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Cen X, Song Y, Yu P, Sun D, Simon J, Bíró I, Gu Y. Effects of plantar fascia stiffness on the internal mechanics of idiopathic pes cavus by finite element analysis: implications for metatarsalgia. Comput Methods Biomech Biomed Engin 2023:1-9. [PMID: 37817665 DOI: 10.1080/10255842.2023.2268231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023]
Abstract
Metatarsalgia occurring in individuals with pes cavus is typically associated with abnormal loading patterns in the forefoot resulting from structural alterations. Simultaneously, the frequent overstress of the plantar fascia (PF) caused by the persistence of this foot deformity may further exacerbate the chronic pain induced by metatarsal overload. We aimed to investigate and quantify the effects of PF stiffness on the internal biomechanics of pes cavus using a computational modelling approach. A patient-specific finite element model of the foot-ankle complex using the actual three-dimensional geometry of idiopathic pes cavus bones and soft tissues was reconstructed. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the PF on the metatarsal stress distribution, and force transmission through the metatarsophalangeal (MTP) and tarsometatarsal (TMT) joints in the pes cavus. The results indicated that variations in PF stiffness led to stress redistribution in the metatarsal region. Peak stress gradually reduced with decreasing stiffness until the PF was released, eventually resulting in a reduction of 22.39% compared to the reference value of 350 MPa. Furthermore, adjusting the PF stiffness to twice the reference value (700 MPa) increased the contact forces through the TMT and MTP joints by up to 23% and 116%, respectively. The reduction of PF stiffness alleviated focal metatarsal loading, and therefore, surgical fascia release can be considered to alleviate metatarsalgia in patients with pes cavus.
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Affiliation(s)
- Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Peimin Yu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - János Simon
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - István Bíró
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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2
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Malakoutikhah H, Latt LD. Disease-Specific Finite element Analysis of the Foot and Ankle. Foot Ankle Clin 2023; 28:155-172. [PMID: 36822685 DOI: 10.1016/j.fcl.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Finite-element analysis is a computational modeling technique that can be used to quantify parameters that are difficult or impossible to measure externally in a geometrically complex structure such as the foot and ankle. It has been used to improve our understanding of pathomechanics and to evaluate proposed treatments for several disorders, including progressive collapsing foot deformity, ankle arthritis, syndesmotic injury, ankle fracture, plantar fasciitis, diabetic foot ulceration, hallux valgus, and lesser toe deformities. Parameters calculated from finite-element models have been widely used to make predictions about their biomechanical correlates.
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Affiliation(s)
- Hamed Malakoutikhah
- Department of Aerospace and Mechanical Engineering, University of Arizona, 1130 North Mountain Avenue, Tucson, AZ 85721, USA.
| | - Leonard Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, 1501 N. Campbell Ave, Suite 8401, Tucson, AZ, 85724 USA
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Moayedi M, Arshi AR, Salehi M, Akrami M, Javadi Asl N, Naemi R. An investigation into the hammer toe effects on the lower extremity mechanics and plantar fascia tension: A case for a vicious cycle and progressive damage. Comput Biol Med 2023; 152:106381. [PMID: 36563541 DOI: 10.1016/j.compbiomed.2022.106381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/14/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Hammer toes are one of the common deformities of the forefoot that can lead to compensatory changes during walking in individuals with this condition. Predicting the adverse effects of tissue damage on the performance of other limbs is very important in the prevention of progressive damage. Finite element (FE) and musculoskeletal modeling can be helpful by allowing such effects to be studied in a way where the internal stresses in the tissue could be investigated. Hence, this study aims to investigate the effects of the hammer toe deformity on the lower extremity, especially on the plantar fascia functions. To compare the joint reactions of the hammer toe foot (HTF) and healthy foot (HF), two musculoskeletal models (MSM) of the feet of a healthy individual and that of a participant with hammer toe foot were developed based on gait analysis. A previously validated 3D finite element model which was constructed using Magnetic Resonance Imaging (MRI) of the diabetic participant with the hammer toe deformity was processed at five different events during the stance phase of gait. It was found that the hammer toe deformity makes dorsiflexion of the toes and the windlass mechanism less effective during walking. Specifically, the FE analysis results showed that plantar fascia (PF) in HTF compared to HF played a less dominant role in load bearing with both medial and lateral parts of PF loaded. Also, the results indicated that the stored elastic energy in PF was less in HTF than the HF, which can indicate a higher metabolic cost during walking. Internal stress distribution shows that the majority of ground reaction forces are transmitted through the lateral metatarsals in hammer toe foot, and the probability of fifth metatarsal fracture and also progressive deformity was subsequently increased. The MSM results showed that the joint reaction forces and moments in the hammer toe foot have deviated from normal, where the metatarsophalangeal joint reactions in the hammer toe were less than the values in the healthy foot. This can indicate a vicious cycle of foot deformity, leading to changes in body weight force transmission line, and deviation of joint reactions and plantar fascia function from normal. These in turn lead to increased internal stress concentration, which in turn lead to further foot deformities. This vicious cycle cause progressive damage and can lead to an increase in the risk of ulceration in the diabetic foot.
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Affiliation(s)
- M Moayedi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - A R Arshi
- Biomechanics and Sports Engineering Groups, Biomedical Engineering Department, Amirkabir University of Technology, Iran.
| | - M Salehi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - M Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, UK.
| | - N Javadi Asl
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - R Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, UK.
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Yang Z, Cui C, Wan X, Zheng Z, Yan S, Liu H, Qu F, Zhang K. Design feature combinations effects of running shoe on plantar pressure during heel landing: A finite element analysis with Taguchi optimization approach. Front Bioeng Biotechnol 2022; 10:959842. [PMID: 36177186 PMCID: PMC9513060 DOI: 10.3389/fbioe.2022.959842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Large and repeated impacts on the heel during running are among the primary reasons behind runners’ injuries. Reducing plantar pressure can be conducive to reducing running injury and improving running performance and is primarily achieved by modifying the design parameters of running shoes. This study examines the effect of design parameters of running shoes (i.e., heel-cup, insole material, midsole material, and insole thickness) on landing peak plantar pressure and determines the combination of different parameters that optimize cushion effects by employing the Taguchi method. We developed the foot–shoe finite element (FE) model through reverse engineering. Model assembly with different design parameters was generated in accordance with the Taguchi method orthogonal table. The effectiveness of the model was verified using the static standing model in Ansys. The significance and contribution of different design parameters, and the optimal design to reduce plantar pressure during landing, were determined using the Taguchi method. In the descending order of percentage contribution was a conforming heel-cup (53.18%), insole material (25.89%), midsole material (7.81%), and insole thickness (2.69%). The more conforming heel-cup (p < 0.001) and softer insole (p = 0.001) reduced the heel pressure during landing impact. The optimal design of running shoe in this study was achieved with a latex insole, a 6 mm insole thickness, an Asker C-45 hardness midsole, and a 100% conforming heel-cup. The conforming heel-cup and the insole material significantly affected the peak plantar pressure during heel landing. The implementation of a custom conforming heel-cup is imperative for relieving high plantar pressure for long-distance heel-strike runners.
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Affiliation(s)
- Zihan Yang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- School of Sport Sciences, Beijing Sport University, West Lafayette, IN, United States
- Fashion Accessory Art and Engineering College, Beijing Institute Of Fashion Technology, Beijing, China
| | - Chuyi Cui
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Xianglin Wan
- School of Sport Sciences, Beijing Sport University, West Lafayette, IN, United States
| | - Zhiyi Zheng
- Anta Sports Science Laboratory, Xiamen, China
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Hui Liu
- School of Sport Sciences, Beijing Sport University, West Lafayette, IN, United States
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Feng Qu
- School of Sport Sciences, Beijing Sport University, West Lafayette, IN, United States
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- *Correspondence: Kuan Zhang,
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Karaytug K, Bayram S, Ekinci M, Hürmeydan ÖM, Batibay SG. Comparison of the Isolated Plantar Fascia Release Versus Plantar Fascia Release Combined With Calcaneal Decompression in Management of the Patients With Resistant Heel Pain. J Foot Ankle Surg 2022; 61:459-463. [PMID: 34654637 DOI: 10.1053/j.jfas.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/17/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023]
Abstract
We aimed to compare isolated percutaneous plantar fascia release by using a needle versus percutaneous plantar fascia release combined with calcaneal decompression in treatment of the patients with resistant heel pain. We reviewed the prospectively recorded data of patients who treated and follow-up for resistant heel pain (treated more than 6 months with other treatment modalities) with a minimum 1-year follow-up. Twenty patients were treated with plantar fascia release using a needle (group 1) and 21 patients were treated with a similar percutaneous release combined with calcaneal decompression (group 2). Functional outcomes were evaluated using visual analog scale (VAS) and Foot Function Index (FFI) pre- and postoperatively. No significant differences were observed between both groups in terms of age (44.3 years in group 1 vs 46.8 years in group 2), gender (18 females and 2 males in group 1 vs 19 females and 3 males in group 2), body mass index (25.1 in group 1 vs 26.3 in group 2), and follow-up (14.6 months in group 1 vs 15.7 months in group 2). The decrease in postoperative FFI and VAS scores compared with preoperative VAS scores was statistically significant in both groups. However, improvement of FFI and VAS score was significantly higher in group 2 than group 1. Although both methods are very effective in the treatment of persistent heel pain, the group 2 has a better improvement in functional scores than group 1 with a mean 15 months following the procedure.
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Affiliation(s)
- Kayahan Karaytug
- Department of Orthopaedics and Traumatology, Acıbadem Maslak Hospital, Istanbul, Turkey.
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Ekinci
- Department of Orthopedics and Traumatology, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Önder Murat Hürmeydan
- Department of Orthopedics and Traumatology, Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sefa Giray Batibay
- Associate Professor, Department of Orthopedics and Traumatology, Ankara Occupational and Environmental Diseases Hospital, Ankara, Turkey
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Kurtoglu A, Kochai A, Inanmaz ME, Sukur E, Keskin D, Türker M, Sen Z, Daldal I, Avan LY. Effectiveness of radiofrequency ablation for treatment of plantar fasciitis. Medicine (Baltimore) 2022; 101:e29142. [PMID: 35357356 PMCID: PMC11319323 DOI: 10.1097/md.0000000000029142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Plantar fasciitis is the most common cause of heel pain. Pain can be persistent in some patients and interrupt daily activities and sportive activities. There are a lot of treatment options available for plantar fasciitis. We hypothesized that patients with chronic persistent plantar fasciitis can be successfully treated with radiofrequency nerve ablation (RFNA).Two hundred sixty-one patients with plantar fasciitis (378 feet) treated with RFNA from February 2017 to January 2019 were retrospectively assessed. All the patients had plantar heel pain for at least 6months. Based on their body mass index (BMI), the enrolled patients were divided into obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2) groups. The patients were asked to complete a questionnaire just before and after the procedure and during the final follow-up. The BNS Radiofrequency Lesion Generator was used during a single session. The patients' information, including their visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) score, was assessed. During their final follow-up, the patients were asked to rate the success of their treatment by choosing one of the following options: completely successful, very successful, moderately successful, marginally successful, or not successful.The VAS and AOFAS scores of all the patients were evaluated pre-procedure, in the first month after procedure, and during the final follow-up (8-24 months). There was a statistically significant difference between the pre-procedure and postprocedure VAS scores (P < .001), there was no statistically significant difference between the VAS scores in the first month postprocedure and during the final follow-up.There was a statistically significant difference between the pre-procedure and postprocedure AOFAS scores (P < .001), there was no statistically significant difference between the AOFAS scores in the first month postprocedure and during the final follow-up.RFNA can be used as an alternative method to surgical procedures for treating plantar fasciitis because it is safe and effective. The advantages of RFNA are that patients can quickly return to their work and resume weight-bearing activities.
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Affiliation(s)
- Alper Kurtoglu
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Alauddin Kochai
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | | | - Erhan Sukur
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Dogan Keskin
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Mehmet Türker
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Zafer Sen
- University of Health Sciences, Konya City Hospital Orthopedics and Traumatology, Turkey,
| | - Ismail Daldal
- Lokman Hekim Akay Hospital, Department of Orthopaedic and Traumatology, Ankara, Turkey.
| | - Laçin Yüksel Avan
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
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Wu J, Liu H, Xu C. Biomechanical Effects of Graft Shape for the Evans Lateral Column Lengthening Procedure: A Patient-Specific Finite Element Investigation. Foot Ankle Int 2022; 43:404-413. [PMID: 34549634 DOI: 10.1177/10711007211043822] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Evans calcaneal lengthening osteotomy procedure is widely used for correcting progressive collapsing foot deformity. However, it can result in overcorrection and degenerations of the calcaneocuboid joint. Different shapes of graft have been used in the Evans calcaneal osteotomy, but potential differences in their biomechanical effects is still unclear. The present study was designed to explore the biomechanical effects of graft shape and improve the Evans procedure to avoid or minimize detrimental effects. METHODS Twelve patient-specific finite element models were established and validated. A triangular or rectangular wedge of varying size was inserted at the lateral edge of calcaneus, and the degree of correction was quantified. The stress in spring ligaments and plantar fascia and the contact characteristics of the talonavicular and calcaneocuboid joints were calculated and compared accordingly. RESULTS The rectangular graft provided a much higher degree of correction than triangular grafts did. However, the contact characteristics of the calcaneocuboid joint and talonavicular joint were abnormal, with clear sensitivity to increased graft size, and the modeled strain of the spring ligament increased. CONCLUSION The finite element analysis predicts that the rectangular grafts provide a higher degree of correction, but risks overcorrection compared with triangular grafts. The triangular graft may have a lower degree of disturbance to the biomechanical behaviors of the midtarsal joint. CLINICAL RELEVANCE The model shows that both the shape and size of an Evans osteotomy bone wedge can have effects on the contiguous joints and ligamentous structures. Those effects should be considered when selecting a bone wedge for an Evans calcaneal osteotomy. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Jiajun Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Perforating Fat Injections for Chronic Plantar Fasciitis: A Randomized, Crossover Clinical Trial. Plast Reconstr Surg 2022; 149:297e-302e. [PMID: 35077429 DOI: 10.1097/prs.0000000000008765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Plantar fasciitis affects 2 million patients per year. Ten percent of cases are chronic, with thickened plantar fascia. Treatment may lead to prolonged recovery, foot instability, and scar. The authors hypothesized that perforating fat injections would decrease plantar fascia thickness, reduce pain, and improve quality of life. Adults with plantar fascia greater than 4 mm for whom standard treatment had failed were included in a prospective, randomized, crossover pilot study. Group 1 (intervention) was followed for 12 months. Group 2 was observed for 6 months, injected, and then followed for 6 months. Validated patient reported outcome measures, ultrasound, and complications were assessed. Group 1 had nine female patients and group 2 had five patients. A total of 2.6 ± 1.6 ml of fat was injected per foot at one to two sites. In group 1, plantar fascia thickness decreased from screening at 6 and 12 months (p < 0.05). Group 2 had decreased plantar fascia thickness from screening to 6 months after injection (p < 0.05). Group 1 had pain improvements at 6 and 12 months compared with screening (p < 0.01). Group 2 reported no pain difference after injections (p > 0.05). Group 1 had improved activities of daily living and sports activity at 6 and 12 months compared with screening (p < 0.003). Group 2 noted increased sports activity 6 months after injection compared with screening (p < 0.03). In conclusion, perforating fat injections for chronic plantar fasciitis demonstrate significant improvement in pain, function, and plantar fascia thickness. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Zhu J, Forman J. A Review of Finite Element Models of Ligaments in the Foot and Considerations for Practical Application. J Biomech Eng 2022; 144:1133332. [PMID: 35079785 DOI: 10.1115/1.4053401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE Finite element (FE) modeling has been used as a research tool for investigating underlying ligaments biomechanics and orthopedic applications. However, FE models of the ligament in the foot have been developed with various configurations, mainly due to their complex 3D geometry, material properties, and boundary conditions. Therefore, the purpose of this review was to summarize the current state of finite element modeling approaches that have been used in the ?eld of ligament biomechanics, to discuss their applicability to foot ligament modeling in a practical setting, and also to acknowledge current limitations and challenges. METHODS A comprehensive literature search was performed. Each article was analyzed in terms of the methods used for: (a) ligament geometry, (b) material property, (c) boundary and loading condition related to its application, and (d) model verification and validation. RESULTS Of the reviewed studies, 80% of the studies used simplified representations of ligament geometry, the non-linear mechanical behavior of ligaments was taken into account in only 19.2% of the studies, 33% of included studies did not include any kind of validation of the FE model. CONCLUSION Further refinement in the functional modeling of ligaments, the micro-structure level characteristics, nonlinearity, and time-dependent response, may be warranted to ensure the predictive ability of the models.
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Affiliation(s)
- Junjun Zhu
- School of Mechatronic Engineering and Automation, Shanghai University, 333 Nanchen Rd., Shanghai, China, 200444
| | - Jason Forman
- Center for Applied Biomechanics, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA 22911, USA
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Zimmerman JC, Smith PE, Casey K, Falci MJ, Naugle K. A Cadaveric Study of the Plantar Fascia for the In-Step Plantar Fasciotomy. J Foot Ankle Surg 2021; 59:957-960. [PMID: 32409113 DOI: 10.1053/j.jfas.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
The in-step plantar fasciotomy has remained a viable option for treatment of plantar fasciitis. The level of the in-step procedure has previously been described as 1.5 cm distal to the anterior heel fat pad. The authors are unaware of any study defining mean width and thickness of the plantar fascia at specific distances from its insertion. The authors performed a standardized cadaveric dissection of 25 fresh frozen cadaveric specimens from a local region in Pennsylvania. Each fascial band width and thickness of the plantar fascia was measured at the fascial insertion, 2 cm distal from insertion, and 3 cm distal from insertion. The mean (± standard deviation) width of the medial, central, and lateral band of the plantar fascia 3 cm from its insertion was 25.3 ± 5.3, 25 ± 3.41, and 23.3 ± 4.49 mm, respectively. At the same anatomic distance, the band thicknesses were 1.5 ± 0.82, 3.3 ± 0.85, and 1.9 ± 0.33 mm, respectively. The literature describes 2 techniques. The first is transecting between one-third to two-thirds of the plantar fascia during a fasciotomy from medial to lateral. The second is identifying, isolating, and releasing the central band. Our study allows to further quantify this, equating to 24.5 to 49 mm in total medial to lateral transection at 3 cm distal from insertion and an isolated central band equating to 25 ± 3.41 mm. With quantitative measurements of transection length, the surgeon will avoid having to estimate and potentially overtransect. This may help in preventing postoperative sequela related to overcorrection.
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Affiliation(s)
| | - Peter E Smith
- Resident Physician, Reading Hospital Tower Health, West Reading, PA; Chief of Podiatry, General Leonard Wood Army Community Hospital, Fort Leonard Wood, MO
| | - Kerry Casey
- Resident Physician, Reading Hospital Tower Health, West Reading, PA
| | - Michael J Falci
- Resident Physician, Reading Hospital Tower Health, West Reading, PA; Physician, OSS Orthopaedic Hospital, York, PA
| | - Kevin Naugle
- Residency Director, Reading Hospital Tower Health, West Reading, PA
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11
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Lyle SA, Bernasconi A, Welck MJ, Cullen NP, Singh D, Patel S. Staples and locking plates provide comparable outcomes for fixation of first metatarsal dorsiflexion osteotomies in pes cavovarus. Foot (Edinb) 2021; 47:101815. [PMID: 33964534 DOI: 10.1016/j.foot.2021.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND One commonly encountered deformity within the cavovarus foot is plantarflexion of the first metatarsal which may be a primary or secondary deformity. Correcting the plantarflexion may be achieved through a dorsiflexion osteotomy although the optimal fixation device for this osteotomy has not been determined. This clinical study compared the outcomes using staples and locking plates. METHODS A retrospective evaluation was performed of 52 feet that had undergone dorsiflexion osteotomy of the first metatarsal as part of a cavovarus foot correction with a minimum follow-up of two years. Data was collected on deformity correction, complications and cost-analysis. RESULTS As a cohort, Meary's angle improved from 13.4° to 7.72° (p < 0.001), Hibbs' angle improved from 117.1° to 124.2° (p < 0.001) and navicular height dropped from 52.7 mm to 47.7 mm (p < 0.001) while calcaneal inclination changed from 20.9° to 21.2° but this did not reach significance (p = 0.66). These indices and the number of complications were not significantly different between the staple and locking plate group. The overall cost of using staples was less than using locking plates. CONCLUSIONS Both staples and locking plates are effective devices for fixation of the first metatarsal after a dorsiflexion osteotomy in cavovarus foot surgery. They were both able to provide comparable fixation, although staples were less expensive to use in our study.
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Affiliation(s)
- Shirley A Lyle
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Matthew J Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Nick P Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Dishan Singh
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
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12
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Iborra A, Villanueva M, Sanz-Ruiz P, Martin A, Noriega C. A novel closed technique for ultrasound-guided plantar fascia release with a needle: review of 107 cases with a minimum follow-up of 24 months. J Orthop Surg Res 2021; 16:153. [PMID: 33627158 PMCID: PMC7903032 DOI: 10.1186/s13018-021-02302-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis. METHODS We performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia. The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7-66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27-72). Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index. RESULTS Heel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. We recorded no nerve complications (e.g., paresthesia), vascular injuries, or wound-related problems. CONCLUSION Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. Stitches are not necessary, and recovery is fast. Consequently, costs are low, and the patient can return to work quickly. This technique may represent a valid option for treatment of plantar fasciitis.
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Affiliation(s)
- A. Iborra
- School of Health Sciences, Department of Podiatry, University of La Salle, Institute Avanfi, 28020 Madrid, Spain
| | | | - P. Sanz-Ruiz
- Institute Avanfi, 28020 Madrid, Spain
- Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Martin
- Institute Avanfi, 28020 Madrid, Spain
- Orthopaedic and Trauma Department, Hospital General Universitario Donostia, Madrid, Spain
| | - Concepción Noriega
- University of Alcalá, Madrid. School of Medicine and Health Sciences, Department of Nursery and Physiotherapy, University of Alcalá, Alcalá de Henares, Spain
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Lv ML, Zhang H, Chen L, Liu Y, Wang F, Wong DWC, Sun L, Ni M. Finite element method based parametric study of Gastrocnemius-soleus recession: implications to the treatment of midfoot-forefoot overload syndrome. Comput Methods Biomech Biomed Engin 2020; 24:913-921. [PMID: 33320018 DOI: 10.1080/10255842.2020.1858817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gastrocnemius-soleus recession has been used to treat midfoot-forefoot overload syndrome and plantar fasciitis induced by equinus of the ankle joint. A controlled and selective amount of recession is imperative to maintain muscle strength and stability. The objective of this study was to conduct a parametric study to quantify the relationship between the level of recession and plantar fascia stress. A finite element model of the foot-ankle-shank complex was reconstructed from magnetic resonance and computed tomography images of a 63-year-old normal female. The model was validated by comparing modeled stresses to the measured plantar pressure distribution of the model participant during balanced standing. The midstance and push-off instants of walking stance were simulated with different levels and combinations of gastrocnemius-soleus recession resembled by different amounts of muscle forces. Halving the muscle forces at midstance reduced the average plantar fascia stress by a quarter while reducing two-third of the muscle forces at push-off reduced the average fascia stress by 18.2%. While the first ray of the plantar fascia experienced the largest stress among the five fasciae, the stress was reduced by 77.8% and 16.9% when the load was halved and reduced by two-third at midstance and push-off instants, respectively. Reduction in fascia stress implicates a lower risk of plantar fasciitis and other midfoot-forefoot overload syndromes. The outcome of this study can aid physicians to determine the amount of gastrocnemius-soleus recession towards patients with vdifferent levels of plantar fascia overstress. A detailed three-dimensional modelling on the plantar fascia is warranted in future study.
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Affiliation(s)
- Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Department of Mechanical Engineering, University of Houston, Houston, TX, USA
| | - Haowei Zhang
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Liang Chen
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ying Liu
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Fei Wang
- Department of Mechanical Engineering, University of Houston, Houston, TX, USA
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Li Sun
- Department of Mechanical Engineering, University of Houston, Houston, TX, USA
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples' Hospital, affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
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Treatment of "plantar fasciitis"/Plantar Heel Pain Syndrome with botulinum toxin - A novel injection paradigm pilot study. Foot (Edinb) 2020; 45:101711. [PMID: 33038660 DOI: 10.1016/j.foot.2020.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]
Abstract
Randomized controlled trials over the last two decades, although promising with favorable results, have shown varied efficacy in treatment of "plantar fasciitis" with botulinum toxin injection1. One reason may be due to conflating the variabilities of plantar heel conditions solely as plantar fasciitis. Plantar Heel Pain Syndrome can be of one or more etiologies and symptoms which refutes the mistaken tendency to categorize all plantar heel pain singularly as either plantar fasciitis or fasciosis. Recognizing that there is likely an interplay of inflammatory, degenerative, and neuropathic etiologic conditions of this often-difficult malady to treat, a novel injection paradigm of botulinum toxin is explored in the treatment of 4 distinct presentations of Plantar Heel Pain Syndrome with encouraging results. Botulinum toxin injection into two intrinsic foot muscles; Abductor Hallucis and Quadratus Plantae at their origins with electrical stimulation is presented as novel method to treat four distinct etiologies of Plantar Heel Pain Syndrome. This method of botulinum toxin injection resulted in significant prolonged improvement of patient function and pain reduction in four variations of Plantar Heel Pain Syndrome. A precise injection paradigm facilitated with direct intrinsic muscle stimulation of the Abductor Hallucis and Quadratus Plantae at their origins may prove to be effective in reducing the disabilities of Plantar Heel Pain Syndrome and its associated pain.
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15
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Can X, Mingqing L, Chenggong W, Hua L. Biomechanical comparison of tenodesis reconstruction for subtalar instability: a finite element analysis. BMC Musculoskelet Disord 2020; 21:669. [PMID: 33036597 PMCID: PMC7547424 DOI: 10.1186/s12891-020-03693-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 10/01/2020] [Indexed: 01/11/2023] Open
Abstract
Background There are several types of tenodesis reconstruction designed for subtalar instability. However, no comprehensive comparison has been conducted among these procedures in terms of their correcting power so far. The objective of this study is to evaluate the biomechanical behaviors of 5 representative procedures through finite element analysis. Methods Finite element models were established and validated based on one of our previous studies. The Pisani interosseous talocalcaneal ligament (ITCL) reconstruction, Schon cervical ligament (CL) reconstruction and Choisne calcaneofibular ligament (CFL) reconstruction were compared on the model with the CFL, ITCL and CL sectioned. The Schon triligamentous reconstruction and Mann triligamentous reconstruction were compared on the model with the CFL, ITCL and CL, as well as the ATFL sectioned. The inversion and external/internal rotation were quantified at different ankle positions based on the rotational moment. Then, the stress in ligaments and reconstructed grafts and the contact characteristics of the subtalar joint under inversional stress test were calculated and compared accordingly. Results For single ligament reconstruction, the Choisne CFL reconstruction provided the greatest degree of correction for subtalar instability, followed by the Schon CL reconstruction and then the Pisani ITCL reconstruction. For triligamentous reconstruction, the Mann procedure outperformed the Schon procedure in alleviating the subtalar instability. Conclusion The finite element analysis showed that the Choisne CFL reconstruction and Mann triligamentous reconstruction provided the greatest degree of immediate postoperative subtalar stability. However, both procedures could not restore the biomechanical behaviors of the subtalar joint to normal. The long-term efficacy of these procedures warrants further investigation using a substantially larger sample of clinical cases.
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Affiliation(s)
- Xu Can
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Li Mingqing
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Wang Chenggong
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Liu Hua
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China.
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Khurana A, Dhankhar V, Goel N, Gupta R, Goyal A. Comparison of midterm results of Platelet Rich Plasma (PRP) versus Steroid for plantar fasciitis: A randomized control trial of 118 patients. J Clin Orthop Trauma 2020; 13:9-14. [PMID: 33717869 PMCID: PMC7920137 DOI: 10.1016/j.jcot.2020.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Plantar fasciitis, which is a common cause of heel pain, often results in significant morbidity. In cases who are not responsive to initial conservative treatment, invasive procedures, often in the form of local infiltration of steroid are required. These procedures are associated with significant complications. Local Platelet Rich Plasma (PRP) infiltration is an emerging addition to these treatments. However, whether it is more effective in reducing pain and improving function than other treatments (such as steroid injections or whole blood) remains controversial. METHODS Skeletally mature patients with plantar fasciitis who had failed conservative therapy were randomized using envelope method into 2 groups: PRP and Steroid group. The participants were assessed for pain using Visual Analog Scale on the day of presentation, and then after therapy at 2 weeks, 4 weeks, 3 months, and 6 months. They were additionally assessed on final follow-up using AOFAS hind-foot Score. RESULTS 118 patients were randomized into 2 groups: 58 patients to the PRP group and 60 to the Steroid group. PRP was associated with greater improvement in VAS score and resulted in superior AOFAS score at 6 months as compared to steroid injection. The authors did not find any local or systemic complications in any of the groups. The result and difference were more pronounced as the time from injection increased and maximal benefit was observed at 6 months follow-up. None of the patients needed a repeat injection at 6 months. CONCLUSION Our study expands on the previous studies to provide a better evidence for superiority of PRP over local injection of steroid in plantar fasciitis, and the authors conclude that PRP provides better pain relief and function as compared to steroid injection. LEVEL OF EVIDENCE Level 1 Prospective Randomized Control Trial (RCT).
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Affiliation(s)
- Ankit Khurana
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India,Corresponding author. Department of Orthopaedics, Dr BSA Medical college and Hospital, Rohini Sector 6, Delhi, 110085, India.
| | - Vaneet Dhankhar
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India
| | - Navneet Goel
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India
| | - Rishi Gupta
- Department of Biostatistics, Manokalp Clinic, Delhi, India
| | - Ashish Goyal
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India
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Schaarup SO, Burgaard P, Johannsen FE. Surgical Repair of Complete Plantar Fascia Ruptures in High-Demand Power Athletes: An Alternative Treatment Option. J Foot Ankle Surg 2020; 59:195-200. [PMID: 31882140 DOI: 10.1053/j.jfas.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/31/2019] [Accepted: 07/28/2019] [Indexed: 02/03/2023]
Abstract
Surgical repair of complete plantar fascia ruptures has not yet been reported in the literature. Operative technique and outcome are described in 2 gymnasts with heavy plyometric demands who received surgical repair compared with 3 athletes treated nonoperatively. Biomechanics and clinical implications are discussed. In the last 8 years, we have seen 5 high-demand athletes with total rupture of the plantar fascia. This is a retrospective clinical evaluation 1.5 to 8 years postinjury of all 5 patients using dynamic ultrasound, Foot Function Index, sports-specific questions, Foot Posture Index, and foot length. The operated gymnasts returned to the same level of performance within 12 months. None of the conservatively treated athletes returned to preinjury plyometric sports levels but reached a foot load capacity of distance running with the injured foot as limiting factor. Ultrasound with simultaneous dorsiflexion of the toes showed a normal fascia in the operated patients, but a slack fascia that tightened up only at terminal toe dorsiflexion in the conservatively treated group. According to the Foot Function Index, the operated patients reported no complaints, whereas the nonoperative group had clinical relevant impairments in activities of daily life. The Foot Posture Index in all nonoperated patients showed a relative shift toward pronation with increased foot length compared with the noninjured foot. The operated patients showed no difference in foot length but minimal shift into supination with a slightly altered arch contour. Surgical repair of plantar fascia ruptures is technically feasible to restore normal foot load capability with return to high-demand plyometric sports within 12 months.
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Affiliation(s)
| | - Peder Burgaard
- Surgeon, Rigshospitalet, Department of Orthopedic Surgery, Copenhagen, Denmark
| | - Finn Elkjær Johannsen
- Sports Physician and Scientist, Bispebjerg Hospital, Institute of Sportsmedicine Copenhagen, University of Copenhagen, Copenhagen, Denmark
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18
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De Prado M, Cuervas-Mons M, De Prado V, Golanó P, Vaquero J. Does the minimally invasive complete plantar fasciotomy result in deformity of the Plantar arch? A prospective study. Foot Ankle Surg 2020; 26:347-353. [PMID: 31113726 DOI: 10.1016/j.fas.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/09/2018] [Accepted: 04/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Complete 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. METHODS A 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. RESULTS A 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. CONCLUSIONS Percutaneous 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.
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Affiliation(s)
- Mariano De Prado
- Department of Orthopaedics and Trauma Surgery, Quirónsalud Murcia Hospital, Calle Miguel Hernandez, 12, 30011, Murcia, Spain
| | - Manuel Cuervas-Mons
- Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañón' University Hospital, Calle Dr Esquerdo, 46, 28007, Madrid, Spain; Complutense University of Madrid, Avenida. Séneca, 2, 28040, Madrid, Spain.
| | - Virginia De Prado
- Department of Podiatry Quirónsalud Murcia Hospital, Calle Miguel Hernandez, 12, 30011, Murcia, Spain
| | - Pau Golanó
- Human Anatomy & Embriology Unit, University of Barcelona, Gran Via de les Corts Catalanes, 585, 08007, Barcelona, Spain
| | - Javier Vaquero
- Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañón' University Hospital, Calle Dr Esquerdo, 46, 28007, Madrid, Spain; Complutense University of Madrid, Avenida. Séneca, 2, 28040, Madrid, Spain
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Deschamps K, Matricali G, Peters H, Eerdekens M, Wuite S, Leardini A, Staes F. Contribution of foot joints in the energetics of human running. Comput Methods Biomech Biomed Engin 2020; 23:557-563. [DOI: 10.1080/10255842.2020.1746287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kevin Deschamps
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
- Institut D’Enseignement, Division of Podiatry, Supérieur Parnasse Deux-Alice, Bruxelles, Belgium
- Department of Podiatry, Artevelde University College, Ghent, Belgium
| | - Giovanni Matricali
- Department of Development and Regeneration, KULeuven, Leuven, Belgium
- Foot and Ankle Surgery, UZ Leuven, Leuven, Belgium
- Member Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium
| | - Helen Peters
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
| | - Maarten Eerdekens
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
| | - Sander Wuite
- Department of Development and Regeneration, KULeuven, Leuven, Belgium
- Foot and Ankle Surgery, UZ Leuven, Leuven, Belgium
- Member Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium
| | | | - Filip Staes
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
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20
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Mao DW, Chandrakumara D, Zheng Q, Kam C, Kon Kam King C. Endoscopic plantar fasciotomy for plantar fasciitis: A systematic review and network meta-analysis of the English literature. Foot (Edinb) 2019; 41:63-73. [PMID: 31706064 DOI: 10.1016/j.foot.2019.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/16/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is limited evidence on outcomes for endoscopic plantar fasciotomy. OBJECTIVES An evidence-based literature review for outcomes of endoscopic plantar fasciotomy for the treatment of plantar fasciitis is provided. METHODS A comprehensive evidence-based literature review of PubMed and Cochrane databases was conducted on 9th March 2019, which identified 12 relevant articles assessing the efficacy of endoscopic plantar fasciotomy. The studies were then assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against endoscopic plantar fascia release. RESULTS Based on the results of this evidence-based review, there is poor evidence (grade C) to support endoscopic plantar fascia release. Release of the medial 2/3 of the plantar fascia in endoscopic plantar fasciotomy was associated with higher AOFAS score. CONCLUSION Although the majority of the level of evidence was low (level IV) and grade of recommendation was poor (grade C), there seemed to be good outcomes for endoscopic plantar fasciotomy. There is a need for more high quality level I randomized controlled trials with validated outcome measures to allow for stronger recommendations to be made.
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Affiliation(s)
- David Weijia Mao
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, 529889, Singapore.
| | - Darshana Chandrakumara
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, 529889, Singapore
| | - Qishi Zheng
- Department of Epidemiology, Singapore Clinical Research Institute, 31 Biopolis Way, 138669, Singapore
| | - Carmen Kam
- Clinical Trials & Research Unit, Changi General Hospital, 2 Simei St 3, 529889, Singapore
| | - Charles Kon Kam King
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, 529889, Singapore
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21
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The Receptive and Propulsive Behavior of Human Foot Joints During Running With Different Striking Strategies. J Appl Biomech 2019; 35:336-343. [DOI: 10.1123/jab.2018-0442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/05/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022]
Abstract
Foot structure and kinematics have long been considered as risk factors for foot and lower-limb running injuries. The authors aimed at investigating foot joint kinetics to unravel their receptive and propulsive characteristics while running barefoot, both with rearfoot and with midfoot striking strategies. Power absorption and generation occurring at different joints of the foot in 6 asymptomatic adults were calculated using both a 3-segment and a 4-segment kinetic model. An inverse dynamic approach was used to quantify mechanical power. Major power absorption and generation characteristics were observed at the ankle joint complex as well as at the Chopart joint in both the rearfoot and the midfoot striking strategies. The power at the Lisfranc joint, quantified by the 4-segment kinetic model, was predominantly generated in both strategies, and at the toes, it was absorbed. The overall results show a large variability in the receptive and propulsive characteristics among the analyzed joints in both striking strategies. The present study may provide novel insight for clinical decision making to address foot and lower-limb injuries and to guide athletes in the adoption of different striking strategies during running.
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22
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Xu C, Li MQ, Wang C, Liu H. Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model. J Orthop Surg Res 2019; 14:114. [PMID: 31036018 PMCID: PMC6489249 DOI: 10.1186/s13018-019-1154-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Several approaches to spring ligament reconstruction have been reported. However, a comparative study of nonanatomic and anatomic techniques with respect to biomechanical responses, such as kinematics and contact characteristics, has not been previously performed via a finite element analysis. The purpose of this study was to evaluate the biomechanical results of such spring ligament reconstructions via a finite element analysis. Methods A three-dimensional finite element model of the foot was developed and validated, and four reconstruction methods were simulated. The talonavicular dorsiflexion and abduction, hindfoot valgus, and contact characteristics in the Chopart joints were quantified in each model. Results Nonanatomic reconstructions corrected the talonavicular and hindfoot deformities to a greater extent than the anatomic reconstructions. The anatomic techniques also corrected the abduction and dorsiflexion deformities, although they presented insufficient power to correct for hindfoot valgus. None of the procedures restored the contact characteristics of the talonavicular and calcaneocuboid joints to those of a normal condition. Conclusion Nonanatomic reconstruction of the spring ligament complex provided the greatest correction for midfoot and hindfoot misalignments in flatfoot. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods. The spring ligament reconstruction method may mitigate the need for nonanatomic bony procedures associated with complications and allows for the preservation of the triple joint complex.
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Affiliation(s)
- Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Ming Qing Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Chenggong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Al-Ashhab ME, Elbegawy HEDA, Hasan HAA. Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy. J Foot Ankle Surg 2018; 57:264-268. [PMID: 29224949 DOI: 10.1053/j.jfas.2017.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Indexed: 02/03/2023]
Abstract
Plantar fasciopathy is a common cause of heel pain. Endoscopic plantar fasciotomy has the advantage of less surgical trauma and rapid recovery. The aim of the present prospective study was to delineate the results of endoscopic plantar fascia release through 2 medial portals. The present study included 2 groups. The first group included 27 feet in 25 patients that had undergone endoscopic plantar fascia release followed up for 19.7 (range 12 to 33) months. The second group, the control group, included 20 feet in 16 patients treated conservatively and followed up for 16.4 (range 12 to 24) months. The results of endoscopic plantar fascia release were superior to the conservative methods. The surgically treated group experienced significantly less pain, activity limitations, and gait abnormality. The presence of a calcaneal spur had no effect on the final postoperative score. In conclusion, endoscopic plantar fascia release through 2 medial portals is an effective procedure for treatment of resistant plantar fasciopathy that fails to respond to conservative management options.
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Affiliation(s)
- Mohamed Ebrahim Al-Ashhab
- Associate Professor, Orthopedics and Traumatology Department, Benha Faculty of Medicine, Benha University, Qualubia, Benha, Egypt.
| | - Hossam El-Dein A Elbegawy
- Associate Professor, Orthopedics and Traumatology Department, Benha Faculty of Medicine, Benha University, Qualubia, Benha, Egypt
| | - Hala Ali Abed Hasan
- Lecturer, Public Health Department, Benha Faculty of Medicine, Benha University, Qualubia, Benha, Egypt
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24
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Ling Y, Wang S. Effects of platelet-rich plasma in the treatment of plantar fasciitis: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e12110. [PMID: 30212938 PMCID: PMC6156022 DOI: 10.1097/md.0000000000012110] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Plantar fasciitis is a common cause of heel pain, which often results in significant morbidity. There have been several treatment options that are used for plantar fasciitis, including nonsteroidal anti-inflammatory drugs, orthoses, physical therapy, and steroid injections. OBJECTIVES The aim of this meta-analysis was to compare the effects of platelet-rich plasma (PRP) and other treatments in patients with plantar fasciitis. SEARCH METHODS Medline, Web of Science, and Embase were systematically searched to identify relevant trials. SELECTION CRITERIA Randomized controlled trials (RCTs) that compared the effects of PRP and other treatments on plantar fasciitis were included. DATA COLLECTION AND ANALYSIS The main outcomes included changes from baseline in visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society Score (AOFAS), and Roles-Maudsley score (RMS). Results were expressed as weight mean difference (WMD) with 95% confidence interval (95% CI). The meta-analysis was performed using a fixed-effects or random-effects model according to heterogeneity. MAIN RESULTS Ten RCTs involving a total of 445 patients with plantar fasciitis were included. Among these studies, 9 compared PRP with steroid, and 1 compared PRP with whole blood.Four studies were categorized as being at low risk of bias, and the remaining 6 as being at unclear risk of bias.Pooled estimates suggested that PRP had greater changes in VAS and AOFAS scores than other treatments. However, it had no benefit effect in the RMS.Subgroup analysis for VAS and AOFAS showed that PRP had superior effect than other treatments at 12 months, but not at the 1, 3, 6 months.Subgroup analysis based on treatment regimens demonstrated that PRP was more effective than steroid in the change from baseline in AOFAS, but not in VAS and RMS scores. AUTHORS' CONCLUSION PRP was as effective as other treatments in reducing pain and improving function in patients with plantar fasciitis. Subgroup analysis indicated that PRP had better effect than steroid in AOFAS Score and its effect was durable in a long term. However, considering the potential limitations in this study, more large-scale RCTs are needed to confirm the current findings.
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Affiliation(s)
- Yan Ling
- Department of Rehabilitation, Research Center of Sports Rehabilitation of Shandong
| | - Shu Wang
- Department of Rehabilitation, Shandong Sports Hospital, Jinan, China
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Wang Z, Kido M, Imai K, Ikoma K, Hirai S. Towards patient-specific medializing calcaneal osteotomy for adult flatfoot: a finite element study. Comput Methods Biomech Biomed Engin 2018; 21:332-343. [PMID: 29544347 DOI: 10.1080/10255842.2018.1452202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Clinically in medializing calcaneal osteotomy (MCO), foot and ankle surgeons are facing difficulties in choosing appropriate surgical parameters due to the individual differences in deformities among flatfoot patients. Traditional cadaveric studies have provided important information regarding the biomechanical effects of tendons, ligaments, and plantar fascia, but limitations have been reached when dealing with individual differences and tailoring patient-specific surgeries. Therefore, this study aimed at implementing the finite element (FE) method to investigate the effect of different MCO parameters to help foot and ankle surgeons performing patient-specific surgeries. This study constructed FE models of a flatfoot and a healthy foot based on computed tomography (CT) images. After validating the FE models with experimental measurements, differences in plantar stress were compared between two models and a criterion was established for evaluating the performance of surgical simulations. Four MCO parameters were then studied through FE simulations. Results suggested that the transverse angle, β, and translation distance, d, affected surgical performance. Therefore, special attentions may be recommended when choosing these two parameters clinically. However, the sagittal angle, α, and osteotomy position, p, were found to have less effect on the MCO performance.
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Affiliation(s)
- Zhongkui Wang
- a Department of Robotics , Ritsumeikan University , Shiga , Japan
| | - Masamitsu Kido
- b Department of Orthopaedics , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Kan Imai
- b Department of Orthopaedics , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Kazuya Ikoma
- b Department of Orthopaedics , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Shinichi Hirai
- a Department of Robotics , Ritsumeikan University , Shiga , Japan
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Finite Element Analysis of Tongue Type Calcaneal Fracture with Open Reduction and Internal Fixation with Locking Plate. J Med Biol Eng 2018. [DOI: 10.1007/s40846-017-0296-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rizk AS, Kandel WA, Tabl EAE, Kandil MI. Mid-Sole Release of the Plantar Fascia Combined With Percutaneous Drilling of the Calcaneus for Treatment of Resistant Heel Pain. Foot Ankle Int 2017; 38:1271-1277. [PMID: 28891313 DOI: 10.1177/1071100717723131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heel pain with or without calcaneal spur is a challenging problem. Once conservative measures have failed, surgery may be indicated; there has been debate about the best surgical procedure. Two standard operative procedures have been either releasing the plantar fascia or removing the spur with drilling of the calcaneus. In this study, we evaluated the results of percutaneous drilling of the calcaneus combined with mid-sole release of the plantar fascia for treatment of resistant heel pain. METHODS This study included 20 cases with resistant heel pain after failure of conservative measures for 6 months. Clinical, radiological evaluation and scoring patients' conditions according to the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scale was done preoperatively and postoperatively. Percutaneous drilling of the calcaneus combined with mid-sole release of the plantar fascia was done in all cases, and the functional results were evaluated through the follow-up period that extended from 9 to 16 months with a mean duration of 12 ± 2.3 months. RESULTS There was statistically significant improvement in the mean AOFAS Ankle-Hindfoot scale score from 50.8 ± 7.5 preoperatively to 91.6 ± 7 postoperatively at the last follow-up. There were no surgery-related complications, and the mean time for full recovery was 8 ± 3.7 weeks with no recurrence of pain by the last follow-up. CONCLUSIONS The results were very satisfactory with using this minimally invasive and simple technique for treatment for resistant heel pain. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Wael A Kandel
- 1 Benha Faculty of Medicine, Benha University, Benha, Egypt
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Smolen C, Quenneville CE. A Finite Element Model of the Foot/Ankle to Evaluate Injury Risk in Various Postures. Ann Biomed Eng 2017; 45:1993-2008. [PMID: 28470459 DOI: 10.1007/s10439-017-1844-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/25/2017] [Indexed: 11/25/2022]
Abstract
The foot/ankle complex is frequently injured in many types of debilitating events, such as car crashes. Numerical models used to assess injury risk are typically minimally validated and do not account for ankle posture variations that frequently occur during these events. The purpose of this study was to evaluate a finite element model of the foot and ankle accounting for these positional changes. A model was constructed from computed tomography scans of a male cadaveric lower leg and was evaluated by comparing simulated bone positions and strain responses to experimental results at five postures in which fractures are commonly reported. The bone positions showed agreement typically within 6° or less in all anatomical directions, and strain matching was consistent with the range of errors observed in similar studies (typically within 50% of the average strains). Fracture thresholds and locations in each posture were also estimated to be similar to those reported in the literature (ranging from 6.3 kN in the neutral posture to 3.9 kN in combined eversion and external rotation). The least vulnerable posture was neutral, and all other postures had lower fracture thresholds, indicating that examination of the fracture threshold of the lower limb in the neutral posture alone may be an underestimation. This work presents an important step forward in the modeling of lower limb injury risk in altered ankle postures. Potential clinical applications of the model include the development of postural guidelines to minimize injury, as well as the evaluation of new protective systems.
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Affiliation(s)
- Chris Smolen
- Department of Mechanical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
| | - Cheryl E Quenneville
- Department of Mechanical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada. .,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
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Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study. Med Biol Eng Comput 2017; 55:1799-1807. [DOI: 10.1007/s11517-017-1623-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/25/2017] [Indexed: 12/12/2022]
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Finite element modelling of the foot for clinical application: A systematic review. Med Eng Phys 2017; 39:1-11. [DOI: 10.1016/j.medengphy.2016.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 10/13/2016] [Accepted: 10/23/2016] [Indexed: 11/20/2022]
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Abstract
BACKGROUND This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial. MATERIALS Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection. RESULTS At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group ( P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group ( P < .05). By that time, 0 (0%) and 3 (12%) patients who received IBTA and saline, respectively, underwent surgery for recalcitrant plantar fasciitis ( P < .005). CONCLUSION Compared with placebo saline injection, using IBTA to treat plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis. LEVEL OF EVIDENCE I, Randomized, double-blinded, placebo-controlled study.
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Affiliation(s)
- Jamal Ahmad
- 1 Orthopaedic Foot and Ankle Surgery, Rothman Institute Orthopaedics, Philadelphia, PA, USA
| | - Stacy H Ahmad
- 2 Department of Anatomy, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kennis Jones
- 3 Rothman Institute Orthopaedics, Philadelphia, PA
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Suzuki R, Ito K, Lee T, Ogihara N. Parameter identification of hyperelastic material properties of the heel pad based on an analytical contact mechanics model of a spherical indentation. J Mech Behav Biomed Mater 2017; 65:753-760. [DOI: 10.1016/j.jmbbm.2016.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022]
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Thompson JV, Saini SS, Reb CW, Daniel JN. Diagnosis and management of plantar fasciitis. J Osteopath Med 2016; 114:900-6. [PMID: 25429080 DOI: 10.7556/jaoa.2014.177] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary.
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Affiliation(s)
- John V Thompson
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
| | - Sundeep S Saini
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
| | - Christopher W Reb
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
| | - Joseph N Daniel
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
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Nie B, Panzer MB, Mane A, Mait AR, Donlon JP, Forman JL, Kent RW. Determination of the in situ mechanical behavior of ankle ligaments. J Mech Behav Biomed Mater 2016; 65:502-512. [PMID: 27665085 DOI: 10.1016/j.jmbbm.2016.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022]
Abstract
The mechanical behavior of ankle ligaments at the structural level can be characterized by force-displacement curves in the physiologic phase up to the initiation of failure. However, these properties are difficult to characterize in vitro due to the experimental difficulties in replicating the complex geometry and non-uniformity of the loading state in situ. This study used a finite element parametric modeling approach to determine the in situ mechanical behavior of ankle ligaments at neutral foot position for a mid-sized adult foot from experimental derived bony kinematics. Nine major ankle ligaments were represented as a group of fibers, with the force-elongation behavior of each fiber element characterized by a zero-force region and a region of constant stiffness. The zero-force region, representing the initial tension or slackness of the whole ligament and the progressive fiber uncrimping, was identified against a series of quasi-static experiments of single foot motion using simultaneous optimization. A range of 0.33-3.84mm of the zero-force region was obtained, accounting for a relative length of 6.7±3.9%. The posterior ligaments generally exhibit high-stiffness in the loading region. Following this, the ankle model implemented with in situ ligament behavior was evaluated in response to multiple loading conditions and proved capable of predicting the bony kinematics accurately in comparison to the cadaveric response. Overall, the parametric ligament modeling demonstrated the feasibility of linking the gross structural behavior and the underlying bone and ligament mechanics that generate them. Determination of the in situ mechanical properties of ankle ligaments provides a better understanding of the nonlinear nature of the ankle joint. Applications of this knowledge include functional ankle joint mechanics and injury biomechanics.
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Affiliation(s)
- Bingbing Nie
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA.
| | - Matthew B Panzer
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA
| | - Adwait Mane
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA
| | - Alexander R Mait
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA
| | - John-Paul Donlon
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA
| | - Jason L Forman
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA
| | - Richard W Kent
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA 22911, USA
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Nie B, Panzer MB, Mane A, Mait AR, Donlon JP, Forman JL, Kent RW. A framework for parametric modeling of ankle ligaments to determine the in situ response under gross foot motion. Comput Methods Biomech Biomed Engin 2015; 19:1254-65. [PMID: 26712301 DOI: 10.1080/10255842.2015.1125474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ligament sprains account for a majority of injuries to the foot and ankle complex, but ligament properties have not been understood well due to the difficulties in replicating the complex geometry, in situ stress state, and non-uniformity of the strain. For a full investigation of the injury mechanism, it is essential to build up a foot and ankle model validated at the level of bony kinematics and ligament properties. This study developed a framework to parameterize the ligament response for determining the in situ stress state and heterogeneous force-elongation characteristics using a finite element ankle model. Nine major ankle ligaments and the interosseous membrane were modeled as discrete elements corresponding functionally to the ligamentous microstructure of collagen fibers and having parameterized toe region and stiffness at the fiber level. The range of the design variables in the ligament model was determined from existing experimental data. Sensitivity of the bony kinematics to each variable was investigated by design of experiment. The results highlighted the critical role of the length of the toe region of the ligamentous fibers on the bony kinematics with the cumulative influence of more than 95%, while the fiber stiffness was statistically insignificant with an influence of less than 1% under the given variable range and loading conditions. With the flexibility of variable adjustment and high computational efficiency, the presented ankle model was generic in nature so as to maximize its applicability to capture the individual ligament behaviors in future studies.
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Affiliation(s)
- Bingbing Nie
- a Center for Applied Biomechanics , University of Virginia , Charlottesville , VA , USA
| | - Matthew Brian Panzer
- a Center for Applied Biomechanics , University of Virginia , Charlottesville , VA , USA
| | - Adwait Mane
- a Center for Applied Biomechanics , University of Virginia , Charlottesville , VA , USA
| | - Alexander Ritz Mait
- a Center for Applied Biomechanics , University of Virginia , Charlottesville , VA , USA
| | - John-Paul Donlon
- a Center for Applied Biomechanics , University of Virginia , Charlottesville , VA , USA
| | - Jason Lee Forman
- a Center for Applied Biomechanics , University of Virginia , Charlottesville , VA , USA
| | - Richard Wesley Kent
- a Center for Applied Biomechanics , University of Virginia , Charlottesville , VA , USA
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Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. Foot (Edinb) 2015; 25:235-7. [PMID: 26362235 DOI: 10.1016/j.foot.2015.08.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Intractable plantar fasciitis can be a difficult condition to treat. Early results of platelet rich plasma (PRP) injection have been promising. We compared PRP to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. The aim of the study was to compare the efficacy of PRP to that of Steroid at 3, 6 and 12 months after injection. METHODS 60 heels with intractable plantar fasciitis who had failed conservative treatment were randomised to receive either PRP or Steroid injection. All patients were assessed with the Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection and the results were compared. RESULTS Pre-injection, the two groups were well matched with no statistically significant difference. At 3 months, all three outcome scores had significantly improved from their pretreatment level in both groups. The scores in the Steroid arm were marginally better than in the PRP arm, but this difference was not statistically significant. At 6 months, there was no statistically significant difference between the two groups, though there was a trend for the PRP scores to become better than the Steroid scores. At 12 months, the RM, VAS and AOFAS scores in the PRP arm (1.9, 3.3 and 88.5) were significantly better than the Steroid arm (2.6, 5.3 and 75) with P values of .013, .028 and .033, respectively. CONCLUSIONS PRP is as effective as Steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis, but unlike Steroid, its effect does not wear off with time. At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection.
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Alkhamaali ZK, Crocombe AD, Solan MC, Cirovic S. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis. Comput Methods Biomech Biomed Engin 2015; 19:1069-78. [PMID: 26465270 DOI: 10.1080/10255842.2015.1096348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot.
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Affiliation(s)
- Zaied K Alkhamaali
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK.,b Department of Mechanical Engineering Sciences , University of Surrey , Guildford , UK
| | - Andrew D Crocombe
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK
| | - Matthew C Solan
- c Department of Orthopaedic Surgery , Royal Surrey County Hospital, Guildford , UK
| | - Srdjan Cirovic
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK.,b Department of Mechanical Engineering Sciences , University of Surrey , Guildford , UK
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Wang Y, Wong DWC, Zhang M. Computational Models of the Foot and Ankle for Pathomechanics and Clinical Applications: A Review. Ann Biomed Eng 2015; 44:213-21. [DOI: 10.1007/s10439-015-1359-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/09/2015] [Indexed: 01/01/2023]
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Primary Stability of Absorbable Screw Fixation for Intra-articular Calcaneal Fractures: A Finite Element Analysis. J Med Biol Eng 2015. [DOI: 10.1007/s40846-015-0019-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Miller LE, Latt DL. Chronic Plantar Fasciitis is Mediated by Local Hemodynamics: Implications for Emerging Therapies. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:1-5. [PMID: 25709971 PMCID: PMC4325390 DOI: 10.4103/1947-2714.150080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Plantar fasciitis (PF) is a common, disabling condition affecting millions of patients each year. With early diagnosis and timely application of traditional nonsurgical treatments, symptoms generally resolve over time. However, despite adequate treatment, 20% of patients will experience persistent symptoms. In these patients, minimally invasive therapies that augment local hemodynamics to initiate a regenerative tissue-healing cascade have the greatest potential to resolve long-standing symptoms. We performed a narrative review based on a best evidence evaluation of manuscripts published in Medline-indexed journals to determine the mechanisms involved in soft tissue injury and healing. This evaluation also highlights emerging minimally invasive therapies that exploit these mechanisms in recalcitrant PF.
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Affiliation(s)
- Larry E Miller
- Miller Scientific Consulting, Inc., Asheville, North Carolina, United States
| | - Daniel L Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, United States
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Rajasekaran S, Finnoff JT. Plantar Fasciopathy: A Clinical Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0069-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Niu W, Tang T, Zhang M, Jiang C, Fan Y. An in vitro and finite element study of load redistribution in the midfoot. SCIENCE CHINA-LIFE SCIENCES 2014; 57:1191-6. [PMID: 25249199 DOI: 10.1007/s11427-014-4731-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/17/2014] [Indexed: 10/24/2022]
Abstract
A good knowledge of midfoot biomechanics is important in understanding the biomechanics of the entire foot, but it has never been investigated thoroughly in the literature. This study carried out in vitro experiments and finite element analysis to investigate the midfoot biomechanics. A foot-ankle finite element model simulating the mid-stance phase of the normal gait was developed and the model validated in in vitro experimental tests. Experiments used seven in vitro samples of fresh human cadavers. The simulation found that the first principal stress peaks of all midfoot bones occurred at the navicular bone and that the tensile force of the spring ligament was greater than that of any other ligament. The experiments showed that the longitudinal strain acting on the medial cuneiform bone was -26.2±10.8 μ-strain, and the navicular strain was -240.0±169.1 μ-strain along the longitudinal direction and 65.1±25.8 μ-strain along the transverse direction. The anatomical position and the spring ligament both result in higher shear stress in the navicular bone. The load from the ankle joint to five branches of the forefoot is redistributed among the cuneiforms and cuboid bones. Further studies on the mechanism of loading redistribution will be helpful in understanding the biomechanics of the entire foot.
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Affiliation(s)
- WenXin Niu
- Tongji Hospital, Tongji University School of Medicine, Shanghai, 200092, China
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Petre M, Erdemir A, Panoskaltsis VP, Spirka TA, Cavanagh PR. Optimization of nonlinear hyperelastic coefficients for foot tissues using a magnetic resonance imaging deformation experiment. J Biomech Eng 2014; 135:61001-12. [PMID: 23699713 DOI: 10.1115/1.4023695] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 02/19/2013] [Indexed: 11/08/2022]
Abstract
Accurate prediction of plantar shear stress and internal stress in the soft tissue layers of the foot using finite element models would provide valuable insight into the mechanical etiology of neuropathic foot ulcers. Accurate prediction of the internal stress distribution using finite element models requires that realistic descriptions of the material properties of the soft tissues are incorporated into the model. Our investigation focused on the creation of a novel three-dimensional (3D) finite element model of the forefoot with multiple soft tissue layers (skin, fat pad, and muscle) and the development of an inverse finite element procedure that would allow for the optimization of the nonlinear elastic coefficients used to define the material properties of the skin muscle and fat pad tissue layers of the forefoot based on a Ogden hyperelastic constitutive model. Optimization was achieved by comparing deformations predicted by finite element models to those measured during an experiment in which magnetic resonance imaging (MRI) images were acquired while the plantar surface forefoot was compressed. The optimization procedure was performed for both a model incorporating all three soft tissue layers and one in which all soft tissue layers were modeled as a single layer. The results indicated that the inclusion of multiple tissue layers affected the deformation and stresses predicted by the model. Sensitivity analysis performed on the optimized coefficients indicated that small changes in the coefficient values (±10%) can have rather large impacts on the predicted nominal strain (differences up to 14%) in a given tissue layer.
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Affiliation(s)
- Marc Petre
- Division of Anesthesiology and Critical Care Medicine,Cleveland Clinic, Cleveland, OH 44195, USA
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LIN SHIHCHERNG, CHEN CARLPAICHU, TANG SIMONFUKTAN, CHEN CHENGWEI, WANG JIUNJIE, HSU CHIHCHIN, HSIEH JUIHSIANG, CHEN WENGPIN. STRESS DISTRIBUTION WITHIN THE PLANTAR APONEUROSIS DURING WALKING — A DYNAMIC FINITE ELEMENT ANALYSIS. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414500535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Excessive and repeated loading of the plantar aponeurosis (PA) is believed to be the most likely risk factor for developing plantar fasciitis. This study provided a novel approach to investigate the biomechanical responses of the PA during the entire stance phase of gait. One healthy subject was recruited for all the experimental measurements to validate the approach in this study. A three-dimensional (3D) finite element (FE) foot model representing this individual, with emphasis on the PA as a transversely isotropic tissue, was constructed. Kinematic data of foot motions were collected during a walking trial to serve as input conditions for the model. A peak tensile force of 922 N on the PA was found during the terminal-stance phase rather than during the mid-stance phase. The maximal peak von Mises stresses in the PA from the medial to lateral regions of the foot measured 15.61, 14.98 and 11.4 MPa at 74%, 77% and 82% of the stance phase, respectively. These peak stresses all occurred near the proximal calcaneal bony insertion site of the PA and correspond closely with the location where plantar fasciitis develops. Future work should include more subjects and clinical trials before applying these findings to the treatment of plantar fasciitis.
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Affiliation(s)
- SHIH-CHERNG LIN
- Department of Biomedical Engineering, Chung-Yuan Christian University, Taoyuan, Taiwan
- Department of Physical Medicine & Rehabilitation, Chang-Gung Memorial Hospital at Linkou and College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - CARL PAI-CHU CHEN
- Department of Physical Medicine & Rehabilitation, Chang-Gung Memorial Hospital at Linkou and College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - SIMON FUK-TAN TANG
- Department of Physical Medicine & Rehabilitation, Chang-Gung Memorial Hospital at Linkou and College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - CHENG-WEI CHEN
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - JIUN-JIE WANG
- Department of Medical Imaging and Radiological Sciences, Chang-Gung University, Taoyuan, Taiwan
| | - CHIH-CHIN HSU
- Department of Physical Medicine & Rehabilitation, Chang-Gung Memorial Hospital at Keelung and College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - JUI-HSIANG HSIEH
- Department of Biomedical Engineering, Chung-Yuan Christian University, Taoyuan, Taiwan
| | - WENG-PIN CHEN
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
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Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int 2014; 35:313-8. [PMID: 24419823 DOI: 10.1177/1071100713519778] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat. In this study, autologous platelet-rich plasma (PRP), a concentrated bioactive blood component rich in cytokines and growth factors, was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. METHODS Forty patients (23 females and 17 males) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection (pretreatment = time 0) and at 3, 6, 12, and 24 months following injection treatment. Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis. RESULTS The cortisone group had a pretreatment average AOFAS score of 52, which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months, then dropped to near baseline levels of 58 at 12 months, and continued to decline to a final score of 56 at 24 months. In contrast, the PRP group started with an average pretreatment AOFAS score of 37, which increased to 95 at 3 months, remained elevated at 94 at 6 and 12 months, and had a final score of 92 at 24 months. CONCLUSIONS PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis. LEVEL OF EVIDENCE Level I, prospective randomized comparative series.
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Wheeler P, Boyd K, Shipton M. Surgery for Patients With Recalcitrant Plantar Fasciitis: Good Results at Short-, Medium-, and Long-term Follow-up. Orthop J Sports Med 2014; 2:2325967114527901. [PMID: 26535314 PMCID: PMC4555569 DOI: 10.1177/2325967114527901] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes. PURPOSE To assess the outcome following surgical intervention for patients with plantar fasciitis. STUDY DESIGN Case series; Level of evidence, 4. METHODS Seventy-nine patients were identified from operative diaries undergoing plantar fasciotomy surgery between 1993 and 2009. They were contacted to investigate long-term results using self-reported outcome measures. RESULTS Sixty-eight responses were received (86% response rate), with an average of 7 years (range, 1-15 years) of follow-up. Patients reported an average reduction in pain by visual analog scale of 79%, and 84% of patients were happy with the surgical results. Greater success was achieved in patients with shorter duration of symptoms preoperatively. No deterioration in success was seen over time. CONCLUSION Plantar fasciotomy surgery for plantar fasciitis remains controversial, with biomechanical arguments against surgery; however, this article reports good success following surgery over a long follow-up period. The results of current operative techniques need to be fully investigated for longer term success, as do the outcomes of newer nonoperative management strategies.
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Affiliation(s)
- Patrick Wheeler
- Sport & Exercise Medicine Department, University Hospitals of Leicester NHS Trust, Leicester, UK. ; School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK. ; Department for Health, University of Bath, Bath, UK
| | - Kevin Boyd
- Sport & Exercise Medicine Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mary Shipton
- Sport & Exercise Medicine Department, University Hospitals of Leicester NHS Trust, Leicester, UK
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Spratley EM, Matheis EA, Hayes CW, Adelaar RS, Wayne JS. Validation of a population of patient-specific adult acquired flatfoot deformity models. J Orthop Res 2013; 31:1861-8. [PMID: 24038128 DOI: 10.1002/jor.22471] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/30/2013] [Indexed: 02/04/2023]
Abstract
Adult acquired flatfoot deformity (AAFD) is a degenerative disease resulting in malalignment of the mid- and hindfoot secondary to posterior tibial tendon dysfunction and increasing implication of ligament pathologies. Despite the complex 3D nature of AAFD, 2D radiographs are still employed to diagnose and stage the disease. Computer modeling techniques allow for accurate 3D recreations of musculoskeletal systems for the investigation of biomechanical factors contributing to disease. Following Institutional Review Board approval, the lower limbs of six diagnosed AAFD sufferers were imaged with MRI, photographs, and X-ray. Next, a radiologist graded the MRI attenuation of eight soft-tissues implicated in AAFD. Six patient-specific rigid-body models were then created and loaded according to patient weight, graded soft-tissues, and extrinsic muscles. Model function was validated using clinically relevant kinematic measures in three planes. Agreement varied depending on the measure, with average absolute deviations of < 7° for angles and <4 mm for distances. Additionally, the clinically favored AP talonavicular coverage angle, ML talo-1st metatarsal angle, and ML 1st cuneiform height showed strong correlations of R(2) = 0.63, 0.75, and 0.85, respectively. Thus, computer modeling offers a promising methodology for the non-invasive investigation of in vivo kinematic behavior in pathologic feet and, once validated, may further be used to investigate biomechanical parameters that are difficult to measure clinically.
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Affiliation(s)
- E Meade Spratley
- Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 843067, Richmond, Virginia, 23284-3067
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Yamakado K. Subcalcaneal bursitis with plantar fasciitis treated by arthroscopy. Arthrosc Tech 2013; 2:e135-9. [PMID: 23875139 PMCID: PMC3716222 DOI: 10.1016/j.eats.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 01/04/2013] [Indexed: 02/03/2023] Open
Abstract
We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging.
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Affiliation(s)
- Kotaro Yamakado
- Address correspondence to Kotaro Yamakado, M.D., Ph.D., 58-16-1 Egami, Fukui 9108561, Japan.
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Nery C, Raduan F, Mansur N, Baunfeld D, Del Buono A, Maffulli N. Endoscopic approach for plantar fasciopathy: a long-term retrospective study. INTERNATIONAL ORTHOPAEDICS 2013; 37:1151-6. [PMID: 23483259 DOI: 10.1007/s00264-013-1847-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 02/19/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to report the long term effectiveness of endoscopic plantar fascia release for recalcitrant plantar fasciopathy. MATERIALS Twenty-three consecutive patients underwent endoscopically-assisted plantar fascia release for symptomatic plantar fasciopathy unresponsive to nonoperative measures. The clinical diagnosis was supported by imaging (plain radiographs and magnetic resonance imaging [MRI]) and the American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to all patients. All patients underwent endoscopic plantar fascia release. Postoperatively, patients were assessed at clinical examination and the AOFAS score was administered. RESULTS Twenty-two (26 feet) of the 23 patients included in our original cohort returned to our clinic at an average final follow-up of 9.6 years. The mean preoperative AOFAS score of 51 (range, 41-63) improved to 89 (range, 41-97) at the last follow-up, with no statistically significant difference between patients with or without calcaneal bone spur (p = 0.43). At the last appointment, physically active patients reported significantly higher AOFAS scores than sedentary patients (p = .008). CONCLUSIONS This endoscopic plantar approach could be a viable alternative to more invasive procedures for management of recalcitrant plantar fasciopathy. Future randomised controlled trials are needed.
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Affiliation(s)
- Caio Nery
- Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, Brazil.
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Open technique is more effective than percutaneous technique for TOPAZ radiofrequency coblation for plantar fasciitis. Foot Ankle Surg 2012; 18:287-92. [PMID: 23093126 DOI: 10.1016/j.fas.2012.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 03/31/2012] [Accepted: 05/13/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Microtenotomy coblation using a radiofrequency (RF) probe is a minimally invasive procedure for treating chronic tendinopathy. It has been described for conditions including tennis elbow and rotator cuff tendinitis. There have been no long term studies to show its effectiveness in plantar fasciitis. METHODS A prospective non-randomised trial was conducted on 48 patients who had failed conservative treatment for plantar fasciitis, between 2007 and 2009. The procedure was performed using the TOPAZ microdebrider device (ArthroCare, Sunnyvale, CA), either via an open or a percutaneous method. Fifty-nine feet were treated and followed up for up to 1 year thereafter. Preoperative, 3, 6 and 12 months post-operative VAS pain, American Orthopaedic Foot-Ankle Society (AOFAS) hindfoot and SF-36 scores, patient expectation and satisfaction scores were analysed. RESULTS VAS scores improved significantly in both groups at 1-year follow-up. The open group had a more significant improvement in the VAS score at 1-year follow-up. AOFAS hindfoot scores improve significantly for both groups pre- and post-operatively, but there was no significant difference between both groups at the 1-year mark. SF-36 scores showed equally significant improvement in both groups 1 year post-operatively. Expectation and satisfaction scores were equally high in both arms. CONCLUSIONS TOPAZ RF coblation is a good and effective method for the treatment of recalcitrant plantar fasciitis. Clinical results improve with time for up to 1-year post-operatively. The open method seems to have a more significant improvement in pain VAS scores at 1-year postoperatively.
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