Quantitative ultrasound of the calcaneus with parametric imaging: correlation with bone mineral density at different sites and with anthropometric data in menopausal women

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Louis, O.; Kaufman, L.; Osteaux, M

2000-07-01

Objective: To prospectively study the relationship of quantitative ultrasound of the calcaneus with anthromopometric variables and with bone mineral density (BMD) assessed at the level of the calcaneus as well as at other sites. Method: Osteosonography of the non-dominant calcaneus was performed in 135 menopausal women, using a DTU-one device with parametric imaging. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were assessed. BMD of the calcaneus (BMDcal) was measured using dual energy X-ray absorptiometry (DXA), in a subregion matched with the region of interest for osteosonography. BMD of the lumbar trabecular bone was measured using quantitative computed tomography (BMD QCT) while the non-dominant hip was studied using DXA, which provided the total bone mineral density (BMDhip) and that of the Ward triangle (BMDWard). Results: The Pearson correlation coefficients between BUA, SOS and the various measurements of BMD ranged from 0.305 (SOS versus BMDhip) to 0.717 (BUA versus BMDcal). BMD QCT and BMDWard were found to depend on age, but not on weight or height, while BUA, SOS, BMDcal, BMDhip were unrelated to age, but correlated with weight (SOS, BMDhip) or with weight and height (BUA, BMDcal). In a multiple stepwise regression analysis, age was a significant predictor for BMD QCT, BMD hip and BMDWard; BMD QCT, BMDWard and BMDhip admitted BUA as sole predictor, while BMDcal was significantly related to both BUA and SOS. Conclusion: BUA and SOS of the calcaneus, assessed in 135 menopausal women using a parametric imaging device, reflected BMDcal, measured with DXA at a matched region of interest, and did not decline significantly with age.

Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms

International Nuclear Information System (INIS)

Ouellette, H.; Salamipour, H.; Thomas, B.J.; Kassarjian, A.; Torriani, M.

2006-01-01

To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief

Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms

Energy Technology Data Exchange (ETDEWEB)

Ouellette, H.; Salamipour, H.; Thomas, B.J.; Kassarjian, A.; Torriani, M. [Division of Musculoskeletal Radiology, Massachusetts General Hospital, Boston, MA (United States)

2006-11-15

To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief.

Avulsion Fracture of the Calcaneus Treated With a Soft Anchor Bridge and Lag Screw Technique: A Report of Two Cases.

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Yoshida, Kazushige; Kasama, Kentaro; Akahane, Tsutomu

2016-01-01

The displaced extra-articular avulsion fracture of the calcaneus has been classified as a Böhler type 1c calcaneal fracture, and most cases will require surgical repair. In the present report, we describe 2 patients in whom we performed the soft anchor bridge technique using single loaded suture anchors with lag screws for the repair of Böhler type 1c avulsion fractures of the calcaneus. In one of these patients, clinically relevant osteoporosis complicated the injury. In both cases, bone union was achieved, and by 1.5 months after surgery satisfactory recovery was observed. To our knowledge, the soft anchor bridge technique was first used for the treatment of rotator cuff tears, and the greatest merit of this technique is the ability to generate vertical compression force to the pulled out rotator cuff through the use of knotting sutures. In recent years, the soft anchor bridge technique using 4 suture anchors has also been used for fractures of the greater tuberosity of the humerus, an injury that poses operative difficulties similar to those encountered with an avulsion fracture of the calcaneus owing to the traction force of the rotator cuff and relative weakness of adjacent bone. The outcomes of our patients suggest that the soft anchor bridge technique combined with adjunct lag screws is useful in the fixation of avulsion fractures of the calcaneus. In addition, the result in the elderly patient indicates the possibility of using this technique for patients with osteoporosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Lateral column lengthening for acquired adult flatfoot deformity caused by posterior tibial tendon dysfunction stage II: a retrospective comparison of calcaneus osteotomy with calcaneocuboid distraction arthrodesis.

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Haeseker, Guus A; Mureau, Marc A; Faber, Frank W M

2010-01-01

In this study, clinical and radiological results after lateral column lengthening by calcaneocuboid distraction arthrodesis and calcaneus osteotomy were compared. Thirty-three patients (35 feet) treated with lateral column lengthening by distraction arthrodesis (14 patients, 16 feet; group I) or by calcaneus osteotomy (19 patients, 19 feet; group II) for adult-acquired flatfoot deformity caused by stage II posterior tibial tendon dysfunction were compared retrospectively. Mean follow-up was 42.4 months (range, 6-78 months) for group I and 15.8 months (range, 6-32 months) for group II (P lengthening by means of calcaneus osteotomy rather than distraction arthrodesis of the calcaneocuboid joint, for correction of stage II posterior tibial tendon dysfunction. Copyright 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The effect of sports activities in children and adolescents on the calcaneus - an investigation with quantitative ultrasound

International Nuclear Information System (INIS)

Mentzel, H.J.; Malich, A.; Boettcher, J.; Vogt, S.; Kaiser, W.A.; Wuensche, K.

2005-01-01

Purpose: To determine whether quantitative ultrasound (QUS) parameters speed of sound (SOS) and broadband ultrasound attenuation (BUA) on the calcaneus are different between athletic children and a reference population. Patients and Methods: From a college of physical education, 177 children and adolescents (121 boys and 56 girls, age range from 11 to 18 years) were included in this study. QUS was performed on the calcaneus using the Sahara trademark device (Hologic, USA). SOS and BUA were estimated. Regional reference values of 3299 children were used to determine significant differences between athletes and reference population. The influence of activity level, age, height, and weight was estimated using correlation analysis. Results: Sportsmen showed significant (p<0.05) higher values of the QUS parameters (SOS 1581.1 m/s; BUA 69.7 dB/MHz) compared to the reference data (SOS 1563.9 m/s; BUA 64.2 dB/MHz). Significant correlation was observed between BUA and the level of activity, age, weight, and height (p<0.01) and between SOS and weight and height (p<0.05). In the group of soccer players and athletes, significant correlation was found between BUA vs. age and BUA vs. weight (p<0.05). Furthermore, significant correlation was observed between BUA vs. age and weight in Judokas and Wrestlers. For the level of activity, a significant correlation to BUA was only found in the group of Judokas and Wrestlers (p<0.01). Conclusion: An increase in quantitative ultrasound parameters on the calcaneus occurs in children and adolescents with increased physical activity. (orig.)

Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures.

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Li, Shaoliang

2018-05-01

Background The purpose of this study was to evaluate the optimal timing and measures of the sinus tarsi approach for calcaneus fractures to avoid iatrogenic injury of the sural nerve and to assess for wound complications. A case series of 53 patients with calcaneus fractures treated by a single surgeon with the sinus tarsi approach was retrospectively analyzed. On the basis of the delay time from injury to surgery, patients were classified into 4 groups: immediate (0-3 days), early (4-6 days), intermediate (7-14 days), and late (14-18 days). All patients were followed for at least 1 year to observe wound conditions. The rate of wound complications and iatrogenic sural nerve injury was described. Incisions were classified into 2 groups: group A included patients with incisions extending posterior to the lateral malleolus, and group B included patients with incisions confined anterior to the lateral malleolus. The rates of nerve injury were compared between both groups. Forty-three patients with 52 Sanders type II fractures were included. The average time to surgery from injury was 8.8 days (range, 0-18 days). The overall postoperative rate of wound complications was 5.8% (3 of 52). In the immediate group, deep infections and wound necrosis were found in 2 of 8 fractures (25%). In the early group, 1 of 15 fractures developed superficial infection (6.7%). In the intermediate and late groups, no wound complication was identified. Iatrogenic sural nerve injury was recorded in 5 of 52 patients (9.6%). Group A had 33% (4 of 12) nerve injuries and group B had 2.5% (1 of 40) ( P = .009). In 70% of cases, a main branch of the sural nerve was directly under the incision. The sinus tarsi approach was generally effective and safe for calcaneus fractures. However, it was relatively risky to perform open reduction and internal fixation by the sinus tarsi approach within 6 days of injury. Because the sural nerve is in the vicinity of the approach, iatrogenic injury should be

The Effect of Suture Anchor Insertion Angle on Calcaneus Pullout Strength: Challenging the Deadman's Angle.

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Weiss, William M; Saucedo, Ramon P; Robinson, John D; Lo, Chung-Chieh Jason; Morris, Randal P; Panchbhavi, Vinod K

2017-10-01

Refractory cases of Achilles tendinopathy amenable to surgery may include reattachment of the tendon using suture anchors. However, there is paucity of information describing the optimal insertion angle to maximize the tendon footprint and anchor stability in the calcaneus. The purpose of this investigation is to compare the fixation strength of suture anchors inserted at 90° and 45° (the Deadman's angle) relative to the primary compressive trabeculae of the calcaneus. A total of 12 matched pairs of adult cadaveric calcanei were excised and potted to approximate their alignment in vivo. Each pair was implanted with 5.5-mm bioabsorbable suture anchors placed either perpendicular (90°) or oblique (45°) to the primary compressive trabeculae. A tensile load was applied until failure of anchor fixation. Differences in failure load and stiffness between anchor fixation angles were determined by paired t-tests. No significant differences were detected between perpendicular and oblique suture anchor insertion relative to primary compressive trabeculae in terms of load to failure or stiffness. This investigation suggests that the fixation strength of suture anchors inserted perpendicular to the primary compression trabeculae and at the Deadman's angle are possibly comparable. Biomechanical comparison study.

Treatment of intraarticular displaced fractures of the calcaneus bone using nail blocked calcanail

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Weiss, Marcin; Dolata, Tomasz; Weiss, Waldemar; Maksymiak, Martyna; Kałużny, Krystian; Kałużna, Anna; Zukow, Walery; Hagner‑Derengowska, Magdalena

2018-01-01

Weiss Marcin, Dolata Tomasz, Weiss Waldemar, Maksymiak Martyna, Kałużny Krystian, Kałużna Anna, Zukow Walery, Hagner‑Derengowska Magdalena. Treatment of intraarticular displaced fractures of the calcaneus bone using nail blocked calcanail. Journal of Education, Health and Sport. 2018;8(4):338-345. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1226782 http://ojs.ukw.edu.pl/index.php/johs/article/view/5439 https://pbn.nauka.gov.pl/sedno-webapp/works/863609 ...

Contact characteristics of the subtalar joint after a simulated calcaneus fracture.

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Sangeorzan, B J; Ananthakrishnan, D; Tencer, A F

1995-06-01

A simple calcaneus fracture consisting of two parts was modeled in nine fresh cadaver hindfoot specimens to assess changes in subtalar joint contact characteristics with increasing plantar depression of the posterolateral fracture component. To perform the experiment, rods were placed in the tibial and fibular shafts of each specimen, which was mounted in a frame in neutral stance. A pneumatic cylinder was used to deliver a vertical compressive load through the rods into the foot while permitting free motion of the foot in the horizontal plane. Sealed packets of pressure-sensitive film were inserted into the anterior-middle and posterior facets of the talocalcaneal articulation, and a 700-N load was applied. After testing of the intact foot, a primary fracture line was created using a microoscillating saw. The osteotomized posterolateral component was anatomically reduced and fixed, the film inserted, and the load reapplied. The test was repeated after the posterolateral fragment was displaced 2, 5, and 10 mm in a plantar direction. The resulting pressure prints were scanned along with pressure/color density calibration strips using a flat-bed scanner, and an image analysis system was used to determine contact areas within specified pressure intervals. The contact area (> 0.5 MPa) of the posterior facet was significantly decreased with 2, 5, and 10 mm displacements of the posterolateral calcaneus fracture component. The ratio of high-pressure area (< 5.0 MPa) to contact area in the posterior facet was significantly increased only with displacements of 5 and 10 mm. There were no significant changes in any contact parameters in the anterior-middle facet.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic value of computed tomography classification systems for intra-articular calcaneus fractures.

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Swords, Michael P; Alton, Timothy B; Holt, Sarah; Sangeorzan, Bruce J; Shank, John R; Benirschke, Stephen K

2014-10-01

There are several published computed tomography (CT) classification systems for calcaneus fractures, each validated by a different standard. The goal of this study was to measure which system would best predict clinical outcomes as measured by a widely used and validated musculoskeletal health status questionnaire. Forty-nine patients with isolated intra-articular joint depression calcaneus fractures more than 2 years after treatment were identified. All had preoperative CT studies and were treated with open reduction and plate fixation using a lateral extensile approach. Four different blinded reviewers classified injuries according to the CT classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders. Functional outcomes evaluated with a Musculoskeletal Functional Assessment (MFA). The mean follow-up was 4.3 years. The mean MFA score was 15.7 (SD = 11.6), which is not significantly different from published values for midfoot injuries, hindfoot injuries, or both, 1 year after injury (mean = 22.1, SD = 18.4). The classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders, the number of fragments of the posterior facet, and payer status were not significantly associated with outcome as determined by the MFA. The Sanders classification trended toward significance. Anterior process comminution and surgeon's overall impression of severity were significantly associated with functional outcome. The amount of anterior process comminution was an important determinant of functional outcome with increasing anterior process comminution significantly associated with worsened functional outcome (P = .04). In addition, the surgeon's overall impression of severity of injury was predictive of functional outcome (P = .02), as determined by MFA. Level III, comparative series. © The Author(s) 2014.

Unicameral Bone Cyst in the Calcaneus of Mirror Image Twins.

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Lenze, Ulrich; Stolberg-Stolberg, Josef; Pohlig, Florian; Lenze, Florian; von Eisenhart-Rothe, Rüdiger; Rechl, Hans; Toepfer, Andreas

2015-01-01

Unicameral bone cysts (UBCs) are benign tumor-like lesions that commonly occur in the diaphyseal or metaphyseal region of the long bones within the first 2 decades of life. Until today, the pathogenesis of UBC has been unclear, but mechanisms such as vascular occlusion or a response to trauma have been supposed. During the past decade, in particular, the genetic aspects of the development of this rare lesion have been discussed. We present the first case of mirror image monozygotic twins with a mirror image UBC of the calcaneus. Our findings reinforce the importance of additional studies to understand the significance of cytogenetic factors in the etiology of UBC. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

[Menopause and ultrasonographic measurements of calcaneus].

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López-Caudana, Alma Ethelia; Castillo-Calderón, María Griselda; Ávila-Jiménez, Laura

2014-01-01

In Mexico, calcaneal ultrasound measurements -bone mineral density (BMD), broadband ultrasound attenuation (BUA), speed of sound (SOS), ultrasonic quantitative index (QUI)- and their differences in regards to menopause have not been documented. It was carried out a cross-sectional study in 862 women from 20 to 90 years old, incorporated through consecutive sample, who were users of the Sistema para el Desarrollo Integral de la Familia (DIF) in Morelos. Sociodemographic, reproductive and life style factors were identified. BMD, BUA, SOS and QUI were measured with quantitative ultrasound (QUS), using a Sunlight Omnisense 7000 S device. Adjusted differences in the mean of these measurements were estimated between pre and postmenopausal women through multiple linear regression. The medians were: BMD, 0.455 g/cm² (IQR, interquartile range = 0.378, 0.538); BUA, 66.0 dB/mHz (IQR = 54.3, 78.1); SOS, 1530.7 m/s (IQR = 1509.8, 1551.7); QUI = 83.7 units (IQR = 71.1, 96.6). In postmenopausal women, adjusted mean for BUA was -4.34 dB/mHz (CI 95 % = -8.23,-0.43); for SOS, -4.26 m/s (CI 95 % = -13.82, 5.30) ; for QUI, -4.42 units (CI 95 % = -8.64,-0.19). This report increases information about the clinical applicability of QUS. SOS in calcaneus does not reflect changes related with menopause.

Mid-Sole Release of the Plantar Fascia Combined With Percutaneous Drilling of the Calcaneus for Treatment of Resistant Heel Pain.

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Rizk, Ahmed Shawkat; Kandel, Wael A; Tabl, Eslam Abd Elshafi; Kandil, Mahmoud I

2017-11-01

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. 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. 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. The results were very satisfactory with using this minimally invasive and simple technique for treatment for resistant heel pain. Level IV, retrospective case series.

Diabetes and change in bone mineral density at the hip, calcaneus, spine, and radius in older women

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Ann V. Schwartz

2013-05-01

Full Text Available Older women with type 2 diabetes mellitus (DM have higher bone mineral density (BMD but also have higher rates of fracture compared to those without DM. Limited evidence suggests that DM may also be associated with more rapid bone loss. To determine if bone loss rates differ by DM status in older women, we analyzed BMD data in the Study of Osteoporotic Fractures (SOF between 1986 and 1998. SOF participants were women >65 years at baseline who were recruited from four regions in the U.S. DM was ascertained by self-report. BMD was measured with dual x-ray absorptiometry (DXA at baseline and at least one follow-up visit at the hip (N=6624 and calcaneus (N=6700 and, on a subset of women, at the spine (N=396 and distal radius (N=306. Annualized percent change in BMD was compared by DM status, using random effects models. Of 6,867 women with at least one follow-up DXA scan, 409 had DM at baseline. Mean age was 70.8 (SD 4.7 years. Baseline BMD was higher in women with DM at all measured sites. In models adjusted for age and clinic, women with prevalent DM lost bone more rapidly than those without DM at the femoral neck (-0.96% vs. -0.59% per year, p < 0.001, total hip (-0.98% vs. -0.70% per year, p<0.001, calcaneus (-1.64% vs. -1.40% per year, p=0.005, and spine (-0.33% vs. +0.33% per year, p=0.033, but not at the distal radius (-0.97% vs. -0.90% per year, p=0.91. These findings suggest that despite higher baseline BMD, older women with DM experience more rapid bone loss than those without DM at the hip, spine and calcaneus, but not the radius. Higher rates of bone loss may partially explain higher fracture rates in older women with DM.

Errors and complications in surgical treatment of non-stable equino-plano-valgus foot deformity in patients with cerebral palsy, with use of the calcaneus correcting osteotomy technique

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Valery V. Umnov

2017-03-01

Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

ERRORS AND COMPLICATIONS IN SURGICAL TREATMENT OF NON-STABLE EQUINO-PLANO-VALGUS FOOT DEFORMITY IN PATIENTS WITH CEREBRAL PALSY, WITH USE OF THE CALCANEUS CORRECTING OSTEOTOMY TECHNIQUE

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Valery V. Umnov

2017-03-01

Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

Determination of the bone-mineral content of the peripheral skeleton (ulna and calcaneus) in chronic renal failure patients on maintenance dialysis using 125 I-photon absorptiometry

International Nuclear Information System (INIS)

Hieber, U.

1982-01-01

The bone-mineral content (BMC) of the peripheral skeleton was measured in 53 chronic renal-failure patients on maintenance dialysis using the 125 I photon absorptiometry according to Cameron. 39.6% of the patients were found to have a clearly pathological calcium content in calcaneus and ulna (33%). In total BMC assessments 43.4% of the patients examined showed strongly reduced BMC values at two measurement sites at least. Average bone-mineral content was below the value of the corresponding normal groups in all age groups of the dialysis patients. In addition, a significant correlation was verified to exist between the calcium contents of calcaneus and ulna. A significant correlation was found as well between reduced BMC values and dialysis duration. The correlation between the increased serum level of alkaline phosphatase and the reduced mineral content of the skeleton was significant as well. A minor but not significant correlation existed between the increase of the parathormone (PTH) level in the serum and the decrease of calcium content in calcaneus and ulna. A good correlation was found when contrasting the results of visual roentgenography and the BMC values established by photodensitometry: the median BMC value of patients with clear pathological X-ray findings was significantly below the one of patients without pathological X-ray findings. However, photon absorptiometry is superior to the subjective evaluation of X-ray pictures in the early diagnosis of bone diseases involving bone-mineral loss. (orig.) [de

Unicameral bone cyst of the calcaneus - minimally invasive endoscopic surgical treatment. Case report.

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Stoica, Ioan Cristian; Pop, Doina Mihaela; Grosu, Florin

2017-01-01

The role of arthroscopic surgery for the treatment of various orthopedic pathologies has greatly improved during the last years. Recent publications showed that benign bone lesion may benefit from this minimally invasive surgical method, in order to minimize the invasiveness and the period of immobilization and to increase visualization. Unicameral bone cysts may be adequately treated by minimally invasive endoscopic surgery. The purpose of the current paper is to present the case report of a patient with a unicameral bone cyst of the calcaneus that underwent endoscopically assisted treatment with curettage and bone grafting with allograft from a bone bank, with emphasis on the surgical technique. Unicameral bone cyst is a benign bone lesion, which can be adequately treated by endoscopic curettage and percutaneous injection of morselized bone allograft in symptomatic patients.

[Sinus tarsi approach combined with medial distraction technique for treatment of intra-articular calcaneus fractures].

Science.gov (United States)

Zhou, Haichao; Ren, Haoyang; Li, Bing; Yu, Tao; Yang, Yunfeng

2016-07-08

?To discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision. ?A retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative Böhler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative Böhler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated. ?Sixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the

Bilateral complex regional pain syndrome following spinal cord injury and bilateral calcaneus fracture

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Ahmet Boyacı

2013-09-01

Full Text Available Complex regional pain syndrome (CRPS is a disease affectingone or more extremities, characterized by spontaneouspain, allodynia, hyperpathia and hyperalgesia.CRPS is separated into Type 1 and Type 2. CRPS whichdevelops after a nociceptive event is labeled as Type 1and when it develops following peripheral nerve damage,Type 2. Although the pathogenesis is not fully understood,peripheral and central sensitivity are held responsible.Bilateral lower extremity involvement is extremely rare.However, it should be borne in mind that it can develop intraumatic injuries which occur in more than one area anddiagnosis and commencement of a rehabilitation programshould be made in the early period. The case is presentedhere of bilateral Type 1 CRPS developing after incompletespinal cord injury and bilateral calcaneus fracture. JClin Exp Invest 2013; 4 (3: 360-363Key words: complex regional pain syndrome, calcaneusfracture, spinal cord injury

Risk factors for bone mineral density at the calcaneus in 40–59 year-old male workers: A cross-sectional study in Korea

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Kim Chong-Soon

2008-07-01

Full Text Available Abstract Background Few epidemiologic studies have attempted to investigate the prevalence and risk factors for osteopenia and osteoporosis in middle-aged Asian men. We performed this study to determine the prevalence and risk factors of osteopenia and osteoporosis in this population. Methods This cross-sectional study was conducted from March to July, 2004. The subjects were 2,073 males aged from 40 to 59 years in the KHNP (Korea Hydro & Nuclear Power workplace-based cohort. Bone mineral density (BMD was measured by peripheral, dual-energy, X-ray absorptiometry (DXA at the calcaneus. Anthropometric and lifestyle factors were investigated using a standard, self-reported questionnaire. Results BMD was 0.60 ± 0.09 g/cm2 (mean ± standard deviation and was negatively correlated with age (r = -0.18, P P P P P P In multiple linear regression analysis, the independent determinants associated with BMD were increasing age (coefficient = -0.002, P P P P P Conclusion We suggest that BMD of the calcaneus is correlated negatively with exposure to smoke and increased WHR, but positively with regular exercise and increased BMI.

Association between polymorphisms of apolipoprotein E, bone mineral density of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in postmenopausal women with hip or lower forearm fracture

DEFF Research Database (Denmark)

Sennels, Henriette Pia; Sand, J C; Madsen, B

2003-01-01

are contradictory. The aim of this study was to examine the association between polymorphisms of APOE, BMD of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in a population of postmenopausal women with hip or lower forearm fractures admitted to a department of orthopaedic...... surgery and age-matched controls from the population register. The APOE genotypes of 327 women were studied: 73 with lower forearm fractures, 43 with hip fractures and 211 age-matched controls. The participants were not receiving antiosteoporotic treatment. Polymerase chain reaction restriction fragment...... length polymorphism (PCR-RFLP) was used to detect the APOE genotypes. Quantitative ultrasound was measured at the calcaneus. Bone mineral density (BMD) of the lower forearm was measured with dual-energy X-ray absorptiometry. The distributions of genotype frequencies in this study were: E2/E2: 0.3%; E2/E3...

Influence of treatment with alendronate on the speed of sound, an ultrasound parameter, of the calcaneus in postmenopausal Japanese women with osteoporosis: a clinical practice-based observational study

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Iwamoto J

2012-06-01

Full Text Available Jun Iwamoto,1 Tetsuya Takada,2 Yoshihiro Sato,3 Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, 2Department of Internal Medicine, Hiyoshi Medical Clinic, Kanagawa, 3Department of Neurology, Mitate Hospital, Fukuoka, JapanPurpose: The influence of alendronate (ALN treatment on the quantitative ultrasound parameters of the calcaneus remains to be established in Japanese patients. The aim of the present clinical practice-based observational study was to examine the influence of ALN treatment for 1 year on the speed of sound (SOS of the calcaneus and bone turnover markers in postmenopausal Japanese women with osteoporosis.Patients and methods: Forty-five postmenopausal Japanese women with osteoporosis who had received treatment with ALN for more than 1 year were enrolled in the study. The SOS and bone turnover markers were monitored over 1 year of ALN treatment.Results: The urinary levels of cross-linked N-terminal telopeptides of type I collagen and serum levels of alkaline phosphatase decreased significantly from the baseline values (–44.9% at 3 months and –22.2% at 12 months, respectively. The SOS increased modestly, but significantly, from the baseline value (0.6% at both 6 and 12 months. The percentage decrease in the urinary levels of cross-linked N-terminal telopeptides of type I collagen at 3 months was significantly correlated with the percentage increase in the SOS only at 6 months (correlation coefficient, 0.299.Conclusion: The present study confirmed that ALN treatment suppressed bone turnover, producing a clinically significant increase in the SOS of the calcaneus in postmenopausal Japanese women with osteoporosis.Keywords: postmenopausal osteoporosis, quantitative ultrasound (QUS, SOS, bone turnover, biochemical markers

The effect of sports activities in children and adolescents on the calcaneus - an investigation with quantitative ultrasound; Einfluss sportlicher Aktivitaet von Kindern und Jugendlichen auf den Kalkaneus - Eine Untersuchung mit quantitativem Ultraschall

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Mentzel, H.J.; Malich, A.; Boettcher, J.; Vogt, S.; Kaiser, W.A. [Inst. fuer Diagnostische und Interventionelle Radiologie, Klinikum der Friedrich-Schiller-Univ., Jena (Germany); Wuensche, K. [Rontgenavdelingen, HNT Sykehuset Namsos (Norway)

2005-04-01

Purpose: To determine whether quantitative ultrasound (QUS) parameters speed of sound (SOS) and broadband ultrasound attenuation (BUA) on the calcaneus are different between athletic children and a reference population. Patients and Methods: From a college of physical education, 177 children and adolescents (121 boys and 56 girls, age range from 11 to 18 years) were included in this study. QUS was performed on the calcaneus using the Sahara trademark device (Hologic, USA). SOS and BUA were estimated. Regional reference values of 3299 children were used to determine significant differences between athletes and reference population. The influence of activity level, age, height, and weight was estimated using correlation analysis. Results: Sportsmen showed significant (p<0.05) higher values of the QUS parameters (SOS 1581.1 m/s; BUA 69.7 dB/MHz) compared to the reference data (SOS 1563.9 m/s; BUA 64.2 dB/MHz). Significant correlation was observed between BUA and the level of activity, age, weight, and height (p<0.01) and between SOS and weight and height (p<0.05). In the group of soccer players and athletes, significant correlation was found between BUA vs. age and BUA vs. weight (p<0.05). Furthermore, significant correlation was observed between BUA vs. age and weight in Judokas and Wrestlers. For the level of activity, a significant correlation to BUA was only found in the group of Judokas and Wrestlers (p<0.01). Conclusion: An increase in quantitative ultrasound parameters on the calcaneus occurs in children and adolescents with increased physical activity. (orig.)

Calcaneus, calcaneal tendon and retrocalcaneal bursa. Historical overview and plea for an accurate terminology.

Science.gov (United States)

Kachlik, D; Musil, V; Vasko, S; Klaue, K; Stingl, J; Baca, V

2010-01-01

Diseases and injuries of several specific structures in the heel region have been an enduring focus of medicine: The anatomical terminology of many of these structures has not been established until recently. The aim of the study was a historical analysis of the advances of anatomical terminology of three selected morphological units in the heel region--the Achilles tendon, calcaneus and retrocalcaneal bursa. It starts with a critical evaluation of the mythological eposes, the Illiad and Odyssey, describing the exploits of heroes in the Trojan war, followed by a review of relevant terms used for the designation of selected heel structures in the Middle Ages as well as in the 18" and 19" centuries. Principal versions of Latin anatomical terms used for the denotation of the mentioned structures are discussed. Recently applicable Latin terms and their recommended English synonyms, according to the latest version of Terminologia Anatomica (1998) are summed up. It surveys examples of "not very appropriate" terms, which are frequently used in clinical literature. The authors consider the use of official anatomical terms (both Latin and English) as an important step for the improvement of the clinical expressions and formulations.

Relationships among ultrasonic and mechanical properties of cancellous bone in human calcaneus in vitro.

Science.gov (United States)

Wear, Keith A; Nagaraja, Srinidhi; Dreher, Maureen L; Sadoughi, Saghi; Zhu, Shan; Keaveny, Tony M

2017-10-01

Clinical bone sonometers applied at the calcaneus measure broadband ultrasound attenuation and speed of sound. However, the relation of ultrasound measurements to bone strength is not well-characterized. Addressing this issue, we assessed the extent to which ultrasonic measurements convey in vitro mechanical properties in 25 human calcaneal cancellous bone specimens (approximately 2×4×2cm). Normalized broadband ultrasound attenuation, speed of sound, and broadband ultrasound backscatter were measured with 500kHz transducers. To assess mechanical properties, non-linear finite element analysis, based on micro-computed tomography images (34-micron cubic voxel), was used to estimate apparent elastic modulus, overall specimen stiffness, and apparent yield stress, with models typically having approximately 25-30 million elements. We found that ultrasound parameters were correlated with mechanical properties with R=0.70-0.82 (pmechanical properties beyond that provided by bone quantity alone (p≤0.05). Adding ultrasound variables to linear regression models based on bone quantity improved adjusted squared correlation coefficients from 0.65 to 0.77 (stiffness), 0.76 to 0.81 (apparent modulus), and 0.67 to 0.73 (yield stress). These results indicate that ultrasound can provide complementary (to bone quantity) information regarding mechanical behavior of cancellous bone. Published by Elsevier Inc.

Treatment of Unicameral Bone Cysts of the Calcaneus: A Systematic Review.

Science.gov (United States)

Levy, David M; Gross, Christopher E; Garras, David N

2015-01-01

The calcaneus is the most common tarsal affected by unicameral bone cysts (UBCs); however, the treatment of calcaneal UBCs remains controversial. The purpose of the present systematic review was to evaluate the treatment modalities for calcaneal UBCs. A systematic review was performed using clinical studies of calcaneal UBCs with a minimum of 1 year of follow-up and level I to IV evidence. Ten studies with 171 patients (181 cysts) were selected. Heel pain and radiographic cyst consolidation were the primary outcomes. A series of Z tests were used to compare the outcomes in the nonoperative and operative groups, cannulated screw and bone augmentation groups, and autografting and allografting groups. All patients treated with open curettage and bone augmentation had significant improvements in heel pain (p < .001). Only 1.1% ± 1.0% of the cysts treated conservatively had healed on radiographs compared with 93.0% ± 13.0% of the cysts after surgery (p < .001). A greater percentage of patients treated with bone augmentation had preoperative heel pain and resolution of that pain than did patients treated with cannulated screws (p < .001). Autografting had a significantly greater percentage of radiographic cyst consolidation than did allografting (97.4% ± 11.1% versus 85.1% ± 15.8%, p < .001, Z = 3.5). Objective outcomes data on calcaneal UBCs are relatively sparse. The results of the present review suggest that open curettage with autograft bone augmentation is the most effective procedure. We would encourage future comparative clinical studies to elucidate differences in UBC treatment modalities. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A validation of the first genome-wide association study of calcaneus ultrasound parameters in the European Male Ageing Study

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Han Thang S

2011-01-01

Full Text Available Abstract Background A number of single nucleotide polymorphisms (SNPs have been associated with broadband ultrasound attenuation (BUA and speed of sound (SOS as measured by quantitative ultrasound (QUS at the calcaneus in the Framingham 100K genome-wide association study (GWAS but have not been validated in independent studies. The aim of this analysis was to determine if these SNPs are associated with QUS measurements assessed in a large independent population of European middle-aged and elderly men. The association between these SNPs and bone mineral density (BMD measured using dual-energy X-ray absorptiometry (DXA was also tested. Methods Men aged 40-79 years (N = 2960 were recruited from population registers in seven European centres for participation in an observational study of male ageing, the European Male Ageing Study (EMAS. QUS at the calcaneus was measured in all subjects and blood was taken for genetic analysis. Lumbar spine (LS, femoral neck (FN and total hip (TH BMD were measured by DXA in a subsample of 620 men in two centres. SNPs associated with BUA or SOS in the Framingham study with p -4 were selected and genotyped using SEQUENOM technology. Linear regression was used to test for the association between SNPs and standardised (SD bone outcomes under an additive genetic model adjusting for centre. The same direction of effect and p Results Thirty-four of 38 selected SNPs were successfully genotyped in 2377 men. Suggestive evidence of replication was observed for a single SNP, rs3754032, which was associated with a higher SOS (β(SD = 0.07, p = 0.032 but not BUA (β(SD = 0.02, p = 0.505 and is located in the 3'UTR of WDR77 (WD repeat domain 77 also known as androgen receptor cofactor p44. A single SNP, rs238358, was associated with BMD at the LS (β(SD = -0.22, p = 0.014, FN (β(SD = -0.31,p = 0.001 and TH (β(SD = -0.36, p = 0.002 in a locus previously associated with LS BMD in large-scale GWAS, incorporating AKAP11 and RANKL

COMPARISON OF PATHWAY AND CENTER OF GRAVITY OF THE CALCANEUS ON NON-INVOLVED AND INVOLVED SIDES ACCORDING TO ECCENTRIC AND CONCENTRIC STRENGTHENING IN PATIENTS WITH ACHILLES TENDINOPATHY

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JaeHo Yu

2012-03-01

Full Text Available This study compares the changes in pathway and center of gravity (COG on the calcaneus of non-involved and involved sides according to eccentric and concentric strengthening in patients with unilateral Achilles tendinopathy. The goal was to define the biomechanical changes according to eccentric strengthening for the development of clinical guidelines. Eighteen patients with Achilles tendinopathy were recruited at the K Rehabilitation Hospital in Seoul. The subjects were instructed to perform 5 sessions of concentric strengthening. The calcaneal pathway was measured using a three-dimensional (3D motion analyzer, and COG was measured by a force plate. Subsequently, eccentric strengthening was implemented, and identical variables were measured. Concentric and eccentric strengthening was carried out on both the involved and non-involved sides. There was no significant difference in the calcaneal pathway in patients with Achilles tendinopathy during concentric and eccentric strengthening. However, during eccentric strengthening, the calcaneal pathway significantly increased on the involved side compared to the non-involved side for all variables excluding the z-axis. COG significantly decreased on the involved side when compared to the non-involved side in patients with Achilles tendinopathy during eccentric and concentric strengthening. During concentric strengthening, all variables of the COG significantly increased on the involved side compared to the non-involved side. Compared with eccentric strengthening, concentric strengthening decreased the stability of ankle joints and increased the movement distance of the calcaneus in patients with Achilles tendinopathy. Furthermore, eccentric strengthening was verified to be an effective exercise method for prevention of Achilles tendinopathy through the reduction of forward and backward path length of foot pressure. The regular application of eccentric strengthening was found to be effective in the

Association between polymorphisms of apolipoprotein E, bone mineral density of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in postmenopausal women with hip or lower forearm fracture

DEFF Research Database (Denmark)

Sennels, Henriette Pia; Sand, J C; Madsen, B

2003-01-01

surgery and age-matched controls from the population register. The APOE genotypes of 327 women were studied: 73 with lower forearm fractures, 43 with hip fractures and 211 age-matched controls. The participants were not receiving antiosteoporotic treatment. Polymerase chain reaction restriction fragment...... are contradictory. The aim of this study was to examine the association between polymorphisms of APOE, BMD of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in a population of postmenopausal women with hip or lower forearm fractures admitted to a department of orthopaedic....... In conclusion, this study showed no association between bone mass parameters (BMD, speed of sound (SOS), broadband ultrasound attenuation (BUA)), hip or lower forearm fracture and APOE genotypes in a population of postmenopausal women and age-matched controls....

Discrimination of hip fractures by quantitative ultrasound of the phalanges and the calcaneus and dual X-ray absorptiometry

International Nuclear Information System (INIS)

Damilakis, John; Papadokostakis, George; Perisinakis, Kostas; Maris, Thomas; Dimitriou, P.; Hadjipavlou, Alexander; Gourtsoyiannis, Nicholas

2004-01-01

The aim of the current study was to evaluate the ability of different techniques used for the assessment of bone status to discriminate between postmenopausal women with and without hip fracture. Fifty-one postmenopausal women (mean age 64.5±6.5) who had sustained a low energy hip fracture and 51 age-matched controls (mean age 64.6±6.0) were studied. Quantitative ultrasound (QUS) assessment was carried out using the Ubis 3000 device capable of measuring broadband ultrasound attenuation (BUA) and speed of sound at the calcaneus (SOS C ) and the Sunlight Omnisense device capable of estimating speed of sound at the phalanges (SOS P ). Femoral neck bone mineral density (BMD) was assessed using dual X-ray absorptiometry. Correlations between QUS variables ranged from r=0.35 to 0.72 and between QUS variables and BMD from r=0.30 to 0.36. BMD was the best discriminator of hip fractures (odds ratio = 3.61, area under curve = 0.824). All QUS variables were significant discriminators of hip fractures with odds ratios ranging from 1.88 to 2.63 and areas under the ROC curves ranging from 0.663 to 0.740. Among the QUS variables, the SOS P showed the best odds ratio and area under curve. Comparison between the areas under the ROC curve did not show any significant difference between SOS P , BUA and BMD. On the contrary, the difference between SOS C and BMD was significant (P P , although the difference did not reach statistical significance

Usefulness of circuit training at home for improving bone mass and muscle mass while losing fat mass in undergraduate female students.

Science.gov (United States)

Takahata, Yoko

2018-05-09

The purpose of this study was to determine whether or not circuit training at home affects the calcaneus quantitative ultrasound status as well as other indices of body composition among undergraduate female students. Forty-one adolescents were recruited (18.5 ± 0.6 years old). The stiffness index of the calcaneus, broadband ultrasound attenuation of the calcaneus, speed of sound of the calcaneus, and body frame index. This was a three-month intervention study, so the measurements were conducted at baseline, 2 months later, and 3 months later while the subjects underwent circuit training at home. The subjects were divided into two groups: namely, the exercising group and non-exercising group. In the exercising group, broadband ultrasound attenuation of the calcaneus was higher 2 months later (p = 0.033) as well as 3 months later (p = 0.036), and the speed of sound of the calcaneus was higher 3 months later (p = 0.018). In addition, the muscle mass was strongly positively correlated with the calcaneus QUS-SOS (p = 0.004), while the body fat percentage was a strongly negatively correlated with the calcaneus QUS-BUA (p = 0.043). In the non-exercising group, the stiffness index of the calcaneus was higher 2 months later (p = 0.002) as well as 3 months later (p = 0.002). Furthermore, the body percentage was strongly positively correlated with the calcaneus QUS-SI (p = 0.009). These findings suggest that the calcaneus quantitative ultrasound status and muscle mass while losing fat mass may be improved by means of a simple exercise regimen within a short period among undergraduate female students.

Sex differences in bone marrow density measured by quantitative ultrasonometry: For 20 year old college student

International Nuclear Information System (INIS)

Lee, Won Jeong

2017-01-01

The purpose of this study is to compare the bone marrow density measured by quantitative ultrasonometry (QUS) between men and women. Questionnaires for general characteristics were obtained from 104 participants, and then their both calcaneus was measured by using QUS. Sex differences for bone marrow density (BMD) were analyzed by an Independent t-test using the SPSS 19.0 program. Of 104 participants, women and men were 69(66.3%) and 35(33.7%), respectively. T-value of left calcaneus was high significantly in women than that in men(0.443 vs. 0.031, p=0.161) as well as that of right calcaneus(0.555 vs. 0.049, p=0.093). T-value of right calcaneus was high than that of left calcaneus in women and men (not significant, p>0.05). T-value of both calcaneus was increasing with physical activity. T-value of calcaneus was no statistically significant with age and body mass index. The BMD of women is high significantly more than that of men, and BMD is relation with physical activity

Sex differences in bone marrow density measured by quantitative ultrasonometry: For 20 year old college student

Energy Technology Data Exchange (ETDEWEB)

Lee, Won Jeong [Dept. of Radiological Technology, Daejeon Health Institute of Technology, Daejeon (Korea, Republic of)

2017-09-15

The purpose of this study is to compare the bone marrow density measured by quantitative ultrasonometry (QUS) between men and women. Questionnaires for general characteristics were obtained from 104 participants, and then their both calcaneus was measured by using QUS. Sex differences for bone marrow density (BMD) were analyzed by an Independent t-test using the SPSS 19.0 program. Of 104 participants, women and men were 69(66.3%) and 35(33.7%), respectively. T-value of left calcaneus was high significantly in women than that in men(0.443 vs. 0.031, p=0.161) as well as that of right calcaneus(0.555 vs. 0.049, p=0.093). T-value of right calcaneus was high than that of left calcaneus in women and men (not significant, p>0.05). T-value of both calcaneus was increasing with physical activity. T-value of calcaneus was no statistically significant with age and body mass index. The BMD of women is high significantly more than that of men, and BMD is relation with physical activity.

Contrast material filling of the peroneal tendon sheath

International Nuclear Information System (INIS)

Zadravecz, Gy.; Grexa, E.

1981-01-01

In case of complaints after fracture of the calcaneus the common sheath of the peroneus tendons was filled up with contrast material. The tendon sheath was punctured Oehind the external ankle. The three-directional radiograms clearly showed the dislocation and compression of the tendons, caused by the exostosis of the calcaneus. The concomitant tendovaginitis caused the complaints. This alteration was observed in 11% of all the calcaneus fractures. (L.E.)

Assess the discrimination of Achilles InSight calcaneus quantitative ultrasound device for osteoporosis in Chinese women: Compared with dual energy X-ray absorptiometry measurements

Energy Technology Data Exchange (ETDEWEB)

Jin Ningning, E-mail: ningning_jin@163.com [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China); Lin Shouqing, E-mail: Shouqing_Lin2003@yahoo.com.cn [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China); Zhang Ying, E-mail: steel_lee@sina.com.cn [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China); Chen Fengling, E-mail: bjzqk@126.com [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China)

2010-11-15

Since the implementation of quantitative ultrasound (QUS) technology may become a part of future clinical decision making to identify osteoporosis and prevent fractures, this study was initiated to evaluate the correlations of QUS parameters and axial bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) and to assess the discrimination of QUS measurements for osteoporosis and osteopenia defined by WHO criteria. 106 native Chinese women (aged 50.2 {+-} 10.9 SD, 21-74 years) were involved. Each subject received both QUS measurements at left calcaneus with Achilles InSight and DXA measurements with DPX-L at lumbar spine (L{sub 2-4}), total hip and femoral neck. Achilles InSight provided the stiffness index (SI) which derived from Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS), and the T-scores of SI were calculated. We found that the QUS parameter SI was statistically significant but medium correlated (r = 0.458-0.587) with DXA at the lumbar spine, total hip and femoral neck (P < 0.0001 for all correlations). With ROC analysis, the area under the ROC curve of diagnosis of osteoporosis and osteopenia were 0.933 and 0.796, respectively. To identify osteoporosis, when the T-score threshold of SI was defined as -1.4, the sensitivity was 100%, and the specificity was 73.7%. Our study confirmed that QUS measurements performed with Achilles InSight were capable to identify osteoporosis defined by axial BMD using DXA in Chinese women.

Assess the discrimination of Achilles InSight calcaneus quantitative ultrasound device for osteoporosis in Chinese women: Compared with dual energy X-ray absorptiometry measurements

International Nuclear Information System (INIS)

Jin Ningning; Lin Shouqing; Zhang Ying; Chen Fengling

2010-01-01

Since the implementation of quantitative ultrasound (QUS) technology may become a part of future clinical decision making to identify osteoporosis and prevent fractures, this study was initiated to evaluate the correlations of QUS parameters and axial bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) and to assess the discrimination of QUS measurements for osteoporosis and osteopenia defined by WHO criteria. 106 native Chinese women (aged 50.2 ± 10.9 SD, 21-74 years) were involved. Each subject received both QUS measurements at left calcaneus with Achilles InSight and DXA measurements with DPX-L at lumbar spine (L 2-4 ), total hip and femoral neck. Achilles InSight provided the stiffness index (SI) which derived from Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS), and the T-scores of SI were calculated. We found that the QUS parameter SI was statistically significant but medium correlated (r = 0.458-0.587) with DXA at the lumbar spine, total hip and femoral neck (P < 0.0001 for all correlations). With ROC analysis, the area under the ROC curve of diagnosis of osteoporosis and osteopenia were 0.933 and 0.796, respectively. To identify osteoporosis, when the T-score threshold of SI was defined as -1.4, the sensitivity was 100%, and the specificity was 73.7%. Our study confirmed that QUS measurements performed with Achilles InSight were capable to identify osteoporosis defined by axial BMD using DXA in Chinese women.

The cut-off point of dual energy X-ray and laser of calcaneus osteoporosis diagnosis in postmenopausal women

International Nuclear Information System (INIS)

Salimzadeh, A.; Forough, B.; Olia, B.; Alishiri, G. H.; Ghasemzadeh, A.

2005-01-01

Dual X-Ray Absorptiometry is a method which can extensively be used for bone mineral densitometry . Another more recent method is dual energy X-ray and laser, which associate with dual X ray absorptiometry, assisted by laser measure heel thickness. In this study the cut off points for dual energy X-ray and laser of calcaneus in the diagnosis of osteoporosis in different bone regions in postmenopausal women had been determined. Materials and Methods: In 268 postmenopausal women, BMD of the spinal and femoral regions was measured by DM, and the value for the calcaneous was measured by dual energy X-ray and laser. The agreement of the two methods in the diagnosis of osteoporosis and optimal cut-off point for dual energy X-ray and laser in defining osteoporosis was obtained. What obtained was the agreement of the two methods in the diagnosis of osteoporosis, as well as the optimal cut-off point for dual energy X-ray and laser in defining osteoporosis. Results: Dual X-Ray Absorptiometry showed osteoporosis in 40.7% of cases with 35.2% in L2-L4, 16.2% in the femoral neck, and 11.7% for the femoral total region. The dual energy X-ray and laser found osteoporosis, considering -2.5 SD as a threshold, in 26.1% of cases. Agreement of the two methods in the diagnosis of osteoporosis (Kappa score) was 0.443 for the lumbar region, 0.464 for the neck, and, 0.421 for total femur regions (all P values were significant). Using Receiver Operating Characteristic curves, it was found that a T-score of -2.1, -2.6 and -2.4 as the optimal cut-off point of dual energy X-ray and laser in the diagnosis of osteoporosis in the lumbar spine, the neck and total region of femur, respectively. Conclusion: The results of this study showed a moderate agreement between the two methods in the diagnosis of osteoporosis. It seems that the dual energy X-ray and laser cannot be used as a substitute for the DM method, but it can be used as a screening method to find (to diagnose) osteoporosis

Introduction of hind foot coronal alignment view

International Nuclear Information System (INIS)

Moon, Il Bong; Jeon, Ju Seob; Yoon, Kang Cheol; Choi, Nam Kil; Kim, Seung Kook

2006-01-01

Accurate clinical evaluation of the alignment of the calcaneus relative to the tibia in the coronal plane is essential in the evaluation and treatment of hind foot pathologic condition. Previously described standard anteroposterior, lateral, and oblique radiographic methods of the foot or ankle do not demonstrate alignment of the tibia relation to the calcaneus in the coronal plane. The purpose of this study was to introduce hind foot coronal alignment view. Both feet were imaged simultaneously on an elevated, radiolucent foot stand equipment. Both feet stood on a radiolucent platform with equal weight on both feet. Both feet are located foot axis longitudinal perpendicular to the platform. Silhouette tracing around both feet are made, and line is then drawn to bisect the silhouette of the second toe and the outline of the heel. The x-ray beam is angled down approximately 15 .deg. to 20 .deg. This image described tibial axis and medial, lateral tuberosity of calcaneus. Calcaneus do not rotated. The view is showed by talotibial joint space. Although computed tomographic and magnetic resonance imaging techniques are capable of demonstrating coronal hind foot alignment, they lack usefulness in most clinical situations because the foot is imaged in a non-weight bearing position. But hind foot coronal alignment view is obtained for evaluating position changing of inversion, eversion of the hind foot and varus, valgus deformity of calcaneus

Lengthening osteotomy of the calcaneus and flexor digitorum longus tendon transfer in flexible flatfoot deformity improves talo-1st metatarsal-Index, clinical outcome and pedographic parameter.

Science.gov (United States)

Richter, Martinus; Zech, Stefan

2013-03-01

Lengthening osteotomy of the calcaneus (LO) and flexor digitorum longus tendon (FDL) transfer to the navicular is one option for the treatment of flexible flatfoot deformity (FD). The aim of the study was to analyse the amount of correction and clinical outcome including pedographic assessment. In a prospective consecutive non-controlled clinical followup study, all patients with FD that were treated with LO and FDL from September 1st 2006 to August 31st, 2009 were included. Assessment was performed before surgery and at 2-year-followup including clinical examination (with staging of posterior tibialis insufficiency) weight bearing radiographs (Talo-1st metatarsal angles (TMT)), pedography (increased midfoot contact area and force) and Visual Analogue Scale Foot and Ankle (VAS FA). 112 feet in 102 patients were analysed (age, 57.6 (13-82), 42% male). In 12 feet (9%) wound healing delay without further surgical measures was registered. All patients achieved full weight bearing during the 7th postoperative week. Until followup, revision surgery was done in 3 patients (fusion calcaneocuboid joint (n=2), correction triple arthrodesis (n=1)). 101 feet (90%) completed 2-year-followup. TMT dorsoplantar/lateral/Index and VAS FA scores were increased, and posterior tibialis insufficiency stage, pedographic midfoot contact area and force percentage were decreased (each pstage of posterior tibialis insufficiency, TMT angles and Index, pedographic midfoot contact area and force percentage, VAS FA) were improved 2 years after LO and FDL transfer to the navicular in FD. The complication rate was low. This method allows safe and predictable correction. Copyright © 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Can We Measure the Heel Bump? Radiographic Evaluation of Haglund's Deformity.

Science.gov (United States)

Bulstra, Gythe H; van Rheenen, Thijs A; Scholtes, Vanessa A B

2015-01-01

Haglund's deformity is a symptomatic posterosuperior deformity of the heel. The lateral radiograph of the ankle will show a prominent, large, posterosuperior part of the calcaneus, which can be measured using the Fowler and Philips angle (FPA, the angle between the posterior and plantar surface of the calcaneus) and the calcaneal pitch angle (CPA, the angle between the sole of the foot and the plantar part of the calcaneus). Although these angles are commonly used, these radiographic angle measurements have never shown a relationship with Haglund's deformity. In 78 patients (51% male) with symptomatic Haglund's deformity and a control group of 100 patients (41% male) with no heel complaints, we measured the FPA and CPA on weightbearing lateral radiographs of the foot. Using an unpaired t tests, no significant difference was found between the 2 groups in the FPA (p = .40). We measured a significant difference in the CPA between the Haglund group and the control group (p = .014). Subgroup analysis showed that this difference was mainly found in females (p verticalization of the calcaneus. This change in position results in extra traction on the Achilles tendon and can eventually cause tendinitis and bursitis. Radiographic measurement should be used as an auxiliary tool. If the calcaneus tends to change position, it would be interesting to understand this process, which could eventually lead to improvement in the treatment of Haglund's deformity. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The evolutionary emergence and refinement of the mammalian pattern of foot architecture.

Science.gov (United States)

Lewis, O J

1983-08-01

It is shown that in form and function the articular complexes of the monotreme foot are pre-adaptive to the therian condition, but the echidna differs by having a tuber calcaneus which is directed downward and distally. The cynodont foot (TR. 8) and that of the Triassic mammal Eozostrodon seem to possess the essential articular features present in monotremes, but they are assembled rather differently. In both, tuber calcaneus was apparently directed downwards. It follows that monotremes were probably derived from some way along the lineage usually, but inappropriately, termed "Theria'. A calcaneofibular articulation is present in kangaroos, certain shrews, elephant shrews, rabbits and artiodactyls. In all of them it is an apomorphic condition involving annexation of part of the posterior talar facet on the calcaneus by the fibula, which invariably shows some degree of amalgamation with the tibia. It is shown that the trochlear process of the mammalian calcaneus has the dual function of providing origin for the m. flexor accessorius and acting as a supporting shelf for the bundle of peroneal tendons. It is almost certainly a derivative of the lateral flange on the cynodont calcaneus, which presumably had a comparable function. In man, the process is fragmented, one of its derivatives being the lateral process of the calcaneal tuber which shows varying degrees of migration towards the medial process and amalgamation with it. The importance of these morphological features is discussed in relation to their use in cladistic analysis and their relevance to theories of the early evolution of the mammals.

The pathological changes in the hind limb of a horse from the Roman Period

International Nuclear Information System (INIS)

Janeczek, M.; Chroszcz, A.; Miklikova, Z.; Fabis, M.

2010-01-01

During the archaeological excavation of a multicultural settlement at the Nitra-Chrenova site (south-western Slovakia) an assemblage of animal bone remains was revealed. In one of the settlement features dated to the Roman period a complete horse skeleton was discovered. An investigation was carried out in the hind limb of the horse's skeleton involving macroscopic and radiographic analysis. Exostoses were observed on the tibia, talus, calcaneus, tarsal and metatarsal bones. The articular surfaces were destroyed. The anatomical structure of the talus, calcaneus and tarsal bones was not visible due to new bone formation. Additionally, osteomyelitis was observed in the talus, calcaneus and tarsal bones. It is suggested that the pathological changes developed during the septic inflammation process as a consequence of the complicated wound of the tarsal region or the tarsal joint perforating trauma

Determination of normal values for navicular drop during walking: a new model correcting for foot length and gender

DEFF Research Database (Denmark)

Nielsen, Rasmus G; Rathleff, Michael S; Simonsen, Ole H

2009-01-01

participants. Normal values have not yet been established as foot length, age, gender, and Body Mass Index (BMI) may influence the navicular drop. The purpose of the study was to investigate the influence of foot length, age, gender, and BMI on the navicular drop during walking. METHODS: Navicular drop...... was measured with a novel technique (Video Sequence Analysis, VSA) using 2D video. Flat reflective markers were placed on the medial side of the calcaneus, the navicular tuberosity, and the head of the first metatarsal bone. The navicular drop was calculated as the perpendicular distance between the marker...... on the navicular tuberosity and the line between the markers on calcaneus and first metatarsal head. The distance between the floor and the line in standing position between the markers on calcaneus and first metatarsal were added afterwards. RESULTS: 280 randomly selected participants without any foot problems...

Overset traethedsbrud i haelbenet

DEFF Research Database (Denmark)

Jeppesen, Katrine Arp; Palm, Henrik; Ebskov, Lars

2009-01-01

A stress fracture of the calcaneus is the result of rhythmically recurring sub-threshold traumata and is typically seen in athletes. The diagnosis is difficult because stress fractures are easily missed in traditional radiographs. It is therefore recommended to perform magnetic resonance imaging........ Treatment includes paracetamol and rest - and in severe cases plaster bandage and/or walker. Stress fracture of the calcaneus should be considered in cases with acute onset of severe and persistent heel pain in physically active individuals. Udgivelsesdato: 2009-Sep...

Overset traethedsbrud i haelbenet

DEFF Research Database (Denmark)

Jeppesen, Katrine Arp; Palm, Henrik; Ebskov, Lars

2009-01-01

A stress fracture of the calcaneus is the result of rhythmically recurring sub-threshold traumata and is typically seen in athletes. The diagnosis is difficult because stress fractures are easily missed in traditional radiographs. It is therefore recommended to perform magnetic resonance imaging........ Treatment includes paracetamol and rest - and in severe cases plaster bandage and/or walker. Stress fracture of the calcaneus should be considered in cases with acute onset of severe and persistent heel pain in physically active individuals....

Successful intraosseous infusion in the critically ill patient does not require a medullary cavity.

LENUS (Irish Health Repository)

McCarthy, Gerard

2012-02-03

OBJECTIVES: To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. DESIGN: Infusion of methyl green dye via standard intraosseous needles into bones without medullary cavity-in this case calcaneus and radial styloid-in cadaveric specimens. SETTING: University department of anatomy. PARTICIPANTS: Two adult cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green dye in peripheral veins of the limb in which the intraosseous infusion was performed. RESULTS: Methyl green dye was observed in peripheral veins of the chosen limb in five out of eight intraosseous infusions into bones without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.

Correlation between anatomic foot and ankle movement measured with MRI and with a motion analysis system.

Science.gov (United States)

Marquez-Barrientos, C; Liu, X C; Lyon, R; Tassone, C; Thometz, J; Tarima, S

2012-07-01

Several studies have attempted to measure how well external markers track internal bone movement using pins drilled into the foot, but this is too invasive for the pediatric population. This study investigated how well a six segment foot model (6SFM) using external markers was able to measure bone movement in the foot compared to MRI measurements. The foot was moved into different positions using a plastic foot jig and measurements were taken with both systems. The aims were to: (1) Look at the correlation between movement tracked with an Electronic Motion Tracking System (EMTS) and by measurements derived from MRI images, specifically the principal intercept angles (PIAs) which are the angles of intersection between principal axes of inertia of bone volumes. (2) To see how well external motion measured by the 6SFM could predict PIAs. Four bone pairs had their movement tracked: Tibia-Calcaneus, Calcaneus-Cuboid, Navicular-1st Metatarsal, and 1st Metatarsal-Hallux. The results showed moderate correlation between measured PIAs and those predicted at the Tibia-Calcaneus, Navicular-1st Metatarsal, and 1st Metatarsal-Hallux joints. Moderate to high correlation was found between the PIA and movement in a single anatomic plane for all four joints at several positions. The 6SFM using the EMTS allows reliable tracking of 3D rotations in the pediatric foot, except at the Calcaneus-Cuboid joint. Copyright © 2012 Elsevier B.V. All rights reserved.

Fractal dimension analysis in digital periapical radiographs: A diagnostic indicator of osteoporosis in post-menopausal women

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Mathivanan Kavitha

2017-01-01

Full Text Available Objectives: To assess the alveolar bone density by fractal dimension (FD analysis in radiovisiograph of postmenopausal women of mandibular posterior region and to correlate FD values with t-scores of quantitative ultrasound of the calcaneus bone. Materials and Methods: This study, approved by the institutional review board, included 40 participants, aged 45–60 years divided into two groups. Twenty postmenopausal women with osteoporosis comprised group 1, and 20 postmenopausal women without osteoporosis comprised group 2 based on bone mineral density assessment of ultrasound of the calcaneus bone. Digital dental radiograph of mandibular first molar were obtained and used for assessing alveolar bone density by FD analysis and were correlated with t-scores of ultrasound of calcaneus bone. Results: The mean FD values were evaluated using SPSS 14 version software, and were found to be 1.738 and 1.867 for group 1 and group 2, respectively, which was statistically significant (P 0.05. Conclusion: FD analysis using direct digital periapical radiographs is a novel method, which can be used for early diagnosis of osteoporosis in the alveolar bone.

Age-related decrements in bone mineral density in women over 65

Science.gov (United States)

Steiger, P.; Cummings, S. R.; Black, D. M.; Spencer, N. E.; Genant, H. K.

1992-01-01

Age-related changes in bone density contribute to the risk of fractures. To describe the relationship between age and bone mass in elderly women, we studied a large cohort of women over age 65 years who were recruited from population-based lists in four cities in the United States. Bone density in g/cm2 was measured by single-photon absorptiometry (SPA) and dual x-ray absorptiometry (DXA) at the distal and proximal radius, the calcaneus, the lumbar spine, and the proximal femur. Centralized data collection was used to control data quality and consistency. We found a strong inverse relationship between bone density and age for most sites. Decrements in bone density between women aged 65-69 years and women 85 years and older exceeded 16% in all regions except the spine, where the difference between the two age groups was 6%. Ward's triangle and the calcaneus exhibited the largest decrements, with 26 and 21%, respectively. The estimates of annual changes in bone mineral density by linear regression at sites other than the spine ranged from -0.82% at the femoral neck and trochanter to -1.30% at Ward's triangle. Correlations between the different regions ranged from r = 0.51 between the proximal radius and Ward's triangle to r = 0.66 between the distal radius and calcaneus. We conclude that the inverse relationship between age and bone mass measured by absorptiometry techniques in white women continues into the ninth decade of life. The relationship is strongest for bone density of Ward's triangle and the calcaneus and weakest for the spine.

Treatment of chronic heel osteomyelitis in vasculopathic patients. Can the combined use of Integra® , skin graft and negative pressure wound therapy be considered a valid therapeutic approach after partial tangential calcanectomy?

Science.gov (United States)

Fraccalvieri, Marco; Pristerà, Giuseppe; Zingarelli, Enrico; Ruka, Erind; Bruschi, Stefano

2012-04-01

Osteomyelitis of the calcaneus is a difficult problem to manage. Patients affected by osteomyelitis of the calcaneus often have a below-the-knee amputation because of their comorbidity. In this article, we present seven cases of heel ulcerations with chronic osteomyelitis treated with Integra(®) Dermal Regeneration Template, skin graft and negative pressure wound therapy after partial tangential calcanectomy, discussing the surgical and functional results. In this casuistic of patients, all wounds healed after skin grating of the neodermis generated by Integra(®), with no patient requiring a below-knee amputation. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Juvenile intraosseous gout of the calcaneus

International Nuclear Information System (INIS)

Yun, Chun-Ho; Fang, Yang-Kai; Hung, Yu-Chung; Shih, Shin-Lin; Huang, Jon-Kway

2005-01-01

Gout presenting as an osteolytic lesion is exceedingly rare in children with asymptomatic hyperuricemia. We report the clinical and radiological presentation of intraosseous gout in a 13-year-old boy. (orig.)

Juvenile intraosseous gout of the calcaneus

Energy Technology Data Exchange (ETDEWEB)

Yun, Chun-Ho; Fang, Yang-Kai; Hung, Yu-Chung [Mackay Memorial Hospital, Department of Radiology, Taipei (Taiwan); Shih, Shin-Lin; Huang, Jon-Kway [Taipei Medical University, Department of Radiology, Taipei (Taiwan)

2005-09-01

Gout presenting as an osteolytic lesion is exceedingly rare in children with asymptomatic hyperuricemia. We report the clinical and radiological presentation of intraosseous gout in a 13-year-old boy. (orig.)

Surgical management of calcaneal unicameral bone cysts.

Science.gov (United States)

Glaser, D L; Dormans, J P; Stanton, R P; Davidson, R S

1999-03-01

Unicameral bone cysts are not seen commonly in the calcaneus. Little is known about the etiology and natural history of these lesions. Calcaneal cysts often are symptomatic, although some of these lesions are detected as incidental findings. Treatment has been advocated based on the fear of pathologic fracture and collapse. Several published series have been divided in their favor for either open treatment or injection management. These series are small, and the optimal treatment is still in question. The current study compared the efficacy of methylprednisolone acetate injection treatment with curettage and bone grafting in the treatment of unicameral bone cysts of the calcaneus. All patients treated for unicameral bone cysts of the calcaneus during the past 7 years at two institutions were reviewed. Eleven patients met inclusion criteria. All diagnoses were confirmed radiographically or histologically. Demographic information, presenting complaints, diagnostic imaging, treatment modalities, and outcome were analyzed. Long term radiographic and subjective followup was obtained. Eighteen surgical procedures were performed on 11 patients with 12 cysts. Nine injections performed on six patients failed to show healing of the cyst. Nine cysts treated with curettage and bone grafting showed cyst healing. At mean followup of 28 months (range, 12-77 months), all 11 patients had no symptoms; there were no recurrences of the cyst in the nine patients who underwent bone grafting and persistence of the cyst in the two patients who underwent injection therapy. This review reports one of the largest series of cysts in this location. The results indicate that steroid injection treatment, although useful in other locations, may not be the best option for the management of unicameral bone cysts in the calcaneus. Curettage and bone grafting yielded uniformly good results.

The role of the reversed oblique radiograph in trauma of the foot and ankle

International Nuclear Information System (INIS)

Geusens, E.; Geyskens, W.; Brys, P.; Janzing, H.

2000-01-01

The objective of this study was to demonstrate the statistical significance of a reversed oblique radiograph of the foot in patients with ankle or foot trauma. In 100 consecutive patients a reversed oblique radiograph of the foot was taken in addition to the conventional plain films. Ten of 29 fractures were not visualised on the conventional films of foot and ankle and could only be diagnosed on the reversed oblique film. In 7 of these 10 cases an avulsion fracture at the anterolateral aspect of the calcaneus was present. This additional reversed oblique film of the foot seems to be of considerable importance, especially when an anterolateral avulsion fracture of the calcaneus is clinically suspected. (orig.)

The role of the reversed oblique radiograph in trauma of the foot and ankle

Energy Technology Data Exchange (ETDEWEB)

Geusens, E.; Geyskens, W.; Brys, P. [Dept. of Radiology, University Hospitals, Leuven (Belgium); Janzing, H. [Dept. of Traumatology, University Hospitals, Leuven (Belgium)

2000-03-01

The objective of this study was to demonstrate the statistical significance of a reversed oblique radiograph of the foot in patients with ankle or foot trauma. In 100 consecutive patients a reversed oblique radiograph of the foot was taken in addition to the conventional plain films. Ten of 29 fractures were not visualised on the conventional films of foot and ankle and could only be diagnosed on the reversed oblique film. In 7 of these 10 cases an avulsion fracture at the anterolateral aspect of the calcaneus was present. This additional reversed oblique film of the foot seems to be of considerable importance, especially when an anterolateral avulsion fracture of the calcaneus is clinically suspected. (orig.)

A Novel Minimally Invasive Reduction Technique by Balloon and Distractor for Intra-Articular Calcaneal Fractures: A Report of 2 Cases

Directory of Open Access Journals (Sweden)

M. Prod’homme

2018-01-01

Full Text Available Treatment of displaced intra-articular fractures of the calcaneus remains a challenge for the orthopaedic surgeon. Conservative therapy is known to produce functional impairment. Surgical approach is plagued by soft-tissue complications and insufficient fracture reduction. We describe a minimally invasive technique that will hopefully improve these issues. We want to present our first experience through two cases. The first was a 46-year-old man who presented with a Sanders type IIBC calcaneal fracture, and the second was a 86-year-old woman with a type IIIBC calcaneal fracture. We introduced 2 Schanz screws in the talus and the calcaneus. After distraction, we introduced an inflatable balloon inside the calcaneus. By inflating the balloon, the articular surface was reduced by lifting it up. Then bone cement was injected in order to maintain the reduction. Additional screw fixation was used in the young patient. Postoperative imaging showed good congruence of the subtalar joint without leakage of cement, for the two cases. After 2 months, the patients had no pain and were without soft-tissue complications. We advocate this technique to perform a minimally invasive reduction and fixation of intra-articular calcaneal fractures because it preserves soft-tissues and provides good clinical results with early weight-bearing.

Comparative anatomy of rabbit and human achilles tendons with magnetic resonance and ultrasound imaging.

Science.gov (United States)

Doherty, Geoffrey P; Koike, Yoichi; Uhthoff, Hans K; Lecompte, Martin; Trudel, Guy

2006-02-01

We sought to describe the comparative anatomy of the Achilles tendon in rabbits and humans by using macroscopic observation, magnetic resonance imaging, and ultrasonography. The calcaneus-Achilles tendon-gastrocnemius-soleus complexes from 18 New Zealand white rabbits underwent ultrasound (US) and magnetic resonance (MR) imaging and gross anatomic sectioning; these results were compared with those from a cadaveric gastrocnemius-soleus-Achilles tendon-calcaneus specimen from a 68-y-old human male. The medial and lateral gastrocnemius muscle tendons merged 5.2 +/- 0.6 mm proximal to the calcaneal insertion macroscopically, at 93% of their course, different from the gastrocnemius human tendons, which merged at 23% of their overall course. The rabbit flexor digitorum superficialis tendon, corresponding to the flexor digitorum longus tendon in human and comparable in size with the gastrocnemius tendons, was located medial and anterior to the medial gastrocnemius tendon proximally and rotated dorsally and laterally to run posterior to the Achilles tendon-calcaneus insertion. In humans, the flexor digitorum longus tendon tracks posteriorly to the medial malleolus. The soleus muscle and tendon are negligible in the rabbit; these particular comparative anatomic features in the rabbit were confirmed on the MR images. Therefore the rabbit Achilles tendon shows distinctive gross anatomical and MR imaging features that must be considered when using the rabbit as a research model, especially for mechanical testing, or when generalizing results from rabbits to humans.

Comparison of Suture-Based Anchors and Traditional Bioabsorbable Anchors in Foot and Ankle Surgery.

Science.gov (United States)

Hembree, W Chad; Tsai, Michael A; Parks, Brent G; Miller, Stuart D

We compared the pullout strength of a suture-based anchor versus a bioabsorbable anchor in the distal fibula and calcaneus and evaluated the relationship between bone mineral density and peak load to failure. Eight paired cadaveric specimens underwent a modified Broström procedure and Achilles tendon reattachment. The fibula and calcaneus in the paired specimens received either a suture-based anchor or a bioabsorbable suture anchor. The fibular and calcaneal specimens were loaded to failure, defined as a substantial decrease in the applied load or pullout from the bone. In the fibula, the peak load to failure was significantly greater with the suture-based versus the bioabsorbable anchors (133.3 ± 41.8 N versus 76.8 ± 35.3 N; p = .002). No significant difference in load with 5 mm of displacement was found between the 2 groups. In the calcaneus, no difference in the peak load to failure was found between the 2 groups, and the peak load to failure with 5 mm of displacement was significantly lower with the suture-based than with the bioabsorbable anchors (52.2 ± 9.8 N versus 75.9 ± 12.4 N; p = .003). Bone mineral density and peak load to failure were significantly correlated in the fibula with the suture-based anchor. An innovative suture-based anchor had a greater peak load to failure compared with a bioabsorbable anchor in the fibula. In the calcaneus, the load at 5 mm of displacement was significantly lower in the suture-based than in the bioabsorbable group. The correlation findings might indicate the need for a cortical bone shelf with the suture-based anchor. Suture-based anchors could be a viable alternative to bioabsorbable anchors for certain foot and ankle procedures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Osteoporosis: a new approach of digital processing of radiological images

International Nuclear Information System (INIS)

Salles, Adilson Dias; Braz, Valeria Silva

1998-01-01

The authors applied a method based on digital processing of radiological images (fast Fourier transform) to analyze the radius distal epiphysis and calcaneus spongy bone architecture. The study revealed distinct patterns of trabecular distribution. Prior studies about osteoporosis have focused on bone density quantification and its role on fracture prediction. However, resistance to fractures (mechanical strength) is also determined by structural arrangement of bone. THe digital processing (spectral analysis) was applied to radiological images of the radius and calcaneus from 15 normal and osteopenic individuals. Normal bone trabeculae showed an individualized behavior (stress lines). On the other hand, porotic bone trabeculae revealed a diffuse pattern (honey comb). The scattered frequency components showed that the porotic bone trabeculae were remodeled. This process would be responsible for the maintenance of its physical properties. (author)

Two cases of multiple skeletal tuberculosis with spina ventosa

Energy Technology Data Exchange (ETDEWEB)

Jeon, Byung Hee; Choi, Sung Wook; Kim, Byung Soo [Busan National University College of Medicine, Busan (Korea, Republic of)

1974-10-15

Two cases of multiple skeletal tuberculosis with spina ventosa proved by radiological and pathological methods, were reported. One of the cases was 3 years old boy who had multiple abscess formations in both lower legs, intermittent high fever and soft tissue swelling in both hands, and the other was 19 years old boy who had soft tissue swelling in both hands and feet. Radiologically, the former showed active hilar tuberculosis of the chest, and destructive changes with cortical expansion in the left humerus, left tibra, left calcaneus and both hands; the latter showed almost fibroconsolidated lesions of the chest, and the bony lesions in both radii, left calcaneus, and both hands and feet. Biopsy specimen showed tubercles composed of epithelial cells, small round cells and fibroblasts with caseous necrosis in part.

Characteristics of calcaneal bone infarction: an MR imaging investigation

Energy Technology Data Exchange (ETDEWEB)

Abrahim-Zadeh, R.; Klein, R.M.; Leslie, D.; Norman, A. [Department of Radiology, New York Medical College, Macy Pavillion, Valhalla, NY 10595 (United States)

1998-06-01

Objective. Bone infarction (BI) of the calcaneus is an uncommon entity which has received little mention in the recent literature. In this paper, we review the MR images of six calcanei with BI, which demonstrate a pattern of presentation that may explain the etiology of BI at this unusual location. Design. A retrospective review was performed of the transcribed reports of the foot or ankle MR examinations at our institution. MR images of examinations with any marrow signal abnormality were reviewed for presence of BI and its distribution. Patients. Based on MRI criteria, four patients had calcaneal BI (none biopsy proven); they ranged in age from 37 to 51 years old. Two patients were diagnosed with systemic lupus erythematosus, one with fibrositis, and another with polymyositis. All were treated with corticosteroids. Results. Six calcanei (in four patients) contained a region of calcaneal BI. In five of the six, the lesions were entirely or predominantly located in the posterior half of the calcaneus. Conclusion. Two theories are proposed which may explain why BI predominantly occurs in the posterior half of the calcaneus. First, the convergence of the recurrent intraosseous calcaneal vessels may occasionally produce the equivalent of a single dominant vessel that is more prone to vascular accidents. Secondly, the region between the recurrent and the epiphyseal vessels may act as a watershed zone, increasing its susceptibility to ischemia. (orig.) With 4 figs., 1 tab., 8 refs.

Comparison of the femoral neck bone density, quantitative ultrasound and bone density of the heel between dominant and non-dominant side

Energy Technology Data Exchange (ETDEWEB)

Meszaros, Szilvia [First Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Koranyi Sandor Str. 2/a, Budapest H-1083 (Hungary); Ferencz, Viktoria [First Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Koranyi Sandor Str. 2/a, Budapest H-1083 (Hungary); Csupor, Emoke [Health Service, Budavar Local Authorities, Budapest (Hungary); Mester, Adam [Department of Radiology and Oncotherapy, Faculty of Medicine, Semmelweis University, Budapest (Hungary); Hosszu, Eva [Second Department of Paediatrics, Faculty of Medicine, Semmelweis University, Budapest (Hungary); Toth, Edit [Department of Reumatology, Ferenc Flor County Hospital, Kerepestarcsa (Hungary); Horvath, Csaba [First Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Koranyi Sandor Str. 2/a, Budapest H-1083 (Hungary)]. E-mail: horcsa@bel1.sote.hu

2006-11-15

Our study was initiated to evaluate whether there are differences between the two sides, depending on hand dominance, in densitometry values and quantitative ultrasound parameters (QUS) of the lower limb. One hundred and six women and 44 men were involved. The hand dominance was determined by interview. The bone mineral density (BMD) of the left and the right femoral necks and the calcanei were measured by dual-energy X-ray absorpiometry (DXA). The QUS examination consisted of measuring the attenuation (BUA), the speed of the ultrasound (SOS) and quantitative ultrasound index (QUI) transversing the left and right calcanei. The density of the neck of femur of the non-dominant side did not differ from that of the dominant side. On the other hand, BMD, BUA and the QUI of the calcaneus were higher on the non-dominant side in both genders (p < 0.05 for each parameter). No similar differences were seen for the SOS values. Our study has confirmed the side-to-side differences of the calcaneus in both genders, lower values were found on the dominant side. No similar differences were seen on the femur. The AUC values seemed to be higher on the dominant side, however, these differences were not strictly significant. In the case of peripheral site (heel) measurements, the practical significance of our observations is that they raise the possibility of performing peripheral DXA and QUS examinations of the calcaneus on the dominant side of the patient according to handedness.

Targeting the Plantar Fascia for Corticosteroid Injection.

Science.gov (United States)

Salvi, Andrea Emilio

2015-01-01

Plantar fasciitis is often a difficult condition to treat. It is related to repetitive strain of the fascia at its attachment to the heel bone. This condition quite often appears with the concomitant presence of a plantar calcaneal heel spur. Corticosteroid injection is a popular treatment choice for plantar fasciitis, and accurate localization of the injected medication is essential for successful resolution of symptoms after the injection. In the present brief technical communication, a method for targeting the attachment of the plantar fascia to the medial tubercle of the tuberosity of the calcaneus is described. The targeting method uses the lateral radiograph of the foot to aid in localization of the proximal attachment of the plantar fascia to the calcaneus. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Ultrasound and X-ray-based bone densitometry in patients with anorexia nervosa.

Science.gov (United States)

Resch, H; Newrkla, S; Grampp, S; Resch, A; Zapf, S; Piringer, S; Hockl, A; Weiss, P

2000-05-01

In 20 patients (mean age 23+/-5 years) with anorexia nervosa (AN), bone mass was evaluated by broadband ultrasound attenuation (BUA) of the calcaneus, peripheral quantitative computed tomography (pQCT) of the distal radius, and dual X-ray absorptiometry (DXA) of the lumbar spine and the hip. Compared with 20 age- and sex- matched healthy controls, patients with AN showed marked osteopenia at all measuring sites. Values of BUA (33.0+/-9 dB/MHz vs. 51.0+/-5.7 dB/MHz; P<0.0001) and of BMD of all regions of the hip (e.g., femoral neck: 0.71+/-0.13 g/cm(2) versus 0.89+/-0.07 g/cm(2); P<0.001), lumbar spine (0.82+/-0.15 g/cm(2) versus 1.24+/-0.06 g/cm(2); P<0.003) and total BMD of the peripheral radius (303.2+/-75 g/cm(3) versus 369.4+/-53.2 g/cm(3), P<0.001) were significantly reduced. Calculating a Z-score we found the most prominent differences between AN and controls by BUA of the calcaneus (-3.2+/-1.6), followed by DXA at the lumbar spine (-2.9+/-2.2) and the hip (femoral neck -2.1+/-1.7) and by pQCT at the distal radius (total BMD -1.2+/-2.0). There were highly significant correlations between BUA of the calcaneus and BMD of the femoral neck (r = 0.78, P<0.0001) and lumbar spine (r = 0.75, P<0.0001) as well as between BMD values of the femoral neck and lumbar spine (r = 0.95; P<0.0001). In addition, there were significant correlations (P<0.001) between body mass index (BMI) and the three different measuring sites and between the duration of the disease and BUA (r = 0.5, P<0.05). Our data suggest that BUA of the calcaneus is a valuable tool in the management of osteoporosis. Being a fast, radiation-free investigation method of good acceptance, it may be well suited for an assessment of the skeletal status in patients with AN.

FUNCTIONAL OUTCOME OF INTERNAL FIXATION FOR DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURE

Directory of Open Access Journals (Sweden)

Saket Jati

2016-12-01

Full Text Available BACKGROUND There are always difference of opinion in the importance of Bohler’s angle in evaluating the severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following surgical fixation. The purpose of this research, the relationship exists between Bohler’s angle and the injury severity of displaced calcaneal fractures and between surgical improvement of Bohler’s angle and its practical outcome. MATERIALS AND METHODS Patients were treated surgically for unilateral closed displaced intra-articular calcaneal fractures from May 2014 to October 2016 were identified. The Bohler’s angles of bilateral calcaneus were measured and was compared to the dimension of the uninjured foot was used as its normal control. The difference in the value of Bohler’s angle measured preoperatively or after surgery between the angle of the damaged foot and that of the contralateral calcaneus was calculated, respectively. The change in Bohler’s angle by ratio was calculated by dividing the variation in the value of Bohler’s angle between bilateral calcaneus by its typical control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot and Ankle Society hindfoot scores. RESULTS 30 patients were included into the study with a mean follow-up duration of 30 months. According to Sanders classification, the fracture pattern included 12 type II, 10 type III and 8 type IV fractures. According to American Orthopaedic Foot and Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 10, 8, 4 and 2 patients, respectively. The preoperative Bohler’s angle, difference value of Bohler’s angle between bilateral calcaneus and change in Bohler’s angle by ratio each has a significant relationship with Sanders classification (P=0.003; P=0.004; P=0.005, respectively, however, is not correlated with

Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis

NARCIS (Netherlands)

van Sterkenburg, M.N.; Muller, B.; Maas, M.; Sierevelt, I.N.; van Dijk, C.N.

2010-01-01

Background and purpose A retrocalcaneal bursitis is caused by repetitive impingement of the bursa between the Achilles tendon and the posterosuperior calcaneus. The bursa is situated in the posteroinferior corner of Kager's triangle (retrocalcaneal recess), which is a radiolucency with sharp borders

Evaluation of the normal calcaneal angles in Egyptian population

African Journals Online (AJOL)

Fahmy Anwar Shoukry

2012-02-01

Feb 1, 2012 ... striated, which is the subcutaneous weight-bearing surface.3. Plantar surface: ... graph (AP and lateral) of the calcaneus and the measurements of these angles are ... It is derived from a line in the plane of the inferior surface of.

The influence of physical activity and fractures on ultrasound parameters in elderly people

NARCIS (Netherlands)

Graafmans, W.C.; Bouter, L.M.; Lips, P.T.A.M.

1998-01-01

In this cross-sectional study we investigated the relationship between ultrasound measurements in the calcaneus versus daily physical activity and fractures sustained in the past in elderly subjects. Ultrasound measurements were performed at both heels, which enabled us to examine determinants of

Finite Element Analysis of the Achilles Tendon While Running

Directory of Open Access Journals (Sweden)

Anițaș Răzvan

2013-02-01

Full Text Available Introduction: The Achilles tendon is the most frequent recipient of traumatic injuries. The aim of this study is to identify and describe the varying load at ankle level and especially at the Achilles tendon’s insertion on the calcaneus.

approach to and management of acute ankle ligamentous injuries

African Journals Online (AJOL)

Enrique

Tibionavicular part. Medial (deltoid) ligament of ankle {. Table I. Differential diagnosis of acute ankle injury. ATFL sprain. CFL sprain. Syndesmosis sprain. Anterior process calcaneus fracture. Lateral process talus fracture. Fifth metatarsal base fracture. Subtalar injury. Peroneal tendon injury. Osteochondral injury of the talus.

Biomechanical Analysis of Suture Anchor vs Tenodesis Screw for FHL Transfer.

Science.gov (United States)

Drakos, Mark C; Gott, Michael; Karnovsky, Sydney C; Murphy, Conor I; DeSandis, Bridget A; Chinitz, Noah; Grande, Daniel; Chahine, Nadeen

2017-07-01

Chronic Achilles injury is often treated with flexor hallucis longus (FHL) tendon transfer to the calcaneus using 1 or 2 incisions. A single incision avoids the risks of extended dissections yet yields smaller grafts, which may limit fixation options. We investigated the required length of FHL autograft and biomechanical profiles for suture anchor and biotenodesis screw fixation. Single-incision FHL transfer with suture anchor or biotenodesis screw fixation to the calcaneus was performed on 20 fresh cadaveric specimens. Specimens were cyclically loaded until maximal load to failure. Length of FHL tendon harvest, ultimate load, stiffness, and mode of failure were recorded. Tendon harvest length needed for suture anchor fixation was 16.8 ± 2.1 mm vs 29.6 ± 2.4 mm for biotenodesis screw ( P = .002). Ultimate load to failure was not significantly different between groups. A significant inverse correlation existed between failure load and donor age when all specimens were pooled (ρ = -0.49, P Anchor failure occurred mostly by suture breakage (n = 8). Adequate FHL tendon length could be harvested through a single posterior incision for fixation to the calcaneus with either fixation option, but suture anchor required significantly less graft length. Stiffness, fixation strength, and load to failure were comparable between groups. An inverse correlation existed between failure load and donor age. Younger specimens with screw fixation demonstrated significantly greater failure loads. Adequate harvest length for FHL transfer could be achieved with a single posterior incision. There was no difference in strength of fixation between suture anchor and biotenodesis screw.

Disease: H00903 [KEGG MEDICUS

Lifescience Database Archive (English)

Full Text Available an idiopathic deformity of the lower limb that consists of malalignment of the bones and joints of the foot ...and ankle. It is defined as a fixation of the foot in a hand-like orientation. The calcaneus, navicular and cuboid bones

Three-dimensional bone kinematics in an anterior laxity test of the ankle joint

NARCIS (Netherlands)

Kerkhoffs, G.; Blankevoort, L.; Kingma, I.; van Dijk, C.N.

2007-01-01

Questions addressed in this in-vitro study are (1) what are the actual three-dimensional kinematics of talus and calcaneus during an anterior drawer test as performed with the quasi-static anterior ankle tester (QAAT) (2) does laxity measurement with the QAAT represent the true anterior translation

Accuracy of the Peak (TM) Two and Three-Dimensional Videography Analysis for a Rearfoot Model

Science.gov (United States)

1993-01-01

the plantar fascia . 18 Decreased pronation, or the calcaneus remaining neutral or slightly inverted, during stance phase of gait can create any number...projection onto a plane. They stated that this 3 potential error would be compounded during medial and lateral foot rotations and plantar and

Os sustentaculi: depiction on MR images

International Nuclear Information System (INIS)

Bencardino, J.; Rosenberg, Z.S.; Beltran, J.; Sheskier, S.

1997-01-01

We describe a 14-year old patient with pain in the medial ankle. The MR study depicted a rare accessory ossicle called the os sustentaculi. This accessory bone should not be confused with a fracture of the sustentaculum tali of the calcaneus. (orig.). With 1 fig

Unusual localizations of unicameral bone cysts and aneurysmal bone cysts: A retrospective review of 451 cases.

Science.gov (United States)

Aycan, Osman Emre; Çamurcu, İsmet Yalkın; Özer, Devrim; Arıkan, Yavuz; Kabukçuoğlu, Yavuz Selim

2015-06-01

Unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC) are benign cystic lesions of bone which are easily diagnosed. However, unusual locations may lead to a false diagnosis. Therefore the aim of this retrospective study was to determine the frequency of unusual localizations. The authors studied 451 cases with histopathologically confirmed diagnosis of UBC or ABC, seen between 1981 and 2012. In the UBC group (352 cases) humerus, femur and calcaneus were found to be the most common sites, while acetabulum, scapula, scaphoid, lunatum, metacarpals, metatarsals, toe phalanges and ulna each accounted for less than 1%. In the ABC group (99 cases) the most common sites of involvement were femur, humerus and tibia, while finger phalanges, ilium, acetabulum, pubis, calcaneus, cuboid, and toe phalanges each accounted for only 1%. The differential diagnosis of cystic bone lesions should include both UBC and ABC. Pain complaints plead for the latter, except in case of fracture.

Radiographic appearance of Ewing sarcoma of the hands and feet: report from the Intergroup Ewing Sarcoma Study

International Nuclear Information System (INIS)

Reinus, W.R.; Gilula, L.A.; Shirley, S.K.; Askin, F.B.; Siegal, G.P.

1985-01-01

Review of current data from the Intergroup Ewing Sarcoma Study (IESS) shows that Ewing sarcoma is rare in bones of the hands and feet. The 12 patients from the IESS protocols with hand or foot Ewing sarcoma are comparable to those already reported in the literature. With the exception of lesions in the calcaneus, the prognosis for disease-free survival is excellent. The radiographic features of hand and foot Ewing sarcoma are generally those of classic Ewing sarcoma: permeation, soft-tissue mass, and often, associated sclerotic reaction. However, with the exception of sclerosis, features suggesting bone reaction and slow tumor growth in these patients were distinctly uncommon compared with Ewing sarcoma in general. Apparently location of the lesion is important, since in the reported cases in the literature and in this series, lesions of the calcaneus fared poorly. The importance of this set of patients therefore relates to awareness and early recognition of an unusual appearance and location of Ewing sarcoma

The Use of the String of Pearls Locking Plate System in the Stabilisation of a Comminuted Calcaneal Fracture in a Giant Breed Dog

Directory of Open Access Journals (Sweden)

A. B. Scrimgeour

2011-01-01

Full Text Available An eight-year-old male Pyrenean mountain dog was presented with a comminuted fracture of the right calcaneus following motor vehicle trauma. The fracture was stabilised with a plate-rod construct, using the String of Pearls locking plate system and an intramedullary pin. Healing was uncomplicated.

Optimization of portal placement for endoscopic calcaneoplasty

NARCIS (Netherlands)

van Sterkenburg, Maayke N.; Groot, Minke; Sierevelt, Inger N.; Spennacchio, Pietro A.; Kerkhoffs, Gino M. M. J.; van Dijk, C. Niek

2011-01-01

The purpose of our study was to determine an anatomic landmark to help locate portals in endoscopic calcaneoplasty. The device for optimal portal placement (DOPP) was developed to measure the distance from the distal fibula tip to the calcaneus (DFC) in 28 volunteers to determine the location of the

Bohler's angle's role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.

Science.gov (United States)

Su, Yanling; Chen, Wei; Zhang, Tao; Wu, Xingwang; Wu, Zhanpo; Zhang, Yingze

2013-09-24

Controversy exits over the role of Böhler's angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between Böhler's angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of Böhler's angle and functional outcome. Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The Böhler's angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of Böhler's angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in Böhler's angle by ratio was calculated by dividing the difference value of Böhler's angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative Böhler's angle, difference value of Böhler's angle between bilateral calcaneus, and change in Böhler's angle by ratio each has a significant correlation with Sanders classification (rs=-0.178, P=0.003; rs=-0.174, P=0.004; rs=-0.172, P=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements

Shewanella algae infection after surgical treatment of Haglund's heel and rupture of the Achilles tendon.] [Article in Danish

DEFF Research Database (Denmark)

Laursen, Malene

2014-01-01

This is a case report of soft tissue infection with the marine bacterium Shewanella algae that is rare in Denmark. The patient was a 43-year-old male and he was treated surgically for Haglund's heel, a bony protrusion at the calcaneus. After clinical healing the patient suffered a rupture...

Bone status in rheumatoid arthritis assessed at peripheral sites by three different quantitative ultrasound devices

DEFF Research Database (Denmark)

Madsen, O R; Suetta, C; Egsmose, C

2004-01-01

sites in 27 women with RA (mean disease duration 15 years) and in 36 healthy women matched for age, height and weight. Speed of sound (SOS, m/s), broadband ultrasound attenuation (BUA, dB/MHz) and stiffness of the calcaneus were assessed by a Lunar Achilles device. Amplitude-dependent SOS (Ad-SOS, m...

Addis Ababa, Ethiopia

African Journals Online (AJOL)

user

about 1-3/1000 live births on average. The main components of the deformity are: forefoot adduction, hind foot varus, inverted calcaneus under equinus talus, and medial displacement of navicular and cuboid bones. New molecular- biology studies confirmed that the deforming genes are active at the 2nd trimester; hence it ...

Movement coordination patterns between the foot joints during walking

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John B. Arnold

2017-10-01

Full Text Available Abstract Background In 3D gait analysis, kinematics of the foot joints are usually reported via isolated time histories of joint rotations and no information is provided on the relationship between rotations at different joints. The aim of this study was to identify movement coordination patterns in the foot during walking by expanding an existing vector coding technique according to an established multi-segment foot and ankle model. A graphical representation is also described to summarise the coordination patterns of joint rotations across multiple patients. Methods Three-dimensional multi-segment foot kinematics were recorded in 13 adults during walking. A modified vector coding technique was used to identify coordination patterns between foot joints involving calcaneus, midfoot, metatarsus and hallux segments. According to the type and direction of joints rotations, these were classified as in-phase (same direction, anti-phase (opposite directions, proximal or distal joint dominant. Results In early stance, 51 to 75% of walking trials showed proximal-phase coordination between foot joints comprising the calcaneus, midfoot and metatarsus. In-phase coordination was more prominent in late stance, reflecting synergy in the simultaneous inversion occurring at multiple foot joints. Conversely, a distal-phase coordination pattern was identified for sagittal plane motion of the ankle relative to the midtarsal joint, highlighting the critical role of arch shortening to locomotor function in push-off. Conclusions This study has identified coordination patterns between movement of the calcaneus, midfoot, metatarsus and hallux by expanding an existing vector cording technique for assessing and classifying coordination patterns of foot joints rotations during walking. This approach provides a different perspective in the analysis of multi-segment foot kinematics, and may be used for the objective quantification of the alterations in foot joint

Anatomical and magnetic resonance imaging study of the medial ...

African Journals Online (AJOL)

Introduction: The medial collateral ligament of the ankle joint also known as the deltoid ligament, is a multifascicular group of ligaments. It can be divided into a superficial and deep group of fibers originating from the medial malleolus to insert in the talus, calcaneus, and navicular bones. Wide variations have been noted in ...

Unicameral bone cyst of the calcaneum.

Science.gov (United States)

Hazmy, C H Wan

2004-12-01

The calcaneus is not a common site for a unicameral solitary bone cyst. Little is known about the etiology and natural history of these lesions. The author reports an adult man with a solitary bone cyst of the os calcis which was confirmed radiologically and histologically and successfully treated with curretage and bone grafting.

Soft tissue technique - lateral view of the foot

Energy Technology Data Exchange (ETDEWEB)

Seyss, R.

1980-02-01

For exact anatomic analysis, radiographs are made of and correlated with anatomic sections of a cadaver foot. Three regions are being differentiated: The dorsal and the plantar and the calcaneal region. Normal findings are being presented as well as some pathologic soft tissue changes with special emphasis on the syndrome of 'high edge calcaneus'.

Soft tissue technique - lateral view of the foot

International Nuclear Information System (INIS)

Seyss, R.

1980-01-01

For exact anatomic analysis, radiographs are made of and correlated with anatomic sections of a cadaver foot. Three regions are being differentiated: The dorsal and the plantar and the calcaneal region. Normal findings are being presented as well as some pathologic soft tissue changes with special emphasis on the syndrome of 'high edge calcaneus'. (orig.) [de

Effect of weightlessness on mineral saturation of bone tissue

Science.gov (United States)

Krasnykh, I. G.

1975-01-01

X-ray photometry of bone density established dynamic changes in mineral saturation of bone tissues for Soyuz spacecraft and Salyut orbital station crews. Calcaneus optical bone densities in all crew members fell below initial values; an increase in spacecrew exposure time to weightlessness conditions also increased the degree of decalcification. Demineralization under weightlessness conditions took place at a higher rate than under hypodynamia.

[Manipulative reduction and external fixation with cardboard splint for the treatment of calcaneal fractures: a 60-case report].

Science.gov (United States)

Hao, Bo-Chuan; Xie, Ke-Bo

2014-07-01

To investigate the therapeutic effects of manipulative reduction for calcaneal fractures. From January 2009 to June 2012, 53 cases (60 affected feet) of Sanders type I-IV calcaneal fractures were treated by manipulative reduction and external fixation with cardboard splint,including 45 males and 8 females with an average age of (33.5 +/- 1.54) years old ranging from 18 to 65. The course of disease ranged 0.5 h to 7 d. Before treatment the feet were swelling, ache and activity limitation in evidence, some feet were wide flat deformity, the cortical bone was broken in the imaging examination. All selected cases were evaluated using Creighton-Nebraska health foundation assessment scale for fractures of calcaneus. All cases were followed up at 12 months after treatment, 13 feet got excellent curative effect, 34 good, 11 moderate and 2 poor. Manipulative reduction for Sanders type I-IV calcaneal fractures could get excellent curative effect. Manipulative reduction for calcaneal fractures could avoid surgical trauma while assure high curative effects. Manipulative reduction is not only economical and easy therapy, but also can restore maximum function of the calcaneus with few complications and facilitate early rehabilitation of ankle and joint function.

New dental and postcranial material of Agerinia smithorum (Primates, Adapiformes) from the type locality Casa Retjo-1 (early Eocene, Iberian Peninsula).

Science.gov (United States)

Femenias-Gual, Joan; Marigó, Judit; Minwer-Barakat, Raef; Moyà-Solà, Salvador

2017-12-01

New material attributed to Agerinia smithorum from Casa Retjo-1 (early Eocene, NE Iberian Peninsula), consisting of 13 isolated teeth and a fragment of calcaneus, is studied in this work. These fossils allow the first description of the calcaneus and the upper premolars for the genus Agerinia, as well as the first description of the P 2 and M 2 for A. smithorum. The newly recovered lower teeth are virtually identical to the holotype of A. smithorum and are clearly distinguishable from the other species of Agerinia. The upper teeth also show clear differences with Agerinia marandati. The morphology of the calcaneal remains reveals that A. smithorum practiced a moderately active arboreal quadrupedal mode of locomotion, showing less leaping proclivity than notharctines but more than asiadapids. All the morphological features observed in the described material reinforce the hypothesis of a single lineage consisting of the species A. smithorum, A. marandati, and Agerinia roselli. Furthermore, the phylogenetic analysis developed in this work, which incorporates the newly described remains of A. smithorum, maintains the position of Agerinia as closely related to sivaladapids and asiadapids. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical evaluation of stress fractures using bone scintigraphy

International Nuclear Information System (INIS)

Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki; Kobayashi, Yozi; Nakazima, Hiroyuki.

1984-01-01

Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptome, course and tomographic and CT finding. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus. (author)

Clinical evaluation of stress fractures using bone scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan)); Kobayashi, Yozi; Nakazima, Hiroyuki

1984-05-01

Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptoms, course and tomographic and CT findings. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus.

[Assessment of plantar fasciitis using shear wave elastography].

Science.gov (United States)

Zhang, Lining; Wan, Wenbo; Zhang, Lihai; Xiao, Hongyu; Luo, Yukun; Fei, Xiang; Zheng, Zhixin; Tang, Peifu

2014-02-01

To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis. The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion. The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126). SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.

Using an optimization approach to design an insole for lowering plantar fascia stress--a finite element study.

Science.gov (United States)

Hsu, Yu-Chun; Gung, Yih-Wen; Shih, Shih-Liang; Feng, Chi-Kuang; Wei, Shun-Hwa; Yu, Chung-Huang; Chen, Chen-Sheng

2008-08-01

Plantar heel pain is a commonly encountered orthopedic problem and is most often caused by plantar fasciitis. In recent years, different shapes of insole have been used to treat plantar fasciitis. However, little research has been focused on the junction stress between the plantar fascia and the calcaneus when wearing different shapes of insole. Therefore, this study aimed to employ a finite element (FE) method to investigate the relationship between different shapes of insole and the junction stress, and accordingly design an optimal insole to lower fascia stress.A detailed 3D foot FE model was created using ANSYS 9.0 software. The FE model calculation was compared to the Pedar device measurements to validate the FE model. After the FE model validation, this study conducted parametric analysis of six different insoles and used optimization analysis to determine the optimal insole which minimized the junction stress between plantar fascia and calcaneus. This FE analysis found that the plantar fascia stress and peak pressure when using the optimal insole were lower by 14% and 38.9%, respectively, than those when using the flat insole. In addition, the stress variation in plantar fascia was associated with the different shapes of insole.

Pathomechanics of Post-Traumatic OA Development in the Military Following Articular Fracture

Science.gov (United States)

2017-10-01

ankle, the soft tissue support in the knee may aid in preventing post-fracture deterioration, despite similar energies involved in the injuries ...patient outcomes, and/or surgeon rankings of injury severity in the knee , ankle, and in the calcaneus. The different distributions of fracture...stress analysis through a previously validated discrete element analysis (DEA) methodology [3]. Contact stresses were computed at heel - strike , mid

Lateral luxation of the superficial digital flexor tendon from the calcaneal tuber in two horses

International Nuclear Information System (INIS)

Meagher, D.M.; Aldrete, A.V.

1989-01-01

Lateral luxation of the superficial digital flexor tendon from the calcaneal tuber occurs in horses as a result of tearing or rupture of the medial retinaculum of the tendon. This report describes the repair of this condition in 2 Thoroughbred race horses, using a surgical technique in which 2 cancellous bone screws were placed in the calcaneus lateral to the tendon, along with suturing the medial retinaculum

Quantifying skin motion artifact error of the hindfoot and forefoot marker clusters with the optical tracking of a multi-segment foot model using single-plane fluoroscopy.

Science.gov (United States)

Shultz, R; Kedgley, A E; Jenkyn, T R

2011-05-01

The trajectories of skin-mounted markers tracked with optical motion capture are assumed to be an adequate representation of the underlying bone motions. However, it is well known that soft tissue artifact (STA) exists between marker and bone. This study quantifies the STA associated with the hindfoot and midfoot marker clusters of a multi-segment foot model. To quantify STA of the hindfoot and midfoot marker clusters with respect to the calcaneus and navicular respectively, fluoroscopic images were collected on 27 subjects during four quasi-static positions, (1) quiet standing (non-weight bearing), (2) at heel strike (weight-bearing), (3) at midstance (weight-bearing) and (4) at toe-off (weight-bearing). The translation and rotation components of STA were calculated in the sagittal plane. Translational STA at the calcaneus varied from 5.9±7.3mm at heel-strike to 12.1±0.3mm at toe-off. For the navicular the translational STA ranged from 7.6±7.6mm at heel strike to 16.4±16.7mm at toe-off. Rotational STA was relatively smaller for both bones at all foot positions. For the calcaneus they varied between 0.1±2.2° at heel-strike to 0.2±0.6° at toe-off. For the navicular, the rotational STA ranged from 0.6±0.9° at heel-strike to 0.7±0.7° at toe-off. The largest translational STA found in this study (16mm for the navicular) was smaller than those reported in the literature for the thigh and the lower leg, but was larger than the STA of individual spherical markers affixed to the foot. The largest errors occurred at toe-off position for all subjects for both the hindfoot and midfoot clusters. Future studies are recommended to quantify true three-dimensional STA of the entire foot during gait. Copyright © 2011. Published by Elsevier B.V.

Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy.

Science.gov (United States)

Beitzel, Knut; Mazzocca, Augustus D; Obopilwe, Elifho; Boyle, James W; McWilliam, James; Rincon, Lina; Dhar, Yasmin; Arciero, Robert A; Amendola, Annunziato

2013-07-01

Because of intratendinous ossifications, retrocalcaneal bursitis, or intratendinous necrosis commonly found in insertional tendinosis, it is often necessary to detach the tendon partially or entirely from its tendon-to-bone junction. Double-row repair for insertional Achilles tendinopathy will generate an increased contact area and demonstrate higher biomechanical stability. Controlled laboratory study. Eighteen cadaver Achilles tendons were split longitudinally and detached, exposing the calcaneus; an ostectomy was performed and the tendon was reattached to the calcaneus in 1 of 2 ways: 2 suture anchors (single row) or a 4-anchor (double row) construct. Footprint area measurements over time, displacement after cyclic loading (2000 cycles), and final load to failure were measured. The double-row refixation technique was statistically superior to the single-row technique in footprint area measurement initially and 5 minutes after repair (P = .009 and P = .01, respectively) but not after 24 hours (P = .713). The double-row construct demonstrated significantly improved measures for peak load (433.9 ± 84.3 N vs 212.0 ± 49.7 N; P = .042), load at yield (354.7 ± 106.2 N vs 198.7 ± 39.5 N; P = .01), and slope (51.8 ± 9.9 N/mm vs 66.7 ± 16.2 N/mm; P = .021). Cyclic loading did not demonstrate significant differences between the 2 constructs. Double-row construct for reinsertion of a completely detached Achilles tendon using proximal and distal rows resulted in significantly larger contact area initially and 5 minutes after repair and led to significantly higher peak load to failure on destructive testing. In treatment for insertional Achilles tendinosis, the tendon often has to be detached and anatomically reattached to its insertion at the calcaneus. To our knowledge there is a lack of biomechanical studies supporting either a number or a pattern of suture anchor fixation. Because the stresses going across the insertion site of the Achilles tendon are significant

[Decubitus ulcer in the calcaneus region: rapid development, difficult recovery].

Science.gov (United States)

Fugazza, G; Bona, F

1996-03-01

Heel pressure sores frequently arise in patients kept in bed for a long time independently of their primary disease. In account of this event the authors completed a study concerning possible mutual relations between heel pressure sores and primary disease of the patients; to validate the pharmacological treatment in less severe sores and the surgical resolution in more serious cutaneous lesions. In the last 3 years (1992-1995) at the Rehabilitation Centre of Montescano the authors have treated 39 patients suffering from 63 different severe cutaneous lesions: from phlycten to deep necrosis. The therapeutic plane utilized pharmacological treatment for 1st, 2nd, 3rd degree pressure sores, and surgical treatment for 4th degree. Pharmacological treatment included: enzymatic drugs, bactericidal and bacteriostatic medicines and cicatrizing substances. Different healing times were related to different pressure sore severity. Surgical treatment consisted of transposition of flap into wound defect. This system caused considerable reduction in resolution times. The authors noticed how easily pressure sores arise in the heel region, and how difficultly they heal. This is probably connected with particular anatomical and vascular characteristics of this region.

Bilateral calcaneal epiphysiolysis in a dog.

Science.gov (United States)

Font, J; Pèlach, M; Font, C; Cairo, J

2013-01-01

A case of bilateral calcaneal epiphysiolysis in a six-month-old female Dobermann Pinscher is described in this report. The absence of a traumatic event and the clinical, radiographic and histopathological abnormalities led us to the diagnosis of simultaneous bilateral epiphysiolysis of the calcaneus. A tension band and a type II transarticular external fixator were placed. The clinical signs were resolved only temporarily because of the gravity of the bone changes.

Strategies for Managing Massive Defects of the Foot in High-Energy Combat Injuries of the Lower Extremity

Science.gov (United States)

2010-01-01

distraction osteogenesis, bone segment short- ening/rotationplasty, and fusion all have a role to play in salvaging massive bone defects in the foot...internal fixation (Fig. 3B). As a long bone, the metatarsals are also well suited for distraction lengthening. This strategy has been successfully...cuboid bone loss. (C) Oblique foot radiograph demonstrating healed cuboid bone defect. Keeling et al144 Extra- articular bone loss in the calcaneus can

Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

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Malkoc Melih

2015-03-01

Full Text Available Plantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.

Mechanical alterations of rabbit Achilles' tendon after immobilization correlate with bone mineral density but not with magnetic resonance or ultrasound imaging.

Science.gov (United States)

Trudel, Guy; Koike, Yoichi; Ramachandran, Nanthan; Doherty, Geoff; Dinh, Laurent; Lecompte, Martin; Uhthoff, Hans K

2007-12-01

To assess the usefulness of magnetic resonance imaging (MRI), ultrasound (US) imaging, or bone mineral density (BMD) in predicting the mechanical properties of immobilized rabbit Achilles' tendons. Experimental study. Basic university laboratory. Twenty-eight rabbits. Twelve rabbits had 1 hindlimb casted for 4 weeks and 10 rabbits were casted for 8 weeks. Contralateral legs and 12 normal hindlimbs served as controls. Achilles' tendon dimensions on MRI and US, T1- and T2-signal intensities on MRI, classification of abnormalities on MRI and US; BMD of the calcaneus with dual-energy x-ray absorptiometry. Biomechanic measures consisted of peak load, stiffness, and stress. Imaging variables were correlated with biomechanic alterations. Immobilized Achilles' tendons were weaker and showed decreased mechanical stress compared with their contralateral legs and controls (all PAchilles' tendons after immobilization. However, neither increased MRI nor US signal abnormality was found. BMD was lower in immobilized calcanei and larger in contralateral legs than controls. Only BMD correlated with both the decreased peak load (R2=.42, PAchilles' tendon. This study established weakened mechanical properties of immobilized Achilles' tendons. BMD of the calcaneus, but not MRI and US, was predictive of the mechanical alterations in immobilized Achilles' tendons. BMD may be a useful biomarker to monitor disease and recovery in Achilles' tendons.

Reliability of a Seven-Segment Foot Model with Medial and Lateral Midfoot and Forefoot Segments During Walking Gait.

Science.gov (United States)

Cobb, Stephen C; Joshi, Mukta N; Pomeroy, Robin L

2016-12-01

In-vitro and invasive in-vivo studies have reported relatively independent motion in the medial and lateral forefoot segments during gait. However, most current surface-based models have not defined medial and lateral forefoot or midfoot segments. The purpose of the current study was to determine the reliability of a 7-segment foot model that includes medial and lateral midfoot and forefoot segments during walking gait. Three-dimensional positions of marker clusters located on the leg and 6 foot segments were tracked as 10 participants completed 5 walking trials. To examine the reliability of the foot model, coefficients of multiple correlation (CMC) were calculated across the trials for each participant. Three-dimensional stance time series and range of motion (ROM) during stance were also calculated for each functional articulation. CMCs for all of the functional articulations were ≥ 0.80. Overall, the rearfoot complex (leg-calcaneus segments) was the most reliable articulation and the medial midfoot complex (calcaneus-navicular segments) was the least reliable. With respect to ROM, reliability was greatest for plantarflexion/dorsiflexion and least for abduction/adduction. Further, the stance ROM and time-series patterns results between the current study and previous invasive in-vivo studies that have assessed actual bone motion were generally consistent.

Microsurgical reconstruction in patients with calcaneal deformities and defects (review

Directory of Open Access Journals (Sweden)

E. S. Tsybul’

2015-01-01

Full Text Available The data of scientific literature on various aspects of the treatment of patients with deformities and defects of the calcaneus for the period from 1976 to 2015. Basic search and selection of publications conducted using PubMed search engine and eLIBRARY. The aim of the study was a comparative analysis of current approaches to the treatment of these patients with the study of the role, place, opportunities and prospects of application technologies of reconstructive microsurgery. It was established that the key challenges for the treatment of patients with lesions of the calcaneus is to achieve stable remission of the infectious process, the maximum possible recovery of the biomechanical properties of the hindfoot and creation, thus, opportunities for achieving a normal gait stereotype. Their solution was developed and proposed to use the set of fundamentally different in its essence surgical techniques. But the possibility of the practical use of most of them are limited to the unfavorable state of the soft tissues of the heel and the heel bone, and often - and its complete absence. Technology reconstructive microsurgery, despite its complexity, high cost and large labor intensity, today represents the most effective means of solving these problems.

An osteomalacia related to phosphate diabetes - bone scintigraphy with SPECT/CT contribution; Une osteomalacie liee a un diabete phosphore - role de la scintigraphie osseuse couplee a la TEMP-TDM

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Ruyer, A.; Granier, P.; Mourad, M. [Centre Hospitalier Antoine-Gayraud, Service de Medecine Nucleaire, 11 - Carcassonne (France)

2009-12-15

We report the case of a 59-year-old woman, investigated for disabling pain of the left thigh, unrelated to any traumatic event. Interrogation had found diffuse pain of myalgia-type and arthralgia-type for approximately a year without local inflammatory signs and insufficiency fractures of both calcaneus two years before. The Technetium {sup 99m}-labeled hydroxy-methylene diphosphonate ({sup 99m}Tc-H.D.P.) whole-body bone scintigraphy evidenced multiple hot spots on the higher third of left femur, rib cage, sternum, scapula, pelvis, right hip and both calcaneus. Moreover, a more diffuse and heterogeneous prominent uptake appeared on rib cage, spine and pelvis. These images suggested a diffuse metastatic disease of the skeleton. The single photon emission computerized tomography guided by computerized tomography (SPECT/CT), centered on lumbar spine, pelvis and the upper end of femurs showed that the multiple hot spots were in fact bone fractures. These findings pointed diagnosis to a metabolic disease. The clinical context was in favour of an osteomalacia. Further explorations showed an osteomalacia related to phosphate diabetes. A thorough work-up did not reveal any known aetiology. To date, idiopathic phosphate diabetes seems the most likely diagnosis. Nuclear medicine input in osteomalacia is discussed. (authors)

An osteomalacia related to phosphate diabetes - bone scintigraphy with SPECT/CT contribution

International Nuclear Information System (INIS)

Ruyer, A.; Granier, P.; Mourad, M.

2009-01-01

We report the case of a 59-year-old woman, investigated for disabling pain of the left thigh, unrelated to any traumatic event. Interrogation had found diffuse pain of myalgia-type and arthralgia-type for approximately a year without local inflammatory signs and insufficiency fractures of both calcaneus two years before. The Technetium 99m -labeled hydroxy-methylene diphosphonate ( 99m Tc-H.D.P.) whole-body bone scintigraphy evidenced multiple hot spots on the higher third of left femur, rib cage, sternum, scapula, pelvis, right hip and both calcaneus. Moreover, a more diffuse and heterogeneous prominent uptake appeared on rib cage, spine and pelvis. These images suggested a diffuse metastatic disease of the skeleton. The single photon emission computerized tomography guided by computerized tomography (SPECT/CT), centered on lumbar spine, pelvis and the upper end of femurs showed that the multiple hot spots were in fact bone fractures. These findings pointed diagnosis to a metabolic disease. The clinical context was in favour of an osteomalacia. Further explorations showed an osteomalacia related to phosphate diabetes. A thorough work-up did not reveal any known aetiology. To date, idiopathic phosphate diabetes seems the most likely diagnosis. Nuclear medicine input in osteomalacia is discussed. (authors)

Reflex sympathetic dystrophy/complex regional pain syndrome, type 1

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S.H. Botha

2004-06-01

Full Text Available Complex regional pain syndrome (CPRS, type 1 is a pain disorder that develops unpredictably and can follow a minor injury. A 12-year-old boy presented with severe pain in the feet and could not walk or stand weight bearing. Normal X-rays showed osteopenic changes and radiolucent lines, which appeared to be stress fractures. Three-phase bone scintigraphy showed no uptake in the left lower leg on the blood pool phase or on the immediate or delayed images. This indicated typical CPRS type 1 in children. The uptake in the right foot was increased and the stress fracture and other illness could not be differentiated. Computed tomography was done to exclude stress fractures. Only osteopenic changes in both calcaneus bones were found and there was no evidence of cortical stress fractures. Magnetic resonance images revealed oedema in the calcaneus and talus bones of both feet. The patient received epidural narcotic infusion with sympathetic blockage for 1 week combined with extensive physiotherapy. The blood pool phase of the bone scan became normal within 2 weeks, and increased uptake in both feet was noticed. The patient was followed up with MRI every 3 months and the bone marrow oedema disappeared after 6 months.

Partial calcanectomy and Ilizarov external fixation may reduce amputation need in severe diabetic calcaneal ulcers

OpenAIRE

Akkurt, Mehmet Or?un; Demirkale, Ismail; ?znur, Ali

2017-01-01

ABSTRACT Objective: The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon?s armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-thre...

An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia

OpenAIRE

Malkoc, Melih; Korkmaz, Ozgur; Ormeci, Tugrul; Oltulu, Ismail; Isyar, Mehmet; Mahirogulları, Mahir

2014-01-01

INTRODUCTION Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral. PRESENTATION OF CASE This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for las...

Calcaneal Fractures and Böhler’s Angle

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Lindsey Spiegelman

2017-01-01

Full Text Available History of present illness: 40-year-old male presents to the emergency department after falling off a ladder. He was repairing a window when he fell, landing on the ground 12 feet below. The patient landed onto his feet bilaterally and then fell backwards onto his buttocks. On arrival, the patient had bilateral foot pain. He denied any back pain, headache, or loss of consciousness. Significant findings: The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow in addition to fracture fragments along the heel pad margin (blue arrow. The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow. There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle. Discussion: Calcaneal fractures occur typically in adults who have undergone significant axial load on their feet secondary to a fall from high height.2,3 There are two broad types of calcaneal fractures: intraarticular and extraarticular.2 The intraarticular fractures are colloquially referred to as a “Lover’s Fracture” as they have been known to occur in those jumping out of a tall window to escape the wrath of a lover’s spouse.1 Calcaneal fractures are best diagnosed with a CT scan or with lateral x-ray by measuring Böhler’s angle.2,3 This is the angle formed by the intersection of two lines demonstrated on a normal lateral ankle radiograph. The first line is drawn between the superior aspect of the anterior process of the calcaneus (point A and the superior edge of the posterior articular facet (point B. The second line is drawn between the superior aspect of the posterior calcaneal tuberosity (point C and point B.2

Estudo comparativo de propriedades biomecânicas da porção central do tendão calcâneo congelado e a fresco Comparative study on biomechanical properties of the central portion of frozen and fresh calcaneus tendon

Directory of Open Access Journals (Sweden)

Rodrigo Bezerra de Menezes Reiff

2007-01-01

Full Text Available Métodos de armazenamento de aloenxertos podem alterar certas características mecânicas dos tecidos. Com o objetivo de analisar a influência do fenômeno de congelamento e do tempo de armazenamento sobre as propriedades biomecânicas de tendões, os autores estudaram 40 tendões calcâneos obtidos de 20 cadáveres humanos com idade média de 41,95 anos, variando de 31 a 54 anos, sendo 17 do sexo masculino e três do sexo feminino. De cada cadáver foram retirados dois tendões, sendo que um foi testado a fresco e o contralateral congelado a - 85º C em freezer elétrico, durante um período de seis ou 12 semanas. Os corpos de prova foram submetidos a ensaios de tração em uma máquina de ensaios mecânicos Kratos K5002, fornecendo gráficos força-deformação. Foram analisados os parâmetros de força no limite de resistência máxima, rigidez, tensão no limite de resistência máxima, deformação relativa e módulo de elasticidade. Os resultados foram comparados e a analisados estatisticamente pelo método de "t-student", com índice de significância de 0,05, sendo que não houve diferença significativa nos valores obtidos entre os grupos. Concluímos que o congelamento a - 85º C não altera as propriedades biomecânicas de tendões, a despeito do tempo de armazenamento.Allograft storage methods can change some mechanical characteristics of tissues. With the objective of analyzing the influence of freezing phenomenon and storage time on tendons’ biomechanical properties, the authors studied 40 calcaneus tendons obtained from 20 human cadavers, with an average age of 41.95 years, ranging from 31 to 54 years old, being 17 males and three females. From each cadaver, two tendons were removed, one tested in its fresh state and the contralateral one frozen at -85º C in an electric freezer, during a period of six or 12 weeks. The bodies of evidence were submitted to traction assays in a Kratos K5002 mechanical assay machine, delivering

Effects of cast-mediated immobilization on bone mineral mass at various sites in adolescents with lower-extremity fracture.

Science.gov (United States)

Ceroni, Dimitri; Martin, Xavier; Delhumeau, Cécile; Rizzoli, René; Kaelin, André; Farpour-Lambert, Nathalie

2012-02-01

Leg or ankle fractures occur commonly in the pediatric population and are primarily treated with closed reduction and cast immobilization. The most predictable consequences of immobilization and subsequent weight-bearing restriction are loss of bone mineral mass, substantial muscle atrophy, and functional limitations. The purposes of this study were to determine if lower-limb fractures in adolescents are associated with abnormal bone mineral density or content at the time of fracture, and to quantify bone mineral loss at various sites due to cast-mediated immobilization and limited weight-bearing. We recruited fifty adolescents aged ten to sixteen years who had undergone cast immobilization for a leg or ankle fracture. Dual x-ray absorptiometry scans of the total body, lumbar spine, hip, leg, and calcaneus were performed at the time of fracture and at cast removal. Patients with a fracture were paired with healthy controls according to sex and age. Values at baseline and at cast removal, or at equivalent time intervals in the control group, were compared between groups and between the injured and uninjured legs of the adolescents with the fracture. At the time of fracture, there were no observed differences in the bone mineral density or bone mineral content Z-scores of the total body or the lumbar spine, or in the bone mineral density Z-scores of the calcaneus, between the injured and healthy subjects. At cast removal, bone mineral parameters on the injured side were significantly lower than those on the uninjured side in the injured group. Differences ranged from -5.8% to -31.7% for bone mineral density and from -5.2% to -19.4% for bone mineral content. During the cast period, the injured adolescents had a significant decrease of bone mineral density at the hip, greater trochanter, calcaneus, and total lower limb as compared with the healthy controls. Lower-limb fractures are not related to osteopenia in adolescents at the time of fracture. However, osteopenia

Bone lead (Pb) content at the tibia is associated with thinner distal tibia cortices and lower volumetric bone density in postmenopausal women

Science.gov (United States)

Wong, Andy K.O.; Beattie, Karen A.; Bhargava, Aakash; Cheung, Marco; Webber, Colin E.; Chettle, David R.; Papaioannou, Alexandra; Adachi, Jonathan D.

2016-01-01

Conflicting evidence suggests that bone lead or blood lead may reduce areal bone mineral density (BMD). Little is known about how lead at either compartment affects bone structure. This study examined postmenopausal women (N = 38, mean age 76 ± 8, body mass index (BMI): 26.74 ± 4.26 kg/m2) within the Hamilton cohort of the Canadian Multicentre Osteoporosis Study (CaMos), measuring bone lead at 66% of the non-dominant leg and at the calcaneus using 109Cadmium X-ray fluorescence. Volumetric BMD and structural parameters were obtained from peripheral quantitative computed tomography images (200 μm in-plane resolution, 2.3 ± 0.5 mm slice thickness) of the same 66% site and of the distal 4% site of the tibia length. Blood lead was measured using atomic absorption spectrometry and blood-to-bone lead partition coefficients (PBB, log ratio) were computed. Multivariable linear regression examined each of bone lead at the 66% tibia, calcaneus, blood lead and PBB as related to each of volumetric BMD and structural parameters, adjusting for age and BMI, diabetes or antiresorptive therapy. Regression coefficients were reported along with 95% confidence intervals. Higher amounts of bone lead at the tibia were associated with thinner distal tibia cortices (−0.972 (−1.882, −0.061) per 100 μg Pb/g of bone mineral) and integral volumetric BMD (−3.05 (−6.05, −0.05) per μg Pb/g of bone mineral). A higher PBB was associated with larger trabecular separation (0.115 (0.053, 0.178)), lower trabecular volumetric BMD (−26.83 (−50.37, −3.29)) and trabecular number (−0.08 (−0.14, −0.02)), per 100 μg Pb/g of bone mineral after adjusting for age and BMI, and remained significant while accounting for diabetes or use of antiresorptives. Total lead exposure activities related to bone lead at the calcaneus (8.29 (0.11, 16.48)) and remained significant after age and antiresorptives-adjustment. Lead accumulated in bone can have a mild insult on bone structure; but

Mineral content of the peripheral skeleton in patients with diabetes mellitus

International Nuclear Information System (INIS)

Vogl, T.; Frey, K.W.; Rohloff, R.; Doerfler, H.; Muenchen Univ.

1981-01-01

In order to determine the effect of diabetes mellitus on bone mineral content, measurements with the iodine 125 isotope method of Cameron were carried out in the distal ulna and calcaneus of 40 patients. 38% of female and 20% of male diabetic patients showed abnormally low values. The most severe changes were found in patients with complications of diabetes. There was a correlation between the duration of the diabetes and the severity of the mineral loss. (orig.) [de

Final Report of the Lower Extremity Assessment Program (LEAP 99-2). Volume 2

Science.gov (United States)

2000-08-01

demonstrates a near complete traumatic amputation at the ankle level, with a 7 to 8 cm dorsal skin bridge. There is no remnant of the plantar fascia from the...the plantar fascia was excised and draped over the foot. There is no distal extension. Proceeding proximally, there is no other proximal muscle...Foot/ankle: The calcaneus and cuboid are severely coniminuted. The talus is displaced, and embedded in the plantar fascia with a neck fracture. The

The role of functional foot orthoses on calcaneal and tibial kinematics : a clinical perspective using 3-dimensional motion analysis

OpenAIRE

Kelly, Joseph J

2010-01-01

peer-reviewed In-shoe orthoses are used in the treatment and prevention of lower limb injuries in particular patellofemoral pain associated with subtalar joint pronation. The aim of this thesis was to investigate the precise effects of in-shoe orthotic on the Calcaneus and Tibia. Two-dimension frontal plane kinematics may be used in the clinical setting to determine static and dynamic kinematics of the lower limb and foot. The findings of this thesis highlight several limitations of the...

Mineral content of the peripheral skeleton in patients with diabetes mellitus

Energy Technology Data Exchange (ETDEWEB)

Vogl, T; Frey, K W; Rohloff, R; Doerfler, H

1981-07-01

In order to determine the effect of diabetes mellitus on bone mineral content, measurements with the iodine 125 isotope method of Cameron were carried out in the distal ulna and calcaneus of 40 patients. 38% of female and 20% of male diabetic patients showed abnormally low values. The most severe changes were found in patients with complications of diabetes. There was a correlation between the duration of the diabetes and the severity of the mineral loss.

The effect of platelet rich plasma from bone marrow aspirate with added bone morphogenetic protein-2 on the Achilles tendon-bone junction in rabbits.

Science.gov (United States)

Kim, Hak Jun; Nam, Hyok-Woo; Hur, Chang-Yong; Park, Misu; Yang, Hee Seok; Kim, Byung-Soo; Park, Jung-Ho

2011-12-01

To determine if exogenously injected bone marrow derived platelet-rich plasma (PRP) plus bone morphogenetic protein (BMP)-2 could accelerate the healing of bone-tendon junction injuries and increase the junction holding strength during the early regeneration period. A direct injury model of the bone-tendon junction was made using an Achilles tendon-calcaneus bone junction in a rabbit. In the PRP/BMP-2/fibrin group, 0.05 mL of bone marrow derived PRP and 100 ng/mL of BMP-2 both incorporated into 0.1 mL of fibrin glue were injected into Achilles tendon-calcaneus bone junctions. The effect of the intervention was tested by comparing the results of an intervention group to a control group. The results of biomechanical testing, and histological and gross analyses were compared between the 2 groups at the following time points after surgery: 2 weeks, 4 weeks, and 8 weeks. Histologic examinations showed that woven bone developed in tendon-bone junctions at 2 weeks after surgery in the PRP/BMP-2/fibrin group. Mechanical test results showed no significant difference between the PRP/BMP-2/fibrin and control groups at 2 and 4 weeks after surgery, but the mean maximal load in the PRP/BMP-2/fibrin group was significantly higher than in the control group (p rabbit model of tendon-bone junction injury.

Correlation between quantitative ultrasound parameters of the calcinosis and bone density of the spine and femur in Arabian women: Relation to menopausal status

International Nuclear Information System (INIS)

Al Suhaili, A.R.; Saadi, H.F.; Reed, R.L.; Carter, A.O.

2002-01-01

Aims: Quantitative ultrasound (QUS) of the calcaneus is being frequently used to screen for osteoporosis. This technique correlates very well with dual-energy X-ray absorptiometry (DXA) of the spine and femur, and predicts fracture risk in postmenopausal women. The correlation between QUS and DXA in premenopausal women with prevalent vitamin D deficiency however is not known. We assessed the correlation between both techniques in 55 pre- and postmenopausal Arabian women, a population with high prevalence of vitamin D deficiency. Methods: BMD of the right calcaneus was estimated by Sahara ultrasound (Hologic, Waltham, MA). Spine and right total femur BMD was determined by DXA scan (Lunar Expert XL, Madison, WI). Results: Overall, the correlation between calcaneal BMD estimated by QUS and spine and femur BMD measured by DXA in pre- and postmenopausal United Arab Emirates women was statistically significant (r=0.41; p=0.002 for spine and r=0.44; p=0.001 for femur, respectively). In postmenopausal women, all correlations between DXA and QUS parameters were statistically significant. In contrast, only BUA and SOS correlated significantly with spine BMD in premenopausal women. Conclusion: The correlation between DXA and QUS is statistically significant in postmenopausal United Arab Emirates women. However, this correlation is much weaker in premenopausal UAE women suggesting that other factors such as vitamin D deficiency may influence this correlation

Human calcanei from the Middle Pleistocene site of Sima de los Huesos (Sierra de Atapuerca, Burgos, Spain).

Science.gov (United States)

Pablos, Adrián; Martínez, Ignacio; Lorenzo, Carlos; Sala, Nohemi; Gracia-Téllez, Ana; Arsuaga, Juan Luis

2014-11-01

The existence of calcanei in the fossil record prior to modern humans and Neandertals is very scarce. This skeletal element is fundamental to understanding the evolution of the morphology of the foot in human evolution. Here we present and metrically and comparatively describe 29 calcaneus remains from the Middle Pleistocene site of Sima de los Huesos (SH) (Sierra de Atapuerca, Burgos, Spain). These calcanei belong to 15 individuals (nine adults, two adolescents and four immature individuals). The metric and morphological differences in the calcanei among Middle and Late Pleistocene hominins tend to be subtle. However, the calcanei from SH are broad and robust with large articular surfaces and most significantly, exhibit a very projected sustentaculum tali. A biomechanical and phylogenetic interpretation is proffered to explain the observed morphology of these calcanei. It has been possible to propose tentative sex assignments for the SH calcanei based on size, using methods similar to those used to establish sex from the talus bones from SH. The estimation of stature based on the calcaneus provides a mean of 175.3 cm for males and 160.6 for females, which is similar to that obtained using other skeletal parts from the site. In sum, the SH calcanei are robust with a proportionally long tubercle and a projected sustentaculum tali, which are traits shared by Neandertals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Precision of dual-energy X-ray absorptiometry of the knee and heel: methodology and implications for research to reduce bone mineral loss after spinal cord injury.

Science.gov (United States)

Peppler, W T; Kim, W J; Ethans, K; Cowley, K C

2017-05-01

Methodological validation of dual-energy x-ray absorptiometry (DXA)-based measures of leg bone mineral density (BMD) based on the guidelines of the International Society for Clinical Densitometry. The primary objective of this study was to determine the precision of BMD estimates at the knee and heel using the manufacturer provided DXA acquisition algorithm. The secondary objective was to determine the smallest change in DXA-based measurement of BMD that should be surpassed (least significant change (LSC)) before suggesting that a biological change has occurred in the distal femur, proximal tibia and calcaneus. Academic Research Centre, Canada. Ten people with motor-complete SCI of at least 2 years duration and 10 people from the general population volunteered to have four DXA-based measurements taken of their femur, tibia and calcaneus. BMDs for seven regions of interest (RIs) were calculated, as were short-term precision (root-mean-square (RMS) standard deviation (g cm -2 ), RMS-coefficient of variation (RMS-CV, %)) and LSC. Overall, RMS-CV values were similar between SCI (3.63-10.20%, mean=5.3%) and able-bodied (1.85-5.73%, mean=4%) cohorts, despite lower absolute BMD values at each RIs in those with SCI (35%, heel to 54%, knee; P10% are needed to detect differences between treated and untreated groups in studies aimed at reducing bone mineral loss after SCI.

Komplekse skader i forbindelse med søvngaengeri

DEFF Research Database (Denmark)

Sillesen, Nanna Hylleholt; Nielsen, Lisa Toft; Bonde, Christian

2010-01-01

Up to 3% of adults walk in their sleep and some perform complex behaviours. Treatment recommendations for sleepwalking are inconsistent. This case report describes a 64-year-old man who climbed out of a 2nd floor toilet window during somnambulism. He fell 6-8 meters and fractured the tibia, fibul......, cervical columna, lumbal columna, calcaneus, costae and suffered a pneumothorax. Evidence to support sleepwalking treatment is lacking and besides benzodiazepines, prevention is the preferred treatment choice according to the literature....

Mechanical properties of the human Achilles tendon, in vivo

DEFF Research Database (Denmark)

Kongsgaard, M; Nielsen, C H; Hegnsvad, S

2011-01-01

Ultrasonography has been widely applied for in vivo measurements of tendon mechanical properties. Assessments of human Achilles tendon mechanical properties have received great interest. Achilles tendon injuries predominantly occur in the tendon region between the Achilles-soleus myotendinous...... junction and Achilles-calcaneus osteotendinous junction i.e. in the free Achilles tendon. However, there has been no adequate ultrasound based method for quantifying the mechanical properties of the free human Achilles tendon. This study aimed to: 1) examine the mechanical properties of the free human...

Long-term effects of intermittent equine parathyroid hormone fragment (ePTH-1-37) administration on bone metabolism in healthy horses.

Science.gov (United States)

Weisrock, Katharina U; Winkelsett, Sarah; Martin-Rosset, William; Forssmann, Wolf-Georg; Parvizi, Nahid; Coenen, Manfred; Vervuert, Ingrid

2011-11-01

Intermittent administration of parathyroid hormone (PTH) is an anabolic therapy for osteoporotic conditions in humans. This study evaluated the effects of equine PTH fragment (ePTH-1-37) administration on bone metabolism in 12 healthy horses. Six horses each were treated once daily for 120days with subcutaneous injections of 0.5μg/kg ePTH-1-37 or placebo. Blood was collected to determine ionized calcium (Ca(++)), total Ca (Ca(T)), inorganic phosphorus, serum equine osteocalcin (eOC), carboxy-terminal telopeptide of type I collagen (ICTP), bone-specific alkaline phosphatase, and carboxy-terminal cross-linked telopeptide of type I collagen. Bone mineral density (BMD) was determined with dual X-ray absorptiometry of the metacarpus and calcaneus. Significantly higher blood Ca(++) and plasma Ca(T) concentrations were measured 5h after ePTH-1-37 administration compared to placebo. Higher serum eOC concentrations were found for ePTH-1-37 treatment at days 90 (P<0.05) and 120 (P=0.05). Significantly higher serum ICTP levels were observed with ePTH-1-37 treatment at days 60 and 90. For both study groups, BMD increased significantly in the calcaneus. Long-term use of ePTH-1-37 seemed to have no negative effects on bone metabolism in healthy horses. The absence of undesirable side effects is the premise to ensure safety for further clinical investigations in horses with increased bone resorption processes. Copyright © 2011 Elsevier Ltd. All rights reserved.

Presence of a long accessory flexor tendon of the toes in surgical treatment for tendinopathy of the insertion of the calcaneal tendon: case report

Directory of Open Access Journals (Sweden)

Nelson Pelozo Gomes Júnior

2016-02-01

Full Text Available ABSTRACT The presence of accessory tendons in the foot and ankle needs to be recognized, given that depending on their location, they may cause disorders relating either to pain processes or to handling of the surgical findings. We describe the presence of an accessory flexor tendon of the toes, seen in surgical exposure for transferring the long flexor tendon of the hallux to the calcaneus, due to the presence of a disorder of tendinopathy of the insertion of the calcaneal tendon in association with Haglund's syndrome.

Percutaneous release of the plantar fascia. New surgical procedure.

Science.gov (United States)

Oliva, Francesco; Piccirilli, Eleonora; Tarantino, Umberto; Maffulli, Nicola

2017-01-01

Plantar fasciopathy presents with pain at the plantar and medial aspect of the heel. If chronic, it can negatively impact on quality of life. Plantar fasciopathy is not always self-limiting, and can be debilitating. Surgical management involves different procedures. We describe a percutaneous plantar fascia release. A minimally invasive access to the plantar tuberosity of the calcaneus is performed, and a small scalpel blade is used to release the fascia. With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities. V.

External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation.

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Tao, Xingguang; Chen, Nong; Pan, Fugen; Cheng, Biao

2017-10-01

The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation.Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups.The mean follow-up time was 18.6 months (range: 5-24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P  .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P  0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05).External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation.

Osteoporosis and Osteopathy Markers in Patients with Mastocytosis

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Nilüfer Alpay Kanıtez

2015-03-01

Full Text Available OBJECTIVE: Osteoporosis, osteosclerosis, and lytic bone lesions have been observed in patients with systemic mastocytosis (SM. We examined bone mineral density (BMD biochemical turnover markers and serum tryptase levels in SM, which is considered a rare disease. METHODS: Seventeen adult patients (5 females, 12 males; median age: 33 years, range: 20-64 with mastocytosis were included in this study. We investigated the value of quantitative ultrasound (QUS of the calcaneus in the assessment of BMD in SM patients, as well as BMD of the lumbar spine (L1-L4, femoral neck, and distal radius using dual energy x-ray absorptiometry (DXA and plasma tryptase levels, biochemical markers of bone turnover. RESULTS: At lumbar spine L1-L4, the femoral neck, and the distal radius or as calcaneus stiffness, 12 of 17 patients had T-scores of less than -1 at least at 1 site, reflecting osteopenia. Three of 17 patients had T-scores showing osteoporosis (T-score <-2.5. There was no relationship between DXA and bone lesion severity. We also found a significant positive correlation between tryptase levels and disease severity, as well as between disease severity and pyridinoline (p<0.01 by Spearman’s test. CONCLUSION: DXA and calcaneal QUS may not be appropriate techniques to assess bone involvement in SM patients because of the effects of osteosclerosis. This study further shows that the osteoclastic marker pyridinoline is helpful in patients with severe disease activity and sclerotic bone lesions to show bone demineralization.

Evaluation of peripheral enthesitis in spondyloarthritis: Ultrasonography versus clinical examination

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Anupam Wakhlu

2017-01-01

Full Text Available Background: Enthesitis is an important feature of spondyloarthritis but may often be subclinical. Data is sparse, especially from India, on the ultrasonography (USG detection of enthesitis in these patients. The present study aimed to find the prevalence and pattern of entheseal involvement assessed clinically and by USG. Methods: Fifty-two spondyloarthritis, 26 rheumatoid arthritis, and 26 healthy controls were evaluated for enthesitis by clinical examination and by USG using 2014 OMERACT consensus group definitions at bilateral Achilles insertion on the calcaneus, plantar fascia attachment on the calcaneus, quadriceps tendon insertion on the patella, patellar tendon origin from the inferior pole of the patella, and patellar tendon insertion on the tibial tuberosity. At least one ultrasonographic finding at any of the above sites was considered positive for enthesitis. Results: The number of entheseal sites screened in spondyloarthritis patients was 520 and 260 each in rheumatoid arthritis and healthy controls. USG (sensitivity - 94.2% was better in detecting enthesitis than clinical examination (sensitivity - 69.2%. Clinical examination was highly specific (100% compared to USG (55.7% in differentiating from rheumatoid arthritis and healthy controls. USG alone without clinical findings was positive at 23.8% of sites while clinical examination alone without USG findings was positive at 5.2% of sites. Frequency of enthesitis in rheumatoid arthritis was not more than healthy controls (6.1% vs. 8.1%, respectively and was much less than spondyloarthritis (34%. Conclusion: USG is a good screening tool for detection of enthesitis but cannot replace clinical examination completely.

Ultrasonography of ankle ligaments

International Nuclear Information System (INIS)

Peetrons, P.A.; Silvestre, A.; Cohen, M.; Creteur, V.

2002-01-01

The lateral collateral ligament of the ankle is a complex of 3 ligaments: The anterior and posterior talofibular ligaments and the calcaneofibular ligament; these ligaments work together to support the lateral aspect of the ankle. The anterior talofibular (ATF) ligament (Fig. 1) runs from the anterior of the talus. The probe is placed in a slightly oblique position from the malleolus toward the forefoot. The ligament is hyperechoic when its fibres are perpendicular to the ultrasound beam (anisotropy artifact is present in ligaments as well as in tendons). It is approximately 2 mm thick and, during examination, must be straight and tight from one insertion point to the other, as seen in Fig. 2. The posterior talofibular (PTF) ligament, which runs from the posterior part of the malleolus to the posterior part of the talus, is difficult to see on US, being partially or sometimes completely hidden by the malleolus. The calcaneofibular ligament forms the middle portion of the lateral collateral ligament. It is tight between the inferior part of the lateral malleolus and the calcaneus, and runs in a slightly posterior oblique direction toward the heel (Fig. 3). The ligament lies on the deep surface of the fibular tendons, forming a hammock to fall deep on the calcaneus surface (Fig. 4). The calcaneofibular ligament is approximately 2-3 nun thick and is hyperechoic in the distal two-thirds only because of the obliquity of the proximal part. When examining this ligament, it is mandatory that the ankle be flexed dorsally; this stretches the ligament so that it can be seen clearly. (author)

Incidence and Association of CT Findings of Ankle Tendon Injuries in Patients Presenting With Ankle and Hindfoot Fractures.

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Golshani, Ashkahn; Zhu, Liang; Cai, Chunyan; Beckmann, Nicholas M

2017-02-01

Tendon injuries are a commonly encountered finding in ankle CT examinations performed for fractures. This study was designed to identify the incidence and associations of tendon injuries in ankle CT examinations performed for fractures. A retrospective review was performed of 410 patients who underwent ankle CT during a 6-year period. Tendon injuries were common, seen in 25% of all ankle CT examinations. Tendon subluxation-dislocation accounted for most of the tendon injuries (77 of 196 total injuries). Pilon fractures carried 2.2 times increased risk of tibialis posterior tendon injury (p = 0.0094). Calcaneus fractures carried 11.86 times increased risk of peroneus brevis tendon and 10.71 times increased risk of peroneus longus tendon injury (p < 0.0001). Calcaneus fractures also carried 5.21 times increased risk of flexor hallucis longus tendon injury (p = 0.0024). Talus fracture was associated with injury to all flexor compartment tendons. Talus fractures carried 3.43 times increased risk of tibialis posterior tendon injury (p < 0.0001), 4.51 times increased risk of flexor digitorum longus tendon injury (p = 0.0005), and 6.97 times increased risk of flexor hallucis longus tendon injury (p < 0.0001). Calcaneal fractures are prone to peroneal tendon injury, and talus fractures are prone to flexor tendon injury. In patients with pilon fractures, it is important to look for tibialis posterior tendon injury, specifically for entrapment. Overall, the most common type of injury is tendon malalignment, so it is imperative to know the normal tendon paths and associated bony landmarks to identify tendon injury.

Congenital vascular malformations in scintigraphic evaluation

International Nuclear Information System (INIS)

Pilecki, Stanisław; Gierach, Marcin; Gierach, Joanna; Świętaszczyk, Cyprian; Junik, Roman; Lasek, Władysław

2014-01-01

Congenital vascular malformations are tumour-like, non-neoplastic lesions caused by disorders of vascular tissue morphogenesis. They are characterised by a normal cell replacement cycle throughout all growth phases and do not undergo spontaneous involution. Here we present a scintigraphic image of familial congenital vascular malformations in two sisters. A 17-years-old young woman with a history of multiple hospitalisations for foci of vascular anomalies appearing progressively in the upper and lower right limbs, chest wall and spleen. A Parkes Weber syndrome was diagnosed based on the clinical picture. Due to the occurrence of new foci of malformations, a whole-body scintigraphic examination was performed. A 12-years-old girl reported a lump in the right lower limb present for approximately 2 years, which was clinically identified as a vascular lesion in the area of calcaneus and talus. Phleboscintigraphy visualized normal radiomarker outflow from the feet via the deep venous system, also observed in the superficial venous system once the tourniquets were released. In static and whole-body examinations vascular malformations were visualised in the area of the medial cuneiform, navicular and talus bones of the left foot, as well as in the projection of right calcaneus and above the right talocrural joint. People with undiagnosed disorders related to the presence of vascular malformations should undergo periodic follow-up to identify lesions that may be the cause of potentially serious complications and to assess the results of treatment. Presented scintigraphic methods may be used for both diagnosing and monitoring of disease progression

Gait Analysis by Multi Video Sequence Analysis

DEFF Research Database (Denmark)

Jensen, Karsten; Juhl, Jens

2009-01-01

The project presented in this article aims to develop software so that close-range photogrammetry with sufficient accuracy can be used to point out the most frequent foot mal positions and monitor the effect of the traditional treatment. The project is carried out as a cooperation between...... and the calcaneus angle during gait. In the introductory phase of the project the task has been to select, purchase and draw up hardware, select and purchase software concerning video streaming and to develop special software concerning automated registration of the position of the foot during gait by Multi Video...

Congenital dislocation of the deep digital flexor tendon associated with hypoplasia of the sustentaculum tali in a Thoroughbred colt

International Nuclear Information System (INIS)

Lepage, O.M.; Leveille, R.; Breton, L.; Marcoux, M.

1995-01-01

An 11-month-old Thoroughbred colt was presented with a hard swelling at the proximal third of the right 4th metatarsal bone. A medial dislocation of the deep digital flexor tendon (flexor digitorum profundus) was also observed on the same leg. On the plantaroproximal-plantarodistal projection of the calcaneus, there was flattening and shortening of the sustentaculum tali. The smooth bony proliferation at the proximal third of the right 4th metatarus was compatible with a chronic splint bone fracture. This report describes a medial deep digital flexor dislocation associated with hypoplasia of the sustentaculum tali

Endoscopic surgery for young athletes with symptomatic unicameral bone cyst of the calcaneus.

Science.gov (United States)

Innami, Ken; Takao, Masato; Miyamoto, Wataru; Abe, Satoshi; Nishi, Hideaki; Matsushita, Takashi

2011-03-01

Open curettage with bone graft has been the traditional surgical treatment for symptomatic unicameral calcaneal bone cyst. Endoscopic procedures have recently provided less invasive techniques with shorter postoperative morbidity. The authors' endoscopic procedure is effective for young athletes with symptomatic calcaneal bone cyst. Case series; Level of evidence, 4. Of 16 young athletes with symptomatic calcaneal bone cyst, 13 underwent endoscopic curettage and percutaneous injection of bone substitute under the new method. Three patients were excluded because of short-term follow-up, less than 24 months. For the remaining 10 patients, with a mean preoperative 3-dimensional size of 23 × 31 × 35 mm as calculated by computed tomography, clinical evaluation was made with the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale just before surgery and at the most recent follow-up (mean, 36.2 months; range, 24-51 months), and radiologic assessment was performed at the most recent follow-up, to discover any recurrence or pathologic fracture. Furthermore, the 10 patients-all of whom returned to sports activities-were asked how long it took to return to initial sports activity level after surgery. Mean ankle-hindfoot scale score improved from preoperative 78.7 ± 4.7 points (range, 74-87) to postoperative 98.0 ± 4.2 points (range, 90-100) (P < .001). Pain and functional scores significantly improved after surgery (P < .01 and P < .05, respectively). Radiologic assessment at most recent follow-up revealed no recurrence or pathologic fracture, with retention of injected calcium phosphate cement in all cases. All patients could return to their initial levels of sports activities within 8 weeks after surgery (mean period, 7.1 weeks; range, 4-8 weeks), which was quite early as compared with past reports. Endoscopic curettage and injection of bone substitute appears to be an excellent option for young athletes with symptomatic calcaneal bone cyst for early return to sports activities, because it has the possibility to minimize the risk of postoperative pathologic fracture and local recurrence after early return to initial level of sports activities.

Subtalar distraction osteogenesis for posttraumatic arthritis following intra-articular calcaneal fractures.

Science.gov (United States)

Fan, Wei-Li; Sun, Hong-Zhen; Wu, Si-Yu; Wang, Ai-Min

2013-03-01

The most common treatment for old calcaneal fractures accompanied by subtalar joint injury is the use of subtalar in situ arthrodesis and subtalar distraction bone-block arthrodesis or osteotomy. This article describes the introduction of a novel surgical treatment, gradual subtalar distraction with external fixation and restoration of the calcaneal height, and presents an assessment of its efficacy. The protruding lateral calcaneus and the articular surfaces and subchondral bone of the posterior facet of the subtalar joint were surgically removed. An external fixator, attached with 2 pins in the subcutaneous tibia and 2 pins in the posterolateral calcaneus, was used to fix the subtalar joint for 7 to 10 days followed by gradual subtalar distraction at 1 mm/d. The lengthening procedure was stopped when the calcaneal height was restored according to radiography. The external fixator was removed after bone fusion. Seven cases of old calcaneal fractures accompanied by severe subtalar joint injury (8 feet) were treated using this method. Average follow-up was 14.3 months (range, 7-36 months). In all 7 cases (1 case of both feet), the postoperative wound healed primarily. The calcaneal heights of all 8 feet were partially restored. Subtalar joint bone fusion was completed within 4 to 6 months after the operation. The average preoperative American Orthopedic Foot & Ankle Society (AOFAS) hindfoot score was 25.3, and the average postoperative AOFAS score was 76.3. Subtalar distraction osteogenesis with external fixation was a novel and effective method for the treatment of old calcaneal fractures accompanied by severe subtalar joint injury in this small group of patients. Level IV, retrospective case series.

Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury

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Gorbachova, Tetyana; Wang, Peter S.; Hu, Bing [Einstein Medical Center Philadelphia, Department of Radiology, Philadelphia, PA (United States); Horrow, Jay C. [Drexel University, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA (United States)

2016-06-15

To evaluate the significance of plantar talar head injury (PTHI) in predicting osseous and soft tissue injuries on ankle MRI. The IRB approved this HIPAA-compliant retrospective study. The study group consisted of 41 ankle MRIs with PTHI that occurred at our institution over a 5 1/2 year period. Eighty MRIs with bone injuries in other locations matched for age, time interval since injury, and gender formed a control group. Injuries to the following structures were recorded: medial malleolus, lateral malleolus/distal fibula, posterior malleolus, talus, calcaneus, navicular, cuboid, lateral, medial and syndesmotic ligaments, spring ligament complex, and extensor digitorum brevis (EDB) muscle. Twenty separate logistic regressions determined which injuries PTHI predicted, using the Holm procedure to control for family-wise alpha at 0.05. PTHI strongly predicted the occurrence of injuries involving the anterior process of the calcaneus [24 % of cases, odds ratio (OR) 12.66], plantar components of the spring ligament (27 %, OR 9.43), calcaneal origin of the EDB and attachment of the dorsolateral calcaneocuboid ligament (22 %, OR 7.22), cuboid (51 %, OR 6.58), EDB (27 %, OR 5.49), anteromedial talus (66 %, OR 4.78), and posteromedial talus (49 %, OR 4.48). PTHI strongly predicted lack of occurrence of syndesmotic ligament injury (OR 19.6). The PTHI group had a high incidence of lateral ligamentous injury (78 %), but not significantly different from the control group (53 %). PTHI is strongly associated with injury involving the transverse tarsal joint complex. We hypothesize it results from talo-cuboid and/or talo-calcaneal impaction from a supination injury of the foot and ankle. (orig.)

The peak bone mass of Hawaiian, Filipino, Japanese, and white women living in Hawaii.

Science.gov (United States)

Davis, J W; Novotny, R; Ross, P D; Wasnich, R D

1994-10-01

Our study compares the bone mass of Hawaiian, Filipino, Japanese, and white women living in Oahu, Hawaii. Eligible women ranged in age from 25 to 34; all had bone mass measurements at the spine, calcaneus, and proximal and distal radius. Their average bone mineral density (BMD) remained stable with age at all four bone sites, indicating that the age range 25-34 may represent the peak bone mass. Bone mass varied, however, between ethnicities; differences in BMD up to 11% were observed. The Hawaiian women had the greatest BMD, and whites had the second greatest BMD at the spine and calcaneus. The Japanese most frequently had the lowest BMD. Differences in body size partly explained the differences; most ethnic differences were reduced or eliminated after adjusting for height and weight. At the spine, the ethnic differences for BMD were also apparent with BMC and with vertebral area. Hawaiian and white women had greater values than Japanese or Filipino women. Differences at the proximal radius resembled the spine, except that whites had the widest proximal widths. The results were more complex for the distal radius. At the distal radius whites had the lowest BMD of the four ethic groups. The difference between whites and Hawaiians derived from the greater bone mineral content (BMC) of the Hawaiian women. By contrast, the difference between whites and the Japanese and Filipinos derived from the wider distal widths of the white women. Compared with the Japanese and Filipino women, the white women appeared to disperse their BMC at the distal radius across a wider bone width.(ABSTRACT TRUNCATED AT 250 WORDS)

EFFECT OF ORTHOTICS AND FOOTWEAR ON STATIC REARFOOT KINEMATICS

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Molly Winkelmeyer

2006-09-01

Full Text Available This study examined the effect of foot orthotics and footwear on static rearfoot kinematics. Thirty-four subjects (5 males, 29 females from physical therapy clinics and the college community gave informed consent to participate. Subject age was 42 (18 years; subject height was 1.7 (0.1 meters; subject body mass was 72.6 (12.1 kg. Markers were placed on specific sites of the lower leg and calcaneus to determine the rearfoot angle. Rearfoot angle was measured with a goniometer and digitized with video-based software (Ariel Performance Analysis System. A calcaneal mold was utilized to determine the position of the calcaneus in the shod conditions. Static rearfoot angles were measured in the following conditions: barefoot (B, barefoot with the calcaneal mold (BM, barefoot with the calcaneal mold plus the orthotic (BMO, shod with the calcaneal mold (SM, and shod with the calcaneal mold plus the orthotic (SMO. An independent t-test analyzed differences between each condition as measured with the APAS and goniometer. A one-way analysis of variance (ANOVA was utilized to determine statistically significant differences among the 5 foot conditions (p 0.05 between the APAS and goniometer measurements within each condition. One-way ANOVA showed a significant difference (p < 0.01 among the five conditions as measured by APAS. Post-hoc analysis determined that the difference between BM and SM; and the BM and SMO conditions were significantly different (p < 0.01. It was observed that the orthotic slightly decreased the amount of calcaneal eversion in the standing position. The shoes worn in the study, though neutral in construction, did significantly alter rearfoot kinematics in comparison to BM

Talocalcaneal luxation: an anatomic and clinical study

International Nuclear Information System (INIS)

Gorse, M.J.; Purinton, P.T.; Penwick, R.C.; Aron, D.N.; Roberts, R.E.

1990-01-01

Talocalcaneal luxation in dogs was studied by anatomic dissection of the talocalcaneal joint in cadavers and review of five clinical cases. The integrity of the talocalcaneal joint was maintained by two strong ligaments traversing the tarsal sinus between the two bones. The joint was found to be a low motion joint. Luxation in clinical cases was not always apparent on standard radiographic views. Three dogs were treated surgically with a screw inserted in lag fashion from talus to calcaneus. One luxation was treated surgically with figure-of-eight orthopedic wires and one was treated with external coaptation. Four dogs returned to their previous levels of function without clinically detectable lameness

Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

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Tresley, Jonathan [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States); University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States)

2016-07-15

To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

International Nuclear Information System (INIS)

Tresley, Jonathan; Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D.

2016-01-01

To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

BONE MINERAL DENSITY IN PHYSICALLY ACTIVE WOMEN ASSESSED BY ULTRASOUND DESINTOMETRY

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Ana Marijanac

2015-05-01

Full Text Available Osteoporosis is a disease characterized by low bone mass and density. Physical activity has a positive effect on bone tissue, and it is recommended to prevent bone loss which comes with age. Methods: In purpose of determining bone mineral density in women who are physically active we examined 35 women divided into two groups – subjects who are premenopausal (n=20, 43.52 ± 7.56 years, and subjects who are postmenopausal (n=15, 55.89 ± 5.48. The subjects exercised Pilates method twice a week for one hour. Bone mineral density measurements were done by ultrasound densitometer „Sahara“ through the calcaneus. We get the data of the estimated bone density and T-score for right and left foot separate. Results: According to results premenopausal women have normal bone density, and postmenopausal values represent osteopenia, according to the WHO. There is no subjects who established osteoporosis. Discussion: Previous investigations have confirmed that physical activity is important for the preservation of the bone quality. Increasing steps, using simple everyday tasks, can prevent decrease in BMD in postmenopausal women (Muir et al., 2013, Ashe et al, 2008. There’s difference in the density of the calcaneus between physically active and those who are not, measured by ultrasound densitometry (Vainionpää et al, 2005. We use quantitative ultrasound densitometry to describe BMI of women who exercise Pilates and support the finding that physical activity is one of the ways that may prevent the BMD loss. These research was done as a part of long-term project entitled „Impact of physical activity of the working population“ which is co-financed by Provincial Secretariat for Science and Technological Development.

Unlocking the talus by eversion limits medial ankle injury risk during external rotation.

Science.gov (United States)

Button, Keith D; Wei, Feng; Haut, Roger C

2015-10-15

Eversion prior to excessive external foot rotation has been shown to predispose the anterior tibiofibular ligament (ATiFL) to failure, yet protect the anterior deltoid ligament (ADL) from failure despite high levels of foot rotation. The purpose of the current study was to measure the rotations of both the subtalar and talocrural joints during foot external rotation at sub-failure levels in either a neutral or a pre-everted position as a first step towards understanding the mechanisms of injury in previous studies. Fourteen (seven pairs) cadaver lower extremities were externally rotated 20° in either a pre-everted or neutral configuration, without producing injury. Motion capture was performed to track the tibia, talus, and calcaneus motions, and a joint coordinate system was used to analyze motions of the two joints. While talocrural joint rotation was greater in the neutral ankle (13.3±2.0° versus 10.5±2.7°, p=0.006), subtalar joint rotation was greater in the pre-everted ankle (2.4±1.9° versus 1.1±1.0°, p=0.014). Overall, the talocrural joint rotated more than the subtalar joint (11.9±2.8° versus 1.8±1.6°, p<0.001). It was proposed that the calcaneus and talus 'lock' in a neutral position, but 'unlock' when the ankle is everted prior to rotation. This locking/unlocking mechanism could be responsible for an increased subtalar rotation, but decreased talocrural rotation when the ankle is pre-everted, protecting the ADL from failure. This study may provide information valuable to the study of external rotation kinematics and injury risk. Copyright © 2015 Elsevier Ltd. All rights reserved.

Wholebody and pinhole bone scan manifestations of reiter's syndorme: distribution pattern and specific and early signs

Energy Technology Data Exchange (ETDEWEB)

Kim, S. H.; Chung, S. K.; Park, Y. H.; Lee, S. Y.; Sohn, H. S.; Han, B. H.; Bahk, Y. W. [College of Medicine, Catholic Univ., Seoul (Korea, Republic of)

1998-07-01

We wish to describe the characteristics panoramic wholebody bone distribution, and specific and preradiographic pinhole bone scan signs of Reiter's syndrome(RS) featured by pauciarthritis and enthesopathies in and about weight-bearing joints of the lower extremities and axial bones. We analyzed 55 sets of wholebody and pinhole bone scintigraphs of 55 patients with RS. The population was 44 men and 11 women with age ranging from 15 to 52 yr (mean=29.3). The scintigraphy was performed 2-2.5 hr pi of Tc-99m-HDP using a single-head gamma camera with a LEHR collimator and a 4-mm pinhole collimator for the wholebody and pinhole scintigraphy, respectively. We found 223 lesions with increased tracer uptake in total. Wholebody scans showed asymmetric pauciarticular distribution in weight bearing joints and periarticular entheses in the lower extremities in 63.2% (calcaneus=24.2%, ankle=8.1%, tibia=8.1% and others). The sternum, sacroiliac joint and spine were involved in 8.5%, 5.8% and 4.5%, respectively. Pinhole scan portrayed many specific signs including the 'tear-drop' sign of paravertebral ossification. 'whiskers' sign of femoral osteophytes and 'knuckle bone' sign of sausage digit. Twenty-four lesions (10.8%) showed preradiogrpahic signs in symptomatic ehthesopathies mostly in the calcaneus and proximal tibia. Nine cases with calcaneal enthesopathies and four cases with proximal tibial enthesopathy without radiographic bone change showed intense tracer uptake. Wholebody and pinhole magnification scans were useful in studying RS. The asymmetric pauciarticular distribution in the weight-bearing bones with enthesopathies was characteristic. Pinhole scan portrayed many specific signs and was sensitive permitting accurate preradiographic diagnosis in many cases.

Bone density determination using I125 densitometry with idiopathic scoliosis

International Nuclear Information System (INIS)

Weinberger, N.

1984-01-01

Based on the assumption that radiographs from patients with idiopathic scoliosis show osteoporotic changes in the curved area, investigation with I 125 -densitometry were made, and specifically with measurement points at the ulna and the calcaneus. A difference in the bone density between patients with scoliosis and normal controls could not be proven. The mineral-salt content of the scoliosis patients lay on the average 6.5 to 9.3% lower than the normal controls. No relation could be found between the degree of curvature of the scoliosis and the peripheral bone density, from which it can be concluded that no generalized mineral-salt deficiency exists. Radiographs show only local changes (photo densitometry, computed tomography). (TRV) [de

Do three-dimensional reconstructions add to the diagnostic value of computed tomography in the field of traumatology?

International Nuclear Information System (INIS)

Billet, F.P.J.; Schmitt, W.G.H.; Hofmann, M.; Huber, M.; Gay, B.

1990-01-01

Very little time was needed for three-dimensional techniques to show that they are of great importance to the accurracy and, above all, interpretation of CT-based diagnostic findings in the skeleton. This method is not associated with any increased risks from radiation and if there is no absolute requirement for a 'second plane' to be displayed, as for instance in fractures of the calcaneus, radiation exposure can be reduced even further. Particular mention should here also be made of the sternoclavicular joint, coracoid process and intervertebral foramina, even more so as we feel that the diagnostic advantages offered by three-dimensional techniques in traumatology have so far not been described in sufficient detail. (orig./GDG) [de

MRI appearances of the anterior fibulocalcaneus muscle: a rare anterior compartment muscle

Energy Technology Data Exchange (ETDEWEB)

Upadhyay, Bhavin [Basildon and Thurrock University Hospitals NHS Foundation Trust, Imaging Department, Essex (United Kingdom); Amiras, Dimitri [Imperial College Health Care NHS Trust, Imaging Department, London (United Kingdom)

2015-05-01

MRI of a 62-year-old female presenting with ankle pain demonstrated an accessory muscle within the anterior compartment of the lower leg. The muscle originated from the fibula and anterior crural septum. The tendon passed anterior to the lateral malleolus and inserted at the critical angle of Gissane on the calcaneus. This muscle was initially described in the anatomic literature by Lambert and Atsas in 2010. To our knowledge, this is the first time the MRI appearances of this muscle has been described in the radiological literature. Awareness of the fibulocalcaneal muscle is important as it may represent a cause of ankle pain. In addition, the tendon could potentially be harvested for use in reconstructive procedures. (orig.)

[MRI changes of Achilles tendon and hindfoot in experienced runners and beginners during training and after a (half)-marathon competition].

Science.gov (United States)

Freund, W; Billich, C; Brambs, H-J; Weber, F; Schütz, U H

2011-08-01

Marathon running is gaining in popularity. Its benefits regarding the cardiovascular system as well as the metabolism are beyond doubt. However, whether or not there are detrimental side effects to the musculoskeletal system such as wear and tear is an unsolved question. We therefore prospectively looked at beginners and experienced runners at a city marathon during training and after the competition for lesions to the Achilles tendon (AT) or hindfoot. 73 healthy subjects were prospectively included in our study. They were recruited from the applicants of the city marathon or half-marathon. They underwent an initial clinical orthopaedic as well as three magnetic resonance (MRI) examinations. The MRI were conducted at the time point of study enrolment, near the end of training and directly (up to 72 hours) after the run. MRI evaluation (fat saturated T (2)-weighted sagittal STIR sequence) was performed by two independent experienced radiologists blinded to the clinical context. The results were compared for subgroups of runners, also a factorial analysis was performed. Statistical results were deemed significant for p ≤ 0.05. 32 women and 41 men were included. In the end there were 53 finishers and 20 non-finishers; 28 seasoned runners and 25 novices. 57 runners had no foot complaints, while 14 had foot pain during training and 13 during the marathon. Mean body weight was 71.6 kg, height was 173 cm, age was 40.2 years. Mean AT diameter was 7.0 mm and showed no change during training or after the marathon. There was no significant influence of gender on other variables investigated. There was a significant and positive correlation between AT diameter and weight (r = 0.37), also AT and height (r = 0.34), while there was negative correlation between height and signal intensity of calcaneus (r = -0.50). The signal intensity of the AT decreased during training. The signal intensity of the calcaneus decreased from inclusion until after the marathon

Spring ligament complex: Illustrated normal anatomy and spectrum of pathologies on 3T MR imaging

Energy Technology Data Exchange (ETDEWEB)

Omar, Hythem [Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX (United States); Saini, Vikram [Center for Infection and Inflammation Imaging Research, Johns Hopkins University, Baltimore, MD (United States); Wadhwa, Vibhor [Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR (United States); Liu, George [Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX (United States); Chhabra, Avneesh, E-mail: avneesh.chhabra@utsouthwestern.edu [Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX (United States)

2016-11-15

Highlights: • The Spring ligament complex is an important stabilizer of medial arch of foot. • Of all SLC components, the integrity of Supero-Medial band is the most important. • Associated pathologies with SLC instability include PTT injury, pes planovalgus and sinus tarsi syndrome. • Conservative and operative management are viable depending on pes planovalgus progression. - Abstract: The spring (plantar calcaneonavicular) ligament complex connects the calcaneus and navicular bone of the foot and serves as the primary static stabilizer of the medial longitudinal arch of the foot. In this article, we describe the normal anatomy of the spring ligament complex, illustrate 3T magnetic resonance imaging appearances in its normal and abnormal states, and discuss the pathological associations with relevant case examples.

Biomechanics – Elastic Foundation Applied in Modelling of Calcaneal Nails

Directory of Open Access Journals (Sweden)

Sejda František

2015-12-01

Full Text Available This paper presents a strength analysis of a calcaneal nail (material Ti6Al4V and stainless steel which is used to treat complex heel fractures. The application focuses on a unique calcaneal nail, the C-NAIL, produced by Medin a.s. (Nové Město na Moravě, Czech Republic. The paper first presents an analysis of fracture types, treatment methods and loading of the calcaneus. It then presents an analysis of limit conditions and loading. Calculations (displacement and stress are performed for 6 and 7 fixing screws using FEM (Ansys Workbench 14 software. The calculation involves a new, original application of an elastic foundation, which effectively replaces the complex interaction of the calcaneal nail and the heel bone.

Treatment of unicameral calcaneal bone cysts in children: review of literature and results using a cannulated screw for continuous decompression of the cyst.

Science.gov (United States)

Saraph, Vinay; Zwick, Ernst-Bernhard; Maizen, Claudia; Schneider, Frank; Linhart, Wolfgang E

2004-01-01

Nine unicameral bone cysts of the calcaneus in children were managed surgically using the technique of continuous decompression with titanium cannulated cancellous screws. The average age of the patients at surgery was 12.8 years. At follow-up a minimum of 2 years after surgery, eight cysts showed complete healing; one patient showed healing with residuals. Irritation at the screw insertion site necessitated early removal of the screw in one patient; implant-related problems were not observed in the other patients. Patients were allowed to bear weight after surgery. Implant extraction was performed after full consolidation of the cyst and was uneventful in all patients. A review of the literature and the different treatment modalities used for managing calcaneal cysts is also presented.

Radiodiagnosis of hemophiliac bone pseudotumors

International Nuclear Information System (INIS)

Fedorov, V.V.; Chantseva, E.A.

1992-01-01

Of 259 hemophiliacs bone pseudotumors were diagnosed in 11 (4.3 %); they were localised in the femur (6 cases), calcaneus (4) and in the iliac bone (3). Two cases of combined fermoral and calcaneal lesions and 4 cases of bone fracture were observed. As a rule, pseudotumors developed in hemophiliacs with severe disease. An x-ray picture of a pseudotumor depended on its site and was characterized by a large soft tissue tumor shadow, often with calcinosis, and serious destructive changes in bones in the form or round foci of 7 cm in diameter with clear-cut contours. An adge defect of the cortical layer was defined in the diaphysis of the femoral bone (15 cm long). Destructive changes were often accompanied by osteosclerosis and periostitis

Bone grafting in surgery about the foot and ankle: indications and techniques.

Science.gov (United States)

Fitzgibbons, Timothy C; Hawks, Michael A; McMullen, Scott T; Inda, David J

2011-02-01

Bone grafting is a common procedure in foot and ankle surgery. Historically, autogenous bone graft has most often been harvested from the ipsilateral iliac crest. However, other sites offer similar volumes of cancellous bone and are associated with fewer complications. The ipsilateral proximal tibia, distal tibia, and calcaneus provide adequate amounts of bone graft material for most arthrodesis procedures about the foot and ankle. Emerging techniques have enabled the development of a seemingly unlimited supply of alternative bone graft materials with osteoconductive properties. The osteoprogenitor cells in bone marrow aspirates can be concentrated by use of selective retention systems. These aspirate-matrix composites may be combined with allograft preparations, resulting in a product that promotes osteoconduction, osteoinduction, and osteogenesis with limited morbidity.

Uncontacted tire explosion causing trauma to bilateral lower extremities: A case report.

Science.gov (United States)

Yu, Ming-Yang; Su, Yun; Meng, Xiang-Jun; Luan, Bo-Wu; Gu, Gui-Shan; Sun, Qiang; Zhao, De-Wei

2017-06-01

It is uncommon for tire explosion related injuries on the lower extremity. The bilateral lower extremities were injured by tire explosion when the patient was seated in a bus. She sustained an open fracture with partial bone loss in the right calcaneus (a comminuted fracture in the right ankle joint) and a closed comminuted fracture in the left tibia and fibula. This damage was caused by uncontacted tire explosion, thanks to a thick floor between the exploded tire and the patient's feet. This type of injury on lower extremity caused by uncontacted tire explosion was uncommon. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

The Variations in Calcaneal Articular Facets In North Indian Population and its Clinical Implication

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Seema

2012-01-01

Full Text Available Aims and Objectives- To know the most common type of calcanei in North Indian population and itsclinical importance. There are three articular facets on superior surface of calcaneus- anterior, middle andposterior. Three types of calcanei are noted according to number and arrangement of the articular facets-type A, B and C. Methodology - The present studywas done on 300 dry adult human calcanei of unknownsex taken from Department of Anatomy Sri Guru Ram Das Institute of Medical Sciences and ResearchVallah (Amritsar. Results- In our study Type B was found as the most common type. Type A is the nextmost common. Interpretation- The talocalcaneal joint is important in arthritis and coalition, flat foot, valgus deformity, congenital anomalies and intra articular fractures.

Calcaneus length determines running economy: implications for endurance running performance in modern humans and Neandertals.

Science.gov (United States)

Raichlen, David A; Armstrong, Hunter; Lieberman, Daniel E

2011-03-01

The endurance running (ER) hypothesis suggests that distance running played an important role in the evolution of the genus Homo. Most researchers have focused on ER performance in modern humans, or on reconstructing ER performance in Homo erectus, however, few studies have examined ER capabilities in other members of the genus Homo. Here, we examine skeletal correlates of ER performance in modern humans in order to evaluate the energetics of running in Neandertals and early Homo sapiens. Recent research suggests that running economy (the energy cost of running at a given speed) is strongly related to the length of the Achilles tendon moment arm. Shorter moment arms allow for greater storage and release of elastic strain energy, reducing energy costs. Here, we show that a skeletal correlate of Achilles tendon moment arm length, the length of the calcaneal tuber, does not correlate with walking economy, but correlates significantly with running economy and explains a high proportion of the variance (80%) in cost between individuals. Neandertals had relatively longer calcaneal tubers than modern humans, which would have increased their energy costs of running. Calcaneal tuber lengths in early H. sapiens do not significantly differ from those of extant modern humans, suggesting Neandertal ER economy was reduced relative to contemporaneous anatomically modern humans. Endurance running is generally thought to be beneficial for gaining access to meat in hot environments, where hominins could have used pursuit hunting to run prey taxa into hyperthermia. We hypothesize that ER performance may have been reduced in Neandertals because they lived in cold climates. Copyright © 2011 Elsevier Ltd. All rights reserved.

Acquired cavo-varus deformity caused by an accessory calcaneus: a case report and literature review

International Nuclear Information System (INIS)

Singh Baghla, Davinder Paul; Shariff, Sajid; Bashir, Waseem A.

2010-01-01

We describe an unusual cause of an acquired cavo-varus foot deformity produced by progressive enlargement of an accessory calcaneal ossicle. A 13-year-old boy with constitutional plano-valgus flat feet noted a gradual change in foot shape associated with lateral ankle pain on ambulation following an inversion injury 2 years earlier. CT and MRI scans confirmed a large accessory calcaneal ossicle lying within the sinus tarsi, with associated marrow oedema. Following surgical excision of the ossicle, the foot returned to its original shape and the symptoms were alleviated. This is the fifth reported case of an accessory calcaneal ossicle, but the only case that has occurred in a flatfooted individual. We also present the first reported MRI images of the lesion confirming pathological marrow oedema as a response to mechanical stress. (orig.)

Effect of Calcaneus Fracture Gap Without Step-Off on Stress Distribution Across the Subtalar Joint.

Science.gov (United States)

Barrick, Brett; Joyce, Donald A; Werner, Frederick W; Iannolo, Maria

2017-03-01

Subtalar arthritis is a common consequence following calcaneal fracture, and its development is related to the severity of the fracture. Previous calcaneal fracture models have demonstrated altered contact characteristics when a step-off is created in the posterior facet articular surface. Changes in posterior facet contact characteristics have not been previously characterized for calcaneal fracture gap without step-off. The contact characteristics (peak pressure, area of contact, and centroid of pressure) of the posterior facet of the subtalar joint were determined in 6 cadaveric specimens. After creating a calcaneal fracture to simulate a Sanders type II fracture, the contact characteristics were determined with the posterior facet anatomically reduced followed by an incremental increase in fracture gap displacement of 2, 3, and 5 mm without a step-off of the articular surface. Peak pressure on the medial fragment was significantly less with a 5-mm gap compared to a 2- or 3-mm gap, or reduced. On the lateral fragment, the peak pressure was significantly increased with a 5-mm gap compared to a 2- or 3-mm gap. Contact area significantly changed with increased gap. In this study, there were no significant differences in contact characteristics between a <3-mm gap and an anatomically reduced fracture, conceding the study limitations including limiting axial loading to 50% of donor body weight. A small amount of articular incongruity without a step-off can be tolerated by the subtalar joint, in contrast to articular incongruity with a step-off present.

Real-time subject-specific monitoring of internal deformations and stresses in the soft tissues of the foot: a new approach in gait analysis.

Science.gov (United States)

Yarnitzky, G; Yizhar, Z; Gefen, A

2006-01-01

No technology is presently available to provide real-time information on internal deformations and stresses in plantar soft tissues of individuals during evaluation of the gait pattern. Because internal deformations and stresses in the plantar pad are critical factors in foot injuries such as diabetic foot ulceration, this severely limits evaluation of patients. To allow such real-time subject-specific analysis, we developed a hierarchal modeling system which integrates a two-dimensional gross structural model of the foot (high-order model) with local finite element (FE) models of the plantar tissue padding the calcaneus and medial metatarsal heads (low-order models). The high-order whole-foot model provides real-time analytical evaluations of the time-dependent plantar fascia tensile forces during the stance phase. These force evaluations are transferred, together with foot-shoe local reaction forces, also measured in real time (under the calcaneus, medial metatarsals and hallux), to the low-order FE models of the plantar pad, where they serve as boundary conditions for analyses of local deformations and stresses in the plantar pad. After careful verification of our custom-made FE solver and of our foot model system with respect to previous literature and against experimental results from a synthetic foot phantom, we conducted human studies in which plantar tissue loading was evaluated in real time during treadmill gait in healthy individuals (N = 4). We concluded that internal deformations and stresses in the plantar pad during gait cannot be predicted from merely measuring the foot-shoe force reactions. Internal loading of the plantar pad is constituted by a complex interaction between the anatomical structure and mechanical behavior of the foot skeleton and soft tissues, the body characteristics, the gait pattern and footwear. Real-time FE monitoring of internal deformations and stresses in the plantar pad is therefore required to identify elevated deformation

Bone structure assessed by HR-pQCT, TBS and DXL in adult patients with different types of osteogenesis imperfecta.

Science.gov (United States)

Kocijan, R; Muschitz, C; Haschka, J; Hans, D; Nia, A; Geroldinger, A; Ardelt, M; Wakolbinger, R; Resch, H

2015-10-01

Bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) was assessed in adult patients with mild, moderate, and severe osteogenesis imperfecta (OI). The trabecular bone score (TBS), bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and dual X-ray and laser (DXL) at the calcaneus were likewise assessed in patients with OI. Trabecular microstructure and BMD in particular were severely altered in patients with OI. OI is characterized by high fracture risk but not necessarily by low BMD. The main purpose of this study was to assess bone microarchitecture and BMD at different skeletal sites in different types of OI. HR-pQCT was performed in 30 patients with OI (mild OI-I, n = 18 (41.8 [34.7, 55.7] years) and moderate to severe OI-III-IV, n = 12 (47.6 [35.3, 58.4] years)) and 30 healthy age-matched controls. TBS, BMD by DXA at the lumbar spine and hip, as well as BMD by DXL at the calcaneus were likewise assessed in patients with OI only. At the radius, significantly lower trabecular parameters including BV/TV (p = 0.01 and p < 0.0001, respectively) and trabecular number (p < 0.0001 and p < 0.0001, respectively) as well as an increased inhomogeneity of the trabecular network (p < 0.0001 and p < 0.0001, respectively) were observed in OI-I and OI-III-IV in comparison to the control group. Similar results for trabecular parameters were found at the tibia. Microstructural parameters were worse in OI-III-IV than in OI-I. No significant differences were found in cortical thickness and cortical porosity between the three subgroups at the radius. The cortical thickness of the tibia was thinner in OI-I (p < 0.001), but not OI-III-IV, when compared to controls. Trabecular BMD and trabecular bone microstructure in particular are severely altered in patients with clinical OI-I and OI-III-IV. Low TBS and DXL and their significant associations to HR-pQCT parameters of trabecular bone support this conclusion.

IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS

Directory of Open Access Journals (Sweden)

N. S. Konovalchuk

2017-01-01

Full Text Available Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of

Dietary Silicon Intake of Korean Young Adult Males and Its Relation to their Bone Status.

Science.gov (United States)

Choi, Mi-Kyeong; Kim, Mi-Hyun

2017-03-01

Accumulated data suggests a positive effect of silicon on bone health; however, limited research exists on the silicon content of foods. To further the understanding of the relationship between dietary silicon intake and bone health, a food composition database of commonly consumed foods in Korea is required. For quantitative data on the intake levels of silicon, we analyzed the silicon content of 365 food items commonly consumed in Korea using inductively coupled plasma-atomic emission spectrometry following microwave-assisted digestion. To investigate the dietary silicon intake status and to examine the potential role of dietary silicon intake in the bone status of men, a total of 400 healthy Korean adult males aged 19-25 were observed for their diet intake and calcaneus bone density using the 24-h recall method and quantitative ultrasound, respectively. Clinical markers reflecting bone metabolism such as serum total alkaline phosphatase, N-mid osteocalcin, and type 1 collagen C-terminal telopeptide concentrations were also analyzed. Silicon intake of the subjects was estimated as 37.5 ± 22.2 mg/day. Major food sources of dietary silicon in the Korean male were cereal and cereal products (25.6 % of total silicon intake), vegetables (22.7 %), beverages and liquors (21.2 %), and milk and milk products (7.0 %). Silicon intake correlated positively with age, weight, energy intake, protein intake, calcium intake, and alcohol intake. After adjusted for age, weight, energy intake, protein intake, calcium intake, alcohol intake, smoking cigarettes, and regular exercise status, daily total silicon intake had no correlation with calcaneus bone density and the bone metabolism markers, but silicon intake from vegetables had a positive correlation with serum total alkaline phosphatase activity, a bone formation maker. These findings show the possible positive relationship between dietary silicon intake from vegetables and the bone formation of young adult males. Further

Sonographically guided deep plantar fascia injections: where does the injectate go?

Science.gov (United States)

Maida, Eugene; Presley, James C; Murthy, Naveen; Pawlina, Wojciech; Smith, Jay

2013-08-01

To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach. In each case, 1.5 mL of 50% diluted colored latex was injected deep to the plantar fascia. After a minimum of 72 hours, study coinvestigators dissected each specimen to assess injectate placement. All 10 injections accurately placed latex adjacent to the deep side of the plantar fascia at the anterior calcaneus. However, the flexor digitorum brevis (FDB) origin from the plantar fascia variably limited direct latex contact with the plantar fascia, and small amounts of latex interdigitated with the FDB origin in 90% (9 of 10). In all 10 specimens, latex also covered the traversing first branch of the lateral plantar nerve (FBLPN, ie, Baxter nerve) between the FDB and quadratus plantae muscles. No latex was found in the plantar fat pad or plantar fascia in any specimen. Sonographically guided deep plantar fascia injections reliably deliver latex deep to the plantar fascia while avoiding intrafascial injection. However, the extent of direct plantar fascia contact is variable due to the intervening FDB. On the contrary, the traversing FBLPN is reliably covered by the injection. Deep plantar fascia injections may have a role in the management of refractory plantar fasciitis, particularly following failed superficial perifascial or intrafascial injections, in cases of preferential deep plantar fascia involvement, or when entrapment

Stress fractures of ankle and wrist in childhood: nature and frequency

International Nuclear Information System (INIS)

Oestreich, Alan E.; Bhojwani, Nicholas

2010-01-01

Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain. (orig.)

L-form plastics in the treatment of post-burn trophic ulcers and cicatrices of the foot calcaneal area.

Science.gov (United States)

Shakirov, Babur M; Tagaev, Komil R; Tursunov, Bachron S; Achtamov, Dgamshed A

2009-03-01

The burn trauma of the posterior surface of calcaneus region and ankle joint followed by cicatrix formation in the Achilles tendon zone is often complicated by unhealing trophic ulcers. Eleven patients (seven men and four women, aged 9-54 years) have been operated on under our observation for prolonged unhealing ulcers and cicatrices located in the Achilles tendon zone. After cicatrices dissection, L-form plastic surgery was performed. The postoperative period was smooth; a skin graft was appropriately fixed to the proper tissues and the wound margins. Good results were achieved in 10 cases, and no complications were noted. However, in only one patient a marginal necrosis of the external talus part adjoining the ulcer due to tissue changes has been noted, but that had no influence on the good results of the operation.

Stress fractures of ankle and wrist in childhood: nature and frequency

Energy Technology Data Exchange (ETDEWEB)

Oestreich, Alan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Bhojwani, Nicholas [University of Cincinnati College of Medicine, Cincinnati, OH (United States)

2010-08-15

Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain. (orig.)

Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

Directory of Open Access Journals (Sweden)

Farhang Babamahmoodi

2015-01-01

Full Text Available Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.

On the comparison between MRI and US imaging for human heel pad thickness measurements

DEFF Research Database (Denmark)

Matteoli, Sara; Corbin, Nadège Corbin; Wilhjelm, Jens E.

2011-01-01

The human heel pad thickness, defined as the shortest distance between the calcaneus and heel skin, is one of the intrinsic factor which must be taken into account when investigating the biomechanics of the heel pad. US and MRI are the preferable imaging modalities used to measure the heel pad...... thickness as they are both ionizing-free radiations. The aim of this paper is to measure the bone to skin distance of nine heel pad phantoms from MRI and US images, and to compare the results with a true value (TV) in order to find the errors. Paired sample t-test was used to compare the measurements......1530 (P-value=0.402). Results confirm the necessity to investigate on the real speed of sound for the heel pad tissues, in order to have realistic measurements when dealing with human heel pads. __________________________________________________________________________________________________________...

Fryns anophthalmia-plus syndrome in an 18-week-old fetus.

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Jayasinghe, Caren; Gembruch, Ulrich; Kuchelmeister, Klaus; Körber, Friederike; Müller, Annette M

2012-01-01

Fryns anophthalmia-plus syndrome is a very rare condition initially described by Fryns and colleagues in 1995 in a pair of siblings of nonconsanguineous parents. Since that time, only a few cases have been reported, most of them in newborns and young children. Clinical presentation is variable and includes anophthalmia/microphthalmia, cleft lip/palate, and other facial deformities. Furthermore, skeletal, central nervous system, and endocrine anomalies have been described. We report the case of a male fetus of 18 weeks of gestation with normal karyotype and findings matching Fryns anophthalmia-plus syndrome. Pregnancy was terminated because of sonographically proven facial midline defects and a marked cerebral ventriculomegaly. Macroscopic and histological findings obtained at autopsy showed extreme bilateral microphthalmia, unilateral cleft palate, unilateral nasal deformity, and low-set ears. Skeletal anomalies included 13 pairs of ribs, premature ossification of the calcaneus, and talipes.

Stress fractures of the foot and ankle.

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Welck, M J; Hayes, T; Pastides, P; Khan, W; Rudge, B

2017-08-01

Stress fractures occur as a result of microscopic injuries sustained when bone is subjected to repeated submaximal stresses. Overtime, with repeated cycles of loading, accumulation of such injuries can lead to macro-structural failure and frank fracture. There are numerous stress fractures about the foot and ankle of which a trauma and orthopaedic surgeon should be aware. These include: metatarsal, tibia, calcaneus, navicular, fibula, talus, medial malleolus, sesamoid, cuneiform and cuboid. Awareness of these fractures is important as the diagnosis is frequently missed and appropriate treatment delayed. Late identification can be associated with protracted pain and disability, and may predispose to non-union and therefore necessitate operative intervention. This article outlines the epidemiology and risk factors, aetiology, presentation and management of the range of stress fractures in the foot and ankle. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Calcaneo-fibular ligament surgery for chronic lateral instability of the upper ankle : Broström technique with modification by Wille. Video article].

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Kosiol, J; Wille, M; Putzer, D; Biedermann, R

2015-11-01

An acute ligament rupture of the lateral ligament complex of the ankle joint is treated without surgery. Treatment failure may lead to a chronically unstable situation of the ankle joint, in which case surgery is an effective procedure for stabilizing the ruptured ligaments. Anatomical reconstruction is the best operative technique if the ligament tissue is of good quality. In our video we demonstrate a new possibility for the positioning of an anchor to tighten the calcaneo-fibular ligament. Modified Broström repairs are described in the literature in which the calcaneo-fibular ligament is released and reattached to the fibula to tighten it. We present the option to release the ligament at the calcaneus and reattach it using a suture anchor. This offers the advantage of preventing the possible dislocation of the peroneal tendons.

Os cuboideum secundarium: A rare accessory ossicle with the potential to mimic a mass on magnetic resonance imaging

International Nuclear Information System (INIS)

Kauffmann, Gregory; Stacy, G.S.

2014-01-01

Accessory ossicles are common incidental findings on radiographs of the ankle and foot. While typically asymptomatic and of no clinical significance, they are sometimes associated with local pain or even mistaken for pathological conditions such as fractures. Given the potential for misinterpretation, it is important to understand their typical locations and appearances. This case highlights an exceptionally rare accessory ossicle called the os cuboideum secundarium, located adjacent to the cuboid and calcaneus. Interestingly, this case demonstrates the potential for this rare ossicle to mimic a mass on magnetic resonance imaging (MRI). Furthermore, despite the significant improvements in the understanding of musculoskeletal pathology afforded by advancements in cross-sectional imaging techniques, this case is a reminder of certain pitfalls that remain. Lastly, it highlights the importance of radiographs as an initial diagnostic study in evaluating foot pain. (orig.)

Fracture Surgery of the extremities with the intra-operative use of 3D-RX: A randomized multicenter trial (EF3X-trial

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Marmor Meir

2011-07-01

Full Text Available Abstract Background Posttraumatic osteoarthritis can develop after an intra-articular extremity fracture, leading to pain and loss of function. According to international guidelines, anatomical reduction and fixation are the basis for an optimal functional result. In order to achieve this during fracture surgery, an optimal view on the position of the bone fragments and fixation material is a necessity. The currently used 2D-fluoroscopy does not provide sufficient insight, in particular in cases with complex anatomy or subtle injury, and even an 18-26% suboptimal fracture reduction is reported for the ankle and foot. More intra-operative information is therefore needed. Recently the 3D-RX-system was developed, which provides conventional 2D-fluoroscopic images as well as a 3D-reconstruction of bony structures. This modality provides more information, which consequently leads to extra corrections in 18-30% of the fracture operations. However, the effect of the extra corrections on the quality of the anatomical fracture reduction and fixation as well as on patient relevant outcomes has never been investigated. The objective of this study protocol is to investigate the effectiveness of the intra-operative use of the 3D-RX-system as compared to the conventional 2D-fluoroscopy in patients with traumatic intra-articular fractures of the wrist, ankle and calcaneus. The effectiveness will be assessed in two different areas: 1 the quality of fracture reduction and fixation, based on the current golden standard, Computed Tomography. 2 The patient-relevant outcomes like functional outcome range of motion and pain. In addition, the diagnostic accuracy of the 3D-RX-scan will be determined in a clinical setting and a cost-effectiveness as well as a cost-utility analysis will be performed. Methods/design In this protocol for an international multicenter randomized clinical trial, adult patients (age > 17 years with a traumatic intra-articular fracture of the

Treatment of a unicameral bone cyst of calcaneus with endoscopic curettage and percutaneous filling with corticocancellous allograft.

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Yildirim, Cengiz; Mahiroğullari, Mahir; Kuşkucu, Mesih; Akmaz, Ibrahim; Keklikci, Kenan

2010-01-01

The surgical procedures for unicameral solitary calcaneal bone cysts have ranged from simple curettage and grafting to subperiosteal resection with internal fixation and grafting. In this article, an endoscopically assisted technique is proposed for the curettage of a simple calcaneal cyst that takes advantage of direct visualization of the cyst wall and contents and permits accurate assessment of the extent of the lesion. After curettage, percutaneous filling of the defect with corticocancellous allograft makes the technique a complete, minimally invasive surgical approach for this condition. The technique uses 2 lateral portals, one for viewing and the other for manipulation, both of which are created under fluoroscopic control. Once the cyst has been located, the 30 degrees arthroscope is used to evacuate fluid, after which more solid cyst contents are fragmented and removed. Thereafter, curettage of the inner surface of the cavernous cyst wall is performed. Finally, complete packing of the previously cystic cavity with crushed corticocancellous allograft is performed under endoscopic visualization and confirmed radiographically. Copyright 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Influence of pregnancy on bone density: a risk factor for osteoporosis? Measurements of the calcaneus by ultrasonometry.

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Kraemer, Bernhard; Schneider, Silke; Rothmund, Ralf; Fehm, Tanja; Wallwiener, Diethelm; Solomayer, Erich-Franz

2012-04-01

There are conflicting opinions in the literature about whether pregnancy influences maternal bone density or osteoporosis development. The study aim was to investigate whether there is a significant alteration in maternal bone density during normal pregnancy. Bone mass of 200 pregnant women aged 22-42 years was measured twice with quantitative ultrasonometry (QUS) of the heel (Os calcaneum). The first measurement was performed between the 10th and 22nd week of pregnancy, follow-up of 149 women took place 0-9 days postpartum. A questionnaire focusing on data affecting bone metabolism and bone turnover was handed out at the first visit. Median reduction in speed of sound (SOS) was 11 m/s at follow-up indicating a decline of the stiffness during pregnancy. No significant correlation was found between lactation period and the obtained values for stiffness, SOS, T score and Z score. For broadband ultrasonographic attenuation, there was a statistically significant difference (p osteoporosis (n = 30) compared to patients without did not reveal statistical significance during pregnancy. Glucocorticoid therapy, nicotine consumption, physical exercise and nutrition was not statistically significant (p > 0.05). SOS value of women with a twin pregnancy was different over the study period (p pregnancy. Routine evaluation of the bone density in all pregnant women does not seem to be justified; however, it is reasonable in women who present with risk factors. These women could be screened with QUS.

Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

Science.gov (United States)

Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

2013-01-01

Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

Roentgenographic appearance of ossification centers in the Japanese fetus, stillborn and neonatal death infants, Hiroshima and Nagasaki

Energy Technology Data Exchange (ETDEWEB)

Kawamoto, Sadahisa

1964-01-01

A roentgenographic study of the presence of the ossification centers has been made on a total of 235 cases of miscarriage, therapeutic abortion, stillbirth and neonatal death according to criteria of sex, length of gestational age, and weight at birth. The cases were aged from 16 to 42 gestational weeks. The weight of the cases ranged from 110 g to 3780 g at birth. The order of appearance of the eight centers in fetal life was as follows: Ischium, pubis, calcaneus, talus, distal epiphysis of femur, hyoid, proximal epiphysis of tibia, and cuboid bone. Some of the eight ossification centers appeared earlier in girls than in boys of the same gestational age and birth weight. The osseous development of Japanese fetuses and infants weighing over 2000 g was judged less mature than in similar Caucasian and Negro subjects. 10 references, 1 figure, 6 tables.

Salvage Flexor Hallucis Longus Transfer for a Failed Achilles Repair: Endoscopic Technique.

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Gonçalves, Sérgio; Caetano, Rubén; Corte-Real, Nuno

2015-10-01

Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon.

Bone mineral density in patients with destructive arthrosis of the hip joint.

Science.gov (United States)

Okano, Kunihiko; Aoyagi, Kiyoshi; Enomoto, Hiroshi; Osaki, Makoto; Chiba, Ko; Yamaguchi, Kazumasa

2014-05-01

Recent reports have shown the existence of subchondral insufficiency fracture in rapidly destructive arthrosis of the hip joint (RDA), and the findings suggest that osteopenia is related to the pathogenesis of the rapid progression of this disease. Therefore, we measured bone mineral density (BMD) in RDA patients. We measured BMD of the lumbar spine, radius, and calcaneus using dual-energy X-ray absorptiometry in 19 patients with RDA and 75 with osteoarthritis of the hip (OA) and compared BMD at different skeletal sites between RDA and OA patients. No significant differences were observed in BMD of the lumbar spine, ultradistal radius, mid-radius, and calcaneous between the RDA and OA groups. Our data suggest that RDA is not accompanied by generalized osteoporosis. Factors other than generalized bone status, for example, BMD around the affected hip joint before destruction, need to be analyzed to elucidate the pathophysiological mechanism of RDA.

Evidence-based screening for low bone mineral density in HIV-infected men.

Science.gov (United States)

Albright, Patsi; Du, Ping; Haas, Richard E; Pugh, Linda C

2014-01-01

Low bone mineral density, which leads to osteoporosis and fracture risk, is an emerging clinical problem in HIV-infected patients. Our evidence-based practice project screened a convenience sample of 225 HIV-infected men for low bone mineral density using the Osteoporosis Self-Assessment Tool, and of those men, 173 were also screened by quantitative ultrasound of the calcaneus. One hundred twelve men had low bone mineral density by either or both screening methods. Seventy-one of these 112 men were tested by dual-energy x-ray absorptiometry and 73% had low bone mineral density. The positive protective value of the Osteoporosis Self-Assessment Tool was 73% and for quantitative ultrasound was 88%. These results suggest that routine low bone mineral density screening should be included as standard practice for all HIV-infected patients. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Partial calcanectomy: A procedure to cherish or to reject?

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Van Riet, A; Harake, R; Stuyck, J

2012-03-01

Large ulcers on the heel often lead to major amputations. When a conservative treatment fails, a partial or subtotal calcanectomy is a possible treatment option. 24 Patients were evaluated regarding limb salvage and infection eradication. Fourteen of these completed a questionnaire regarding functional outcome and satisfaction. Only 1 of 24 patients needed a below-knee amputation. Three patients did not heal and still have minor drainage of the wounds. However, hospital stay was long and in many cases additional surgery was necessary. Recurrences are seen, especially in patients with impaired sensation of the foot. In the fourteen patients who completed the questionnaire, pain was not a major problem. Many patients use orthotics and external support. The majority, however, is satisfied with the procedure and would consider the same treatment again. Calcanectomy still has a place in the treatment of osteitis of the calcaneus. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Foot bones from Omo: implications for hominid evolution.

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Gebo, Daniel L; Schwartz, Gary T

2006-04-01

We reanalyze a hominid talus and calcaneus from Omo dating to 2.2 mya and 2.36 mya, respectively. Although both specimens occur at different localities and times, both tarsals articulate well together, suggesting a single taxon on the basis of size and function. We attribute these foot bones to early Homo on the basis of their morphology. The more modern-like tarsal morphology of these Omo foot bones makes them very similar to a talus from Koobi Fora (KNM-ER 813), a specimen attributed to Homo rudolfensis or Homo erectus. Although the Omo tarsals are a million years younger than the oldest known foot bones from Hadar, both localities demonstrate anatomical differences representing two distinct morphological patterns. Although all known hominid tarsals demonstrate clear bipedal features, the tarsal features noted below suggest that biomechanical changes did occur over time, and that certain features are associated with different hominid lineages (especially the robust australopithecines). Copyright 2006 Wiley-Liss, Inc.

Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity.

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Saunders, Stuart M; Ellis, Scott J; Demetracopoulos, Constantine A; Marinescu, Anca; Burkett, Jayme; Deland, Jonathan T

2018-01-01

The forefoot abduction component of the flexible adult-acquired flatfoot can be addressed with lengthening of the anterior process of the calcaneus. We hypothesized that the step-cut lengthening calcaneal osteotomy (SLCO) would decrease the incidence of nonunion, lead to improvement in clinical outcome scores, and have a faster time to healing compared with the traditional Evans osteotomy. We retrospectively reviewed 111 patients (143 total feet: 65 Evans, 78 SLCO) undergoing stage IIB reconstruction followed clinically for at least 2 years. Preoperative and postoperative radiographs were analyzed for the amount of deformity correction. Computed tomography (CT) was used to analyze osteotomy healing. The Foot and Ankle Outcome Scores (FAOS) and lateral pain surveys were used to assess clinical outcomes. Mann-Whitney U tests were used to assess nonnormally distributed data while χ 2 and Fisher exact tests were used to analyze categorical variables (α = 0.05 significant). The Evans group used a larger graft size ( P lengthening. Level III, retrospective cohort study.

A new method for assessment of skeletal maturity in the first 2 years of life

International Nuclear Information System (INIS)

Hernandez, M.; Sanchez, E.; Sobradillo, B.; Rincon, J.M.; Narvaiza, J.L.

1988-01-01

We present an original scoring method for assessing skeletal maturity in the first 2 years of life. We propose a lateral radiograph of the ankle and foot. Five different bony centers were examined: The calcaneus, the cuboid, the third cuneiform, the distal tibial epiphysis and the distal fibular epiphysis. The maturity scores given to the different stages of each bony center were calculated in proportion to the coefficients of regression between the skeletal maturity and a factor that expresses the influence of weight and head circumference as high multiple correlation coefficients of skeletal maturity with the factor obtained (0.920 for boys ad 0.929 for girls). Our method was standardized in a children population of less than two years of life in Biscaye, where 1,164 radiographs were taken. The distribution of scores in this study shows the discriminative ability of our method and its validity as an adequate method for skeletal maturity assessment in children less than 2 years of age. (orig.)

Characteristic findings of computed tomography in cerebral metastatic malignant melanomas

International Nuclear Information System (INIS)

Kukita, Chikashige; Nose, Tadao; Nakagawa, Kunio; Tomono, Yuji; Enomoto, Takao; Hashikawa, Masanori; Egashira, Taihei; Maki, Yutaka

1986-01-01

Four cases with metastatic cerebral melanoma were studied by means of computed tomography (CT). Two cases were male, and the other two were female, with an average age of 55 years. Their primary lesions were on the chest wall in two cases, around the calcaneus in one, and around the genitalia in one. All cases died within 6 months after the metastatic brain lesions were found. Necropsies were carried out in two cases. CT revealed high-density areas in all cases, and contrast studies showed an enhancement of the lesions, as has previously been reported. On the other hand, autopsied cases revealed neither fresh nor old intratumoral bleedings such as a scattered focus of hemosiderin. These findings suggest that the high-density tumoral shadows in CT are probably not intratumoral bleedings due to a bleeding tendency of the tumors, as some authors have previously supposed. We mentioned some other factors contributing to the high density of the melanoma on computed tomograms. (author)

Association between bone mineral density and low backache in postmenopausal women

International Nuclear Information System (INIS)

Qayum, M.; Ali, W.

2017-01-01

Objective: To determine association between bone mineral density (BMD) and low backache in post menopausal women in general population of Lahore. Study Design: Descriptive study. Place and Duration of Study: Gynaecological outpatint department of Punjab Rangers Hospital Lahore during the period, from Feb 2015 to Feb 2016. Material and Methods: Screening for association between BMD and low backache in 481 post menopausal women was carried out. Low back pain was considered clinically relevant if the patient complained of moderate to severe pain, or if the patient needed any medical treatment. Their BMD was measured. The measurement site for BMD was the calcaneus of patient. The diagnosis was based on T score. Data was analyzed. Result: Osteoporosis was found in 303 (88.3%) of 50-60 years age group and 40 (11.7%) of 61-plus years age group. Conclusion: Bone mineral density was significantly lower in postmenopausal women and there was a strong association between low back ache and decreased BMD value. (author)

Can bone marrow edema be seen on STIR images of the ankle and foot after 1 week of running?

International Nuclear Information System (INIS)

Trappeniers, L.; Maeseneer, M. de; Ridder, F. de; Machiels, F.; Shahabpour, M.; Tebache, C.; Verhellen, R.; Osteaux, M.

2003-01-01

Purpose: To evaluate whether initiation of running in sedentary individuals would lead to bone marrow edema on MR images, within the time span of 1 week. Materials and methods: The feet of 10 healthy volunteers were imaged by MR imaging before and after running during 30 min a day for 1 week. The images were evaluated by consensus of 2 musculoskeletal radiologists who graded the presence of bone marrow edema on a 4-point scale. Edema scores and number of bones involved before and after running were compared statistically. Results: Edema was present on the baseline images in 3 subjects. After running edema showed an increase or was present in 5 subjects. The changes after running were statistically significant. Bones involved were the talus, calcaneus, navicular bone, cuboid bone, and 5th metatarsal. Conclusion: Edema patterns can be seen in the feet of asymptomatic individuals. During initiation of running an increase of edema or development of new edema areas can be seen

Talar Neck Fracture after United Tibiotalar Fusion

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W. Platt

2015-01-01

Full Text Available Tibiotalar arthrodesis is a well-established treatment for tibiotalar arthritis, for example, in younger high demand patients. Talar neck fractures are less common though well-recognised sequelae of foot ankle trauma. Here we present the clinical case of a 69-year-old male who presented to our institution with a nonunion of a talar neck fracture, having undergone a left tibiotalar fusion 24 years previously. To the authors’ knowledge, this injury has only been described once previously in the literature. However, the original case described a fracture sustained in the very early postoperative period following tibiotalar fusion, postulated to be secondary to postimmobilisation osteopaenia or stress risers from metalwork. The aetiology in this case is likely due to axial compression transmitted to the talar neck via the calcaneus. The predisposing factors for nonunion are discussed, highlighting the importance of vigilance for this injury in any patient with concomitant tibiotalar fusion and foot trauma. The management of this patient is discussed.

Variant Branching Pattern of Dorsalis Pedis Artery Accompanied with Anomalous Presence of Extensor Hallucis Brevis Muscle

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Ashwini Aithal Padur

2017-10-01

Full Text Available During routine dissection, we came across multiple variations in the dorsum of the right foot. Dorsalis pedis artery (DPA presented with an unusual branching pattern. The arcuate artery was completely absent, and hence three tarsal branches arose from lateral side of DPA. The first branch continued as first dorsal metatarsal artery, the second branch continued as the second dorsal metatarsal artery, and the third branch continued as third dorsal metatarsal artery which also provided a small twig to the fourth intermetatarsal space as the fourth dorsal metatarsal artery. We also observed the unique presence of extensor hallucis brevis muscle with the origin from the medial part of superior surface of the calcaneus and inserted to proximal phalanx of great toe. Since the DPA was just beneath this muscle, anomalous presence of the muscle may lead to compression of DPA. Awareness regarding such variations is critical for angiographers, vascular surgeons, reconstructive and plastic surgeons.

Vitamin D and Calcium Intakes, Physical Activity, and Calcaneus BMC among School-Going 13-Year Old Malaysian Adolescents.

Science.gov (United States)

Suriawati, A A; Majid, Hazreen Abdul; Al-Sadat, Nabilla; Mohamed, Mohd Nahar Azmi; Jalaludin, Muhammad Yazid

2016-10-24

Dietary calcium and vitamin D are essential for bone development. Apart from diet, physical activity may potentially improve and sustain bone health. To investigate the relationship between the dietary intake of calcium and vitamin D, physical activity, and bone mineral content (BMC) in 13-year-old Malaysian adolescents. Cross-sectional. Selected public secondary schools from the central and northern regions of Peninsular Malaysia. The subjects were from the Malaysian Health and Adolescents Longitudinal Research Team Cohort study (MyHeARTs). The data included seven-day diet histories, anthropometric measurements, and the BMC of calcaneal bone using a portable broadband ultrasound bone densitometer. Nutritionist Pro software was used to calculate the dietary calcium and vitamin D intakes from the diet histories, based on the Nutrient Composition of Malaysian Food Database guidance for the dietary calcium intake and the Singapore Energy and Nutrient Composition of Food Database for vitamin D intake. A total of 289 adolescents (65.7% females) were recruited. The average dietary intakes of calcium and vitamin D were 377 ± 12 mg/day and 2.51 ± 0.12 µg/day, respectively, with the majority of subjects failing to meet the Recommended Nutrient Intake (RNI) of Malaysia for dietary calcium and vitamin D. All the subjects had a normal Z-score for the BMC (-2.00 or higher) with a mean of 0.55 ± 0.01. From the statistical analysis of the factors contributing to BMC, it was found that for those subjects with a higher intake of vitamin D, a higher combination of the intake of vitamin D and calcium resulted in significantly higher BMC quartiles. The regression analysis showed that the BMC might have been influenced by the vitamin D intake. A combination of the intake of vitamin D and calcium is positively associated with the BMC.

Vitamin D and Calcium Intakes, Physical Activity, and Calcaneus BMC among School-Going 13-Year Old Malaysian Adolescents

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A. A. Suriawati

2016-10-01

Full Text Available Background: Dietary calcium and vitamin D are essential for bone development. Apart from diet, physical activity may potentially improve and sustain bone health. Objective: To investigate the relationship between the dietary intake of calcium and vitamin D, physical activity, and bone mineral content (BMC in 13-year-old Malaysian adolescents. Design: Cross-sectional. Setting: Selected public secondary schools from the central and northern regions of Peninsular Malaysia. Participants: The subjects were from the Malaysian Health and Adolescents Longitudinal Research Team Cohort study (MyHeARTs. Methods: The data included seven-day diet histories, anthropometric measurements, and the BMC of calcaneal bone using a portable broadband ultrasound bone densitometer. Nutritionist Pro software was used to calculate the dietary calcium and vitamin D intakes from the diet histories, based on the Nutrient Composition of Malaysian Food Database guidance for the dietary calcium intake and the Singapore Energy and Nutrient Composition of Food Database for vitamin D intake. Results: A total of 289 adolescents (65.7% females were recruited. The average dietary intakes of calcium and vitamin D were 377 ± 12 mg/day and 2.51 ± 0.12 µg/day, respectively, with the majority of subjects failing to meet the Recommended Nutrient Intake (RNI of Malaysia for dietary calcium and vitamin D. All the subjects had a normal Z-score for the BMC (−2.00 or higher with a mean of 0.55 ± 0.01. From the statistical analysis of the factors contributing to BMC, it was found that for those subjects with a higher intake of vitamin D, a higher combination of the intake of vitamin D and calcium resulted in significantly higher BMC quartiles. The regression analysis showed that the BMC might have been influenced by the vitamin D intake. Conclusions: A combination of the intake of vitamin D and calcium is positively associated with the BMC.

Vitamin D and Calcium Intakes, Physical Activity, and Calcaneus BMC among School-Going 13-Year Old Malaysian Adolescents

OpenAIRE

Suriawati, A. A.; Abdul Majid, Hazreen; Al-Sadat, Nabilla; Mohamed, Mohd Nahar Azmi; Jalaludin, Muhammad Yazid

2016-01-01

Background: Dietary calcium and vitamin D are essential for bone development. Apart from diet, physical activity may potentially improve and sustain bone health. Objective: To investigate the relationship between the dietary intake of calcium and vitamin D, physical activity, and bone mineral content (BMC) in 13-year-old Malaysian adolescents. Design: Cross-sectional. Setting: Selected public secondary schools from the central and northern regions of Peninsular Malaysia. Participants: The sub...

Quantitative Evaluation of Trabecular Bone Structure by Calcaneus MR Images Texture Analysis of Healthy Volunteers and Osteoporotic Subjects

National Research Council Canada - National Science Library

Herlidou, S

2001-01-01

...), Texture analysis is not used very, frequently since the interpretation of the large number of calculated parameters is difficult, We here apply multiparametric data analyses such as Correspondence Factorial Analysis (CFA...

[Stump forming after traumatic foot amputation of a child--description of a new surgical procedure and literature review of lawnmower accidents].

Science.gov (United States)

Bayer, J; Zajonc, H; Strohm, P C; Vohrer, M; Maier-Lenz, D; Südkamp, N P; Schwering, L

2009-01-01

Amputation injuries in children occur in motor vehicle, farming and, importantly, lawn mower accidents. Treatment of lawn mower related injuries is complicated by gross wound contamination, avascular tissue, soft tissue defects and exposed bone. Many treatment options exist and often an adequate prosthetic supply is needed for rehabilitation. We report on an 8-year old boy who got under a ride-on lawn mower and sustained a subtotal amputation of his right foot. After initial surgery an amputation was subsequently necessary. For this, it had to be taken into account that the traumatic loss of the talus, calcaneus and parts of the cuboid bone would result in a length shortening of the right leg and so far not injured metatarsal and tarsal bones had to be sacrificed. Thus, we aimed to develop a new operation technique to optimize stump length as well as preserve tarsal bones and the possibility of limb growth. In order to achieve this, we performed a new stump forming operation in which we integrated uninjured tarsal and metatarsal bones. First a Lisfranc's amputation was performed and a metatarsal bone was kept aside. The talus, calcaneus as well as the cuboid bone were either completely or almost completely destroyed and were removed. The remaining cuneiform bones were transfixed by a notched metatarsal bone, thus achieving a tarsal arthrodesis, and the cartilages of the proximal joint surfaces were removed. The cartilage of the cranial and caudal navicular as well as the distal tibial joint surface was also removed and an arthrodesis between the distal tibia and the navicular bone was achieved by crossed Kirschner wires. Finally the cuneiform bones were placed inferior to the navicular bone. Further stump coverage was managed by skin and muscle flaps as well as split skin graft. Our patient was discharged on day 34. A fluent gait without crutches as well as sports activities were possible again as early as 6 1/2 months after the injury. Using our stump forming

Correlação entre a ultrassonometria óssea do calcâneo e a densitometria em mulheres pós-menopausadas com fraturas por fragilidade óssea Correlation between calcaneal bone ultrasound measurements and densitometry among postmenopausal women with fractures caused by bone fragility

Directory of Open Access Journals (Sweden)

Frederico Barra Moraes

2011-04-01

Full Text Available OBJETIVO: Avaliar a correlação entre a ultrassonometria (US do calcâneo e a densitometria (DEXA em mulheres pós-menopausadas que já apresentavam uma fratura por fragilidade. MÉTODOS: Realizada coorte retrospectiva em 35 mulheres com fraturas osteoporóticas (punho ou coluna, deambulando, acima dos 40 anos, pós-menopausadas, sem tratamento prévio para osteoporose. Dessas, 16 com menos de 60 anos e 19 acima. Foram comparadas a Broadband Ultrasound Attenuation (BUA e a Speed of Sound (SOS com os sítios de DEXA (L1-L4, fêmur total, colo de fêmur e punhos, sendo utilizados dois valores de BUA diferentes como ponto de corte para osteoporose: BUA OBJECTIVE: To assess the correlation between ultrasound (US measurement on the calcaneus and bone densitometry (DEXA, among postmenopausal women who already presented fragility fractures. METHODS: 35 postmenopausal women over 40 years of age, with the ability to walk and presenting osteoporotic fractures of the wrist or spine, without previous treatment for osteoporosis, were analyzed in a retrospective cohort. Of these, 16 were under 60 and 19 were over 60. The broadband ultrasound attenuation (BUA and speed of sound (SOS were compared using DEXA (L1-L4, total femur, femoral neck and wrist. Two different values of BUA were used as cutoff points for osteoporosis: BUA < 60 dB/MHz and BUA < 64 dB/MHz (P < 0.05; and SOS < 1600 m/s. The confidence interval was 95%. The DEXA and US data were plotted on dispersion graphs and, through linear regression, it was possible to establish correlations. Following this, the sample was stratified according to age (up to 60 years and 60 years and over. Thus, the values were again compared and correlated. RESULTS: The best correlation obtained between DEXA and US was between the T-score of the wrist and BUA < 64 dB/ MHz, with 92% sensitivity and 95% specificity. Better sensitivity at all DEXA sites was obtained when US was performed on patients over 60 years of age

Early decrements in bone density after completion of neoadjuvant chemotherapy in pediatric bone sarcoma patients

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Hardes Jendrik

2010-12-01

Full Text Available Abstract Background Bone mineral density (BMD accrual during childhood and adolescence is important for attaining peak bone mass. BMD decrements have been reported in survivors of childhood bone sarcomas. However, little is known about the onset and development of bone loss during cancer treatment. The objective of this cross-sectional study was to evaluate BMD in newly diagnosed Ewing's and osteosarcoma patients by means of dual-energy x-ray absorptiometry (DXA after completion of neoadjuvant chemotherapy. Methods DXA measurements of the lumbar spine (L2-4, both femora and calcanei were performed perioperatively in 46 children and adolescents (mean age: 14.3 years, range: 8.6-21.5 years. Mean Z-scores, areal BMD (g/cm2, calculated volumetric BMD (g/cm3 and bone mineral content (BMC, g were determined. Results Lumbar spine mean Z-score was -0.14 (95% CI: -0.46 to 0.18, areal BMD was 1.016 g/cm2 (95% CI: 0.950 to 1.082 and volumetric BMD was 0.330 g/cm3 (95% CI: 0.314 to 0.347 which is comparable to healthy peers. For patients with a lower extremity tumor (n = 36, the difference between the affected and non-affected femoral neck was 12.1% (95% CI: -16.3 to -7.9 in areal BMD. The reduction of BMD was more pronounced in the calcaneus with a difference between the affected and contralateral side of 21.7% (95% CI: -29.3 to -14.0 for areal BMD. Furthermore, significant correlations for femoral and calcaneal DXA measurements were found with Spearman-rho coefficients ranging from ρ = 0.55 to ρ = 0.80. Conclusions The tumor disease located in the lower extremity in combination with offloading recommendations induced diminished BMD values, indicating local osteopenia conditions. However, the results revealed no significant decrements of lumbar spine BMD in pediatric sarcoma patients after completion of neoadjuvant chemotherapy. Nevertheless, it has to be taken into account that bone tumor patients may experience BMD decrements or secondary osteoporosis

The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

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Gulseren Kayalar

2009-01-01

Full Text Available OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA. MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO, dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT, covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05. A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001, body mass index (BMI (r=0.223, p=0.001, number of live births (r=-0.229, p=0.001, breast feeding time (r=-0.064, p=0.001, and age at menarche (r=-0.050, p=0.008. The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001 and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001 at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001 and calcaneal

Radiographic Evaluation of Ankle Joint Stability After Calcaneofibular Ligament Elevation During Open Reduction and Internal Fixation of Calcaneus Fracture.

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Wang, Chien-Shun; Tzeng, Yun-Hsuan; Lin, Chun-Cheng; Huang, Ching-Kuei; Chang, Ming-Chau; Chiang, Chao-Ching

2016-09-01

The aim of this prospective study was to evaluate the influence of sectioning the calcaneofibular ligament (CFL) during an extensile lateral approach during open reduction and internal fixation (ORIF) of calcaneal fractures on ankle joint stability. Forty-two patients with calcaneal fractures that received ORIF were included. Talar tilt stress and anterior drawer radiographs were performed on the operative and contralateral ankles 6 months postoperatively. The average degree of talar tilt on stress radiographs was 3.4 degrees (range, 0-12 degrees) on the operative side and 3.2 degrees (range, 0-14 degrees) on the contralateral side. The mean anterior drawer on stress radiographs of the CFL incised ankle was 6.1 mm (range, 2.4-11.8 mm) and on the contralateral ankle was 5.7 mm (range, 2.6-8.6 mm). There was no statistically significant difference of talar tilt and anterior drawer between the CFL incised side and the contralateral side (P = .658 and .302, respectively). The results suggest that sectioning of the CFL without any repair during ORIF of a calcaneal fracture does not have a negative effect on stability of the ankle. Repair of the CFL is, thus, probably not necessary following extended lateral approach for ORIF of calcaneal fractures. Level II, comparative study. © The Author(s) 2016.

Axial compressive strength of human vertebrae trabecular bones classified as normal, osteopenic and osteoporotic by quantitative ultrasonometry of calcaneus

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Reinaldo Cesar

2017-06-01

Full Text Available Abstract Introduction Biomechanical assessment of trabecular bone microarchitecture contributes to the evaluation of fractures risk associated with osteoporosis and plays a crucial role in planning preventive strategies. One of the most widely clinical technics used for osteoporosis diagnosis by health professionals is bone dual-energy X-ray absorptiometry (DEXA. However, doubts about its accuracy motivate the introduction of congruent technical analysis such as calcaneal ultrasonometry (Quantitative Ultrasonometry - QUS. Methods Correlations between Bone Quality Index (BQI, determined by calcaneal ultrasonometry of thirty (30 individuals classified as normal, osteopenic and osteoporotic, and elastic modulus (E and ultimate compressive strength (UCS from axial compression tests of ninety (90 proof bodies from human vertebrae trabecular bone, which were extracted from cadavers in the twelfth thoracic region (T12, first and fourth lumbar (L1 and L4. Results Analysis of variance (ANOVA showed significant differences for E (p = 0.001, for UCS (p = 0.0001 and BQI. Spearman’s rank correlation coefficient (rho between BQI and E (r = 0.499 and BQI and UCS (r = 0.508 were moderate. Discussion Calcaneal ultrasonometry technique allowed a moderate estimate of bone mechanical strength and fracture risk associated with osteoporosis in human vertebrae.

The peroneus quartus muscle: clinical correlation with evolutionary importance.

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Athavale, Sunita Arvind; Gupta, Vanita; Kotgirwar, Sheetal; Singh, Vikrant

2012-06-01

The peroneus quartus (PQ) is an accessory muscle of the peroneal/lateral compartment of the leg. The muscle has often been implicated as a cause of pain in the lateral ankle region, and subluxation or attrition of the peroneal tendons. The present study was aimed at observing the prevalence and morphology of this muscle in human cadavers. Ninety-two embalmed lower limbs were dissected for this study. The PQ muscle was found in 21% of the limbs. In all these limbs it originated from the lower part of the lateral surface of the fibula, the undersurface of peroneus brevis and the posterior intermuscular septum. In the majority of limbs, insertion was on the retrotrochlear eminence of the calcaneus. Taking into account the possibility of this muscle being a cause of lateral ankle pathology, the present study attempts to correlate the findings with the anatomy of the surrounding region. The frequent occurrence of this muscle in humans is suggestive of a progressive evolutionary change to evert the foot in order to assume a bipedal gait.

Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures.

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Zhou, Hai-Chao; Yu, Tao; Ren, Hao-Yang; Li, Bing; Chen, Kai; Zhao, You-Guang; Yang, Yun-Feng

2017-02-01

To study and compare the clinical outcomes of open reduction and internal fixation via extensile L-shape incision and limited open reduction via the sinus tarsi approach using the medial distraction technique for intra-articular calcaneal fractures. We performed a retrospective review of 65 intra-articular calcaneal fractures treated operatively between March 2012 and February 2015. Patients were divided into two groups: 28 were in the sinus tarsi approach group and 37 were in the extensile lateral approach group. All patients were asked to return for a research visit that included radiography and clinical evaluation. The postoperative function was evaluated using the ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and the visual analogue scale (VAS). No significant difference was found in demographics between the two groups. The corrected value of the calcaneal varus angle between the two groups is statistically significant (P articular calcaneal fractures could reduce the incidence of wound complications effectively, and the medial distraction technique is helpful for correcting the calcaneus varus deformity. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Gait comparison of subjects with hemiplegia walking unbraced, with ankle-foot orthosis, and with Air-Stirrup brace.

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Burdett, R G; Borello-France, D; Blatchly, C; Potter, C

1988-08-01

The effects of the Air-Stirrup (AS) standard ankle brace on the gait of 19 subjects with hemiplegia resulting from a cerebrovascular accident who exhibited excessive subtalar joint motion were studied. Videotaped trials and footprint analyses were used to measure subjects' hip, knee, and ankle sagittal plane angles; inversion and eversion of the calcaneus; and time-distance gait characteristics. A one-way analysis of variance for repeated measures was used to compare the gait of 19 subjects with the AS brace and unbraced and 11 subjects with the AS brace, unbraced, and with an ankle-foot orthosis. The AS brace was associated with more calcaneal stability during standing than the unbraced condition. The ankle-foot orthosis was associated with less plantar flexion at foot-strike than either the AS brace or unbraced condition. Both the AS brace and the ankle-foot orthosis were associated with less mid-swing plantar flexion and increased step length on the paretic side compared with no brace. These results support the effectiveness of the AS brace in controlling inversion and eversion instability in patients with hemiplegia.

A radiographic comparative study of two series of skeletally mature clubfeet treated by two different protocols

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Ippolito, E.; Caterini, R.; Farsetti, P. [Department of Orthopaedic Surgery, University of Rome ' ' Tor Vergata' ' , Via della Ricerca Scientifica 135, 00173, Rome (Italy); Fraracci, L.; Di Mario, M. [Department of Radiology, IRCCS Santa Lucia Institute, Via Ardeatina 306, 00179, Rome (Italy)

2003-08-01

To compare the radiographic features of two series of congenital clubfeet to determine whether a different treatment protocol may influence the radiographic results at the end of skeletal growth. Two series of patients with congenital clubfeet, treated by two different manipulative techniques and by two different complementary soft tissue release operations, were radiographically studied at skeletal maturity. Twenty-one normal feet of the unilateral cases in both series served as controls. Anteroposterior and lateral radiographs of the feet were taken with the patient standing, and several radiographic parameters were studied. The size of the talus and calcaneus and the height of the talar trochlea were smaller than normal in all cases of clubfeet, were similar in both series and were not influenced by treatment, whereas all the other radiographic parameters studied were more or less different between the two series and seemed to be influenced by treatment. In no treated clubfoot of either series was a normal radiographic foot anatomy restored, not even in those feet that had an excellent clinical result. (orig.)

A radiographic comparative study of two series of skeletally mature clubfeet treated by two different protocols

International Nuclear Information System (INIS)

Ippolito, E.; Caterini, R.; Farsetti, P.; Fraracci, L.; Di Mario, M.

2003-01-01

To compare the radiographic features of two series of congenital clubfeet to determine whether a different treatment protocol may influence the radiographic results at the end of skeletal growth. Two series of patients with congenital clubfeet, treated by two different manipulative techniques and by two different complementary soft tissue release operations, were radiographically studied at skeletal maturity. Twenty-one normal feet of the unilateral cases in both series served as controls. Anteroposterior and lateral radiographs of the feet were taken with the patient standing, and several radiographic parameters were studied. The size of the talus and calcaneus and the height of the talar trochlea were smaller than normal in all cases of clubfeet, were similar in both series and were not influenced by treatment, whereas all the other radiographic parameters studied were more or less different between the two series and seemed to be influenced by treatment. In no treated clubfoot of either series was a normal radiographic foot anatomy restored, not even in those feet that had an excellent clinical result. (orig.)

Peritendinous calcinosis of calcaneus tendon associated with dermatomyositis: correlation between conventional radiograph, ultrasound, magnetic resonance imaging and gross surgical pathology

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Rosa, Ana Claudia Ferreira; Gomide, Lidyane Marques de Paula; Lemes, Marcella Stival

2006-01-01

Interstitial calcinosis is an uncommon condition in which there is either localized or widely disseminated deposition of calcium in the skin, subcutaneous tissues, muscles, and tendons. Calcinosis is often associated with collagen diseases, scleroderma and dermatomyositis. The authors report a case of interstitial calcinosis associated with dermatomyositis studied with conventional radiograph, ultrasound and magnetic resonance imaging, and correlate the imaging findings with the results of surgical pathology gross examination. (author)

Bilateral talipes equinovarus from Tikal, Guatemala.

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Wright, Lori E

2011-03-01

An incomplete skeleton recovered from a multiple, secondary burial at Tikal, Guatemala, shows malformed foot bones consistent with a diagnosis of bilateral idiopathic talipes equinovarus. Bones attributable to the skeleton include paired bowed fibulae, fragmentary calcanei, complete tali, naviculars, cuneiforms, metatarsals, and some phalanges. The tali are reduced in size, flattened, and hyperextended, with the tibia partially articulated on the calcaneus, posterior to the talus. The cuboid and cuneiforms show marked contraction of the inferior surfaces, and angulation. The metatarsals and phalanges present minor changes to the articulations, and slender shafts. Articulated, both feet show marked equinovarus deformity, with weight carried on the lateral margin and superior surface of the feet. Key conditions considered in the differential diagnosis are those producing an equinovarus or a calcaneocavovarus deformation, especially progressive neuromuscular disorders. This paper describes the nature of the bony changes, reconstructs the morphology of the feet, and offers a differential diagnosis. Scholars of the ancient Maya have identified artwork that appears to depict talipes equinovarus, although there was no osteological evidence for the condition among the Maya prior to the diagnosis of this case. Copyright © 2011 Elsevier Inc. All rights reserved.

Morphology of sustentaculum tali: Biomechanical importance and correlation with angular dimensions of the talus.

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Mahato, Niladri Kumar

2011-12-01

The talus and the calcaneus share the bulk of load transmitted from the leg to the skeleton of the foot. The present study analyses the inter-relationship between the superior articular surface and the angular dimensions of the talus with the morphology of the sustentaculum tali. Identification of possible relationships between different angular parameters of the talus morphology and the sustentaculum tali in context of load transmission through the foot. One articular surface and three angular parameters at the junction of the head and the body were measured from dried human talar bones. Corresponding calcaneal samples were measured for four dimensions at the sustentaculum tali. Correlation and regression statistical values between parameters were worked out and analysed. Several parameters within the talus demonstrated significant correlations amongst themselves. The neck vertical angle showed a strong correlation with the articulating surface area below the head of the talus. The inter-relationship between articular and angular parameters within the talus demonstrates strong correlation for certain parameters. Data presented in the study may be helpful to adjust calcaneal and talar screw placement techniques, prosthesis designing and bio-mechanical studies at this important region. Copyright © 2011 Elsevier Ltd. All rights reserved.

Osteoporosis of lumbar spine, hip joints and calcaneous: a clinical-radiological study

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Knoplich, J.; Braun, W.; Roque, J.A.O.; Strapetti, F.; Iachida, O.; Staub, H.

1987-01-01

In order to accurately ascertain the presence of osteoporosis, the AA examined 92 women over 65 by means of radiographies of lumbar spine, hip joints and calcaneus. They concluded that even with examinations by four investigators the certainty ratio is 29.8% of the X-ray examinations reviewed, which is still very low. The ratio psoas-3rd lumbar vertebra width is an indicator which is difficult to apply in women over 65 owing to the prevalence of lumbar scoliosis in this age group. Pain is a complaint commonly found in this age group. 82 patients (89.2%) complained of some kind of pain (abdominal, articular bones and spine) but the complaint of pain in general was more frequent in the osteoporotic group. The women in the osteoporotic group were leaner than non-osteoporotic ones, as measured by the ratio height (which may be shortened) to weight (p < 0.05), and also older (p < 0.05) patients. The gamma globulin was elevated in 55.5% of the patients in this sample and the relative tests aided in detecting three cases of more serious pathologies. (author)

Grizzly bears (Ursus arctos horribilis) and black bears (Ursus americanus) prevent trabecular bone loss during disuse (hibernation).

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McGee-Lawrence, Meghan E; Wojda, Samantha J; Barlow, Lindsay N; Drummer, Thomas D; Castillo, Alesha B; Kennedy, Oran; Condon, Keith W; Auger, Janene; Black, Hal L; Nelson, O Lynne; Robbins, Charles T; Donahue, Seth W

2009-12-01

Disuse typically causes an imbalance in bone formation and bone resorption, leading to losses of cortical and trabecular bone. In contrast, bears maintain balanced intracortical remodeling and prevent cortical bone loss during disuse (hibernation). Trabecular bone, however, is more detrimentally affected than cortical bone in other animal models of disuse. Here we investigated the effects of hibernation on bone remodeling, architectural properties, and mineral density of grizzly bear (Ursus arctos horribilis) and black bear (Ursus americanus) trabecular bone in several skeletal locations. There were no differences in bone volume fraction or tissue mineral density between hibernating and active bears or between pre- and post-hibernation bears in the ilium, distal femur, or calcaneus. Though indices of cellular activity level (mineral apposition rate, osteoid thickness) decreased, trabecular bone resorption and formation indices remained balanced in hibernating grizzly bears. These data suggest that bears prevent bone loss during disuse by maintaining a balance between bone formation and bone resorption, which consequently preserves bone structure and strength. Further investigation of bone metabolism in hibernating bears may lead to the translation of mechanisms preventing disuse-induced bone loss in bears into novel treatments for osteoporosis.

MECHANISMS FOR TRICEPS SURAE INJURY IN HIGH PERFORMANCE FRONT ROW RUGBY UNION PLAYERS: A KINEMATIC ANALYSIS OF SCRUMMAGING DRILLS

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Carol A. Flavell

2013-03-01

Full Text Available The front row of a rugby union scrum consists of three players. The loose head prop, hooker and tight head prop. The objective of this study was to determine if known biomechanical risk factors for triceps surae muscle injury are exhibited in the lower limb of front row players during contested scrummaging. Eleven high performance front row rugby union players were landmarked bilaterally at the posterior superior iliac spine (PSIS, greater trochanter, lateral femoral epicondyle, midline of the calcaneus above the plantar aspect of the heel, midline lower leg 5cm and 20cm proximal to the lateral malleolus, at the axis of subtalar joint, lateral malleolus, and head of the fifth metatarsal. Players were video recorded during a series of 2 on 1 live scrummaging drills. Biomechanical three dimensional analysis identified large angular displacements, and increased peak velocities and accelerations at the ankle joint during attacking scrummaging drill techniques when in the stance phase of gait. This places the triceps surae as increased risk of injury and provides valuable information for training staff regarding injury prevention and scrum training practices for front row players

Is There a Role for MRI in Plantar Heel Pain.

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Fazal, Muhammad Ali; Tsekes, Demetris; Baloch, Irshad

2018-06-01

There is an increasing trend to investigate plantar heel pain with magnetic resonance imaging (MRI) scan though plantar fasciitis is the most common cause. The purpose of our study was to evaluate the role of MRI in patients presenting with plantar heel pain. Case notes and MRI scans of 141 patients with a clinical diagnosis of plantar fasciitis were reviewed retrospectively. There were 98 females and 43 males patients. Fourteen patients had bilateral symptoms. Average age for male patients was 51 years (range = 26-78 years), and for female patients the average age was 52 years (range = 29-76 years). A total of 121 feet had MRI features suggestive of plantar fasciitis. MRI was normal in 32 feet. There was one case of stress fracture of calcaneus and another of a heel fibroma diagnosed on MRI scan. In our study, MRI scan was normal in 20.7% of the cases; 1.3% had a diagnosis other than plantar fasciitis but no sinister pathology. We therefore conclude that MRI scan is not routinely indicated and key is careful clinical assessment. Therapeutic, Level IV: Retrospective, Case series.

Influence of cortical endplates on ultrasonic properties of trabecular bone

International Nuclear Information System (INIS)

Kim, Yoon Mi; Lee, Kang Il

2015-01-01

The present study investigated the influence of thick cortical endplates on the ultrasonic properties of trabecular bone in a femur with a high fracture risk. Twelve trabecular bone samples were prepared from bovine femurs, and acrylic plates with thicknesses of 1.25, 1.80, and 2.75 mm were manufactured to simulate the cortical endplates using acrylic with a density and a sound speed similar to cortical bone. Although the thickness of the acrylic plates attached to the two sides of the trabecular bone increased, high correlations were observed between the speed of sound and the apparent bone density of the trabecular bone, with Pearson's correlation coefficients of 0.80-0.86. High correlations were also observed between the attenuation coefficient at 0.5 mm and the apparent bone density of the trabecular bone, with Pearson's correlation coefficients of 0.84-0.91. These results suggest that the speed of sound and attenuation coefficient at a specific frequency measured in a femur with relatively thick cortical endplates compared to the calcaneus could be used as indices for predicting the bone mineral density of the femur.

Modified Thomas splint-cast combination for the management of limb fractures in small equids.

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Ladefoged, Søren; Grulke, Sigrid; Busoni, Valeria; Serteyn, Didier; Salciccia, Alexandra; Verwilghen, Denis

2017-04-01

To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). Retrospective case series. Client owned horses and donkeys. Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb. Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure. © 2017 The American College of Veterinary Surgeons.

Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures

International Nuclear Information System (INIS)

Mennel, Emilie A.; John, Susan D.

2003-01-01

We report the case of a 23-month-old male with hypotonia, developmental delay, and complex seizures. Radiographs revealed profound sclerosis of the metaphyses and epiphyses of the long and short bones in the extremities, with a unique pattern of distribution. Sclerosis also involved the anterior ribs, iliac crests, talus, and calcaneus. The skull and vertebral bodies appeared unaffected. Blood lead levels were normal. We believe that this constellation of clinical and radiographic abnormalities closely resembles osteosclerotic metaphyseal dysplasia (OMD) due to an autosomal recessive defect. Characteristic skeletal findings were instrumental in determining the diagnosis. OMD is a very rare sclerosing bone disorder, first described in 1993. The syndrome is characterized clinically by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase, and late-onset spastic paraplegia. We encountered a young child with these neurologic symptoms who displayed sclerotic metaphyseal changes on hand radiographs obtained to determine the bone age. Lead poisoning, a known cause of metaphyseal sclerosis, was initially suspected. Careful analysis of the metaphyseal bone changes helped to distinguish this bone dysplasia from lead poisoning and other causes of metaphyseal sclerosis. (orig.)

Thermographic Imaging of the Superficial Temperature in Racing Greyhounds before and after the Race

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Mari Vainionpää

2012-01-01

Full Text Available A total of 47 racing greyhounds were enrolled in this study on two race days (in July and September, resp. at a racetrack. Twelve of the dogs participated in the study on both days. Thermographic images were taken before and after each race. From the images, superficial temperature points of selected sites (tendo calcaneus, musculus gastrocnemius, musculus gracilis, and musculus biceps femoris portio caudalis were taken and used to investigate the differences in superficial temperatures before and after the race. The thermographic images were compared between the right and left legs of a dog, between the raced distances, and between the two race days. The theoretical heat capacity of a racing greyhound was calculated. With regard to all distances raced, the superficial temperatures measured from the musculus gastrocnemius were significantly higher after the race than at baseline. No significant differences were found between the left and right legs of a dog after completing any of the distances. Significant difference was found between the two race days. The heat loss mechanisms of racing greyhounds during the race through forced conduction, radiation, evaporation, and panting can be considered adequate when observing the calculated heat capacity of the dogs.

Thermographic imaging of the superficial temperature in racing greyhounds before and after the race.

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Vainionpää, Mari; Tienhaara, Esa-Pekka; Raekallio, Marja; Junnila, Jouni; Snellman, Marjatta; Vainio, Outi

2012-01-01

A total of 47 racing greyhounds were enrolled in this study on two race days (in July and September, resp.) at a racetrack. Twelve of the dogs participated in the study on both days. Thermographic images were taken before and after each race. From the images, superficial temperature points of selected sites (tendo calcaneus, musculus gastrocnemius, musculus gracilis, and musculus biceps femoris portio caudalis) were taken and used to investigate the differences in superficial temperatures before and after the race. The thermographic images were compared between the right and left legs of a dog, between the raced distances, and between the two race days. The theoretical heat capacity of a racing greyhound was calculated. With regard to all distances raced, the superficial temperatures measured from the musculus gastrocnemius were significantly higher after the race than at baseline. No significant differences were found between the left and right legs of a dog after completing any of the distances. Significant difference was found between the two race days. The heat loss mechanisms of racing greyhounds during the race through forced conduction, radiation, evaporation, and panting can be considered adequate when observing the calculated heat capacity of the dogs.

Efficacy of computed tomography guided radiofrequency ablation forosteoid osteomas in 31 patients

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Kim, Jung Hoon; Ahn, Joong Mo; Lee, Joon Woo; Lee, Guen Young; Lee, Eu Gene; Oh, Joo Han; Cho, Hwan Seong; Kang, Heung Sik [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2015-04-15

To present the clinical outcome of computed tomography (CT) guided radiofrequency ablation (RFA) for osteoid osteoma. Thirty-one patients (M:F = 23:8, mean age: 20 years, range: 4-54 years) who underwent RFA for clinically suspected osteoid osteoma from May 2004 to December 2013 were retrospectively reviewed. RFA was done in all cases under CT guidance by one of three radiologists in our department. Electronic medical records and images were retrospectively reviewed in all patients. Lesions were located in femur (n = 20), tibia (n = 5), fibula (n = 2), humerus (n = 3), talus (n = 2), and calcaneus (n = 1). On discharge, 27 of 33 cases showed complete remission of pain (82%). One major complication (compartment syndrome) and 2 minor complications (reactive synovitis, minimal skin burn at electrode insertion site) were observed. On the last follow-up (0-78 months, mean: 12.6 months) 27 of 33 cases were successfully treated (82%) and had no more complaints. 3 cases presented remaining pain (9%). In 3 cases relapse occurred (9%) and RFA was repeated in 1 case. The repeated treatment was successful. CT-guided RFA is an effective method for the treatment of osteoid osteoma.

[Bone ultrasonography in kidney disease: applications and limitations].

Science.gov (United States)

Aucella, Filippo; Gesuete, Antonio; Cicchella, Antonio; Granata, Antonio; Fiorini, Fulvio; Guglielmi, Giuseppe

2012-01-01

Quantitative ultrasound (QUS) of the bone is a technique that is generating great interest among bone structure researchers because of its intrinsic features. Its safety and low cost make it an ideal technique for repeated measurements over time such as in chronic disease or when it is necessary to monitor the effects of prescribed therapies. The method was developed for the study of osteoporosis and the sites of measurement are all peripheral, including the distal diaphyses and metaphyses of the phalanges, calcaneus, radius and tibia. QUS parameters, however, cannot be used directly for the diagnosis of osteoporosis according to the WHO criteria, although many authors have shown that ultrasound parameters, particularly those of calcaneal QUS, can predict the risk of osteoporotic fractures independently of MBD. Very promising results with the use of QUS have been obtained in corticosteroid-induced osteoporosis, rheumatoid arthritis, Cushing's syndrome, cystic fibrosis, osteomalacia, thalassemia and osteopenia related to parenteral nutrition. QUS can also monitor the effectiveness of therapy in various pathological conditions. In nephrology the combined use of phalangeal QUS and biochemical markers of bone turnover allows adequate follow-up of patients on dialysis and renal transplant recipients with alterations or disorders of the bone.

Morphology of the dorsal and lateral calcaneocuboid ligaments.

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Dorn-Lange, Nadja V; Nauck, Tanja; Lohrer, Heinz; Arentz, Sabine; Konerding, Moritz A

2008-09-01

The dorsolateral calcaneocuboid ligaments have different configurations. In the literature they are only described as either the dorsal or lateral calcaneocuboid ligament. However, recent reconstructive surgical techniques may benefit from a better understanding of the anatomy. The aims of this study were to classify the morphology and attachments of the dorso-lateral calcaneocuboid ligaments and to determine their dimensions. The dorso-lateral aspects of the calcaneocuboid joint of 30 cadaver feet were dissected to expose the associated ligaments. Further, we evaluated possible bony landmarks of the calcaneus that could imply which shape or course the ligament would have in a specific individual. Our findings showed a wide variety of configurations in shape, number, and attachment sites. A constant dorsal ligament and an additional narrower lateral ligament was detectable in half of the cases. The majority of the dorso-lateral calcaneocuboid ligament-complex had an upward course and fanning out from proximal to distal. No bony predictor for the ligaments' shape or course was found. The dorso-lateral ligament-complex of the calcaneocuboid joint revealed a wide variety of configurations. Better understanding of the anatomy of these ligaments may aid in the anatomic reconstruction of these ligaments.

Evaluation of a morphing based method to estimate muscle attachment sites of the lower extremity.

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Pellikaan, P; van der Krogt, M M; Carbone, V; Fluit, R; Vigneron, L M; Van Deun, J; Verdonschot, N; Koopman, H F J M

2014-03-21

To generate subject-specific musculoskeletal models for clinical use, the location of muscle attachment sites needs to be estimated with accurate, fast and preferably automated tools. For this purpose, an automatic method was used to estimate the muscle attachment sites of the lower extremity, based on the assumption of a relation between the bone geometry and the location of muscle attachment sites. The aim of this study was to evaluate the accuracy of this morphing based method. Two cadaver dissections were performed to measure the contours of 72 muscle attachment sites on the pelvis, femur, tibia and calcaneus. The geometry of the bones including the muscle attachment sites was morphed from one cadaver to the other and vice versa. For 69% of the muscle attachment sites, the mean distance between the measured and morphed muscle attachment sites was smaller than 15 mm. Furthermore, the muscle attachment sites that had relatively large distances had shown low sensitivity to these deviations. Therefore, this morphing based method is a promising tool for estimating subject-specific muscle attachment sites in the lower extremity in a fast and automated manner. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ankle and Midfoot Power During Walking and Stair Ascent in Healthy Adults.

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DiLiberto, Frank E; Nawoczenski, Deborah A; Houck, Jeff

2018-02-27

Ankle power dominates forward propulsion of gait, but midfoot power generation is also important for successful push off. However, it is unclear if midfoot power generation increases or stays the same in response to propulsive activities that induce larger external loads and require greater ankle power. The purpose of this study was to examine ankle and midfoot power in healthy adults during progressively more demanding functional tasks. Multi-segment foot motion (tibia, calcaneus, forefoot) and ground reaction forces were recorded as participants (N=12) walked, ascended a standard step, and ascended a high step. Ankle and midfoot positive peak power and total power, and the proportion of midfoot to ankle total power were calculated. One-way repeated measures ANOVAs were conducted to evaluate differences across tasks. Main effects were found for ankle and midfoot peak and total powers (all p power (p = .331). Ankle and midfoot power significantly increased across each task. Midfoot power increased in proportion to ankle power and in congruence to the external load of a task. Study findings may serve to inform multi-segment foot modeling applications and internal mechanistic theories of normal and pathological foot function.

Die Osteonekrose des Fußes: Eine Übersicht

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Schenk S

2007-01-01

Full Text Available Die Osteonekrose (ON am Fuß ist eine heterogene Gruppe von Krankheitsbildern, die sich deutlich hinsichtlich Klinik, Verlauf, Prädilektionsalter und Prognose unterscheiden. Ebenso sind die Ursachen für diese Erkrankungen vielfältig: Neben idiopathischen finden sich auch posttraumatische und postoperative Formen. Seltene Ursachen sind Kollagenosen, Stoffwechselerkrankungen wie Diabetes mellitus und Kortikoidtherapie. ON finden sich gehäuft nach Nierentransplantationen. Je nach Ursache tritt eine ON gehäuft in typischer Lokalisation auf. Idiopathische Formen findet man am Os naviculare pedis – Morbus Köhler 1 (MK1, an den Metatarsaleköpfchen – Morbus Köhler 2, "Freiberg’s disease" (MK2, an den Sesambeinen und an der Apophyse des Calcaneus. Operationsbedingte Fälle sind gehäuft am Metatarsaleköpfchen 1 nach Versorgung eines Hallux valgus lokalisiert, posttraumatische Nekrosen am Talus. In diesem Artikel werden die idiopathischen Formen hinsichtlich Klinik und Therapie näher beleuchtet. Bezüglich der Therapie gibt es konservative und operative Ansätze. Die wissenschaftlichen Daten zur Behandlung von idiopathischen Nekrosen sind spärlich, die Behandlungsstrategien jedoch einheitlich und allgemein anerkannt.

The exploration of the changes in bone metabolism in patients with abnormal thyroid function

International Nuclear Information System (INIS)

Chu Shaolin; Li Xiaohong; Lei Qiufang; Ye Peihong; Chai Luhua

2001-01-01

To explore the changes in bone metabolism with abnormal thyroid function, BGP and PTH in 91 patients with hyperthyroidism, 37 patients with hypothyroidism, 51 controls, were measured by means of IRMA, calcaneus heel bone density (BMD) was measured by means of 241 Am single photon absorptiometry. BGP levels in hyperthyroidism were significantly higher than those in controls (P < 0.001). BGP levels in hypothyroidism were significantly lower than those in controls (P < 0.001). PTH levels in hyperthyroidism were a little lower than those in controls (P < 0.05). PTH levels in hypothyroidism were significantly higher than those in controls (P < 0.001). The measurement of BMD showed that the prevalence rates of osteoporosis (OP) in hyperthyroidism and hypothyroidism were significantly higher than those in controls. In hyperthyroidism and hypothyroidism groups the age of OP tends to be younger. The patients with hyperthyroidism over 55 years of age were all suffered from OP. The changes in BGP and PTH were earlier than BMD, so BGP and PTH can be used as sensitive indicator of the changes in bone metabolism with abnormal thyroid function, especially for curative effect observations

Intraarticular calcaneal fractures. Clinical results and functional analysis of the surgical treatment

International Nuclear Information System (INIS)

Calixto B, Luis Fernando; Gomez R, Jairo Fernando; Prieto S, Hernan Augusto

2004-01-01

This study evaluated the clinical and functional outcome of open reduction and internal fixation in intraarticular calcaneal fractures 22 patients with 24 intra-articular fractures of calcaneous were treated, 19 with open reduction and internal fixation using a 3.5 mm AO/ASIF calcaneal plate. The fractures were classified according the Sanders tomographic system. The Bohler angle was measured before and after the surgery. All patients were evaluated using the functional ankle-hind foot AOFAS scale (American Orthopaedics Foot and Ankle Society) 6 and 12 months after the surgery. Mean age was 39.8 years. The distribution according the type of fracture was: Sanders II: 41.67% and Sanders III: 58.33%. The mean value of the initial Bohler angle was 11.45% and the final was 24.5 degrees. The functional outcome after 6 months was 70 points and after 12 months was 82 points. There were only two complications (12.5%) a fistula and a wound dehiscence. The displaced and slightly comminuted intra articular fractures have the calcaneus (Sandres II and Sandres III) benefit of ORIF obtaining good functional outcomes 6 and 12 months after surgery. This procedure allows a better articular surface reduction, a satisfactory Bohler angle correction and earlier rehabilitation

Restoration of strength despite low stress and abnormal imaging after Achilles injury.

Science.gov (United States)

Trudel, Guy; Doherty, Geoffrey P; Koike, Yoichi; Ramachandran, Nanthan; Lecompte, Martin; Dinh, Laurent; Uhthoff, Hans K

2009-11-01

To determine the usefulness of clinical imaging in predicting the mechanical properties of rabbit Achilles tendons after acute injury. We created a 2 x 7-mm full-thickness central tendon defect in one Achilles tendon of healthy rabbits. Rabbits in groups of 10 were killed immediately and 4 and 8 wk after surgery (n = 30). We then performed magnetic resonance (MR) imaging, ultrasonography (US), bone mineral densitometry (BMD), and mechanical testing to failure using a dual-cryofixation assembly on experimental and contralateral tendons. The main outcome measures included tendon dimensions, optical density (OD) of T1-weighted, proton density (PD), and T2-weighted MR sequences, US focal abnormalities, BMD of the calcaneus, and stress and peak load to failure. On MR imaging and US, all dimensions of the injured tendons after 2 wk and more were greater than those of the contralateral tendons (P tendons at both 4 wk (39 +/- 9 vs 77 +/- 16 N x mm(-2)) and 8 wk (58 +/- 6 vs 94 +/- 26 N x mm(-2); P tendons, higher T1-weighted OD correlated with lower peak load (r = -0.46; P tendon of lower stress. These findings support progressive physical loading 4 wk after an Achilles tendon injury. T1-weighted OD constituted a marker of tendon mechanical recovery.

Application of nonlinear phenomena induced by focused ultrasound to bone imaging.

Science.gov (United States)

Callé, Samuel; Remenieras, Jean-Pierre; Bou Matar, Olivier; Defontaine, Marielle; Patat, Frederic

2003-03-01

A tissue deformability image is obtained with the vibroacoustography imaging method using mechanical low-frequency (LF) excitation. This ultrasonic excitation is created locally by means of a focused annular array emitting two primary beams at two close frequencies, f(1) and f(2) (f(2) = f(1) + f(LF)). The LF acoustic emission resulting from the vibration of the medium is detected by a sensitive hydrophone and then used to form the image. This noninvasive imaging method was demonstrated in this study to be suitable for bone imaging, with x and y transverse resolutions less than 300 micro m. Two bone sites susceptible to demineralization were tested: the calcaneus and the neck of the femur. The vibroacoustic method provides valuable ultrasonic images regarding the structure and the elastic properties of bone tissue. Correlation was made between vibroacoustic bone images, performed in vitro, and images acquired by other imaging methods (i.e., bone ultrasound attenuation and x-ray computerized tomography (CT)). Moreover, the amplitudes of vibroacoustic signals radiating from phosphocalcic ceramic samples (bone substitute) of different porosity were evaluated. The good correlation between these results and the description of our images and the quality of vibroacoustic images indicate that bone decalcification could be detected using vibroacoustography.

Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis

Science.gov (United States)

Muller, Bart; Maas, Mario; Sierevelt, Inger N; van Dijk, C Niek

2010-01-01

Background and purpose A retrocalcaneal bursitis is caused by repetitive impingement of the bursa between the Achilles tendon and the posterosuperior calcaneus. The bursa is situated in the posteroinferior corner of Kager's triangle (retrocalcaneal recess), which is a radiolucency with sharp borders on the lateral radiograph of the ankle. If there is inflammation, the fluid-filled bursa is less radiolucent, making it difficult to delineate the retrocalcaneal recess. We assessed whether the radiographic appearance of the retrocalcaneal recess on plain digital (filmless) radiographs could be used in the diagnosis of a retrocalcaneal bursitis. Methods Whether or not there was obliteration of the retrocalcaneal recess (yes/no) on 74 digital weight-bearing lateral radiographs of the ankle was independently assessed by 2 observers. The radiographs were from 24 patients (25 heels) with retrocalcaneal bursitis (confirmed on endoscopic calcaneoplasty); the control group consisted of 50 patients (59 heels). Results The sensitivity of the test was 83% for observer 1 and 79% for observer 2. Specificity was 100% and 98%, respectively. The kappa value of the interobserver reliability test was 0.86. For observer 1, intraobserver reliability was 0.96 and for observer 2 it was 0.92. Interpretation On digital weight-bearing lateral radiographs of a retrocalcaneal bursitis, the retrocalcaneal recess has a typical appearance. PMID:20450438

Correlation of bone mineral density with biochemical markers in different menopausal statuses of Pakistani women

International Nuclear Information System (INIS)

Maqsood, A.; Nadia, N.; Farzana, A.; Bashir, A.

2005-01-01

Aim: The present study is aimed to use bone mineral density (BMD) and various biochemical markers to predict the fracture risk at different menopausal statuses in Pakistani women. Method: Seventy women aged between 28-80 years at various menopausal statuses participated in this study. BMD (T score) of right calcaneus was determined using SAHARA ultrasound bone densitometer that measures the transmission of high frequency from heel. Various biochemical markers such as alkaline phosphates, calcium and inorganic phosphorus were measured from the serum of venous blood using standard kits of Randox. Results: Alkaline phosphates was raised in per menopausal, postmenopausal and postmenopausal with hysterectomy and ligation groups of women as compared to premenopausal women but did not achieve significance (P>0.05). Serum calcium level was significantly lower in postmenopausal women than premenopausal women and inorganic phosphorus decrease significantly when compared with premenopausal and postmenopausal with ligation and hysterectomy. BMD (T score) values of postmenopausal osteopenic and postmenopausal osteoprotic women were significantly lower than those of premenopausal women. BMD values of women under study have negative correlation with age, alkaline phosphates and calcium. Conclusion: Our study conclude that in addition to BMD, serum levels of alkaline phosphate, calcium and inorganic phosphorus can be valuable biochemical markers in predicting bone fracture risk at different menopausal states. (author)

Cancer survivors exhibit a different relationship between muscle strength and health-related quality of life/fatigue compared to healthy subjects.

Science.gov (United States)

Morishita, S; Tsubaki, A; Fu, J B; Mitobe, Y; Onishi, H; Tsuji, T

2018-05-16

We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long-term cancer survivors and healthy subjects. Thirty-six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health-related QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p < .05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p < .05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p < .05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors. © 2018 John Wiley & Sons Ltd.

Subtalar joint stress imaging with tomosynthesis.

Science.gov (United States)

Teramoto, Atsushi; Watanabe, Kota; Takashima, Hiroyuki; Yamashita, Toshihiko

2014-06-01

The purpose of this study was to perform stress imaging of hindfoot inversion and eversion using tomosynthesis and to assess the subtalar joint range of motion (ROM) of healthy subjects. The subjects were 15 healthy volunteers with a mean age of 29.1 years. Coronal tomosynthesis stress imaging of the subtalar joint was performed in a total of 30 left and right ankles. A Telos stress device was used for the stress load, and the load was 150 N for both inversion and eversion. Tomographic images in which the posterior talocalcaneal joint could be confirmed on the neutral position images were used in measurements. The angle of the intersection formed by a line through the lateral articular facet of the posterior talocalcaneal joint and a line through the surface of the trochlea of the talus was measured. The mean change in the angle of the calcaneus with respect to the talus was 10.3 ± 4.8° with inversion stress and 5.0 ± 3.8° with eversion stress from the neutral position. The result was a clearer depiction of the subtalar joint, and inversion and eversion ROM of the subtalar joint was shown to be about 15° in healthy subjects. Diagnostic, Level IV.

Localized accumulation of lead within and among bones from lead-dosed goats

International Nuclear Information System (INIS)

Cretacci, Yan; Parsons, Patrick J.

2010-01-01

The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia Pb levels were found to correlate strongly with the cumulative Pb dose (r 2 =0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the noninvasive measurement of lead in bone by XRF methods are discussed.

Localized accumulation of lead within and among bones from lead-dosed goats

Energy Technology Data Exchange (ETDEWEB)

Cretacci, Yan [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, P.O. Box 509, Albany, NY 12201-0509 (United States); Department of Environmental Health Sciences, School of Public Health, The University at Albany, P.O. Box 509, Albany, NY 12201-0509 (United States); Parsons, Patrick J., E-mail: pparsons@wadsworth.org [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, P.O. Box 509, Albany, NY 12201-0509 (United States); Department of Environmental Health Sciences, School of Public Health, The University at Albany, P.O. Box 509, Albany, NY 12201-0509 (United States)

2010-01-15

The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia Pb levels were found to correlate strongly with the cumulative Pb dose (r{sup 2}=0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the noninvasive measurement of lead in bone by XRF methods are discussed.

Clinical and X-ray findings of mycetoma (report of 18 cases)

International Nuclear Information System (INIS)

Qiu Qiande

2002-01-01

Objective: To investigate the characteristic clinical and X-ray findings of mycetoma and to enhance the understanding of mycetoma. Methods: The clinical and X-ray findings of mycetoma in 18 cases were analyzed with the review of literatures. There were 11 males and 7 females, the age ranged from 21-65 years, with the average of 41.5 year. The cases were all peasants, barefoot and with the history of trauma, which lasted for 4-17 years with the average of 9.8 year. Results: Sixty-seven lesions of bone in 18 cases (30 metatarsal, 20 cuneiform, 7 cuboid, 5 phalanx, 3 tibia, 2 calcaneus) were presented, including 8 rodent, 3 osteolytic, 3 cystic, 2 rodent and sclerosis changes, 2 sclerosis, 9 irregular thickened bony cortex, 7 irregular deleted bony cortex, 12 periosteal reaction, 3 irregular crest of bone in lesion, 13 rarefaction of bone cortex, 11 swimmy of surface arthrosis, 8 constriction of interval arthrosis, 2 spot calcification in the soft tissue, 2 sequestrum, and 2 soft tissue mass. The mycelium had been discovered in grain in 18 cases and the colour of grain was from brown to black. Conclusion: Mycetoma involves extensively and tends to involve multiple bones. The main X-ray findings are rodent and osteolytic changes

Correlation in the Coronal Angle between Knee and Hindfoot Was Observed in Patients with Rheumatoid Arthritis Unless Talocrural Joint Was Destroyed

Directory of Open Access Journals (Sweden)

Kohei Nishitani

2017-01-01

Full Text Available The purpose of this study is to investigate the compensatory correlation between knee and hindfoot in patients with rheumatoid arthritis (RA. This cross-sectional study included 218 patients (407 lower extremities. Radiographs of the hindfoot and full-length posteroanterior hip-to-calcaneus standing radiographs were evaluated. The destruction of the hindfoot was evaluated using the Larsen grading system. The coronal angular deformity of the knee and hindfoot was evaluated by the femorotibial angle (FTA and the angle between the tibial shaft and the entire hindfoot (tibiohindfoot angle, THFA. The correlation between FTA and THFA was determined by Pearson’s coefficient. For all patients, FTA correlated to THFA (R = 0.28, p<0.001. The correlation was observed as long as the talocrural joint was preserved (Larsen grade ≤ 2, even if the subtalar joint had been destroyed (Larsen grade ≥ 3. However, the correlation was not observed when the talocrural joint was destroyed (Larsen grade ≥ 3, R = −0.02, p=0.94. The pain in the hindfoot did not correlate with FTA or THFA. In conclusion, a compensatory deformity of the hindfoot against the deformity of the knee was observed in RA, and the correlation was lost when talocrural joint was destroyed.

Dependences of Ultrasonic Parameters for Osteoporosis Diagnosis on Bone Mineral Density

International Nuclear Information System (INIS)

Hwang, Kyo Seung; Kim, Yoon Mi; Park, Jong Chan; Choi, Min Joo; Lee, Kang Il

2012-01-01

Quantitative ultrasound technologies for osteoporosis diagnosis measure ultrasonic parameters such as speed of sound(SOS) and normalized broadband ultrasound attenuation(nBUA) in the calcaneus (heel bone). In the present study, the dependences of SOS and nBUA on bone mineral density in the proximal femur with high risk of fracture were investigated by using 20 trabecular bone samples extracted from bovine femurs. SOS and nBUA in the femoral trabecular bone samples were measured by using a transverse transmission method with one matched pair of ultrasonic transducers with a center frequency of 1.0 MHz. SOS and nBUA measured in the 20 trabecular bone samples exhibited high Pearson's correlation coefficients (r) of r = 0.83 and 0.72 with apparent bone density, respectively. The multiple regression analysis with SOS and nBUA as independent variables and apparent bone density as a dependent variable showed that the correlation coefficient r = 0.85 of the multiple linear regression model was higher than those of the simple linear regression model with either parameter SOS or nBUA as an independent variable. These high linear correlations between the ultrasonic parameters and the bone density suggest that the ultrasonic parameters measured in the femur can be useful for predicting the femoral bone mineral density.

Sonographic evaluation of plantar fasciitis and relation to body mass index

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Ozdemir, Huseyin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)]. E-mail: ozdemir@firat.edu.tr; Yilmaz, Erhan [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Murat, Ayse [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Karakurt, Lokman [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Poyraz, A. Kursad [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Ogur, Erkin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)

2005-06-01

Purpose: We have investigated the role of sonography in the diagnosis of plantar fasciitis. Materials and methods: This study evaluates 39 patients with plantar fasciitis and control group of 22 healthy volunteers. The plantar fascia thickness was measured 5 mm distal to the insertion of the calcaneus of plantar aponeurosis. Qualitative parameters such as decreased echogenity, biconvexity, perifascial fluid and calcification of plantar fascia were also noted. Results: Mean plantar fascia thickness was measured 2.9 mm in patients with unilateral heel pain, 2.2 mm for contralateral normal heel and 2.5 mm for control group. There was a statistically significant difference between heel with plantar fasciitis, contralateral normal heel and control groups (p = 0.009 and 0.0001, respectively). Mean body mass index was 28 kg/m{sup 2} in patients with heel pain and 25 kg/m{sup 2} in control group. Body mass index measurements were significantly different between plantar fasciitis and control groups. We found reduced plantar fascia echogenity in 16 cases (41%), calcaneal spur in 20 cases (51%), biconvex appearance in two cases (5.1%) and perifascial fluid in one case (2.5%). Conclusion: We conclude that in patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascia thickness even in clinically unequivocal plantar fasciitis.

Sonographic evaluation of plantar fasciitis and relation to body mass index

International Nuclear Information System (INIS)

Ozdemir, Huseyin; Yilmaz, Erhan; Murat, Ayse; Karakurt, Lokman; Poyraz, A. Kursad; Ogur, Erkin

2005-01-01

Purpose: We have investigated the role of sonography in the diagnosis of plantar fasciitis. Materials and methods: This study evaluates 39 patients with plantar fasciitis and control group of 22 healthy volunteers. The plantar fascia thickness was measured 5 mm distal to the insertion of the calcaneus of plantar aponeurosis. Qualitative parameters such as decreased echogenity, biconvexity, perifascial fluid and calcification of plantar fascia were also noted. Results: Mean plantar fascia thickness was measured 2.9 mm in patients with unilateral heel pain, 2.2 mm for contralateral normal heel and 2.5 mm for control group. There was a statistically significant difference between heel with plantar fasciitis, contralateral normal heel and control groups (p = 0.009 and 0.0001, respectively). Mean body mass index was 28 kg/m 2 in patients with heel pain and 25 kg/m 2 in control group. Body mass index measurements were significantly different between plantar fasciitis and control groups. We found reduced plantar fascia echogenity in 16 cases (41%), calcaneal spur in 20 cases (51%), biconvex appearance in two cases (5.1%) and perifascial fluid in one case (2.5%). Conclusion: We conclude that in patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascia thickness even in clinically unequivocal plantar fasciitis

Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

Science.gov (United States)

Yamakado, Kotaro

2013-01-01

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. PMID:23875139

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

Science.gov (United States)

Pascual Huerta, Javier; Alarcón García, Juan María

2007-06-01

The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. There were statistically significant differences in plantar fascia thickness at the four different locations (pplantar fascia thickness at 1cm proximal to the insertion. At origin and 1cm distal to insertion weight was an independent predictor of plantar fascia thickness. There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1cm proximal to the insertion is influenced by sex and thickness at origin and at 1cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.

Chondroblastoma: A clinical and radiological study of 104 cases

Energy Technology Data Exchange (ETDEWEB)

Bloem, J.L.; Mulder, J.D.

1985-06-01

The clinical and radiographic findings in 104 patients with chondroblastoma are presented. Pain was an almost constant presenting complaint, often accompanied in the case of para-articular lesions by impaired function of an adjacent joint. The majority (80%) were in long bones with a mean age of presentation of 16 years. The characteristic radiological image of these lesions was an eccentric radiolucency, having a sharply defined sclerotic margin and containing areas of calcification in approximately a third of cases. They were always related to a growth plate. Nearly half were confined to the affected epiphysis or apophysis itself, but most of the remainder had traversed the growth plate to involve also the adjacent metaphysis. The bones around the knee and the proximal ends of the humerus and femur were the sites of predilection. A minority (20%) affected flat bones and short tubular bones of the hand and foot, with a peculiar affinity for the calcaneus and talus. The mean age of presentation of these was 28 years. The radiological pattern was similar, except for a greater tendency to expand the affected bone. Complications included the formation of a secondary aneurysmal bone cyst in 16 cases (10 of them in long bones), one malignant chondroblastoma, and one fibrosarcoma developing after radiation of the original chondroblastoma.

[Tibio-talo-calcaneal arthrodesis with the retrograde intramedullary nail MEDIN].

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Popelka, S; Vavřík, P; Landor, I; Bek, J; Popelka ml, S; Hromádka, R

2013-01-01

When the talus and the talocalcaneal joint are both affected, their fusion is the method of treatment. Ankle arthrodesis is carried out using various osteosynthetic materials such as external fixators, screws and plates. One of the options is retrograde nailing. Tibio-talo-calcaneal arthrodesis is frequently indicated in patients with rheumatoid arthritis (RA) in whom both the talus and the subtalar joint are often affected. A retrograde nail for tibio-talo-calcaneal arthrodesis was developed at our department in cooperation with MEDIN Company. This is a titanium double-curved nail, with the distal part bent at 8 degrees ventrally and 10 degrees laterally. It is inserted from the transfibular approach. Sixty-two patients, 35 women and 27 men, were treated at our department from 2005. Since one patient had bilateral surgery, 63 ankles were included. The indications for arthrodesis involved rheumatoid arthritis in 42, post-traumatic arthritis in 10, failed ankle arthrodesis in two and failed total ankle arthroplasty in five ankles; tibial stress fractures close above the ankle in two RA patients, one patient with dermatomyositis and one with lupus erythematodes. The average age at the time of surgery was 64.2 years (range, 30 to 80). The average follow-up was 4.5 years (range, 1 to 9 years), Satisfaction with the treatment outcome and willingness to undergo surgery on the other side were reported by 82% of the patients. The AOFAS score improved from 35 to 74 points. Three (4.8%) patients complained of painful feet due to the fact that exact correction of the calcaneus was not achieved and the heel after arthrodesis remained in a slightly varus position. Of them, two had a failed total ankle arthroplasty. Post-operative complications included early infection managed by antibiotic treatment and early surgical revision with irrigation.in two (3.2%) RA patients, who were undergoing biological therapy. Late infection developed at 2 to 3 years after surgery in three (4

Static and dynamic biomechanical properties of the regenerating rabbit Achilles tendon.

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Nagasawa, Koji; Noguchi, Masahiko; Ikoma, Kazuya; Kubo, Toshikazu

2008-07-01

Since tendons show viscoelastic behavior, dynamic viscoelastic properties should be assessed in addition to static biomechanical properties. We evaluated differences between static and dynamic biomechanical properties of the regenerating rabbit Achilles tendon following tenotomy. At 3, 6, or 12 weeks after right Achilles tenotomy, the right (regenerating) and left (control) tendons were collected with the calcaneus from 49 rabbits. A unidirectional failure test and a dynamic viscoelastic test were conducted. Tensile strength and Young's modulus (static biomechanical properties) in the regenerating group at Week 6 were significantly greater than at Week 3, while at Week 12, these were significantly greater than at Week 6. However, even at Week 12, both parameters were less than in the control group. The value of tan delta represents dynamic viscoelasticity, a smaller tan delta indicates greater elasticity. tan delta for the regenerating group was significantly greater than for the control group at Week 3, but regenerating and control groups did not significantly differ at Week 6. No marked change was seen from Weeks 6 to 12 in the regenerating group, and no significant difference in tan delta was evident between the regenerating and control groups at Week 12. Dynamic biomechanical properties of regenerating rabbit Achilles tendons may improve more rapidly than static biomechanical properties. Ability to tolerate dynamic movement in the healing Achilles tendon may improve more rapidly than ability to withstand static stresses.

Clinical usefulness of calcaneal measurements using dual energy x-ray absorptiometry

International Nuclear Information System (INIS)

Kohno, Jun; Nakata, Tomoko; Ito, Masako

1999-01-01

To investigate the clinical usefulness of calcaneal measurement using dual-energy x-ray absorptiometry (DXA), the ability to detect bone loss and fracture risk were evaluated in comparison with spinal bone mineral density (BMD) measured using DXA and quantitative CT (QCT) and with calcaneal quantitative ultrasound (QUS). Furthermore, to investigate the region in calcaneus in which to detect bone change sensitively, the ability to detect bone loss and fracture risk were also evaluated using new regions of interest (ROIs) that were manually defined. The subjects were 165 healthy women, and 188 female patients with fracture, estrogen deficiency, and steroid-induced osteoporosis. Calcaneal BMD with some manually defined ROIs showed lower precision and less sensitivity in detecting bone loss than BMD measured with automatically defined ROIs. Calcaneal DXA, spinal DXA, and QCT demonstrated significant age-related bone loss, and all measurements could discriminate fracture cases from non-fracture cases. Calcaneal DXA could discriminate the bone loss associated with estrogen deficiency as well as spinal DXA. Furthermore, calcaneal measurements showed a greater ability to detect steroid-induced bone loss than spinal DXA, probably because this group included subjects of advanced age with spondylosis. In conclusion, calcaneal DXA is useful to assess BMD in subjects who are not suitable for spinal measurement, although the ability to detect age-related bone loss in calcaneal DXA is less than in spinal measurements. (author)

Neurovascular Structures at Risk With Curved Retrograde TTC Fusion Nails.

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de Cesar Netto, Cesar; Johannesmeyer, David; Cone, Brent; Araoye, Ibukunoluwa; Hudson, Parke William; Sahranavard, Bahman; Johnson, Michael; Shah, Ashish

2017-10-01

The purpose of this study was to assess the risk of iatrogenic injury to plantar neurovascular structures of the foot during insertion of a curved retrograde tibiotalocalcaneal (TTC) fusion nail. Ten below-knee thawed fresh-frozen cadaveric specimens underwent curved retrograde nailing of the ankle. The shortest distance between the nail and the main plantar neurovascular branches and injured structures were recorded during dissection. We also evaluated the relative position of these structures along 2 lines (AB, connecting the calcaneus to the first metatarsal, and BC, connecting the first and fifth metatarsal). The lateral plantar artery was found to be in direct contact with the nail 70% of the time, with a macroscopic laceration 30% of the time. The Baxter nerve was injured 20% of the time, as was the lateral plantar nerve. The medial plantar artery and nerve were never injured. The most proximal structure to cross line AB was the Baxter nerve followed by the lateral plantar artery, the nail, the lateral plantar nerve, and the medial plantar nerve. Our cadaveric anatomic study found that the most common structures at risk for iatrogenic injury by lateral curved retrograde TTC fusion nails were the lateral plantar artery and nerve, and the Baxter nerve. Determination of a true neurovascular safe zone is challenging and therefore warrants careful operative dissection to minimize neurovascular injuries.

Biomechanical and structural parameters of tendons in rats subjected to swimming exercise.

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Bezerra, M A; Santos de Lira, K D; Coutinho, M P G; de Mesquita, G N; Novaes, K A; da Silva, R T B; de Brito Nascimento, A K; Inácio Teixeira, M F H B; Moraes, S R A

2013-12-01

The aim of this study was to evaluate the effect of swimming exercise, without overloading, on the biomechanical parameters of the calcaneal tendon of rats. 27 male Wistar rats (70 days) were distributed randomly into 2 groups, Control Group (CG; n=15) with restricted movements inside the cage and Swimming Group (SG; n=12), subjected to exercise training in a tank with a water temperature of 30±1°C, for 1 h/day, 5 days/week for 8 weeks. All animals were kept in a reversed light/dark cycle of 12 h with access to food and water ad libitum. After that, they were anesthetized and had their calcaneus tendons collected from their left rear paws. The tendon was submitted to a mechanical test on a conventional test machine. From the stress vs. strain curve, the biomechanical data were analyzed. For the statistical analysis, the Student-T test was used (penergy of deformation/tendon cross sectional area (p=0.017) and elastic modulus of the tendon (p=0.013) showed positive outcomes in SG. There was no difference in the other parameters. The results indicate that the swimming exercise training, without overloading, was an important stimulus for improving the biomechanical parameters and structural properties of the calcaneal tendon. © Georg Thieme Verlag KG Stuttgart · New York.

Precision of different quantitative ultrasound densitometers

International Nuclear Information System (INIS)

Pocock, N.A.; Harris, N.D.; Griffiths, M.R.

1998-01-01

Full text: Quantitative ultrasound (QUS) of the calcaneus, which measures Speed of Sound (SOS) and Broadband ultrasound attenuation (BUA), is predictive of the risk of osteoporotic fracture. However, the utility of QUS for predicting fracture risk or for monitoring treatment efficacy depends on its precision and reliability. Published results and manufacturers data vary significantly due to differences in statistical methodology. We have assessed the precision of the current model of the Lunar Achilles and the McCue Cuba QUS densitometers; the most commonly used QUS machines in Australia. Twenty seven subjects had duplicate QUS measurements performed on the same day on both machines. These data were used to calculate the within pair standard deviation (SD) the co-efficient of variation, CV and the standardised co efficient of variation (sCV) which is corrected for the dynamic range. In addition, the co-efficient of reliability (R) was calculated as an index of reliability which is independent of the population mean value, or the dynamic range of the measurements. R ranges between 0 (for no reliability) to 1(for a perfect reliability). The results indicate that the precision of QUS is dependent on the dynamic range and the instrument. Furthermore, they suggest that while QUS is a useful predictor of fracture risk, at present it has limited clinical value in monitoring short term age-related bone loss of 1-2% per year

Os Trigonum Syndrome: Two Case Reports Focusing On Possible Risk Factors

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Senem Şaş

2016-09-01

Full Text Available An accessory bone, Os trigonum is placed at the poste­rior of talus. Os trigonum occurs as ossification center be­tween 7-13 years at the posterior of talus and combines with talus within a year. However, this combination does not occur in 7 % of population that results in Os trigonum syndrome. Os trigonum syndrome is a clinic disorders that can cause posterior foot pain. This bone causes back foot pain as a result of compression between talus and calcaneus. These symptoms are seen as a result of re­petitive strain or traumas that are frequently seen in balle­rinas and soccer players with the force of ankle to plantar flexion. People with Os trigonum are generally stated to be asymptomatic, however due to additional risk factors that cause posterior foot pain such as overuse or occupa­tional one can call this syndrome to be symptomatic. In this study two different cases with symptomatic Os trigo­num are reported one due to wearing of high heel shoes and other due to occupational overuse (farming. In this report we present two cases of an 18 years and a 65 years old who have back foot pain and diagnosed with os trigonum syndrome with the review of current lit­erature.

Exploring Eucladoceros ecomorphology using geometric morphometrics.

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Curran, Sabrina C

2015-01-01

An increasingly common method for reconstructing paleoenvironmental parameters of hominin sites is ecological functional morphology (ecomorphology). This study provides a geometric morphometric study of cervid rearlimb morphology as it relates to phylogeny, size, and ecomorphology. These methods are then applied to an extinct Pleistocene cervid, Eucladoceros, which is found in some of the earliest hominin-occupied sites in Eurasia. Variation in cervid postcranial functional morphology associated with different habitats can be summarized as trade-offs between joint stability versus mobility and rapid movement versus power-generation. Cervids in open habitats emphasize limb stability to avoid joint dislocation during rapid flight from predators. Closed-adapted cervids require more joint mobility to rapidly switch directions in complex habitats. Two skeletal features (of the tibia and calcaneus) have significant phylogenetic signals, while two (the femur and third phalanx) do not. Additionally, morphology of two of these features (tibia and third phalanx) were correlated with body size. For the tibial analysis (but not the third phalanx) this correlation was ameliorated when phylogeny was taken into account. Eucladoceros specimens from France and Romania fall on the more open side of the habitat continuum, a result that is at odds with reconstructions of their diet as browsers, suggesting that they may have had a behavioral regime unlike any extant cervid. © 2014 Wiley Periodicals, Inc.

3D Biometrics for Hindfoot Alignment Using Weightbearing CT.

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Lintz, François; Welck, Matthew; Bernasconi, Alessio; Thornton, James; Cullen, Nicholas P; Singh, Dishan; Goldberg, Andy

2017-06-01

Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups. In this retrospective cohort study, 135 data sets (57 normal, 38 varus, 40 valgus) from WBCT (PedCAT; CurveBeam LLC, Warrington, PA) were obtained from a specialized foot and ankle unit. 3D coordinates of specific anatomical landmarks (weightbearing points of the calcaneus, of the first and fifth metatarsal heads and the highest and centermost point on the talar dome) were collected. These data were processed with the TALAS system (CurveBeam), which resulted in an FAO value for each case. Intraobserver and interobserver reliability were also assessed. In normal cases, the mean value for FAO was 2.3% ± 2.9%, whereas in varus and valgus cases, the mean was -11.6% ± 6.9% and 11.4% ± 5.7%, respectively, with a statistically significant difference among groups ( P biometrics. The present study introduces the concept of 3D biometrics and describes an efficient, semiautomatic tool for measuring hindfoot alignment. Level III, retrospective comparative study.

Partial calcanectomy and Ilizarov external fixation may reduce amputation need in severe diabetic calcaneal ulcers.

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Akkurt, Mehmet Orçun; Demirkale, Ismail; Öznur, Ali

2017-01-01

Objective : The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon's armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-threatening diabetic calcaneal ulcers. Methods : The study included 23 patients with diabetic hindfoot ulcers who were treated with radical excision of the necrotic tissue and application of circular external fixation. The treatment protocol was a combination of magnetic resonance imaging (MRI)-guided debridement of the necrotic tissues and application of an Ilizarov external fixator in plantarflexion to decrease the soft-tissue defect. Primary outcome measures were total cure of infection and obvious healing of the osteomyelitis at 12 weeks determined by MRI, and clinical cure through objective assessment of the appearance of the wound. Results : The wounds healed in 18 of the 23 patients (78%), partial recovery occurred and subsequent flap operation was performed in three patients (13%), and below-the-knee amputation was performed in two patients (9%). Conclusions : This surgical protocol is effective in ameliorating diabetic hindfoot ulcers with concomitant calcaneal osteomyelitis, and satisfactorily reduces the need for amputation.

An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia.

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Malkoc, Melih; Korkmaz, Ozgur; Ormeci, Tugrul; Oltulu, Ismail; Isyar, Mehmet; Mahirogulları, Mahir

2014-01-01

Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral. This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for last one month and after imaging studies posterior longitudinal tibial stress fracture was detected on his left tibia. After six months the patient was admitted to our clinic with the same type of complaints in his right leg. All imaging modalities and blood counts were performed and as a result longitudinal posterior tibial stress fractures were detected on his right tibia. Treatment of tibial stress fracture includes rest and modified activity, followed by a graded return to activity commensurate with bony healing. We have applied the same treatment protocol and our results were acceptable but our follow up time short for this reason our study is restricted for separate stress fractures of the posterior tibia. Although the main localization of tibial stress fractures were unilateral, anterior and transverse pattern, rarely, like in our case, the unusual bilateral posterior localization and longitudinal pattern can be seen. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

PTT functional recovery in early stage II PTTD after tendon balancing and calcaneal lengthening osteotomy.

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Brilhault, Jean; Noël, Vincent

2012-10-01

The decision to offer surgery for Stage II posterior tibial tendon deficiency (PTTD) is a difficult one since orthotic treatment has been documented to be a viable alternative to surgery at this stage. Taking this into consideration we limited our treatment to bony realignment by a lengthening calcaneus Evans osteotomy and tendon balancing. The goal of the study was to clinically evaluate PTT functional recovery with this procedure. The patient population included 17 feet in 13 patients. Inclusion was limited to early Stage II PTTD flatfeet with grossly intact but deficient PTT. Deficiency was assessed by the lack of hindfoot inversion during single heel rise test. The surgical procedure included an Evans calcaneal opening wedge osteotomy with triceps surae and peroneus brevis tendon lengthening. PTT function at follow up was evaluated by an independent examiner. Evaluation was performed at an average of 4 (range, 2 to 6.3) years. One case presented postoperative subtalar pain that required subtalar fusion. Every foot could perform a single heel rise with 13 feet having active inversion of the hindfoot during elevation. The results of this study provide evidence of PTT functional recovery without augmentation in early Stage II. It challenges our understanding of early Stage II PTTD as well as the surgical guidelines recommending PTT augmentation at this specific stage.

[An evaluation of eight cases of intraosseous lipoma].

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Sahin, Yilmaz; Dabak, Nevzat; Selçuk, M Bekir; Bariş, Y Sancar

2007-01-01

We retrospectively evaluated patients with intraosseous lipoma. The study included eight patients (5 males, 3 females; mean age 39 years; range 23 to 60 years) who were treated between 1997 and 2005 for intraosseous lipoma. Localizations of the lipomas were the calcaneus in six patients, proximal humerus in one patient, and proximal femur in one patient. The presenting complaints were heel pain in patients with calcaneal involvement, and shoulder pain associated with proximal humeral involvement. In one patient, detection of intraosseous lipoma in the left proximal femur was incidental during examination for right hip pain. According to the Milgram classification, five of the intraosseous lipomas were stage 1, while two calcaneal lesions and one femoral lesion were stage 2. Treatment consisted of excisional biopsy, curettage, and allografting under regional or general anesthesia. The diagnosis was confirmed histopathologically in all cases. The mean follow-up period was 28 months (range 9 to 110 months). Complaints of heel pain and shoulder pain resolved within four and five months, respectively. No infection or skin necrosis occurred at the wound site. No neurovascular complications developed during or after surgery. Radiological consolidation of the implanted bone allografts were complete by a mean of three months (range 2 to 4 months). No pathological fractures or recurrences were encountered. Treatment of intraosseous lipomas with curettage and grafting is effective in relieving pain and preventing possible pathological fractures.

An Ultrasonic Backscatter Instrument for Cancellous Bone Evaluation in Neonates

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Chengcheng Liu

2015-09-01

Full Text Available Ultrasonic backscatter technique has shown promise as a noninvasive cancellous bone assessment tool. A novel ultrasonic backscatter bone diagnostic (UBBD instrument and an in vivo application for neonatal bone evaluation are introduced in this study. The UBBD provides several advantages, including noninvasiveness, non-ionizing radiation, portability, and simplicity. In this study, the backscatter signal could be measured within 5 s using the UBBD. Ultrasonic backscatter measurements were performed on 467 neonates (268 males and 199 females at the left calcaneus. The backscatter signal was measured at a central frequency of 3.5 MHz. The delay (T1 and duration (T2 of the backscatter signal of interest (SOI were varied, and the apparent integrated backscatter (AIB, frequency slope of apparent backscatter (FSAB, zero frequency intercept of apparent backscatter (FIAB, and spectral centroid shift (SCS were calculated. The results showed that the SOI selection had a direct influence on cancellous bone evaluation. The AIB and FIAB were positively correlated with the gestational age (|R| up to 0.45, P10 µs. Moderate positive correlations (|R| up to 0.45, P10 µs. The T2 mainly introduced fluctuations in the observed correlation coefficients. The moderate correlations observed with UBBD demonstrate the feasibility of using the backscatter signal to evaluate neonatal bone status. This study also proposes an explicit standard for in vivo SOI selection and neonatal cancellous bone assessment.

Correlations of radiological assessment of skeletal maturity and orthopaedic injuries in the standardbred

International Nuclear Information System (INIS)

Pasolini, M.P.; Meomartino, L.; Fatone, G.; Brunetti, A.; Laratta, I.

2003-01-01

The aim of this study was to define a correlation between the incidence of orthopaedic injuries and the skeletal maturity, radiologically assessed, in a group of 23 standardbred horses. Starting at 18 months of age, radiograms of calcaneus and distal radial physis were taken at two months intervals, until X-ray evidence of closure. All the physis were blindly graded as: C: open physis; B-: initial evidence of central closure; B: partially closed physis; B+: full closure of the central portion of the physis; A: closed physis. Based on this classification, the horses were grouped as I (immature subject - C, B- and B), or M (mature subject - B+ and A). Orthopaedic injuries were classified as major lesion, if causing prolonged or definitive interruption of training, or minor, if causing brief or no interruption of training. Estimation of injury incidence in the different groups was calculated using the chi-square test (significance level P0.01). The average ages of physis closure (mean +- SD) were 24.1 +- 2.6 months (range 19-28), for the calcaneal physis, and 28.2 +- 2 months (range 26-33), for the distal radial physis, without significant differences between colts and fillies. In our study, according to a previous report, no correlation between X-ray skeletal maturity and incidence of orthopaedic injuries was demonstrated [it

A new RF transmit coil for foot and ankle imaging at 7T MRI.

Science.gov (United States)

Santini, Tales; Kim, Junghwan; Wood, Sossena; Krishnamurthy, Narayanan; Farhat, Nadim; Maciel, Carlos; Raval, Shailesh B; Zhao, Tiejun; Ibrahim, Tamer S

2018-01-01

A four-channel Tic-Tac-Toe (TTT) transmit RF coil was designed and constructed for foot and ankle imaging at 7T MRI. Numerical simulations using an in-house developed FDTD package and experimental analyses using a homogenous phantom show an excellent agreement in terms of B 1 + field distribution and s-parameters. Simulations performed on an anatomically detailed human lower leg model demonstrated an B 1 + field distribution with a coefficient of variation (CV) of 23.9%/15.6%/28.8% and average B 1 + of 0.33μT/0.56μT/0.43μT for 1W input power (i.e., 0.25W per channel) in the ankle/calcaneus/mid foot respectively. In-vivo B 1 + mapping shows an average B 1 + of 0.29μT over the entire foot/ankle. This newly developed RF coil also presents acceptable levels of average SAR (0.07W/kg for 10g per 1W of input power) and peak SAR (0.34W/kg for 10g per 1W of input power) over the whole lower leg. Preliminary in-vivo images in the foot/ankle were acquired using the T2-DESS MRI sequence without the use of a dedicated receive-only array. Copyright © 2017. Published by Elsevier Inc.

Ewing's sarcoma of the tarsal bone

International Nuclear Information System (INIS)

Kwon, Jung Hyeok; Kim, Yong Sun; Kim, Tae Hun; Park, In Kyu; Kim, Yong Joo; Kang, Duk Sik; Sohn, Kyung Rak

1985-01-01

The Ewing's sarcoma comprises approximately less than 10 percent of malignant bone tumors and 5 percent of all bone tumors, occurs in almost all bones of the body, and presents a widely divergent roentgenographic manifestations. The tarsal bones are involved only 2 percent in the Ewing's sarcoma. Two cases experienced by authors and ten cases published in literatures of Ewing's sarcoma of the tarsal bone were analyzed retrospectively. The result were as follows: 1. Of the tarsal bones, the calcaneus was 7 cases, the talus 4 cases, cuneiform 1 case. 2. Female was affected more commonly than male, the ratio being 4 to 1 in the tarsal bones. 3. About sixty percent of total cases in the tarsal bones had evidence of diffuse sclerotic pattern. All the cases of the talus had evidence of diffuse sclerotic pattern. 4. The diseases to be considered in differential diagnosis are as follows: avascular necrosis, tuberculous osteomyelitis, osteosarcoma, and pyogenic osteomyelitis. 5. The diffuse sclerosis radiographically showed a close relation with dead bone resulting from avascular necrosis due to tumor infiltration histologically. Periosteal reactive new bone and osteoid deposition on the dead bone were also correlated with diffuse sclerosis. 6. Because it is difficult to differentiate sclerotic lesions in the tarsal bones by radiographic methods alone, all such lesions should be subject to biopsy as early as possible

Ewing's sarcoma of the tarsal bone

Energy Technology Data Exchange (ETDEWEB)

Kwon, Jung Hyeok; Kim, Yong Sun; Kim, Tae Hun; Park, In Kyu; Kim, Yong Joo; Kang, Duk Sik; Sohn, Kyung Rak [College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)

1985-06-15

The Ewing's sarcoma comprises approximately less than 10 percent of malignant bone tumors and 5 percent of all bone tumors, occurs in almost all bones of the body, and presents a widely divergent roentgenographic manifestations. The tarsal bones are involved only 2 percent in the Ewing's sarcoma. Two cases experienced by authors and ten cases published in literatures of Ewing's sarcoma of the tarsal bone were analyzed retrospectively. The result were as follows: 1. Of the tarsal bones, the calcaneus was 7 cases, the talus 4 cases, cuneiform 1 case. 2. Female was affected more commonly than male, the ratio being 4 to 1 in the tarsal bones. 3. About sixty percent of total cases in the tarsal bones had evidence of diffuse sclerotic pattern. All the cases of the talus had evidence of diffuse sclerotic pattern. 4. The diseases to be considered in differential diagnosis are as follows: avascular necrosis, tuberculous osteomyelitis, osteosarcoma, and pyogenic osteomyelitis. 5. The diffuse sclerosis radiographically showed a close relation with dead bone resulting from avascular necrosis due to tumor infiltration histologically. Periosteal reactive new bone and osteoid deposition on the dead bone were also correlated with diffuse sclerosis. 6. Because it is difficult to differentiate sclerotic lesions in the tarsal bones by radiographic methods alone, all such lesions should be subject to biopsy as early as possible.

Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph: A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan.

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Chin-Hua Yang

Full Text Available Flatfoot (pes planus is one of the most important physical examination items for military new recruits in Taiwan. Currently, the diagnosis of flatfoot is mainly based on radiographic examination of the calcaneal-fifth metatarsal (CA-MT5 angle, also known as the arch angle. However, manual measurement of the arch angle is time-consuming and often inconsistent between different examiners. In this study, seventy male military new recruits were studied. Lateral radiographic images of their right and left feet were obtained, and mutual information (MI registration was used to automatically calculate the arch angle. Images of two critical bones, the calcaneus and the fifth metatarsal bone, were isolated from the lateral radiographs to form reference images, and were then compared with template images to calculate the arch angle. The result of this computer-calculated arch angle was compared with manual measurement results from two radiologists, which showed that our automatic arch angle measurement method had a high consistency. In addition, this method had a high accuracy of 97% and 96% as compared with the measurements of radiologists A and B, respectively. The findings indicated that our MI registration measurement method cannot only accurately measure the CA-MT5 angle, but also saves time and reduces human error. This method can increase the consistency of arch angle measurement and has potential clinical application for the diagnosis of flatfoot.

Comparative measurements of mineral salt concentrations in the calcaneus by 125I γ-absorption measurement in the course of fractures of the lower extremities

International Nuclear Information System (INIS)

Mehrlich, P.

1979-01-01

In a group of 52 patients aged between 16 and 78 years, all with fractures of the lower extremities, BMC concentrations were determined in a period from 10 weeks to 50 month after the accident in both calcaneal bones and the right ulna. The gamma absorption measurements were carried out in a single-isotope technique in a water bath, using a 125 I source as radionuclides. The results were evaluated by planimetrisation of the absorption curve. The patients were divided in groups according to clinically complicated, clinically uncomplicated, radiologically demineralized, and radiologically and clinically uncomplicated healing. In 11 patients, up to 4 measurements were also carried out as course control measures. The results differed in dependence of the patients' age. The localisation of the fracture had no effect on the degree of demineralisation. (orig./MG) [de

A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow.

Science.gov (United States)

Park, Il-Hyung; Micic, Ivan Dragoljub; Jeon, In-Ho

2008-02-01

The treatment of unicameral bone cyst varies from percutaneous needle biopsy, aspiration and local injection of steroid, autologous bone marrow, or demineralized bone matrix to curettage and open bone-grafting. The purpose of this study was to compare the results of open chip allogeneic bone graft versus percutaneous injection of demineralized bone powder with autogenous bone marrow in management of calcaneal cysts. Twenty-three calcaneal unicameral cysts in 20 patients were treated. Lyophilized irradiated chip allogeneic bone (CAB) and autogenous bone marrow were used for treatment of 13 cysts in 11 patients, and 10 cysts in 9 patients were treated with percutaneous injection of irradiated allogeneic demineralized bone powder (DBP) and autogenous bone marrow. There were 11 males and 9 female patients with mean age of 17 years. The patients were followed for an average of 49.4 months. Complete healing was achieved in 9 cysts treated with chip allogeneic bone and in 5 cysts treated with powdered bone. Four cysts treated with CAB and 3 cysts treated with DBP healed with a defect. Two cysts treated with powdered bone and autogenous bone marrow were classified as persistent. No infections or pathological fractures were observed during the followup period. Percutaneous injection of a mixture of allogeneic bone powder with autogenous bone marrow is a minimal invasive method and could be an effective alternative in the treatment of unicameral calcaneal bone cysts. The postoperative morbidity was low, the hospital stay was brief, and patient's comfort for unrestricted activity was enhanced.

Global body posture and plantar pressure distribution in individuals with and without temporomandibular disorder: a preliminary study.

Science.gov (United States)

Souza, Juliana A; Pasinato, Fernanda; Corrêa, Eliane C R; da Silva, Ana Maria T

2014-01-01

The aim of this study was to evaluate body posture and the distribution of plantar pressure at physiologic rest of the mandible and during maximal intercuspal positions in subjects with and without temporomandibular disorder (TMD). Fifty-one subjects were assessed by the Diagnostic Criteria for Research on Temporomandibular Disorders and divided into a symptomatic group (21) and an asymptomatic group (30). Postural analysis for both groups was conducted using photogrammetry (SAPo version 0.68; University of São Paulo, São Paulo, Brazil). The distribution of plantar pressures was evaluated by means of baropodometry (Footwork software), at physiologic rest and maximal intercuspal positions. Of 18 angular measurements, 3 (17%) were statistically different between the groups in photogrammetric evaluation. The symptomatic group showed more pronounced cervical distance (P = .0002), valgus of the right calcaneus (P = .0122), and lower pelvic tilt (P = .0124). The baropodometry results showed the TMD subjects presented significantly higher rearfoot and lower forefoot distribution than those in the asymptomatic group. No differences were verified in maximal intercuspal position in the between-group analysis and between the 2 mandibular positions in the within-group analysis. Subjects with and without TMD presented with global body posture misalignment. Postural changes were more pronounced in the subjects with TMD. In addition, symptomatic subjects presented with abnormal plantar pressure distribution, suggesting that TMD may have an influence on the postural system. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Correlation between hindfoot joint three-dimensional kinematics and the changes of the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot.

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Zhang, Yi-Jun; Xu, Jian; Wang, Yue; Lin, Xiang-Jin; Ma, Xin

2015-02-01

The aim of this study was to explore the correlation between the kinematics of the hindfoot joint and the medial arch angle change in stage II posterior tibial tendon dysfunction flatfoot three-dimensionally under loading. Computed tomography (CT) scans of 12 healthy feet and 12 feet with stage II posterior tibial tendon dysfunction flatfoot were taken both in non- and full-body-weight-bearing condition. The CT images of the hindfoot bones were reconstructed into three-dimensional models with Mimics and Geomagic reverse engineering software. The three-dimensional changes of the hindfoot joint were calculated to determine their correlation to the medial longitudinal arch angle. The medial arch angle change was larger in stage II posterior tibial tendon dysfunction flatfoot compared to that in healthy foot under loading. The rotation and translation of the talocalcaneal joint, the talonavicular joint and the calcanocuboid joint had little influence on the change of the medial arch angle in healthy foot. However, the eversion of the talocalcaneal joint, the proximal translation of the calcaneus relative to the talus and the dorsiflexion of talonavicular joint could increase the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot under loading. Joint instability occurred in patients with stage II posterior tibial tendon dysfunction flatfoot under loading. Limitation of over movement of the talocalcaneal joint and the talonavicular joint may help correct the medial longitudinal arch in stage II posterior tibial tendon dysfunction flatfoot. Copyright © 2014 Elsevier Ltd. All rights reserved.

Outcome of limb fracture repair in rabbits: 139 cases (2007-2015).

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Sasai, Hiroshi; Fujita, Daisuke; Seto, Eiko; Denda, Yuki; Imai, Yutaro; Okamoto, Kanako; Okamura, Kensaku; Furuya, Masaru; Tani, Hiroyuki; Sasai, Kazumi

2018-02-15

OBJECTIVE To evaluate outcome of limb fracture repair in rabbits. DESIGN Retrospective case series. ANIMALS 139 client-owned rabbits with limb fractures treated between 2007 and 2015. PROCEDURES Medical records were reviewed for information on fracture location, fracture treatment, and time to fracture healing. RESULTS 25 rabbits had fractures involving the distal aspects of the limbs (ie, metacarpal or metatarsal bones, phalanges, and calcaneus or talus). Fractures were treated in 23 of these 25 rabbits (external coaptation, n = 17; external skeletal fixation, 4; and intramedullary pinning, 2) and healed in all 23, with a median healing time of 28 days (range, 20 to 45 days). One hundred ten rabbits had long bone fractures, and fractures were treated in 100 of the 110 (external skeletal fixation, n = 89; bone plating, 1; intramedullary pinning, 3; and external coaptation, 7). The percentage of fractures that healed was significantly lower for open (14/18) than for closed (26/26) tibial fractures and was significantly lower for femoral (19/26) and treated humeral (4/6) fractures than for radial (23/24) or closed tibial (26/26) fractures. Micro-CT was used to assess fracture realignment during external skeletal fixator application and to evaluate fracture healing. CONCLUSIONS AND CLINICAL RELEVANCE The prognosis for rabbits with limb fractures was good, with fractures healing in most rabbits following fracture repair (109/123). Micro-CT was useful in assessing fracture realignment and evaluating fracture healing.

CT for diagnosing fractures of the undersurface of the talus and mechanism of injury

International Nuclear Information System (INIS)

Okamoto, Hideaki; Shibata, Yoshimori; Nishi, Genzaburo; Tago, Kyoji; Tsuchiya, Daiji; Chiba, Takehiro; Okumura, Hisashi; Ikeda, Takeshi; Wada, Ikuo

2000-01-01

Talus fractures whose fracture lines extend to the subtalar joint, except fractures of the neck and the body of the talus, are defined as fractures of the lower portion of the talus. It is difficult to make a correctly diagnosis of inferior fractures of the talus by plain radiography or tomography alone. The author encountered 12 cases of inferior fractures of the talus between 1989 and 1997, and CT imaging in 2 directions, in the horizontal and frontal plane, was useful in making the diagnosis. The correct diagnosis rate was 100%, and differentiation of the site and extent of the fractures was possible. Based on the CT findings, the fractures were classified into 8 types (fractures of the lateral process of the talus, fractures of the medial tubercle, fractures of the posterior process, and combinations of the above, and comminuted fractures). The mechanism of the injuries was also investigated, and the fractures of the lateral process of the talus seemed to have been caused by excessive eversion force on the ankle joint, with the lateral process becoming trapped between the fibula and the calcaneus. Medial tubercle fractures also seemed to be caused by forcible inversion of the ankle, with the tip of the medial malleous impacting and the medial tubercle being trapped between it and the sustentaculum tali. The comminuted fractures seem to have been caused by axial compression added to various of external forces. (K.H.)

Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis.

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Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E

2017-09-01

Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

A 3-year physical activity intervention program increases the gain in bone mineral and bone width in prepubertal girls but not boys: the prospective copenhagen school child interventions study (CoSCIS).

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Hasselstrøm, H A; Karlsson, M K; Hansen, S E; Grønfeldt, V; Froberg, K; Andersen, L B

2008-10-01

The aim of this study was to evaluate the effect of increasing the amount of time spent in physical education classes on bone mineral accrual and gain in bone size in prepubertal Danish children. A total of 135 boys and 108 girls, aged 6-8 years, were included in a school-based curriculum intervention program where the usual time spent in physical education classes was doubled to four classes (180 min) per week. The control group comprised age-matched children (62 boys and 76 girls) recruited from a separate community who completed the usual Danish school curriculum of physical activity (90 min/week). Dual-energy X-ray absorptiometry was used to evaluate bone mineral content (BMC; g), bone mineral density (g/cm(2)), and bone width at the calcaneus and distal forearm before and after 3 years of intervention. Anthropometrics and Tanner stages were evaluated on the same occasions. General physical activity was measured with an accelerometer worn for 4 days. In girls, the intervention group had a 12.5% increase (P = 0.04) in distal forearm BMC and a 13.2% increase (P = 0.005) in distal forearm scanned area compared with girls in the control group. No differences were found between the intervention and control groups in boys. Increasing the frequency of physical education classes for prepubertal children is associated with a higher accrual of bone mineral and higher gain in bone size after 3 years in girls but not in boys.

Additional diagnostic value of digital radiology in plantar fasciitis diagnosis

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Marcel Prasetyo

2017-08-01

Full Text Available Background: Ultrasonography (USG is regarded as the gold standard to differentiate normal plantar fascia and plantar fasciitis. Conventional radiography or plain X-ray is typically used to exclude differential diagnosis. Lately, conventional radiography has been digitalized and leads to better visualization of the soft tissue. However, it is not known whether digital radiography evaluation for calcaneus area, both qualitative and quantitative, has a similar diagnostic value as USG findings. Therefore, this study aimed to evaluate whether there is a strong correlation between digital radiographic and USG findings for diagnosing plantar fasciitis.Methods: This is a cross sectional study examining adult patients (>18 years old presenting with inferior heel pain. Plantar aponeurosis thickness was measured by digital radiography and ultrasonography; measurement was performed three times in each modality, and the average value was recorded. Fat stranding, presence of calcaneal enthesophyte, and microfracture were also evaluated in digital radiography. Measurement results were classified into plantar fasciitis diagnosis using the cut-off value 4 mm.Results: There was no significant correlation between plantar aponeurosis thickness measured by digital radiography and by ultrasonography (r=0.069, p=0.688. There was no significant association between plantar fasciitis diagnosis by digital radiography and ultrasonography (p=0.162. However, digital radiography showed good sensitivity to detect plantar fasciitis using a cut-off value of >4 mm plantar fascia thickness.Conclusion: Digital radiography might be used to aid definitive diagnosis for plantar fasciitis.

Treatment of acute achilles tendon rupture with the panda rope bridge technique.

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Yin, Liangjun; Wu, Yahong; Ren, Changsong; Wang, Yizhong; Fu, Ting; Cheng, Xiangjun; Li, Ruidong; Nie, Mao; Mu, Yuan

2018-03-01

Although nonsurgical methods and many surgical techniques have been developed for repairing a ruptured Achilles tendon, there is no consensus on its best treatment. In this article, a novel minimally invasive technique called the Panda Rope Bridge Technique (PRBT) is described. Patient with acute Achilles tendon rupture was operated on in the prone position. The PRBT begin with making the proximal bridge anchor (Krackow sutures in the myotendinous junction), the distal bridge anchor (two suture anchors in the calcaneus bone) and the ropes (threads of the suture anchors) stretched between the anchor sites. Then a small incision was made to debride and reattach the stumps of ruptured tendon. After the surgery, no cast or splint fixation was applied. All patients performed enhanced recovery after surgery (ERAS), which included immediate ankle mobilisation from day 1, full weight-bearing walking from day 5 to 7, and gradually take part in athletic exercises from 8 weeks postoperatively. PBRT was performed in 11patients with acute Achilles tendon rupture between June 2012 and June 2015. No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re-rupture was found. One year after the surgery, all patients reported 100 AOFAS ankle-hindfoot score points and the mean ATRS was 96.6. The PRBT is a simple, effective and minimally invasive technique, with no need for immobilisation of the ankle, making possible immediate and aggressive postoperative rehabilitation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Dioxin-like compounds are not associated with bone strength measured by ultrasonography in Inuit women from Nunavik (Canada): results of a cross-sectional study.

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Paunescu, Alexandra-Cristina; Ayotte, Pierre; Dewailly, Eric; Dodin, Sylvie

2013-01-01

Bone strength in Inuit people appears lower than that of non-Aboriginals. Inuit are exposed to persistent organic pollutants including dioxin-like compounds (DLCs) through their traditional diet that comprises predatory fish and marine mammal fat. Results from experimental and population studies suggest that some DLCs can alter bone metabolism and increase bone fragility. This cross-sectional descriptive study was conducted to examine the relationship between the stiffness index (SI) and plasma concentrations of total DLCs or specific dioxin-like polychlorinated biphenyls (DL-PCBs) in Inuit women of Nunavik (Northern Quebec, Canada). SI was determined by ultrasonography at the right calcaneus of 194 Inuit women aged 35-72 years who participated to Qanuippitaa? How Are We? Nunavik Inuit Health Survey in 2004. Plasma total DLC levels were quantified by measuring the aryl hydrocarbon receptor-mediated transcriptional activity elicited by plasma sample extracts in a cell-based reporter gene assay. Plasma concentrations of DL-PCBs nos. 105, 118, 156, 157, 167 and 189 were measured by gas chromatography-mass spectrometry. We used multiple linear regression analyses to investigate relations between total DLCs or specific DL-PCBs and SI, taking into consideration several potential confounders. Neither total plasma DLCs nor specific DL-PCBs were associated with SI after adjustment for several confounders and covariates. Our results do not support a relation between exposure to DLCs and bone strength measured by ultrasonography in Inuit women of Nunavik.

Template-based automatic extraction of the joint space of foot bones from CT scan

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Park, Eunbi; Kim, Taeho; Park, Jinah

2016-03-01

Clean bone segmentation is critical in studying the joint anatomy for measuring the spacing between the bones. However, separation of the coupled bones in CT images is sometimes difficult due to ambiguous gray values coming from the noise and the heterogeneity of bone materials as well as narrowing of the joint space. For fine reconstruction of the individual local boundaries, manual operation is a common practice where the segmentation remains to be a bottleneck. In this paper, we present an automatic method for extracting the joint space by applying graph cut on Markov random field model to the region of interest (ROI) which is identified by a template of 3D bone structures. The template includes encoded articular surface which identifies the tight region of the high-intensity bone boundaries together with the fuzzy joint area of interest. The localized shape information from the template model within the ROI effectively separates the bones nearby. By narrowing the ROI down to the region including two types of tissue, the object extraction problem was reduced to binary segmentation and solved via graph cut. Based on the shape of a joint space marked by the template, the hard constraint was set by the initial seeds which were automatically generated from thresholding and morphological operations. The performance and the robustness of the proposed method are evaluated on 12 volumes of ankle CT data, where each volume includes a set of 4 tarsal bones (calcaneus, talus, navicular and cuboid).

Dioxin-like compounds are not associated with bone strength measured by ultrasonography in Inuit women from Nunavik (Canada: results of a cross-sectional study

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Alexandra-Cristina Paunescu

2013-05-01

Full Text Available Background. Bone strength in Inuit people appears lower than that of non-Aboriginals. Inuit are exposed to persistent organic pollutants including dioxin-like compounds (DLCs through their traditional diet that comprises predatory fish and marine mammal fat. Results from experimental and population studies suggest that some DLCs can alter bone metabolism and increase bone fragility. Objective. This cross-sectional descriptive study was conducted to examine the relationship between the stiffness index (SI and plasma concentrations of total DLCs or specific dioxin-like polychlorinated biphenyls (DL-PCBs in Inuit women of Nunavik (Northern Quebec, Canada. Methods. SI was determined by ultrasonography at the right calcaneus of 194 Inuit women aged 35–72 years who participated to Qanuippitaa? How Are We? Nunavik Inuit Health Survey in 2004. Plasma total DLC levels were quantified by measuring the aryl hydrocarbon receptor–mediated transcriptional activity elicited by plasma sample extracts in a cell-based reporter gene assay. Plasma concentrations of DL-PCBs nos. 105, 118, 156, 157, 167 and 189 were measured by gas chromatography–mass spectrometry. We used multiple linear regression analyses to investigate relations between total DLCs or specific DL-PCBs and SI, taking into consideration several potential confounders. Results. Neither total plasma DLCs nor specific DL-PCBs were associated with SI after adjustment for several confounders and covariates. Conclusion. Our results do not support a relation between exposure to DLCs and bone strength measured by ultrasonography in Inuit women of Nunavik.

Differences in foot kinematics between young and older adults during walking.

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Arnold, John B; Mackintosh, Shylie; Jones, Sara; Thewlis, Dominic

2014-02-01

Our understanding of age-related changes to foot function during walking has mainly been based on plantar pressure measurements, with little information on differences in foot kinematics between young and older adults. The purpose of this study was to investigate the differences in foot kinematics between young and older adults during walking using a multi-segment foot model. Joint kinematics of the foot and ankle for 20 young (mean age 23.2 years, standard deviation (SD) 3.0) and 20 older adults (mean age 73.2 years, SD 5.1) were quantified during walking with a 12 camera Vicon motion analysis system using a five segment kinematic model. Differences in kinematics were compared between older adults and young adults (preferred and slow walking speeds) using Student's t-tests or if indicated, Mann-Whitney U tests. Effect sizes (Cohen's d) for the differences were also computed. The older adults had a less plantarflexed calcaneus at toe-off (-9.6° vs. -16.1°, d = 1.0, p = range of motion (ROM) of the midfoot (11.9° vs. 14.8°, d = 1.3, p = young adults. Walking speed did not influence these differences, as they remained present when groups walked at comparable speeds. The findings of this study indicate that independent of walking speed, older adults exhibit significant differences in foot kinematics compared to younger adults, characterised by less propulsion and reduced mobility of multiple foot segments. Copyright © 2013 Elsevier B.V. All rights reserved.

Differential vulnerability of 3 rapidly conducting somatosensory pathways in the dog with vitamin B6 neuropathy.

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Schaeppi, U; Krinke, G

1985-09-01

In anesthetized dogs with chronically implanted cortical electrodes somatic sensory-evoked potentials (SEPs) were produced by electrical stimulation at neural, muscular or cutaneous sites of the contralateral hind leg. Stimulation of the tibial nerve at the calcaneus or of the short flexor muscles of the hind paw caused SEPs having characteristics following activation of rapidly conducting afferents from muscle spindles. Stimulation of the glabrous skin of the central pad resulted in SEPs arriving after a more protracted latency evidently related to activation of afferents from Merkel cells, Krause and Pacinian corpuscles known to be located at these sites. Stimulation of the hairy skin from the dorsal surface of the hindpaw produced a further type of SEP presumably resulting from activation of afferents from receptors of tylotrich hair follicles. Vitamin B6-induced neuropathy involves the selective degeneration of the largest neurons in the spinal ganglia and of associated long peripheral and central neurites performing rapid impulse transmission. In the course of vitamin B6 neuropathy the relatively slow impulse transmission following stimulation of the central pad was more severely impaired than the faster one after activation of afferents from muscle spindles or receptors from hair follicles. This allows us to conclude that in the dog afferents from the glabrous skin of the central pad conduct centrally via the dorsal columns, susceptible to vitamin B6 intoxication, while muscle and hair receptor afferents ascend in the dorsal spinocerebellar and spinocervical tract, respectively, which are vitamin B6 resistant.

CT for diagnosing fractures of the undersurface of the talus and mechanism of injury

Energy Technology Data Exchange (ETDEWEB)

Okamoto, Hideaki; Shibata, Yoshimori; Nishi, Genzaburo; Tago, Kyoji; Tsuchiya, Daiji; Chiba, Takehiro; Okumura, Hisashi [Aichiken Koseiren Kainan Hospital, Yatomi (Japan); Ikeda, Takeshi; Wada, Ikuo

2000-02-01

Talus fractures whose fracture lines extend to the subtalar joint, except fractures of the neck and the body of the talus, are defined as fractures of the lower portion of the talus. It is difficult to make a correctly diagnosis of inferior fractures of the talus by plain radiography or tomography alone. The author encountered 12 cases of inferior fractures of the talus between 1989 and 1997, and CT imaging in 2 directions, in the horizontal and frontal plane, was useful in making the diagnosis. The correct diagnosis rate was 100%, and differentiation of the site and extent of the fractures was possible. Based on the CT findings, the fractures were classified into 8 types (fractures of the lateral process of the talus, fractures of the medial tubercle, fractures of the posterior process, and combinations of the above, and comminuted fractures). The mechanism of the injuries was also investigated, and the fractures of the lateral process of the talus seemed to have been caused by excessive eversion force on the ankle joint, with the lateral process becoming trapped between the fibula and the calcaneus. Medial tubercle fractures also seemed to be caused by forcible inversion of the ankle, with the tip of the medial malleous impacting and the medial tubercle being trapped between it and the sustentaculum tali. The comminuted fractures seem to have been caused by axial compression added to various of external forces. (K.H.)

Preditores espaço-temporais do andar para testes de capacidade funcional em pacientes com doença de Parkinson Gait spatial and temporal predictors for functional capacity tests in Parkinson's disease patients

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MDR Sánchez-Arias

2008-10-01

Full Text Available OBJETIVOS: Determinar quais parâmetros espaço-temporais são preditores do andar de indivíduos com doença de Parkinson idiopática para os testes de resistência aeróbia e agilidade, propostos pela bateria de testes da American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD. MATERIAIS E MÉTODOS: Foram selecionados seis homens e seis mulheres com comprometimento e estágio da doença em níveis leve e moderado, que realizaram os testes de agilidade e resistência aeróbia, conforme o protocolo da AAHPERD, e andaram 8m sobre uma passarela. Uma câmera digital registrou uma passada central. Marcadores foram fixados no quinto metatarso e na face lateral do calcâneo do membro inferior direito e no primeiro metatarso e na face medial do calcâneo do membro inferior esquerdo. As variáveis dependentes selecionadas foram: tempo nos testes de agilidade e resistência e as variáveis cinemáticas (comprimento da passada - CP, cadência - CAD, duração da passada - DP, duração da fase de duplo suporte - DDS, duração do suporte simples - SS, duração da fase de balanço - DB e velocidade da passada - VP. RESULTADOS: Para agilidade, o teste de Pearson apontou correlação estatisticamente significativa entre as variáveis CP (r=-0,70; pOBJECTIVE: To determine which spatial and temporal parameters are predictors of the gait pattern of individuals with idiopathic Parkinson's disease, for the aerobic endurance and agility tests included in the battery of tests of the AAHPERD protocol. METHODS: Six men and six women with mild and moderate impairment and disease stage were selected. They performed agility and aerobic endurance test in accordance with the AAHPERD protocol, and walked 8 m on a walkway. A digital video camera recorded one central stride. Markers were attached to the fifth metatarsal and lateral face of the calcaneus of the right leg and to the first metatarsal and medial face of the calcaneus of the left leg. The

Skeletal deformations of newborn mice after X-ray exposure in fetal stage, with particular regard to hyperplastic growth phenomena in the neurocranium

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Meyer, I.

1980-11-01

The following comprises a literary review of the effects of prenatal X-ray irradiation, known mainly from the mouse. Our own investigations were carried out with NMRI mice which on gestation days 11-13, 11-16 or 14-16 were exposed to whole-body irradiation comprising individual daily doses of between 80 and 160 R. All the examinations were carried out on the 18th day of gestation. Findings of special nature were ascertained on the talus and calcaneus. These bones indicate that the X-ray irradiation has an accelerating effect on development. It was possible to ascertain a corresponding effect with regard to the deformations of the os supraoccipital. After irradiation with 3 x 120 R and 3 x 160 R on the 11th-13th gestation days, both inhibitory deformities and also the occurence of an additional, novel bone anlage were observed. These findings were subjected to detailed histological examinations. In doing so, it was found that following a single irradiation with 200 R on the 12th day of gestation, 86,6% of the fetuses showed hyperostoses on the roof of the skull. In 13,2% of all cases there was in addition a clear, abnormal chondrification of the neurocranium, at the same time combined with an excessive formation of the bone, which protruded deep into the cerebral hemispheres. The patogeneses of this excessive growth phenomenon is explained on the basis of the complex relationship between the fetal brain formation and the formation of the skull cap.

Thyrotropin serum levels are differentially associated with biochemical markers of bone turnover and stiffness in women and men: results from the SHIP cohorts.

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Tsourdi, E; Wallaschofski, H; Rauner, M; Nauck, M; Pietzner, M; Rettig, R; Ittermann, T; Völzke, H; Völker, U; Hofbauer, L C; Hannemann, A

2016-02-01

In two large German population-based cohorts, we showed positive associations between serum thyrotropin (TSH) concentrations and the Fracture Risk Assessment score (FRAX) in men and positive associations between TSH concentrations and bone turnover markers in women. The role of thyroid hormones on bone stiffness and turnover is poorly defined. Existing studies are confounded by differences in design and small sample size. We assessed the association between TSH serum concentrations and bone stiffness and turnover in the SHIP cohorts, which are two population-based cohorts from a region in Northern Germany comprising 2654 men and women and 3261 men and women, respectively. We calculated the bone stiffness index using quantitative ultrasound (QUS) at the calcaneus, employed FRAX score for assessment of major osteoporotic fractures, and measured bone turnover markers, N-terminal propeptide of type I procollagen (P1NP), bone-specific alkaline phosphatase (BAP), osteocalcin, and type I collagen cross-linked C-telopeptide (CTX) in all subjects and sclerostin in a representative subgroup. There was no association between TSH concentrations and the stiffness index in both genders. In men, TSH correlated positively with the FRAX score both over the whole TSH range (p < 0.01) and within the reference TSH range (p < 0.01). There were positive associations between TSH concentrations and P1NP, BAP, osteocalcin, and CTX (p < 0.01) in women but not in men. There was no significant association between TSH and sclerostin levels. TSH serum concentrations are associated with gender-specific changes in bone turnover and stiffness.

Comparison of the Calcaneal Pitch Angle and Modified Projection Area Per Length Squared Method for Medial Longitudinal Arch Evaluation of the Foot

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Esat Kıter2

2012-12-01

Full Text Available Objective: To compare the calcaneal pitch angle (CPA values measured on direct lateral radiographs of feet, and the modified projection area per length squared (PAL, which was calculated as a new method for the evaluation of the medial longitudinal arch (MLA of the foot.Material and Methods: Direct lateral radiographs of patients who had weightbearing feet radiographies for any reason except trauma were retrospectively obtained from the archives. Direct lateral radiographs of the feet were printed and a transparent sheet was placed on it. A straight line was drawn between the most plantar process of the calcaneus and the head of the first metatarsal bone for the calculation of the PAL of the MLA. Two semilunar arcs were drawn upon this straight line. PAL1 and PAL2 were estimated using a point-counting technique. The CPA, lateral talo-calcaneal angles (LTCA, and talo-first metatarsal angles (TFMA were measured. The correlations between PAL1, PAL2 of right and left feet and CPA, LTCA, and TFMA were explored.Results: Fifty patients (27 females, 23 males with a mean age of 40.12 (4-78 years were evaluated. Significant correlations were detected between PAL1, PAL2 and CPA, and TFMA for both right and left feet (p<0.05. Conclusion: A significant correlation was detected between the modified PAL method as a new technique and the standard CPA method for MLA evaluation. The PAL method is suggested as a simple and practical method for MLA evaluation.

Fetal development of the pulley for muscle insertion tendons: A review and new findings related to the tensor tympani tendon.

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Rodríguez-Vázquez, Jose Francisco; Honkura, Yohei; Katori, Yukio; Murakami, Gen; Abe, Hiroshi

2017-01-01

The existence of hard tissue pulleys that act to change the direction of a muscle insertion tendon is well known in the human body. These include (1) the trochlea for the extraocular obliquus superior muscle, (2) the pterygoid hamulus for the tensor veli palatini muscle, (3) the deep sulcus on the plantar aspect of the cuboid bone for the peroneus longus tendon, (4) the lesser sciatic notch for the obturator internus muscle, and (5) the bony trochleariformis process for the tensor tympani muscle tendon. In addition, (6) the stapedius muscle tendon shows a lesser or greater angulation at the pyramidal eminence of the temporal bone. Our recent studies have shown that the development of pulleys Nos. 1 and 2 can be explained by a change in the topographical relationship between the pulley and the tendon, that of pulley No. 3 by the rapidly growing calcaneus pushing the tendon, and that of pulley No. 4 by migration of the insertion along the sciatic nerve and gluteus medius tendon. Therefore, in Nos. 1-4, an initially direct tendon curves secondarily and obtains an attachment to the pulley. In case No. 6, the terminal part of the stapedius tendon originates secondarily from the interzone mesenchymal tissue of the incudostapedial joint. In the case of pulley No. 5, we newly demonstrated that its initial phase of development was similar to No. 6, but the tensor tympani tendon achieved a right-angled turn under guidance by a specific fibrous tissue and it migrated along the growing malleus manubrium. Copyright © 2016 Elsevier GmbH. All rights reserved.

Biomechanical consequences of plantar fascial release or rupture during gait. Part II: alterations in forefoot loading.

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Sharkey, N A; Donahue, S W; Ferris, L

1999-02-01

With a model using feet from cadavers, we tested the hypothesis that plantar fascial release or rupture alters the loading environment of the forefoot during the latter half of the stance phase of gait. The model simulated the position and loading environment of the foot at two instants: early in terminal stance immediately after heel-off and late in terminal stance just preceding contralateral heel strike. Eight feet were loaded at both positions by simulated plantar flexor contraction, and the distribution of plantar pressure was measured before and after progressive release of the plantar fascia. Strain in the diaphysis of the second metatarsal was also measured, from which the bending moments and axial force imposed on the metatarsal were calculated. Cutting the medial half of the central plantar fascial band significantly increased peak pressure under the metatarsal heads but had little effect on pressures in other regions of the forefoot or on second metatarsal strain and loading. Dividing the entire central band or completely releasing the plantar fascia from the calcaneus had a much greater effect and caused significant shifts in plantar pressure and force from the toes to beneath the metatarsal heads. These shifts were accompanied by significantly increased strain and bending in the second metatarsal. Complete fasciotomy increased the magnitude of strain in the dorsal aspect of the second metatarsal by more than 80%, suggesting that plantar fascial release or rupture accelerates the accumulation of fatigue damage in these bones. Altered forefoot loading may be a potential complication of plantar fasciotomy.

Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

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Rossi, Ignacio [Musculoskeletal Research Fellow at NYU Langone Medical Center, New York, NY (United States); Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires (Argentina); Rosenberg, Zehava [NYU Langone Medical Center, New York, NY (United States); Zember, Jonathan [Albert Einstein College of Medicine Jacobi Medical Center, Bronx, NY (United States)

2016-04-15

Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

High-resolution US and MR imaging of peroneal tendon injuries.

Science.gov (United States)

Taljanovic, Mihra S; Alcala, Jennifer N; Gimber, Lana H; Rieke, Joshua D; Chilvers, Margaret M; Latt, L Daniel

2015-01-01

Injuries of the peroneal tendon complex are common and should be considered in every patient who presents with chronic lateral ankle pain. These injuries occur as a result of trauma (including ankle sprains), in tendons with preexisting tendonopathy, and with repetitive microtrauma due to instability. The peroneus brevis and peroneus longus tendons are rarely torn simultaneously. Several anatomic variants, including a flat or convex fibular retromalleolar groove, hypertrophy of the peroneal tubercle at the lateral aspect of the calcaneus, an accessory peroneus quartus muscle, a low-lying peroneus brevis muscle belly, and an os peroneum, may predispose to peroneal tendon injuries. High-resolution 1.5-T and 3-T magnetic resonance (MR) imaging with use of dedicated extremity coils and high-resolution ultrasonography (US) with high-frequency linear transducers and dynamic imaging are proved to adequately depict the peroneal tendons for evaluation and can aid the orthopedic surgeon in injury management. An understanding of current treatment approaches for partial- and full-thickness peroneal tendon tears, subluxation and dislocation of these tendons with superior peroneal retinaculum (SPR) injuries, intrasheath subluxations, and peroneal tendonopathy and tenosynovitis can help physicians achieve a favorable outcome. Patients with low functional demands do well with conservative treatment, while those with high functional demands may benefit from surgery if nonsurgical treatment is unsuccessful. Radiologists should recognize the normal anatomy and specific pathologic conditions of the peroneal tendons at US and MR imaging and understand the various treatment options for peroneal tendon and SPR superior peroneal retinaculum injuries. Online supplemental material is available for this article. RSNA, 2015

[Dietary patterns in college freshmen and its relation to bone mineral density].

Science.gov (United States)

Wang, Sufang; Mu, Min; Zhao, Yan; Wang, Xiaoqin; Shu, Long; Li, Qingyan; Li, Yingchun

2012-07-01

In order to investigate the bone density of freshmen, and to analyze the association between dietary pattern and bone mineral density (BMD). A questionnaire survey on the situation of dietary pattern was conducted in 1414 freshmen. Effective dietary survey questionnaires and bone mineral density measurements were completed for 1319 participants. Bone mass was assessed by using an Ultrasound Bone Densitometer on the right calcaneus (CM-200, Furuno Electric Corporation, Japan), and the speed of sound (SOS, m/s) was used as an indicator for bone density. Factor analysis with varimax rotation was used to identify the dietary patterns. After adjusting for confounders, covariance with Bonferroni's was used to further examine the associations between dietary patterns and bone mineral density (BMD). (1) Four major dietary patterns were noticed. Western food pattern (high consumption in hamburger, fried food, nuts, biscuit, chocolate, cola, coffee, sugars). Animal protein pattern (high consumption in pork, mutton, beef, poultry meat, animal liver). Calcium pattern (high consumption in fresh fruits, eggs, fish and shrimps, kelp laver and sea fish, milk and dairy products, beans and bean products). Traditional Chinese pattern (high consumption in rice and grain, fresh fruits, fresh vegetables, pork). (2) No association was observed between the western food pattern and bone mineral density. High animal protein pattern showed lower SOS value compared with low animal protein pattern. High calcium pattern showed higher SOS value compared with low calcium pattern. High traditional Chinese pattern showed higher SOS value compared with the low traditional Chinese pattern. Dietary patterns are closely related with bone mineral density (BMD) of freshmen.

Risk factors for hip fracture among institutionalised older people.

Science.gov (United States)

Chen, Jian Sheng; Sambrook, Philip N; Simpson, Judy M; Cameron, Ian D; Cumming, Robert G; Seibel, Markus J; Lord, Stephen R; March, Lyn M

2009-07-01

risk factors for hip fracture in community-dwelling individuals have been extensively studied, but there have been fewer studies of institutionalised older people. a total of 1,894 older people (1,433 females, 461 males; mean age 86 years, SD 7.1 years) were recruited from 52 nursing homes and 30 intermediate-care nursing care facilities in Australia during March 1999 and February 2003. We assessed clinical risk factors for hip fracture and skeletal fragility by calcaneus broadband ultrasound attenuation (BUA) at baseline and then followed up for fracture for 4 years. Hip fractures were validated by x-ray reports. Survival analysis with age as a time-dependent covariate was used to analyse the data. during a mean follow-up period of 2.65 years (SD 1.38), 201 hip fractures in 191 residents were recorded, giving an overall hip fracture incidence rate of 4.0% per person year (males 3.6% and females 4.1%). Residents living in intermediate-care hostels had a higher crude hip fracture rate (4.6% vs. 3.0%) than those living in high-care nursing homes. In multivariate analysis, an increased risk of hip fracture was significantly associated with older age, cognitive impairment, a history of fracture since age 50, lower body weight, longer lower leg length and poorer balance in intermediate-care hostel residents, but not with lower BUA. institutionalised older people, who are at a higher risk of hip fracture than community-dwelling individuals, have differences in some risk factors for hip fracture that should be considered in targeting intervention programs.

Medial subtalar dislocation: Case report

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Manojlović Radovan

2010-01-01

Full Text Available Introduction. Subtalar dislocation (SI is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact. Case Outline. A case of medial subtalar dislocation as a result of basketball injury, so-called 'basketball foot', is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone. Conclusion. Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.

Effect of age and disease on bone mass in Japanese patients with schizophrenia.

Science.gov (United States)

Sugawara, Norio; Yasui-Furukori, Norio; Umeda, Takashi; Tsuchimine, Shoko; Fujii, Akira; Sato, Yasushi; Saito, Manabu; Furukori, Hanako; Danjo, Kazuma; Matsuzaka, Masashi; Takahashi, Ippei; Kaneko, Sunao

2012-02-20

There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan. We recruited patients (n = 362), aged 48.8 ± 15.4 (mean ± SD) years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI) was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community. Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males. Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender.

CALCANEAL MINERAL DENSITY IN CHILDREN ATHLETES AND TAKE-OFF LEG

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Borislav Obradović

2010-06-01

Full Text Available It is well-known that physical activity has an anabolic effect on the bone tissue. To examine the influence of the take-off lower limb to the bone density we studied a group of prepubertal boys and girls at the initial phase of their peak bone mass acquisition. A sample consisted of 60 subjects ie., 32 soccer players (boys, 10.7±0.5 years old and 28 swimmers (15 girls and 13 boys, 10.8±0.8 years old, who had performed at least one year of high-level sport training (10-15 hours per week for soccer players, 8-12 hours per week for swimmers. The sample was divided into two groups: the first consisted of 40 subjects, with the left take-off leg, while the second consisted of 20 subjects, with the right take-off leg. The bone mineral density (BMD measurements of the left and the right calcaneus were performed using ultrasound densitometer “Sahara” (Hologic, Inc., MA, USA. There were no significant differences between the groups in regard to BUA and SOS of both the left and the right take-off lower legs. Mean BUA of the take-off left leg and the take-off right leg were different, but not significantly (p>0.05. Likewise, mean SOS of the take-off left leg and the take-off right leg were different, but it was not significant (p>0.05. The results do not indicate that the take-off lower limb has an influence on calcaneal bone mineral density.

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

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Pascual Huerta, Javier [Department of Podiatry, Universidad Europea de Madrid (Spain)]. E-mail: javier.pascual@uem.es; Alarcon Garcia, Juan Maria [Ultrasound Unit, Hospital Nuestra Senora de America, Madrid (Spain)

2007-06-15

Purpose: The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. Material and methods: The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1 cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. Results: There were statistically significant differences in plantar fascia thickness at the four different locations (p < 0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1 cm proximal to the insertion. At origin and 1 cm distal to insertion weight was an independent predictor of plantar fascia thickness. Conclusions: There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1 cm proximal to the insertion is influenced by sex and thickness at origin and at 1 cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.

Sonographic evaluation of plantar fasciitis

Energy Technology Data Exchange (ETDEWEB)

Yoon, Sook Ja; Choi, Yun Sun; Tien, Kuang Lung; Jung, Hye Jeon; Lee, Kyoung Tae; Yoon, Yong Kyu [Eulji College of Medicine Eulji Hospital, Seoul (Korea, Republic of)

1999-03-01

To evaluate the sonographic findings of plantar fasciitis. Both feet of 30 patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthy volunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel pain was unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. We also evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis(3.2-8mm; mean, 5.1{+-}1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5{+-}0.78)(p<0.0001), in which it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0{+-}0.71)(p<0.0001). The proximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and in none of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%), and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomatic heels(5.9%). In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinical diagnosis.

Sonographic evaluation of plantar fasciitis

International Nuclear Information System (INIS)

Yoon, Sook Ja; Choi, Yun Sun; Tien, Kuang Lung; Jung, Hye Jeon; Lee, Kyoung Tae; Yoon, Yong Kyu

1999-01-01

To evaluate the sonographic findings of plantar fasciitis. Both feet of 30 patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthy volunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel pain was unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. We also evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis(3.2-8mm; mean, 5.1±1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5±0.78)(p<0.0001), in which it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0±0.71)(p<0.0001). The proximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and in none of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%), and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomatic heels(5.9%). In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinical diagnosis

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

International Nuclear Information System (INIS)

Pascual Huerta, Javier; Alarcon Garcia, Juan Maria

2007-01-01

Purpose: The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. Material and methods: The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1 cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. Results: There were statistically significant differences in plantar fascia thickness at the four different locations (p < 0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1 cm proximal to the insertion. At origin and 1 cm distal to insertion weight was an independent predictor of plantar fascia thickness. Conclusions: There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1 cm proximal to the insertion is influenced by sex and thickness at origin and at 1 cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects

Evaluation of a New Knotless Suture Anchor Repair in Acute Achilles Tendon Ruptures: A Biomechanical Comparison of Three Techniques.

Science.gov (United States)

Cottom, James M; Baker, Joseph S; Richardson, Phillip E; Maker, Jared M

Acute ruptures of the Achilles tendon are a common injury, and debate has continued in published studies on how best to treat these injuries. Specifically, controversy exists regarding the surgical approaches for Achilles tendon repair when one considers percutaneous versus open repair. The present study investigated the biomechanical strength of 3 different techniques for Achilles tendon repair in a cadaveric model. A total of 36 specimens were divided into 3 groups, each of which received a different construct. The first group received a traditional Krackow suture repair, the second group was repaired using a jig-assisted percutaneous suture, and the third group received a repair using a jig-assisted percutaneous repair modified with suture anchors placed into the calcaneus. The specimens were tested with cyclical loading and to ultimate failure. Cyclical loading showed a trend toward a stronger repair with the use of suture anchors after 10 cycles (p = .295), 500 cycles (p = .120), and 1000 cycles (p = .040). The ultimate load to failure was greatest in the group repaired with the modified knotless technique using the suture anchors (p = .098). The results of the present study show a clear trend toward a stronger construct in Achilles repair using a knotless suture anchor technique, which might translate to a faster return to activity and be more resistant to an early and aggressive rehabilitation protocol. Further clinical studies are warranted to evaluate this technique in a patient population. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Physical activity effects on bone metabolism.

Science.gov (United States)

Smith, E L; Gilligan, C

1991-01-01

The incidence of osteoporotic fractures rises exponentially with age and is increasing faster than the demographic increase in the aging population. Physical activity has great potential to reduce the risk for osteoporotic fractures. Three independent but interactive factors contribute to the risk of fractures: bone strength, the risk of falling, and the effectiveness of neuromuscular response that protects the skeleton from injury. Exercise can reduce fracture risk not only by preventing bone loss, but by decreasing the risk of falling and the force of impact by improving strength, flexibility, balance, and reaction time. Extreme inactivity causes rapid bone loss of up to 40%, while athletic activity results in bone hypertrophy of up to 40%. Exercise intervention programs have reduced bone loss or increased bone mass in both men and women of various ages and initial bone status. These benefits have been shown for arm bone mineral content, total body calcium, spine, calcium bone index, tibia, and calcaneus. In both middle-aged and elderly women, physical activity intervention reduced bone loss or increased bone mass. The mechanisms for maintenance of skeletal integrity rely on a cellular response to hormonal and mechanical load stimuli. Studies in animal models show that training affects cellular activity. In osteoporotics, cellular erosion is increased and mineral apposition rate (MAR) decreased compared with normal age-matched controls. In contrast to this, sows trained on a treadmill 20 min per day for 20 weeks had greater active periosteal surface, periosteal MAR, and osteonal MAR than untrained sows.

Polyunsaturated fatty acids and calcaneal ultrasound parameters among Inuit women from Nuuk (Greenland): a longitudinal study.

Science.gov (United States)

Paunescu, Alexandra-Cristina; Ayotte, Pierre; Dewailly, Eric; Dodin, Sylvie; Pedersen, Henning S; Mulvad, Gert; Côté, Suzanne

2013-01-01

The traditional diet of Inuit people comprises large amounts of fish and marine mammals that are rich in omega-3 polyunsaturated fatty acids (PUFAs). Results from in vitro studies, laboratory animal experiments and population studies suggest that omega-3 PUFA intake and a high omega-3/omega-6 ratio exert a positive effect on bone health. This longitudinal study was conducted to examine the relationship between omega-3 and omega-6 PUFA status and quantitative ultrasound (QUS) parameters in Greenlandic Inuit women. The study included 118 Inuit women from Nuuk (Greenland), aged 49-64 years, whose QUS parameters measured at baseline (year 2000), along with PUFA status and covariates, and follow-up QUS measurements 2 years later (year 2002). QUS parameters [speed of sound (SOS); broadband ultrasound attenuation (BUA)] were measured at the right calcaneus with a water-bath Lunar Achilles instrument. Omega-3 and omega-6 PUFA contents of erythrocyte membrane phospholipids were measured after transmethylation by gas chromatography coupled with a flame ionization detector. Relationships between QUS parameters and different PUFAs were studied in multiple linear regression models. Increasing values of EPA, DHA and the omega-3/omega-6 PUFA ratio were associated with increased BUA values measured at follow-up (year 2002). These associations were still present in models adjusted for several confounders and covariates. We found little evidence of associations between PUFAs and SOS values. The omega-3 PUFA intake from marine food consumption seems to have a positive effect on bone intrinsic quality and strength, as revealed by higher BUA values in this group of Greenlandic Inuit women.

Comparing fixation used for calcaneal displacement osteotomies: a look at removal rates and cost.

Science.gov (United States)

Lucas, Douglas E; Simpson, G Alex; Philbin, Terrence M

2015-02-01

The calcaneal displacement osteotomy is a procedure frequently used by foot and ankle surgeons for hindfoot angular deformity. Traditional techniques use compression screw fixation that can result in prominent hardware. While the results of the procedure are generally good, a common concern is the development of plantar heel pain related to prominent hardware. The primary purpose of this study is to retrospectively compare clinical outcomes of 2 fixation methods for the osteotomy. Secondarily a cost analysis will compare implant costs to hardware removal costs. Records were reviewed for patients who had undergone a calcaneal displacement osteotomy fixated with either lag screw or a locked lateral compression plate (LLCP). Neuropathy, previous ipsilateral calcaneus surgery, heel pad trauma, or incomplete radiographic follow-up were exclusionary. Thirty-two patients (19.4%) required hardware removal from the screw fixation group compared to 1 (1.6%) of the LLCP group, which is significant (P cost was remarkably different with screw fixation costing on average $247.12, compared to the LLCP costing $1175.59. Although the LLCP cost was significantly higher, cost savings were identified when the cost of removal and removal rates were included. This study demonstrates that this device provides adequate stabilization for healing in equivalent time to screw fixation. The LLCP required decreased rates of hardware removal with fewer postoperative visits over a shorter period of time. Significant savings were demonstrated in the LLCP group despite the higher implant cost. Therapeutic, Level III, Retrospective Comparative Study. © 2014 The Author(s).

High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes?

International Nuclear Information System (INIS)

Shabshin, Nogah; Schweitzer, Mark E.; Morrison, William B.; Carrino, John A.; Keller, Marc S.; Grissom, Leslie E.

2006-01-01

High-signal T2-weighted bone marrow changes can be found in both bone marrow edema and hematopoietic marrow and are often seen on pediatric MR images of the feet and ankle. To evaluate whether high-signal T2 changes of the bone marrow seen on pediatric MRI of feet and ankles represent residual hematopoietic marrow. A total of 402 bones in 41 pediatric MRI studies of feet and ankles (34 children, 1-18 years) were reviewed by two observers who were blinded to the patients' ages. The studies were reviewed for the presence of high-signal changes of the bone marrow on sagittal fluid-sensitive images. The frequency and location of these foci were correlated with the patients' ages. High-signal T2 changes of the bone marrow were seen in 45/402 bones (11%) and in 24/41 patients younger than 16 years (59%). The changes were most commonly located in the calcaneus (54%), followed by the talus (35%) and navicular bone (35%), invariably at the endosteal surface. In 16 ankles, such foci were seen in the feet but not in the distal tibia/fibula. Symmetric presence (two ankles) or absence (four ankles) of high-signal marrow were seen in six of seven patients with bilateral ankles. High-signal T2 changes of the bone marrow in pediatric feet and ankle MRIs have a symmetric, fairly consistent pattern and disappear after the age of 15 years. We believe that these high-signal areas are normal and represent residual hematopoietic marrow. (orig.)

Effects of Bone Young’s Modulus on Finite Element Analysis in the Lateral Ankle Biomechanics

Directory of Open Access Journals (Sweden)

W. X. Niu

2013-01-01

Full Text Available Finite element analysis (FEA is a powerful tool in biomechanics. The mechanical properties of biological tissue used in FEA modeling are mainly from experimental data, which vary greatly and are sometimes uncertain. The purpose of this study was to research how Young’s modulus affects the computations of a foot-ankle FEA model. A computer simulation and an in-vitro experiment were carried out to investigate the effects of incremental Young’s modulus of bone on the stress and strain outcomes in the computational simulation. A precise 3-dimensional finite element model was constructed based on an in-vitro specimen of human foot and ankle. Young’s moduli were assigned as four levels of 7.3, 14.6, 21.9 and 29.2 GPa respectively. The proximal tibia and fibula were completely limited to six degrees of freedom, and the ankle was loaded to inversion 10° and 20° through the calcaneus. Six cadaveric foot-ankle specimens were loaded as same as the finite element model, and strain was measured at two positions of the distal fibula. The bone stress was less affected by assignment of Young’s modulus. With increasing of Young’s modulus, the bone strain decreased linearly. Young’s modulus of 29.2 GPa was advisable to get the satisfactory surface strain results. In the future study, more ideal model should be constructed to represent the nonlinearity, anisotropy and inhomogeneity, as the same time to provide reasonable outputs of the interested parameters.

Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

International Nuclear Information System (INIS)

Rossi, Ignacio; Rosenberg, Zehava; Zember, Jonathan

2016-01-01

Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

Activity of intraarterial carboplatin as a single agent in the treatment of newly diagnosed extremity osteosarcoma.

Science.gov (United States)

Petrilli, A S; Kechichian, R; Broniscer, A; Garcia, R J; Tanaka, C; Francisco, J; Lederman, H; Odone Filho, V; Camargo, O P; Bruniera, P; Pericles, P; Consentino, E; Ortega, J A

1999-08-01

Chemotherapy has dramatically improved the rates of cure and survival of patients with localized and metastatic osteosarcoma. Nonetheless, the number of chemotherapeutic agents active against osteosarcoma is limited to doxorubicin, cisplatin, high-dose methotrexate, and ifosfamide. Carboplatin, a cisplatin analogue, has been tested as a single agent in patients with recurrent osteosarcoma or as part of multiagent chemotherapy in newly diagnosed patients. We tested the activity and toxicity of two cycles of intraarterial carboplatin as a "window therapy" (600 mg/m2 per cycle) in 33 consecutive patients with extremity osteosarcoma before the start of multiagent chemotherapy. Response was based on clinical (tumor diameter, local inflammatory signs, and range of motion) and radiological parameters (plain local films and arteriographic studies prior to drug administration). Patients' age ranged between 8 and 18 years (median age 13 years). Primary tumor originated from the femur (15 patients), tibia (10 patients), fibula (4 patients), humerus (3 patients), and calcaneus (1 patient). Only 7 patients (21%) had metastatic disease at diagnosis (5 in the lung and 2 in other bones). A favorable clinical and radiological response was documented in 81% and 73% of the patients, respectively. Clinical and radiological progression occurred in 12% and 9% of the patients, respectively. Seventeen of the patients remain alive and disease-free. Survival and event-free survival at 3 years for nonmetastatic patients are 71% (SE = 9%) and 65% (SE = 9%), respectively; for metastatic patients, the figures are 17% (SE = 15%) and 14% (SE = 13%), respectively. We conclude that carboplatin is an active agent in the treatment of newly diagnosed extremity osteosarcoma. Copyright 1999 Wiley-Liss, Inc.

Small hook thread (Quill) and soft felt internal splint to increase the primary repair strength of lacerated rabbit Achilles tendons: biomechanical analysis and considerations for hand surgery.

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Buschmann, Johanna; Müller, Angela; Feldman, Kirill; Tervoort, Theo A; Fessel, Gion; Snedeker, Jess G; Giovanoli, Pietro; Calcagni, Maurizio

2011-07-01

For the prevention of re-rupture during early healing phase, the primary repair strength of repaired lacerated tendons in hand surgery should be maximal and the reconstructed diameter minimal. Two new repair methods (small hook thread and internal splint) were assessed for strength and reconstructed diameter characteristics. Achilles tendons of 43 female New Zealand White rabbits were sectioned 2 cm above the calcaneus. Specimens were divided into 7 groups and repaired as follows: Kirchmayr method 2-strand with 4.0 polypropylene thread; Becker method 4-strand; 6-strand; internal splint; Kirchmayr method small hook 2-strand; Becker method small hook 4-strand, non-modified tendon. Load until failure, load until gap formation, gap length, cross-sectional area and failure stress were determined. The small hook 2-strand suture had 1.3 fold higher loads until failure compared to a conventional 2-strand suture, P<0.05. The internal splint had a similar load until failure (22 N (SD 6)) as the conventional 2-strand suture (23 N (SD 4)); around half the load until failure of the conventional 4-strand suture (38 N (SD 9)). Load until gap formation correlated positively with load until failure (y=0.65+3.6; r(2)=0.72). The running suture increased the cross-sectional area at the repair site by a factor of 1.3. Using a small hook thread instead of a 4.0 polypropylene thread significantly increases the primary repair strength with the same number of strands. Internal splints may be an alternative to conventional 2-strand sutures for bridging large gaps. Copyright © 2011 Elsevier Ltd. All rights reserved.

Vitamin D and Musculoskeletal Status in Nova Scotian Women Who Wear Concealing Clothing

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Jo M. Welch

2012-05-01

Full Text Available Bone and muscle weakness due to vitamin D deficiency is common among Muslim women who reside in sunny, equatorial countries. The purpose of this study was to determine if living in a northern maritime location additionally disadvantages women who wear concealing clothes. A cross-sectional matched pair design was used to compare women who habitually wore concealing clothing with women who dressed according to western norms. Each premenopausal hijab-wearing woman (n = 11 was matched by age, height, weight and skin tone with a western-dressed woman. Subjects were tested by hand grip dynamometry to assess muscular strength and by quantitative ultrasound at the calcaneus to assess bone status. Nutritional intake was obtained by 24 h recall. Serum 25-hydroxyvitamin D (s-25(OHD status was determined in seven matched pairs. The hijab group had lower s-25(OHD than women who wore western clothes (40 ± 28 vs. 81 ± 32 nmol/L, p = 0.01. Grip strength in the right hand was lower in the hijab-wearing women (p = 0.05 but this appeared to be due to less participation in intense exercise. Bone status did not differ between groups (p = 0.9. Dietary intake of vitamin D was lower in the hijab-wearers (316 ± 353 vs. 601 ± 341 IU/day, p = 0.001. This pilot study suggests that women living in a northern maritime location appear to be at risk for vitamin D insufficiency and therefore should consider taking vitamin D supplements.

Anterior process calcaneal fractures: a systematic evaluation of associated conditions

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Petrover, David [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Hopital Beaujon, Service de Radiologie, Paris (France); Schweitzer, Mark E. [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Laredo, J.D. [Hopital Lariboisiere, Service de Radiologie, Paris (France)

2007-07-15

The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

Anterior process calcaneal fractures: a systematic evaluation of associated conditions

International Nuclear Information System (INIS)

Petrover, David; Schweitzer, Mark E.; Laredo, J.D.

2007-01-01

The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

High prevalence of vitamin D deficiency among middle-aged and elderly individuals in northwestern China: its relationship to osteoporosis and lifestyle factors.

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Zhen, Donghu; Liu, Lijuan; Guan, Conghui; Zhao, Nan; Tang, Xulei

2015-02-01

Vitamin D deficiency has reached epidemic proportions; this deficiency has been associated with osteoporosis and certain lifestyle factors in adults. This relationship is not well documented among the Lanzhou population in northwest China. This study sought to determine the prevalence of vitamin D deficiency and its risk factors in addition to its relationship with osteoporosis in a Chinese population living in Lanzhou. This cross-sectional study involved 2942 men and 7158 women aged 40-75years who were randomly selected from 3 communities in the Lanzhou urban district and examined medically. Levels of 25-hydroxy-vitamin D [25(OH)D] and other parameters were measured according to detailed inclusion criteria. Vitamin D deficiency was defined as serum 25(OH)D levels below 20ng/mL. Calcaneus bone mineral density (BMD) was measured by quantitative ultrasound (QUS). The prevalence of vitamin D deficiency (25(OH)D levels Vitamin D deficiency was more prevalent in women (79.7%) than in men (64%; Pvitamin D deficiency included coronary heart disease (CHD), obesity, dyslipidemia, older age, female sex, and smoking (all Pvitamin D supplementation and sun exposure were protective (all Pvitamin D levels (0.53±0.13 vs. 0.54±0.13; P=0.089). The risk of having osteoporosis did not increase when vitamin D levels decreased from ≥20ng/mL to Vitamin D deficiency is prevalent in the middle-aged and elderly northwestern Chinese population and is largely attributed to CHD, obesity, dyslipidemia, older age, female sex, and smoking. Reduced 25(OH)D levels are not associated with an increased osteoporosis risk. Copyright © 2014 Elsevier Inc. All rights reserved.

The influence of lifestyle, menstrual function and oral contraceptive use on bone mass and size in female military cadets

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Tendy Susan

2007-08-01

Full Text Available Abstract Purpose To determine the influence of menstrual irregularity, oral contraceptive use and other factors on bone mineral density (BMD and bone size at different skeletal sites in 135 college-aged fit women. Methods Menstrual history, oral contraceptive use, exercise history, and nutritional factors including calcium, caffeine, and alcohol intake as well as tobacco use were determined by written survey. Height, weight and fitness levels were measured. Spine and hip BMD were measured by dual x-ray absorptiometry (DXA, calcaneus BMD by peripheral DXA, and tibial bone mineral content (BMC and size by peripheral Quantitative Computed Tomography (pQCT. Results The mean age was 18.4 ± 0.8 years. Weight and prior exercise were positively related to BMD at most skeletal sites and to tibial bone size. Milk intake was positively related to calcaneal BMD, tibial BMC and cortical thickness. Fracture history was an important predictor of spine, hip and heel BMD. Women who had ≥ 10 menstrual cycles in the year prior to BMD measurement had higher BMD at all sites as well as a greater tibial mineral content and cortical thickness than women who had oligomenorrhea/amenorrhea (≤ 9 cycles in the prior year; all p p p = 0.04, smaller tibial periosteal circumference and lower tibial mineral content (p Conclusion In a population of fit, college-aged women, OC use and oligomenorrhea were associated with reduced BMD and bone size. Weight, as well as prior exercise and milk intake was positively related to bone density and size at some skeletal sites. Understanding these relationships would help improve skeletal health in young women.

Whole-body and pinhole bone scintigraphic manifestations of Reiter`s syndrome: distribution patterns and early and characteristic signs

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Kim, Sung-Hoon; Chung, Soo-Kyo; Park, Young-Ha; Lee, Sung-Yong; Sohn, Hyung-Sun [Department of Nuclear Medicine, Catholic University Hospitals, Seoul (Korea, Republic of); Bahk, Yong-Whee [Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

1999-02-01

The characteristic whole-body and pinhole scintigraphic manifestations of osteo-enthesopathy and arthropathy in Reiter`s syndrome (RS) are described, with an emphasis on early diagnosis. We analysed 59 sets of whole-body and pinhole bone scintigrams of 59 patients with RS. The population comprised 47 men and 12 women with an age range from 15 to 53 years (mean=29.4). Bone scintigraphy was carried out 2-2.5 h after intravenous injection of technetium-99m hydroxydiphosphonate using a single-head gamma camera (Siemens Orbiter Model 6601) with a low-energy high-resolution and a 4-mm pinhole collimator for whole-body and pinhole scintigraphy, respectively. In total 262 lesions of osteo-enthesopathy and arthritis were detected on 59 whole-body scintigrams, an incidence of 4.4 lesions per patient. As anticipated, the lesional distribution was asymmetrical: 68% were in the lower limb skeleton and 32% in the axial and upper limb skeleton. Pinhole bone scintigraphy, applied selectively to one region of interest in each case, enabled us to accurately diagnose arthritis and osteo-enthesopathy. It was noteworthy that osteo-enthesopathy, alone or in combination with arthritis, occurred in 78.9%, and had a strong predilection for the foot bones, especially the calcaneus (25.6%). Pinhole scintigraphy detected enthesopathy in the absence of radiographic alteration in 14.1% of cases and portrayed characteristic signs of RS in 6.9%. Whole-body bone scintigraphy augmented with pinhole scintigraphy was found to be useful in order to panoramically display the systemic involvement pattern, to assess the characteristic bone and articular alterations and to detect early signs of RS. (orig.) With 10 figs., 3 tabs., 19 refs.

Fracture Risk and Risk Factors for Osteoporosis.

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Schürer, Christian; Wallaschofski, Henri; Nauck, Matthias; Völzke, Henry; Schober, Hans-Christof; Hannemann, Anke

2015-05-25

As the population ages, diseases of the elderly are becoming more common, including osteoporosis. Ways to assess the risk of fracture and the distribution and effects of known risk factors for osteoporosis will be important in planning for future healthcare needs, as well as in the development of preventive strategies. The study population included 6029 men and women aged 20-90 who underwent examination in the second follow-up wave of the Study of Health in Pomerania (SHIP-2) or in the basal SHIP-Trend Study. The risk of fracture was estimated on the basis of quantitative ultrasonography of the calcaneus. Prior fractures and risk factors for osteoporosis were ascertained in standardized interviews. 4.6% of the male subjects and 10.6% of the female subjects were judged to have an elevated risk of fracture. The corresponding percentages among subjects over age 65 were 8.8% for men and 28.2% for women. Even among subjects under age 55, risk factors for osteoporosis were associated with lower bone stiffness: the mean stiffness index was 103/98 (men/women) without risk factors, 99/96 with one risk factor, and 93/95 with more than one risk factor. Logistic regression analysis yielded an odds ratio of 1.89 (95% confidence interval: 1.44-2.50; p<0.01) for prevalent fractures among subjects aged 75 and older compared to subjects under age 55. The data indicate a high prevalence of osteoporosis from age 65 onward. These findings are consistent with those of other studies from Germany and across Europe. Younger men and women should already begin taking steps to counteract modifiable risk factors.

Effect of age and disease on bone mass in Japanese patients with schizophrenia

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Sugawara Norio

2012-02-01

Full Text Available Abstract Background There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan. Methods We recruited patients (n = 362, aged 48.8 ± 15.4 (mean ± SD years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV. Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community. Results Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males. Conclusions Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender.

Treatment of Osteoid Osteomas Using a Navigational Bipolar Radiofrequency Ablation System

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Wallace, Adam N., E-mail: wallacea@mir.wustl.edu; Tomasian, Anderanik, E-mail: tomasiana@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Chang, Randy O., E-mail: changr@wusm.wustl.edu [Washington University School of Medicine (United States); Jennings, Jack W., E-mail: jenningsj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

2016-05-15

BackgroundPercutaneous CT-guided radiofrequency ablation is a safe and effective minimally invasive treatment for osteoid osteomas. This technical case series describes the use of a recently introduced ablation system with a probe that can be curved in multiple directions, embedded thermocouples for real-time monitoring of the ablation volume, and a bipolar design that obviates the need for a grounding pad.MethodsMedical records of all patients who underwent radiofrequency ablation of an osteoid osteoma with the STAR Tumor Ablation System (DFINE; San Jose, CA) were reviewed. The location of each osteoid osteoma, nidus volume, and procedural details were recorded. Treatment efficacy and long-term complications were assessed at clinical follow-up.ResultsDuring the study period, 18 osteoid osteomas were radiofrequency ablated with the multidirectional bipolar system. Lesion locations included the femur (50 %; 9/18), tibia (22 %; 4/18), cervical spine (11 %; 2/18), calcaneus (5.5 %; 1/18), iliac bone (5.5 %; 1/18), and fibula (5.5 %; 1/18). The median nidus volume of these cases was 0.33 mL (range 0.12–2.0 mL). All tumors were accessed via a single osseous channel. Median cumulative ablation time was 5 min and 0 s (range 1 min and 32 s–8 min and 50 s). All patients with clinical follow-up reported complete symptom resolution. No complications occurred.ConclusionSafe and effective CT-guided radiofrequency ablation of osteoid osteomas can be performed in a variety of locations using a multidirectional bipolar system.

Sensitivity of the Oxford Foot Model to marker misplacement: A systematic single-case investigation.

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Carty, Christopher P; Walsh, Henry P J; Gillett, Jarred G

2015-09-01

The purpose of this paper was to systematically assess the effect of Oxford Foot Model (OFM) marker misplacement on hindfoot relative to tibia, and forefoot relative to hindfoot kinematic calculations during the stance phase of gait. Marker trajectories were recorded with an 8-camera motion analysis system (Vicon Motion Systems Ltd., UK) and ground reaction forces were recorded from three force platforms (AMTI, USA). A custom built marker cluster consisting of 4 markers in a square arrangement (diagonal distance 2 cm) was used to assess the effect of marker misplacement in the superior, inferior, anterior and posterior direction for the sustentaculum tali (STL), the proximal 1st metatarsal (P1M), distal 5th metatarsal (D5M), proximal 5th metatarsal (P5M) and lateral calcaneus (LCA) markers. In addition manual movement of the heel complex 1 cm superiorly, inferiorly, medially and laterally, and also an alignment error of 10° inversion and 10° eversion was assessed. Clinically meaningful effects of marker misplacement were determined using a threshold indicating the minimal clinically important difference. Misplacement of the heel-wand complex had the most pronounced effect on mean kinematic profiles during the stance phase across all degrees-of-freedom with respect to hindfoot-tibia and forefoot-hindfoot angles. Vertical marker misplacement of the D5M and P5M markers affected the sagittal plane, and to a lesser extent frontal plane, forefoot-hindfoot kinematics. In conclusion, the OFM is highly sensitive to misplacement of the heel-wand complex in all directions and the P5M marker in the vertical direction. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

A method to investigate the effect of shoe-hole size on surface marker movement when describing in-shoe joint kinematics using a multi-segment foot model.

Science.gov (United States)

Bishop, Chris; Arnold, John B; Fraysse, Francois; Thewlis, Dominic

2015-01-01

To investigate in-shoe foot kinematics, holes are often cut in the shoe upper to allow markers to be placed on the skin surface. However, there is currently a lack of understanding as to what is an appropriate size. This study aimed to demonstrate a method to assess whether different diameter holes were large enough to allow free motion of marker wands mounted on the skin surface during walking using a multi-segment foot model. Eighteen participants underwent an analysis of foot kinematics whilst walking barefoot and wearing shoes with different size holes (15 mm, 20mm and 25 mm). The analysis was conducted in two parts; firstly the trajectory of the individual skin-mounted markers were analysed in a 2D ellipse to investigate total displacement of each marker during stance. Secondly, a geometrical analysis was conducted to assess cluster deformation of the hindfoot and midfoot-forefoot segments. Where movement of the markers in the 15 and 20mm conditions were restricted, the marker movement in the 25 mm condition did not exceed the radius at any anatomical location. Despite significant differences in the isotropy index of the medial and lateral calcaneus markers between the 25 mm and barefoot conditions, the differences were due to the effect of footwear on the foot and not a result of the marker wands hitting the shoe upper. In conclusion, the method proposed and results can be used to increase confidence in the representativeness of joint kinematics with respect to in-shoe multi-segment foot motion during walking. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

AN INVESTIGATION OF A REFERENCE POSTURE USED IN DETERMINING REARFOOT KINEMATICS FOR BOTH HEALTHY AND PATELLOFEMORAL PAIN SYNDROME INDIVIDUALS

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Pazit Levinger

2005-09-01

Full Text Available The choice of a reference posture is important when investigating rearfoot motion in clinical populations. The reference posture used may affect the magnitude of the peak angles and therefore may not enable comparison of the rearfoot kinematics across different populations. This study examined the relationship between the rearfoot frontal plane pattern of motion and three reference postures during the stance phase of walking in healthy and patellofemoral pain syndrome (PFPS subjects. The three reference postures investigated were: Relaxed Standing posture, subtalar joint neutral position (STJN and when the calcaneus and the lower leg were vertically aligned (Vertical Alignment. The rearfoot inversion/eversion during the stance phase was measured in 14 healthy subjects and 13 subjects with diagnosed PFPS using three dimensional motion analysis with the three different reference postures. The graphs of rearfoot inversion/eversion motion were overlaid with the angle at the rearfoot in the static posture and any intersection between the static angle and rearfoot motion was noted. An ANOVA showed significant differences in static posture between the groups for Relaxed Standing (p = 0.01, and STJN (p = 0.02. For both groups, with Relaxed Standing as a reference posture, the mean rearfoot pattern of motion did not intersect the Relaxed Standing static angle during the stance phase. The use of Vertical Alignment reference posture, however, showed an intersection of this reference posture through the rearfoot pattern of motion. The use of the Vertical Alignment reference posture also generated a typical rearfoot motion pattern for both groups and therefore it may be an appropriate reference posture for both healthy and PFPS individuals

Bone suture anchor fixation in the lower extremity: a review of insertion principles and a comparative biomechanical evaluation.

Science.gov (United States)

Scranton, Pierce E; Lawhon, S Michael; McDermott, John E

2005-07-01

Suture anchors have been developed for the fixation of ligaments, capsules, or tendons to bone. These devices have led to improved fixation, smaller incisions, earlier limb mobility, and improved outcomes. They were originally developed for use in shoulder reconstructions but are now used in almost all extremities. In the lower leg they are used in the tibia, the talus, the calcaneus, tarsal bones, and phalanges. Nevertheless, techniques for insertion and mechanisms of failure are not well described. Five suture anchors were studied to determine the pullout strength in four distal cadaver femurs and four proximal cadaver tibias from 55- and 62-year-old males. Eight hundred ninety Newton line was used, testing the anchors to failure with an Instron testing device (Instron, Norwood, MA). The anchor devices were inserted randomly and tested blindly (12 tests per anchor device, 60 tests in all). Two anchors in each group tested failed at low loads. Both types of plastic anchors had failures at the eyelet. Average pullout strength varied from 85.4 to 185.6 N. Insertion techniques are specific for each device, and they must be followed for optimal fixation. In this study, in all five groups of anchors tested two of the 12 anchors in each group failed with minimal force. On the basis of this finding we recommend that, if suture anchor fixation is necessary, at least two anchors should be used. Since there appears to be a percentage of failure in all devices, the second anchor can serve as a backup. It is imperative that surgeons be familiar with the insertion techniques of each device before use.

Foot posture in basketball players with history of the shin splint

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Saeed Forghany

2013-07-01

Full Text Available Introduction: Shin splint is one of the common injuries in most athletes. Although the relationship between abnormal foot posture and shin splint has been reported previously but, the relation between foot posture and shin splint has not been well documented. The aim of this study was to explore the relationship between foot postures in basketball players and the history of shin splint. Materials and Methods: Thirty Iranian male basketball players who had experience of shin splint during last three months were participated in this study. Foot Posture Index (FPI-6 was used as the measure of foot posture. Talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, prominence in the region of the talonavicular joint, congruence of the medial longitudinal arch, abduction /adduction of the forefoot on the rear foot were 6 items which were assessed with FPI in the standing position. Foot posture was defined as ‘normal’, ‘supinated’ or ‘pronated. Data were collected and analyzed by SPSS, version16. Results: Most participants showed abnormal foot posture (%80. Fifty-three percent of subjects had pronated foot (%53 and 10% did hyper-pronation. The foot postures of 17% of participants were in supination. The results of this study did not show a significant difference in foot posture between right and left foot (P > 0.05. Conclusion: abnormal foot posture were common (%80 in basketball players with the history of shin splints. These findings could support this idea that the footwear and orthotic prescription both can prevent and treat basketball players with history of shin splints. Keywords: Foot posture, Shin splints, Basketball

Single-row versus double-row repair of the distal Achilles tendon: a biomechanical comparison.

Science.gov (United States)

Pilson, Holly; Brown, Philip; Stitzel, Joel; Scott, Aaron

2012-01-01

Surgery for recalcitrant insertional Achilles tendinopathy often consists of partial or total release of the insertion site, debridement of the diseased portion of the tendon, calcaneal ostectomy, and reattachment of the Achilles to the calcaneus. Although single-row and double-row techniques exist for repair of the detached Achilles tendon, biomechanical data are lacking to support one technique over the other. Based on data extrapolated from the study of rotator cuff repairs, we hypothesized that a double-row construct would provide superior fixation strength over a single-row repair. Eighteen human cadaveric Achilles tendons (9 matched pairs) with attached calcanei were repaired with single-row or double-row techniques. Specimens were mounted in a servohydraulic materials testing machine, subjected to a preconditioning cycle, and loaded to failure. Failure was defined as suture breakage or pullout, midsubstance tendon rupture, or anchor pullout. Among the failures were 12 suture failures, 5 proximal-row anchor failures, and 1 distal-row anchor failure. No midsubstance tendon ruptures or testing apparatus failures were observed. There were no statistically significant differences in the peak load to failure between the single-row and double-row repairs (p = .46). Similarly, no significant differences were observed with regards to mean energy expenditure to failure (p = .069). The present study demonstrated no biomechanical advantages of the double-row repair over a single-row repair. Despite the lack of a clear biomechanical advantage, there may exist clinical advantages of a double-row repair, such as reduction in knot prominence and restoration of the Achilles footprint. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Treatment of Osteoid Osteomas Using a Navigational Bipolar Radiofrequency Ablation System

International Nuclear Information System (INIS)

Wallace, Adam N.; Tomasian, Anderanik; Chang, Randy O.; Jennings, Jack W.

2016-01-01

BackgroundPercutaneous CT-guided radiofrequency ablation is a safe and effective minimally invasive treatment for osteoid osteomas. This technical case series describes the use of a recently introduced ablation system with a probe that can be curved in multiple directions, embedded thermocouples for real-time monitoring of the ablation volume, and a bipolar design that obviates the need for a grounding pad.MethodsMedical records of all patients who underwent radiofrequency ablation of an osteoid osteoma with the STAR Tumor Ablation System (DFINE; San Jose, CA) were reviewed. The location of each osteoid osteoma, nidus volume, and procedural details were recorded. Treatment efficacy and long-term complications were assessed at clinical follow-up.ResultsDuring the study period, 18 osteoid osteomas were radiofrequency ablated with the multidirectional bipolar system. Lesion locations included the femur (50 %; 9/18), tibia (22 %; 4/18), cervical spine (11 %; 2/18), calcaneus (5.5 %; 1/18), iliac bone (5.5 %; 1/18), and fibula (5.5 %; 1/18). The median nidus volume of these cases was 0.33 mL (range 0.12–2.0 mL). All tumors were accessed via a single osseous channel. Median cumulative ablation time was 5 min and 0 s (range 1 min and 32 s–8 min and 50 s). All patients with clinical follow-up reported complete symptom resolution. No complications occurred.ConclusionSafe and effective CT-guided radiofrequency ablation of osteoid osteomas can be performed in a variety of locations using a multidirectional bipolar system.

MRI findings of achilles tendon rupture

International Nuclear Information System (INIS)

Zhang Xuezhe

2009-01-01

Objective: To evaluate the MRI findings of achilles tendon rupture. Methods: The MRI data of 7 patients with achilles tendon rupture were retrospectively analysed. All 7 patients were male with the age ranging from 34 to 71 years. Routine MR scanning was performed in axial and sagittal planes, including T 1 WI, T 2 WI and a fat suppression MRI (SPIR). Results: Among 7 patients, complete achilles tendon rupture was seen in 6 cases, partial achilles tendon rupture 1 case. The site of tendon disruption were 2.6-11.0 cm( mean 5.4 cm) proximal to the insertion in the calcaneus. The MRI findings of a partial or complete rupture of the achilles tendon included enlarged and thickened achilles tendon (7 cases), wavy lax achilles tendon (2 cases), discontinuity of some or all of its fibers and intratendinous regions of increased signal intensity (7 cases). In the cases of complete tendon rupture, the size of the tendinous gap varied from 3.0-8.0 mm, which was filled with blood and appeared as edema of increase signal intensity on T 2 WI and SPIR. In all 7 patients, MR scanning showed medium signal intensity (7 cases) on T 1 WI, or medium signal intensity (1 cases), medium-high signal intensity (3 cases ), high signal intensity (3 cases) on T 2 WI, and medium-high signal intensity (2 cases), high signal intensity (5 cases) on fat suppression MRI. The preachilles fat pad showed obscure in 6 cases of complete achilles tendon rupture. Conclusion: MRI is an excellent method for revealing achilles tendon rupture and confirming the diagnosis. (authors)

Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study.

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Koo, Seungbum; Lee, Kyoung Min; Cha, Young Joo

2015-10-01

Gross motion of the ankle joint complex (AJC) is a summation of the ankle and subtalar joints. Although AJC kinematics have been widely used to evaluate the function of the AJC, the coordinated movements of the ankle and subtalar joints are not well understood. The purpose of this study was to accurately quantify the individual kinematics of the ankle and subtalar joints in the intact foot during ground walking by using a bi-planar fluoroscopic system. Bi-planar fluoroscopic images of the foot and ankle during walking and standing were acquired from 10 healthy subjects. The three-dimensional movements of the tibia, talus, and calcaneus were calculated with a three-dimensional/two-dimensional registration method. The skeletal kinematics were quantified from 9% to 86% of the full stance phase because of the limited camera speed of the X-ray system. At the beginning of terminal stance, plantar-flexion of the AJC was initiated in the subtalar joint on average at 75% ranging from 62% to 76% of the stance phase, and plantar-flexion of the ankle joint did not start until 86% of the stance phase. The earlier change to plantar-flexion in the AJC than the ankle joint due to the early plantar-flexion in the subtalar joint was observed in 8 of the 10 subjects. This phenomenon could be explained by the absence of direct muscle insertion on the talus. Preceding subtalar plantar-flexion could contribute to efficient and stable ankle plantar-flexion by locking the midtarsal joint, but this explanation needs further investigation. Copyright © 2015 Elsevier B.V. All rights reserved.

Reliability of a Skin Diagnostic Device in Assessing Hydration and Erythema.

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Huimin, Koh; Rowledge, Alexandra M; Borzdynski, Caroline J; Miller, Charne; Frescos, Nicoletta; McKenzie, Gayle; Perry, Elizabeth; McGuiness, William

2017-10-01

To examine the reliability of a skin diagnostic device, the SD202 (Courage+Khazaka GmBH, Cologne, Germany), in assessing hydration and erythema of periwound skin and pressure injury-prone areas. Intrarater reliabilities from 3 cross-sectional and prospective studies are reported. Patients attending an outpatient, nurse-led wound dressing clinic (n = 16), a podiatrist-led high-risk foot clinic (n = 17), and residents (n = 38) at a single residential aged-care facility. Skin hydration and erythema levels assessed using the SD202. High internal consistency was maintained for consecutive skin hydration and erythema measures at a single point on the venous leg ulcer periwound (α > .996 and α > .970 for hydration and erythema, respectively) and for the pressure-prone areas of the sacrum (α > .916), right (α > .994) and left (α > .967) ischium, right (α > .989) and left (α > .916) trochanter, right (α > .985) and left (α > .992) calcaneus, and right (α > .991) and left (α > .990) lateral malleolus. High consistency was also found for the measures obtained at 4 different locations around the periwound for the venous leg ulcer (α > .935 and α > .870 for hydration and erythema, respectively). In diabetic foot ulcer assessment, acceptable internal consistency of hydration measures around the periwound was observed (α > .634). Internal consistency of erythema measures was variable, ranging from low to high reliability, particularly among predebridement measures. Using the protocols outlined in this study, the SD202 demonstrates high reliability for assessing skin hydration and erythema levels. It is possible that the SD202 can be used in clinical practice as an appropriate tool for skin hydration and erythema assessment.

Appendicular bone mass and knee and hand osteoarthritis in Japanese women: a cross-sectional study

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Moji Kazuhiko

2002-10-01

Full Text Available Abstract Background It has been reported that there is an inverse association between osteoarthritis (OA and osteoporosis. However, the relationship of bone mass to OA in a Japanese population whose rates of OA are different from Caucasians remains uncertain. Methods We studied the association of appendicular bone mineral density (second metacarpal; mBMD and quantitative bone ultrasound (calcaneus; stiffness index with knee and hand OA among 567 Japanese community-dwelling women. Knee and hand radiographs were scored for OA using Kellgren-Lawrence (K/L scales. In addition, we evaluated the presence of osteophytes and of joint space narrowing. The hand joints were examined at the distal and proximal interphalangeal (DIP, PIP and first metacarpophalangeal/carpometacarpal (MCP/CMC joints. Results After adjusting for age and body mass index (BMI, stiffness index was significantly higher in women with K/L scale, grade 3 at CMC/MCP joint compared with those with no OA. Adjusted means of stiffness index and mBMD were significantly higher in women with definite osteophytes at the CMC/MCP joint compared to those without osteophytes, whereas there were no significant differences for knee, DIP and PIP joints. Stiffness index, but not mBMD, was higher in women with definite joint space narrowing at the CMC/MCP joint compared with those with no joint space narrowing. Conclusions Appendicular bone mass was increased with OA at the CMC/MCP joint, especially among women with osteophytes. Our findings suggest that the association of peripheral bone mass with OA for knee, DIP or PIP may be less clearcut in Japanese women than in other populations.

MRI signal changes of the bone marrow in HIV-infected patients with lipodystrophy: correlation with clinical parameters

International Nuclear Information System (INIS)

Garcia, Ana I.; Tomas, Xavier; Pomes, Jaume; Amo, Montserrat del; Milinkovic, Ana; Perez, Inaki; Mallolas, Josep; Rios, Jose; Vidal-Sicart, Sergi

2011-01-01

To assess the prevalence, imaging appearance, and clinical significance, of bone marrow MR signal changes in a group of human immunodeficiency virus (HIV)-infected patients with lipodystrophy syndrome. Twenty-eight HIV-infected patients with lipodystrophy syndrome treated with highly active antiretroviral therapy, and 12 HIV-negative controls underwent MRI of the legs. Whole-body MRI, SPECT/CT, and a complete radiographic skeletal survey were obtained in subjects with signal changes in bone marrow. MRI and clinical evaluations were reviewed 6 months after baseline to determine changes after switching from thymidine analogs (TA) to tenofovir-DF (TDF). MRI results correlated with clinical parameters. We observed foci of a serous-like pattern (low signal and no enhancement on T1-weighted, high signal on T2-weighted images) in 4 out of 28 patients (14.3%) and an intermediate signal on T1-weighted images in 4 out of 28 patients (14.3%). Serous-like lesions were located in the lower limbs and scattered in the talus, calcaneus, femurs, and humeral bones; they showed slight uptake on SPECT bone scans and were normal on CT and radiographs. Patients with serous-like lesions had significantly lower peripheral and total fat at baseline than other groups (P < 0.05). No changes at 6 months were observed on MRI, and the serous-like lesion group showed good peripheral fat recovery after changing drug treatment. A serous-like MRI pattern is observed in the peripheral skeletons of HIV-infected patients with lipodystrophy, which correlates with peripheral lipoatrophy, and should not be misdiagnosed as malignant or infectious diseases. Although the MR lesions did not improve after switching the treatment, there was evidence of lipoatrophy recovery. (orig.)

Rabbit Achilles tendon full transection model - wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery.

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Meier Bürgisser, Gabriella; Calcagni, Maurizio; Bachmann, Elias; Fessel, Gion; Snedeker, Jess G; Giovanoli, Pietro; Buschmann, Johanna

2016-09-15

After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. © 2016. Published by The Company of Biologists Ltd.

Rabbit Achilles tendon full transection model – wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery

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Gabriella Meier Bürgisser

2016-09-01

Full Text Available After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization, or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization, while in the other groups (3 and 12 weeks a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011, and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points. Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand.

Lower limb stress fractures in sport: Optimising their management and outcome

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Robertson, Greg A J; Wood, Alexander M

2017-01-01

Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting. PMID:28361017

Mechanical stability of the subtalar joint after lateral ligament sectioning and ankle brace application: a biomechanical experimental study.

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Kamiya, Tomoaki; Kura, Hideji; Suzuki, Daisuke; Uchiyama, Eiichi; Fujimiya, Mineko; Yamashita, Toshihiko

2009-12-01

The roles of each ligament supporting the subtalar joint have not been clarified despite several biomechanical studies. The effects of ankle braces on subtalar instability have not been shown. The ankle brace has a partial effect on restricting excessive motion of the subtalar joint. Controlled laboratory study. Ten normal fresh-frozen cadaveric specimens were used. The angular motions of the talus were measured via a magnetic tracking system. The specimens were tested while inversion and eversion forces, as well as internal and external rotation torques, were applied. The calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament were sectioned sequentially, and the roles of each ligament, as well as the stabilizing effects of the ankle brace, were examined. Complete sectioning of the ligaments increased the angle between the talus and calcaneus in the frontal plane to 51.7 degrees + or - 11.8 degrees compared with 35.7 degrees + or - 6.0 degrees in the intact state when inversion force was applied. There was a statistically significant difference in the angles between complete sectioning of the ligaments and after application of the brace (34.1 degrees + or - 7.3 degrees ) when inversion force was applied. On the other hand, significant differences in subtalar rotation were not found between complete sectioning of the ligaments and application of the brace when internal and external rotational torques were applied. The ankle brace limited inversion of the subtalar joint, but it did not restrict motion after application of internal or external rotational torques. In cases of severe ankle sprains involving the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament injuries, application of an ankle brace might be less effective in limiting internal-external rotational instabilities than in cases of inversion instabilities in the subtalar joint. An improvement in the design of the brace is needed to restore

Analysis of image findings in forty-one patients with primary lymphoma of the bone

International Nuclear Information System (INIS)

Yu Baohai; Liu Jie; Zhong Zhiwei; Zhao Jingpin; Peng Zhigang; Liu Jicun; Wu Wenjuan

2011-01-01

Objective: To analyze the imaging features of primary lymphoma of the bone, and discuss the special feature of the 'floating ice sign'. Methods: Forty-one cases of primary lymphoma of the bone in our unit from 1963.1-2009.6 were retrospectively studied. All 41 patients underwent X-ray examination, and 20 patients underwent CT examination, 12 patients underwent MR examination (3 cases simultaneously with enhancement). Results: Involvement of the flat bone was seen in 12 cases. Vertebral column was affected in 8 cases, and 17 cases showed lesions in long bones and irregular bones were involved in 4 cases. The most common location was the femur (10, 24.4%), followed by the ilium (8, 19.5%). Lesions were found in the metaphyses of the long bone in 11 cases (64.7%). 'Floating ice sign' was showed in the calcaneus of 2 patients and in the lumbar vertebra of 2 cases respectively, accounted for 9.8% of all cases. Slight bone destruction with soft tissue mass on CT image could be found in 12 cases, while obvious soft tissue mass was found in 9 cases. No periosteal reaction was found in 37 cases (90.2%). MRI examinations of 12 patients revealed soft tissue mass in 10 patients, and the extent of the lesion was larger in MR than CT. One case showed extensive bone destruction on MR but inconspicuous bone destruction on X-ray plain film and CT scan. Conclusion: Slight bone destruction with conspicuous soft tissue mass, conspicuous bone destruction on MR but slight or inconspicuous bone destruction on X-ray film and CT, could strongly imply the diagnosis of primary lymphoma of the bone. 'Floating ice sign' was a special imaging feature of primary lymphoma of the bone, which could be used as a clue for the diagnosis of lymphoma. (authors)

Prevalence of low trauma fractures in long-term kidney transplant patients with preserved renal function

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J.W.R. Braga Júnior

2006-01-01

Full Text Available We evaluated the prevalence of low bone mineral density (BMD and osteoporotic fractures in kidney transplantation (KT patients and determined risk factors associated with osteoporotic fractures. The study was conducted on 191 patients (94 men and 97 women with first KT for 3 years or more presenting stable and preserved renal function (serum creatinine levels lower than 2.5 mg/dl. KT patients were on immunosuppressive therapy and the cumulative doses of these drugs were also evaluated. BMD was determined by dual-energy X-ray absorptiometry at multiple sites (spine, femur and total body. Quantitative ultrasound of the calcaneus (broadband ultrasound attenuation, speed of sound, and stiffness index, SI was also performed. Twenty-four percent (46 of all patients had either vertebral (29/46 or appendicular (17/46 fractures. We found osteoporosis and osteopenia in 8.5-13.4 and 30.9-35.1% of KT patients, respectively. Women had more fractures than men. In women, prevalent fractures were associated with diabetes mellitus [OR = 11.5, 95% CI (2.4-55.7], time since menopause [OR = 3.7, 95% CI (1.2-11.9], femoral neck BMD [OR = 1.99, 95% CI (1.4-2.8], cumulative dose of steroids [OR = 1.1, 95% CI (1.02-1.12] and low SI [OR = 1.1, 95% CI (1.0-1.2]. In men, fractures were associated with lower lumbar spine BMD [OR = 1.75, 95% CI (1.1-2.7], lower SI [OR = 1.1, 95% CI (1.03-1.13], duration of dialysis [OR = 1.3, 95% CI (1.13-2.7], and lower body mass index [OR = 1.24, 95% CI (1.1-1.4. Our results demonstrate high prevalence of low BMD and osteoporotic fractures in patients receiving a successful kidney transplant and indicate the need for specific intervention to prevent osteoporosis in this population.

The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.

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Kelly, Luke A; Farris, Dominic J; Lichtwark, Glen A; Cresswell, Andrew G

2018-01-01

The aim of this study was to investigate the influence of foot-strike technique on longitudinal arch mechanics and intrinsic foot muscle function during running. Thirteen healthy participants ran barefoot on a force-instrumented treadmill at 2.8 ms with a forefoot (FFS) and rearfoot (RFS; habitual) running technique, whereas kinetic, kinematic, and electromyographic data from the intrinsic foot muscles were collected simultaneously. The longitudinal arch was modeled as a single "midfoot" joint representing motion of the rearfoot (calcaneus) relative to the forefoot (metatarsals). An inverse dynamic analysis was performed to estimate joint moments generated about the midfoot, as well as mechanical work and power. The midfoot was more plantar flexed (higher arch) at foot contact when running with a forefoot running technique (RFS 0.2 ± 1.8 vs FFS 6.9 ± 3.0°, effect size (ES) = 2.7); however, there was no difference in peak midfoot dorsiflexion in stance (RFS -11.6 ± 3.0 vs FFS -11.4 ± 3.4°, ES = 0.63). When running with a forefoot technique, participants generated greater moments about the midfoot (27% increase, ES = 1.1) and performed more negative work (240% increase, ES = 2.2) and positive work (42% increase, ES = 1.1) about the midfoot. Average stance-phase muscle activation was greater for flexor digitorum brevis (20% increase, ES = 0.56) and abductor hallucis (17% increase, ES = 0.63) when running with a forefoot technique. Forefoot running increases loading about the longitudinal arch and also increases the mechanical work performed by the intrinsic foot muscles. These findings have substantial implications in terms of injury prevention and management for runners who transition from a rearfoot to a forefoot running technique.

VALIDITY AND REPRODUCIBILITY OF MEASURING THE KINEMATIC COUPLING BEHAVIOR OF CALCANEAL PRONATION/SUPINATION AND SHANK ROTATION DURING WEIGHT BEARING USING AN OPTICAL THREE-DIMENSIONAL MOTION ANALYSIS SYSTEM

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Masahiro Edo

2017-12-01

Full Text Available Background: It’s important to understand the kinematic coupling of calcaneus and shank to optimize the pathological movement of the lower extremity. However, the quantitative indicator to show the kinematic coupling hasn’t been clarified. We measured the angles of calcaneal pronation-to-supination and shank rotation during pronation and supination of both feet in standing position and devised a technique to quantify the kinematic coupling behavior of calcaneal pronation/supination and shank rotation as the linear regression coefficient (kinematic chain ratio: KCR of those measurements. Therefore, we verified the validity and reproducibility of this technique. Methods: This study is a non-comparative cross-sectional study. The KCR, which is an outcome, was measured using an optical three-dimensional motion analysis system in 10 healthy subjects. The coefficient of determination (R² was calculated for the linear regression equation of the angle of calcaneal pronation-to-supination and angle of shank rotation, and the intraclass correlation coefficient (ICC [1,1] was calculated for the KCR during foot pronation and foot supination and for the KCR measured on different days. And also, skin movement artifacts were investigated by measurement of the displacement of bone and body surface markers in one healthy subject. Results: The linear regression equation of calcaneal pronation/supination and the angle of shank rotation included R²≥0.9 for all subjects. The KCR on foot pronation and supination had an ICC(1,1 of 0.95. The KCR measured on different days had an ICC(1,1 of 0.72. Skin movement artifacts were within the allowable range. Conclusion: The validity and reproducibility of this technique were largely good, and the technique can be used to quantify kinematic coupling behavior.

Lumbar spondylosis, lumbar spinal stenosis, knee pain, back muscle strength are associated with the locomotive syndrome: Rural population study in Japan.

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Chiba, Daisuke; Tsuda, Eiichi; Wada, Kanichiro; Kumagai, Gentaro; Sasaki, Eiji; Nawata, Atsushi; Nakagomi, Sho; Takahashi, Ippei; Nakaji, Shigeyuki; Ishibashi, Yasuyuki

2016-05-01

To comprehensively investigate the clinical and physical factors associating with locomotive syndrome (Loc-S); the locomotorium-disability for daily life. 647 volunteers participated (247 males, 400 females, Age: 58.4 ± 11.0, BMI: 22.5 ± 3.3). Three self-assessment questionnaires were administered: 1) "25-question Geriatric Locomotive Function Scale" (GFLS-25) for evaluating Loc-S (GLFS-25 ≥ 16 defined as Loc-S); 2) "diagnostic support tool for LSS" (LSS-DST) for evaluating the prevalence of lumbar spinal stenosis (LSS); 3) Knee injury and Osteoarthritis Outcome Score (KOOS). Plain radiographs of the bilateral knees and lumbar spine were evaluated, and the severity of lumbar spondylosis (LS) and knee osteoarthritis (KOA) defined by Kellgren-Lawrence grade. Bone status was evaluated by using the osteo-sono assessment index (OSI) at the calcaneus. Isometric muscle strength of trunk and leg (Nm/kg, both extension and flexion) were evaluated. Linear regression analysis was performed to elucidate the factors concerned with GFLS-25 including age, sex, and BMI. Thirty-nine subjects (6.0%, 13 males, 26 females) were defined as having Loc-S. Single regression model showed that age, height, BMI, skeletal muscle mass, OSI, LSS, KOOS, the severity of LS and KOA, and trunk- and leg-muscle strength were correlated with the degree of GLFS-25. Stepwise multiple regression model showed that sex, height, LSS, KOOS, the severity of LS, and back muscle strength were significantly correlated with that of GLFS-25. In this cross-sectional study, pain status associated with LSS and knee joint, structural severity for LS, and back muscle strength primarily affected the degree of GFLS-25. For managing Loc-S, we must pay more intensive attention to these factors. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Chondroblastoma of the hands and feet

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Davila, Jesse A.; Amrami, Kimberly K.; Sundaram, Murali; Adkins, Mark C. [Mayo Clinic, Department of Radiology, Rochester (United States); Unni, Krishnan K. [Mayo Clinic, Department of Surgical Pathology, Rochester (United States)

2004-10-01

To review the imaging findings, age and gender distribution of chondroblastoma of the hands and feet. Twenty-five cases of pathologically proven chondroblastoma of the hands and feet were reviewed. Available imaging modalities included radiographs (n=24), CT (n=3), MRI (n=5), and radionuclide bone scintigraphy (n=1). The following imaging features for each case were tabulated: location, presence of sclerotic margin, calcification, expansion, presence of fluid/fluid levels on cross-sectional imaging and surrounding edema on MRI. The images were evaluated for skeletal maturity using closure of the physeal plate in the region as a standard. The average age at time of diagnosis was 23 years (range 7-57 years). Eighty-four percent (n=21) of the patients were skeletally mature. Males (20 of 25) outnumbered females by a ratio of 5:1. The bones of the foot accounted for 22 cases: calcaneus (n=8), talus (n=8), metatarsals (n=3), and the cuboid (n=3). The bones of the hand accounted for three cases: phalanx (n=1), triquetrum (n=1), and a metacarpal (n=1). Radiographically all lesions were osteolytic with identifiable calcification in 54% (13 of 24). Fluid/fluid levels were seen in four of five cases on MRI. Edema on MR images was seen in 40% (2 of 5). The size of the lesions ranged from 2 to 41 cm{sup 2}. Chondroblastomas of the hands and feet share many of the radiographic characteristics seen in the long bones, but manifest in skeletally mature patients with a higher male to female ratio than in long bone chondroblastoma. Talar and calcaneal lesions were encountered only in males. Chondroblastoma of the wrist and hand appears to be exceptionally rare. (orig.)

Reference values of bone stiffness index and C-terminal telopeptide in healthy European children.

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Herrmann, D; Intemann, T; Lauria, F; Mårild, S; Molnár, D; Moreno, L A; Sioen, I; Tornaritis, M; Veidebaum, T; Pigeot, I; Ahrens, W

2014-09-01

Quantitative ultrasound measurements and bone metabolic markers can help to monitor bone health and to detect impaired skeletal development. Population-based reference values for children may serve as a basis for preventive measures to reduce the risk of osteoporosis and osteoporotic fractures in later life. This is the first paper providing age-, sex- and height-specific reference values for bone stiffness index (SI) and serum carboxy-terminal cross-linking telopeptide of type I collagen (CTX) in healthy, apparently prepubertal children. In the population-based IDEFICS baseline survey (2007-2008) and follow-up (2009-2010), 18,745 children from eight European countries were newly recruited. A total of 10,791 2-10.9-year-old and 1646 3-8.9-year-old healthy children provided data on SI of the right and left calcaneus and serum CTX, respectively. Furthermore, height and weight were measured. Percentile curves were calculated using the General Additive Model for Location Scale and Shape (GAMLSS) to model the distribution of SI and CTX depending on multiple covariates while accounting for dispersion, skewness, and the kurtosis of this distribution. SI was negatively associated with age and height in children aged 2-5 years, whereas a positive association was observed in children aged 6-10 years. The dip in SI occurred at older age for higher SI percentiles and was observed earlier in taller children than in smaller children. The CTX reference curves showed a linear-positive association with age and height. No major sex differences were observed for the SI and CTX reference values. These reference data lay the ground to evaluate bone growth and metabolism in prepubertal children in epidemiological and clinical settings. They may also inform clinical practice to monitor skeletal development and to assess adverse drug reactions during medical treatments.

Lower limb stress fractures in sport: Optimising their management and outcome.

Science.gov (United States)

Robertson, Greg A J; Wood, Alexander M

2017-03-18

Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by "high" and "low" risk. "Low risk" stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. "High risk" stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting.

Imaging features of foot osteoid osteoma

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Shukla, Satyen; Clarke, Andrew W.; Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom)

2010-07-15

We performed a retrospective review of the imaging of nine patients with a diagnosis of foot osteoid osteoma (OO). Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) had been performed in all patients. Radiographic features evaluated were the identification of a nidus and cortical thickening. CT features noted were nidus location (affected bone - intramedullary, intracortical, subarticular) and nidus calcification. MRI features noted were the presence of an identifiable nidus, presence and grade of bone oedema and whether a joint effusion was identified. Of the nine patients, three were female and six male, with a mean age of 21 years (range 11-39 years). Classical symptoms of OO (night pain, relief with aspirin) were identified in five of eight (62.5%) cases (in one case, the medical records could not be retrieved). In five patients the lesion was located in the hindfoot (four calcaneus, one talus), while four were in the mid- or forefoot (two metatarsal and two phalangeal). Radiographs were normal in all patients with hindfoot OO. CT identified the nidus in all cases (89%) except one terminal phalanx lesion, while MRI demonstrated a nidus in six of nine cases (67%). The nidus was of predominantly intermediate signal intensity on T1-weighted (T1W) sequences, with intermediate to high signal intensity on T2-weighted (T2W) sequences. High-grade bone marrow oedema, limited to the affected bone and adjacent soft tissue oedema was identified in all cases. In a young patient with chronic hindfoot pain and a normal radiograph, MRI features suggestive of possible OO include extensive bone marrow oedema limited to one bone, with a possible nidus demonstrated in two-thirds of cases. The presence or absence of a nidus should be confirmed with high-resolution CT. (orig.)

[The effect of different types of sports and athletes' age on the pathological changes of the musculoskeletal system].

Science.gov (United States)

Achkasov, E E; Puzin, S N; Litvinenko, A S; Kurshev, V V; Bezuglov, E N

2014-01-01

Our aim was to determine the most common musculoskeletal diseases, depending on the type of sports and athletes' age. The results of examination of 976 athletes aged from 16 to 42 years (average age - 28,9±2,3) with musculoskeletal diseases were analyzed. Medical diagnostic procedures included clinical, laboratory, instrumental (radiography, magnetic resonance imaging, ultrasound) investigations and functional testing (goniometry, manual muscle testing). Majority of patients were diagnosed to have diseases of the knee (17.9%) and ankle joints (11.3%), the heel bone (12.9%), Achilles tendon (10.2%), post-traumatic musculoskeletal diseases (16.2%), degenerative-dystrophic diseases of the spine (12.8%). In the young age group (16 to 20 years) post-traumatic disorders were most common. In the middle-age group (21 to 30 years) along with post-traumatic disorders diseases of the knee frequently occurred. For athletes over 30 years old, along with diseases of the knee spinal diseases were found to occur 2-3 times more frequently in comparison with other age groups. Injuries which are more common for different types of sports were identified: acute traumas - competitive sports, diseases of the calcaneus - sports with running and jumping (athletics, volleyball, soccer), disease of ankle joints - sport with sharp change in movement direction (hockey, figure skating), disease of the knee - sports with high load of the knee joint (figure skating, gymnastics, volleyball, diseases of bones and joints of the upper extremity - tennis, disease of spine - weightlifting. pathological changes in the musculoskeletal system depend on the type of sports and the age of athletes. The combination of age and risk factors associated with type of sport increases the possibility of development of these diseases of the musculoskeletal system.

Magnetic resonance imaging of the ankle in female ballet dancers en pointe

Energy Technology Data Exchange (ETDEWEB)

Russell, Jeffrey A. (Dept. of Dance, Univ. of California-Irvine, Irvine, CA (United States)), e-mail: jeff.russell@uci.edu; Shave, Ruth M. (Dept. of Radiology, Russells Hall Hospital, Dudley (United Kingdom)); Yoshioka, Hiroshi (Dept. of Radiological Sciences, Univ. of California-Irvine, Irvine, CA (United States)); Kruse, David W. (Dept. of Orthopaedic Surgery and Family Medicine, Univ. of California-Irvine, Irvine, CA (United States)); Koutedakis, Yiannis; Wyon, Matthew A. (School of Sport, Performing Arts and Leisure, Univ. of Wolverhampton, Walsall (United Kingdom))

2010-07-15

Background: Ballet dancers require extreme range of motion of the ankle, especially weight-bearing maximum plantar flexion (en pointe). In spite of a high prevalence of foot and ankle injuries in ballet dancers, the anatomy and pathoanatomy of this position have not been sufficiently studied in weight-bearing. Magnetic resonance imaging (MRI) is a beneficial method for such study. Purpose: To develop an MRI method of evaluating the ankles of female ballet dancers standing en pointe and to assess whether pathological findings from the MR images were associated with ankle pain reported by the subjects. Material and Methods: Nine female ballet dancers (age, 21+-2.9 years; dance experience, 16+-4.1 years; en pointe dance experience, 7+-4.9 years) completed an ankle pain visual analog scale questionnaire and underwent T1- and T2-weighted scans using a 0.25 T open MRI device. The ankle was scanned in three positions: supine with full plantar flexion, standing with the ankle in anatomical position, and standing en pointe. Results: Obtaining MR images of the ballet dancers en pointe was successful in spite of limitations imposed by the difficulty of remaining motionless in the en pointe position during scanning. MRI signs of ankle pathology and anatomical variants were observed. Convergence of the posterior edge of the tibial plafond, posterior talus, and superior calcaneus was noted in 100% of cases. Widened anterior joint congruity and synovitis/joint effusion were present in 71% and 67%, respectively. Anterior tibial and/or talar spurs and Stieda's process were each seen in 44%. However, clinical signs did not always correlate with pain reported by the subjects. Conclusion: This study successfully established an ankle imaging technique for ballet dancers en pointe that can be used in the future to assess the relationship between en pointe positioning and ankle pathoanatomy in ballet dancers

Multiple bony lesions other than femoral heads on {sup 99m}Tc-MDP bone scan in patients with avascular necrosis of the femoral head

Energy Technology Data Exchange (ETDEWEB)

Choi, Yun Young; Yang, Seoung Oh; Moon, Dae Hyuk; Ryu, Jin Sook; Weon, Young Cheol; Shin, Myung Jin; Lee, Soo Ho; Lee, Hee Kyung [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Chun, Hae Kyung [St. Francisco Hospital, Seoul (Korea, Republic of)

1997-03-01

To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. One hundred and seventy three patients with clinical diagnosis of avascular necrosis of the emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of in volvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8%); the location of 79 lesions was other than the femoral head. This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to aveid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.

Rabbit Achilles tendon full transection model – wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery

Science.gov (United States)

Meier Bürgisser, Gabriella; Calcagni, Maurizio; Bachmann, Elias; Fessel, Gion; Snedeker, Jess G.; Giovanoli, Pietro

2016-01-01

ABSTRACT After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. PMID:27635037

Chondroblastoma of the hands and feet

International Nuclear Information System (INIS)

Davila, Jesse A.; Amrami, Kimberly K.; Sundaram, Murali; Adkins, Mark C.; Unni, Krishnan K.

2004-01-01

To review the imaging findings, age and gender distribution of chondroblastoma of the hands and feet. Twenty-five cases of pathologically proven chondroblastoma of the hands and feet were reviewed. Available imaging modalities included radiographs (n=24), CT (n=3), MRI (n=5), and radionuclide bone scintigraphy (n=1). The following imaging features for each case were tabulated: location, presence of sclerotic margin, calcification, expansion, presence of fluid/fluid levels on cross-sectional imaging and surrounding edema on MRI. The images were evaluated for skeletal maturity using closure of the physeal plate in the region as a standard. The average age at time of diagnosis was 23 years (range 7-57 years). Eighty-four percent (n=21) of the patients were skeletally mature. Males (20 of 25) outnumbered females by a ratio of 5:1. The bones of the foot accounted for 22 cases: calcaneus (n=8), talus (n=8), metatarsals (n=3), and the cuboid (n=3). The bones of the hand accounted for three cases: phalanx (n=1), triquetrum (n=1), and a metacarpal (n=1). Radiographically all lesions were osteolytic with identifiable calcification in 54% (13 of 24). Fluid/fluid levels were seen in four of five cases on MRI. Edema on MR images was seen in 40% (2 of 5). The size of the lesions ranged from 2 to 41 cm 2 . Chondroblastomas of the hands and feet share many of the radiographic characteristics seen in the long bones, but manifest in skeletally mature patients with a higher male to female ratio than in long bone chondroblastoma. Talar and calcaneal lesions were encountered only in males. Chondroblastoma of the wrist and hand appears to be exceptionally rare. (orig.)

Finite element analysis of plantar fascia during walking: a quasi-static simulation.

Science.gov (United States)

Chen, Yen-Nien; Chang, Chih-Wei; Li, Chun-Ting; Chang, Chih-Han; Lin, Cheng-Feng

2015-01-01

The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling. A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject. The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism. Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase. Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis. © The Author(s) 2014.

Effect of Achilles tendon loading on plantar fascia tension in the standing foot.

Science.gov (United States)

Cheung, Jason Tak-Man; Zhang, Ming; An, Kai-Nan

2006-02-01

The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.

Safety of achilles detachment and reattachment using a standard midline approach to insertional enthesophytes.

Science.gov (United States)

McAlister, Jeffrey E; Hyer, Christopher F

2015-01-01

Detachment with reattachment of the Achilles tendon is a common surgery for debridement of retrocalcaneal exostosis, bursitis, and other insertional pathologic entities. The technique involves a midline skin incision on the posterior Achilles to the tendon. The distal Achilles attachment is removed in a U-shaped manner, leaving the medial and lateral flares, but exposing the posterior spur. This midline approach provides excellent exposure and allows for rapid and efficient surgical debridement. The tendon is reapproximated and repaired with a suture anchor to facilitate fixation to the posterior calcaneus. Some surgeons have expressed concerned that the rupture risk could be increased in the postoperative period using this technique. The present study was a retrospective medical record review of 98 patients (100 feet) who had undergone a midline approach with Achilles reattachment after insertional Achilles debridement during a 3-year period. The demographic and comorbidity data were collected and analyzed. The outcome measures were postoperative rupture and the need for revision surgery. The mean age was 51.9 years, and the patients included 59 females (60.2%) and 39 males (39.8%). The complications included 4 rupture or avulsion revisions (4.0%) and 2 recurrent pain and tendinitis revisions (2.0%). The most common repeat repair procedure included hardware removal and a flexor hallucis longus transfer or augmentation. Nine patients (9.0%) had wound complications, 7 (77.8%) of which necessitated incision and drainage. The midline approach with Achilles detachment and reattachment is a safe and effective method of surgical treatment of insertional Achilles pathologic entities. The low reoperation rate of 4.0% will allow foot and ankle surgeons to safely rely on this approach. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

[Excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for treatment of flatfoot related with accessory navicular].

Science.gov (United States)

Cao, Honghui; Tang, Kanglai; Deng, Yinshuan; Tan, Xiaokang; Zhou, Binghua; Tao, Xu; Chen, Lei; Chen, Qianbo

2012-06-01

To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 +/- 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. All patients got primary wound healing without any complication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain relief at 6 months after surgery and had good appearance of the feet. The AOFAS ankle-midfoot score was 90.4 +/- 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus inclination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P < 0.01). The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.

Mechanisms for triceps surae injury in high performance front row rugby union players: a kinematic analysis of scrummaging drills.

Science.gov (United States)

Flavell, Carol A; Sayers, Mark G L; Gordon, Susan J; Lee, James B

2013-01-01

The front row of a rugby union scrum consists of three players. The loose head prop, hooker and tight head prop. The objective of this study was to determine if known biomechanical risk factors for triceps surae muscle injury are exhibited in the lower limb of front row players during contested scrummaging. Eleven high performance front row rugby union players were landmarked bilaterally at the posterior superior iliac spine (PSIS), greater trochanter, lateral femoral epicondyle, midline of the calcaneus above the plantar aspect of the heel, midline lower leg 5cm and 20cm proximal to the lateral malleolus, at the axis of subtalar joint, lateral malleolus, and head of the fifth metatarsal. Players were video recorded during a series of 2 on 1 live scrummaging drills. Biomechanical three dimensional analysis identified large angular displacements, and increased peak velocities and accelerations at the ankle joint during attacking scrummaging drill techniques when in the stance phase of gait. This places the triceps surae as increased risk of injury and provides valuable information for training staff regarding injury prevention and scrum training practices for front row players. Key pointsFront rowers exhibited patterns of single leg weight bearing, in a position of greater ankle plantar flexion and knee extension at toe off during scrummaging, which is a risk position for TS injury.Front rowers also exhibited greater acceleration at the ankle, knee, and hip joints, and greater changes in ankle ROM from toe strike to toe off during attacking scrum drills.These reported accelerations and joint displacements may be risk factors for TS injury, as the ankle is accelerating into plantar flexion at final push off and the muscle is shortening from an elongated state.

Effect of deep stripping massage alone or with eccentric resistance on hamstring length and strength.

Science.gov (United States)

Forman, Jeffrey; Geertsen, Lisbeth; Rogers, Michael E

2014-01-01

Many studies have evaluated the effects of different interventions on hamstring length. However, little research has been conducted on the effects of deep stripping massage strokes (DSMS) alone, or combined with eccentric resistance, on hamstring length and strength. To determine: 1) if DSMS have an effect on hamstring length and strength and 2) if the effects on hamstring length and strength are any different when DSMS are combined with eccentric exercise. 89 Community College students and community members between the ages of 18 and 62 volunteered for the study. Of these, 64 demonstrated tight hamstrings on either one or both sides as defined by supine, passive terminal knee extension of ≤75° and participated in the study. Strength was assessed by pressing the posterior calcaneus into a strain gauge for approximately 5 s while seated with the knee flexed to 90°. On their tighter side, participants were administered longitudinal DSMS during 15, 10-s bouts of eccentric resistance with an elastic resistance band. On their other hamstring, participants were administered 15, 10-s longitudinal DSMS while lying passive. All massage strokes were performed at a depth of 7 out of 10 on a verbal pressure scale index. Afterwards, the hamstring flexibility and strength tests were repeated. Both DSMS with eccentric resistance (10.7%) and DSMS alone (6.3%) resulted in improved (p alone. Strength was not significantly affected by either treatment. These results suggest that DSMS increases hamstring length in less than 3 min but has no affect on strength. Furthermore, combining DSMS with eccentric resistance produces more hamstring flexibility gains than DSMS alone and does not affect strength. Copyright © 2013 Elsevier Ltd. All rights reserved.

Assessment of hindfoot alignment using MRI and standing hindfoot alignment radiographs (Saltzman view)

Energy Technology Data Exchange (ETDEWEB)

Bueber, Nydia; Zanetti, Marco [Clinic Hirslanden, Department of Musculoskeletal Radiology, Zurich (Switzerland); Frigg, Arno [Clinic Hirslanden, Centre for Foot and Ankle Surgery, Zurich (Switzerland); Saupe, Nadja [Clinic Hirslanden, Department of Musculoskeletal Radiology, Zurich (Switzerland); Clinic Hirslanden Zurich, Department of Musculoskeletal Radiology, Zurich (Switzerland)

2018-01-15

To compare the hindfoot alignment measured on standing HAV radiographs (Saltzman view) and on non-weight-bearing coronal MR images. The apparent moment arm was measured on weight-bearing conventional radiographs (Saltzman views) and on MRIs of the ankle in 50 consecutive patients (mean age, 54 years; age range, 18-77 years). The evaluation was performed independently by three readers using analogous reference points for both methods. Positive values were assigned when the deepest point of the calcaneus was lateral to the tibial axis as valgus, negative values as varus. The intertechnique agreement and correlation for the measurements performed with HAV radiographs and MRI were assessed for each reader using the Bland-Altman method and the Pearson correlation coefficient, respectively. The interobserver agreement was assessed using the intraclass correlation coefficient. The means of apparent moment arms, with the standard deviation (SD) in parentheses, of three readers were +2.0 (±8.4) mm, +1.5 (±6.6) mm and -1.4 (±8.2) mm on HAV radiographs and +4.6 (±7.4) mm, +6.3 (±5.3) mm and +5.4 (±6.4) mm on MRI. The Bland-Altman analysis found a systematic bias for all three readers, corresponding to an overestimation of measurements with MRI (systematic bias ranging from 2.6 to 4.8 mm). The intertechnique correlation was found moderate to high. The Pearson coefficients for the three readers were 0.75, 0.64 and 0.65. The interobserver agreement among the three readers was 0.72, 0.77 and 0.68 for HAV, MRI and both modalities together, respectively. Hindfoot alignment can be estimated on MRI but the correlation between the values on HAV radiographs and MR images is only moderate with a tendency to increased positive values (valgization) on MR images. (orig.)

Magnetic resonance imaging of the ankle in female ballet dancers en pointe.

Science.gov (United States)

Russell, Jeffrey A; Shave, Ruth M; Yoshioka, Hiroshi; Kruse, David W; Koutedakis, Yiannis; Wyon, Matthew A

2010-07-01

Ballet dancers require extreme range of motion of the ankle, especially weight-bearing maximum plantar flexion (en pointe). In spite of a high prevalence of foot and ankle injuries in ballet dancers, the anatomy and pathoanatomy of this position have not been sufficiently studied in weight-bearing. Magnetic resonance imaging (MRI) is a beneficial method for such study. To develop an MRI method of evaluating the ankles of female ballet dancers standing en pointe and to assess whether pathological findings from the MR images were associated with ankle pain reported by the subjects. Nine female ballet dancers (age, 21+/-2.9 years; dance experience, 16+/-4.1 years; en pointe dance experience, 7+/-4.9 years) completed an ankle pain visual analog scale questionnaire and underwent T1- and T2-weighted scans using a 0.25 T open MRI device. The ankle was scanned in three positions: supine with full plantar flexion, standing with the ankle in anatomical position, and standing en pointe. Obtaining MR images of the ballet dancers en pointe was successful in spite of limitations imposed by the difficulty of remaining motionless in the en pointe position during scanning. MRI signs of ankle pathology and anatomical variants were observed. Convergence of the posterior edge of the tibial plafond, posterior talus, and superior calcaneus was noted in 100% of cases. Widened anterior joint congruity and synovitis/joint effusion were present in 71% and 67%, respectively. Anterior tibial and/or talar spurs and Stieda's process were each seen in 44%. However, clinical signs did not always correlate with pain reported by the subjects. This study successfully established an ankle imaging technique for ballet dancers en pointe that can be used in the future to assess the relationship between en pointe positioning and ankle pathoanatomy in ballet dancers.

Assessment of female ballet dancers' ankles in the en pointe position using high field strength magnetic resonance imaging.

Science.gov (United States)

Russell, Jeffrey A; Yoshioka, Hiroshi

2016-08-01

The en pointe position of the ankle in ballet is extreme. Previously, magnetic resonance imaging (MRI) of ballet dancers' ankles en pointe was confined to a low field, open MR device. To develop a reproducible ankle MRI protocol for ballet dancers en pointe and to assess the positions of the key structures in the dancers ankles. Six female ballet dancers participated; each was randomly assigned to stand en pointe while one of her feet and ankles was splinted with wooden rods affixed with straps or to begin with the ankle in neutral position. She lay in an MR scanner with the ankle inside a knee coil for en pointe imaging and inside an ankle/foot coil for neutral position imaging. Proton density weighted images with and without fat suppression and 3D water excitation gradient recalled echo images were obtained en pointe and in neutral position in sagittal, axial, and coronal planes. We compared the bones, cartilage, and soft tissues within and between positions. No difficulties using the protocol were encountered. En pointe the posterior articular surface of the tibial plafond was incongruent with the talar dome and rested on the posterior talus. The posterior edge of the plafond impinged Kager's fat pad. All participants exhibited one or more small ganglion cysts about the ankle and proximal foot, as well as fluid accumulation in the flexor and fibularis tendon sheaths. Our MRI protocol allows assessment of female ballet dancers' ankles in the extreme plantar flexion position in which the dancers perform. We consistently noted incongruence of the talocrural joint and convergence of the tibia, talus, and calcaneus posteriorly. This protocol may be useful for clinicians who evaluate dancers. © The Foundation Acta Radiologica 2015.

Orthotopic Transplantation of Achilles Tendon Allograft in Rats

Science.gov (United States)

Aynardi, Michael; Zahoor, Talal; Mitchell, Reed; Loube, Jeffrey; Feltham, Tyler; Manandhar, Lumanti; Paudel, Sharada; Schon, Lew; Zhang, Zijun

2018-01-01

The biology and function of orthotopic transplantation of Achilles tendon allograft are unknown. Particularly, the revitalization of Achilles allograft is a clinical concern. Achilles allografts were harvested from donor rats and stored at −80 °C. Subcutaneous adipose tissue was harvested from the would-be allograft recipient rats for isolation of mesenchymal stem cells (MSCs). MSCs were cultured with growth differentiation factor-5 (GDF-5) and applied onto Achilles allografts on the day of transplantation. After the native Achilles tendon was resected from the left hind limb of the rats, Achilles allograft, with or without autologous MSCs, was implanted and sutured with calf muscles proximally and calcaneus distally. Animal gait was recorded presurgery and postsurgery weekly. The animals were sacrificed at week 4, and the transplanted Achilles allografts were collected for biomechanical testing and histology. The operated limbs had altered gait. By week 4, the paw print intensity, stance time, and duty cycle (percentage of the stance phase in a step cycle) of the reconstructed limbs were mostly recovered to the baselines recorded before surgery. Maximum load of failure was not different between Achilles allografts, with or without MSCs, and the native tendons. The Achilles allograft supplemented with MSCs had higher cellularity than the Achilles allograft without MSCs. Deposition of fine collagen (type III) fibers was active in Achilles allograft, with or without MSCs, but it was more evenly distributed in the allografts that were incubated with MSCs. In conclusion, orthotopically transplanted Achilles allograft healed with host tissues, regained strength, and largely restored Achilles function in 4 wk in rats. It is therefore a viable option for the reconstruction of a large Achilles tendon defect. Supplementation of MSCs improved repopulation of Achilles allograft, but large animal models, with long-term follow up and cell tracking, may be required to fully

Orthotopic Transplantation of Achilles Tendon Allograft in Rats: With or without Incorporation of Autologous Mesenchymal Stem Cells.

Science.gov (United States)

Aynardi, Michael; Zahoor, Talal; Mitchell, Reed; Loube, Jeffrey; Feltham, Tyler; Manandhar, Lumanti; Paudel, Sharada; Schon, Lew; Zhang, Zijun

2018-02-01

The biology and function of orthotopic transplantation of Achilles tendon allograft are unknown. Particularly, the revitalization of Achilles allograft is a clinical concern. Achilles allografts were harvested from donor rats and stored at -80 °C. Subcutaneous adipose tissue was harvested from the would-be allograft recipient rats for isolation of mesenchymal stem cells (MSCs). MSCs were cultured with growth differentiation factor-5 (GDF-5) and applied onto Achilles allografts on the day of transplantation. After the native Achilles tendon was resected from the left hind limb of the rats, Achilles allograft, with or without autologous MSCs, was implanted and sutured with calf muscles proximally and calcaneus distally. Animal gait was recorded presurgery and postsurgery weekly. The animals were sacrificed at week 4, and the transplanted Achilles allografts were collected for biomechanical testing and histology. The operated limbs had altered gait. By week 4, the paw print intensity, stance time, and duty cycle (percentage of the stance phase in a step cycle) of the reconstructed limbs were mostly recovered to the baselines recorded before surgery. Maximum load of failure was not different between Achilles allografts, with or without MSCs, and the native tendons. The Achilles allograft supplemented with MSCs had higher cellularity than the Achilles allograft without MSCs. Deposition of fine collagen (type III) fibers was active in Achilles allograft, with or without MSCs, but it was more evenly distributed in the allografts that were incubated with MSCs. In conclusion, orthotopically transplanted Achilles allograft healed with host tissues, regained strength, and largely restored Achilles function in 4 wk in rats. It is therefore a viable option for the reconstruction of a large Achilles tendon defect. Supplementation of MSCs improved repopulation of Achilles allograft, but large animal models, with long-term follow up and cell tracking, may be required to fully

Status of bone mineral content and body composition in boys engaged in intensive physical activity

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Madić Dejan

2010-01-01

Full Text Available Background/Aim. It is well known that physical activity has an anabolic effect on bone tissue. But there is a lack of information about the effect of intensive physical activity in childhood, particularly at the prepubertal stage. To examine the influence of training on body composition and bone mineral density we have studied a group of prepubertal soccer players as well as a group of inactive prepubertal boys at the starting phase of their peak bone mass acquisition. Methods. A total of 62 healthy prepubertal boys took part in this study. They were divided into two groups. The first one consisted of 32 soccer players (aged 10.7 ± 0.5 years, who had been playing football for at least 1 year (10-15 h per week. The second group a control group 30 boys (aged 11.2 ± 0.7 years doing 1.5 h per week physical activity at school. Body composition was assessed by a Body Fat Analyzer 'BES 200 Z'. Bone mineral density measurements of the left and the right calcaneus were done by using ultrasound densitometer 'Sahara' (Hologic, Inc., MA, USA. Results. There were significant differences between soccer players and the control group in fat mass (p = 0.01. Besides, a significant difference was determined between the group of athletes and the control group in bone mineral density of both calcaneal bones (p = 0.01. Conclusion. The results of this study confirm the significant effects of physical activity on reducing body mass and increasing bone density. Considering that football training can be very easily implemented in the broader population of children and young people, which does not apply to many other sports, it should be used more in the prevention of obesity and osteoporosis.

Multiple bony lesions other than femoral heads on 99mTc-MDP bone scan in patients with avascular necrosis of the femoral head

International Nuclear Information System (INIS)

Choi, Yun Young; Yang, Seoung Oh; Moon, Dae Hyuk; Ryu, Jin Sook; Weon, Young Cheol; Shin, Myung Jin; Lee, Soo Ho; Lee, Hee Kyung; Chun, Hae Kyung

1997-01-01

To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. One hundred and seventy three patients with clinical diagnosis of avascular necrosis of the emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of in volvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8%;the location of 79 lesions was other than the femoral head, This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to aveid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated

Hypophosphatemic osteomalacia induced by low-dose adefovir therapy: focus on manifestations in the skeletal system and literature review.

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Kim, Du Hwan; Sung, Duk Hyun; Min, Yong Ki

2013-03-01

Osteomalacia is a metabolic bone disease that leads to softening of the bones and can be caused by hypophosphatemia. Large clinical studies of low-dose adefovir dipivoxil (adefovir) have found no evidence of renal tubular dysfunction leading to hypophosphatemia after 48 weeks of treatment. We report two cases of low-dose adefovir-induced hypophosphatemic osteomalacia that initially presented with diffuse musculoskeletal pain. The first patient was a 62-year-old man with a 2-year history of bone pain involving the dorsal mid-thorax, lower anterior chest wall, right sacroiliac joint area, and both knees. The patient had been receiving adefovir for 5 years before confirmation of hypophosphatemia and urinary phosphate wasting. Bone scintigraphy revealed multifocal lesions including multiple ribs, costochondral junctions, costovertebral junctions, sacrum, both posterior iliac bones, both proximal tibia, right calcaneus, and the left second metatarsophalangeal joint area, which were suggestive of metabolic bone disorder. Bone pain was significantly reduced within 3 months after supplementation with phosphate and calcitriol. The second patient was a 54-year-old male who presented with an 18-month history of severe bone pain of the right medial knee and low back. The patient had been taking adefovir for approximately 40 months before the development of bone pain. Laboratory data revealed hypophosphatemia and vitamin D deficiency. Bone scintigraphy showed increased uptake in bilateral ribs, sternum, both scapulae, both costovertebral junctions, both pelvic bones, medial cortex of the right proximal femur, right proximal tibia, and the left lateral tarsal bone. The symptoms improved by changing the antiviral agent from adefovir to entecavir. Because osteomalacia often presents with diffuse bone pain, non-specific radiologic findings and non-characteristic routine serum biochemical changes, the disease can be confused with various musculoskeletal diseases and a high index

Efeitos do laser de baixa potência sobre a dor e edema no trauma tendíneo de ratos Effects of the low level laser over pain and edema in tendon trauma of rats

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Gladson Ricardo Flor Bertolini

2008-08-01

repair, thus gain body the use of physical resources for the process control. The aim of this study was to evaluate the use of low level laser therapy on the pain and edema of the rats calcaneus tendon, subjected to experimental trauma. We used 28 rats Wistar, divided into four groups: GC - subjected to traumatic injury and the placebo treatment; G2 - subject to injury and irradiated with laser 2 J/cm²; G4 - subject to injury and irradiated with 4 J/cm²; G8 - submitted to injury and irradiated with 8 J/cm². The lesion was performed with the fall of a weight on the side of the right calcaneus tendon of each animal, with energy of about 0.40 J. The pain was evaluated by the paw elevation time (PET for a minute, the animal walking on a metal cylinder with 30 cm in diameter at 3 rpm; the edema evaluation occurred through caliper; moments of the evaluation were: after and before injury, before treatment, 2 hours, 8 hours, 24 hours and 5th injury day. Treatment with laser 670 nm, was so punctual and daily. The results showed increases in PET and formation of edema in all groups after the injury, and for the groups treated there were reducing the pain and edema, being observed in the control group only with the edema reduction in the 5th placebo day. We concluded that the treatment with low level laser therapy decreased the pain and edema of the animals with tendon trauma, in a dose-dependent manner.

Recovery of decreased bone mineral mass after lower-limb fractures in adolescents.

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Ceroni, Dimitri; Martin, Xavier E; Delhumeau, Cécile; Farpour-Lambert, Nathalie J; De Coulon, Geraldo; Dubois-Ferrière, Victor; Rizzoli, René

2013-06-05

Loss of bone mineral mass, muscle atrophy, and functional limitations are predictable consequences of immobilization and subsequent weight-bearing restriction due to leg or ankle fractures. The aim of this study was to prospectively determine whether decreased bone mineral mass following lower-limb fractures recovers at follow-up durations of six and eighteen months in adolescents. In the present study, we included fifty adolescents who underwent cast immobilization for a leg or ankle fracture. Dual x-ray absorptiometry scans of four different sites (total hip, femoral neck, entire lower limb, and calcaneus) were performed at the time of the fracture, at cast removal, and at follow-ups of six and eighteen months. Patients with fractures were paired with healthy controls according to sex, age, and ethnicity. Dual x-ray absorptiometry values were compared between groups and between injured and non-injured legs in adolescents with fractures. Among those with fractures, lower-limb bone mineral variables were significantly lower at the injured side compared with the non-injured side at cast removal, with differences ranging from 6.2% to 31.7% (p < 0.0001). Similarly, injured adolescents had significantly lower bone mineral values at the level of the injured lower limb compared with healthy controls (p < 0.0001). At the six-month follow-up, there were still significant residual differences between injured and non-injured legs in adolescents with fractures (p < 0.0001). However, a significant residual difference between healthy controls and injured adolescents was present only for femoral neck bone mineral density (p = 0.011). At the eighteen-month follow-up, no significant difference was observed at any lower-limb site. Bone mineral loss following a fracture of the lower limb in adolescents is highly significant and affects the lower limb both proximal to and distal to the fracture site. In contrast to observations in adults, a rapid bone mass reversal occurs with full

Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases

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Kienast B

2010-02-01

Full Text Available Abstract Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82, 104 patients were male (67,1%. Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AO-FAS-Score and radiographs. 92,7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5% the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63,7 (53-92. Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.

Flat Foot in a Random Population and its Impact on Quality of Life and Functionality.

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Pita-Fernandez, Salvador; Gonzalez-Martin, Cristina; Alonso-Tajes, Francisco; Seoane-Pillado, Teresa; Pertega-Diaz, Sonia; Perez-Garcia, Sergio; Seijo-Bestilleiro, Rocio; Balboa-Barreiro, Vanesa

2017-04-01

Flat foot is a common deformity in adults. It is characterized by medial rotation and plantar flexion of the talus, eversion of the calcaneus, collapsed medial arch and abduction of the forefoot. The aim of this study was to determine the prevalence of flat foot and its impact on quality of life, dependence, foot pain, disability and functional limitation among random population of 40-year-old and above. A cross-sectional study in a random population sample from Cambre (A Coruña-Spain) (n=835) was performed (α =0.05; Precision=±3.4%). The diagnosis of flat foot was stablished by the study of the footprint obtained with a pedograph. Anthropometric variables were studied, Charlson's Comorbidity Index, function and state of foot (Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ)), quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). A logistic and linear multiple regression analysis was performed. The prevalence of flat foot was 26.62%. Patients with flat foot were significantly older (65.73±11.04 vs 61.03±11.45-year-old), showed a higher comorbidity index (0.92±1.49 vs 0.50±0.98), had a greater BMI (31.45±5.55 vs 28.40±4.17) and greater foot size (25.16±1.66 vs 24.82±1.65). The presence of flat foot diminishes the quality of life, as measured by the FHSQ, and foot function, measured by the FFI. The presence of flat foot does not alter the physical and mental dimension of the SF-36 or the degree of dependence. Flat foot was associated with age, Charlson's Comorbidity Index, BMI and foot size. The SF-36, Barthel and Lawton questionnaires remained unaltered by the presence of flat foot. The FHSQ and FFI questionnaires did prove to be sensitive to the presence of flat foot in a significant manner.

Recent progress of the bone densitometer

International Nuclear Information System (INIS)

Tamegai, Toshiaki

1996-01-01

A Bone Densitometer is the equipment which non-invasively evaluates bone mineral such as calcium contained in the bone of human. It is widely accepted as a useful equipment for the purpose of diagnosis of the bone, especially of the osteoporosis. Human body is considered as two-component system composed of bone and soft tissue at the point of view of radiation absorption. Therefore it is necessary to eliminate soft tissue component to determine bone mineral content or density. To cancel soft tissue component, there are a few methods employed to the bone densitometers. Accordingly the bone densitometers are classified into two types. In SXA, X-ray source having effective energy of approximately 30keV is used. The measurement site of patient should be soaked in water to eliminate soft tissue component according to the theory that the linear attenuation coefficient of water is nearly equal to that of soft tissue. Therefore the difference between the intensity of X-ray transmitted through soft tissue and that of X-ray through soft tissue plus bone indicates amount of bone mineral directly under the constant water thickness condition. SXA is a very convenient method, but the necessity of water may not be desirable in the clinical use. Therefore, clinical applications of SXA are limited to peripheral site such as forearm or calcaneus. In DXA, X-ray source having dual effective energies of approximately 40keV and 80keV is used. The theory is based on the difference of intensities between X-ray transmitted through soft tissue and that of transmitted through bone. The amount of bone mineral is then estimated by the theoretical calculations. Therefore, DXA is applicable for not only spine or femur but also all sites of patients. The bone densitometers based on SXA or DXA are widely accepted as the equipments for the measurement of bone mineral. However, recently, equipments based on other theoretical method, pQCT and QUS are proposed. (J.P.N.)

Understanding the links among neuromedin U gene, beta2-adrenoceptor gene and bone health: an observational study in European children.

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Francesco Gianfagna

Full Text Available Neuromedin U, encoded by the NMU gene, is a hypothalamic neuropeptide that regulates both energy metabolism and bone mass. The beta-2 adrenergic receptor, encoded by the ADRB2 gene, mediates several effects of catecholamine hormones and neurotransmitters in bone. We investigated whether NMU single nucleotide polymorphisms (SNPs and haplotypes, as well as functional ADRB2 SNPs, are associated with bone stiffness in children from the IDEFICS cohort, also evaluating whether NMU and ADRB2 interact to affect this trait. A sample of 2,274 subjects (52.5% boys, age 6.2 ± 1.8 years from eight European countries, having data on calcaneus bone stiffness index (SI, mean of both feet and genotyping (NMU gene: rs6827359, rs12500837, rs9999653; ADRB2 gene: rs1042713, rs1042714, was studied. After false discovery rate adjustment, SI was significantly associated with all NMU SNPs. rs6827359 CC homozygotes showed the strongest association (recessive model, Δ= -1.8, p=0.006. Among the five retrieved haplotypes with frequencies higher than 1% (range 2.0-43.9%, the CCT haplotype (frequency=39.7% was associated with lower SI values (dominant model, Δ= -1.0, p=0.04 as compared to the most prevalent haplotype. A non-significant decrease in SI was observed in in ADRB2 rs1042713 GG homozygotes, while subjects carrying SI-lowering genotypes at both SNPs (frequency = 8.4% showed much lower SI than non-carriers (Δ= -3.9, p<0.0001; p for interaction=0.025. The association was more evident in preschool girls, in whom SI showed a curvilinear trend across ages. In subgroup analyses, rs9999653 CC NMU or both GG ADRB2 genotypes were associated with either lower serum calcium or β-CrossLaps levels (p=0.01. This study in European children shows, for the first time in humans, a role for NMU gene through interaction with ADRB2 gene in bone strength regulation, more evident in preschool girls.

AN EVALUATION OF THE REARFOOT POSTURE IN INDIVIDUALS WITH PATELLOFEMORAL PAIN SYNDROME

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Wendy Gilleard

2004-11-01

Full Text Available Structural abnormalities of the foot may cause abnormal subtalar joint compensatory motion in order to attain normal function of the lower extremity during gait although studies have not been conclusive. Current conflict in the literature may be related to the differing measures focused on the varying protocols and also the absence of a control group in some studies. This study investigated the rearfoot posture including Subtalar Joint Neutral Position (STJN and Relaxed Calcaneal Standing (RCS measurements in patellofemoral pain syndrome (PFPS and healthy subjects. The angle of STJN during non-weight bearing position and the two dimensional (2D rearfoot RCS posture was measured using a goniometer in 14 healthy females and 13 females with PFPS. The RCS posture was also measured three dimensionally (3D by attaching external markers to a tibia shell and the calcaneus and videoing with a four-camera three-dimensional motion analysis system. A one way ANOVA was used to assess the differences between the groups. The 2D and 3D RCS were significantly different between the groups (p ¡Ü 0.001 with mean -0.23¡ã ¡À 1.35¡ã , 2.52¡ã ¡À 3.11¡ã for the control group and 2.35¡ã ¡À 1.4¡ã, 7.02¡ã ¡À 3.33¡ã for the clinical group respectively. STJN showed a slight rearfoot varus (although significant p = 0.04 in PFPS (-2.20¡ã ¡À 1.51¡ã compared to the control group (-1.00¡ã ¡À 1.36¡ã. Negative values indicated inversion and positive values indicated eversion. The 2D and 3D RCS showed a significantly more everted posture of the rearfoot for the PFPS group. Subtalar joint varus may contribute to the increased eversion during relaxed standing in the PFPS group. Rearfoot measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS.

[Endoscopic calcaneoplasty (ECP) in Haglund's syndrome. Indication, surgical technique, surgical findings and results].

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Jerosch, J; Sokkar, S; Dücker, M; Donner, A

2012-06-01

Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems. Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months. According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia. ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the

Double row anchor fixation: a novel technique for a diabetic calanceal insufficiency avulsion fracture.

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Greenhagen, Robert M; Highlander, Peter D; Burns, Patrick R

2012-01-01

Avulsion fractures of the calcaneal tuberosity represent only 1.3% to 2.7% of calcaneal fractures. These fractures are common pathologically in nature and attributed to decreased bone mineral density. Calcaneal insufficiency avulsion (CIA) fracture in patients with diabetes mellitus is most likely due to Charcot neuroarthropathy (CN) as described by the Brodsky classification (Brodsky 3B). Traditional open reduction and internal fixation is difficult in all calcaneal avulsion fractures because of poor bone quality. The authors report the first known description of the use of fracture fragment excision and double row anchor fixation.A 39-year-old woman with type I diabetes mellitus and a history of CN presented with an avulsion fracture of the calcaneal tuberosity. Excision of the fracture fragment and a gastrocnemius recession and reattachment of the Achilles tendon with double row anchor fixation to the calcaneus were performed. At 1 year, the patient's American Orthopaedic Foot & Ankle Society rearfoot score improved from 27/100 to 88/100. CIA fractures are an infrequently described injury. Because diabetes mellitus is frequently associated with this disease, it most likely represents a CN event. Traditionally, CIA fractures have been operatively treated with open reduction internal fixation. Previous authors have described difficulty with fixation because of poor quality. In the current report, the authors describe a novel operative approach to CIA fractures through the use of double row anchor fixation and excision of the fracture fragments. The authors feel that this previously undescribed treatment is superior to traditional methods and may serve as a new treatment option for all patients who have sustained this unusual pathology regardless of the underlying cause. The current authors provide a novel operative technique that provides inherent advantages to the traditional repair of CIA fractures. We believe CIA fractures represent a CN-type event and care

[PART-KESSLER TECHNIQUE WITH SUTURE ANCHOR IN REPAIR OF SPONTANEOUS Achilles TENDON RUPTURE].

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Qi, Jie; Duan, Liang; Li, Weiwei; Wei, Wenbo

2016-02-01

To summarize the application and experience of repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor. Between January 2011 and December 2013, 31 patients with spontaneous Achilles tendon rupture were treated by part-Kessler technique with suture anchor. Of 31 cases, 23 were male and 8 were female, aged 16-53 years (mean, 38 years). The left side was involved in 15 cases and the right side in 16 cases. The causes of injury included sudden heel pain and walking weakness during sports in 22 cases; no surefooted down-stairs, slip, and carrying heavy loads in 9 cases. The distance from broken site to the calcaneus adhension of Achilles tendon was 3-6 cm (mean, 4.2 cm). The time from injury to operation was 7 hours to 4 days (mean, 36.8 hours). All incisions healed by first intention without nerve injury or adhering with skin. The patients were followed up 6-24 months (mean, 15 months). All patients could complete 25 times heel raising without difficulty at 6 months after operation. No Achilles tendon rupture occurred again during follow-up. At 6 months after operation, the range of motion of the ankle joint in dorsiflexion and plantar flexion showed no significant difference between normal and affected sides (t=0.648, P=0.525; t=0.524, P=0.605). The circumference of the affected leg was significantly smaller than that of normal leg at 6 months after operation (t=2.074, P=0.041), but no significant difference was found between affected and normal sides at 12 months after operation (t=0.905, P=0.426). The American Orthopedic Foot and Ankle Society (AOFAS) scores at 6, 12, 18, and 24 months after operation were significantly higher than preoperative score (P0.05). Repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor can supply strong strain and decrease the shear forces of suture. So part-Kessler technique with suture anchor is successful in repairing spontaneous Achilles tendon rupture.

Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions.

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Huh, Jeannie; Easley, Mark E; Nunley, James A

2016-06-01

An Achilles sleeve avulsion occurs when the tendon ruptures distally from its calcaneal insertion as a continuous "sleeve." This relatively rare injury pattern may not be appreciated until the time of surgery and can be challenging to treat because, unlike a midsubstance rupture, insufficient tendon remains on the calcaneus to allow for end-to-end repair, and unlike a tuberosity avulsion fracture, any bony element avulsed with the tendon is inadequate for internal fixation. This study aimed to highlight the characteristics of Achilles sleeve avulsions and present the outcomes of operative repair using suture anchor fixation. A retrospective analysis was conducted on 11 consecutive Achilles tendon sleeve avulsions (10 males, 1 female; mean age 44 years) that underwent operative repair between 2008 and 2014. Patient demographics, injury presentation, and operative details were reviewed. Postoperative outcomes were collected at a mean follow-up of 38.4 (range, 12-83.5) months, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, visual analog scale (VAS) for pain, plantarflexion strength, patient satisfaction, and complications. Eight patients (72.7%) had preexisting symptoms of insertional Achilles disease. Ten of 11 (90.9%) injuries were sustained during recreational athletic activity. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. All patients healed after suture anchor repair. The average AOFAS score was 92.8 and VAS score was 0.9. Ten patients (90.9%) were completely satisfied. One complication occurred, consisting of delayed wound healing. Achilles tendon sleeve avulsions predominantly occurred in middle-aged men with preexisting insertional

Geographic variation in gorilla limb bones.

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Jabbour, Rebecca S; Pearman, Tessa L

2016-06-01

Gorilla systematics has received increased attention over recent decades from primatologists, conservationists, and paleontologists. Studies of geographic variation in DNA, skulls, and teeth have led to new taxonomic proposals, such as recognition of two gorilla species, Gorilla gorilla (western gorilla) and Gorilla beringei (eastern gorilla). Postcranial differences between mountain gorillas (G. beringei beringei) and western lowland gorillas (G. g. gorilla) have a long history of study, but differences between the limb bones of the eastern and western species have not yet been examined with an emphasis on geographic variation within each species. In addition, proposals for recognition of the Cross River gorilla as Gorilla gorilla diehli and gorillas from Tshiaberimu and Kahuzi as G. b. rex-pymaeorum have not been evaluated in the context of geographic variation in the forelimb and hindlimb skeletons. Forty-three linear measurements were collected from limb bones of 266 adult gorillas representing populations of G. b. beringei, Gorilla beringei graueri, G. g. gorilla, and G. g. diehli in order to investigate geographic diversity. Skeletal elements included the humerus, radius, third metacarpal, third proximal hand phalanx, femur, tibia, calcaneus, first metatarsal, third metatarsal, and third proximal foot phalanx. Comparisons of means and principal components analyses clearly differentiate eastern and western gorillas, indicating that eastern gorillas have absolutely and relatively smaller hands and feet, among other differences. Gorilla subspecies and populations cluster consistently by species, although G. g. diehli may be similar to the eastern gorillas in having small hands and feet. The subspecies of G. beringei are distinguished less strongly and by different variables than the two gorilla species. Populations of G. b. graueri are variable, and Kahuzi and Tshiaberimu specimens do not cluster together. Results support the possible influence of

Reduced quantitative ultrasound bone mineral density in HIV-infected patients on antiretroviral therapy in Senegal.

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Amandine Cournil

Full Text Available BACKGROUND: Bone status in HIV-infected patients on antiretroviral treatment (ART is poorly documented in resource-limited settings. We compared bone mineral density between HIV-infected patients and control subjects from Dakar, Senegal. METHODS: A total of 207 (134 women and 73 men HIV-infected patients from an observational cohort in Dakar (ANRS 1215 and 207 age- and sex-matched controls from the general population were enrolled. Bone mineral density was assessed by quantitative ultrasound (QUS at the calcaneus, an alternative to the reference method (i.e. dual X-absorptiometry, often not available in resource-limited countries. RESULTS: Mean age was 47.0 (±8.5 years. Patients had received ART for a median duration of 8.8 years; 45% received a protease inhibitor and 27% tenofovir; 84% had undetectable viral load. Patients had lower body mass index (BMI than controls (23 versus 26 kg/m(2, P<0.001. In unadjusted analysis, QUS bone mineral density was lower in HIV-infected patients than in controls (difference: -0.36 standard deviation, 95% confidence interval (CI: -0.59;-0.12, P = 0.003. Adjusting for BMI, physical activity, smoking and calcium intake attenuated the difference (-0.27, CI: -0.53;-0.002, P = 0.05. Differences in BMI between patients and controls explained a third of the difference in QUS bone mineral density. Among patients, BMI was independently associated with QUS bone mineral density (P<0.001. An association between undetectable viral load and QUS bone density was also suggested (β = 0.48, CI: 0.02;0.93; P = 0.04. No association between protease inhibitor or tenofovir use and QUS bone mineral density was found. CONCLUSION: Senegalese HIV-infected patients had reduced QUS bone mineral density in comparison with control subjects, in part related to their lower BMI. Further investigation is needed to clarify the clinical significance of these observations.

2D and 3D assessment of sustentaculum tali screw fixation with or without Screw Targeting Clamp.

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De Boer, A Siebe; Van Lieshout, Esther M M; Vellekoop, Leonie; Knops, Simon P; Kleinrensink, Gert-Jan; Verhofstad, Michael H J

2017-12-01

Precise placement of sustentaculum tali screw(s) is essential for restoring anatomy and biomechanical stability of the calcaneus. This can be challenging due to the small target area and presence of neurovascular structures on the medial side. The aim was to evaluate the precision of positioning of the subchondral posterior facet screw and processus anterior calcanei screw with or without a Screw Targeting Clamp. The secondary aim was to evaluate the added value of peroperative 3D imaging over 2D radiographs alone. Twenty Anubifix™ embalmed, human anatomic lower limb specimens were used. A subchondral posterior facet screw and a processus anterior calcanei screw were placed using an extended lateral approach. A senior orthopedic trauma surgeon experienced in calcaneal fracture surgery and a senior resident with limited experience in calcaneal surgery performed screw fixation in five specimens with and in five specimens without the clamp. 2D lateral and axial radiographs and a 3D recording were obtained postoperatively. Anatomical dissection was performed postoperatively as a diagnostic golden standard in order to obtain the factual screw positions. Blinded assessment of quality of fixation was performed by two surgeons. In 2D, eight screws were considered malpositioned when placed with the targeting device versus nine placed freehand. In 3D recordings, two additional screws were malpositioned in each group as compared to the golden standard. As opposed to the senior surgeon, the senior resident seemed to get the best results using the Screw Targeting Clamp (number of malpositioned screws using freehand was eight, and using the targeting clamp five). In nine out of 20 specimens 3D images provided additional information concerning target area and intra-articular placement. Based on the 3D assessment, five additional screws would have required repositioning. Except for one, all screw positions were rated equally after dissection when compared with 3D examinations

Biomechanical Comparison of External Fixation and Compression Screws for Transverse Tarsal Joint Arthrodesis.

Science.gov (United States)

Latt, L Daniel; Glisson, Richard R; Adams, Samuel B; Schuh, Reinhard; Narron, John A; Easley, Mark E

2015-10-01

Transverse tarsal joint arthrodesis is commonly performed in the operative treatment of hindfoot arthritis and acquired flatfoot deformity. While fixation is typically achieved using screws, failure to obtain and maintain joint compression sometimes occurs, potentially leading to nonunion. External fixation is an alternate method of achieving arthrodesis site compression and has the advantage of allowing postoperative compression adjustment when necessary. However, its performance relative to standard screw fixation has not been quantified in this application. We hypothesized that external fixation could provide transverse tarsal joint compression exceeding that possible with screw fixation. Transverse tarsal joint fixation was performed sequentially, first with a circular external fixator and then with compression screws, on 9 fresh-frozen cadaveric legs. The external fixator was attached in abutting rings fixed to the tibia and the hindfoot and a third anterior ring parallel to the hindfoot ring using transverse wires and half-pins in the tibial diaphysis, calcaneus, and metatarsals. Screw fixation comprised two 4.3 mm headless compression screws traversing the talonavicular joint and 1 across the calcaneocuboid joint. Compressive forces generated during incremental fixator foot ring displacement to 20 mm and incremental screw tightening were measured using a custom-fabricated instrumented miniature external fixator spanning the transverse tarsal joint. The maximum compressive force generated by the external fixator averaged 186% of that produced by the screws (range, 104%-391%). Fixator compression surpassed that obtainable with screws at 12 mm of ring displacement and decreased when the tibial ring was detached. No correlation was found between bone density and the compressive force achievable by either fusion method. The compression across the transverse tarsal joint that can be obtained with a circular external fixator including a tibial ring exceeds that

Prenatal congenital vertical talus (rocker bottom foot). A marker for multisystem anomalies

International Nuclear Information System (INIS)

Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I.; Mehta, Nimisha

2017-01-01

Congenital vertical talus is a rare foot anomaly characterized by a prominent calcaneus and rigid forefoot dorsiflexion. While congenital vertical talus has been associated with anomalies such as trisomy 18, myelomeningocele and arthrogryposis, postnatal series have reported cases of isolated congenital vertical talus. The purpose of our study was to determine the incidence of isolated congenital vertical talus prenatally and identify the most common anomalies associated with this finding. A retrospective review was performed of congenital vertical talus cases identified in our fetal center from 2006 to 2015. The prenatal US and MR imaging appearance of congenital vertical talus was evaluated and differentiation from congenital talipes equinovarus was assessed. Studies were evaluated for additional abnormalities affecting the central nervous system, face, limbs, viscera, growth and amniotic fluid. Imaging findings were recorded and correlated with outcomes when available. Twenty-four cases of congenital vertical talus were identified prenatally (gestational age: 19-36 weeks). All 24 had prenatal US and 21 also underwent fetal MRI on the same day. There were no isolated cases of congenital vertical talus in this series; all 24 had additional anomalies identified prenatally. Sixteen cases had bilateral congenital vertical talus (67%). Additional anomalies were identified in the brain (15), spine (11), face (6), abdominal wall (3), heart (8) and other limbs (12). Chromosomal abnormalities were identified in 6 of 20 patients who underwent genetic testing. Overall, US held some advantage in detecting the abnormality: in 10 cases, US depicted congenital vertical talus more clearly than MRI; in 8 cases, US and MRI were equal in detection and in 3 cases, MRI was superior. In 9/15 cases with intracranial abnormalities, MRI was superior to US in demonstrating structural anomalies. Outcomes included termination (11), intrauterine fetal demise (1), stillbirth or immediate

Prenatal congenital vertical talus (rocker bottom foot). A marker for multisystem anomalies

Energy Technology Data Exchange (ETDEWEB)

Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I. [Children' s National Health System, Division of Diagnostic Imaging and Radiology, Washington, DC (United States); Mehta, Nimisha [George Washington University School of Medicine, Washington, DC (United States)

2017-12-15

Congenital vertical talus is a rare foot anomaly characterized by a prominent calcaneus and rigid forefoot dorsiflexion. While congenital vertical talus has been associated with anomalies such as trisomy 18, myelomeningocele and arthrogryposis, postnatal series have reported cases of isolated congenital vertical talus. The purpose of our study was to determine the incidence of isolated congenital vertical talus prenatally and identify the most common anomalies associated with this finding. A retrospective review was performed of congenital vertical talus cases identified in our fetal center from 2006 to 2015. The prenatal US and MR imaging appearance of congenital vertical talus was evaluated and differentiation from congenital talipes equinovarus was assessed. Studies were evaluated for additional abnormalities affecting the central nervous system, face, limbs, viscera, growth and amniotic fluid. Imaging findings were recorded and correlated with outcomes when available. Twenty-four cases of congenital vertical talus were identified prenatally (gestational age: 19-36 weeks). All 24 had prenatal US and 21 also underwent fetal MRI on the same day. There were no isolated cases of congenital vertical talus in this series; all 24 had additional anomalies identified prenatally. Sixteen cases had bilateral congenital vertical talus (67%). Additional anomalies were identified in the brain (15), spine (11), face (6), abdominal wall (3), heart (8) and other limbs (12). Chromosomal abnormalities were identified in 6 of 20 patients who underwent genetic testing. Overall, US held some advantage in detecting the abnormality: in 10 cases, US depicted congenital vertical talus more clearly than MRI; in 8 cases, US and MRI were equal in detection and in 3 cases, MRI was superior. In 9/15 cases with intracranial abnormalities, MRI was superior to US in demonstrating structural anomalies. Outcomes included termination (11), intrauterine fetal demise (1), stillbirth or immediate

Serum pentosidine concentration is associated with radiographic severity of lumbar spondylosis in a general Japanese population.

Science.gov (United States)

Chiba, Daisuke; Wada, Kanichiro; Tanaka, Toshihiro; Kumagai, Gentaro; Sasaki, Eiji; Takahashi, Ippei; Nakaji, Shigeyuki; Ishibashi, Yasuyuki

2017-01-01

The aim of this study was to investigate the relationship between the radiographic severity of lumbar spondylosis (LS) and serum bone metabolic markers. A total of 681 individuals volunteered for this study (269 men, 412 women; age: 54.9 ± 14.3; body mass index [BMI]: 23.1 ± 3.3 kg/m 2 ). Lateral lumbar radiographs were evaluated in each intervertebral section (L1/2 to L5/S1) using the Kellgren-Lawrence grade (KL). If at least one intervertebral section was graded as KL 2 or greater, the participants were considered to have LS. The summation of each section of intervertebral section was used as the radiographic severity value of LS. In addition, bone status was evaluated with an osteo-sono assessment index (OSI) at the calcaneus. Serum bone alkaline phosphatase (μg/mL), N-telopeptide of type I collagen (nMBCE/L), and pentosidine (pmol/mL) concentrations were examined and used as the bone metabolism index. Stepwise multiple linear regression analysis was conducted with the radiographic severity value of LS as the dependent variable and age, sex, BMI, OSI, and the value of serum bone metabolic markers as the independent variables. The total number of LS participants was 470 (69.0 %); the frequency of LS was higher in men (n = 198) than in women (n = 272; P = 0.036, χ 2 test). The mean severity value of LS was 7.1 ± 4.4, and the mean value of pentosidine was 120.7 ± 54.8 pmol/mL. On multiple regression analysis, age (B = 0.190, β = 0.611), sex (men = 1, women = 2; B = -0.900, β = -0.099), BMI (B = 0.185, β = 0.136), and pentosidine (B = 0.009, β = 0.115) were significantly correlated with the severity of LS. Serum pentosidine concentration was positively correlated with the radiographic severity of LS in this cross-sectional study.

Sonographic evaluation of acute osteomyelitis in infants

International Nuclear Information System (INIS)

Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung

2002-01-01

To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

Sonographic evaluation of acute osteomyelitis in infants

Energy Technology Data Exchange (ETDEWEB)

Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

2002-03-01

To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

Bone mineral content (bmc and bone mineral density (bmd in postmenopausal women formerly practising kayaking and fencing

Directory of Open Access Journals (Sweden)

B Raczyńska

2003-06-01

Full Text Available The investigation was aimed at answering the following questions: 1 Can a prolonged career in sports associated with considerable training loads, in conjunction with other osteoporosis risk factors (both past and present, affect the bone mineral content (BMC and bone mineral density (BMD of the former female athletes in their postmenopausal period of life?, and 2 How does the present lifestyle of the tested women, including physical activity and diet (calcium intake, influence the preservation of the optimal bone mass in these subjects? The postmenopausal subjects recruited to the present study included 15 former athletes (ten kayakers and five fencers and 11 women who never actively engaged in sports (control group. BMC (g and BMD (g/cm2 were densitometrically determined in the lumbar segment (L2-L4 of the spine, and the bone stiffness coefficient was ultrasonically determined in calcaneus. The effects of the osteoporosis risk factors (both past and present were estimated from individual replies to the questionnaire inquiries about the past career in sports, present physical activity, gonadal dysfunctions (dysmenorrhoea during the career and the present need for hormonal supplementary treatment, and the current dietary patterns. The results indicate that mean BMC and BMD values detected in the former athletes did not differ significant from those obtained in the non-athlete, control women: the BMC values equalled to 54.5±10.5, 52.6±14.6, and 46.5±3.2 g in the kayakers, the fencers, and the control women, respectively, while the respective BMD values were 1.05±0.45, 0.96±0.66, and 1.08±0.58 g/cm2. The questionnaire-based studies showed that neither the former female athletes nor the non-athlete controls exhibited in the past longer (i.e., lasting more than three months periods of hormonal disorders (amenorrhoea. As assessed from the dietary intake, only in the former fencers the diet covered the demand for calcium in 100%. In conclusion

Peritendinous calcinosis of calcaneus tendon associated with dermatomyositis: correlation between conventional radiograph, ultrasound, magnetic resonance imaging and gross surgical pathology; Calcinose peritendinea do tendao calcaneo associada a dermatomiosite: correlacao entre radiografia convencional, ultra-sonografia, ressonancia magnetica e macroscopia cirurgica

Energy Technology Data Exchange (ETDEWEB)

Rosa, Ana Claudia Ferreira; Gomide, Lidyane Marques de Paula; Lemes, Marcella Stival [Universidade Federal de Goias (UFG), Goiana, GO (Brazil). Faculdade de Medicina. Hospital das Clinicas; Costa, Edegmar Nunes; Rocha, Valney Luiz da [Universidade Federal de Goias (UFG), Goiania, GO (Brazil). Faculdade de Medicina. Dept. de Ortopedia; Machado, Marcio Martins; Santos Junior, Rubens Carneiro dos; Barros, Nestor de; Cerri, Giovanni Guido [Universidade Federal de Goias (UFG), Goiania, GO (Brazil). Faculdade de Medicina. Dept. de Radiologia; Sernik, Renato Antonio [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Inst. de Radiologia; Nunes, Rodrigo Alvarenga [Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG (Brazil). Faculdade de Ciencias Medicas; Albieri, Alexandre Daher [Hospital de Acidentados de Goiania, GO (Brazil)

2006-01-15

Interstitial calcinosis is an uncommon condition in which there is either localized or widely disseminated deposition of calcium in the skin, subcutaneous tissues, muscles, and tendons. Calcinosis is often associated with collagen diseases, scleroderma and dermatomyositis. The authors report a case of interstitial calcinosis associated with dermatomyositis studied with conventional radiograph, ultrasound and magnetic resonance imaging, and correlate the imaging findings with the results of surgical pathology gross examination. (author)

Lactose intolerance among Malay and Orang Asli female children in selected rural Selangor and its effect on bone mineral density

Science.gov (United States)

Makbul, Ika Aida Aprilini; Daud, Norlida Mat; Aziz, Nurul Azrianti Abdul; Yahya, Noor Fairuzi Suhana

2016-11-01

Sufficient intake of calcium during childhood is very important to ensure an optimal growth and strong bones development. However, lactose intolerance (LI) may limit the intake of milk and dairy products due to the inability of the body to digest lactose to its constituents, glucose and galactose. Children in rural area were a major concern as they are commonly associated with an inadequate intake of nutrients. Hence, the objectives of this study are to determine the prevalence of LI among Malay and Orang Asli female children in rural Selangor and its association with bone mineral density (BMD). A total of 65 (39 Malay, 26 Orang Asli) female primary school students with a mean age of 10.4 ± 0.6 years old underwent hydrogen breath test and lactose tolerance test (LTT) during fasting and after ingestion of 25g lactose solution. A Wong Baker Face Pain Rating Scale (WBFPRS) was used to assess the presence of gastrointestinal (GI) symptoms during the study. LI symptoms are defined when breath H2 levels exceed 20 ppm above baseline values, an increase of postprandial blood glucose (PBG) levels of less than 1.1 mmol/L and GI symptom score is more or equal than score 2. BMD was measured in the calcaneus using QUS-2 Ultrasonometer. The result showed that 35 subjects (15 Malay, 20 Orang Asli) had a positive breath test (>20ppm). A total of 74.4% Malay and 88.5% Orang Asli children had an increase of PBG of less than 1.1 mmol/L. Both groups have low percentage (35.9 % Malay, 34.6 % Orang Asli) of GI symptoms. A total of 20.0% children (n=13, Malay=4, Orang Asli=9) was found to experience LI. Orang Asli children showed a significantly higher (p<0.001) BMD (95.7 ± 11.0 dB/MHz) compared to Malay children (71.7 ± 8.6 dB/MHz). The result shown there is an association between LI with BMD (p=0.031). Hence, LI does affect in decreasing an individual BMD. In conclusion, the prevalence of LI among female children in rural Selangor is low. However, the relationship between LI and BMD

Laws' masks descriptors applied to bone texture analysis: an innovative and discriminant tool in osteoporosis

International Nuclear Information System (INIS)

Rachidi, M.; Marchadier, A.; Gadois, C.; Lespessailles, E.; Chappard, C.; Benhamou, C.L.

2008-01-01

The objective of this study was to explore Laws' masks analysis to describe structural variations of trabecular bone due to osteoporosis on high-resolution digital radiographs and to check its dependence on the spatial resolution. Laws' masks are well established as one of the best methods for texture analysis in image processing and are used in various applications, but not in bone tissue characterisation. This method is based on masks that aim to filter the images. From each mask, five classical statistical parameters can be calculated. The study was performed on 182 healthy postmenopausal women with no fractures and 114 age-matched women with fractures [26 hip fractures (HFs), 29 vertebrae fractures (VFs), 29 wrist fractures (WFs) and 30 other fractures (OFs)]. For all subjects radiographs were obtained of the calcaneus with a new high-resolution X-ray device with direct digitisation (BMA, D3A, France). The lumbar spine, femoral neck, and total hip bone mineral density (BMD) were assessed by dual-energy X-ray absorptiometry. In terms of reproducibility, the best results were obtained with the TR E5E5 mask, especially for three parameters: ''mean'', ''standard deviation'' and ''entropy'' with, respectively, in vivo mid-term root mean square average coefficient of variation (RMSCV)%=1.79, 4.24 and 2.05. The ''mean'' and ''entropy'' parameters had a better reproducibility but ''standard deviation'' showed a better discriminant power. Thus, for univariate analysis, the difference between subjects with fractures and controls was significant (P -3 ) and significant for each fracture group independently (P -4 for HF, P=0.025 for VF and P -3 for OF). After multivariate analysis with adjustment for age and total hip BMD, the difference concerning the ''standard deviation'' parameter remained statistically significant between the control group and the HF and VF groups (P -5 , and P=0.04, respectively). No significant correlation between these Laws' masks parameters and

The influence of ibandronate treatment on bone density and biochemical bone markers in patients with osteogenesis imperfecta

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Ingmar Ipach

2012-09-01

Full Text Available Osteogenesis imperfecta (OI is characterized by different signs including increased bone fragility, short stature, blue sclera, abnormal tooth growth and often secondary immobility. No curative therapy has been found for this rare disease up to now, and different pharmacological substances have been tried as treatment for severe forms of OI. Promising results were seen with intravenous bisphosphonates in the treatment of patients with OI. The aim of present study was to show the effect of intravenous ibandronate therapy on bone density and bone metabolism markers. We analyzed the data of 27 patients with the diagnosis of OI who were treated off-label with intravenous ibandronate. Ibandronate was administered by intravenous infusion every three months at a dosage of 0.3-2 mg. Bone turnover markers and bone density were measured before starting therapy and every three months during treatment. Bone density was measured by using an ultrasound imaging system providing an accurate image of the calcaneus and by evaluating broadband ultrasound attenuation (BUA. Twenty-seven patients were treated with intravenous iban- dronate during the observation period. 18 were female. The mean age of all patients was 23.9 years ± 19.6 (range 4-63. Seventeen patients were categorized to have OI Type I, 5 patients to have OI Type III and 5 patients to have OI Type IV. There was a statistically significant decrease in total alkaline phosphatase (P<0.0001. We detected also a statistically significant decrease in the ratio urinary deoxypyridinoline/urinary creatinine (P=0.0048 and the ratio urinary pyridinoline/urinary creatinine (P<0.0001 respectively. There was also a statistically significant increase in serum magnesium (P=0.034 and BUA (P=0.0071. No statistically significant changes were seen for total serum calcium (P=0.16, the ratio of urine calcium/urine creatinine (P=0.29, alkaline phosphatase (isoform bone (P=0.3, procollagen-I-peptide (P=0.5, osteocalcin (P=0

Percutaneous lateral ligament reconstruction with allograft for chronic lateral ankle instability.

Science.gov (United States)

Youn, Hyunkook; Kim, Yong Sang; Lee, Jongseok; Choi, Woo Jin; Lee, Jin Woo

2012-02-01

The majority of lateral ankle instability can be treated successfully with conservative method. However, if such treatments fail, surgical treatment should be considered. A wide variety of procedures have been introduced to treat chronic lateral ankle instability. The percutaneous method avoids dissection which is associated with open surgery and can lead to excessive morbidity. The purpose of this study was to evaluate the clinical and radiological outcomes of percutaneous lateral ligament reconstruction with an allograft in the treatment of chronic lateral ankle instability. Between October 2006 and April 2009, percutaneous lateral ligament reconstruction using an allograft was performed on 15 ankles in 13 patients for chronic lateral ankle instability. The patients included in this study satisfied at least one of the following criteria: a previously failed reconstruction of the ligament, severe ankle instability (more than 15 degrees of talar tilt, more than 10 mm of anterior drawer), general laxity of ligaments, body mass index (BMI) higher than 25. The mean followup period was 18.1 (range, 12 to 40) months. The grafted tendon was secured by double tenodeses at both the talus and calcaneus or triple tenodeses which included a fibular tenodesis. The clinical outcomes were evaluated with Visual Analogue Scale (VAS) for pain, Karlsson-Peterson ankle score, and patients' subjective satisfaction. The radiological results were evaluated using the varus tilting angle and the anterior displacement distance. The VAS improved from preoperative 3.7 ±2.2 to 1.6 ±1.3 at the last followup (p = 0.002). The Karlsson-Peterson ankle score increased from 54.2 ±8.8 to 80.9 ±7.2 (p = 0.001). Patients were satisfied in 13 cases (86.7%) with excellent or good results. Radiologically, the mean varus tilting angle was 15.5 ±4.4 degrees preoperatively and 7.3 ±3.6 at the last followup (p = 0.001). The anterior drawer distance was 10.1 ±3.3 mm preoperatively and 7.2 ±2.7 mm at

The relationship between the bone mineral density and urinary cadmium concentration of residents in an industrial complex

Energy Technology Data Exchange (ETDEWEB)

Shin, Minah; Paek, Domyung [Institute of Health and Environment, Department of Environmental Health, School of Public Health, Seoul National University, Gwanak-599, Gwanak-gu, Seoul 151-742 (Korea, Republic of); Yoon, Chungsik, E-mail: csyoon@snu.ac.kr [Institute of Health and Environment, Department of Environmental Health, School of Public Health, Seoul National University, Gwanak-599, Gwanak-gu, Seoul 151-742 (Korea, Republic of)

2011-01-15

Background: An association between cadmium exposure and bone mineral density (BMD) has been demonstrated in elderly women, but has not been well studied in youths and men. Some studies report either no or a weak association between cadmium exposure and bone damage. Objectives: This study was designed to investigate the relationship between the urinary cadmium (U-Cd) levels and BMD of females and males of all ages. Methods: A total of 804 residents near an industrial complex were surveyed in 2007. U-Cd and BMD on the heel (non-dominant calcaneus) were analyzed with AAS-GTA and Dual-Energy X-ray absorptiometry, respectively. Demographic characteristics were collected by structured questionnaires. Osteoporosis and osteopenia were defined by BMD cut-off values and T-scores set by the WHO; T score>-1, normal; -2.5=}1.0 {mu}g/g creatinine) in females (OR=2.92; 95% CI, 1.51-5.64) and in males (OR=3.37; 95% CI, 1.09-10.38). With the multiple linear regression model, the BMD of the adult group was negatively associated with U-Cd (<0.05), gender (female, p<0.001) and age (p<0.001). The BMD of participants who were {<=}19 years of age was negatively associated with gender (female, p<0.01), whereas it was positively associated with age and BMI (p<0.001). BMD was not associated with exercise, smoking habits, alcohol consumption, job or parental education. Conclusion: Results suggested that U-Cd might be associated with osteopenia as well as osteoporosis in both male and female adults. Age and female gender were negatively associated with BMD in the adult group, whereas age was positively

The relationship between the bone mineral density and urinary cadmium concentration of residents in an industrial complex

International Nuclear Information System (INIS)

Shin, Minah; Paek, Domyung; Yoon, Chungsik

2011-01-01

Background: An association between cadmium exposure and bone mineral density (BMD) has been demonstrated in elderly women, but has not been well studied in youths and men. Some studies report either no or a weak association between cadmium exposure and bone damage. Objectives: This study was designed to investigate the relationship between the urinary cadmium (U-Cd) levels and BMD of females and males of all ages. Methods: A total of 804 residents near an industrial complex were surveyed in 2007. U-Cd and BMD on the heel (non-dominant calcaneus) were analyzed with AAS-GTA and Dual-Energy X-ray absorptiometry, respectively. Demographic characteristics were collected by structured questionnaires. Osteoporosis and osteopenia were defined by BMD cut-off values and T-scores set by the WHO; T score>-1, normal; -2.5< T score <-1, osteopenia; and T score <-2.5, osteoporosis. Logistic and multiple linear regressions were applied to estimate the association between U-Cd levels and BMD. Results: The U-Cd levels in females (0.64 μg/g creatinine) were higher than those in males (0.48 μg/g creatinine) (p<0.001). With the logistic regression model, osteopenia was associated with high U-Cd levels (≥1.0 μg/g creatinine) in females (OR=2.92; 95% CI, 1.51-5.64) and in males (OR=3.37; 95% CI, 1.09-10.38). With the multiple linear regression model, the BMD of the adult group was negatively associated with U-Cd (<0.05), gender (female, p<0.001) and age (p<0.001). The BMD of participants who were ≤19 years of age was negatively associated with gender (female, p<0.01), whereas it was positively associated with age and BMI (p<0.001). BMD was not associated with exercise, smoking habits, alcohol consumption, job or parental education. Conclusion: Results suggested that U-Cd might be associated with osteopenia as well as osteoporosis in both male and female adults. Age and female gender were negatively associated with BMD in the adult group, whereas age was positively associated with

Prevalence of lactose intolerance and its relation with bone mineral density among Malay students of Universiti Kebangsaan Malaysia, Malaysia

Science.gov (United States)

Yahya, Noor Fairuzi Suhana; Daud, Norlida Mat; Makbul, Ika Aida Aprilini; Aziz, Qurratul Aini Salma Abdul

2016-11-01

Lactose intolerance (LI), a risk factor for low bone mineral density (BMD), is the most common type of carbohydrate intolerance, which predominantly affects Southeast Asian populations. However, data on the prevalence of LI and its association with BMD among Malaysian adults are still lacking as not much research has been done on this matter. Thus, the aims of this study are to determine the prevalence of LI and to evaluate its association with BMD among students of Universiti Kebangsaan Malaysia. A total of 100 Malay students (50 males and 50 females) with mean age of 23.9 ± 4.7 years old and body mass index of 24.5 ± 5.8 kg/m2 were selected to involve in this preliminary study. After an overnight fast, subjects were asked to perform hydrogen breath test (HBT) and lactose tolerance test (LTT) after an intake of 300 ml lactose drink (50g lactose). HBT measurements were recorded at every 30 minutes intervals while LTT results were recorded at fasting and 30 minutes after lactose consumption. Visual analogue scales were used to measure gastrointestinal symptoms. BMD was measured at calcaneus bone using quantitative ultrasound and expressed as T-score. A consistent rise by >20 ppm for HBT and failure of blood sugar to rise by >1.10 mmol/L above basal level were considered as abnormal HBT and LTT. Lactose malabsorption (LM) is defined by abnormal HBT and LTT whilst LI is characterized by having abnormal HBT, LTT and gastrointestinal symptoms. The result showed that 86% male and 90% female subjects exhaled breath hydrogen >20 ppm but there was no significant difference (p>0.05) between them. LTT results showed that 86% male subjects failed to rise their blood sugar level >1.10 mmol/L compared to 60% in female subjects. Both male and female subjects had high percentage occurrence of gastrointestinal symptom (82 % and 80% respectively) although no significant difference (p>0.05) was demonstrated. The prevalence of LI and LM among all subjects was 77% and 18

3D automatic anatomy segmentation based on iterative graph-cut-ASM.

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Chen, Xinjian; Bagci, Ulas

2011-08-01

This paper studies the feasibility of developing an automatic anatomy segmentation (AAS) system in clinical radiology and demonstrates its operation on clinical 3D images. The AAS system, the authors are developing consists of two main parts: object recognition and object delineation. As for recognition, a hierarchical 3D scale-based multiobject method is used for the multiobject recognition task, which incorporates intensity weighted ball-scale (b-scale) information into the active shape model (ASM). For object delineation, an iterative graph-cut-ASM (IGCASM) algorithm is proposed, which effectively combines the rich statistical shape information embodied in ASM with the globally optimal delineation capability of the GC method. The presented IGCASM algorithm is a 3D generalization of the 2D GC-ASM method that they proposed previously in Chen et al. [Proc. SPIE, 7259, 72590C1-72590C-8 (2009)]. The proposed methods are tested on two datasets comprised of images obtained from 20 patients (10 male and 10 female) of clinical abdominal CT scans, and 11 foot magnetic resonance imaging (MRI) scans. The test is for four organs (liver, left and right kidneys, and spleen) segmentation, five foot bones (calcaneus, tibia, cuboid, talus, and navicular). The recognition and delineation accuracies were evaluated separately. The recognition accuracy was evaluated in terms of translation, rotation, and scale (size) error. The delineation accuracy was evaluated in terms of true and false positive volume fractions (TPVF, FPVF). The efficiency of the delineation method was also evaluated on an Intel Pentium IV PC with a 3.4 GHZ CPU machine. The recognition accuracies in terms of translation, rotation, and scale error over all organs are about 8 mm, 10 degrees and 0.03, and over all foot bones are about 3.5709 mm, 0.35 degrees and 0.025, respectively. The accuracy of delineation over all organs for all subjects as expressed in TPVF and FPVF is 93.01% and 0.22%, and all foot bones for

Soft tissue reconstruction for calcaneal fractures or osteomyelitis.

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Attinger, C; Cooper, P

2001-01-01

A systematic approach of the surgical management of a calcaneal fracture can minimize the potential of soft tissue complications. When reducing a closed calcaneal fracture, the incision used affects the postoperative complications. The L-shaped incision with the horizontal limb lying on the lateral glabrous junction ensures maximum blood flow to either side of the incision. Whether or not the wound can be closed primarily depends on the preexisting edema, the lost calcaneal height, and the delay between the fracture and reduction (Fig. 20). The wrinkle test is a good indicator that the incision can be closed primarily if the amount of height restored is minimal. If the edema is too great, steps should be taken to reduce it sufficiently to allow successful wound closure. If the wound, after reduction, is too wide to allow primary closure, an ADM flap laterally or an AHM flap medially should be used. For larger defects, a free flap should be considered. The three important steps to reconstruction of soft tissue defects around the calcaneus include good blood supply, a infection-free wound, and the simplest soft tissue reconstructive option that covers the wound successfully. Adequate blood supply can be determined by the use of Doppler. If the supply is inadequate, revascularization is necessary before proceeding. Achieving a clean wound requires aggressive debridement, intravenous antibiotics, and good wound care. Adjuncts that can help in achieving a clean wound include topical antibiotics (silver sulfadiazine), the VAC, and hyperbaric oxygen. Osteomyelitis has to be treated aggressively. Any suspicious bone has to be removed. Only clean, healthy, bleeding bone is left behind. Antibiotic beads can be useful when there is doubt as to whether the cancellous bone is infection-free. The beads are not a substitute for good debridement, however. Soft tissue reconstruction ranges from delayed primary closure to the use of microsurgical free flaps (Fig. 21). When bone or

3D automatic anatomy segmentation based on iterative graph-cut-ASM

International Nuclear Information System (INIS)

Chen, Xinjian; Bagci, Ulas

2011-01-01

Purpose: This paper studies the feasibility of developing an automatic anatomy segmentation (AAS) system in clinical radiology and demonstrates its operation on clinical 3D images. Methods: The AAS system, the authors are developing consists of two main parts: object recognition and object delineation. As for recognition, a hierarchical 3D scale-based multiobject method is used for the multiobject recognition task, which incorporates intensity weighted ball-scale (b-scale) information into the active shape model (ASM). For object delineation, an iterative graph-cut-ASM (IGCASM) algorithm is proposed, which effectively combines the rich statistical shape information embodied in ASM with the globally optimal delineation capability of the GC method. The presented IGCASM algorithm is a 3D generalization of the 2D GC-ASM method that they proposed previously in Chen et al.[Proc. SPIE, 7259, 72590C1-72590C-8 (2009)]. The proposed methods are tested on two datasets comprised of images obtained from 20 patients (10 male and 10 female) of clinical abdominal CT scans, and 11 foot magnetic resonance imaging (MRI) scans. The test is for four organs (liver, left and right kidneys, and spleen) segmentation, five foot bones (calcaneus, tibia, cuboid, talus, and navicular). The recognition and delineation accuracies were evaluated separately. The recognition accuracy was evaluated in terms of translation, rotation, and scale (size) error. The delineation accuracy was evaluated in terms of true and false positive volume fractions (TPVF, FPVF). The efficiency of the delineation method was also evaluated on an Intel Pentium IV PC with a 3.4 GHZ CPU machine. Results: The recognition accuracies in terms of translation, rotation, and scale error over all organs are about 8 mm, 10 deg. and 0.03, and over all foot bones are about 3.5709 mm, 0.35 deg. and 0.025, respectively. The accuracy of delineation over all organs for all subjects as expressed in TPVF and FPVF is 93.01% and 0.22%, and

Fluid Shifts

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Stenger, M. B.; Hargens, A. R.; Dulchavsky, S. A.; Arbeille, P.; Danielson, R. W.; Ebert, D. J.; Garcia, K. M.; Johnston, S. L.; Laurie, S. S.; Lee, S. M. C.;

Assessment Of Knowledge And Practices Related To Tuberculosis And Associated Factors Among HIV Positive People In Addis Ababa, Ethiopia

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Rahel Abebe

2012-03-01

Objectives- To know the most common type of calcanei in North Indian population and itsclinical importance. There are three articular facets on superior surface of calcaneus- anterior, middle andposterior. Three types of calcanei are noted according to number and arrangement of the articular facets-type A, B and C. Methodology - The present studywasdone on 300 dry adult human calcanei of unknownsex taken from Department of Anatomy Sri Guru Ram Das Institute of Medical Sciences and ResearchVallah (Amritsar. Results- In our study Type B was found as the most common type. Type A is the nextmost common. Interpretation- The talocalcaneal joint is important in arthritis and coalition, flat foot, valgus deformity, congenital anomalies and intra articular fractures.

Bursite peritrocantérica: descrição de nova manobra semiológica para auxílio diagnóstico Peritrochanteric bursits: a description of a new semiologic maneuver for diagnostic assistance

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Edson Noburo Fujiki

2008-01-01

Full Text Available O estudo tem como objetivo testar a validade de nova manobra semiológica no diagnóstico de bursite peritrocantérica. Foram avaliados 30 pacientes, com diagnóstico clínico de bursite do grande trocanter. Todos os pacientes foram submetidos à radiografia de bacia AP e Perfil. Quando necessário, outros exames de imagem foram realizados, com a finalidade de descartar doenças associadas; os pacientes foram submetidos a duas manobras semiológicas no quadril são e afetado. TESTE 1: paciente em decúbito dorsal, o membro examinado é aduzido em extensão cruzando sobre o membro contralateral, com o calcâneo em contato com a maca, faz-se a flexão do quadril até aproximadamente 90º, o quadril ao final da manobra estará em flexão, adução e leve rotação externa, durante a manobra poderá ser referida dor na região do trocanter maior. TESTE 2: a posição final do TESTE 1, é a posição inicial desta, faz-se a adução forçada do quadril, pode haver referencia de dor ou exacerbação. Os resultados das manobras foram submetidos ao estudo estatístico, que demonstrou serem os exames diferentes entre si, porém complementares. O teste 2 mostrou ser positivo em 96,6%. As manobras semiológicas denominadas de TESTE 1 e 2, podem ser utilizadas como auxiliares nos diagnósticos clínicos das bursites peritrocanterianas.The objective of the present study was to test the validity of a semiologic maneuver on the diagnosis of peritrochanteric bursitis. Thirty patients with a clinical diagnosis of great trochanter bursitis were assessed. All patients were submitted to X-ray studies at AP and LP. Whenever necessary, other imaging tests were performed, intending to rule out any associated diseases; the patients were submitted to two semiologic maneuvers on both hips, the affected and the normal one. TEST 1: with patient at supine position, the examined limb is adduced in extension and crossing it over the contralateral limb, with the calcaneus

Terapia hormonal y calidad del hueso Hormone therapy and bone quality

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2005-08-01

multidisciplinary office of climacteric of “Ramón Gonzales Coro” Gynecoobstetric Hospital from January 1997 to December 2003, it was determined the bone quality by dual X-ray absorptiometry in the lumbar region (L2-L4 or by calcaneus ultrasound (CALUS. They receive continuing treatment with estrogenic therapy (E or with progestogenous estrogens (PE for no less than a year (n = 30. Women who were not able to receive RHT were grouped and evaluated as a control group (n = 12. During an average observation time of 2 years, the females that receieved RHT improved their bone quality in 16.8 %, whereas those of the control group got worse in 8 % of the cases. The initial results, although modest, showed the usefulness of RHT for improving the bone quality and the need to continue carrying out studies that allow to define in our setting the persistance of bone improvement, as well as the magnitude of postmenopausic osteoporosis.

[Kirschner wire transfixation of unstable ankle fractures: indication, surgical technique and outcomes].

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Marvan, J; Džupa, V; Bartoška, R; Kachlík, D; Krbec, M; Báča, V

2015-01-01

transfixation, no radiographic evidence of ankle osteoarthritis was recorded in 25 (42%) patients. While tibiofibular synostosis was recorded in only few patients (9%) of the group with one-stage osteosynthesis, it showed a high occurrence in the group with temporary transfixation (35%). The patients with one-stage osteosynthesis (188/68%) had a higher proportion of excellent outcomes measured on the Olerund-Molander ankle scoring scale than the other two groups (temporary transfixation, 47%; definitive transfixation,10%); in both cases the difference was significant (p ankle fractures were assessed. The patients with one-stage osteosynthesis were compared with those treated by temporary or definitive transfixation. The majority of patients undergoing temporary transfixation had a fractured posterior margin of the tibia and major ankle joint dislocation, which suggested serious injuries to bone and ligament structures. Generally, the use of only two K-wires inserted through the calcaneus and talus into the distal tibia is recommended. Patients with K-wire transfixation usually require a longer hospital stay because of the serious nature of their injuries. CONCLUSIONS The therapy of choice for unstable ankle fractures is one-stage osteosynthesis. Temporary transfixation is an effective method of primary management when an unstable fracture cannot be treated by definitive osteosynthesis at the early stage due to local or general health conditions of the patient. The temporary transfixation provides good alignment of the ankle joint necessary for successful healing of soft tissues. A higher occurrence of post-traumatic ankle osteoarthritis, ossification and distal tibiotalar synostosis found in the patients treated by temporary transfixation is more related to serious types of ankle fractures the patient had suffered than to the method itself. Key words: unstable ankle fracture, soft tissue condition, indications for transfixation, treatment outcome.

[Experience with the Hind Foot Relaxation Boot].

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Zwipp, Hans; Borrmann, Michael; Walter, Eberhard

2017-06-01

The goal of this paper is to report our experience with hindfoot fractures using our specially developed boot, with a follow-up of 557 cases. This boot works like the well-known Allgöwer-Röck ortheses (ARO), but is a hybrid between a boot and an orthesis. It allows full weightbearing without using crutches and completely protects an acutely operated hind foot fracture, hind foot arthrodesis or a hind foot fracture which is suitable for conservative treatment. In its first generation, this boot was custom made and used in 408 cases, from March 1999 to February 2011. This study was performed exclusively at the Department of Traumatology and Reconstructive Surgery in the University Centre of Orthopaedics and Traumatology, since 2013 at the Carl Gustav Carus University Hospital of the Technical University of Dresden (since 2013). The new improved second generation of this boot has been used in 149 patients between March 2011 and February 2016. This model is lighter and safer, due to an aluminium U-profile which is produced in one piece and interposed and fixed with 4 screws into the sole of the boot. The ground reaction forces are transported to the tibial head by this U-profile, to which the dorsal acryl shell for the calf of the Röck system is fixed with 2 screws on both sides, including the free ventral patellar shell. This is closed individually by two quick fastener buckles. This modular system of the second generation boot is now available for all patients in Dresden. These new boots have replaced the use of a wheel-chair for 3 months and are especially useful in bilateral calcaneus fractures - which occur in about 18% of all cases. In these new boots, the whole sole of the boot is in contact with the ground, rather than a surface of 9 × 3 cm as in the Allgöwer-Röck ortheses. As a result, these boots are considered to be superior to the ARO because standing and walking without crutches is much more easier - even for elderly patients. In contrast to

Resultado do acompanhamento clínico-radiológico pós-cirúrgico do condroblastoma Results from clinical and radiological follow-up, after surgical treatment of chondroblastoma

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Valter Penna

2011-10-01

technique. METHODS: A retrospective study was conducted on 12 patients with histological diagnoses of chondroblastoma, who were attended between 2003 and 2009 at the Pius XII Foundation (Barretos Cancer Hospital, Barretos, State of São Paulo. These patients underwent surgical treatment with intralesional resection of the tumor, adjuvant electrocauterization and replacement with methyl methacrylate (11 cases or an autologous graft from the iliac crest (one case. The preoperative evaluation included physical examination, plain radiographs of the site, magnetic resonance imaging, computed axial tomography and bone scintigraphy. The patients were assessed clinically and radiologically according to a predefined protocol, with a series of plain radiographs, and a functional assessment in accordance with the Enneking functional score. RESULTS: The average age at the time of diagnosis was 14 years and 4 months. The most frequent location affected was the distal femoral epiphysis (75%, followed by the proximal tibial epiphysis (16.6% and the calcaneus (8.4%. There was higher prevalence among the female patients than among the male patients (3:1. In three cases, preoperative biopsy was necessary. During the follow-up, there was no evidence of local tumor recurrence, and all the patients presented an excellent functional result from the surgical technique used, with Enneking scores ranging from 20 to 30. CONCLUSION: Surgical treatment of chondroblastoma, using intralesional resection, adjuvant electrocauterization and replacement with methyl methacrylate or bone graft produced good results.

Influência de diferentes comprimentos de onda da laserterapia de baixa intensidade na regeneração tendínea do rato após tenotomia Influence of different low-intensity laser therapy wavelengths for rat tendon regeneration following tenotomy

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ERB Arruda

2007-08-01

wavelengths (670nm and 904nm and in the combination of both on the tissue repair of the calcaneus tendon. METHODS: We used 37 female Wistar rats divided in 5 groups which had been submitted to the total tenotomy. Group GA (n= 8 was submitted to the laser irradiation in lambda= 904nm, GaAS diode, pulsated emission, peak power 15W and dose of 3J/cm², group GB (n= 8 was submitted to laser irradiation lambda= 670nm AlGaInP diode, continuous emission, power 30 mW and dose 3J/cm², group GAB (n= 8 was submitted to association of both of lasers and group GCL (n= 7 which the calcaneum tendon was submitted to placebo treatment. The group GP (n= 6 was a standard group without lesion and treatment. The animals received 12 sessions of lasertherapy and submitted to euthanasia on 14th day after surgery. The tendons were submitted to histological procedure and were analyzed to evaluate the optic retardation (in nm for the birefringence measurement. RESULTS: The statistic analysis showed that the irradiated groups have higher values of optic retardation statistically significant than placebo group (p= 0,00001. It indicates that all the treated groups show better organization of collagen fibers in the longitudinal axis of the tendon, evidencing better quality in the tissue repair. The group GAB was that shown best results (p= 0,00001 when compared to another groups.

Status Sistematico del Género Geobatrachus Ruthven 1915 (amphibia: Anura Status Sistematico del Género Geobatrachus Ruthven 1915 (amphibia: Anura

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Ardila Robayo María Cristina

1979-06-01

on in the region showed that its distribution cover the area of humid forest, with frequent mists, at. 1.750-3.000 m., and pointed also that the species tolerates paraclimacic situations (in plantations of Cupressus sp., and Pinus sp. , and their habits are exclusively terrestrial and semifossorial.  Among the external characters it can be emphasized the high degree of chromatic individual variation, the absence of xeromorphic adaptations and specialized glandular complexes in the skin, which point towards an adaptation towards a hygrophilic habitat, added to the extreme reduction of the first pedial digit. The skeleton characters, studied through dissection and differential staining, show a generalized type without pronounced reduction in the cranial elements, the occurrence of non-pedicellated teeth in the maxillary arch, the absence of either phragmotic or fossorial adaptations, or epicraneal ornamentation exostosis; a generalized hyoid apparatus; 8 presacral vertebrae without fusion or imbrication, and with specialized transverse processes; no expanded sacral diapophyses, fused talus and calcaneus and only two tarsalia. The T-shaped terminal phalanges might suggest a preadaptation towards an arboreal way of life (or, conversely, an arboreal ancestor; also the full firmisternal condition of the pectoral girdle and the striking clavicular reduction which would show an apparent relationship with the Microhylids. The following muscular characters are noteworthy: M. intermandibularis with medial raphe, the type "s" insertion of the M. adductor mandibularis subexternus, the distal tendon of M. semitendinosus passing ventral to the Mm. graciles, the insertion over the knee of the M. adductor longus, and the absence of an accessory head (or tendon in the M. glutaeus magnus (an unique condition among the Neobatrachia, presumably due to secondary loss.  In contrast with previous wrong assertions, a direct development (without free larval stages was confirmed, a condition