magnetic resonance (MR) imaging. MR imaging allows direct visualization of the plantar fascia and permits a comprehensive evaluation of a wide spectrum of disorders involving the fascia and perifascial structures, including bones, ligaments, musculotendinous units, and intrinsic muscles of the foot. The objectives of our cadaveric and clinical study are to describe the normal MR imaging appearance of the plantar fascia and analyze the signal intensity changes in the fascia and perifascial tissue with conventional MR imaging in symptomatic patients. We present a brief overview of common disease processes involving the plantar fascia that may prove practical for routine imaging evaluation of patients with suspected pathology.     

Ultrasound of the plantar aponeurosis (fascia)

Objective. To assess the plantar aponeurosis origin (plantar fascia) using high-resolution ultrasound. Design. The sonographic appearance of the plantar fascia in asymptomatic volunteers was compared with the appearance in: (1) clinical idiopathic plantar fasciitis, (2) inflammatory arthropathy without clinically active plantar fasciitis and (3) Achilles tendon or ankle ligament injury. Patients. There were 48 asymptomatic volunteers (96 heels), 190 patients with idiopathic plantar fasciitis (297 heels), 35 with rheumatoid factor negative spondyloarthropathy (70 heels), 17 with rheumatoid arthritis (34 heels), 62 with clinical Achilles tendinitis (93 heels) and 17 with instability secondary to previous ankle ligament injury (17 heels). Results. Compared with the asymptomatic volunteers, the symptomatic plantar aponeurosis demonstrated significant thickening in patients with clinically unilateral (P<0.001) and bilateral (P<0.001) idiopathic plantar fasciitis as well as in patients with spondyloarthropathy (P<0.001). However, the plantar aponeurosis on the asymptomatic side in patients with unilateral idiopathic plantar fasciitis (P<0.2), rheumatoid arthritis (P<0.2) and ankle injury (P<0.1) demonstrated no significant thickening. In patients with idiopathic plantar fasciitis, abnormal plantar aponeurosis echogenicity was seen in 78% and subcalcaneal bone spurs in 24%. Peritendinous edema was present in 5% of all symptomatic heels, subcalcaneal bone erosion in 4% and intratendinous calcification in 3% of heels. Retrocalcaneal bursitis was present in 7% of patients with idiopathic plantar fasciitis, 40% with spondyloarthropathy and 19% with rheumatoid arthritis. Conclusion. Ultrasound allows confirmation of the clinical diagnosis in plantar fasciitis and may provide information as to its etiology.     

Sports injuries at the 1985 Junior Olympics. An epidemiologic analysis

The XIX Junior Olympic Games, hosted in Iowa City, Iowa, in August of 1985, involved 3,028 athletes who participated for 7 days in 13 different sports at 8 separate sites. Medical coverage for the Games was provided by the University of Iowa Sports Medicine Service. Staffing for the events involved approximately 75 physicians, 60 athletic trainers, and other health care personnel. A triage protocol was established prior to the Games whereby the athletic trainer would make first contact with the injured athlete and would evaluate and treat the injury based on standing orders. If in the judgment of the trainer, the athlete needed to be referred to a physician, one would be available, either on site or on call. During the Games, 1,113 medical encounters were recorded, 121 of those being deemed serious enough to withhold an athlete from competition pending further evaluation and treatment. The 121 significant injuries and illnesses involved 116 athletes (66% male, 34% female). Thirty-four percent of the significant injuries only required treatment by the trainer, while 46% were referred to an on site physician and 20% needed a specialty consultant. Seventeen percent of the significant injuries resulted in the athlete being medically disqualified for the remainder of the event. The most common injuries/illnesses were contusions (26%), sprains (21%), heat (17%), strains (9%), and other illnesses (12%). According to body region, 44% of the 121 injuries were to the lower extremity, 26% to the head, neck, and trunk, and 12% to the upper extremity.(ABSTRACT TRUNCATED AT 250 WORDS)     

The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete‐days

Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7‐day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete‐days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete‐days (95% CI 24.0–42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8–29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.     

Ultrasound evaluation of foot muscles and plantar fascia in pes planus

BackgroundMultiple intrinsic and extrinsic soft tissue structures that apply forces and support the medial longitudinal arch have been implicated in pes planus. These structures have common functions but their interaction in pes planus is not fully understood. The aim of this study was to compare the cross-sectional area (CSA) and thickness of the intrinsic and extrinsic foot muscles and plantar fascia thickness between normal and pes planus feet.MethodsForty-nine adults with a normal foot posture and 49 individuals with pes planus feet were recruited from a university population. Images of the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles and the plantar fascia were obtained using a Venue 40 ultrasound system with a 5–13 MHz transducer.ResultsThe CSA and thickness of AbH, FHB and PER muscles were significantly smaller (AbH −12.8% and −6.8%, FHB −8.9% and −7.6%, PER −14.7% and −10%), whilst FDL (28.3% and 15.2%) and FHL (24% and 9.8%) were significantly larger in the pes planus group. The middle (−10.6%) and anterior (−21.7%) portions of the plantar fascia were thinner in pes planus group.ConclusionGreater CSA and thickness of the extrinsic muscles might reflect compensatory activity to support the MLA if the intrinsic foot muscle function has been compromised by altered foot structure. A thinner plantar fascia suggests reduced load bearing, and regional variations in structure and function in feet with pes planus.     

An investigation of the relationship between plantar pressure distribution and the morphologic and mechanic properties of the intrinsic foot muscles and plantar fascia

BackgroundThe purpose of this study was to investigate the relationship between plantar pressure distribution and the stiffness, thickness, and cross-sectional area of the plantar fascia (PF) and abductor hallucis (AbH), flexor hallucis brevis (FHB), and flexor digitorum brevis (FDB) muscles.MethodsThe present study included a total of 41 healthy females between the ages of 20 and 34 years. Plantar pressure during static standing position was measured using a pedobarography system (MatScan, Tekscan, Inc., South Boston, Massachusetts, USA). Peak pressure, mean pressure, maximum force (Max-F), contact area (Con-A), pressure time integral, and force time integral (FTI) were measured. The thickness, cross-sectional area and stiffness of the intrinsic foot muscles and PF were measured using an ACUSON S3000 Ultrasound System and a 9L4 probe (4–9 MHz) (Siemens Medical Solution, Mountain View, CA, USA). Shear Wave Velocity (SWV) of the intrinsic foot muscles and PF was measured using a customized software program (Virtual Touch Imaging and Quantification; Siemens Medical Solution).ResultsCon-A had a moderate correlation with the thickness and cross-sectional area of PF, AbH, FHB, and FDB. A fair to moderate correlation was found between heel Max-F and the thickness and cross-sectional area of PF, AbH, FHB, and FDB. There is no significant correlation between the SWV of the assessed tissues and plantar pressure distribution parameters. Body mass and BMI had a fair to good correlation with Mean-P, Con-A, heel Max-F, midfoot Max-F, metatarsal Max-F, FTI, thickness, and cross-sectional area of the PF and assessed musclesSignificanceThe results suggest that abnormal force, contact area, and higher body mass may cause hypertrophy of the PF and foot intrinsic muscles.     

Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances

Magnetic resonance (MR) imaging has emerged as an important noninvasive diagnostic imaging technique for assessment of foot pathology. This modality, owing to its multiplanar imaging capability and inherent superiority in contrast, has been shown to be more accurate and sensitive for detection of plantar fascia pathology than any other imaging method. One of the most important and recognizable causes of heel pain is plantar fasciitis. With the exception of plantar fasciitis, there has been little emphasis on imaging other conditions that affect this important structure. The objective of this review is to demonstrate, from a perspective of MR imaging, the many different pathologic conditions that affect the plantar fascia. Included in this review will be a discussion of normal anatomy as well as entities such as acute plantar fasciitis, chronic plantar fasciitis, traumatic rupture, normal post-surgical changes, pathologic post-fasciotomy conditions, infection, and fibromatosis. Received: 25 January 2000 Revision requested: 21 March 2000 Revision received: 3 April 2000 Accepted: 6 April 2000     

Effect of gender,age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects

Purpose

The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age.

Material and methods

The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1 cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used.

Results

There were statistically significant differences in plantar fascia thickness at the four different locations (p < 0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1 cm proximal to the insertion. At origin and 1 cm distal to insertion weight was an independent predictor of plantar fascia thickness.

Conclusions

There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1 cm proximal to the insertion is influenced by sex and thickness at origin and at 1 cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.     

MR imaging of overuse injuries of the Achilles tendon

OBJECTIVE: This study was conducted to illustrate and classify the abnormalities found on high-resolution MR imaging of symptomatic Achilles tendons in athletic adult patients. SUBJECTS AND METHODS: One hundred patients with 118 painful Achilles tendons were imaged with a 1.5-T magnet. The tendon, peritendinous tissues, tendon insertion, and musculotendinous junction were examined on MR imaging. Twenty-eight patients underwent surgery, and histopathologic samples were taken in 13. Long-term follow-up was performed, on average, 3.4 years after MR imaging. RESULTS: Of 118 painful Achilles tendons, abnormalities were detected in 111. These were in the tendon (n = 90), surrounding structures, or both. Fifty-four tendons had a focal area of increased intratendinous signal, best detected on axial high-resolution T1-weighted gradient-echo MR imaging. Histopathology confirmed abnormal tendon structure. Of the 21 surgically proven foci of tendinosis, 20 were revealed on MR imaging. At the level of the insertion, changes were found in the tendon in 15%, in the retrocalcaneal bursa in 19%, and in the calcaneal bone marrow in 8% of the studies. Abnormalities in peritendinous soft tissues were detected in 67%. More than one type of abnormality was found in 64% of the studies. CONCLUSION: Lesions in the Achilles tendon and in the peritendinous structures can have similar clinical presentation. MR imaging detects and characterizes these changes. A more specific diagnosis and prognosis can be made with the use of MR imaging than with clinical examination alone.     

急性跟腱撕裂的影像学诊断

目的探讨跟腱撕裂的X线平片和MRI诊断价值。方法分析21例有急性踝关节损伤病史、经手术证实为跟腱完全撕裂或部分撕裂患者的X线平片和MRI表现，并与手术结果对照。结果21例MRI均有异常表现，诊断跟腱完全撕裂7例，部分撕裂14例，MRI表现为跟腱增粗，腱内信号增高，腱束连续性完全中断或部分中断。X线片5例诊断跟腱撕裂，12例疑似撕裂，4例正常。手术结果完全撕裂9例，部分撕裂12例。结论MRI能准确显示跟腱撕裂的程度和部位，对临床治疗具有重要的指导意义；X线可作为跟腱撕裂初诊的辅助检查，但明确诊断还有赖于MRI。     

Achilles tendon injuries: the role of MR imaging

Eight magnetic resonance (MR) examinations were performed in seven patients with Achilles tendon injuries and correlated with physical examination and surgical and clinical follow-up. The MR examinations depicted the Achilles tendon in excellent detail and Achilles tendon abnormalities with greater accuracy than physical examination. Of five tendons shown to be at least partially torn on MR, palpable tendinous defects were found in only one, and plantarflexion weakness was found in four. The MR and surgical findings precisely correlated in one case. Magnetic resonance proved valuable in the evaluation of clinically equivocal Achilles tendon tears and may ultimately play a greater role as a research tool in the determination of optimal forms of therapy for specific Achilles tendon injuries.     

Acute effects of long-distance running on mechanical and morphological properties of the human plantar fascia

Long-distance running (LDR) can induce transient lowering of the foot arch, which may be associated with mechanical fatigue of the plantar fascia (PF). However, this has not been experimentally tested in vivo. The purpose of this study was to test our hypothesis that LDR induces transient and site-specific changes in PF stiffness and morphology and that those changes are related to the lowering of the foot arch. Ten male recreational long-distance runners and 10 untrained men were requested to run overground for 10 km. Before and after running, shear wave velocity (SWV: an index of soft tissue stiffness) and thickness of PF at three different sites from its proximal to distal end were measured using supersonic shear imaging and B-mode ultrasonography. Foot dimensions including the navicular height were measured using a three-dimensional foot scanner. SWV at the proximal site of PF and navicular height was significantly decreased in both groups after running, with a higher degree in untrained men (−21.9% and −14.1%, respectively) than in runners (−4.0% and −6.3%, respectively). The relative change (%Δ) in SWV was positively correlated with %Δnavicular height in both groups (r = .69 and r = .65, respectively). Multiple regression analysis revealed that %ΔSWV at the proximal site solely explained 72.7% of the total variance in %Δnavicular height. It is concluded that LDR induces transient and site-specific decreases in PF stiffness. These results suggest that the majority of running-induced lowering of the foot arch is attributable to the reduction of PF stiffness at the proximal site.     

Biomechanical behavior of the plantar flexor muscle-tendon unit after an Achilles tendon rupture

The purpose of this study was to examine the biomechanical behavior of the plantar flexor muscle-tendon unit in subjects who had ruptured their Achilles tendon. Twenty-six men and 14 women volunteered for the study. Eighteen subjects had been treated operatively and 22, nonoperatively. All subjects had ruptured their Achilles tendon more than 1 year before the study, and 28 of the 40 ruptures occurred 5 years or less before the day of testing. A KinCom dynamometer was used to measure ankle joint angle, passive torque, and maximal isometric plantar flexor torque. During a 2-minute passive calf stretch, stiffness and torque relaxation were calculated. Isometric torque and peak passive torque were 17% and 10% greater for the uninvolved versus the involved limb, whereas stiffness and torque relaxation were not different between limbs. The time since injury did not influence the results, nor did the mode of initial treatment, that is, whether the subjects were treated operatively or nonoperatively. These findings suggest that changes in strength and peak passive torque may be chronic adaptations associated with Achilles tendon rupture.     

Imaging in the assessment and management of Achilles tendinopathy and paratendinitis

Achilles tendinopathy is a common overuse injury in patients engaged in athletic activities. Tendon degeneration is often accompanied by paratendinitis. Radiologists are frequently asked to use imaging techniques to evaluate patients with problems at or around the Achilles tendon. The main imaging modalities used in the assessment of Achilles tendon disorders are plain radiography, ultrasound, and magnetic resonance imaging. In recent years, ultrasound has also been used to guide minimally invasive local treatments for Achilles tendinopathy, which may prevent the need for surgery if conservative treatments have failed. In this article, we review the imaging features of Achilles tendinopathy and consider the relative strengths and weaknesses of the various imaging techniques. The role of imaging in directing patient management is also discussed, with particular focus on ultrasound-guided treatments.