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Sample records for fasciitis painful heel

  1. Heel Pain

    Science.gov (United States)

    ... of the foot, by stretching of the long band of tissue that connects the heel and the ... associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the ...

  2. Randomized multicenter follow-up trial on the effect of radiotherapy for plantar fasciitis (painful heels spur) depending on dose and fractionation – a study protocol

    International Nuclear Information System (INIS)

    Holtmann, Henrik; Niewald, Marcus; Prokein, Benjamin; Graeber, Stefan; Ruebe, Christian

    2015-01-01

    An actual clinical trial showed the effect of low dose radiotherapy in painful heel spur (plantar fasciitis) with single doses of 1.0 Gy and total doses of 6.0 Gy applied twice weekly. Furthermore, a lot of animal experimental and in vitro data reveals the effect of lower single doses of 0.5 Gy which may be superior in order to ease pain and reduce inflammation in patients with painful heel spur. Our goal is therefore to transfer this experimentally found effect into a randomized multicenter trial. This was a controlled, prospective, two-arm phase III-multicenter trial. The standard arm consisted of single fractions of 1.0 Gy applied two times a week, for a total dose of 6.0 Gy (total therapy time: 3 weeks). The experimental arm consisted of single fractions of 0.5 Gy applied 3 times a week, for a total dose of 6.0 Gy (total therapy time: 4 weeks). Following a statistical power calculation, there were 120 patients for each investigation arm. The main inclusion criteria were: age > = 40 years, clinical and radiologically diagnosed painful heel spur (plantar fasciitis), and current symptoms for at least 6 months. The main exclusion criteria were: former local trauma, surgery or radiotherapy of the heel; pregnant or breastfeeding women; and a pre-existing severe psychiatric or psychosomatic disorder. After approving a written informed consent the patients are randomized by a statistician into one of the trial arms. After radiotherapy, the patients are seen after six weeks, after twelve weeks and then every twelve weeks up to 48 weeks. Additionally, they receive a questionnaire every six weeks after the follow-up examinations up to 48 weeks. The effect is measured using the visual analogue scale of pain (VAS), the calcaneodynia score according to Rowe and the SF-12 score. The primary endpoint is the pain relief three months after therapy. Patients of both therapy arms with an insufficient result are offered a second radiotherapy series applying the standard dose

  3. Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur) using very low doses – a study protocol

    International Nuclear Information System (INIS)

    Niewald, Marcus; Seegenschmiedt, M Heinrich; Micke, Oliver; Gräber, Stefan

    2008-01-01

    A lot of retrospective data concerning the effect of radiotherapy on the painful heel spur (plantar fasciitis) is available in the literature. Nevertheless, a randomized proof of this effect is still missing. Thus, the GCGBD (German cooperative group on radiotherapy for benign diseases) of the DEGRO (German Society for Radiation Oncology) decided to start a randomized multicenter trial in order to find out if the effect of a conventional total dose is superior compared to that of a very low dose. In a prospective, controlled and randomized phase III trial two radiotherapy schedules are to be compared: standard arm: total dose 6.0 Gy in single fractions of 1.0 Gy applied twice a week experimental arm: total dose 0.6 Gy in single fractions of 0.1 Gy applied twice a week (acting as a placebo) Patients aged over 40 years who have been diagnosed clinically and radiologically to be suffering from a painful heel spur for at least six months can be included. Former trauma, surgery or radiotherapy to the heel are not allowed nor are patients with a severe psychiatric disease or women during pregnancy and breastfeeding. According to the statistical power calculation 100 patients have to be enrolled into each arm. After having obtaining a written informed consent a patient is randomized by the statistician to one of the arms mentioned above. After radiotherapy, the patients are seen first every six weeks, then regularly up to 48 months after therapy, they additionally receive a questionnaire every six weeks after the follow-up examinations. The effect is measured using several target variables (scores): Calcaneodynia-score according to Rowe et al., SF-12 score, and visual analogue scale of pain. The most important endpoint is the pain relief three months after therapy. Patients with an inadequate result are offered a second radiotherapy series applying the standard dose (equally in both arms). This trial protocol has been approved by the expert panel of the DEGRO as well as

  4. Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur using very low doses – a study protocol

    Directory of Open Access Journals (Sweden)

    Micke Oliver

    2008-09-01

    Full Text Available Abstract Background A lot of retrospective data concerning the effect of radiotherapy on the painful heel spur (plantar fasciitis is available in the literature. Nevertheless, a randomized proof of this effect is still missing. Thus, the GCGBD (German cooperative group on radiotherapy for benign diseases of the DEGRO (German Society for Radiation Oncology decided to start a randomized multicenter trial in order to find out if the effect of a conventional total dose is superior compared to that of a very low dose. Methods/Design In a prospective, controlled and randomized phase III trial two radiotherapy schedules are to be compared: standard arm: total dose 6.0 Gy in single fractions of 1.0 Gy applied twice a week experimental arm: total dose 0.6 Gy in single fractions of 0.1 Gy applied twice a week (acting as a placebo Patients aged over 40 years who have been diagnosed clinically and radiologically to be suffering from a painful heel spur for at least six months can be included. Former trauma, surgery or radiotherapy to the heel are not allowed nor are patients with a severe psychiatric disease or women during pregnancy and breastfeeding. According to the statistical power calculation 100 patients have to be enrolled into each arm. After having obtaining a written informed consent a patient is randomized by the statistician to one of the arms mentioned above. After radiotherapy, the patients are seen first every six weeks, then regularly up to 48 months after therapy, they additionally receive a questionnaire every six weeks after the follow-up examinations. The effect is measured using several target variables (scores: Calcaneodynia-score according to Rowe et al., SF-12 score, and visual analogue scale of pain. The most important endpoint is the pain relief three months after therapy. Patients with an inadequate result are offered a second radiotherapy series applying the standard dose (equally in both arms. This trial protocol has been

  5. Ultrasound diagnosis and evaluation of plantar heel pain.

    Science.gov (United States)

    Argerakis, Nicholas G; Positano, Rock G; Positano, Rock C J; Boccio, Ashley K; Adler, Ronald S; Saboeiro, Gregory R; Dines, Joshua S

    2015-03-01

    One of the most common causes of heel pain is plantar fasciitis; however, there are other pathologic disorders that can mimic the symptoms and clinical presentation of this disorder. The purpose of this study was to retrospectively review the prevalence of various pathologic disorders on ultrasound in patients with proximal plantar heel pain. The medical records and diagnostic ultrasound reports of patients presenting with plantar heel pain between March 1, 2006, and March 31, 2007, were reviewed retrospectively, and the prevalence of various etiologies was collected. The inclusion criteria were based on their clinical presentation of plantar fasciitis or previous diagnosis of plantar fasciitis from an unknown source. Ultrasound evaluation was then performed to confirm the clinical diagnosis. We examined 175 feet of 143 patients (62 males and 81 females; age range, 16-79 years). Plantar fibromas were present in 90 feet (51%). Plantar fasciitis was diagnosed in 128 feet (73%). Coexistent plantar fibroma and plantar fascial thickening was found in 63 feet (36%). Of the 47 feet that were negative for plantar fasciitis on ultrasound, 27 (57%) revealed the presence of plantar fibroma. Diagnostic ultrasound can effectively and safely identify the prevalence of various etiologies of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed for confirmation of diagnosis.

  6. 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.

  7. 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.

  8. Plantar fasciitis

    Science.gov (United States)

    ... activities in moderation can also help. Images Plantar fascia Plantar fasciitis References Abu-Laban RB, Rose NGW. Ankle ... Elsevier; 2016:970. Kadakia AR. Heel pain and plantar fasciitis In: Miller MD, ... of tendons and fascia and adolescent and adult pes planus. In: Canale ...

  9. Imaging study of the painful heel syndrome

    International Nuclear Information System (INIS)

    Williams, P.L.; Smibert, J.G.; Cox, R.; Mitchell, R.; Klenerman, L.

    1987-01-01

    A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45 degrees medial oblique radiographs of both feet. Of the 52 painful heels 31 (59.6%) showed increased uptake of tracer at the calcaneum. Patients with scans showing increased uptake tended to have more severe heel pain and responded more frequently to a local hydrocortisone injection. On plain x-ray, 39 of 52 painful heels (75%) and 24 of the 38 opposite nonpainful heels (63%) showed plantar spurs, compared with five of 63 (7.9%) heels in 59 age- and sex-matched controls. No evidence of stress fractures was seen

  10. Calcaneal Insufficiency Fracture Secondary to Celiac Disease-Induced Osteomalacia: A Rare Cause of Heel Pain.

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    Kose, Ozkan; Kilicaslan, Omer Faruk; Ozyurek, Selahattin; Ince, Ahmet

    2016-04-01

    Plantar fasciitis is a common cause of plantar heel pain; however, a broad spectrum of disorders may also present with plantar heel pain. A detailed history, physical examination, laboratory testing, and imaging studies may be necessary to reach an accurate diagnosis. Herein, the clinical presentation of a 33-year-old woman with calcaneal insufficiency fracture secondary to celiac disease-induced osteomalacia is presented, and its diagnosis and treatment are discussed. Calcaneal insufficiency fractures should be kept in mind in a patient with celiac disease that presents with heel pain. Therapeutic, Level IV: Case study. © 2015 The Author(s).

  11. Plantar pain is not always fasciitis

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    N. Romano

    2017-12-01

    Full Text Available The case is described of a patient with chronic plantar pain, diagnosed as fasciitis, which was not improved by conventional treatment. Magnetic resonance imaging revealed flexor hallucis longus tenosynovitis, which improved after local glucocorticoid injection.

  12. Manual therapy for plantar heel pain.

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    Pollack, Yosefa; Shashua, Anat; Kalichman, Leonid

    2018-03-01

    Manual therapy employed in the treatment of plantar heel pain includes joint or soft tissue mobilizations. Efficacy of these methods is still under debate. To determine whether manual therapy, consisting of deep massage, myofascial release or joint mobilization is effective in treating plantar heel pain. A critical review of all available studies with an emphasis on randomized controlled trials (RCTs) was performed. PubMed, PEDro, and Google Scholar databases were searched for keywords relating to plantar heel pain, joint, and soft tissue mobilizations. There were no search limitations or language restrictions. The reference lists of all retrieved articles were searched. The PEDro score was used to assess the quality of the reviewed papers. A total of six relevant RCTs were found: two examined the effectiveness of joint mobilization on plantar heel pain and four the effectiveness of soft tissue techniques. Five studies showed a positive short-term effect after manual therapy treatment, mostly soft tissue mobilizations, with or without stretching exercises for patients with plantar heel pain, compared to other treatments. One study observed that adding joint mobilization to the treatment of plantar heel pain was not effective. The quality of all studies was moderate to high. According to reviewed moderate and high-quality RCTs, soft tissue mobilization is an effective modality for treating plantar heel pain. Outcomes of joint mobilizations are controversial. Further studies are needed to evaluate the short and long-term effect of different soft tissue mobilization techniques. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. An unusual cause of intractable heel pain.

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    Ghani, Samuel; Fazal, Muhammad Ali

    2011-01-01

    We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal cyst is rare. We were unable to identify a previous publication describing the presence of an epidermal cyst localized to the heel without a history of previous trauma. From our experience with the present case, we believe that clinicians should consider the possibility of an epidermal inclusion cyst and should have a low threshold for obtaining magnetic resonance imaging scans, in particular, before the initiation of invasive treatment, in the case of intractable heel pain. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Re-irradiation for painful heel spur syndrome. Retrospective analysis of 101 heels

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    Hautmann, M.G.; Koelbl, O. [University of Regensburg, Department of Radiotherapy, Regensburg (Germany); Neumaier, U. [MVZ Neumaier and Kollegen, Private Clinic for Radiotherapy, Regensburg (Germany)

    2014-03-15

    Painful heel spur syndrome is a common disease with a lifetime prevalence of approximately 10 %. One of the most effective treatment options is radiotherapy. Many authors recommend a second or third series of radiation for recurrent pain and partial or no response to the initial treatment. As the results of re-irradiation have not been systematically analyzed the aim of this study was to document the results of repeated radiation treatment and to identify patients who could benefit from this treatment. The analysis was performed on patients from 2 German radiotherapy institutions and included 101 re-irradiated heels. Pain was documented with the numeric rating scale (NRS) and carried out before and directly after each radiation therapy as well as for the follow-up period of 24 months. The median age of the patients was 56 years with 30.1 % male and 69.9 % female patients. Pain was caused by plantar fasciitis in 72.3 %, Haglund's exostosis in 15.8 % and Achilles tendinitis in 11.9 %. Repeated radiation was indicated because the initial radiotherapy resulted in no response in 35.6 % of patients, partial response in 39.6 % and recurrent pain in 24.8 %. A significant response to re-irradiation could be found. For the whole sample the median NRS pain score was 6 before re-irradiation, 2 after 6 weeks and 0 after 12 and 24 months. Of the patients 73.6 % were free of pain 24 months after re-irradiation. All subgroups, notably those with no response, partial response and recurrent pain had a significant reduction of pain. Re-irradiation of painful heel spur syndrome is an effective and safe treatment. All subgroups showed a good response to re-irradiation for at least 24 months. (orig.) [German] Der schmerzhafte Fersensporn ist eine der haeufigsten Erkrankungen unter den Fusssyndromen. Die Lebenszeitpraevalenz liegt bei etwa 10 %. Eine der wirkungsvollsten Therapieoptionen stellt die Strahlentherapie dar. Dabei beschreiben viele Autoren die Durchfuehrung einer

  15. Determinants of footwear difficulties in people with plantar heel pain.

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    Sullivan, Justin; Pappas, Evangelos; Adams, Roger; Crosbie, Jack; Burns, Joshua

    2015-01-01

    Plantar heel pain is a common foot disorder aggravated by weight-bearing activity. Despite considerable focus on therapeutic interventions such as orthoses, there has been limited investigation of footwear-related issues in people with plantar heel pain. The aim of this study was to investigate whether people with plantar heel pain experience footwear-related difficulties compared to asymptomatic individuals, as well as identifying factors associated with footwear comfort, fit and choice. The footwear domain of the Foot Health Status Questionnaire (FHSQ) was assessed in 192 people with plantar heel pain and 69 asymptomatic controls. The plantar heel pain group was also assessed on a variety of measures including: foot posture, foot strength and flexibility, pedobarography and pain level. A univariate analysis of covariance, with age as the covariate, was used to compare the heel pain and control groups on the FHSQ footwear domain score. A multiple regression model was then constructed to investigate factors associated with footwear scores among participants with plantar heel pain. When compared to asymptomatic participants, people with plantar heel pain reported lower FHSQ footwear domain scores (mean difference -24.4; p footwear scores were associated with maximum force beneath the postero-lateral heel during barefoot walking, toe flexor strength and gender. People with plantar heel pain experience difficulty with footwear comfort, fit and choice. Reduced heel loading during barefoot walking, toe flexor weakness and female gender are all independently associated with reports of footwear difficulties in people with heel pain. Increased focus, in both clinical and research settings, is needed to address footwear-related issues in people with plantar heel pain.

  16. Pain Threshold Tests in Patients With Heel Pain Syndrome.

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    Saban, Bernice; Masharawi, Youssef

    2016-07-01

    Pressure pain threshold (PPT) is a useful tool for evaluating mechanical sensitivity in patients suffering from various musculoskeletal disorders. However, no previous study has investigated PPT in the heel of patients experiencing plantar heel pain syndrome (PHPS). The aim of this study was to compare PPT levels and topographic presentation of sensitivity in the heel of patients with PHPS and in healthy controls. The reliability of PPT testing in patients with PHPS was assessed for intra- and interrater recordings. The PPT levels of 40 feet in each group were then assessed on 5 predetermined sites in the heel using a standardized measurement protocol. Patient functional status (FS) as measured by the Foot & Ankle Computerized Adaptive Test was employed as an external reference. Multivariate analysis of covariance revealed no group differences for PPTs at all sites (P = .406). Age (P = .099) or BMI (P = .510) did not affect PPT values, although there was an effect on gender (P = .006). The analysis revealed significant differences between sites (P < .001) demonstrating a diverse topographic distribution. In the PHPS group, PPT levels at the anterior/medial, posterior/medial and central sites were significantly lower than at the posterior/lateral and anterior/lateral sites (P < .05). For the control group, PPT levels at the anterior/medial site were significantly lower than all other sites (P < .001). No significant differences were found between PPT of the PHPS patients and controls, therefore, PPT cannot be recommended as an assessment tool for these patients. The topographic distribution indicated low PPT levels at the anterior/medial area of the heel in patients with PHPS and controls. Level II, comparative study. © The Author(s) 2016.

  17. Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial

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    Landorf Karl B

    2011-01-01

    Full Text Available Abstract Background Plantar heel pain (plantar fasciitis is a common and disabling condition, which has a detrimental impact on health-related quality of life. Despite the high prevalence of plantar heel pain, the optimal treatment for this disorder remains unclear. Consequently, an alternative therapy such as dry needling is increasingly being used as an adjunctive treatment by health practitioners. Only two trials have investigated the effectiveness of dry needling for plantar heel pain, however both trials were of a low methodological quality. This manuscript describes the design of a randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. Methods Eighty community-dwelling men and woman aged over 18 years with plantar heel pain (who satisfy the inclusion and exclusion criteria will be recruited. Eligible participants with plantar heel pain will be randomised to receive either one of two interventions, (i real dry needling or (ii sham dry needling. The protocol (including needling details and treatment regimen was formulated by general consensus (using the Delphi research method using 30 experts worldwide that commonly use dry needling for plantar heel pain. Primary outcome measures will be the pain subscale of the Foot Health Status Questionnaire and "first step" pain as measured on a visual analogue scale. The secondary outcome measures will be health related quality of life (assessed using the Short Form-36 questionnaire - Version Two and depression, anxiety and stress (assessed using the Depression, Anxiety and Stress Scale - short version. Primary outcome measures will be performed at baseline, 2, 4, 6 and 12 weeks and secondary outcome measures will be performed at baseline, 6 and 12 weeks. Data will be analysed using the intention to treat principle. Conclusion This study is the first randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. The trial will

  18. Sonographic evaluation of plantar fasciitis

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    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.

  19. 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

  20. Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

    OpenAIRE

    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 ...

  1. Reducing neonatal pain during routine heel lance procedures.

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    Morrow, Carla; Hidinger, Andrea; Wilkinson-Faulk, Debbie

    2010-01-01

    To measure the difference in pain scores for newborns who were held and swaddled while undergoing routine heel lance procedures compared to newborns who were lying on their backs and not swaddled during heel lance. Additionally, we sought to compare the total amount of time it took to collect the specimens in each group. A total of 42 neonates recruited from a large tertiary hospital were enrolled in a randomized controlled trial. Infants in the experimental group (n = 22) were swaddled and held in an upright position during routine heel lance procedures while neonates in the control group (n = 20) remained in a standard care position. Pain was measured with the Neonatal Inventory Pain Scale (NIPS) at two points in time for each group (just before the heel lance procedure and at the completion of the heel lance). Total collection time was measured using a stopwatch accurate to 1/100th of a second. Specimen quality was measured based on the number of rejected specimens for each group. Descriptive statistics and t tests were used to analyze the data. The mean NIPS score for neonates who were swaddled and held during the procedure (experimental group) was significantly lower (M = 1.3, SD = .9) than the score for infants in the standard position (control group) (M = 2.7, SD = 1.3), t (40) = -4.48, p lance procedures offers nurses a nonpharmacologic method of neonatal pain reduction for heel sticks. This technique can be easily implemented on any unit independent of facility protocols. Furthermore, the technique is not associated with any cost or policy development, making it more likely that nurses can use it in practice.

  2. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis

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    Barrett Joanna T

    2009-11-01

    Full Text Available Abstract Background Chronic plantar heel pain (CPHP is a generalised term used to describe a range of undifferentiated conditions affecting the plantar heel. Plantar fasciitis is reported as the most common cause and the terms are frequently used interchangeably in the literature. Diagnostic imaging has been used by many researchers and practitioners to investigate the involvement of specific anatomical structures in CPHP. These observations help to explain the underlying pathology of the disorder, and are of benefit in forming an accurate diagnosis and targeted treatment plan. The purpose of this systematic review was to investigate the diagnostic imaging features associated with CPHP, and evaluate study findings by meta-analysis where appropriate. Methods Bibliographic databases including Medline, Embase, CINAHL, SportDiscus and The Cochrane Library were searched electronically on March 25, 2009. Eligible articles were required to report imaging findings in participants with CPHP unrelated to inflammatory arthritis, and to compare these findings with a control group. Methodological quality was evaluated by use of the Quality Index as described by Downs and Black. Meta-analysis of study data was conducted where appropriate. Results Plantar fascia thickness as measured by ultrasonography was the most widely reported imaging feature. Meta-analysis revealed that the plantar fascia of CPHP participants was 2.16 mm thicker than control participants (95% CI = 1.60 to 2.71 mm, P P = 0.01. CPHP participants were also more likely to show radiographic evidence of subcalcaneal spur than control participants (OR = 8.52, 95% CI = 4.08 to 17.77, P Conclusion This systematic review has identified 23 studies investigating the diagnostic imaging appearance of the plantar fascia and inferior calcaneum in people with CPHP. Analysis of these studies found that people with CPHP are likely to have a thickened plantar fascia with associated fluid collection, and that

  3. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis

    Science.gov (United States)

    2009-01-01

    Background Chronic plantar heel pain (CPHP) is a generalised term used to describe a range of undifferentiated conditions affecting the plantar heel. Plantar fasciitis is reported as the most common cause and the terms are frequently used interchangeably in the literature. Diagnostic imaging has been used by many researchers and practitioners to investigate the involvement of specific anatomical structures in CPHP. These observations help to explain the underlying pathology of the disorder, and are of benefit in forming an accurate diagnosis and targeted treatment plan. The purpose of this systematic review was to investigate the diagnostic imaging features associated with CPHP, and evaluate study findings by meta-analysis where appropriate. Methods Bibliographic databases including Medline, Embase, CINAHL, SportDiscus and The Cochrane Library were searched electronically on March 25, 2009. Eligible articles were required to report imaging findings in participants with CPHP unrelated to inflammatory arthritis, and to compare these findings with a control group. Methodological quality was evaluated by use of the Quality Index as described by Downs and Black. Meta-analysis of study data was conducted where appropriate. Results Plantar fascia thickness as measured by ultrasonography was the most widely reported imaging feature. Meta-analysis revealed that the plantar fascia of CPHP participants was 2.16 mm thicker than control participants (95% CI = 1.60 to 2.71 mm, P plantar fascia thickness values greater than 4.0 mm (OR = 105.11, 95% CI = 3.09 to 3577.28, P = 0.01). CPHP participants were also more likely to show radiographic evidence of subcalcaneal spur than control participants (OR = 8.52, 95% CI = 4.08 to 17.77, P plantar fascia and inferior calcaneum in people with CPHP. Analysis of these studies found that people with CPHP are likely to have a thickened plantar fascia with associated fluid collection, and that thickness values >4.0 mm are diagnostic of

  4. Retrospective study on radiotherapy efficacy in case of painful heel spur

    International Nuclear Information System (INIS)

    Klossok-Niethammer, Ruth Giuliana

    2011-01-01

    Objective: The effect of radiotherapy in context of a plantar fasciitis in order to reduce pain was evaluated in this retrospective study. Patients and methods: The data of 188 patients who suffered of heel spur pain and who were irradiated in the period from 1994 to 2009 were evaluated in this study. All of them had at least one follow up examination after radiatiotherapy. The mean age amounted to 57 years. 76.5% of the patients were female. All patients described a local pain which was the basis for the indication. 74.4 % of the patients described pain especially under stress. The duration of anamnesis was averaged as follows: 15 % of the patients had pain for some weeks to 3 months, 43 % for 4 to 6 months, 28% even for 7 to 12 months. The period of medical history was longer than 12 months for 12 % of the patients in this study. 122 of 188 patients received orthopedic arch support (shoe inlays) as first therapy method. Most of the patients were irradiated using regular lateral opposing fields with photons of the energy 4 MV and 6 MV of a linear accelerator, applying a total dose of 6Gy in 6 fractions to 1,0Gy twice weekly. Only one patient was irradiated using a Co 60 machine. The acquisition of data regarding the effect was performed on the last day of the radiotherapy and in 3 to 6 monthly follow ups. Additionally the doctors who attended the patients beyond the radiotherapy received a special questionnaire about the pain reduction, so that the follow up data could be completed. Results: On the last day of radiotherapy 120/188 patients (63,8%)reported an improvement of pain reduction, 7/188 patients (3,7%) absence of pain. For 52/188 patients (27.6 %) pain remained constant. At the second follow up examination after in the median 100 days the effect of radiotherapy of 165 patients could be evaluated, 43/165 patients (26 %) were pain free, 79/165 patients (47,8 %) reported an obvious pain reduction, and for 33/165 patients there was no pain improvement. At the

  5. Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review.

    Science.gov (United States)

    Fraser, John J; Corbett, Revay; Donner, Chris; Hertel, Jay

    2018-05-01

    To assess if manual therapy (MT) in the treatment of plantar fasciitis (PF) patients improves pain and function more effectively than other interventions. A systematic review of all randomized control trials (RCTs) investigating the effects of MT in the treatment of human patients with PF, plantar fasciosis, and heel pain published in English on PubMed, CINAHL, Cochrane, and Web of Science databases was conducted. Research quality was appraised utilizing the PEDro scale. Cohen's d effect sizes (ES) and associated 95% confidence intervals (CI) were calculated between treatment groups. Seven RCTs were selected that employed MT as a primary independent variable and pain and function as dependent variables. Inclusion of MT in treatment yielded greater improvement in function (6 of 7 studies, CI that did not cross zero in 14 of 25 variables, ES = 0.5-21.5) and algometry (3 of 3 studies, CI that did not cross zero in 9 of 10 variables, ES = 0.7-3.0) from 4 weeks to 6 months when compared to interventions such as stretching, strengthening, or modalities. Though pain improved with the inclusion of MT, ES calculations favored MT in only 2 of 6 studies (3 of 13 variables) and was otherwise equivalent in effectiveness to comparison interventions. MT is clearly associated with improved function and may be associated with pain reduction in PF patients. It is recommended that clinicians consider use of both joint and soft tissue mobilization techniques in conjunction with stretching and strengthening when treating patients with PF. Treatment, level 1a.

  6. Depression, Anxiety, and Stress in People With and Without Plantar Heel Pain.

    Science.gov (United States)

    Cotchett, Matthew; Munteanu, Shannon E; Landorf, Karl B

    2016-08-01

    Depression, anxiety, and stress are prevalent in patients with musculoskeletal pain, but the impact of these emotional states has not been evaluated in people with plantar heel pain. The aim of this study was to evaluate the association between depression, anxiety, and stress with plantar heel pain. Forty-five participants with plantar heel pain were matched by sex and age (±2 years) to 45 participants without plantar heel pain. Levels of depression, anxiety, and stress were measured using the Depression, Anxiety and Stress Scale (short version) in participants with and without plantar heel pain. Logistic regression was conducted to determine if levels of depression, anxiety, or stress were associated with having plantar heel pain. Univariate analysis indicated that participants with plantar heel pain had greater levels of depression (mean difference = 4.4, 95% CI 2.3 to 6.5), anxiety (mean difference = 2.6, 95% CI 0.9 to 4.3), and stress (mean difference = 4.8, 95% CI 1.9 to 7.8). After adjusting for age, sex, BMI, and education, for every 1 unit increase in depression, anxiety, or stress (in the DASS subscales), the odds ratios for having plantar heel pain were increased by 1.3 (95% CI 1.1 to 1.6), 1.3 (95% CI 1.1 to 1.5), and 1.2 (95% CI 1.1 to 1.3), respectively. Symptoms of depression, anxiety, and stress were independently associated with plantar heel pain. Larger prospective studies are necessary to evaluate the temporal association between these emotional states and plantar heel pain. Level III, cross sectional, observational. © The Author(s) 2016.

  7. Physiotherapeutic methods in the treatment of heel spurs and inflammation of plantar fasciitis - a review of the literature

    Directory of Open Access Journals (Sweden)

    Mariola Monika Uczciwek

    2017-06-01

    Full Text Available For aim of this paper and analysis of the treatment methods in question articles from Pumbed basis were used. Pumbed basis, which works under the auspices of US National Library of  Medicine and National Institute of  Health, helped to analyze the treatment methods for chronic condition of heel spur and plantar fascia. The analytical process was based on  bibliographical descript. Results of 1204 numbers were summarized because of specialist criterion.  Heel spurs are bony growths growing out of the plantar fascia and other soft tissues lining nearby which conduct to the plantar fascia ignition. The occurrence of these is connected with burdensome feeling of pain that can be felt when making first steps after getting up in the morning. It is a serious condition that applies to more and more people. Being overweight, training sports straining feet are the reasons contributing to this condition. Yet, it is not a general rule for the risk group. Treating methods in this sphere give many opportunities for physical therapist and doctors. The best sustainable method is physical therapy supported by medical aids. However, not every case gives intended results. If the sustainable methods are not enough, the surgical treatment should be introduced. There is no doubt that any method of treatment is individually reclaimed by every patient.

  8. Effectiveness and prognostic factors of radiotherapy for painful plantar heel spurs

    International Nuclear Information System (INIS)

    Schneider, O.; Bosch, E.; Gott, C.; Adamietz, I.A.; Stueckle, C.A.

    2004-01-01

    In this paper, the effectiveness (pain relief rate and long-term results) and prognostic factors of RT for plantar heel pain have been investigated. Patients and methods: From January 2000 to October 2000, 62 patients (73 heels) with painful plantar heel spurs and a minimum pain history of 3 months were treated and evaluated in a prospective study. Mean age was 54 years (range 28-84 years). All patients were treated with a total dose of 5 Gy in seven fractions (= one series), given twice a week at a single-dose sequence of 0.25-0.25-0.5-1.0-1.0-1.0-1-0. Gy (10-MV photons, source-skin distance [SSD] 100 cm, direct portal, field size 12 x 17 cm). The mean duration of heel pain before RT was 26 weeks (= 6.5 months; range 3-120 months). By means of a visual analog scale (VAS) the patients had to self-assess the quantity of their heel pain once before, three times during and four times after RT at a long-term median follow-up of 28 and 40 months. Additionally, the patients had to assess their mechanical heel stress extent during RT. Effectiveness was estimated according to the patients' judgment of pain reduction. The results confirm the high efficacy of RT in painful plantar spur and add new aspects to formerly published data concerning the time course of changes in heel pain reduction. Pain relief can be expected during and shortly after RT. In addition, the initial success can be transformed into effective long-term results >2 years after RT; however, further improvement is not to be expected. As a new prognostic factor, the reduction of mechanical heel stress during RT may ameliorate the short-term results, whereas short heel pain history improves the long-term results. Especially for older patients, RT should be taken into consideration as primary treatment. (orig.)

  9. Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials

    Directory of Open Access Journals (Sweden)

    He C

    2017-08-01

    Full Text Available Chunhui He,1,* Hua Ma2,* 1Internal Medicine of Traditional Chinese Medicine, 2Medical Image Center, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, People’s Republic of China *These authors contributed equally to this work Background: Plantar heel pain can be managed with dry needling of myofascial trigger points (MTrPs; however, whether MTrP needling is effective remains controversial. Thus, we conducted this meta-analysis to evaluate the effect of MTrP needling in patients with plantar heel pain. Materials and methods: PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China, and CNKI (National Knowledge Infrastructure, People’s Republic of China databases were systematically reviewed for randomized controlled trials (RCTs that assessed the effects of MTrP needling. Pooled weighted mean difference (WMD with 95% CIs were calculated for change in visual analog scale (VAS score, and pooled risk ratio (RR with 95% CIs were calculated for success rate for pain and incidence of adverse events. A fixed-effects model or random-effects model was used to pool the estimates, depending on the heterogeneity among the included studies. Results: Extensive literature search yielded 1,941 articles, of which only seven RCTs met the inclusion criteria and were included in this meta-analysis. The pooled results showed that MTrP needling significantly reduced the VAS score (WMD =–15.50, 95% CI: –19.48, –11.53; P<0.001 compared with control, but it had a similar success rate for pain with control (risk ratio [RR] =1.15, 95% CI: 0.87, 1.51; P=0.320. Moreover, MTrP needling was associated with a similar incidence of adverse events with control (RR =1.89, 95% CI: 0.38, 9.39; P=0.438. Conclusion: MTrP needling effectively reduced the heel pain due to plantar fasciitis. However, considering the potential limitations in this study, more large-scale, adequately powered, good

  10. Sonographic evaluation of plantar fasciitis and relation to body mass index

    Energy Technology Data Exchange (ETDEWEB)

    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.

  11. 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

  12. Effect of Vibration on Pain Response to Heel Lance: A Pilot Randomized Control Trial.

    Science.gov (United States)

    McGinnis, Kate; Murray, Eileen; Cherven, Brooke; McCracken, Courtney; Travers, Curtis

    2016-12-01

    Applied mechanical vibration in pediatric and adult populations has been shown to be an effective analgesic for acute and chronic pain, including needle pain. Studies among the neonatal population are lacking. According to the Gate Control Theory, it is expected that applied mechanical vibration will have a summative effect with standard nonpharmacologic pain control strategies, reducing behavioral and physiologic pain responses to heel lancing. To determine the safety and efficacy of mechanical vibration for relief of heel lance pain among neonates. In this parallel design randomized controlled trial, eligible enrolled term or term-corrected neonates (n = 56) in a level IV neonatal intensive care unit were randomized to receive either sucrose and swaddling or sucrose, swaddling, and vibration for heel lance analgesia. Vibration was applied using a handheld battery-powered vibrator (Norco MiniVibrator, Hz = 92) to the lateral aspect of the lower leg along the sural dermatome throughout the heel lance procedure. Neonatal Pain, Agitation, and Sedation Scale (N-PASS) scores, heart rate, and oxygen saturations were collected at defined intervals surrounding heel lancing. Infants in the vibration group (n = 30) had significantly lower N-PASS scores and more stable heart rates during heel stick (P = .006, P = .037) and 2 minutes after heel lance (P = .002, P = .016) than those in the nonvibration group. There were no adverse behavioral or physiologic responses to applied vibration in the sample. Applied mechanical vibration is a safe and effective method for managing heel lance pain. This pilot study suggests that mechanical vibration warrants further exploration as a nonpharmacologic pain management tool among the neonatal population.

  13. The effect of local heat on term neonates pain intensity during heel-blood sampling

    Directory of Open Access Journals (Sweden)

    R. GHobadi Mohebi

    2017-04-01

    Full Text Available Aims: Newborns are more sensitive to pain than adults and are more susceptible to the long-term complications of pain. So, it is necessary to use procedures for reducing pain in newborns. The aim of this study was to determine the effect of local heat on the pain intensity of heel-blood sampling in the term newborns. Material & Methods: In this randomized controlled clinical trial study, in 2012, 63 healthy 3 to 5-day newborns who were referred to Shahid Delkhah Health Center in Ferdows were selected by random sampling method and randomly divided into 3 groups (21 people in each group: test (heat, placebo (sound and control. The pain intensity of newborns before, during and after heel-blood sampling was evaluated. The data collection tools were demographic questionnaire and Neonatal Infant Pain Scale (NIPS. Data were analyzed by SPSS 14.5 software and chi-square test, one-way ANOVA, Tukey's post hoc test, and ANOVA with repeated observations. Finding: The mean pain intensity in the three groups was not significantly different before intervention (p=0.86, but the mean pain intensity was lower in the test group than in the other two groups (p=0.006. After heel-blood sampling, the mean pain intensity was the least in the test group and was the most in the control group (p<0.001. Conclusion: Local heat during and after heel blood sampling decreases pain intensity in the term newborns.

  14. Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease)

    International Nuclear Information System (INIS)

    Heneghan, M.A.; Wallace, T.

    1985-01-01

    Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result from post-traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with a normal Achilles tendon and superficial soft tissue contour, and intact cortex of the underling os calcis. (orig.)

  15. Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease)

    Energy Technology Data Exchange (ETDEWEB)

    Heneghan, M A; Wallace, T

    1985-02-01

    Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result from post-traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with a normal Achilles tendon and superficial soft tissue contour, and intact cortex of the underling os calcis.

  16. Efficacy of foot orthoses for the treatment of plantar heel pain

    DEFF Research Database (Denmark)

    Rasenberg, Nadine; Riel, Henrik; Rathleff, Michael S

    2018-01-01

    BACKGROUND: Plantar heel pain (PHP) is common. Foot orthoses are often applied as treatment for PHP, even though there is little evidence to support this. OBJECTIVE: To investigate the effects of different orthoses on pain, function and self-reported recovery in patients with PHP and compare them...

  17. Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

    Science.gov (United States)

    Malone, Terry R.

    2004-01-01

    Objective: Plantar fasciitis is a prevalent problem, with limited consensus among clinicians regarding the most effective treatment. The purpose of this literature review is to provide a systematic approach to the treatment of plantar fasciitis based on the windlass mechanism model. Data Sources: We searched MEDLINE, SPORT Discus, and CINAHL from 1966 to 2003 using the key words plantar fasciitis, windlass mechanism, pronation, heel pain, and heel spur. Data Synthesis: We offer a biomechanical application for the evaluation and treatment of plantar fasciitis based on a review of the literature for the windlass mechanism model. This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between the conditions and their treatments. Conclusions/Recommendations: Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition. Principles from this approach might also provide a basis for future research investigating the efficacy of plantar fascia treatment. PMID:16558682

  18. The Effect of Swaddling on Pain, Vital Signs, and Crying Duration during Heel Lance in Newborns.

    Science.gov (United States)

    Erkut, Zeynep; Yildiz, Suzan

    2017-10-01

    To determine the effect of swaddling on pain, vital signs, and crying duration during heel lance in the newborn. This was a randomized controlled study of 74 (control: 37, experiment: 37) newborns born between December 2013 and February 2014 at the Ministry of Health Bagcılar Training and Research Hospital. An information form, observation form, and Neonatal Infant Pain Scale were used as data collection tools. Data from the pain scores, peak heart rates, oxygen saturation, total crying time, and duration of the procedure were collected using a video camera. Newborns in the control group underwent routine heel lance, whereas newborns in the experimental group underwent routine heel lance while being swaddled by the researcher. The newborns' pain scores, peak heart rates, oxygen saturation values, and crying durations were evaluated using video recordings made before, during, and 1, 2, and 3 minutes after the procedure. Pain was assessed by a nurse and the researcher. No statistically significant difference was found in the characteristics of the two groups (p > .05). The mean pain scores of swaddled newborns during and after the procedure were lower than the nonswaddled newborns (p  .05). Although there was no significant difference in oxygen saturation values before and during the procedure (p > .05), oxygen saturation values of swaddled newborns were higher afterward (p < .05). For this study sample, swaddling was an effective nonpharmacologic method to help reduce pain and crying in an effort to soothe newborns. Although pharmacologic pain management is the gold standard, swaddling can be recommended as a complementary therapy for newborns during painful procedures. Swaddling is a quick and simple nonpharmacologic method that can be used by nurses to help reduce heel stick pain in newborns. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  19. The role of bone scintigraphy in determining the etiology of heel pain

    International Nuclear Information System (INIS)

    Ozdemir, H.; Soyuncu, Y.; Urguden, M.

    2002-01-01

    In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. Sixty-seven heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging

  20. The role of bone scintigraphy in determining the etiology of heel pain

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemir, H.; Soyuncu, Y.; Urguden, M. [Akdeniz Univ., Antalya (Turkey). Medical School; Ozdemir, A. [General State Hospital, Antalya (Turkey)

    2002-09-01

    In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. Sixty-seven heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging

  1. Effect of Mozart music on heel prick pain in preterm infants: a pilot randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Cristina Cavaiuolo

    2015-02-01

    Full Text Available Objective: The aim of this pilot study was to determine the effect of music by Mozart on heel prick procedural pain in premature infants.Background: Painful procedures are routinely performed in the setting of neonatal intensive care unit (NICU. Pain may exert short- and long-term deleterious effects on premature babies. Many non-pharmacological interventions have been proven efficacious for blunting neonatal pain.Study design: Randomized, controlled trial.Methods: The study was carried out in the NICU of the “G. Rummo” Hospital in Benevento, Italy. The sample consisted of 42 preterm infants, with no hearing loss or significant cerebral lesions on cranial ultrasound. They were randomized to receive heel lance during a music condition or a no-music control condition. We set strict criteria for selecting and delivering the music. Baseline and postprocedural heart rate and transcutaneous oxygen saturation were manually recorded. The Premature Infant Pain Profile (PIPP score was used to measure the behavioral response to prick. An unpaired t-test was performed for the intergroup comparisons.Results: There were significant differences between groups on heart rate increase, oxygen saturation reduction and PIPP score following the procedure.Conclusions: Listening to Mozart music during heel prick is a simple and inexpensive tool for pain alleviating in preterm stable neonates.

  2. Trial of Music, Sucrose, and Combination Therapy for Pain Relief during Heel Prick Procedures in Neonates.

    Science.gov (United States)

    Shah, Swapnil R; Kadage, Shahajahan; Sinn, John

    2017-11-01

    To compare the effectiveness of music, oral sucrose, and combination therapy for pain relief in neonates undergoing a heel prick procedure. This randomized, controlled, blinded crossover clinical trial included stable neonates >32 weeks of postmenstrual age. Each neonate crossed over to all 3 interventions in random order during consecutive heel pricks. A video camera on mute mode recorded facial expressions, starting 2 minutes before until 7 minutes after the heel prick. The videos were later analyzed using the Premature Infant Pain Profile-Revised (PIPP-R) scale once per minute by 2 independent assessors, blinded to the intervention. The PIPP-R scores were compared between treatment groups using Friedman test. For the 35 participants, the postmenstrual age was 35 weeks (SD, 2.3) with an average weight of 2210 g (SD, 710). The overall median PIPP-R scores following heel prick over 6 minutes were 4 (IQR 0-6), 3 (IQR 0-6), and 1 (IQR 0-3) for the music, sucrose, and combination therapy interventions, respectively. The PIPP-R scores were significantly lower at all time points after combination therapy compared with the groups given music or sucrose alone. There was no difference in PIPP-R scores between the music and sucrose groups. In relatively stable and mature neonates, the combination of music therapy with sucrose provided better pain relief during heel prick than when sucrose or music was used alone. Recorded music in isolation had a similar effect to the current gold standard of oral sucrose. www.anzctr.org.au ACTRN12615000271505. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Getting to the heel of the problem: plantar fascia lesions

    International Nuclear Information System (INIS)

    Jeswani, T.; Morlese, J.; McNally, E.G.

    2009-01-01

    Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease.

  4. Getting to the heel of the problem: plantar fascia lesions

    Energy Technology Data Exchange (ETDEWEB)

    Jeswani, T. [Department of Radiology, Worthing and Southlands Hospitals, West Sussex (United Kingdom); Morlese, J. [Department of Radiology, Royal Free Hospital, Pond street, London, NW3 2QG (United Kingdom); McNally, E.G. [Department of Radiology, Nuffield Orthopaedic Centre, Oxford (United Kingdom)], E-mail: eugene.mcnally@gmail.com

    2009-09-15

    Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease.

  5. Getting to the heel of the problem: plantar fascia lesions.

    Science.gov (United States)

    Jeswani, T; Morlese, J; McNally, E G

    2009-09-01

    Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease.

  6. Rationales and treatment approaches underpinning the use of acupuncture and related techniques for plantar heel pain: a critical interpretive synthesis.

    Science.gov (United States)

    Clark, Maria T; Clark, Richard J; Toohey, Shane; Bradbury-Jones, Caroline

    2017-03-01

    Acupuncture shows promise as a treatment for plantar heel pain (PHP) or plantar fasciitis (PF), but data heterogeneity has undermined demonstration of efficacy. Recognising that acupuncture is a diverse field of practice, the aim of this study was to gain a broader, global perspective on the different approaches and rationales used in the application of acupuncture in PHP. We built upon an earlier systematic review (which was limited by the necessity of a methodological focus on efficacy) using the critical interpretive synthesis (CIS) method to draw upon a wider international sample of 25 clinical sources, including case reports and case series. Multiple tracks of analysis led to an emergent synthesis. Findings are presented at three levels: primary (summarised data); secondary (patterns observed); and tertiary (emergent synthesis). Multiple treatments and rationales were documented but no single approach dominated. Notable contradictions emerged such as the application of moxibustion by some authors and ice by others. Synthesis of findings revealed a 'patchwork' of factors influencing the approaches taken. The complexity of the field of acupuncture was illustrated through the 'lens' of PHP. The 'patchwork' metaphor provides a unifying framework for a previously divergent community of practice and research. Several directions for future research were identified, such as: importance of prior duration; existence of diagnostic subgroups; and how practitioners make clinical decisions and report their findings. CIS was found to provide visibility for multiple viewpoints in developing theory and modelling the processes of 'real world' practice by acupuncturists addressing the problem of PHP. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. The effect of nesting positions on pain, stress and comfort during heel lance in premature infants.

    Science.gov (United States)

    Kahraman, Ayşe; Başbakkal, Zümrüt; Yalaz, Mehmet; Sözmen, Eser Y

    2017-11-13

    Nesting positions are commonly used in procedural analgesic administration in premature neonates. The effectiveness of nesting positions is questioned. The aim of the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values in nesting positions during the heel lance procedure in premature infants at the NICU. Experimental research; repeated measurement design. The sample comprised 33 premature neonates with gestational age of 31-35 weeks who had been hospitalized in the NICU. Nesting positions were given using linen or towels. The procedure of heel lance was recorded on camera. The camera recordings were evaluated according to the NIPS and the COMFORTneo scale. Saliva samples were obtained five minutes prior to and 30 min after the heel lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol Elisa Kit and the Salimetrics Melatonin Elisa Kit. The crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the prone position during the procedure were significantly lower than the scores in the supine position (p lance procedure had significantly decreased in the prone position; however, there were insignificant differences in the mean levels of salivary melatonin between the positions. Nesting in the prone position has a pain reducing effect, enhancing comfort and reducing stress in premature infants. Copyright © 2017. Published by Elsevier B.V.

  8. A Preliminary Study on the Effect of Computer-Aided Designed and Manufactured Orthoses on Chronic Plantar Heel Pain.

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    Gatt, Alfred; Grech, Mark; Chockalingam, Nachiappan; Formosa, Cynthia

    2018-04-01

    Chronic plantar heel pain (CPHP) is a significant, painful condition referring to a range of undifferentiated foot conditions that affect the heel of the foot. Participants presenting with CPHP of more than 6 months' duration were recruited on a first through the door basis. Computer-Aided Design and Computer-Aided Manufactured (CAD-CAM) orthoses were designed and constructed for each participant, then dispensed as per normal practice. Pre- and postintervention assessment of pain was performed at baseline and after 6 weeks of use, utilizing the pain subset of the Foot Function Index (FFI). There was a significant reduction in the mean pain scores for all participants in all constructs of the FFI. Total FFI score was also significant ( P = .003). CAD-CAM orthoses have the potential to become a treatment modality of choice in CPHP since they have resulted in a significant improvement in heel pain after only 6 weeks' use. Therapeutic, Level IV: Prospective, comparative trial.

  9. Low back pain and disability in individuals with plantar heel pain.

    Science.gov (United States)

    McClinton, Shane; Weber, Carolyn F; Heiderscheit, Bryan

    2018-03-01

    Lack of response to plantar heel pain (PHP) treatment may be related to unmanaged low back pain (LBP) and low back dysfunction, but a relationship between LBP and PHP has not been established. The purpose of this investigation was to compare the prevalence of LBP among individuals with and without PHP and to assess the association between low back disability and foot/ankle function. A cross-sectional study compared the prevalence and likelihood of LBP in individuals with (n=27) and without (n=27) PHP matched to age, sex, BMI, foot posture, and foot mobility. In individuals with PHP, correlations were examined between foot/ankle function using the foot and ankle ability measure (FAAM), low back disability using the Oswestry low back disability questionnaire (OSW), duration of PHP symptoms, body mass index (BMI), and age. A greater percentage of individuals with PHP had LBP (74% versus 37% of controls, odds ratio=5.2, P=0.009) and higher levels of low back disability (17% higher OSW score than controls, PPHP, FAAM scores were correlated with OSW scores (ρ=-0.463, P=0.015), but not with duration of PHP symptoms, BMI, or age (P>0.150). Individuals with PHP had a greater prevalence of LBP and higher low back disability that was correlated to reduced foot and ankle function. Treatment to address both local and proximal impairments, including impairments related to LBP, may be warranted to improve the management of PHP. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. 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.

  11. 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

  12. Relationship of Plantar Fascia Thickness and Preoperative Pain, Function, and Quality of Life in Recalcitrant Plantar Fasciitis.

    Science.gov (United States)

    Gamba, Carlo; Sala-Pujals, Aleix; Perez-Prieto, Daniel; Ares-Vidal, Jesus; Solano-Lopez, Alberto; Gonzalez-Lucena, Gemma; Ginés-Caspedosa, Alberto

    2018-04-01

    The measurement of plantar fascia thickness has been advocated as a diagnostic and prognostic instrument in patients with plantar fasciitis, but there are no data relative to it in recalcitrant plantar fasciitis. The aim of the study is to evaluate the correlation between plantar fascia thickness and pain, functional score, and health perception in patients with this condition. Thirty-eight feet were studied with ultrasound and magnetic resonance imaging to measure plantar fascia thickness. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS), and SF-36 were then recorded for each patient. The relationship between the fascia and these scores was analyzed to evaluate the correlation of thickness with pain, functional level, and health perception of patients. In patients with recalcitrant plantar fasciitis, plantar fascia thickness did not correlate with pain (VAS), AOFAS, or any item of the SF-36. The thickness of the plantar fascia in patients with recalcitrant plantar fasciitis did not correlate with its clinical impact, and thus, we believe it should not be used in treatment planning. Level IV, case series.

  13. Retrospective study on radiotherapy efficacy in case of painful heel spur; Retrospektive Studie ueber die Wirksamkeit der Strahlentherapie beim schmerzhaftem Fersensporn

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    Klossok-Niethammer, Ruth Giuliana

    2011-07-01

    Objective: The effect of radiotherapy in context of a plantar fasciitis in order to reduce pain was evaluated in this retrospective study. Patients and methods: The data of 188 patients who suffered of heel spur pain and who were irradiated in the period from 1994 to 2009 were evaluated in this study. All of them had at least one follow up examination after radiatiotherapy. The mean age amounted to 57 years. 76.5% of the patients were female. All patients described a local pain which was the basis for the indication. 74.4 % of the patients described pain especially under stress. The duration of anamnesis was averaged as follows: 15 % of the patients had pain for some weeks to 3 months, 43 % for 4 to 6 months, 28% even for 7 to 12 months. The period of medical history was longer than 12 months for 12 % of the patients in this study. 122 of 188 patients received orthopedic arch support (shoe inlays) as first therapy method. Most of the patients were irradiated using regular lateral opposing fields with photons of the energy 4 MV and 6 MV of a linear accelerator, applying a total dose of 6Gy in 6 fractions to 1,0Gy twice weekly. Only one patient was irradiated using a Co{sup 60} machine. The acquisition of data regarding the effect was performed on the last day of the radiotherapy and in 3 to 6 monthly follow ups. Additionally the doctors who attended the patients beyond the radiotherapy received a special questionnaire about the pain reduction, so that the follow up data could be completed. Results: On the last day of radiotherapy 120/188 patients (63,8%)reported an improvement of pain reduction, 7/188 patients (3,7%) absence of pain. For 52/188 patients (27.6 %) pain remained constant. At the second follow up examination after in the median 100 days the effect of radiotherapy of 165 patients could be evaluated, 43/165 patients (26 %) were pain free, 79/165 patients (47,8 %) reported an obvious pain reduction, and for 33/165 patients there was no pain improvement. At

  14. Beneficial effects of platelet-rich plasma on improvement of pain severity and physical disability in patients with plantar fasciitis: A randomized trial

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2016-01-01

    Conclusion: Administration of PRP leads to significant improvement in pain severity and physical limitation in patients with plantar fasciitis. This healing effect may be begun at least 3 months after injection.

  15. Comparative Effect of the Smells of Amniotic Fluid, Breast Milk, and Lavender on Newborns' Pain During Heel Lance.

    Science.gov (United States)

    Akcan, Esma; Polat, Sevinç

    2016-06-17

    The aim of this randomized controlled experimental study was to evaluate the effect of the smells of amniotic fluid, breast milk, and lavender on the pain of newborns during heel lance. The sample of the study consisted of 102 newborn infants who complied with the sampling criteria between August and November, 2011. The newborns smelled the samples (lavender, breast milk, amniotic fluid, and distilled water) for 5 minutes before the heel lance until 5 minutes afterward. The Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation were evaluated 1 minute before, during, and 1 minute after the heel lance. Data were evaluated by descriptive statistics, chi-square, intraclass correlation analysis, Spearman's rho correlation, Bonferroni's advanced analysis, Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney U, Friedman, and Dunnett's tests. The newborns in the control group had severe pain and the newborns in the breast milk, amniotic fluid, and lavender groups had moderate pain during the heel lance (p lance, it was lower in the breast milk and amniotic fluid groups than the lavender group afterward. The lowest falls in oxygen saturation and increased in heart rate were in the breast milk and lavender groups during heel the lance. The smells of lavender and breast milk prevent the increased heart rates, NIPS, falling oxygen saturation, and reduced pain during the invasive procedures in newborns more than amniotic fluid or control group.

  16. Management of plantar fasciitis in the outpatient setting

    Science.gov (United States)

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-01-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

  17. The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review

    Directory of Open Access Journals (Sweden)

    Parish Ben

    2011-06-01

    Full Text Available Abstract Background Plantar heel pain is a commonly occurring foot complaint. Stretching is frequently utilised as a treatment, yet a systematic review focusing only on its effectiveness has not been published. This review aimed to assess the effectiveness of stretching on pain and function in people with plantar heel pain. Methods Medline, EMBASE, CINAHL, AMED, and The Cochrane Library were searched from inception to July 2010. Studies fulfilling the inclusion criteria were independently assessed, and their quality evaluated using the modified PEDro scale. Results Six studies including 365 symptomatic participants were included. Two compared stretching with a control, one study compared stretching to an alternative intervention, one study compared stretching to both alternative and control interventions, and two compared different stretching techniques and durations. Quality rating on the modified Pedro scale varied from two to eight out of a maximum of ten points. The methodologies and interventions varied significantly between studies, making meta-analysis inappropriate. Most participants improved over the course of the studies, but when stretching was compared to alternative or control interventions, the changes only reached statistical significance in one study that used a combination of calf muscle stretches and plantar fascia stretches in their stretching programme. Another study comparing different stretching techniques, showed a statistically significant reduction in some aspects of pain in favour of plantar fascia stretching over calf stretches in the short term. Conclusions There were too few studies to assess whether stretching is effective compared to control or other interventions, for either pain or function. However, there is some evidence that plantar fascia stretching may be more effective than Achilles tendon stretching alone in the short-term. Appropriately powered randomised controlled trials, utilizing validated outcome

  18. Randomized placebo-controlled trial of sucrose analgesia on neonatal skin blood flow and pain response during heel lance.

    Science.gov (United States)

    Tutag Lehr, Victoria; Cortez, Josef; Grever, William; Cepeda, Eugene; Thomas, Ron; Aranda, Jacob V

    2015-05-01

    To evaluate the effect of oral sucrose on skin blood flow (SBF; perfusion units; PU) measured by Laser Doppler Imager (LDI) in term newborns and pain response (Neonatal Infant Pain Scale score; NIPS score) during heel lance; (2) determine SBF changes during heel lance; and (3) the relationship between SBF and NIPS. Term infants ≤7 days old (n=56) undergoing routine heel lance were randomized to pretreatment with 2.0 mL oral 24% sucrose (n=29) or sterile water (n=27) in a double-blinded, placebo-controlled trial. SBF was assessed by LDI scans and NIPS scores at 10 minutes before lance, immediately after lancing, and 5 minutes after blood extraction. Mean SBF and median NIPS scores were compared between groups using General Linear Model or Kruskal-Wallis. Regressions examined the relationship between SBF immediately after heel lance and NIPS score. Mean SBF and median NIPS scores immediately after heel lance were lower in sucrose-treated infants (167.9±15.5 vs. 205.4±16.0 PU, P=0.09; NIPS 1 [interquartile range 0 to 4] vs. NIPS 3 [interquartile range 0 to 6], P=0.02), although no significant difference in mean SBF. During heel lance NIPS score was predictive of SBF. An increase of 1 in NIPS score was associated with 11 PU increase in SBF (R=0.21; P=0.09) for sucrose, and 16 PU increase for placebo-treated infants (R=0.20; P=0.014). Increased SBF assessed by LDI is a pain response among term neonates after routine heel lance, which was not completely attenuated by oral sucrose administration. Increased SBF is associated with NIPS scores. Sucrose analgesic efficacy evidenced by decreased NIPS scores for the sucrose group. Association of SBF with NIPS scores suggests that LDI is potentially useful for assessing newborn procedural pain.

  19. The efficacy of mechanical vibration analgesia for relief of heel stick pain in neonates: a novel approach.

    Science.gov (United States)

    Baba, Lisa R; McGrath, Jacqueline M; Liu, Jiexin

    2010-01-01

    Hospitalized infants are often exposed to many painful procedures as a result of their illness or disease process. Untreated or poorly treated pain can have deleterious effects on normal nociceptive pain development as well as future development of pain pathways. Mechanical vibration has been found to be efficacious in adult and pediatric populations for the relief of mild-to-moderate acute and chronic pain. However, little is known about the efficacy of this intervention in the neonatal population. The purpose of this study was to test the hypothesis that mechanical vibration would be efficacious in the relief of pain associated with heel sticks in neonates. Heel sticks are one of the most common painful procedures during neonatal hospitalization. A random-sequencing crossover design was used with infants acting as their own controls. Newborn infants of 35 weeks' gestation or greater (N = 20) met the inclusion criteria for the study. Pain during heel stick was measured with the Neonatal Infant Pain Scale. The Neonatal Infant Pain Scale is a nonintrusive tool with extensive evidence of its reliability and validity in the neonatal population, when used by trained observers. Mechanical vibration produced an analgesic effect for infants who had previously experienced painful heel sticks that approached statistical significance. The apparent limitations of mechanical vibration as analgesia may be due to the concurrent use of sucrose and pacifier, the effects of order (ie, habituation), or type II error. Because vibration produced the predicted positive effect in some circumstances, further investigation in larger samples within a randomized clinical trial is warranted.

  20. EFFECT OF KINESIO TAPING IN ADJUNCT TO CONVENTIONAL THERAPY IN REDUCING PAIN AND IMPROVING FUNCTIONAL ABILITY IN INDIVIDUALS WITH PLANTAR FASCIITIS A RANDOMIZED CONTROLLED TRIAL

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    S.Tulasi Ratna

    2015-08-01

    Full Text Available Background: Plantar fasciitis is one of the most common musculoskeletal disorders of foot. The pain and discomfort associated with this condition has a dramatic impact on physical mobility and function. Treatment of this condition is usually conservative; however, review of literature revealed no clinical studies demonstrating the efficacy of any targeted treatment for this condition. Methods: This was a prospective study which included 60 subjects with plantar fasciitis, who were randomly divided into two groups. Subjects in group I received ultrasound and exercise therapy while subjects in group II received kinesio tape in addition to ultrasound and exercise therapy. Patients were evaluated at the beginning of the study and at the end of three weeks using VAS (visual analogue scale for pain intensity, PFPS (plantar fasciitis pain / disability scale for functional ability and ultra sonography for any change in the caliber of plantar fascia. Results: A statistically significant difference in improvement was noted within the groups and between the groups in terms of visual analogue scale and plantar fasciitis pain /disability scale score (p0.05. Conclusion: Kinesio taping can be used as an adjunct to conventional therapy in clinical application for greater improvement in pain levels and functional ability in patients with plantar fasciitis.

  1. [Effects of different types and concentration of oral sweet solution on reducing neonatal pain during heel lance procedures].

    Science.gov (United States)

    Leng, Hong-yao; Zheng, Xian-lan; Yan, Li; Zhang, Xian-hong; He, Hua-yun; Xiang, Ming

    2013-09-01

    To compare the effect of different types and concentrations of sweet solutions on neonatal pain during heel lance procedure. Totally 560 full term neonates (male 295, female 265) were randomized into 7 groups:placebo group (plain water), 10% glucose, 25% glucose, 50% glucose, 12% sucrose, 24% sucrose and 30% sucrose groups.In each group, 2 ml corresponding oral solutions were administered through a syringe by dripping into the neonate's mouth 2 minute before heel lance. The procedure process was recorded by videos, from which to collect heart rate, oxygen saturation and pain score 1 min before puncture, 3, 5 and 10 min after puncture. The average heart rate increase 3, 5 and 10 min after procedure in the 25% and 50% glucose groups, 12% and 24% and 30% sucrose groups was significantly lower than those in the placebo group (P lance (both P lance, but the best concentration of sucrose for pain relief needs further study.

  2. Oral glucose and breast milk as a strategy for pain reduction during the heel lance procedure in newborns.

    Science.gov (United States)

    Aguilar Cordero, María José; Mur Villar, Norma; García García, Inmaculada; Rodríguez López, María Ascensión; Rizo Baeza, María Mercedes

    2014-11-01

    This paper presents the results of a study on pain reduction in newborns that undergo painful medical procedures. This research analyzed the reactions of babies before and after the heel lance procedure, a diagnostic test performed to detect phenylketonuria. This test involved the extraction of a capillary blood sample with a heel lance, a medical procedure that is painful for neonates. The main objective of this research was to evaluate the effectiveness of a 24% oral glucose solution and breastfeeding during heal lance. An experimental study was thus conducted on a sample of 93 newborns in the San Cecilio University Hospital in Granada in 2010. The babies in the sample were divided into three groups, depending on what they ingested during the heal lance. The results obtained showed that there was an association between the difference in HR and the time before the newborn's HR returned to normal after the heel lance (r = 0.562; p = 0.000). Moreover, a positive relation was found between the absolute difference in HR and the difference in oxygen saturation (OS) (r = 0.538; p = 0.000). The OS was found to be greater in the group of newborns that received breast milk. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  3. Extracorporeal shock wave therapy for treatment of plantar fasciitis

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    Dastgir, N.

    2014-01-01

    Objective: To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis. Methods: The prospective study was conducted at Department of Orhopaedic, Regional Hospital, Limerick, Ireland from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections had failed, and they were treated with low energy extracorporeal shock wave therapy. Patients were reviewed at 6, 12 and 24 weeks post treatment. Results: At follow-up there was significant decrease in pain on the visual analogue scale (p<0.027), with significant improvement in pain score (p<0.009) and in functional score (p<0.001). The comfortable walking distance had increased significantly and there were no reported side effects. Conclusion: Extracorporeal shock wave therapy is a new modality providing good pain relief and a satisfactory clinical outcome in patients with chronic plantar fasciitis. (author)

  4. Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: a randomized controlled trial.

    Science.gov (United States)

    Zhu, Jiemin; Hong-Gu, He; Zhou, Xiuzhu; Wei, Haixia; Gao, Yaru; Ye, Benlan; Liu, Zuguo; Chan, Sally Wai-Chi

    2015-03-01

    to test the effectiveness of breast feeding (BF), music therapy (MT), and combined breast feeding and music therapy (BF+MT) on pain relief in healthy-term neonates during heel lance. randomised controlled trial. in the postpartum unit of one university-affiliated hospital in China from August 2013 to February 2014. among 288 healthy-term neonates recruited, 250 completed the trial. All neonates were undergoing heel lancing for metabolic screening, were breast fed, and had not been fed for the previous 30 minutes. all participants were randomly assigned into four groups - BF, MT, BF+MT, and no intervention - with 72 neonates in each group. Neonates in the control group received routine care. Neonates in the other three intervention groups received corresponding interventions five minutes before the heel lancing and throughout the whole procedure. Neonatal Infant Pain Scale (NIPS), latency to first cry, and duration of first crying. mean changes in NIPS scores from baseline over time was dependent on the interventions given. Neonates in the BF and combined BF+MT groups had significantly longer latency to first cry, shorter duration of first crying, and lower pain mean score during and one minute after heel lance, compared to the other two groups. No significant difference in pain response was found between BF groups with or without music therapy. The MT group did not achieve a significantly reduced pain response in all outcome measures. BF could significantly reduce pain response in healthy-term neonates during heel lance. MT did not enhance the effect of pain relief of BF. healthy-term neonates should be breast fed to alleviate pain during heel lance. There is no need for the additional input of classical music on breast feeding in clinic to relieve procedural pain. Nurses should encourage breast feeding to relieve pain during heel lance. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm

    2011-01-01

    Objective To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods Information on use...... of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with >/=50 very low birth weight...... admissions per year were included in this analysis. Results Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries...

  6. The effect of extracorporeal shock wave therapy for the treatment of plantar fasciitis in regard to middle-aged patients' activity level and pain localization

    Science.gov (United States)

    Hanada, M.; Takahashi, M.; Matsuyama, Y.

    2017-12-01

    In this retrospective cohort study, we compared the efficacy of extracorporeal shock wave therapy (ESWT) for plantar fasciitis in patients with different activity levels and different pain locations. In total, 92 patients (99 feet) who were over 40 years old with chronic plantar fasciitis were treated with ESWT after being categorized as participating in recreational sports(group R) or only activities of daily living (group D). On the other hand, patients were categorized as having pain in the plantar fascia enthesis (group E) or the entire plantar fascia (group W). Pain during activity and general tenderness were evaluated by using the visual analog scale (VAS) before and after ESWT. Although the VAS for pain score during activity significantly improved in both groups R and D after ESWT (Pplantar fasciitis in middle-aged patients and ESWT was effective in patients not only playing recreational sports but also having activities of daily living. ESWT was more effective in patients with pain in the plantar fascia enthesis than in patients with pain in the entire plantar fascia.

  7. Improvement of a Clinical Score for Necrotizing Fasciitis: 'Pain Out of Proportion' and High CRP Levels Aid the Diagnosis.

    Science.gov (United States)

    Borschitz, Thomas; Schlicht, Svenja; Siegel, Ekkehard; Hanke, Eric; von Stebut, Esther

    2015-01-01

    Necrotizing fasciitis (NF) is a rare mono-/polymicrobial skin infection that spreads to underlying tissues. NF is quickly progressing and leads to life threatening situations. Immediate surgical debridement together with i.v. antibiotic administration is required to avoid fatal outcome. Early diagnosis is often delayed due to underestimation or confusion with cellulitis. We now compared the initial clinical and laboratory presentation of NF and cellulitis in detail to assess if a typical pattern can be identified that aids timely diagnosis of NF and avoidance of fatal outcome. 138 different clinical and laboratory features of 29 NF patients were compared to those of 59 age- and gender matched patients with severe erysipelas requiring a subsequent hospitalization time of ≥10 days. Differences in clinical presentation were not obvious; however, NF patients suffered significantly more often from strong pain. NF patients exhibited dramatically elevated CRP levels (5-fold, p>0.001). The overall laboratory risk indicator for necrotizing fasciitis (LRINEC) score was significantly higher in NF patients as compared to cellulitis. However, a modification of the score (alteration of laboratory parameters, addition of clinical parameters) led to a clear improvement of the score with a higher positive predictive value without losing specificity. In summary, clinical differentiation of NF from cellulitis appears to be hard. 'Pain out of proportion' may be an early sign for NF. An improvement of the LRINEC score emphasizing only relevant laboratory and clinical findings as suggested may aid the early diagnosis of NF in the future leading to improvement of disease outcome by enabling rapid adequate therapy.

  8. [Necrotizing fasciitis after varicella].

    Science.gov (United States)

    Gonçalves, E; Furtado, F; Estrada, J; Vale, M C; Pinto, M; Santos, M; Moura, G; Vasconcelos, C

    2001-01-01

    Necrotizing fasciitis is a rare and severe infection characterised by extremely rapid progressive involvement of the superficial fascias and deep dermal layers of the skin, with resultant vasculitis and necrosis. The authors present three clinical cases of necrotizing fasciitis; all three patients previously had varicella rash, rapid progressive spreading erythema with severe pain and toxic shock syndrome. Two patients had positive cultures of b-haemolytic streptococcus. Early stage differential diagnosis with celulitis, aggressive antibiotic treatment and pediatric intensive care support are essential. However, the main therapy is early extensive surgical approach involving all indurate areas, down to and including the muscle fascia.

  9. Randomised study showed that recorded maternal voices reduced pain in preterm infants undergoing heel lance procedures in a neonatal intensive care unit.

    Science.gov (United States)

    Chirico, G; Cabano, R; Villa, G; Bigogno, A; Ardesi, M; Dioni, E

    2017-10-01

    Alleviating pain in neonates should be the goal of all caregivers. We evaluated whether recorded maternal voices were safe and effective in limiting pain in preterm infants undergoing heel lance procedures in the neonatal intensive care unit of an Italian children's hospital. This prospective, controlled study took place from December 2013 to December 2015. We enrolled 40 preterm infants, born at a 26-34 weeks of gestation, at a corrected gestational age 29-36 weeks and randomised them to listen or not listen to a recording of their mother's voice during a painful, routine heel lance for blood collection. Changes in the infants' Premature Infant Pain Profile, heart rate, oxygen saturation and blood pressure during the procedure were compared by analysis of variance. Possible side effects, of apnoea, bradycardia, seizures and vomiting, were also recorded. Both groups showed a marked increase in PIPP scores and decrease in oxygen saturation during the procedure, but infants in the treatment group had significantly lower PIPP scores (p = 0.00002) and lower decreases in oxygen saturation (p = 0.0283). No significant side effects were observed. Using recorded maternal voices to limit pain in preterm infants undergoing heel lance procedures appeared safe and effective. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  10. Comparison of the Effectiveness of Oral Sucrose and Emla Cream in Reduction of Acute Pain Due to Heel Sticks for Blood Sampling in Neonates

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    S Abyari

    2007-04-01

    Full Text Available Introduction: Certain painful, invasive procedures are necessary for care, and are commonly performed in both healthly and sick neonates. Current evidence shows that the newborn infant has both physiologic and anatomic capacity to experience pain. Recent research suggests that pain experienced in the neonatal period might have long-term effects later in life. Previous research has shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. This effect is considered to be mediated both by the release of endorphins and by a preabsorptive mechanism related to the sweet taste. Methods: This study was a controlled , randomized and double – blind study on 210 neonates. These newborns were randomly divided into 3 groups; A, B and C. Group A received 2 ml of 25% sucrose orally as well as base cream was applied at the site for heel stick, group B received 2 ml of distilled water and application of EMLA cream, while group C received 2 ml of distilled water and base cream. The heart rates of the newborn were recorded by the cardiac monitor before and after heel stick blood sampling and the duration of crying was determined as well. Pain was scored by DAN scale.There were no differences in demographic characteristics of all neonates. Results: The results showed that the DAN scale was significantly lower in the sucrose group (mean : 3.840 as compared to the EMLA group (mean: 3.366 and the placebo group(5.557, but the difference in the duration of crying was not significantly different in the sucrose group (mean: 10.5 second and the EMLA group(mean 8.76. Conclusion: Both sucrose and EMLA are effective in reducing stress associated with heel lancet in newborns, but as sucrose acts faster and is healthier, its usage is proposed in neonates requiring heel sticks for blood sampling.

  11. Comparison of the Efficacy of Oral 25% Glucose with Oral 24% Sucrose for Pain Relief during Heel Lance in Preterm Neonates: A Double Blind Randomized Controlled Trial.

    Science.gov (United States)

    Kumari, Sweta; Datta, Vikram; Rehan, Harmeet

    2017-02-01

    To study the analgesic effect of oral 25% glucose as compared with oral 24% sucrose during heel lance in preterm neonates. Stable preterm neonates within first 48 hours of life were randomized to receive either 24% sucrose or 25% glucose before heel lance. Primary outcome assessed was painful response by the Premature Infant Pain Profile (PIPP) score at 30 seconds after heel lance, and the secondary outcome was immediate adverse events associated with the administration of two solutions and duration of crying immediately following the procedure. A total of 94 neonates were randomly assigned into 24% sucrose and 25% glucose group. The baseline characteristics between the two groups were comparable. No significant difference was observed between the two study groups with respect to PIPP scores, duration of crying and rate of adverse events. When assessed by PIPP score, 25% glucose and 24% sucrose provided comparable analgesia during heel lance in preterm neonates. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    Science.gov (United States)

    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.

  13. Orthosis-Shaped Sandals Are as Efficacious as In-Shoe Orthoses and Better than Flat Sandals for Plantar Heel Pain: A Randomized Control Trial.

    Directory of Open Access Journals (Sweden)

    Bill Vicenzino

    Full Text Available To investigate efficacy of a contoured sandal being marketed for plantar heel pain with comparison to a flat flip-flop and contoured in-shoe insert/orthosis.150 volunteers aged 50 (SD: 12 years with plantar heel pain (>4 weeks were enrolled after responding to advertisements and eligibility determined by telephone and at first visit. Participants were randomly allocated to receive commercially available contoured sandals (n = 49, flat flip-flops (n = 50 or over the counter, pre-fabricated full-length foot orthotics (n = 51. Primary outcomes were a 15-point Global Rating of Change scale (GROC: 1 = a very great deal worse, 15 = a very great deal better, 13 to 15 representing an improvement and the 20-item Lower Extremity Function Scale (LEFS on which participants rate 20 common weight bearing activities and activities of daily living on a 5-point scale (0 = extreme difficulty, 4 = no difficulty. Secondary outcomes were worst level of heel pain in the preceding week, and the foot and ankle ability measure. Outcomes were collected blind to allocation. Analyses were done on an intention to treat basis with 12 weeks being the primary outcome time of interest.The contoured sandal was 68% more likely to report improvement in terms of GROC compared to flat flip-flop. On the LEFS the contoured sandal was 61% more likely than flat flip-flop to report improvement. The secondary outcomes in the main reflected the primary outcomes, and there were no differences between contoured sandal and shoe insert.Physicians can have confidence in supporting a patient's decision to wear contoured sandals or in-shoe orthoses as one of the first and simple strategies to manage their heel pain.The Australian New Zealand Clinical Trials Registry ACTRN12612000463875.

  14. Effect of Environmental and Behavioral Interventions on Pain Intensity in Preterm Infants for Heel Prick Blood Sampling in the Neonatal Intensive Care Unit.

    Science.gov (United States)

    Baharlooei, Fatemeh; Marofi, Maryam; Abdeyazdan, Zahra

    2017-01-01

    Recent researches suggest that preterm infants understand pain and stress. Because of the wide range of effects of pain on infants, the present study was conducted on the effect of environmental and behavioral interventions on pain due to heel-prick blood sampling in preterm infants. A clinical trial was conducted among 32 infants with gestational age of 32-37 weeks in the intervention and control groups. The effects of noise reduction by earplugs, light reduction by blindfolds, reduction of nursing manipulation, and creation of intrauterine position for neonates, 30 minutes before taking blood samples until 30 minutes after it, were measured during the intervention stage. Data were collected using the Neonatal Infant Pain Scale (NIPS) in 5 stages (before intervention, 2 minutes before sampling, during the sampling, and 5 minutes and 30 minutes after the sampling). The data were analyzed using analysis of variance (ANOVA) and paired t -test in SPSS software. The paired t -test results showed no significant differences between the control and intervention stages in terms of pain scores at base time ( P = 0.42) and 2 minutes before sampling ( P = 0.12). However, at the sampling time ( P = 0.0), and 5 minutes ( P = 0.001) and 30 minutes after the sampling ( P = 0.001), mean pain score in the intervention stage was significantly less than that in the control stage. Based on the findings, environmental and behavioral interventions reduced pain and facilitated heel-prick blood sampling in preterm infants.

  15. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

    International Nuclear Information System (INIS)

    Kose, Ozkan

    2010-01-01

    Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot. A prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study. Seventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen. Calcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified. (orig.)

  16. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

    Energy Technology Data Exchange (ETDEWEB)

    Kose, Ozkan [Diyarbakir Education and Research Hospital, Orthopaedics and Traumatology Clinic, Diyarbakir (Turkey); Diclekent Bulvari, Ataslar Serhat Evleri, Diyarbakir (Turkey)

    2010-04-15

    Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot. A prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study. Seventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen. Calcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified. (orig.)

  17. Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?

    Energy Technology Data Exchange (ETDEWEB)

    Hermann, Robert Michael, E-mail: hermann@strahlentherapie-westerstede.com [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Meyer, Andreas [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Gemeinschaftspraxis für Strahlentherapie Hildesheim/Goslar (Germany); Becker, Alexandra [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Schneider, Michael [Orthopaedic Centre for Musculoskeletal Research, University of Würzburg (Germany); Reible, Michael; Carl, Ulrich Martin [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Christiansen, Hans [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Nitsche, Mirko [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel (Germany)

    2013-12-01

    Purpose: Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. Methods and Materials: A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Results: Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Conclusion: Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice.

  18. Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?

    International Nuclear Information System (INIS)

    Hermann, Robert Michael; Meyer, Andreas; Becker, Alexandra; Schneider, Michael; Reible, Michael; Carl, Ulrich Martin; Christiansen, Hans; Nitsche, Mirko

    2013-01-01

    Purpose: Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. Methods and Materials: A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Results: Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Conclusion: Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice

  19. Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis.

    Science.gov (United States)

    Gurcay, Eda; Kara, Murat; Karaahmet, Ozgur Zeliha; Ata, Ayşe Merve; Onat, Şule Şahin; Özçakar, Levent

    We compared the effectiveness of ultrasound (US)-guided corticosteroid, injected superficial or deep to the fascia, in patients with plantar fasciitis. Thirty patients (24 females [75%] and 6 males [25%]) with unilateral chronic plantar fasciitis were divided into 2 groups according to the corticosteroid injection site: superficial (n = 15) or deep (n = 15) to the plantar fascia. Patient heel pain was measured using a Likert pain scale and the Foot Ankle Outcome Scale (FAOS) for foot disability, evaluated at baseline and repeated in the first and sixth weeks. The plantar fascia and heel pad thicknesses were assessed on US scans at baseline and the sixth week. The groups were similar in age, gender, and body mass index (p > .05 for all). Compared with the baseline values, the Likert pain scale (p plantar fascia thickness had decreased significantly in both groups at the sixth week (p  .05 for both). The difference in the FAOS subscales (pain, p = .002; activities of daily living, p = .003; sports/recreational activities, p = .008; quality of life, p = .009) and plantar fascia thickness (p = .049) showed better improvement in the deep than in the superficial injection group. US-guided corticosteroid injections are safe and effective in the short-term therapeutic outcome of chronic plantar fasciitis. Additionally, injection of corticosteroid deep to the fascia might result in greater reduction in plantar fascia thickness, pain, and disability and improved foot-related quality of life. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Necrotizing Fasciitis Associated with Staphylococcus lugdunensis

    Directory of Open Access Journals (Sweden)

    Tony Hung

    2012-01-01

    Full Text Available Necrotizing fasciitis is a life-threatening soft tissue infection that results in rapid local tissue destruction. Type 1 necrotizing fasciitis is characterized by polymicrobial, synergistic infections that are caused by non-Group A streptococci, aerobic and anaerobic organisms. Type 2 necrotizing fasciitis involves Group A Streptococcus (GAS with or without a coexisting staphylococcal infection. Here we provide the first report of necrotizing fasciitis jointly associated with the microbes Group B Streptococcus and Staphylococcus lugdunensis. S. lugdunensis is a commensal human skin bacterium known to cause often painful and prolonged skin and soft tissue infections. To our knowledge, however, this is the first case of Staph. lugdunensis-associated necrotizing fasciitis to be reported in the literature.

  1. Eosinophilic fasciitis

    Directory of Open Access Journals (Sweden)

    Karolina Niklas

    2015-01-01

    Full Text Available Eosinophilic fasciitis is a rare connective tissue disease with unclear etiology and pathogenesis. It is classified as a scleroderma-like syndrome. The disease is characterized by fibrosis of the skin and subcutaneous tissues with significant thickening of fascia. Visceral involvement is rare. Characteristic feature in laboratory tests is peripheral blood eosinophilia. Differential diagnosis should be performed, including ruling out systemic sclerosis, nephrogenic systemic fibrosis, eosinophilia-myalgia syndrome, scleromyxedema, hypereosinophilic syndrome or Churg-Strauss syndrome. Final diagnosis is confirmed by histopathological examination. In treatment of the disease corticosteroids and/or immunosuppressive drugs are used. Some other drugs showed activity in this disease e.g. dapsone, infiximab or rituximab. Prognosis is rather good but sometimes a long-term treatment is necessary. In this paper we summarized the current knowledge on eosinophilic fasciitis.

  2. NECROTIZING FASCIITIS

    OpenAIRE

    HARJAI, MAN MOHAN

    2000-01-01

    Bacterial resistance to antimicrobial agents increases rapidly outside as well as in hospitals. Antimicrobials may remove sensitive organisms from the bacterial flora, but they also foster the establishment of a resistant strain, not only inducing infection by bacteria which had not previously been considered pathogens, but also preventing spontaneous healing. Although necrotizing fasciitis has been seen in the past 20 years throughout the world, it remains unclear which cases are attributabl...

  3. Prognostic Value of Diagnostic Sonography in Patients With Plantar Fasciitis.

    Science.gov (United States)

    Fleischer, Adam E; Albright, Rachel H; Crews, Ryan T; Kelil, Tatiana; Wrobel, James S

    2015-10-01

    The primary objective of this study was to determine whether the sonographic appearance of the plantar fascia is predictive of the treatment (ie, pain) response in patients receiving supportive therapy for proximal plantar fasciitis. This study was a secondary analysis of data obtained from a randomized controlled trial of ambulatory adults, which examined the efficacy of 3 different foot supports for plantar fasciitis. Participants underwent diagnostic sonographic examinations of their heel at baseline and again at 3 months by a single experienced foot and ankle surgeon. Quantitative (eg, thickness) and qualitative (eg, biconvexity) characteristics of the fascia were recorded according to a standard protocol. Logistic regression models were used to identify predictors of the pain response. Seventy patients completed a baseline evaluation, and 63 patients completed a 3-month follow-up assessment. The pain response was not associated with the type of foot support (P> .05). The only significant indicator of an unfavorable response in the univariate and multivariate analyses was biconvexity of the plantar fascia on sonography at presentation (multivariate odds ratio, 4.76 [95% confidence interval, 1.16-19.5; P= .030). Furthermore, changes in self-reported pain over the 3-month study period were not accompanied by alterations in plantar fascia thickness over this time (r = .056; P = .671). We conclude that patients who present with biconvexity of the plantar fascia may be less responsive to tier 1 treatment regimens that center around mechanical support of the plantar fascia. Furthermore, follow-up measurements of the fascia in this population should not weigh heavily in decisions such as return to play. © 2015 by the American Institute of Ultrasound in Medicine.

  4. Analysis of foot kinematics wearing high heels using the Oxford foot model.

    Science.gov (United States)

    Wang, Meizi; Gu, Yaodong; Baker, Julien Steven

    2018-04-29

    Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20-25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55∘± 1.62∘ VS 26.6∘± 2.33∘ for the barefoot; P= 0.001), and less hallux plantarflexion during the initial stance phase (-4.86∘± 2.32∘ VS -8.68∘± 1.13∘; Pfoot demonstrated a larger dorsiflexion in the horizontal plane (16.59∘± 1.69∘ VS 12.08∘± 0.9∘; Pfoot extension rotation (-5.49∘± 0.69∘ VS -10.73∘± 0.42∘; P= 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.

  5. Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound

    Science.gov (United States)

    Moustafa, Asmaa Mahmoud Ali; Hassanein, Eshrak; Foti, Calogero

    2015-01-01

    Summary Background although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. Methods this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. Results increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (pplantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. Conclusion US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis. PMID:26958538

  6. Talalgia: plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Ricardo Cardenuto Ferreira

    2014-06-01

    Full Text Available Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%. The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor.

  7. Effect of environmental and behavioral interventions on pain intensity in preterm infants for heel prick blood sampling in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Fatemeh Baharlooei

    2017-01-01

    Full Text Available Background: Recent researches suggest that preterm infants understand pain and stress. Because of the wide range of effects of pain on infants, the present study was conducted on the effect of environmental and behavioral interventions on pain due to heel-prick blood sampling in preterm infants. Materials and Methods: A clinical trial was conducted among 32 infants with gestational age of 32–37 weeks in the intervention and control groups. The effects of noise reduction by earplugs, light reduction by blindfolds, reduction of nursing manipulation, and creation of intrauterine position for neonates, 30 minutes before taking blood samples until 30 minutes after it, were measured during the intervention stage. Data were collected using the Neonatal Infant Pain Scale (NIPS in 5 stages (before intervention, 2 minutes before sampling, during the sampling, and 5 minutes and 30 minutes after the sampling. The data were analyzed using analysis of variance (ANOVA and paired t-test in SPSS software. Results: The paired t-test results showed no significant differences between the control and intervention stages in terms of pain scores at base time (P = 0.42 and 2 minutes before sampling (P = 0.12. However, at the sampling time (P = 0.0, and 5 minutes (P = 0.001 and 30 minutes after the sampling (P = 0.001, mean pain score in the intervention stage was significantly less than that in the control stage. Conclusions: Based on the findings, environmental and behavioral interventions reduced pain and facilitated heel-prick blood sampling in preterm infants.

  8. Eosinophilic Fasciitis Associated with Myositis

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    Yuko Adachi

    2015-04-01

    Full Text Available Eosinophilic fasciitis is clinically characterized by symmetrical scleroderma-like indurations of the skin with pain. The histological features are fascial inflammation with lymphocytes and eosinophils as well as thickened and fibrotic fascia. Lymphocytic infiltration and degeneration of the underlying muscle are rarely observed. We report a 69-year-old Japanese woman who presented with multiple areas of glossy induration and painful peau d'orange-like lesions on the chest and four extremities. T2-weighted magnetic resonance imaging showed significant hyperintense thickening of the fascia of the lower extremities. Histopathological examination of a biopsy specimen from the induration showed marked fibrinoid degeneration of the fascia and the neighboring muscle with mixed cellular infiltration of lymphocytes and eosinophils. The predominant CD8+ lymphocytic infiltrates were observed by immunohistological study. A diagnosis of eosinophilic fasciitis with myositis was made. Oral administration of prednisolone and discontinuation of exercise significantly improved the lesions and pain.

  9. Effectiveness of Plantar Fascia-Specific Stretching Exercises in Plantar Fasciitis

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    Devrim Özer

    2015-12-01

    Full Text Available Aim: Plantar fasciitis (PF is a painful and disabling disease that affects the quality of life and daily activities of patients and it is the most common cause of heel pain in adults. In primary treatment, conservative treatment is suggested and different conservative options are described in the literature. In our study, we evaluated the efficacy of plantar fascia-specific stretching exercises in the treatment of PF. Methods: Twenty-nine feet - 21 patients with the mean age of 49.3 years were included in the study. The mean length of follow-up was 19.8 months and the mean length of exercise period was 4.94 months. Non-weight bearing plantar fascia-specific stretching exercise was done twice daily, for 10 times at each session. In addition to exercises, silicone heel pad and nonsteroidal anti-inflammatory drugs (NSAID were added. Visual analog scale (VAS was used for pain evaluation. Results: Full recovery detected in 15 feet in 10 patients (52% and a decrease in pain was seen in 10 feet in 8 patients (34%. There was no response in 4 feet in 3 patients (14%. There was statistically significant difference between pre-treatment and post-treatment visual analog scale scores (p=0.0001. Conclusion: Plantar fascia-specific stretching exercise is an effective treatment option in PF.

  10. Mortality in necrotizing fasciitis

    International Nuclear Information System (INIS)

    Waseem, A.R.; Samad, A.

    2008-01-01

    The objective of this study was to determine the mortality rate in patients presenting with Necrotizing Fasciitis. This prospective study was conducted at ward 26, JPMC Karachi over a period of two years from March 2001 to Feb 2003. All patients above the age of 12 years diagnosed to be having Necrotizing Fasciitis and admitted through the Accident and emergency department were included in this study. After resuscitation, the patients underwent the emergency exploration and aggressive surgical debridement. Post-operatively, the patients were managed in isolated section of the ward. The patients requiring grafting were referred to plastic surgery unit. The patients were followed up in outpatients department for about two years. Over all, 25 male and 5 female patients fulfilled the inclusion criteria and were included in this study. The common clinical manifestations include redness, swelling, discharging abscess, pain, fever, skin necrosis and foul smelling discharge etc. The most common predisposing factor was Diabetes mellitus whereas the most commonly involved site was perineum. All patients underwent aggressive and extensive surgical debridements. The common additional procedures included Skin grafting, Secondary suturing, Cystostomy and Orchidectomy. Bacteroides and E. coli were the main micro-organisms isolated in this study. Bacteroides was the most common microorganism isolated among the eight patients who died. Necrotizing Fasciitis is a potentially life threatening emergency condition and carries the mortality rate of about 26.6%. The major contributing factors to increase the mortality missed initially diagnosed, old age, diabetes mellitus truncal involvement and late presentation. Anorectal involvement of disease carry worse prognosis. Hyperbaric oxygen therapy and proper use of unprocessed honey reduced the mortality rate. (author)

  11. Effeciency of extracorporeal shock wave therapy in patients with plantar fasciitis and the relationship with subcalcaneal spur length

    Directory of Open Access Journals (Sweden)

    Serpil Tuna

    2014-06-01

    Full Text Available Objective: ESWT is widely used in the treatment of plantar fascitis. In this study, we aimed to investigate the effect of ESWT on heel pain and symptoms in the short and medium term. We also compared the subcalcaneal spur length and the heel pain severity and examined the effect of the subcalcaneal spur length on the efficiency of ESWT therapy. Methods: The efficiency of ESWT applied to 59 heel of 48 patients compared retrospectively . We used Visual Analog Scale (VAS and Wolgin scale to evaluate the treatment outcomes. We measure the subcalcaneal spurs length of the patients with foot x-ray . Correlation between the VAS scores and the length of subcalcaneal spur were also evaluated. Results: Improvement in VAS in the first week and 3 months after ESWT treatment was statistically significant. There was no correlation between subcalcaneal spur length and the severity of pain. The number of patients in the'' medium, bad'' group decreased while the number of patients in the '' good'' group incresed according to WDS after ESWT treatment. Conclusion: As a result of this study we concluded that ESWT is effective in the treatment of plantar fasciitis in the short and medium term.

  12. Ultrasound guided injection of dexamethasone versus placebo for treatment of plantar fasciitis: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Gilheany Mark F

    2010-07-01

    Full Text Available Abstract Background Plantar fasciitis is the most commonly reported cause of chronic pain beneath the heel. Management of this condition commonly involves the use of corticosteroid injection in cases where less invasive treatments have failed. However, despite widespread use, only two randomised trials have tested the effect of this treatment in comparison to placebo. These trials currently offer the best available evidence by which to guide clinical practice, though both were limited by methodological issues such as insufficient statistical power. Therefore, the aim of this randomised trial is to compare the effect of ultrasound-guided corticosteroid injection versus placebo for treatment of plantar fasciitis. Methods The trial will be conducted at the La Trobe University Podiatry Clinic and will recruit 80 community-dwelling participants. Diagnostic ultrasound will be used to diagnose plantar fasciitis and participants will be required to meet a range of selection criteria. Participants will be randomly allocated to one of two treatment arms: (i ultrasound-guided injection of the plantar fascia with 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group, or (ii ultrasound-guided injection of the plantar fascia with 1 mL normal saline (control group. Blinding will be applied to participants and the investigator performing procedures, measuring outcomes and analysing data. Primary outcomes will be pain measured by the Foot Health Status Questionnaire and plantar fascia thickness measured by ultrasound at 4, 8 and 12 weeks. All data analyses will be conducted on an intention-to-treat basis. Conclusion This will be a randomised trial investigating the effect of dexamethasone injection on pre-specified treatment outcomes in people with plantar fasciitis. Within the parameters of this protocol, the trial findings will be used to make evidence-based recommendations regarding the use of corticosteroid injection for treatment of this

  13. Long-Term Prognosis of Plantar Fasciitis

    DEFF Research Database (Denmark)

    Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell

    2018-01-01

    , exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study....... The risk was significantly greater for women (P heel...... regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us...

  14. Foot mobility and plantar fascia elasticity in patients with plantar fasciitis.

    Science.gov (United States)

    Sahin, Namık; Oztürk, Alpaslan; Atıcı, Teoman

    2010-01-01

    In this study, we investigated the radiologic changes of feet in sagittal plane under weightbearing either with or without plantar fasciitis. The study includes 64 feet of the 42 subjects with heel pain (Group 1: 32 women, 10 men, mean age 48 years, range 33-57 years) and 80 feet of the 40 patients (Group 2: 30 women, 10 men, mean age 47.2 years, range 35-56 years) without heel pain. Calcaneal inclination angle (CIA), calcaneal-first metatarsal angle (CMA), and plantar fascia length (PFL) were measured in the lateral radiographs of the weightbearing and non-weightbearing foot. The values of Group 1 and Group 2 were compared. The mean CIA was 26° (range 18-35°), CMA was 121° (range 115-133°), and PFL was 131 mm (range 110-158 mm) in non-weightbearing position for Group 1. The mean CIA was 27° (range 17-38°), CMA was 122° (range 110-135°), and PFL was 136 mm (range 120-155 mm) in non-weightbearing position for Group 2. The mean CIA was 13.6° (range 5-25°), CMA was 138° (range 130-153°), and PFU was 143.8 mm (range 118-158 mm) in weightbearing position for Group 1. The mean CIA was 9.9° (range 4-25°), CMA was 145° (range 130-155°), and PFU was 151.4 mm (range 137-167 mm) in weightbearing position for Group 2. The difference between CIA, CMA, and PFL values were -13°, 17°, and 12 mm under condition of weightbearing and nonweightbearing position values for Group 1; and -17°, 23°, and 15 mm for Group 2. The differences were significant between weightbearing and non-weightbearing position values (pplantar fascia elasticity, which may lead to posterior heel pain syndrome.

  15. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial.

    Science.gov (United States)

    Malay, D Scot; Pressman, Martin M; Assili, Amir; Kline, Jason T; York, Shane; Buren, Ben; Heyman, Eugene R; Borowsky, Pam; LeMay, Carley

    2006-01-01

    Extracorporeal shockwave therapy (ESWT) has demonstrated efficacy in the treatment of recalcitrant proximal plantar fasciitis. The objective of this investigation was to compare the outcomes of participants treated with a new ESWT device with those treated with placebo. A total of 172 volunteer participants were randomized in a 2:1 active-to-placebo ratio in this prospective, double-blind, multicenter trial conducted between October 2003 and December 2004. ESWT (n=115) or placebo control (n=57) was administered on a single occasion without local or systemic anesthesia or sedation, after which follow-up was undertaken. The primary outcomes were the blind assessor's objective, and the participant's subjective assessments of heel pain during the first 3 months of follow-up. Participants were also followed up to 1 year to identify any adverse outcomes that may have been related to the shockwave device. On the visual analog scale, the blind assessor's objective assessment of heel pain displayed a mean reduction of 2.51 in the shockwave group and 1.57 in the placebo group; this difference was statistically significant (P=.045). On the visual analog scale, the participant's self-assessment of heel pain displayed a mean reduction of 3.39 in the shockwave group and 1.78 in the placebo group; this difference was statistically significant (P<.001). No serious adverse events were observed at any time. It was concluded that ESWT was both efficacious and safe for participants with chronic proximal plantar fasciitis that had been unresponsive to exhaustive conservative treatment.

  16. LOCAL CORTICOSTEROID VS. AUTOLOGOUS BLOOD FOR PLANTAR FASCIITIS

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    Syam Sunder B

    2017-01-01

    Full Text Available BACKGROUND Plantar fasciitis is the most common cause of heel pain for which professional care is sought. Initially thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia and maybe more accurately termed plantar fasciosis. Traditional therapeutic efforts have been directed at decreasing the presumed inflammation. These treatments include icing, Nonsteroidal Anti-inflammatory Drugs (NSAIDs, rest and activity modification, corticosteroids, botulinum toxin type A, splinting, shoe modifications and orthosis. Other treatment techniques have been directed at resolving the degeneration caused by the disease process. In general, these techniques are designed to create an acute inflammatory reaction with the goal of restarting the healing process. These techniques include autologous blood injection, Platelet-Rich Plasma (PRP injection, nitroglycerin patches, Extracorporeal Shock Wave Therapy (ESWT and surgical procedures. Recently, research has focused on regenerative therapies with high expectations of success. The use of autologous growth factors is thought to heal through collagen regeneration and the stimulation of a well-ordered angiogenesis. These growth factors are administered in the form of autologous whole blood or Platelet-Rich Plasma (PRP. Platelets can be isolated using simple cell-separating systems. The degranulation of the alpha granules in the platelets releases many different growth factors that play a role in tissue regeneration processes. Platelet-derived growth factor, transforming growth factor-P, vascular-derived endothelial growth factor, epithelial growth factor, hepatocyte growth factor and insulin-like growth factor are examples of such growth factors. Injections with autologous growth factors are becoming common in clinical practice. The present study was an attempt to compare the efficacy of autologous blood injection in plantar fasciitis by comparing it with the local

  17. Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable

    DEFF Research Database (Denmark)

    Johannsen, Finn E; Jensen, Signe; Stallknecht, Sandra E

    2016-01-01

    PURPOSE: To determine intra- and interobserver reliability and precision of sonographic (US) scanning in measuring thickness of the Achilles tendon, plantar fascia, and heel fat pad in patients with heel pain. METHODS: Seventeen consecutive patients referred with heel pain were included. Two...

  18. Laser Acupuncture at Large Intestine 4 Compared with Oral Glucose Administration for Pain Prevention in Healthy Term Neonates Undergoing Routine Heel Lance: Study Protocol for an Observer-Blinded, Randomised Controlled Clinical Trial

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    Jasmin Stadler

    2018-01-01

    Full Text Available Background. Nonpharmacological strategies have actually become more important in neonatal pain management during routinely applied minor painful procedures. However, commonly used nonpharmacological strategies are inferior to orally administered sweet solutions. Therefore, we will compare laser acupuncture, as a recent nonpharmacological method, with the standard care of oral glucose solution for pain prevention. Methods. Ninety-five healthy term neonates will be allocated into one of two groups. Before routine heel lance for metabolic screening, one group will receive laser acupuncture at acupuncture point Large Intestine 4 (LI 4 bilaterally for 60 seconds per point (acupuncture group and the other will receive the standard care with orally administered glucose solution (glucose group. The complete procedure of blood sampling will be recorded on video, excluding the intervention before heel lance. A paediatric nurse, blinded with respect to the allocation, will evaluate these video recordings and determine the Premature Infant Pain Profile (PIPP for each neonate. Primary outcome will be the mean difference in PIPP scores between groups. Discussion. This observer-blinded randomised controlled trial has been designed to explore potential advantages of laser acupuncture in the management of neonatal pain because more data are required to provide information about its efficacy and safety. Trial Registration. This trial is registered with DRKS00010122.

  19. Laser Acupuncture at Large Intestine 4 Compared with Oral Glucose Administration for Pain Prevention in Healthy Term Neonates Undergoing Routine Heel Lance: Study Protocol for an Observer-Blinded, Randomised Controlled Clinical Trial.

    Science.gov (United States)

    Stadler, Jasmin; Avian, Alexander; Posch, Katrin; Urlesberger, Berndt; Raith, Wolfgang

    2018-01-01

    Nonpharmacological strategies have actually become more important in neonatal pain management during routinely applied minor painful procedures. However, commonly used nonpharmacological strategies are inferior to orally administered sweet solutions. Therefore, we will compare laser acupuncture, as a recent nonpharmacological method, with the standard care of oral glucose solution for pain prevention. Ninety-five healthy term neonates will be allocated into one of two groups. Before routine heel lance for metabolic screening, one group will receive laser acupuncture at acupuncture point Large Intestine 4 (LI 4) bilaterally for 60 seconds per point (acupuncture group) and the other will receive the standard care with orally administered glucose solution (glucose group). The complete procedure of blood sampling will be recorded on video, excluding the intervention before heel lance. A paediatric nurse, blinded with respect to the allocation, will evaluate these video recordings and determine the Premature Infant Pain Profile (PIPP) for each neonate. Primary outcome will be the mean difference in PIPP scores between groups. This observer-blinded randomised controlled trial has been designed to explore potential advantages of laser acupuncture in the management of neonatal pain because more data are required to provide information about its efficacy and safety. This trial is registered with DRKS00010122.

  20. Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review.

    Science.gov (United States)

    Mohseni-Bandpei, Mohammad Ali; Nakhaee, Masoomeh; Mousavi, Mohammad Ebrahim; Shakourirad, Ali; Safari, Mohammad Reza; Vahab Kashani, Reza

    2014-08-01

    Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  1. Case Report of Necrotizing Fasciitis Associated with Streptococcus pneumoniae

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    Lei Jiao

    2016-01-01

    Full Text Available Necrotizing fasciitis, caused by Streptococcus pneumoniae, is an extremely rare and life-threatening bacterial soft tissue infection. We report a case of early necrotizing fasciitis associated with Streptococcus pneumoniae infection in a 26-year-old man who was immunocompromised with mixed connective tissue disease. The patient presented with acute, painful, erythematous, and edematous skin lesions of his right lower back, which rapidly progressed to the right knee. The patient underwent surgical exploration, and a diagnosis of necrotizing fasciitis was confirmed by pathological evidence of necrosis of the fascia and neutrophil infiltration in tissue biopsies. Cultures of fascial tissue biopsies and blood samples were positive for Streptococcus pneumoniae. To our knowledge, this is the first report of necrotizing fasciitis resulting from Streptococcus pneumoniae diagnosed at early phase; the patient recovered well without surgical debridement.

  2. Cervical Necrotizing Fasciitis Caused by Dental Extraction

    Directory of Open Access Journals (Sweden)

    José Alcides Arruda

    2016-01-01

    Full Text Available Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.

  3. Radiotherapy of painful heel spur with two fractionation regimens. Results of a randomized multicenter trial after 48 weeks' follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Prokein, Benjamin; Dzierma, Yvonne; Ruebe, Christian; Fleckenstein, Jochen; Niewald, Marcus [Saarland University Hospital, Department of Radiotherapy and Radiooncology, Homburg (Germany); Holtmann, Henrik [Saarland University Hospital, Department of Radiotherapy and Radiooncology, Homburg (Germany); University Hospital of Duesseldorf, Department of Oral and Maxillofacial Surgery, Duesseldorf (Germany); Hautmann, Matthias G. [University Hospital of Regensburg, Department of Radiotherapy, Regensburg (Germany); Roesler, Hans-Peter [University Hospital of Mainz, Department of Radiooncology and Radiotherapy, Mainz (Germany); Graeber, Stefan [Saarland University Hospital, Institute of Medical Biometrics, Epidemiology and Medical Informatics, Homburg (Germany)

    2017-06-15

    In this randomized multicenter trial, we compared the effect of a lower single dose of 0.5 Gy vs. a standard single dose of 1 Gy concerning pain relief and quality of life, while maintaining a uniform total dose of 6 Gy. On the basis of laboratory observations, the lower single dose would be expected to be more effective. A total of 127 patients suffering from painful heel spur were randomized: Patients in the standard group were treated with single fractions of 6 x 1 Gy twice a week, while the experimental group was treated with single fractions of 12 x 0.5 Gy three times a week. Patients who did not show satisfactory pain relief after 12 weeks were offered re-irradiation with the standard dose. The study's primary endpoints were pain relief and quality of life. Therapy results were evaluated and compared based on follow-up examinations after 12 and 48 weeks. The data of 117 patients could be evaluated. There was no significant difference between the groups concerning the results of a visual analogue scale (VAS), Calcaneodynia Score (CS), and the somatic scale of the 12-Item Short-Form Health Survey(SF-12). Patients undergoing re-irradiation showed a significant benefit concerning pain relief. Their total outcome was comparable to patients showing a good response from the beginning. No relevant acute or chronic side effects were recorded. Both patient groups showed good results concerning pain relief. A fractionation schedule of 12 x 0.5 Gy was not superior to the current standard dose of 6 x 1 Gy. Further trials are necessary to explore the best fractionation schedule. (orig.) [German] In dieser randomisierten Multizenterstudie wurde der Effekt einer niedrigen Einzeldosis von 0,5 Gy hinsichtlich Schmerzen und Lebensqualitaet mit demjenigen einer Standarddosis von 1,0 Gy verglichen, dies bei konstanter Gesamtdosis von 6 Gy. Nach Laborergebnissen war eine Ueberlegenheit der niedrigen Einzeldosis zu erwarten. Es wurden 127 Patienten randomisiert - einerseits in

  4. [Necrotizing fasciitis. 2011 update].

    Science.gov (United States)

    Herr, M; Grabein, B; Palm, H-G; Efinger, K; Riesner, H-J; Friemert, B; Willy, C

    2011-03-01

    Necrotizing fasciitis belongs to a group of complicated soft tissue infections that can be even life threatening. Despite growing knowledge about its etiology, predictors, and the clinical progression, the mortality remains at a high level with 20%. A relevant reduction can be achieved only by an early diagnosis followed by consistent therapy. The clinical findings in about 75% of the cases are pain out of proportion, edema and tenderness, blisters, and erythema. It is elementary to differentiate a necrotizing or a non-necrotizing soft tissue infection early. In uncertain cases it can be necessary to perform a surgical exploration to confirm the diagnosis. The histopathologic characteristics are the fascial necrosis, vasculitis, thrombosis of perforating veins, the presence of the disease-causing bacteria as well as inflammatory cells like macrophages and polymorphonuclear granulocytes. Secondly, both the cutis and the muscle can be affected. In many cases there is a disproportion of the degree of local and systemic symptoms. Depending on the infectious agents there are two main types: type I is a polymicrobial infection and type II is a more invasive, serious, and fulminant monomicrobial infection mostly caused by group A Streptococcus pyogenes.Invasive, severe forms of streptococcal infections seem to occur more often in recent years. Multimodal and interdisciplinary therapy should be based on radical surgical débridement, systemic antibiotic therapy as well as enhanced intensive care therapy, which is sometimes combined with immunoglobulins (in streptococcal or staphylococcal infections) or hyperbaric oxygen therapy (HBOT, in clostridial infections). For wound care of extensive soft tissue defects vacuum-assisted closure has shown its benefit.

  5. Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete.

    Science.gov (United States)

    Saxena, Amol; Fournier, Magali; Gerdesmeyer, Ludger; Gollwitzer, Hans

    2012-10-01

    Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient's return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. II.

  6. [Functional impairment and radiologic fasciitis under erlotinib therapy].

    Science.gov (United States)

    Osdoit, S; Wierzbicka, E; Guillet, G

    2011-01-01

    Targeted molecules are recent and valuable weapons in the management of certain cancers. Among them, erlotinib is an inhibitor of epidermal growth factor receptor approved in non-small lung cancer and pancreatic cancer after failure of first line treatment. Erlotinib is responsible for many cutaneous side effects. We report a case of acute symptomatic fasciitis that has occurred during erlotinib therapy. To our knowledge it is the first case described. A 56-year-old man was treated with erlotinib for a metastatic non-small lung adenocarcinoma. Shortly after the treatment by erlotinib was introduced, he had a severe acneiform rash resistant to doxycycline treatment. After a year of treatment, he presented intense pain in the legs with functional impairment. Medical imaging confirmed fasciitis. It regressed along with the rash after using strong topical corticosteroids during ten days. Besides bacterial fasciitis, inflammatory and oedematous fasciitis have varied aetiologies. The occurrence of a documented fasciitis during anti EGFR-therapy is original and raises the question of underlying mechanism. We suggest three pathophysiological mechanisms: spreading by contiguity; paraneoplastic fasciitis, or specific lesion of the fascia due to anti-EGFR. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  7. Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis

    DEFF Research Database (Denmark)

    Broholm, Rikke; Pingel, Jessica; Simonsen, Lene

    2017-01-01

    -mode ultrasound (US) in patients with plantar fasciitis (PF). 20 patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5) and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat...... pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter...

  8. Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

    Science.gov (United States)

    Cottom, James M; Baker, Joseph S

    2016-10-01

    When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Internal strain estimation for quantification of human heel pad elastic modulus: A phantom study

    DEFF Research Database (Denmark)

    Holst, Karen; Liebgott, Hervé; Wilhjelm, Jens E.

    2013-01-01

    Shock absorption is the most important function of the human heel pad. However, changes in heel pad elasticity, as seen in e.g. long-distance runners, diabetes patients, and victims of Falanga torture are affecting this function, often in a painful manner. Assessment of heel pad elasticity...... is usually based on one or a few strain measurements obtained by an external load-deformation system. The aim of this study was to develop a technique for quantitative measurements of heel pad elastic modulus based on several internal strain measures from within the heel pad by use of ultrasound images. Nine...... heel phantoms were manufactured featuring a combination of three heel pad stiffnesses and three heel pad thicknesses to model the normal human variation. Each phantom was tested in an indentation system comprising a 7MHz linear array ultrasound transducer, working as the indentor, and a connected load...

  10. Static, dynamic balance and functional performance in subjects with and without plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Geiseane Aguiar Gonçalves

    Full Text Available Abstract Introduction: Plantar fasciitis (PF is characterized by non-inflammatory degeneration and pain under the heel, and is one of the most common foot complaints. The compensations and adjustments made to decrease the discomfort caused by the disease are clinical findings and can be a factor that contributes to impaired balance and decreased functional performance. Objective: To compare functional performance as well as static and dynamic balance among subjects with and without PF. Methods: The sample consisted of 124 subjects of both sexes aged 20-60 years. Participants were divided into two groups: a bilateral PF group (PFG; n = 62 and a control group (CG, n = 62. The following outcomes were analyzed: static and dynamic balance (using functional tests and functional performance (using a questionnaire. We used Student’s t test for independent samples to compare variables between the groups. The alpha error was set at 0.05. Results: Subjects with PF showed greater impairment in their overall dynamic balance performance (p < 0.001 than the control group, except for left posteromedial movement (p = 0.19. The CG showed showed better functional performance (p < 0.001 than the PF group. There was no difference between groups for the variable static balance on stable (p = 0.160 and unstable surfaces (p = 0.085. Conclusion: Subjects with PF displayed smaller reach distances in the overall Star Excursion Balance Test (SEBT, demonstrating a deficit in dynamic balance and functional performance when compared with healthy subjects.

  11. HEEL BONE RECONSTRUCTIVE OSTEOSYNTHESIS

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    A. N. Svetashov

    2010-01-01

    Full Text Available To detect the most appropriate to heel bone injury severity variants of reconstructive osteosynthesis it was analyzed treatment results of 56 patients. In 15 (26.8% patients classic methods of surgical service were applied, in 41 (73.2% cases to restore the defect porous implants were used. Osteosynthesis without heel bone plastic restoration accomplishment was ineffective in 60% patients from control group. Reconstructive osteosynthesis method ensures long-term good functional effect of rehabilitation in 96.4% patients from the basic group.

  12. High Heels: A Study of Personality and Fashion Conscience

    Directory of Open Access Journals (Sweden)

    Suzane Strehlau

    2013-06-01

    Full Text Available This article investigates the relationship between the use of high heels, personality traits, and fashion consciousness of adult women. The theory of consumer behavior states that the personality of the consumer is a psychological factor that affects consumer decisions, as well as the attitude towards fashion. A survey with 83 women was conducted with two questionnaires. One questionnaire was about fashion consciousness and the use of high heels, and the other utilized the HumanGuide test. The analysis used univariate and multivariate techniques with the aid of SPSS software and Partial Least Squares. The results indicate that 60% of respondents feel pain when wearing high heels. Although designers indicate that a high heel height is above 8 cm, this research indicates that women consider a high heel from 5 cm. Only 27.3% of the responders over 50 years of age use high heels over 8.5 cm. The HumanGuide proved to be useful for Marketing in the sense that the respondents had no difficulty in answering the questions. The use of high heels is mostly explained by fashion consciousness. The most influential factor was the stability of personality, individuals described as conservative, traditional, economical, stable, cautious, steady, and serious. Thus, it appears that these respondents wear high heels because they are related to an elegant traditional dress.DOI: 10.5585/remark.v12i2.2563

  13. Necrotizing fasciitis caused by group A streptococcus

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    Mikić Dragan

    2002-01-01

    Full Text Available The first case of the confirmed necrotizing fasciitis caused by Group A Streptococcus in Yugoslavia was presented. Male patient, aged 28, in good health, suddenly developed symptoms and signs of severe infective syndrome and intensive pain in the axillary region. Parenteral antibiotic, substitution and supportive therapy was conducted along with the radical surgical excision of the necrotizing tissue. The patient did not develop streptococcal toxic shock syndrome thanks to the early established diagnosis and timely applied aggressive treatment. He was released from the hospital as completely cured two months after the admission.

  14. Lower extremity necrotizing fasciitis: A unique initial presentation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    Anna Weiss

    2015-09-01

    Full Text Available Crohn's disease is a disease of the bowel, typically presenting with diarrhea, weight loss, and abdominal pain. Complications such as abscesses, fistulas, and strictures may require surgical intervention. We would like to report a patient with Crohn's disease who presented for the first time with left lower extremity necrotizing fasciitis. There are very few reports of necrotizing fasciitis in Crohn's disease as the initial presentation.

  15. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

    Directory of Open Access Journals (Sweden)

    Deepak Thapa

    2014-01-01

    Full Text Available Plantar fasciitis (PF is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF. Following a diagnostic medial calcaneal nerve (MCN block at its origin, we observed reduction in verbal numerical rating scale (VNRS in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF. All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

  16. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

    Science.gov (United States)

    Thapa, Deepak; Ahuja, Vanita

    2014-01-01

    Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF. PMID:24963184

  17. EFFECT OF HEEL LIFTS ON PATELLOFEMORAL JOINT STRESS DURING RUNNING.

    Science.gov (United States)

    Mestelle, Zachary; Kernozek, Thomas; Adkins, Kelly S; Miller, Jessica; Gheidi, Naghmeh

    2017-10-01

    Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress. Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. A repeated-measures research design. Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running. When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p0.05) were shown between conditions. Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is to reduce patellofemoral joint stress. 3b.

  18. Venepuncture versus heel lance for blood sampling in term neonates.

    Science.gov (United States)

    Shah, Vibhuti S; Ohlsson, Arne

    2011-10-05

    Heel lance has been the conventional method of blood sampling in neonates for screening tests. Neonates undergoing heel lance experience pain which cannot be completely alleviated. To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates. Randomized or quasi-randomised controlled trials comparing pain response to venepuncture versus heel lance were identified by searching the Cochrane Central Regsiter of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, CINAHL, and clinical trials registries in May 2011. Trials comparing pain response to venepuncture versus heel lance with or with out the use of a sweet tasting solution as a co-intervention in term neonates. Outcomes included pain response to venepuncture versus heel lance with or without the use of a sweet tasting solution using validated pain measures, the need of repeat sampling and cry characteristics. Analyses included typical relative risk (RR), risk difference (RD), number needed to treat (NNT), weighted mean difference (WMD) and standardized mean difference (SMD) with their 95% confidence intervals (CI). Between study heterogeneity was reported including the I squared (I(2)) test. Six studies (n = 478) of variable quality were included. A composite outcome of Infant Pain Scale (NIPS), Neonatal Facial Action Coding System (NFCS) and/or Premature Infant Pain Profile (PIPP) score was reported in 288 infants, who did not receive a sweet tasting solution. Meta-analysis showed a significant reduction in the venepuncture versus the heel lance group (SMD -0.76, 95% CI -1.00 to -0.52; I(2) = 0%). When a sweet tasting solution was provided the SMD remained significant favouring the venepuncture group (SMD - 0.38, 95% CI -0.69 to -0.07). The typical RD for requiring more than one skin puncture for venepuncture versus heel lance (reported in 4 studies; n = 254) was -0.34 (95% CI -0.43 to -0.25; I(2) = 97%). The NNT to avoid one repeat skin

  19. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Zonghuan Li

    Full Text Available It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis.Databases (MEDLINE, Cochrane library and EMBASE and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS, tenderness threshold (TT, heel tenderness index (HTI, response rate, plantar fascia thickness (PFT, hypoechogenicity and heel pad thickness (HPT. The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE system was used to assess the quality of evidence.Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI.Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research.

  20. Ultrasound- versus Palpation-Guided Injection of Corticosteroid for Plantar Fasciitis: A Meta-Analysis

    Science.gov (United States)

    Yu, Aixi; Qi, Baiwen

    2014-01-01

    Background It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis. Methods Databases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Results Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI. Conclusion Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research. PMID:24658102

  1. The Effects of Prolotherapy in Recreational Athletes with Plantar Fasciitis

    Directory of Open Access Journals (Sweden)

    Ali Haydar Apaydın

    2018-03-01

    Results: When pre- and post-treatment values were compared; a statistically significant difference was found between the scores of visual pain scale, foot and ankle outcome score and balance coordination test (p<0.01. Conclusion: According to the results of the research, one can conclude that the application of prolotherapy provides symptomatic and functional improvement in recreational athletes with plantar fasciitis. Prolotherapy application seems to be an alternative treatment method in patients who have not been healed by conservative treatment.

  2. Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain.

    Science.gov (United States)

    Rompe, Jan D; Furia, John; Cacchio, Angelo; Schmitz, Christoph; Maffulli, Nicola

    2015-12-01

    Whether shock wave therapy or shock wave therapy combined with plantar fascia-specific stretching is more efficient in treating chronic plantar heel pain remains unclear. The aim of the study was to test the null hypothesis of no difference of these two forms of management for patients who had unilateral plantar fasciopathy for a minimum duration of twelve months and which had failed at least three other forms of treatment. One hundred and fifty-two patients with chronic plantar fasciopathy were assigned to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group 1, n = 73) or to receive the identical shock wave treatment and to perform an eight-week plantar fascia-specific stretching program (Group 2, n = 79). All patients completed the nine-item pain subscale of the validated Foot Function Index and a subject-relevant outcome questionnaire. Patients were evaluated at baseline, and at two, four, and twenty-four months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first steps of walking in the morning) on this Index, and satisfaction with treatment. No difference in mean age, sex, weight or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with shock-wave therapy plus plantar fascia-specific stretching than those managed with shock-wave therapy alone (p plantar fascia in combination with repetitive low-energy radial shock-wave therapy is more efficient than repetitive low-energy radial shock-wave therapy alone for the treatment of chronic symptoms of proximal plantar fasciopathy. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  3. Atypical presentations of eosinophilic fasciitis

    Directory of Open Access Journals (Sweden)

    Tulin Ergun

    2016-01-01

    Full Text Available Eosinophilic fasciitis is an uncommon connective tissue disease that may mimic and overlap with other sclerosing disorders such as morphea and lichen sclerosus. Herein, we report four patients (two men and two women, aged 16-64 yeas with eosinophilic fasciitis. There was overlap with both morphea and lichen sclerosus in 2 patients and with morphoea alone in 1 patient. Magnetic resonance imaging (MRI was used for diagnosis in three patients and for assessing treatment response in one patient. Eosinophilic fasciitis may co-exist with morhoea and lichen sclerosus. In view of the overlapping clinical and histopathological features of these disorders, MRI may be helful in delineating the conditions by detecting involvement of fascia.

  4. ULTRASONOGRAPHY, AN EFFECTIVE TOOL IN DIAGNOSING PLANTAR FASCIITIS: A SYSTEMATIC REVIEW OF DIAGNOSTIC TRIALS

    Science.gov (United States)

    Wyland, Matthew; Applequist, Lee; Bolowsky, Erin; Klingensmith, Heather; Virag, Isaac

    2016-01-01

    Background Plantar fasciitis (PF) is the most common cause of heel pain that affects 10% of the general population, whether living an athletic or sedentary lifestyle. The most frequent mechanism of injury is an inflammatory response that is caused by repetitive micro trauma. Many techniques are available to diagnose PF, including the use of ultrasonography (US). Purpose The purpose of this study is to systematically review and appraise previously published articles published between the years 2000 and 2015 that evaluated the effectiveness of using US in the process of diagnosing PF, as compared to alternative diagnostic methods. Methods A total of eight databases were searched to systematically review scholarly (peer reviewed) diagnostic and intervention articles pertaining to the ability of US to diagnose PF. Results Using specific key words the preliminary search yielded 264 articles, 10 of which were deemed relevant for inclusion in the study. Two raters independently scored each article using the 15 point modified QUADAS scale. Discussion Six studies compared the diagnostic efficacy of US to another diagnostic technique to diagnose PF, and four studies focused on comparing baseline assessment of plantar fascia before subsequent intervention. The most notable US outcomes measured were plantar fascia thickness, enthesopathy, and hypoechogenicity. Conclusion US was found to be accurate and reliable compared to alternative reference standards like MRI in the diagnosis of PF. The general advantages of US (e.g. cost efficient, ease of administration, non-invasive, limited contraindications) make it a superior diagnostic modality in the diagnosis of PF. US should be considered in rehabilitation clinics to effectively diagnose PF and to accurately monitor improvement in the disease process following rehabilitation interventions. Level of Evidence 1A PMID:27757279

  5. Fatal Necrotizing Fasciitis following Episiotomy

    Directory of Open Access Journals (Sweden)

    Faris Almarzouqi

    2015-01-01

    Full Text Available Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.

  6. Strategic Airlift: Our Achilles' Heel

    National Research Council Canada - National Science Library

    Burns, John

    2001-01-01

    ...) deliberate planning and service programmatic processes. The acknowledged shortage of strategic airlift remains the "Achilles' heel" of our nation's power projection capability and is a classic example of a strategy to resource mismatch...

  7. The influence of high-heeled shoes on strain and tension force of the anterior talofibular ligament and plantar fascia during balanced standing and walking.

    Science.gov (United States)

    Yu, Jia; Wong, Duo Wai-Chi; Zhang, Hongtao; Luo, Zong-Ping; Zhang, Ming

    2016-10-01

    High-heeled shoes have the capability to alter the strain and tension of ligamentous structures between the foot and ankle, which may result in ankle instability. However, high-heeled shoes can also reduce the strain on plantar fascia, which may be beneficial for the treatment of plantar fasciitis. In this study, the influence of heel height on strain and tension force applied to the anterior talofibular ligament (ATL) and plantar fascia were investigated. A three-dimensional finite element model of coupled foot-ankle-shoe complex was constructed. Four heel heights were studied in balanced standing: 0 in. (0cm), 1 in. (2.54cm), 2 in. (5.08cm), and 3 in. (7.62cm). A walking analysis was performed using 2-in. (5.08cm) high-heeled shoes. During balanced standing, the tension force on the ATL increased from 14.8N to 97.0N, with a six-fold increase in strain from 0 in. to 3 in. (0-7.62cm). The tension force and the average strain on the plantar fascia decreased from 151.0N (strain: 0.74%) to 59.6N (strain: 0.28%) when the heel height increased from 0 in. to 2 in. (0-5.08cm). When heel height reached 3 in. (7.62cm), the force and average strain increased to 278.3N (strain: 1.33%). The walking simulation showed that the fascia stretched out while the ATL loading decreased during push off. The simulation outcome demonstrated the influence of heel height on ATL alteration and plantar fascia strain, which implies risks for ankle injury and suggests guidance for the treatment of plantar fasciitis. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  8. Infant with MRSA necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Panglao Rajan M

    2014-05-01

    Full Text Available Maria Panglao Rajan,1 Pinkal Patel,1 Lori Cash,1 Anjali Parish,2 Scott Darby,1 Jack Yu,3 Jatinder Bhatia11Department of Pediatrics, Children's Hospital of Georgia, Augusta, GA, USA; 2Medical Center of Central Georgia, Augusta, GA, USA; 3Department of Plastic Surgery, Children's Hospital of Georgia, Augusta, GA, USAAbstract: This is an unusual case of necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus in this premature infant, which highlights severity, rapid progression of this disease and shows outcome if intervention is initiated at an early stage. This case also highlights one of the possible serious complications of percutaneous inserted central catheter (PICC line, which can be life threatening.Keywords: necrotizing fasciitis, methicillin resistant Staphylococcus aureus, PICC, premature infant

  9. High Heels Increase Women's Attractiveness.

    Science.gov (United States)

    Guéguen, Nicolas

    2015-11-01

    Research has found that the appearance of women's apparel helps increase their attractiveness as rated by men and that men care more about physical features in potential opposite-sex mates. However, the effect of sartorial appearance has received little interest from scientists. In a series of studies, the length of women's shoe heels was examined. A woman confederate wearing black shoes with 0, 5, or 9 cm heels asked men for help in various circumstances. In Study 1, she asked men to respond to a short survey on gender equality. In Study 2, the confederate asked men and women to participate in a survey on local food habit consumption. In Study 3, men and women in the street were observed while walking in back of the female confederate who dropped a glove apparently unaware of her loss. It was found that men's helping behavior increased as soon as heel length increased. However, heel length had no effect on women's helping behavior. It was also found that men spontaneously approached women more quickly when they wore high-heeled shoes (Study 4). Change in gait, foot-size judgment, and misattribution of sexiness and sexual intent were used as possible explanations.

  10. Eosinophilic fasciitis after parasite infection

    Directory of Open Access Journals (Sweden)

    Marta Oliveira

    2016-03-01

    Full Text Available Eosinophilic fasciitis is a systemic inflammatory disease characterized by symmetrical swelling and skin induration of the distal portions of the arms and/or legs, evolving into a scleroderma-like appearance, accompanied by peripheral blood eosinophilia. It is a rare disease with a poorly understood etiology. Corticosteroid treatment remains the standard therapy, either taken alone or in association with an immunosuppressive drug. This paper presents a case of a male patient with palpebral edema and marked eosinophilia, diagnosed with intestinal parasitic infection in October 2006. He was treated with an antiparasitic drug, but both the swelling and the analytical changes remained. This was followed by a skin and muscle biopsy, which turned out to be compatible with eosinophilic fasciitis. There was progressive worsening of the clinical state, with stiffness of the abdominal wall and elevated inflammatory parameters, and the patient was referred to the Immunology Department, medicated with corticosteroids and methotrexate. Over the years there were therapeutic adjustments and other causes were excluded. Currently the patient continues to be monitored, and there is no evidence of active disease. The case described in this article is interesting because of the diagnosis of eosinophilic fasciitis probably associated/coexisting with a parasite infection. This case report differs from others in that there is an uncommon cause associated with the onset of the disease, instead of the common causes such as trauma, medication, non-parasitic infections or cancer.

  11. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination

    Science.gov (United States)

    Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell; Bolvig, Lars; Fredberg, Ulrich

    2018-01-01

    Background: Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown. Purpose: Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study Design: Cohort study; Level of evidence, 3. Methods: From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model. Results: In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women (P Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups (P Fascia thickness (P = .49) and presence of a heel spur (P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been

  12. Odontogenic cervical necrotizing fasciitis, etiological aspects ...

    African Journals Online (AJOL)

    Introduction: Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft‑tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential.

  13. Multifocal necrotizing fasciitis following Hirshsprung's disease ...

    African Journals Online (AJOL)

    Multifocal necrotizing fasciitis following Hirshsprung's disease surgery away from the surgical wound site. Ahmed A. Haseeb, Shadi Okasha and Atef Elbarawi. Necrotizing fasciitis (NF) is a life-threatening infection with rapidly progressive necrosis. Escherichia coli is rarely reported as causative agent of type 2 NF.

  14. Diagnosis of heel pad injuries

    DEFF Research Database (Denmark)

    Matteoli, Sara

    The biomechanics of in vivo heel pads has been investigated for more than 30 years, but unfortunately numerical results from the many individual investigators cannot be compared due to the different methodologies used, and the sometimes modest number of subjects investigated. The overall aim...... of the present thesis is to obtain a thorough understanding of the mechanical properties of in vivo human heel pad by studying the anatomical and physiological structure of healthy and diseased tissue, and to develop quantitative methods for diagnosing injuries. A compression device was built in order to record...... load-displacement curves from in vivo heel pads. To ensure applicability also for pathological feet, the device uses force levels lower than those needed to reproduce the physiological conditions of walking. One hundred twenty seven healthy volunteers were enrolled for compression tests and ultrasound...

  15. The effect of different depths of medial heel skive on plantar pressures

    Directory of Open Access Journals (Sweden)

    Bonanno Daniel R

    2012-08-01

    Full Text Available Abstract Background Foot orthoses are often used to treat lower limb injuries associated with excessive pronation. There are many orthotic modifications available for this purpose, with one being the medial heel skive. However, empirical evidence for the mechanical effects of the medial heel skive modification is limited. This study aimed to evaluate the effect that different depths of medial heel skive have on plantar pressures. Methods Thirty healthy adults (mean age 24 years, range 18–46 with a flat-arched or pronated foot posture and no current foot pain or deformity participated in this study. Using the in-shoe pedar-X® system, plantar pressure data were collected for the rearfoot, midfoot and forefoot while participants walked along an 8 metre walkway wearing a standardised shoe. Experimental conditions included a customised foot orthosis with the following 4 orthotic modifications: (i no medial heel skive, (ii a 2 mm medial heel skive, (iii a 4 mm medial heel skive and (iv a 6 mm medial heel skive. Results Compared to the foot orthosis with no medial heel skive, statistically significant increases in peak pressure were observed at the medial rearfoot – there was a 15% increase (p = 0.001 with the 4 mm skive and a 29% increase (p  Conclusions This study found that a medial heel skive of 4 mm or 6 mm increases peak pressure under the medial rearfoot in asymptomatic adults with a flat-arched or pronated foot posture. Plantar pressures at the midfoot and forefoot were not altered by a medial heel skive of 2, 4 or 6 mm. These findings provide some evidence for the effects of the medial heel skive orthotic modification.

  16. Intra-articular Nodular Fasciitis: An Unexpected Diagnosis for a Joint Lesion: A Case Report

    Directory of Open Access Journals (Sweden)

    MF Michelle Chan

    2014-07-01

    Full Text Available Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically.

  17. Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis.

    Science.gov (United States)

    Broholm, R; Pingel, J; Simonsen, L; Bülow, J; Johannsen, F

    2017-12-01

    Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularization in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). Twenty patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5), and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients, a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. De hele geschiedenis van de gemeente Heel

    NARCIS (Netherlands)

    M.ed Hugo Luijten

    2006-01-01

    Op 1 januari 2007 hield de gemeente Heel (L) op te bestaan. In de laatste gemeentegids uit 2006, wordt in een korte schets de geschiedenis van de drie kernen Heel, Wessem en Beegden uit de doeken gedaan.

  19. How I Manage Heel Spur Syndrome.

    Science.gov (United States)

    Seder, Joseph I.

    1987-01-01

    This article discusses plantar fascitis and heel spurs, the two contributing causes of heel spur syndrome. Treatment methods, which include rest, anti-inflammatory medication, shoe padding, and, as a last resort, surgery are described. (Author/MT)

  20. Necrotizing fasciitis of the breast: a case managed without mastectomy.

    Science.gov (United States)

    Soliman, M O; Ayyash, E H; Aldahham, A; Asfar, S

    2011-01-01

    To report a rare presentation of necrotizing fasciitis (NF) in the breast and its management. A 61-year-old non-diabetic lady presented with a painful swollen right breast and yellowish discharge associated with fever for the last few days. Based on clinical examination and haematological parameters, a provisional diagnosis of breast abscess was made that later proved to be a case of NF. She was managed conservatively with repeated debridement followed by split-skin grafting with preservation of the breast. This case showed that NF of the breast can present as a simple breast abscess which was managed conservatively. Copyright © 2011 S. Karger AG, Basel.

  1. Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without the AirHeel Brace. A randomized controlled trial. A: effects on pain and microcirculation.

    Science.gov (United States)

    Knobloch, Karsten; Schreibmueller, Louisa; Longo, Umile Giuseppe; Vogt, Peter M

    2008-01-01

    To compare eccentric training and the combination of eccentric training with the AirHeel Brace for the management of tendinopathy of the main body of the Achilles tendon. We recruited 116 subjects with unilateral tendinopathy of the main body of the Achilles tendon, who were randomized in two groups. Group A performed a regimen of daily eccentric training associated with the AirHeel Brace (Donjoy Orthopedics, Vista, CA, USA). Group B performed the same eccentric training without the AirHeel Brace. Tendon microcirculatory mapping was performed using combined Laser-Doppler and spectrophotometry. Pre- and post-operative FAOS score and VAS score were used to evaluate the patients. The FAOS score and the VAS score showed significant improvements from pre-operative to post-operative values in both groups (A 5.1 +/- 2 vs. 2.9 +/- 2.4, 43% reduction and B: 5.4 +/- 2.1 vs. 3.6 +/- 2.4, 33% reduction, both p = 0.0001). There were no statistically significant differences in FAOS score and VAS score when comparing the two groups after the end of the intervention. In Group A, tendon oxygen saturation in the main body of the Achilles tendon showed significant increase from pre- to post-management values (68 +/- 12 vs.74 +/- 8%, p = 0.003). Post-capillary venous filling pressures showed significant reduction from pre- to post-intervention values. Eccentric training, associated or not with the AirHeel Brace, produces the same effect in patients with tendinopathy of the main body of the Achilles tendon. The combination of eccentric training with the AirHeel Brace can optimize tendon microcirculation, but these micro-circulator advantages do not translate into superior clinical performance when compared with eccentric training alone.

  2. Necrotizing fasciitis: an urgent diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Paz Maya, Silvia; Dualde Beltran, Delfina [Hospital Clinico Universitario de Valencia, Valencia (Spain); Lemercier, Pierre; Leiva-Salinas, Carlos [Hospital Politecnico y Universitario La Fe, Valencia (Spain)

    2014-05-15

    Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests - e.g., the ''finger test'' or biopsy - and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging. (orig.)

  3. Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis

    Science.gov (United States)

    Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

    2016-01-01

    We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.  PMID:28083457

  4. EFFECTIVENESS OF INSTUMENTAL ASSISTED SOFT TISSUE MOBILIZATION TECHNIQUE WITH STATIC STRETCHING IN SUBJECTS WITH PLANTAR FASCIITIS

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    Vinod Babu. K

    2014-08-01

    Full Text Available Background: Instrumental assisted soft tissue mobilization and static stretching found to be effective in plantar fasciitis, however the combined effectiveness of these techniques were unknown. The purpose of this study is to find the effect of Instrumental assisted soft tissue mobilization technique for plantar fascia combined with static stretching of triceps surae for subjects with chronic stage of Plantar Fasciitis on pain intensity, ankle dorsiflexion range of motion and functional disability. Methods: An experimental study design, selected subjects with chronic Plantar Fasciitis randomized subjects into each Study and Control group. Total of 40 subject’s data who completed study, 20 in each group, was used for analysis. Control group received conventional exercise while Study group received conventional exercises with Instrumental assisted soft tissue mobilization combined with static stretching of triceps surae muscle. Outcome measurements such as Intensity of pain using Numerical Pain Rating Scale-101 (NPRS-101, function disability using Foot Function Index Pain Subscale (FFI and ankle dorsiflexion active range of motion using Goniometer was measured before and after 2 weeks of intervention. Results: There is statistically significant improvement in means of NRS-101, ankle dorsiflexion active range of motion and Foot Function Index Pain Subscale after intervention in both groups. When the post-intervention means were compared between Study and Control group after 2 weeks of treatment there is statistically significant difference in means between the groups whereas study group showed greater percentage of improvement than control group. Conclusion: It is concluded that Instrumental assisted soft tissue mobilization technique combined with static stretching of triceps surae muscle is significantly effective than conventional exercises on reducing pain, improving ankle dorsiflexion range of motion and functional disability for subjects

  5. Oral sucrose for heel lance enhances adenosine triphosphate use in preterm neonates with respiratory distress.

    Science.gov (United States)

    Angeles, Danilyn M; Asmerom, Yayesh; Boskovic, Danilo S; Slater, Laurel; Bacot-Carter, Sharon; Bahjri, Khaled; Mukasa, Joseph; Holden, Megan; Fayard, Elba

    2015-01-01

    To examine the effects of oral sucrose on procedural pain, and on biochemical markers of adenosine triphosphate utilization and oxidative stress in preterm neonates with mild to moderate respiratory distress. Preterm neonates with a clinically required heel lance that met study criteria (n = 49) were randomized into three groups: (1) control (n = 24), (2) heel lance treated with placebo and non-nutritive sucking (n = 15) and (3) heel lance treated with sucrose and non-nutritive sucking (n = 10). Plasma markers of adenosine triphosphate degradation (hypoxanthine, xanthine and uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured using the Premature Infant Pain Profile. Data were analyzed using repeated measures analysis of variance, chi-square and one-way analysis of variance. We found that in preterm neonates who were intubated and/or were receiving ⩾30% FiO2, a single dose of oral sucrose given before a heel lance significantly increased markers of adenosine triphosphate use. We found that oral sucrose enhanced adenosine triphosphate use in neonates who were intubated and/or were receiving ⩾30% FiO2. Although oral sucrose decreased pain scores, our data suggest that it also increased energy use as evidenced by increased plasma markers of adenosine triphosphate utilization. These effects of sucrose, specifically the fructose component, on adenosine triphosphate metabolism warrant further investigation.

  6. Oral sucrose for heel lance increases adenosine triphosphate use and oxidative stress in preterm neonates.

    Science.gov (United States)

    Asmerom, Yayesh; Slater, Laurel; Boskovic, Danilo S; Bahjri, Khaled; Holden, Megan S; Phillips, Raylene; Deming, Douglas; Ashwal, Stephen; Fayard, Elba; Angeles, Danilyn M

    2013-07-01

    To examine the effects of sucrose on pain and biochemical markers of adenosine triphosphate (ATP) degradation and oxidative stress in preterm neonates experiencing a clinically required heel lance. Preterm neonates that met study criteria (n = 131) were randomized into 3 groups: (1) control; (2) heel lance treated with placebo and non-nutritive sucking; and (3) heel lance treated with sucrose and non-nutritive sucking. Plasma markers of ATP degradation (hypoxanthine, xanthine, and uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured with the Premature Infant Pain Profile. Data were analyzed by the use of repeated-measures ANOVA and Spearman rho. We found significant increases in plasma hypoxanthine and uric acid over time in neonates who received sucrose. We also found a significant negative correlation between pain scores and plasma allantoin concentration in a subgroup of neonates who received sucrose. A single dose of oral sucrose, given before heel lance, significantly increased ATP use and oxidative stress in premature neonates. Because neonates are given multiple doses of sucrose per day, randomized trials are needed to examine the effects of repeated sucrose administration on ATP degradation, oxidative stress, and cell injury. Copyright © 2013 Mosby, Inc. All rights reserved.

  7. Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric ? ??

    OpenAIRE

    Santos, Leandro Em?lio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brand?o; Soares, Eduardo Augusto Marques

    2014-01-01

    Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed.

  8. Scleroderma mimicker – Eosinophilic fasciitis

    Directory of Open Access Journals (Sweden)

    Debanjali Sinha

    2017-01-01

    Full Text Available Eosinophilic fasciitis is an uncommon connective tissue disorder characterized by thickening of the deep fascia and overlying skin and subcutaneous tissue. It may mimic scleroderma and other scleroderma-like conditions. It may be a manifestation of paraneoplastic disorders or may be associated with hematological disorders including lymphomas. Definitive diagnosis is made on histological examination of a deep skin biopsy revealing thickened deep fascia and infiltration by lymphocytes and eosinophils. Enhancement of deep fascia on Gadolinium contrast-enhanced magnetic resonance imaging may be used as a substitute for skin biopsy. Ultrasound imaging is an evolving imaging tool for diagnosing it. Glucocorticoids with or without immunosuppressive agents remains the mainstay of therapy with good response, generally. A younger age of onset, morphea like lesions and dermal fibrosclerosis is more likely to be associated with the refractory disease. Early diagnosis and appropriate treatment may result in better outcomes in terms of morbidity and quality of life of the patients.

  9. CT imaging of necrosive fasciitis

    International Nuclear Information System (INIS)

    Schulze, M.; Overkamp, D.; Joanoviciu, S.; Horger, M.

    2008-01-01

    NF is a rare but dramatic and often fatal infection of the fascii and adjoining soft tissues. Contrary to the Fournier's definition, it is most common in elderly people. Patients with immune problems have a higher risk (e.g. Diabetes mellitus, alcohol or drug abuse, AIDS, leukaemia, chemotherapy and immunosuppressive medication). Predisposition factors are diverticulitis, insect bites, or surgical interventions (Uppot RN, Levy HM, PLatel PH, Radiology 2003; 226; 115; Wysoki MG, Santora TA, Shah RM et al. Necrotizing fasciitis: CT characteristics, Radiology 1997; 203;859). Men are affected more frequently than women. In principle, NF may occur everywhere in the body but incidence in the region of the scrotum, perineum and lower extremities are the most common. (orig.)

  10. Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

    Science.gov (United States)

    Park, Jong-Wan; Yoon, Kyungjae; Chun, Kwang-Soo; Lee, Joon-Youn; Park, Hee-Jin; Lee, So-Yeon

    2014-01-01

    Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US. PMID:25229032

  11. Internal strain estimation for quantification of human heel pad elastic modulus: A phantom study.

    Science.gov (United States)

    Holst, Karen; Liebgott, Hervé; Wilhjelm, Jens E; Nikolov, Svetoslav; Torp-Pedersen, Søren T; Delachartre, Philippe; Jensen, Jørgen A

    2013-02-01

    Shock absorption is the most important function of the human heel pad. However, changes in heel pad elasticity, as seen in e.g. long-distance runners, diabetes patients, and victims of Falanga torture are affecting this function, often in a painful manner. Assessment of heel pad elasticity is usually based on one or a few strain measurements obtained by an external load-deformation system. The aim of this study was to develop a technique for quantitative measurements of heel pad elastic modulus based on several internal strain measures from within the heel pad by use of ultrasound images. Nine heel phantoms were manufactured featuring a combination of three heel pad stiffnesses and three heel pad thicknesses to model the normal human variation. Each phantom was tested in an indentation system comprising a 7MHz linear array ultrasound transducer, working as the indentor, and a connected load cell. Load-compression data and ultrasound B-mode images were simultaneously acquired in 19 compression steps of 0.1mm each. The internal tissue displacement was for each step calculated by a phase-based cross-correlation technique and internal strain maps were derived from these displacement maps. Elastic moduli were found from the resulting stress-strain curves. The elastic moduli made it possible to distinguish eight of nine phantoms from each other according to the manufactured stiffness and showed very little dependence of the thickness. Mean elastic moduli for the three soft, the three medium, and the three hard phantoms were 89kPa, 153kPa, and 168kPa, respectively. The combination of ultrasound images and force measurements provided an effective way of assessing the elastic properties of the heel pad due to the internal strain estimation. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. EFFECT OF LOW ENERGY VERSUS MEDIUM ENERGY RADIAL SHOCK WAVE THERAPY IN THE TREATMENT OF CHRONIC PLANTER FASCIITIS

    Directory of Open Access Journals (Sweden)

    Khaled Z. Fouda

    2016-02-01

    Full Text Available Background: Plantar fasciitis (PF is the most common cause of heel pain and it can often be a challenge for clinicians to treat successfully. Radial shock wave therapy (RSWT has been introduced recently for treatment of musculoskeletal disorders. Different energy levels of shock wave therapy have been used in the literatures for treatment of PF with no clear settled parameters. Therefore, the purpose of this study was intended to investigate and compare the efficacy of two different energy levels of RSWT on PF patients. Methods: Forty patients having unilateral chronic PF were recruited for the study from orthopedic outpatient clinics of Cairo University hospitals and National Institute of Neuromotor System Cairo Egypt, with a mean age of (47.15±4.57 years. Patients were randomly assigned into two equal groups. Group (A treated with low intensity level of 1.6 bars (0.16 mJ/mm2 RSWT and group (B treated with medium intensity level of 4 bars (0.38 mJ/mm2 RSWT. Functional assessment of the foot based on Foot Function Index (FFI and Present pain intensity was measured during rest by Visual Analogue Scale (VAS. Results: There was as significant decreased in the total FFI scores from (118.42 ±6.51 to (81.37 ±3.46 for group (A and from (118.93 ±6.85 to (58.50 ±3.22 for group (B. Also regarding VAS Scores there was as significant decreased in the pain intensity from (5.11 ±0.41 to (2.85 ±0.31 for group (A and from (4.95 ±0.39 to (2.05 ±0.22 for group (B. Conclusion: Radial shock wave therapy is an effective modality that should be considered in the treatment of chronic PF, while the medium energy level RSWT is better than the low energy level RSWT in regarding to the measured treatment outcomes.

  13. The correlation between plantar fascia thickness and symptoms of plantar fasciitis.

    Science.gov (United States)

    Mahowald, Sarah; Legge, Bradford S; Grady, John F

    2011-01-01

    The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis. Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed. Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ± 1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols.

  14. Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report

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    Islam Asad

    2008-12-01

    Full Text Available Abstract Introduction Cervical necrotizing fasciitis is an aggressive infection with high morbidity and mortality. We present a case of cervical necrotizing fasciitis and descending mediastinitis in a healthy young man, caused by unilateral tonsillitis with a successful outcome without aggressive debridement. Case presentation A 41-year-old man was admitted to our unit with a diagnosis of severe acute unilateral tonsillitis. On admission, he had painful neck movements and the skin over his neck was red, hot and tender. Computed tomography scan of his neck and chest showed evidence of cervical necrotizing fasciitis and descending mediastinitis secondary to underlying pharyngeal disease. He was treated with broad-spectrum intravenous antibiotics. His condition improved over the next 3 days but a tender and fluctuant swelling appeared in the suprasternal region. A repeat scan showed the appearance of an abscess extending from the pretracheal region to the upper mediastinum which was drained through a small transverse anterior neck incision. After surgery, the patient's condition quickly improved and he was discharged on the 18th day of admission. Conclusion Less invasive surgical techniques may replace conventional aggressive debridement as the treatment of choice for cervical necrotizing fasciitis and descending necrotizing mediastinitis.

  15. Dry cupping for plantar fasciitis: a randomized controlled trial.

    Science.gov (United States)

    Ge, Weiqing; Leson, Chelsea; Vukovic, Corey

    2017-05-01

    [Purpose] The purpose of this study was to determine the effects of dry cupping on pain and function of patients with plantar fasciitis. [Subjects and Methods] Twenty-nine subjects (age 15 to 59 years old, 20 females and 9 males), randomly assigned into the two groups (dry cupping therapy and electrical stimulation therapy groups), participated in this study. The research design was a randomized controlled trial (RCT). Treatments were provided to the subjects twice a week for 4 weeks. Outcome measurements included the Visual Analogue Pain Scale (VAS) (at rest, first in the morning, and with activities), the Foot and Ankle Ability Measure (FAAM), the Lower Extremity Functional Scale (LEFS), as well as the pressure pain threshold. [Results]The data indicated that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function significantly in the population tested, as all the 95% Confidence Intervals (CIs) did not include 0 except for the pressure pain threshold. There was no significant difference between the dry cupping therapy and electrical stimulation groups in all the outcome measurements. [Conclusion] These results support that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function in the population tested.

  16. Significance of heel pad confinement for the shock absorption at heel strike.

    Science.gov (United States)

    Jørgensen, U; Ekstrand, J

    1988-12-01

    Shock absorption (SA) is a simple way to reduce the body load and can be used in the prevention and treatment of injuries. The heel pad is the most important shock absorber in the shoe heel complex. The purpose of this study was to investigate whether the SA at heel strike can be increased by heel support in people and shoes with high or low SA. The impact forces at heel strike were measured on an AMTI (R) force platform. Fourteen legs were tested in seven persons (nine with normal and five with low heel pad SA) in gait analysis and in human drop tests. The tests were performed barefooted, and in a soccer and a running shoe (selected by shoe drop test), with and without the distal 2 cm of the heel counter. The heel pad confinement produced by the heel counter (the heel counter effect) increased the SA in both shoe types significantly in both impact situations. The mean increase in SA was 8.8% (range 5.8%-15.5%). The heel counter effect was in all situations significantly higher in persons with low heel pad shock absorbency (LHPSA) than in those with normal heel pads. The barefoot impact peak force per kg body weight was significantly higher (6% mean) on the side with LHPSA. The running shoe provided the significantly greatest SA compared with the soccer shoe. It is concluded that the shock absorbency at heel strike can be increased significantly by heel support, with highest effect in persons with LHPSA, both in shoes with high and low SA.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Necrotizing Fasciitis Secondary to a Primary Suture for Anoperineal Trauma by Motorcycle Accident in a Healthy Adult

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    Susumu Saigusa

    2015-01-01

    Full Text Available A 41-year-old man experienced a swollen scrotum three days after a motorcycle accident and presented to our hospital. He had had a primary suture repair for anoperineal trauma in an outside hospital at the time of the injury. He presented to us with general fatigue, low grade fevers, and perineal pain. Abdominal computed tomography showed subcutaneous emphysema from the scrotum to the left chest. The sutured wound had foul-smelling discharge and white exudate. We made the diagnosis of necrotizing fasciitis and immediately opened the sutured wound and performed initial debridement and lavage with copious irrigation. We continued antibiotics and lavage of the wound until the infection was controlled. Fortunately, the necrotizing fasciitis did not worsen and he was discharged after 15 days. Our experience indicates that anoperineal injuries should not be closed without careful and intensive follow-up due to the potential of developing necrotizing fasciitis.

  18. Necrotizing fasciitis in nephritic syndrome: a case report

    Science.gov (United States)

    Junaedi, I.; Pasaribu, A. P.

    2018-03-01

    Necrotizing fasciitis is an infection of any layer of tissue compartment; it can be in the dermis, subcutaneous tissue, superficial fascia, deep fascia, or even muscle. Usually, necrotizing fasciitis is associated with necrotizing process caused by the single bacterial organism. The most common pathogen is group A Streptococcus. Delayed in the diagnosis and surgical treatment of necrotizing fasciitis will lead to increased tissue loss and high mortality risk. Here we report a case of necrotizing fasciitis which has a great outcome since the surgical exploration of tissue and debridement was done as soon as the patient is suspected of necrotizing fasciitis.

  19. The Achilles heel of adults and children

    NARCIS (Netherlands)

    Wiegerinck, J.I.

    2014-01-01

    This thesis focuses on the imaging and treatment of the Achilles heel of adults and children. The figurative and literal Achilles heel consists of a number of pathologies: ankle impingement, Achilles tendinopathy, retrocalcaneal bursitis and calcaneal apophysitis. Research as well as diagnosis and

  20. Necrotizing Fasciitis: Diagnostic Challenges in a Mute Bedridden Patient with Atypical Laboratory Parameters

    Directory of Open Access Journals (Sweden)

    Ghan-Shyam Lohiya

    2012-01-01

    Full Text Available A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient’s right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C, and leukocytosis (count: 13×109/L; was 6.5×109/L ten days earlier. Necrotizing fasciitis (NF was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.

  1. Necrotizing fasciitis: diagnostic challenges in a mute bedridden patient with atypical laboratory parameters.

    Science.gov (United States)

    Lohiya, Ghan-Shyam; Tan-Figueroa, Lilia; Krishna, Vijay; Lohiya, Sunita

    2012-01-01

    A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient's right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C), and leukocytosis (count: 13 × 10(9)/L; was 6.5 × 10(9)/L ten days earlier). Necrotizing fasciitis (NF) was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.

  2. Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis.

    Science.gov (United States)

    Chen, Hongying; Ho, Hok-Ming; Ying, Michael; Fu, Siu Ngor

    2013-10-01

    Single-cohort laboratory-based study. To identify whether plantar fascia vascularity and thickness are associated with foot pain and dysfunction in individuals with chronic plantar fasciitis. Background Altered plantar fascia vascularity and thickening of the fascia have been identified in individuals with chronic plantar fasciitis. Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. There were significantly higher VI (mean ± SD, 2.4% ± 1.4%) and fascia thickness (5.0 ± 1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4% ± 0.5%; fascia thickness, 3.3 ± 0.7 mm) and with the dominant side of the controls (VI, 1.6% ± 0.4%; fascia thickness, 2.9 ± 0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. Individuals with unilateral chronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia

  3. Ultrasonographic examination of plantar fasciitis: a comparison of patient positions during examination.

    Science.gov (United States)

    Ahn, Jae Hoon; Lee, Choong Woo; Park, ChanJoo; Kim, Yoon-Chung

    2016-01-01

    Musculoskeletal ultrasound is a non-invasive and low-cost modality for real-time visualisation of the plantar fascia. Ultrasound examination for plantar fasciitis is generally performed with the patient in a prone position, although the rational for using a prone position has not been validated. The aim of the study was to investigate if ultrasound examination in a supine position, which is more comfortable than the prone position, is valid. We conducted a prospective study of 30 participants with plantar fasciitis, 8 men (27 %) and 22 women (73 %), with a mean age of 53.9 ± 12.6 (range, 32 to 77) years, and an equal distribution of left and right feet. The plantar heel was divided into three portions for ultrasound examination: medial, central and lateral. Two measurements of plantar fascia thickness were obtained for each portion, with participants in 2 positions (supine and prone) and for 2 ankle postures (neutral and 15° of plantarflexion). Mean measurements of plantar fascia thickness were compared between the two positions (Wilcoxon signed rank tests for non-normally distributed data and paired t-tests for normally distributed data). Participants were asked to report their preferred position for examination, supine or prone. The measured thickness was comparable for both supine and prone positions, for both ankle postures, neutral and 15° of plantarflexion (p > 0.05). A specific self-reported preferred position was not identified. Ultrasound examination of plantar fasciitis can be performed in the supine position without any significant difference in measurement compared to examination in the conventional prone position. The Catholic Medical Center Office of Human Research Protection Program (CMC-OHRP)/Institutional Review Board approved the current study (Approval No. KC12DISI0338), and all participants provided their written informed consent for participation and publication.

  4. Cervicofacial necrotizing fasciitis following periodontal abscess.

    Science.gov (United States)

    Medeiros, Rui; Catunda, Ivson de Sousa; Queiroz, Isaac Vieira; de Morais, Hecio Henrique Araujo; Leao, Jair Carneiro; Gueiros, Luiz Alcino Monteiro

    2012-01-01

    Soft tissue infections are characterized by acute inflammation, diffuse edema, and suppuration, and are often associated with symptoms such as malaise, fever, tachycardia, and chills. Necrotizing fasciitis is a destructive bacterial infection affecting subcutaneous tissue and superficial fascia and is associated with high rates of mortality. It usually involves the abdomen and extremities, but it also can occur in the head and neck. Early diagnosis is critical and the most commonly accepted treatment includes radical surgical intervention and administration of broad-spectrum antibiotics. This article reports and discusses the case of a patient with odontogenic cervicofacial necrotizing fasciitis, and emphasizes the importance of early and effective treatment.

  5. Multifocal necrotizing fasciitis following Hirshsprung's disease ...

    African Journals Online (AJOL)

    Necrotizing fasciitis (NF) is a life-threatening infection with rapidly progressive necrosis. Escherichia coli is rarely reported as causative agent of type 2 NF. NF typically arises in a single area usually secondary to penetrating injury. NF was only reported as a postoperative complication of Hirshsprung's disease in one report, ...

  6. Necrotizing fasciitis : plain radiographic and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chang Dae; Park, Jeong Hee; Jeon, Hae Jeong; Lim, Jong Nam; Heo, Tae Haeng; Park, Dong Rib [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gas shadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer in four cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focal low density lesion suggestive of focal abscess was not visualized. Plain radiography is useful for early diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.

  7. Cervical necrotizing fasciitis in infant: case report

    Directory of Open Access Journals (Sweden)

    Schiavetto, Renata Rennó

    2008-12-01

    Full Text Available Introduction: Necrotizing fasciitis is a bacterial infection characterized by extensive necrosis of tissues, and may include skin and muscles. It's more frequent in adults than in children and generally involves the trunk and extremities. Head and neck area is less commonly affected. The most frequently isolated pathogens are the Streptococcus pyogenes (group A and Staphylococcus aureus. The anatomopathological exam is the best diagnostic method, which early identifies the disease. The clinical support, surgical debridement, and the intravenous antibiotic therapy, are fundamental for the treatment. Objective: To report a case of an infant who suffered from Cervical Necrotizing Fasciitis. Case Report: Infant, male sex, white, 2 months old, previously healthy, with Necrotizing Fasciitis involving the frontal and right lateral cervical regions. After adequate treatment the patient obtained excellent recovery without presenting important aesthetic or functional alterations. Conclusion: The Cervical Necrotizing Fasciitis is uncommon in children. The early surgical debridement is necessary to control the infection, even if it may result in great and deep injuries. The wide spectrum antibiotic therapy and hemodynamic support are also basic for the therapeutic success.

  8. Nekrotiserende fasciitis hos børn

    DEFF Research Database (Denmark)

    Jensen, Karsten Gjessing; Kristensen, Kim

    2009-01-01

    Necrotizing fasciitis (NF) is a serious condition with infection of the muscular fascia causing rapidly spreading necrosis. NF rarely affects children, and we here report two paediatric cases of NF. The first developed NF after a joint puncture, the other after surgical extirpation of a lymph node...

  9. Disseminated mucormycosis and necrotizing fasciitis in immune ...

    African Journals Online (AJOL)

    Laparotomy revealed extensive abdominal wall necrosis, bowel, liver, kidney and subsequent retroperitoneal, posterior diaphragm and inferior vena cava involvement. Second, a 3-year-old on chemotherapy for Burkitt's lymphoma presented with pancytopenia, sepsis, abdominal wall-necrotizing fasciitis and left lower limb ...

  10. Nodular fasciitis: MRI appearance and literature review

    International Nuclear Information System (INIS)

    Leung, L.Y.J.; Shu, S.J.; Chan, M.K.; Chan, C.H.S.; Chan, A.C.L.

    2002-01-01

    Objective: To describe the MRI features of nodular fasciitis and to review the clinical, MRI and histologic aspects of the tumor. Design and patients: Three patients with biopsy-proven nodular fasciitis were selected for a retrospective study. A literature review was also carried out. Results and conclusions: All the lesions appeared slightly hyperintense to skeletal muscle on T1-weighted images, and hyperintense on T2-weighted images with fat saturation [either frequency saturation or Short TI Inversion Recovery (STIR) sequences]. Two enhanced homogeneously after intravenous gadolinium, whereas the third showed heterogeneous enhancement with a nonenhancing area. Despite the difference in enhancing patterns, the histologic appearances of these lesions were similar. Our study shows that the MRI appearance of nodular fasciitis may not be related to the location of lesion. It is thought that the age of nodular fasciitis may reflect its gross morphology, and it is possible that the MRI and histologic appearances could correlate with the age of the lesion, but it would require a larger series to evaluate this concept. (orig.)

  11. Shock absorbency of factors in the shoe/heel interaction--with special focus on role of the heel pad.

    Science.gov (United States)

    Jørgensen, U; Bojsen-Møller, F

    1989-06-01

    The heel pad acts as a shock absorber in walking and in heel-strike running. In some patients, a reduction of its shock-absorbing capacity has been connected to the development of overuse injuries. In this article, the shock absorption of the heel pad as well as external shock absorbers are studied. Individual variation and the effect of trauma and confinement on the heel pad were specifically investigated. Drop tests, imitating heel impacts, were performed on a force plate. The test specimens were cadaver heel pads (n = 10); the shoe sole component consisted of ethyl vinyl acetate (EVA) foam and Sorbothane inserts. The shock absorption was significantly greater in the heel pad than in the external shock absorbers. The mean heel pad shock absorption was 1.1 times for EVA foam and 2.1 times for Sorbothane. The shock absorption varied by as much as 100% between heel pads. Trauma caused a decrease in the heel pad shock absorbency (24%), whereas heel pad confinement increased the shock absorbency (49% in traumatized heel pads and 29.5% in nontraumatized heel pads). These findings provide a biomechanical rationale for the clinical observations of a correlation between heel pad shock absorbency loss and heel strike-dependent overuse injuries. To increase shock absorbency, confinement of the heel pad should be attempted in vivo.

  12. Effect of shoe heel height on vastus medialis and vastus lateralis electromyographic activity during sit to stand

    Directory of Open Access Journals (Sweden)

    Hodgson David

    2008-01-01

    Full Text Available Abstract Background It has been proposed that high-heeled shoes may contribute to the development and progression of knee pain. However, surprisingly little research has been carried out on how shoe heel height affects muscle activity around the knee joint. The purpose of this study was to investigate the effect of differing heel height on the electromyographic (EMG activity in vastus medialis (VM and vastus lateralis (VL during a sit to stand activity. This was an exploratory study to inform future research. Methods A repeated measures design was used. Twenty five healthy females carried out a standardised sit to stand activity under 4 conditions; barefoot, and with heel wedges of 1, 3, and 5 cm in height. EMG activity was recorded from VM and VL during the activity. Data were analysed using 1 × 4 repeated measures ANOVA. Results Average rectified EMG activity differed with heel height in both VM (F2.2, 51.7 = 5.24, p 3, 72 = 5.32, p 3, 72 = 0.61, p = 0.609. Conclusion We found that as heel height increased, there was an increase in EMG activity in both VM and VL, but no change in the relative EMG intensity of VM and VL as measured by the VM: VL ratio. This showed that no VM: VL imbalance was elicited. This study provides information that will inform future research on how heel height affects muscle activity around the knee joint.

  13. New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis.

    Science.gov (United States)

    Yin, Mengchen; Chen, Ni; Huang, Quan; Marla, Anastasia Sulindro; Ma, Junming; Ye, Jie; Mo, Wen

    2017-12-01

    To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. Randomized, controlled, prospective study. Outpatient of local medical center settings. Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm 2 , respectively (a rate of 8 impulses per second), were applied. The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e [.011+42.807×heel spur+.109×edema+5.395×VAS score] ) -1 .The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The

  14. Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis.

    Science.gov (United States)

    Engkananuwat, Phoomchai; Kanlayanaphotporn, Rotsalai; Purepong, Nithima

    2018-01-01

    Since the plantar fascia and the Achilles tendon are anatomically connected, it is plausible that stretching of both structures simultaneously will result in a better outcome for plantar fasciitis. Fifty participants aged 40 to 60 years with a history of plantar fasciitis greater than 1 month were recruited. They were prospectively randomized into 2 groups. Group 1 was instructed to stretch the Achilles tendon while group 2 simultaneously stretched the Achilles tendon and plantar fascia. After 4 weeks of both stretching protocols, participants in group 2 demonstrated a significantly greater pressure pain threshold than participants in group 1 ( P = .040) with post hoc analysis. No significant differences between groups were demonstrated in other variables ( P > .05). Concerning within-group comparisons, both interventions resulted in significant reductions in pain at first step in the morning and average pain at the medial plantar calcaneal region over the past 24 hours, while there were increases in the pressure pain threshold, visual analog scale-foot and ankle score, and range of motion in ankle dorsiflexion ( P plantar fascia for 4 weeks was a more effective intervention for plantar fasciitis. Patients who reported complete relief from symptoms at the end of the 4-week intervention in the simultaneous stretching group (n = 14; 56%) were double that of the stretching of the Achilles tendon-only group (n = 7; 28%). II, lesser quality RCT or prospective comparative study.

  15. Body load in heel-strike running: the effect of a firm heel counter.

    Science.gov (United States)

    Jørgensen, U

    1990-01-01

    The effect of a firm heel counter in the shoe was studied in 11 athletes during submaximal heel-strike running on a treadmill under standardized conditions. The runners were tested in identical shoes with and without the distal 2 cm of the firm heel counter. Body load was expressed by absolute and relative VO2, surface EMG on the right leg, and g-force registration from an accelerometer below the right tibial tuberosity. The heel counter caused a 2.4% significant decrease in VO2, a reduction in musculoskeletal transients, and a decrease in the activity of the triceps surae and quadriceps muscles at heel strike. The changes found are expressions of kinematic adaptations in the body to increased or decreased load and provide functional evidence for the loading factor in the pathophysiology of overuse injuries.

  16. Periorbital nodular fasciitis arising during pregnancy

    Directory of Open Access Journals (Sweden)

    Brandon N Phillips

    2014-01-01

    Full Text Available Nodular fasciitis (NF is a benign proliferation of fibroblasts and myofibroblasts that rarely occurs in the periorbital region. We report what we believe to be the first case of periorbital NF associated with pregnancy. A case of intravascular fasciitis, a NF variant, has been reported during pregnancy, but it was not located in the periorbital region. A weak presence of estrogen receptors has been reported in NF. This may make it more susceptible to the hormone-related changes during pregnancy and contribute to the development of the lesion by stimulating fibroblasts and smooth muscle cell types. Although rare, NF should be considered in the differential diagnosis of periorbital soft-tissue masses arising during pregnancy.

  17. Necrotizing Fasciitis: An Emergency Medicine Simulation Scenario

    OpenAIRE

    Galust, Henrik; Oliverio, Matthew H; Giorgio, Daniel J; Espinal, Alexis M; Ahmed, Rami

    2016-01-01

    Necrotizing fasciitis?(NF) is a rare and rapidly progressing life-threatening infectious process. By progressing through a simulation involving a patient with NF and participating in a post-scenario debriefing, learners will gain the necessary skills and knowledge to properly diagnose and manage patients with NF. Learners are taught to initiate appropriate and timely treatment and to advocate on behalf of their patient after inappropriate pushback from consultants to improve outcomes.

  18. Necrotizing Fasciitis: An Emergency Medicine Simulation Scenario.

    Science.gov (United States)

    Galust, Henrik; Oliverio, Matthew H; Giorgio, Daniel J; Espinal, Alexis M; Ahmed, Rami

    2016-08-31

    Necrotizing fasciitis (NF) is a rare and rapidly progressing life-threatening infectious process. By progressing through a simulation involving a patient with NF and participating in a post-scenario debriefing, learners will gain the necessary skills and knowledge to properly diagnose and manage patients with NF. Learners are taught to initiate appropriate and timely treatment and to advocate on behalf of their patient after inappropriate pushback from consultants to improve outcomes.

  19. Retroperitoneal necrotizing fasciitis presenting with peritonism in a 33-year-old Nepalese man: a case report

    Directory of Open Access Journals (Sweden)

    Giri Smith

    2012-02-01

    Full Text Available Abstract Introduction Retroperitoneal necrotizing fasciitis is a rare, fulminant, and potentially lethal complication of intra-abdominal suppuration. A retroperitoneal origin is very rare and very few cases have been reported in the literature. To the best of our knowledge, this case is only the fourth case reported of successful management following retroperitoneal necrotizing fasciitis. Case presentation A 33-year-old Tamang man presented to our facility with a history of five days of fever and vomiting and eight days of severe left loin pain. On examination, he had features of peritonism. A laparotomy was performed, revealing extensive necrotizing fasciitis of the retroperitoneum extending to the anterior abdominal wall. Our patient survived following extensive debridement of the necrotic tissues and supportive care. Conclusions Retroperitoneal necrotizing fasciitis can rarely present with features of peritonism, and hence should be included as a possible differential diagnosis for anyone presenting with peritonism. Although a fatal condition, early intervention and aggressive management can save the life of a patient.

  20. Nodular Fasciitis of External Auditory Canal

    Directory of Open Access Journals (Sweden)

    Jihyun Ahn

    2016-09-01

    Full Text Available Nodular fasciitis is a pseudosarcomatous reactive process composed of fibroblasts and myofibroblasts, and it is most common in the upper extremities. Nodular fasciitis of the external auditory canal is rare. To the best of our knowledge, less than 20 cases have been reported to date. We present a case of nodular fasciitis arising in the cartilaginous part of the external auditory canal. A 19-year-old man complained of an auricular mass with pruritus. Computed tomography showed a 1.7 cm sized soft tissue mass in the right external auditory canal, and total excision was performed. Histologic examination revealed spindle or stellate cells proliferation in a fascicular and storiform pattern. Lymphoid cells and erythrocytes were intermixed with tumor cells. The stroma was myxoid to hyalinized with a few microcysts. The tumor cells were immunoreactive for smooth muscle actin, but not for desmin, caldesmon, CD34, S-100, anaplastic lymphoma kinase, and cytokeratin. The patient has been doing well during the 1 year follow-up period.

  1. Cervical necrotizing fasciitis: A potentially fatal disease with varied ...

    African Journals Online (AJOL)

    Necrotizing fasciitis was recognized centuries ago by physicians. It is a rapidly progressive and potentially fatal soft‑tissue infection that is typified by soft‑tissue necrosis, especially affecting the subcutaneous tissues and fascia. Cervico‑facial necrotizing fasciitis is said to be uncommon, but when it occurs, it is often of ...

  2. Review of 58 patients with necrotizing fasciitis in the Netherlands

    NARCIS (Netherlands)

    Stigt, S.F. van; Vries, J. de; Bijker, J.B.; Mollen, R.M.; Hekma, E.J.; Lemson, S.M.; Tan, E.C.T.H.

    2016-01-01

    BACKGROUND: Necrotizing fasciitis is a rare, life threatening soft tissue infection, primarily involving the fascia and subcutaneous tissue. In a large cohort of patients presenting with Necrotizing fasciitis in the Netherlands we analysed all available data to determine the causative pathogens and

  3. Necrotizing fasciitis of breast | Salati | East and Central African ...

    African Journals Online (AJOL)

    Necrotizing fasciitis is an uncommon and rapidly progressive, life-threatening soft tissue infection. Necrotizing fasciitis of breast is even rarely encountered. We managed one such 32 years old nondiabetic, obese lady who developed necrotising fascitis of right breast after lumpectomy. Management involved wide ...

  4. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes.

    Science.gov (United States)

    Yalcin, E; Keskin Akca, A; Selcuk, B; Kurtaran, A; Akyuz, M

    2012-02-01

    Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients' complaints about heel spurs.

  5. Physiotherapy for plantar fasciitis: a UK-wide survey of current practice.

    Science.gov (United States)

    Grieve, Rob; Palmer, Shea

    2017-06-01

    To identify how United Kingdom (UK) physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. Online questionnaire survey. Practising physiotherapists across the UK who treat patients with plantar fasciitis. Physiotherapists were approached via 'interactive Chartered Society of Physiotherapy (CSP)' online networks and an email database of clinical educators in South West England. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. Descriptive statistics were used to analyse the data. 285 physiotherapists responded, with 257 complete survey responses. Pain on palpation and early morning pain were the most common diagnostic criteria, with some physiotherapists using no formal test criteria. Advice (237/257, 92%), plantar fasciitis pathology education (207/257, 81%) and general stretching exercises (189/257, 74%) were most routinely used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. For the manual therapy approach, the most frequently used modalities were massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement. Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. There was uncertainty whether this approach accurately reflected clinical practice used throughout the UK, owing to potential response bias/unknown response rate and the low number of patients with PF treated by the respondents. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  6. [Heel pressure ulcers. Comparative study between heel protective bandage and hydrocellular dressing with special form for the heel].

    Science.gov (United States)

    Torra i Bou, Joan-Enric; Rueda López, Justo; Camañes, Gemma; Herrero Narváez, Elias; Blanco Blanco, Joan; Martínez-Esparza, Elvira Hernández; Aneas Alcántara, Jesús; Verdú Soriano, José

    2002-05-01

    The heels, together with the sacra area, are one of the most frequent spots where pressure sores appear here in Spain. Any preventive measure against pressure sores on heels needs be oriented towards two main objectives: effective relief of pressure and its compatibility with localized care and skin inspection in order to detect lesions early on at least once a day. The authors planned a comparative, multi-centered, open, labeled and controlled study in which patients were assigned to two groups receiving these treatments: one received traditional preventive pressure sore treatment and a protective bandage on their heels while the other used a special Allevyn Heel hydrocellular dressing to protect their heels. The patients took part in this study over an eight week period. The response variable used to determine the effectiveness of the preventive measure in this study was the appearance of pressure sores. At the beginning, 130 patients were included in this study, 65 in each one of the treatment groups. In the bandage group, 50 patients finished this study while 61 in the dressing group finished this study. The appearance of pressure sores in the protective bandage group occurred in 44% of the patients, 22 out of 50, while in the dressing group, the occurrence rate was 3.3%, 2 out of 61 patients with a value of "ji" squared p pressure sore brought us a value of relative risk of 13.42 (IC 95%: 3.31-54.3) in the group wearing the protective bandage compared to the group wearing the dressing. The results of this study allow us to accept as valid the alternate hypothesis that there exist significant statistical differences between both treatment methods in favor of the Allevyn Heel dressing instead of the protective heel bandage. The use of this dressing, even though it is more expensive a priori than the protective bandage, in terms of unit cost for the product, has proven to be more effective in preventing pressure sores, and cheaper than the protective bandage if

  7. A COMPARITIVE STUDY ON EFFECTIVENESS OF TAPING WITH IONTOPHORESIS AND TAPING ALONE IN CHRONIC PLANTAR FASCITIS

    OpenAIRE

    Biju Chetri, U.T. Ifthikar Ali, Madhusmita Koch, Abhijit Dutta

    2016-01-01

    Background: Plantar fasciitis is a painful condition caused by microtrauma to plantar fascia due to overuse. It is a most common cause of heel pain in runners. Various studies proved taping and Iontophoresis as effective in the treating plantar fasciitis. But there are no studies comparing the combined effect of iontophoresis with taping and taping alone in the treatment of plantar fasciitis. Methods: 50 patients suffering from plantar fasciitis who met the inclusion criteria were selected...

  8. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

    Science.gov (United States)

    Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

    2015-01-01

    [Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

  9. Preventing pressure ulcers on the heel: a Canadian cost study.

    Science.gov (United States)

    Torra I Bou, Joan-Enric; Rueda López, Justo; Camañes, Gemma; Herrero Narváez, Elias; Blanco Blanco, Joan; Ballesté Torralba, Jordi; Martinez-Esparza, Elvira Hernández; García, Lorena San Miguel; Soriano, José Verdú

    2009-01-01

    An adaptation of a clinical study of 130 patients at risk of developing a pressure ulcer on the heels was performed using Canadian costs. The aim of the study was to compare the cost effectiveness of a specially shaped hydrocellular dressing (Allevyn Heel) versus that of a protective heel bandage (Soffban and gauze) in pressure ulcer prevention over an 8-week period.

  10. Role of the calcaneal heel pad and polymeric shock absorbers in attenuation of heel strike impact.

    Science.gov (United States)

    Noe, D A; Voto, S J; Hoffmann, M S; Askew, M J; Gradisar, I A

    1993-01-01

    The capacity of the calcaneal heel pad, with and without augmentation by a polymeric shock absorbing material (Sorbothane 0050), to attenuate heel strike impulses has been studied using five fresh human cadaveric lower leg specimens. The specimens, instrumented with an accelerometer, were suspended and impacted with a hammer; a steel rod was similarly suspended and impacted. The calcaneal heel pad attenuated the peak accelerations by 80%. Attenuations of up to 93% were achieved by the shock absorbing material when tested against the steel rod; however, when tested in series with the calcaneal heel pad, the reduction in peak acceleration due to the shock absorbing material dropped to 18%. Any evaluation of the effectiveness of shock absorbing shoe materials must take into account their mechanical interaction with the body.

  11. A STUDY ON SPECTRUM OF NECROTISING FASCIITIS IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    V. Jeyaraman

    2016-12-01

    presented with swelling on initial presentation followed by pain as the second most common clinical symptom. Trauma attributed as the leading predisposing factor with diabetes as the most common co-morbidity in our patients. In comparison to gram-positive bacteria/cocci, gramnegative bacteria were more common on isolating cultures from the wound. CONCLUSION We report that the incidence of NF during this period remained relatively constant. Trauma is the leading cause of NF in this study. Necrotising fasciitis is an uncommon disease presenting initially with symptoms and signs that may mimic cellulitis rendering a delay in the treatment involving surgical debridement. Patients most commonly presented with swelling and pain over the affected area along with fever. Co-morbidities such as diabetes seen in association with NF should be addressed. Though cultures showed more of gram-negative bacilli, initiation with broad-spectrum antibiotics is warranted as many cases reported gram-positive bacilli/cocci as well as combination of both gram-positive and negative growth obtained from the same site.

  12. Novelty in Treatment of Heel Spur

    Directory of Open Access Journals (Sweden)

    S.S. Kasinets

    2012-02-01

    Full Text Available The article deals with data on prevalence, etiopathogenesis, clinical manifestations and principles of heel spur treatment, there had been described clinical case, and also there were given guidelines on Chondrocerin (Mili Healthcare Ltd, Great Britain use in treatment of this pathology.

  13. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2012-01-01

    Full Text Available Background and Aim: Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective evaluations. Materials and Methods: In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to receive ESWT (4000 shock waves/session of 0.2 mJ/mm 2 in 3 sessions at weekly intervals or sham therapy (n = 20 in each group. Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients′ pain scores, performed at baseline and 12 weeks after completion of the therapy. Results : The two groups were similar in baseline characteristics. Over the study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001, but slightly increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03. Both groups showed significant pain improvement over the course of the study (P < 0.001, though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ± 1.8, P = 0.049. Conclusions: Extracorporeal shock wave therapy contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.

  14. Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick.

    Science.gov (United States)

    Marín Gabriel, Miguel Ángel; del Rey Hurtado de Mendoza, Beatriz; Jiménez Figueroa, Lourdes; Medina, Virginia; Iglesias Fernández, Beatriz; Vázquez Rodríguez, María; Escudero Huedo, Virginia; Medina Malagón, Lorena

    2013-11-01

    To investigate the analgesic effect (measured with Neonatal Infant Pain Scale (NIPS)) of breastfeeding (BF) in addition to skin-to-skin contact (SSC) versus other methods of non-pharmacological analgesia during blood sampling through heel lance in healthy term neonates. Randomised controlled trial. Tertiary level maternity ward. One hundred thirty-six healthy term newborns. healthy term neonates, wish to breastfeed and absence of feeding during the previous 60 min. Neonates were randomly assigned to four groups: Group breastfed with SSC (BF+SSC Group) (n=35); Group sucrose with SSC (Sucrose+SSC Group) (n=35); SSC Group (n=33); or Sucrose Group (n=33). Babies were recorded with a video camera. Three observers watched the videos and measured NIPS score at three time points (t0: 2 min before heel prick; t1: During heel prick; and t2: 2 min after the heel prick). The influences of non-pharmacological methods on crying time, percentage of crying while sampling, heart rate, number of attempts and duration of sampling were also studied. BF+SSC Group achieved a significant lower median NIPS score (value=1) compared with other groups (value=2, 4 and 4, respectively). The percentage of neonates with moderate-to-severe pain was also lower in the BF+SSC Group. Both groups BF+SSC and Sucrose+SSC achieved a significant lower percentage of crying compared with SSC Group. This study suggests that BF in addition to SSC provides superior analgesia to other kinds of non-pharmacological analgesia in healthy term neonates during heel prick.

  15. An exploration of emergency department presentations related to high heel footwear in Victoria, Australia, 2006-2010.

    Science.gov (United States)

    Williams, Cylie M; Haines, Terry P

    2014-01-23

    Many women are warned against the dangers of wearing high heel footwear however there is limited empirical evidence demonstrating an association between wearing high heel with injury. Gait laboratory testing has found a higher heel height placed the foot in a position that increases the risk of ankle sprain. Women have also been surveyed about wearing high heels and approximately half of those reported inconvenience and pain after wearing a high heel shoe. This study aims to explore emergency department presentations of injuries and the estimated costs that have been directly attributed to wearing high heeled footwear within Victoria, Australia during 2006-2010. The Victorian Emergency Minimum Dataset (VEMD) was searched for all injuries attributed to wearing high heel footwear presenting to emergency departments in Victoria Australia, between the years of 2006-2010. The VEMD produced a report detailing sex, age at presentation, month of presentation, time of day of presentation, day of presentation, location that injury occurred and type of injury for presentation. Monash Health in Victoria Australia, provided emergency department estimates for injury types to calculate an estimated cost of an acute injury related to wearing high heel footwear. There were 240 injuries presenting to Victorian emergency departments directly attributed to wearing high heeled footwear. The majority of people injured were women (n = 236) and all were less than 55 years of age. More injuries presented on a Sunday (n = 83) and more in the 8 am-12 pm time bracket (n = 64). There were also more injuries presenting in the months of November, December and January (n = 80). The most commonly injured body part was the ankle (n = 123). The emergency department estimate of the cost of these injuries over this time-frame was almost $72,000 (mean of $316.72 per presentation). People who wear high heel footwear on weekends appear to be at higher risk for injury that leads to

  16. Necrotizing fasciitis: strategies for diagnosis and management.

    Science.gov (United States)

    Taviloglu, Korhan; Yanar, Hakan

    2007-08-07

    Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

  17. Necrotizing fasciitis - Report of two unusual cases

    International Nuclear Information System (INIS)

    Kamulegeya, Adriane

    2008-01-01

    Cervico-facial necrotizing fasciitis is a potential complication of odontogenic infection that can lead to mediastinitis and septic shock. A delay or inappropriate treatment of simple infections and immunocompromise increase the risk of developing the disease and in turn increase the morbidity and mortality of the disease. We present two cases one of which we believe developed due to delayed treatment and the other due to immunocompromise. Both cases were successfully treated with surgical debridement and broad spectrum antibiotics. There is need to rethink certain clinical judgments such as treatment during pregnancy and the usefulness of an informative medical history from patients. (author)

  18. Necrotizing fasciitis: strategies for diagnosis and management

    Directory of Open Access Journals (Sweden)

    Yanar Hakan

    2007-08-01

    Full Text Available Abstract Necrotizing fasciitis (NF is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

  19. Necrotizing Fasciitis of the Nose Complicated with Cavernous Sinus Thrombosis

    Directory of Open Access Journals (Sweden)

    D. Swaminath

    2014-01-01

    Full Text Available Necrotizing fasciitis is a rapidly progressive life threatening bacterial infection of the skin, the subcutaneous tissue, and the fascia. We present a case of necrotizing fasciitis involving the nose complicated by cavernous sinus thrombosis. Few cases of septic cavernous sinus thrombosis have been reported to be caused by cellulitis of the face but necrotizing fasciitis of the nose is rare. It is very important to recognize the early signs of cavernous thrombosis. Treatment for septic cavernous sinus thrombosis is controversial but early use of empirical antibiotics is imperative.

  20. Development of Eosinophilic Fasciitis during Infliximab Therapy for Psoriatic Arthritis

    Directory of Open Access Journals (Sweden)

    Richard Hariman

    2016-01-01

    Full Text Available Eosinophilic fasciitis (EF is a rare disorder involving chronic inflammation of the fascia and connective tissue surrounding muscles, nerves, and blood vessels. While its pathogenesis is not entirely understood, this disorder is thought to be autoimmune or allergic in nature. We present here a case of a 59-year-old male who developed peripheral eosinophilia and subsequent eosinophilic fasciitis during treatment with infliximab. To our knowledge, eosinophilic fasciitis has not been previously described in patients during treatment with an inhibitor of tumor necrosis factor α.

  1. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Peerbooms Joost C

    2010-04-01

    Full Text Available Abstract Background If conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporarily pain reduction, but no healing. Blood platelets initiate the natural healing rate. GPS® gives an eightfold concentrate platelets of patients own blood. Injection of these platelets in the attachment of the fascia to the os calcis might induce a healing rate. Methods and design A randomized controlled multi centre trial will be performed. The study population consists of 120 patients of 18 years and older. Patients with chronic plantar fasciitis will be allocated randomly to have a steroid injection or an autologous platelet concentrate injections. Data will be collected before the procedure, 4,8,12,26 weeks and 1 year after the procedure. The main outcome measures of this study are pain and function measured with questionnaires. Conclusion Recent literature show positive effects for the treatment of tendinosis with autologous platelet injections. The forthcoming trial will compare treatment for chronic plantar fasciitis with a steroid injection versus an autologous platelet injection. Our results will be published as soon as they become available. Trial Registration Trial registration number: http://www.clinicaltrials.gov NCT00758641.

  2. Growth factor-enriched autologous plasma improves wound healing after surgical debridement in odontogenic necrotizing fasciitis: a case report

    Directory of Open Access Journals (Sweden)

    Martinez-Fong Daniel

    2011-03-01

    Full Text Available Abstract Background Odontogenic necrotizing fasciitis of the neck is a fulminant infection of odontogenic origin that quickly spreads along the fascial planes and results in necrosis of the affected tissues. It is usually polymicrobial, occurs frequently in immunocompromised patients, and has a high mortality rate. Case presentation A 69-year old Mexican male had a pain in the maxillar right-canine region and a swelling of the submental and submandibular regions. Our examination revealed local pain, tachycardia, hyperthermia (39°C, and the swelling of bilateral submental and submandibular regions, which also were erythematous, hyperthermic, crepitant, and with a positive Godet sign. Mobility and third-degree caries were seen in the right mandibular canine. Bacteriological cultures isolated streptococcus pyogenes and staphylococcus aureus. The histopathological diagnosis was odontogenic necrotizing fasciitis of the submental and submandibular regions. The initial treatment was surgical debridement and the administration of antibiotics. After cultures were negative, the surgical wound was treated with a growth factor-enriched autologous plasma eight times every third day until complete healing occurred. Conclusions The treatment with a growth factor-enriched autologous plasma caused a rapid healing of an extensive surgical wound in a patient with odontogenic necrotizing fasciitis. The benefits were rapid tissue regeneration, an aesthetic and a functional scar, and the avoidance of further surgery and possible complications.

  3. Atypical presentation of cervical necrotizing fasciitis. Case report.

    Directory of Open Access Journals (Sweden)

    Javier Moraga.

    2017-07-01

    Full Text Available Cervical necrotizing fasciitis (NF is a soft tissue infection with a low incidence, characterized by rapid progression and high morbidity and mortality. The purpose of this report is to communicate the case of a patient diagnosed with cervical NF and its successful management. A 54-year-old male consulted after suffering from the condition for seven days. It was characterized by bilateral submandibular swelling, accompanied by fever, dysphagia, odynophagia, which were severely affecting the patient’s general health. Physical examination revealed a painful, erythematous cervical swelling. A cervical computed tomography scan was performed, revealing a gaseous collection in the left mucosal pharyngeal space, extending to the glottis, associated with significant deep plane soft tissue emphysema onon the left side of the neck and with possible involvement of the danger space; pertinent lab findings include 19,190/uL leukocytes and 219mg/L CRP. Broad-spectrum antibiotic therapy was initiated with ceftriaxone and clindamycin. Exploratory surgery, lavage and drainage of the collected material were performed. Streptococcus anginosus was isolated by culture. The patient recovered appropriately showing improvement in clinical as well as in inflammatory parameters, being discharged on the ninth day. He is currently receiving periodical checkups in the surgery polyclinic.

  4. Necrotizing Fasciitis Complicating Pregnancy: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Marinos Nikolaou

    2014-01-01

    Full Text Available Necrotizing fasciitis is a rare, life-threatening surgical infection in pregnancy with high rates of morbidity and mortality. A 15-year-old primigravid woman, at 28 weeks of gestation with no significant previous medical history, was admitted to our hospital complaining of severe left lower extremity pain and high fever the last 72 hours. During clinical examination, she had a swollen, erythematous and tender to palpation inflamed skin over the medial aspect of the upper thigh without any evidence of injury. Incision drainage was performed immediately and she received broad spectrum antibiotics. During initial laboratory examinations, diabetes mellitus was diagnosed. There was no clinical improvement over the following days. Magnetic resonance imaging (MRI revealed subcutaneous tissue inflammation and edema of infected tissues confirming the disease entity. Multidisciplinary therapy with immediate aggressive surgical debridement of necrotic tissues, multiple antibiotics, and intensive care monitoring was performed successfully. The patient’s postoperative course was uncomplicated and skin defect was closed with split thickness skin grafting. Our case emphasized the potential immunosuppressive role of pregnancy state in conjunction with diabetes mellitus in the development of severe necrotizing soft tissue infections.

  5. Necrotizing Soft Tissue Fasciitis after Intramuscular Injection

    Directory of Open Access Journals (Sweden)

    Angelica Abbate

    2018-01-01

    Full Text Available Necrotizing soft tissue fasciitis (NSTIs or necrotizing fasciitis is an infrequent and serious infection. Herein, we describe the clinical course of a female patient who received a diagnosis of NSTIs after gluteus intramuscular injection. We also report the results of our review of published papers from 1997 to 2017. Since now, 19 cases of NSTIs following intramuscular injections have been described. We focus on the correlation between intramuscular injection and NSTIs onset, especially in immunosuppressed patients treated with corticosteroids, suffering from chronic diseases or drug addicted. Intramuscular injections can provoke severe tissue trauma, representing local portal of infection, even if correctly administrated. Otherwise, it is important not to inject drug in subcutaneous, which is a less vascularized area and therefore more susceptible to infections. Likewise, a proper injecting technique and aspiration prior to injection seem to be valid measure to prevent intra-arterial or para-arterial drug injection with the consequent massive inflammatory reaction. Necrosis at the infection site appears to be independent of the drug, and it is a strong additional risk factor for NSTIs.

  6. Movement Behavior of High-Heeled Walking

    DEFF Research Database (Denmark)

    Alkjær, Tine; Raffalt, Peter Christian; Petersen, Nicolas Caesar

    2012-01-01

    The human locomotor system is flexible and enables humans to move without falling even under less than optimal conditions. Walking with high-heeled shoes constitutes an unstable condition and here we ask how the nervous system controls the ankle joint in this situation? We investigated the movement...... behavior of high-heeled and barefooted walking in eleven female subjects. The movement variability was quantified by calculation of approximate entropy (ApEn) in the ankle joint angle and the standard deviation (SD) of the stride time intervals. Electromyography (EMG) of the soleus (SO) and tibialis...... anterior (TA) muscles and the soleus Hoffmann (H-) reflex were measured at 4.0 km/h on a motor driven treadmill to reveal the underlying motor strategies in each walking condition. The ApEn of the ankle joint angle was significantly higher (p...

  7. Percutaneous planter fasciitis release under local anesthesia: A prospective study

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu

    2017-04-01

    Conclusion: Percutaneous planter fasciitis release under local anesthesia is a minimally invasive procedure that can be performed in the outpatient setting. It is easy, quick, effective and moreover with few complications.

  8. Psychological distress in patients with morphea and eosinophilic fasciitis.

    NARCIS (Netherlands)

    Kroft, Ilse; Jong, E.M.G.J. de; Evers, A.W.M.

    2009-01-01

    OBJECTIVE: To examine the level of psychological distress and factors contributing to distress in patients with morphea or eosinophilic fasciitis. DESIGN: Cross-sectional study. SETTING: Dermatology outpatient clinic of a university hospital. PARTICIPANTS: Of 120 patients with morphea or

  9. Tube Thoracostomy-Related Necrotizing Fasciitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Shun-Pin Hsu

    2006-12-01

    Full Text Available Spontaneous pneumothorax is a serious complication of pulmonary tuberculosis that requires immediate treatment. Necrotizing fasciitis is a serious, rapidly progressive infection of the subcutaneous tissue and fascia, most related to trauma or surgery. Here, we report a case of pulmonary tuberculosis with spontaneous pneumothorax. A standard procedure of tube thoracostomy was performed for lung re-expansion. Two days after the tube was removed, necrotizing fasciitis developed from the puncture site. Computed tomography of the chest showed focal thickness with gas formation and loss of the fat plane over the chest wall, which is compatible with the diagnosis of necrotizing fasciitis. Aggressive treatment was given, including emergency fasciectomy and adequate systemic antibiotic and antituberculous treatment. The necrotizing fasciitis was successfully treated. The patient was discharged and sent home with maintenance antituberculous therapy.

  10. Quantitative Ultrasound Measurements at the Heel

    DEFF Research Database (Denmark)

    Daugschies, M.; Brixen, K.; Hermann, P.

    2015-01-01

    Calcaneal quantitative ultrasound can be used to predict osteoporotic fracture risk, but its ability to monitor therapy is unclear possibly because of its limited precision. We developed a quantitative ultrasound device (foot ultrasound scanner) that measures the speed of sound at the heel...... with the foot ultrasound scanner reduced precision errors by half (p quantitative ultrasound measurements is feasible. (E-mail: m.daugschies@rad.uni-kiel.de) (C) 2015 World Federation for Ultrasound in Medicine & Biology....

  11. Necrotizing Fasciitis of vulva: A report of two cases

    Directory of Open Access Journals (Sweden)

    Jamal A

    2000-08-01

    Full Text Available Vulvar necrotizing fascitis is an uncommon infectious disorder. Since the first reported cases almost 100 years, ago, necrotizing fasciitis continues to present a diagnostic and therapeutic challenge. What usually begins as a subtle infection can become life-threatening. We report two cases of vulvar necrotizing fasciitis, one after posterior colporrhaphy in a woman with four risk factors and the other in a young woman without any risk factor.

  12. Bone imaging of the heel in Reiter's syndrome. [/sup 99m/Tc-pyrophosphate

    Energy Technology Data Exchange (ETDEWEB)

    Khalkhali, I. (Univ. of California, Sacramento); Stadalnik, R.C.; Wiesner, K.B.; Shapiro, R.F.

    1979-01-01

    Classic Reiter's syndrome, which affects young adult males, is characterized by arthritis, conjunctivitis, and nongonococcal urethritis. Other features of probably equal significance include circinate balanitis, shallow ulcerations of the buccal mucosa, and a dermatitis. Reiter's arthritis is usually asymmetrical and tends to involve lower extremity joints. Talalgia, or heel pain, is an often underrated characteristic feature of the arthritis. With an incidence of 50% talalgia can be localized to either the posterior aspect of the heel or to the plantar surface of the heel. Radiographic alterations in these regions are common in patients with recurrent or chronic disease, but are infrequent or minimal in patients with acute Reiter's syndrome. Recent observation of a young male with Reiter's syndrome suggests that bone imaging may help substantiate this clinical feature before radiography reveals calcaneal spurs.

  13. Analgesic effect of breast milk versus sucrose for analgesia during heel lance in late preterm infants.

    Science.gov (United States)

    Simonse, Eva; Mulder, Paul G H; van Beek, Ron H T

    2012-04-01

    The purpose of this trial was to investigate whether breast milk (either breastfed or bottle-fed) has a better analgesic effect than sucrose in newborns born at a postmenstrual age between 32 and 37 weeks. We conducted a randomized controlled trial at a secondary care neonatal unit in the Netherlands on 71 preterm neonates (postmenstrual age at birth 32-37 weeks), undergoing heel lance with an automated piercing device. Newborns were randomly assigned to breast milk (either breastfed or bottle-fed) administered during heel lance or oral sucrose administered before heel lance. We assessed the Premature Infant Pain Profile (PIPP) score (range, 0-21) to investigate whether there was a difference in pain score between neonates receiving breast milk and those receiving sucrose solution. There was no significant difference in mean PIPP score between neonates receiving breast milk (6.1) and those receiving sucrose (5.5), with a mean difference of 0.6 (95% confidence interval -1.6 to 2.8; P = .58). From this study, it cannot be concluded that breast milk has a better analgesic effect than sucrose in late preterm infants. From the results, it follows with 95% confidence that the analgesic effect of breast milk is not >1.6 points better and not > 2.8 points worse on the PIPP scale (SD 3.7) than the analgesic effect of sucrose in late preterm infants.

  14. PERIORBITAL NECROTIZING FASCIITIS DUE TO CRYPTOCOCCUS NEOFORMANS IN A HEALTHY-YOUNG MAN

    NARCIS (Netherlands)

    DOORENBOSBOT, ACC; HOOYMANS, JMM; BLANKSMA, LJ

    1990-01-01

    A case report is presented of a healthy 25-year-old man who developed a periorbital necrotising fasciitis after a trivial trauma with a wooden splinter. Necrotising fasciitis of the eyelids occurs rarely. Cryptococcus neoformans is not described as a causative factor of necrotizing fasciitis.

  15. Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman

    Directory of Open Access Journals (Sweden)

    Monié M

    2014-07-01

    Full Text Available Marguerite Monié,1 Laurence Drieux,2–4 Bernadette Nzili,1 Michèle Dicko,5 Catherine Goursot,1 Sandrine Greffard,6 Dominique Decré,3,4,7 Anthony Mézière1 1Assistance Publique-Hôpitaux de Paris (AP-HP, GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, 2Assistance Publique-Hôpitaux de Paris, Hôpital Charles-Foix, Bactériologie-Hygiène, Paris, 3Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology, Paris, 4INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology, Paris, 5AP-HP, GHU Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, 6AP-HP, GHU Pitié Salpêtrière-Charles Foix, site Pitié Salpêtrière, Service de Médecine Gériatrique, Paris, 7AP-HP, Hôpital Saint-Antoine, Bactériologie-Hygiène, Paris, France Abstract: Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K. pneumoniae in a 92-year-old French woman hospitalized in a geriatric rehabilitation unit. The patient initially presented with dermohypodermitis of the leg that developed from a dirty wound following a fall. A few hours later, this painful injury extended to the entire lower limb, with purplish discoloration of the skin, bullae, and necrosis. Septic shock rapidly appeared and the patient died 9 hours after the onset of symptoms. The patient was Caucasian, with no history of travel to Asia or any underlying disease. Computed tomography revealed no infectious metastatic loci. Blood cultures showed growth of capsular serotype K2 K. pneumoniae strains with virulence factors RmpA, yersiniabactin and aerobactin. This rare and fatal case of necrotizing fasciitis caused by a virulent strain

  16. Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

    Directory of Open Access Journals (Sweden)

    Tuite Helen

    2010-11-01

    Full Text Available Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

  17. Streptococcal necrotizing fasciitis with toxic shock syndrome and rapid fatal outcome

    Directory of Open Access Journals (Sweden)

    Kojić Miroslav

    2015-01-01

    Full Text Available Introduction. Streptococcal necrotizing fasciitis (NF is a serious soft tissue infection with rapid progression of inflammatory process among superficial or deep fascia, systemic host response to infection leading to toxic shock syndrome (TSS, and multiple organ failure. Lethality is high. Case Outline. A 46-year-old male without co-morbidities was admitted to the Emergency Department with redness, swelling and pain on his right lower leg. He became sick two day s ea rlier with m alaise, chills and shivering. On admission he was hypotensive, anuric, with erythematous rash on his face, neck and chest, with acute ren al failure and elevated creatine phosphokinase level. During the next several hours, the changes on his right lower leg rapidly spread to the whole leg, followed by skin destruction and subcutaneo us bleeding, indicating NF. Aggressive antimicrobial, supportive and symptom atic therapy was initiated immediately and on the same evening surgical intervention was performed. Despite these measures, a rapid development of severe TSS, with lethal outcome, occurred in less than 40 hours after the admission. Stre ptococcus pyogenes (group A β-hemolytic Streptococcus was isolated from the throat, skin and tissue obtained duri ng the surgery. Conclusion. Necrotizing fasciitis is a very serious disease with unpre dictable course. For that reason doctors must devote a great deal of a ttention to early, i.e. timely diagnosis of this disease, whose treatment with a multid isciplinary approach is very important.

  18. Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

    LENUS (Irish Health Repository)

    Smyth, Andrew

    2010-11-17

    Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

  19. [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.

  20. Necrotizing fasciitis: 11-year retrospective case review in South Auckland.

    Science.gov (United States)

    Kulasegaran, Suheelan; Cribb, Benjamin; Vandal, Alain C; McBride, Stephen; Holland, David; MacCormick, Andrew D

    2016-10-01

    The aims of this paper were to review our experience with necrotizing fasciitis at Middlemore Hospital and to define the trends in incidence, inpatient mortality and microbiological profile. A computerized search of the electronic medical records was undertaken to identify adult patients with a diagnosis of necrotizing fasciitis between January 2000 and December 2010. A retrospective review of the clinical records was performed. Of the 138 patients with necrotizing fasciitis identified, 129 had their diagnosis confirmed at operation. The mortality at 30 days was 20.3% (95% confidence interval (CI) 13.9%-28.0%). There was a significant reduction in hospital mortality in each successive year of the study period with an odds ratio of 0.84 (95% CI 0.71-0.98, P = 0.03). A pattern of increasing incidence was noted until February 2004 (95% CI September 2002-July 2005). This was followed by a significant decrease in incidence. The empirical antibiotic regime of clindamycin, gentamicin and penicillin provides satisfactory cover against 95% of the causative pathogens. This represents the largest single-centre published case series in New Zealand. Despite concerns of increasing incidence and mortality associated with necrotizing fasciitis in New Zealand, the experience in South Auckland shows a decrease in incidence of necrotizing fasciitis since 2004 and a statistically significant decreasing trend in hospital mortality. © 2015 Royal Australasian College of Surgeons.

  1. Hospital epidemiology of emergent cervical necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Background : Necrotizing fasciitis (NF is a surgical emergency. It is a rapidly progressing infection of the fascia and subcutaneous tissue and could be fatal if not diagnosed early and treated properly. NF is common in the groin, abdomen, and extremities but rare in the neck and the head. Cervical necrotizing fasciitis (CNF is an aggressive infection of the neck and the head, with devastating complications such as airway obstruction, pneumonia, pulmonary abscess, jugular venous thrombophlebitis, mediastinitis, and septic shock associated with high mortality. Aim : To assess the presentation, comorbidities, type of infection, severity of disease, and intensive care outcome of CNF. Methods : Medical records of the patients treated for NF in the surgical intensive care unit (SICU from January 1995 to February 2005 were reviewed retrospectively. Results : Out of 94 patients with NF, 5 (5.3% had CNF. Four patients were male. The mean age of our patients was 41.2 ± 14.8 years. Sixty percent of patients had an operative procedure as the predisposing factor and 80% of patients received nonsteroidal anti-inflammatory drugs (NSAIDs. The only comorbidity associated was diabetes mellitus (DM in 3 patients (60%. Sixty percent of the cases had type1 NF. Mean sequential organ failure assessment (SOFA score on admission to the ICU was 8.8 ± 3.6. All patients had undergone debridement at least two times. During the initial 24 h our patients received 5.8 ± 3.0 l of fluid, 2.0 ± 1.4 units of packed red blood cells (PRBC, 4.8 ± 3.6 units of fresh frozen plasma (FFP, and 3.0 ± 4.5 units of platelet concentrate. The mean number of days patients were intubated was 5.2 ± 5.1 days and the mean ICU stay was 6.4 ± 5.2 days. Sixty percent of cases had multiorgan dysfunction (MODS and one patient died, resulting in a mortality rate of 20%. Conclusion : According to our study, CNF represents around 5% of NF patients. CNF was higher among male patients and in

  2. Recovery of plutonium from electrorefining anode heels at Savannah River

    International Nuclear Information System (INIS)

    Gray, J.H.; Gray, L.W.; Karraker, D.G.

    1987-03-01

    In a joint effort, the Savannah River Laboratory (SRL), Savannah River Plant (SRP), and the Rocky Flats Plant (RFP) have developed two processes to recover plutonium from electrorefining anode heel residues. Aqueous dissolution of anode heel metal was demonstrated at SRL on a laboratory scale and on a larger pilot scale using either sulfamic acid or nitric acid-hydrazine-fluoride solutions. This direct anode heel metal dissolution requires the use of a geometrically favorable dissolver. The second process developed involves first diluting the plutonium in the anode heel residues by alloying with aluminum. The alloyed anode heel plutonium can then be dissolved using a nitric acid-fluoride-mercury(II) solution in large non-geometrically favorable equipment where nuclear safety is ensured by concentration control

  3. Nodular Fasciitis of the Auricle: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Majidi

    2013-03-01

    Full Text Available Introduction: Nodular fasciitis is described as a benign reactive proliferation of myofibroblasts. Due to its rapid-growing nature, a precise clinical diagnosis is difficult and the condition is frequently misdiagnosed as malignant lesions.   Case Report: In this study, we present the case of a young woman with an auricular nodular fasciitis as an example of one of the rarest sites of this tumor. The patient underwent an excision of the lesion under general anesthesia. The literature choices for treatment include complete excision, partial excision, or intralesional injection of steroids. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.   Conclusion:  Auricular nodular fasciitis is a rare lesion. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.

  4. Nodular Fasciitis of the Breast Mimicking Breast Cancer

    Directory of Open Access Journals (Sweden)

    Shinya Yamamoto

    2014-01-01

    Full Text Available Nodular fasciitis is a benign proliferative lesion that is usually found in the soft tissue of the upper extremity and trunk in young to middle-aged persons. It has rarely been described in the breast. A 35-year-old woman had noticed a mass in her left breast. It was elastic-hard, 13 mm in size, and located mainly in the upper inner quadrant of the left breast. Mammography did not detect the mass. Ultrasonography revealed a hypoechoic lesion with an irregular margin. Neither fine-needle aspiration cytology nor core needle biopsy established a definitive diagnosis. Excisional biopsy was therefore performed. Histologically, the excised tumor tissue results were consistent with a diagnosis of nodular fasciitis of the breast. We report a case of nodular fasciitis of the breast, a rare histological type of breast tumor.

  5. Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus.

    Science.gov (United States)

    Sánchez, A; Robaina, R; Pérez, G; Cairoli, E

    2016-04-01

    Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory. © The Author(s) 2015.

  6. Necrotizing Fasciitis in Paroxysmal Nocturnal Hemoglobinuria

    Directory of Open Access Journals (Sweden)

    Pusem Patir

    2015-01-01

    Full Text Available Paroxysmal nocturnal hemoglobinuria (PNH is a rare, progressive, and life-threatening hematopoietic stem cell disorder characterized by complement-mediated intravascular hemolysis and a prothrombotic state. Patients with PNH might have slightly increased risk of infections due to complement-associated defects subsequent to CD59 deficiency. Here, we report a rare case of a 65-year-old male patient with necrotic ulcers on both legs, where the recognition of pancytopenia and microthrombi led to the diagnosis of PNH based on FLAER (FLuorescent AERolysin flow cytometric analysis. He was subsequently started on eculizumab therapy, with starting and maintenance doses set as per drug labelling. Progression of the patient’s leg ulcers during follow-up, with fulminant tissue destruction, purulent discharge, and necrotic patches, led to a later diagnosis of necrotizing fasciitis due to Pseudomonas aeruginosa and Klebsiella pneumonia infection. Courses of broad-spectrum antibiotics, surgical debridement, and superficial skin grafting were applied with successful effect during ongoing eculizumab therapy. This case highlights the point that it is important to maintain treatment of underlying disorders such as PNH in the presence of life-threatening infections like NF.

  7. Foot Skin Ischemic Necrosis following Heel Prick in a Newborn

    Directory of Open Access Journals (Sweden)

    Esad Koklu

    2013-01-01

    Full Text Available There are only a few reports on side effects after heel prick in neonates although heel prick has been performed all over the world for many years. The medicine staff had obtained only a drop of blood by pricking the baby’s heel using a lancet without compressing the heel or foot to measure his blood glucose level 3 hours after birth. However he developed a severe and hemorrhagic skin reaction on his entire left foot, beginning 30 minutes after obtaining the drop of blood by pricking the baby’s heel using a lancet. The lesion, which was treated with topical mupirocin and povidone-iodine solution daily, slowly decreased in size and had almost fully resolved within 3 weeks. He was healthy and 9 months old at the time of writing this paper. We herein report a case of foot skin ischemic necrosis following heel prick in a newborn. To our knowledge this patient is the first case of foot skin ischemic necrosis due to heel prick in newborns.

  8. Plantar Pressure Variation during Jogging with Different Heel Height

    Directory of Open Access Journals (Sweden)

    Y. D. Gu

    2013-01-01

    Full Text Available This paper presents the key testing and analysis results of an investigation on the effect of heel height on the plantar pressure over different foot areas in jogging. It is important in improving the understanding of jogging with high heels and damage/injury prevention. It can also potentially guide the development of suitable/adaptive exercise schemes in between daily activities with high heels. In this work, plantar pressure data were collected from 10 habituated healthy female subjects (aged 21–25 years at their natural jogging speed with three different conditions: flat heeled shoes (0.8 cm, low heeled shoes (4.0 cm, and high heeled shoes (6.6 cm. Data analysis showed significantly differences in plantar pressure distribution associated with the heel heights with increased pressure in the first metatarsal region and decreased pressure in the lateral metatarsal and midfoot sections. However, there is no significant alteration of plantar pressure in the central area of the forefoot with jogging gait.

  9. Pain

    OpenAIRE

    H.W. Snyman

    1980-01-01

    The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  10. Pain

    Directory of Open Access Journals (Sweden)

    H.W. Snyman

    1980-09-01

    Full Text Available The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  11. Diagnostic accuracy of heel pad palpation - A phantom study

    DEFF Research Database (Denmark)

    Torp-Pedersen, Søren; Matteoli, Sara; Wilhjelm, Jens E.

    2008-01-01

    Falanga torture involves repetitive blunt trauma to the soles of the feet and typically leaves few detectable changes. Reduced elasticity in the heel pads has been reported as characteristic sequelae and palpatory testing of heel pad elasticity is therefore part of medicolegal assessment of alleged...... torture victims. The goal was to test the accuracy of two experienced investigators in determining whether a heel pad model was soft, medium or hard. The skin-to-bone distance in the models varied within the human range....

  12. Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

    Science.gov (United States)

    Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

    2018-01-01

    Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis. PMID:29862211

  13. Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2018-01-01

    Full Text Available Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40 received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS and modified Roles and Maudsley score (RMS at baseline and 1 month and 3 months after intervention. Plantar fascia (PF thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006 and RMS showed better improvement in intervention group (P = 0.026. There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292. Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

  14. Nekrotiserende fasciitis i hoved-hals-området

    DEFF Research Database (Denmark)

    Wolf, Henning; Ovesen, Therese

    2008-01-01

    OBJECTIVES: To describe the clinical, microbiological, serological and radiological findings including the results of treatment in a Danish patient population with necrotizing fasciitis (NF) in the head and neck region. MATERIALS AND METHODS: Data were retrieved from patient records with the ICD3...

  15. Fasciitis necroticans efter artroskopi af præpatellar bursitis

    DEFF Research Database (Denmark)

    Schlesinger, NH; Friis-Møller, Alice; Hvolris, Jesper

    2007-01-01

    Necrotizing fasciitis (NF) is a life-threatening soft tissue infection in superficial and deep fascias. NF is most often caused by mixed aerobic and anaerobic bacteria. The treatment is early and aggressive surgical debridement, antibiotics and hyperbaric oxygen. In this case description, a nearly...

  16. Necrotizing Fasciitis: An Unusual Sequela Of Injections In Children ...

    African Journals Online (AJOL)

    Background: Necrotising fasciitis (NF) of the head and the trunk in children is a serious infection that carries high morbidity and mortality. We recently managed two infants with NF from injection mishap of the head and the trunk, respectively. The aim of this report is to highlight ways of effectively treating and/preventing ...

  17. Triple diagnostics for early detection of ambivalent necrotizing fasciitis

    NARCIS (Netherlands)

    Hietbrink, Falco; Bode, Lonneke G.; Riddez, Louis; Leenen, Luke P H; van Dijk, MR

    2016-01-01

    Background: Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity.

  18. Necrotising fasciitis of the submandibular region | Nyako | Ghana ...

    African Journals Online (AJOL)

    Two cases of necrotizing fasciitis (NF) complicating different conditions of the maxillofacial region, treated at the Korle Bu Teaching Hospital are reported. These were managed by an early diagnosis, aggressive surgical exploration, fasciotomies and debridement of necrotic tissue. In addition, frequent irrigation within the ...

  19. Retrospective evaluation of necrotizing fasciitis in university college ...

    African Journals Online (AJOL)

    Context: Cervicofacial necrotizing fasciitis (CNF), although a potentially fatal fulminant infection has been largely under‑reported in the dental literature. Aims: To report our experience with cases seen and treated at the University College Hospital, Ibadan, Nigeria. Settings and Design: A descriptive retrospective clinical ...

  20. Necrotizing Fasciitis In A Preterm, HIV Infected Baby | Olutekunbi ...

    African Journals Online (AJOL)

    Necrotizing fasciitis (NF) is a rapidly progressive life threatening bacterial infection of the soft tissues. It is commoner in the adult population where it is associated with systemic and local disease conditions such as diabetes mellitus, intravenous drug abuse, dental lesions, trauma and immunosuppression. It is rare in ...

  1. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial

    Science.gov (United States)

    Lai, Ta-Wei; Ma, Hsiao-Li; Lee, Meng-Shiunn; Chen, Po-Ming; Ku, Ming-Chou

    2018-01-01

    Objectives: Extracorporeal shockwave therapy (ESWT) and corticosteroid injection (CSI) are treatment options for plantar fasciitis. Their clinical outcome comparison remains a debate. Also, the thickness changes of the plantar fascia on objective evaluation under the medium energy ESWT and CSI therapy are elusive. Methods: A total of 97 patients with chronic plantar fasciitis were enrolled in the randomized prospective trial. Forty-seven patients received extracorporeal shock wave therapy (ESWT), and fifty patients received corticosteroid injection (CSI). The thickness of the plantar fascia was evaluated respectively before ESWT and CSI, and at the 4th and 12th week after ESWT and CSI by ultrasonography. Pain level and clinical outcomes were recorded using visual analogue scale (VAS) and 100-points scoring systems. Correlation analysis was performed between the thickness change and clinical outcome. Results: Under ultrasonography, we observed more increase of plantar fascia thickness of ESWT group than CSI group at 4th week (p=0.048). VAS of plantar fasciitis patients receiving ESWT was lower than those who received corticosteroid injection (0.001 and pplantar fascia thickness at 4th week was positively correlated with the decrease of VAS score at 12th week follow-up (R=0.302, P=0.039). Conclusions: At 4th week after treatment, the thickness of plantar fascia increased. Then it decreased gradually, but not to the baseline at 12th week. On the pain level outcome at 12th week, extracorporeal shockwave therapy (ESWT) was more efficient than corticosteroid injection (CSI) on chronic plantar fasciitis. The more change of plantar fascia after ESWT, the more efficient on clinical outcome. PMID:29504578

  2. Heel erosion and other interdigital disorders in dairy cows

    DEFF Research Database (Denmark)

    Enevoldsen, Carsten; Gröhn, Y.T.; Thysen, Iver

    1991-01-01

    Epidemiologic associations between variables obtainable from dairy cow records and the occurrence of heel erosion, interdigital dermatitis, and interdigital hyperplasia at claw trimmings were estimated with multivariable logistic regression analysis on data from 1170 and 542 cows in lactation 1...... and lactations 2 to 9, respectively. In the 17 herds, heel erosion, interdigital dermatitis, and hyperplasia occurred among 43.8, 4.5, and .9% of cows in lactation 1 and among 69.1, 7.6 and 5.9% of cows in lactations 2 to 9, respectively. Severity of heel erosion increased with parity, and risk increased...... with stage of lactation. Strong seasonal effects were present. Various combinations of veterinary treatments were associated with heel erosion and hyperplasia depending on parity, stage of lactation, and the presence of other claw disorders. In contrast, veterinary treatment had a protective effect...

  3. Heeling Moment Acting on a River Cruiser in Manoeuvring Motion

    Directory of Open Access Journals (Sweden)

    Tabaczek Tomasz

    2016-01-01

    Full Text Available By using fully theoretical method the heeling moment due to centrifugal forces has been determined for a small river cruiser in turning manoeuvre. The authors applied CFD software for determination of hull hydrodynamic forces, and open water characteristics of ducted propeller for estimation of thrust of rudder-propellers. Numerical integration of equations of 3DOF motion was used for prediction of ship trajectory and time histories of velocities, forces and heeling moment.

  4. Necrotizing fasciitis due to Serratia marcescens: case report and review of the literature.

    Science.gov (United States)

    Majumdar, Rohit; Crum-Cianflone, Nancy F

    2016-06-01

    Necrotizing fasciitis is a severe, life-threatening infection.  Serratia marcescens, a Gram-negative bacterium, is an extremely rare cause of necrotizing fasciitis. A case of S. marcescens necrotizing fasciitis is described, and a comprehensive review of the literature (1966-2015) of monomicrobial cases due to this organism performed. We report the first case of S. marcescens necrotizing fasciitis in the setting of calciphylaxis associated with end-stage renal disease.  A comprehensive review of the literature of S. marcescens necrotizing fasciitis is provided to enhance the awareness of this increasingly recognized infection, and to provide a concise summary of risk factors, treatment, and outcome. Our case and review highlight the potential risk factors for S. marcescens necrotizing fasciitis, including underlying renal disease and open wounds, and demonstrate the emergence of this organism as a cause of severe, life-threatening soft tissue infections.

  5. Concurrent emphysematous pyelonephritis and thigh necrotizing fasciitis after intramuscular administration of diclofenac

    Directory of Open Access Journals (Sweden)

    Fateme Shamekhi Amiri

    2014-01-01

    Full Text Available Necrotizing fasciitis (NF is a rapidly progressive, life-threatening soft tissue infec-tion. NF may result from any injury to the skin or from hematogenous spread. However, con-current emphysematous pyelonephritis and necrotizing fasciitis of the left thigh has not been reported. We report a case of emphysematous pyelonephritis and necrotizing fasciitis of the left thigh after intramuscular administration of diclofenac that improved with aggressive management including broad-spectrum antibiotics, nephrectomy and surgical intervention.

  6. Necrotizing Fasciitis Caused by Hypermucoviscous Klebsiella pneumoniae in a Filipino Female in North America

    Directory of Open Access Journals (Sweden)

    Ng, Daniel

    2014-12-01

    Full Text Available Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America. [West J Emerg Med. 2015;16(1:165–168.

  7. Morphea and Eosinophilic Fasciitis: An Update.

    Science.gov (United States)

    Mertens, Jorre S; Seyger, Marieke M B; Thurlings, Rogier M; Radstake, Timothy R D J; de Jong, Elke M G J

    2017-08-01

    Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud's phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes

  8. Giant VAC in a patient with extensive necrotizing fasciitis.

    Science.gov (United States)

    Steinstraesser, Lars; Sand, Michael; Steinau, Hans-Ulrich

    2009-03-01

    The authors present a case of an extensive fulminant necrotizing fasciitis of the left flank, thigh, and lower parts of the leg treated with debridement, split-thickness skin grafting, and a giant negative pressure wound dressing covering 0.53 m( 2) or 18% of the body surface. To the authors' knowledge, this is the largest split-thickness grafted body surface successfully treated with negative pressure wound dressing documented in the literature.

  9. Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Arslan, Arzu E-mail: arzuarslan@netscape.net; Pierre-Jerome, Claude; Borthne, Arne

    2000-12-01

    The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the preoperative decision should be based mostly on the evolution of the clinical status.

  10. Damage control apronectomy for necrotising fasciitis and strangulated umbilical hernia.

    LENUS (Irish Health Repository)

    Coyle, P

    2012-01-31

    We present a case of a 50-year-old morbidly obese woman who presented with a case of necrotizing fasciitis of the anterior abdominal wall due to a strangulated umbilical hernia. The case was managed through damage control surgery (DCS) with an initial surgery to stabilise the patient and a subsequent definitive operation and biological graft hernia repair. We emphasise the relevance of DCS principles in the management of severe abdominal sepsis.

  11. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report

    LENUS (Irish Health Repository)

    Zgraj, Oskar

    2011-12-12

    Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  12. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene: a case report

    Directory of Open Access Journals (Sweden)

    Zgraj Oskar

    2011-12-01

    Full Text Available Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  13. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report.

    Science.gov (United States)

    Zgraj, Oskar; Paran, Sri; O'Sullivan, Maureen; Quinn, Feargal

    2011-12-12

    Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  14. Extended retroperitoneal necrotizing fasciitis with genital involvement, resembling fournier gangrene.

    Science.gov (United States)

    Sugimoto, Motokazu; Matsuura, Kenji; Takayama, Hiroshi; Kayo, Munefumi; Ie, Tomotsugu

    2010-10-01

    Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process. We report a 58-year-old man with rapidly progressive, gas-producing, necrotizing inflammation in the retroperitoneum, complicated with genital involvement resembling Fournier gangrene. The patient was managed successfully by aggressive drainage, debridement, and sequential laparotomies to track and control the extensive necrosis of the retroperitoneum and perineum, in addition to systemic care to control sepsis. After his general condition stabilized, early rectosigmoid adenocarcinoma was identified and resected curatively. He remained well at follow up, six months after discharge. In retrospect, the trigger of the disease process was unclear. Although it was believed possibly to be due to the colon lesion, adenocarcinoma of the rectosigmoid colon was identified and the patient was managed successfully. Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.

  15. Two Paraneoplastic Autoimmune Syndromes: Limbic Encephalitis and Palmar Fasciitis in a Patient with Small Cell Lung Cancer.

    Science.gov (United States)

    Lazarev, Irina; Shelef, Ilan; Refaely, Yael; Ariad, Samuel; Ifergane, Gal

    2015-09-07

    Small cell lung cancer (SCLC) is characterized by a relatively high rate of autoimmune phenomena. Paraneoplastic limbic encephalitis (PLE) is an autoimmune syndrome in which a non-neural tumor containing an antigen normally present in the nervous system precipitates an antibody attack on neural tissues. Patients with PLE usually present with rapidly progressive short-term memory deficits, confusion or even dementia. Palmar fasciitis and polyarthritis syndrome (PFPAS) is another autoimmune syndrome characterized by rheumatologic manifestations, especially involving the palms of the hands. We report a case of a 59-year old woman who presented with worsening neurological symptoms of two-week duration, and later coma. The combined clinical, serological, and imaging studies suggested a diagnosis of PLE. A chest computed tomographic scan showed a 1.2 cm-diameter mass in the upper lobe of the left lung that was surgically removed and showed SCLC. Following surgery, neurological symptoms rapidly improved, allowing the patient to receive adjuvant chemotherapy. While in remission for both SCLC and PLE, the patient developed pain, soft-tissue swelling, and stiffness in both palms, suggesting the diagnosis of PFPAS. Five months following the diagnosis of palmar fasciitis, SCLC relapsed with mediastinal and cervical lymphadenopathy. This case report underlines the continuous interaction of SCLC with the immune system, expressed by coexistence of two rare paraneoplastic diseases, PLE, and PFPAS, in a patient with SCLC. While symptoms related to PLE preceded the initial diagnosis of SCLC, other symptoms related to PFPAS preceded relapse.

  16. Two paraneoplastic autoimmune syndromes: limbic encephalitis and palmar fasciitis in a patient with small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Irina Lazarev

    2015-09-01

    Full Text Available Small cell lung cancer (SCLC is characterized by a relatively high rate of autoimmune phenomena. Paraneoplastic limbic encephalitis (PLE is an autoimmune syndrome in which a non-neural tumor containing an antigen normally present in the nervous system precipitates an antibody attack on neural tissues. Patients with PLE usually present with rapidly progressive short-term memory deficits, confusion or even dementia. Palmar fasciitis and polyarthritis syndrome (PFPAS is another autoimmune syndrome characterized by rheumatologic manifestations, especially involving the palms of the hands. We report a case of a 59-year old woman who presented with worsening neurological symptoms of two-week duration, and later coma. The combined clinical, serological, and imaging studies suggested a diagnosis of PLE. A chest computed tomographic scan showed a 1.2 cm-diameter mass in the upper lobe of the left lung that was surgically removed and showed SCLC. Following surgery, neurological symptoms rapidly improved, allowing the patient to receive adjuvant chemotherapy. While in remission for both SCLC and PLE, the patient developed pain, soft-tissue swelling, and stiffness in both palms, suggesting the diagnosis of PFPAS. Five months following the diagnosis of palmar fasciitis, SCLC relapsed with mediastinal and cervical lymphadenopathy. This case report underlines the continuous interaction of SCLC with the immune system, expressed by coexistence of two rare paraneoplastic diseases, PLE, and PFPAS, in a patient with SCLC. While symptoms related to PLE preceded the initial diagnosis of SCLC, other symptoms related to PFPAS preceded relapse.

  17. The 2016 HIGh Heels: Health effects And psychosexual BenefITS (HIGH HABITS study: systematic review of reviews and additional primary studies

    Directory of Open Access Journals (Sweden)

    Max Barnish

    2017-08-01

    Full Text Available Abstract Background High-heeled shoes (high heels are frequently worn by many women and form an important part of female gender identity. Issues of explicit and implicit compulsion to wear high heels have been noted. Previous studies and reviews have provided evidence that high heels are detrimental to health. However, the evidence base remains fragmented and no review has covered both the epidemiological and biomechanical literature. In addition, no review has considered the psychosexual benefits that offer essential context in understanding the public health challenge of high heels. Methods We searched seven major bibliographic databases up to November 2016, in addition to supplementary searches. We initially identified all review articles of any design that assessed either the psychosexual benefits or negative musculoskeletal health effects of high heels, the latter looking at both the epidemiological and biomechanical perspectives. We additionally considered additional primary studies on areas that had not been reviewed before or in which a marked lack of evidence had been noted. Data were extracted onto standardised forms. Proportionate second review was conducted. Results A total of 506 unique records were identified, 27 full-text publications were screened and 20 publications (7 reviews and 13 additional studies were included in our evidence synthesis. The most up-to-date epidemiological review provides clear evidence of an association between high heel wear and hallux valgus, musculoskeletal pain and first-party injury. The body of biomechanical reviews provides clear evidence of changes indicative of increased risk of these outcomes, as well as osteoarthritis, which is not yet evidenced by epidemiological studies. There were no reviews on psychosexual benefits, but all five identified original studies provided evidence of increased attractiveness and/or an impact on men’s behaviour associated with high heel wear. With regard to second

  18. Nodular fasciitis: A pseudomalignant clonal neoplasm characterized by USP gene rearrangements and spontaneous regression

    LENUS (Irish Health Repository)

    Hennebry, Jennifer

    2017-01-01

    Introduction: Nodular fasciitis (NF) is a rapidly growing, self-limited, myofibroblastic neoplasm that typically arises in subcutaneous tissues of young adults and regresses spontaneously. Nodular fasciitis mimics sarcoma on clinical, radiological, and histological grounds and is usually, diagnosed following excision.\\r\

  19. Plantar fascia softening in plantar fasciitis with normal B-mode sonography.

    Science.gov (United States)

    Wu, Chueh-Hung; Chen, Wen-Shiang; Wang, Tyng-Guey

    2015-11-01

    To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography. Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé's test was used to identify where the differences occurred. Compared to healthy participants (red pixel intensity: 146.9 ± 9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4 ± 7.3, p = 0.01), symptomatic sides of unilateral plantar fasciitis (127.1 ± 7.4, p plantar fasciitis (129.4 ± 7.5, p plantar fascia thickness or green or blue pixel intensity among these groups. Sonoelastography revealed that the plantar fascia is softer in patients with typical clinical manifestations of plantar fasciitis, even if they exhibit no abnormalities on B-mode sonography.

  20. Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report.

    Science.gov (United States)

    Yang, Bo Kyu; Yi, Seung Rim; Lee, Ye Hyun; Kim, Hyun See; Nam, Seok Woo; Ahn, Young Joon; Kim, Seong Wan; Yang, Sung Wook; Im, Se Hyuk

    2014-12-01

    As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

  1. [A patient with muscular torticollis caused by nodular fasciitis in the sternocleidomastoid muscle (SCM)].

    Science.gov (United States)

    Hemmi, Shoji; Murakami, Tatufumi; Shirabe, Teruo; Sunada, Yoshihide

    2002-09-01

    Nodular fasciitis is a benign pseudosarcomatous proliferative lesion which is frequently misdiagnosed as malignant tumor clinically and microscopically. It usually occurs as a rapidly enlarging subcutaneous mass on the upper extremities, especially on the forearm. Here we report a patient showing muscular torticollis caused by nodular fasciitis in the sternocleidomastoid muscle (SCM). A 17-year-old woman was hospitalized because of rapidly progressive torticollis. The right SCM was markedly enlarged and firm on palpation. Muscle biopsy taken from the right SCM revealed massive proliferation of spindle shaped fibroblasts infiltrating into the endomysium. These findings coincided with the intramuscular nodular fasciitis. However, different from typical nodular fasciitis, no apparent nodule formation was found in this patient. Instead, diffuse proliferative lesion extended widely into the neck soft tissue. To our knowledge, this is the first report of muscular torticollis caused by nodular fasciitis involving the SCM.

  2. Mechanical behaviour of the heel pad: experimental and numerical approach

    DEFF Research Database (Denmark)

    Matteoli, Sara; Fontanella, C. G.; Virga, A.

    The aim of the present work was to investigate the stress relaxation phenomena of the heel pad region under different loading conditions. A 31-year-old healthy female was enrolled in this study and her left foot underwent both MRI and experimental compression tests. Experimental results were...... compared with those obtained from finite element analysis performed on numerical 3D subject-specific heel pad model built on the basis of MRI. The calcaneal fat pad tissue was described with a visco-hyperelastic model, while a fiber-reinforced hyperelastic model was formulated for the skin. The reliability...

  3. Physiological Achilles' heels of Enteropathogenic bacteria in livestock

    NARCIS (Netherlands)

    Becker, P.M.

    2005-01-01

    An elaborate feeding regimen of animals, which takes advantage of the Achilles' heels of enteropathogenic bacteria, can possibly enable prophylaxis in the intestinal tract, attenuate actual disease symptoms, accelerate recovery from a bacterial gastroenteritis or ensure food safety. There is a wide

  4. When fertility is an Achilles´ heel

    DEFF Research Database (Denmark)

    Dalsgård, Anne Line

    of irresponsibility and violence, their worth as citizens of the modern Brazilian society. Making ends meet economically was only the immediate concern – what was at stake was something more fundamental: Being fertile was an Achilles’ heel, a weakness that under certain conditions was directly associated with death...

  5. Fasciitis necroticans efter artroskopi af præpatellar bursitis

    DEFF Research Database (Denmark)

    Schlesinger, NH; Friis-Møller, Alice; Hvolris, Jesper

    2007-01-01

    Necrotizing fasciitis (NF) is a life-threatening soft tissue infection in superficial and deep fascias. NF is most often caused by mixed aerobic and anaerobic bacteria. The treatment is early and aggressive surgical debridement, antibiotics and hyperbaric oxygen. In this case description, a nearly...... 60-year-old man developed NF after arthroscopic synovectomy of an infected prepatellar bursa. We stress the point that the endoscopic technique itself might be responsible for the spreading of bacteria to the fascias. This is a subject for further investigation Udgivelsesdato: 30. april...

  6. Generalized morphea/eosinophilic fasciitis overlap after epoxy exposure

    Directory of Open Access Journals (Sweden)

    Warren H. Chan, MS

    2018-03-01

    Full Text Available Generalized morphea is associated with epoxy resin vapors and is characterized by the development of lesions shortly after exposure. Morphea presenting along with eosinophilic fasciitis (EF, or morphea/EF overlap, is rare and an indicator of poor prognosis and resistance to treatment. Here we present a case of generalized morphea/EF overlap linked to epoxy exposure. Our patient received multiple therapies—ultraviolet A1 phototherapy, prednisone, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, and rituximab—none of which led to a significant response. The refractory nature of this disease warrants vigilance in its association with epoxy exposure.

  7. First Necrotizing Fasciitis Caused by Haemophilus influenza Serotype a

    Science.gov (United States)

    Quach, Giang T.; Frisby, Jared; Kralovich, Kurt; Bohra, Mustafa

    2017-01-01

    Necrotizing fasciitis (NF) is an infrequently encountered skin infection that has high morbidity and mortality, even with prompt medical and surgical intervention. We describe the case of a 67-year-old male presenting with significant NF in his left lower extremity, despite aggressive surgical intervention, and included multiple surgical debridements, ACell Matrix, split-thickness, and negative wound VAC therapy. Ultimately, this patient required a below the knee amputation. This is the first documented case of Haemophilus influenza type a causing NF. PMID:29124073

  8. Development of inexpensive prosthetic feet for high-heeled shoes using simple shoe insole model

    OpenAIRE

    Margrit R. Meier, PhD; Kerice A. Tucker, BSc; Andrew H. Hansen, PhD

    2014-01-01

    The large majority of prosthetic feet are aimed at low-heeled shoes, with a few models allowing a heel height of up to 5 cm. However, a survey by the American Podiatric Medical Association indicates that most women wear heels over 5 cm; thus, current prosthetic feet limit most female prosthesis users in their choice. Some prosthetic foot components are heel-height adjustable; however, their plantar surface shapes do not change to match the insole shapes of the shoes with different heel height...

  9. Fulminant Necrotizing Fasciitis and Toxic Shock Syndrome Caused by Streptococcus agalactiae

    Directory of Open Access Journals (Sweden)

    Emin UYSAL

    2018-03-01

    Full Text Available Necrotizing fasciitis is a rare and life-threatening soft tissue infection that spreads rapidly and involves the skin, subcutaneous tissue, fascia, and muscle layer. The treatment is possible by initiating appropriate antibiotherapy for the clinically suspected cause and by performing surgical intervention quickly and aggressively. However, it should be known that necrotizing fasciitis is a disease that is difficult to manage despite all interventions, effective treatment protocols, and patient care. This article presents the case of a 60-year-old patient with diabetes mellitus who died of toxic shock syndrome with fulminant necrotizing fasciitis caused by Streptococcus agalactiae.

  10. Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis.

    Science.gov (United States)

    Chang, Ryan; Rodrigues, Pedro A; Van Emmerik, Richard E A; Hamill, Joseph

    2014-08-22

    Clinically, plantar fasciitis (PF) is believed to be a result and/or prolonged by overpronation and excessive loading, but there is little biomechanical data to support this assertion. The purpose of this study was to determine the differences between healthy individuals and those with PF in (1) rearfoot motion, (2) medial forefoot motion, (3) first metatarsal phalangeal joint (FMPJ) motion, and (4) ground reaction forces (GRF). We recruited healthy (n=22) and chronic PF individuals (n=22, symptomatic over three months) of similar age, height, weight, and foot shape (p>0.05). Retro-reflective skin markers were fixed according to a multi-segment foot and shank model. Ground reaction forces and three dimensional kinematics of the shank, rearfoot, medial forefoot, and hallux segment were captured as individuals walked at 1.35 ms(-1). Despite similarities in foot anthropometrics, when compared to healthy individuals, individuals with PF exhibited significantly (pfoot kinematics and kinetics. Consistent with the theoretical injury mechanisms of PF, we found these individuals to have greater total rearfoot eversion and peak FMPJ dorsiflexion, which may put undue loads on the plantar fascia. Meanwhile, increased medial forefoot plantar flexion at initial contact and decreased propulsive GRF are suggestive of compensatory responses, perhaps to manage pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. 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. __________________________________________________________________________________________________________...

  12. Orbital compressed air and petroleum injury mimicking necrotizing fasciitis.

    Science.gov (United States)

    Mellington, Faye E; Bacon, Annette S; Abu-Bakra, Mohammed A J; Martinez-Devesa, Pablo; Norris, Jonathan H

    2014-09-01

    Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Necrotizing Fasciitis Secondary to Aeromonas Infection Presenting with Septic Shock

    Directory of Open Access Journals (Sweden)

    Nikhil Bhatia

    2017-01-01

    Full Text Available This report describes a case of necrotizing fasciitis presenting with septic shock due to an Aeromonas infection. The patient cut his foot while mowing the lawn and then spent time in a pool with black mold. He began feeling ill and developed swelling and a quarter-sized black area on his right lower extremity. Despite being hemodynamically unstable with systolic blood pressure in the low 70s, the patient was transferred to our facility from outside hospital 100 miles away. Upon arriving to facility, the patient appeared to be septic and the infected area of skin had grown. Irrigation and debridement were performed and appropriate antibiotic therapy was given; however, the patient subsequently died on hospital day 8. On review of the literature, cases of necrotizing fasciitis due to Aeromonas infection have been treated successfully with the aforementioned therapy; however, there is high mortality associated with these infections, many times related to a delayed diagnosis. Our patient also had multiple poor prognostic factors including hepatic dysfunction and immunosuppression.

  14. Heel and toe driving on fuel cell vehicle

    Science.gov (United States)

    Choi, Tayoung; Chen, Dongmei

    2012-12-11

    A system and method for providing nearly instantaneous power in a fuel cell vehicle. The method includes monitoring the brake pedal angle and the accelerator pedal angle of the vehicle, and if the vehicle driver is pressing both the brake pedal and the accelerator pedal at the same time and the vehicle is in a drive gear, activating a heel and toe mode. When the heel and toe mode is activated, the speed of a cathode compressor is increased to a predetermined speed set-point, which is higher than the normal compressor speed for the pedal position. Thus, when the vehicle brake is removed, the compressor speed is high enough to provide enough air to the cathode, so that the stack can generate nearly immediate power.

  15. A Case of Postsurgical Necrotizing Fasciitis Invading the Rectus Abdominis Muscle and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Francesco Carbonetti

    2014-01-01

    Full Text Available Necrotizing fasciitis is a life-threatening, soft tissue infection and an early diagnosis is needed to permit a prompt surgical and medical intervention. Due to the high fatal potential of the disease complications, the radiologist should distinguish necrotizing fasciitis from the most common soft tissue infections, in order to permit a prompt surgical and medical treatment. We present a case of a wide necrotizing fasciitis who presented at our emergency department and we also provide the basic tools, through a review of the literature, for the general radiologist to distinguish, with computed tomography and magnetic resonance imaging, necrotizing fasciitis from the most common infections that could present during our routine practice.

  16. Fulminant necrotizing fasciitis following the use of herbal concoction: a case report

    Directory of Open Access Journals (Sweden)

    Nasir Abdulrasheed A

    2010-10-01

    Full Text Available Abstract Introduction Necrotizing fasciitis is a rare and life-threatening rapidly progressive soft tissue infection. A fulminant case could involve muscle and bone. Necrotizing fasciitis after corticosteroid therapy and intramuscular injection of non-steroidal anti-inflammatory drugs has been reported. We present a case of fulminant necrotizing fasciitis occurring in a patient who used a herbal concoction to treat a chronic leg ulcer. Case presentation A 20-year-old Ibo woman from Nigeria presented with a three-year history of recurrent chronic ulcer of the right leg. She started applying a herbal concoction to dress the wound two weeks prior to presentation. This resulted in rapidly progressive soft tissue necrosis that spread from the soft tissue to the bone, despite aggressive emergency debridement. As a result she underwent above-knee amputation. Conclusion The herbal concoction used is toxic, and can initiate and exacerbate necrotizing fasciitis. Its use for wound dressing should be discouraged.

  17. The relationship between the flexible flatfoot and plantar fasciitis: ultrasonographic evaluation.

    Science.gov (United States)

    Huang, Yu-Chi; Wang, Lin-Yi; Wang, Her-Cherng; Chang, Kai-Lan; Leong, Chau-Peng

    2004-06-01

    The purpose of this study was to investigate the relationship between flexible flatfoot and plantar fasciitis. Twenty-three subjects with flexible flatfoot and 23 subjects with normal arched feet were enrolled. Footprint analysis was used to evaluate the foot conditions in both groups to calculate the individual arch index. We compared the sonographic images of plantar fascia in the flexible flatfoot group with the normal arch group using high-frequency ultrasound. The analysis results indicated that the thickening of the plantar fascia in the flexible flatfoot group was significantly different from the normal arch group. In the flexible flatfoot group, 10 of 23 patients (43.4%) had plantar fasciitis, but only two subjects (8.7%) in the normal arch group had plantar fasciitis. There was a higher incidence of plantar fasciitis in the flexible flatfoot group than the normal arch control group in this study.

  18. Prototype heel effect compensation filter for cone-beam CT

    International Nuclear Information System (INIS)

    Mori, Shinichiro; Endo, Masahiro; Nishizawa, Kanae; Ohno, Mari; Miyazaki, Hiroaki; Tsujita, Kazuhiko; Saito, Yasuo

    2005-01-01

    The prototype cone-beam CT (CBCT) has a larger beam width than the conventional multi-detector row CT (MDCT). This causes a non-uniform angular distribution of the x-ray beam intensity known as the heel effect. Scan conditions for CBCT tube current are adjusted on the anode side to obtain an acceptable clinical image quality. However, as the dose is greater on the cathode side than on the anode side, the signal-to-noise ratio on the cathode side is excessively high, resulting in an unnecessary dose amount. To compensate for the heel effect, we developed a heel effect compensation (HEC) filter. The HEC filter rendered the dose distribution uniform and reduced the dose by an average of 25% for free air and by 20% for CTDI phantoms compared to doses with the conventional filter. In addition, its effect in rendering the effective energy uniform resulted in an improvement in image quality. This new HEC filter may be useful in cone-beam CT studies. (note)

  19. Necrotizing Fasciitis and Toxic Shock Syndrome from Clostridium septicum following a Term Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    B. H. Rimawi

    2014-01-01

    Full Text Available Necrotizing fasciitis and toxic shock syndrome are life-threatening conditions that can be seen after any surgical procedure. With only 4 previous published case reports in the obstetrics and gynecology literature of these two conditions occurring secondary to Clostridium septicum, we describe a case of necrotizing fasciitis and toxic shock syndrome occurring after a term cesarean delivery caused by this microorganism, requiring aggressive medical and surgical intervention.

  20. Monomicrobial necrotizing fasciitis in a white male caused by hypermucoviscous Klebsiella pneumoniae

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon L; Brandt, Pernille B; Gad, Dorte

    2009-01-01

    We report a case of monomicrobial necrotizing fasciitis caused by hypermucoviscous Klebsiella pneumoniae in an immunocompromised white male after travel to China. The K. pneumoniae isolate belonged to the K2 serotype, and carried the virulence factors RmpA and aerobactin. To the best of our...... knowledge this is the first report of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae resembling the highly virulent K. pneumoniae isolates associated with liver abscess syndrome in Asia....

  1. A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature

    OpenAIRE

    Abdulkareem, Abdullateef; D’Souza, Ryan S.; Shogbesan, Oluwaseun; Donato, Anthony

    2017-01-01

    Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrob...

  2. Knowledge of and attitudes toward heel prick screening for sickle cell disease in Saint Lucia.

    Science.gov (United States)

    Alexander, Sonia; Belmar-George, Sharon; Eugene, Alisha; Elias, Vanessa

    2017-06-08

    In the Caribbean country of Saint Lucia, umbilical-cord-blood screening for sickle cell disease (SCD) was the testing method that health care workers (HCWs) on the maternity wards of the hospitals preferred until the new heel prick (HP) testing method was introduced in the country in 2014. This SCD study sought to assess HCWs' knowledge of and attitude toward HP screening and also determine new mothers' favorability toward HP screening. A total of 70 HCWs and 132 new mothers answered survey questionnaires in three hospitals. In addition, four focus group discussions were held, two with HCWs and two with the mothers. Among the HCWs interviewed, 85.7% of them had knowledge of the HP test. However, only 25.7% had attended training sessions on the procedure. Among the HCWs, 64.3% of them felt the HP test should be mandatory, 27.1% said it should not be mandatory, and 8.6% did not know if it should be mandatory. In their focus groups, the HCWs said they believed the mothers would accept the HP method. For their part, 22.0% of the mothers said they had heard about the HP test, and 63.6% reported knowing the reason why the baby would be tested. Further, 83.3% indicated that the test would be beneficial for the baby. In addition, 88.6% of the mothers said that more information on the HP test was needed. In their focus group discussions, the mothers said they were generally not concerned about the pain the heel prick method might cause the baby. The HCWs' knowledge of the HP screening method was high. The mothers trust HCWs, and the mothers would accept the HP procedure irrespective of their knowledge of the test and any discomfort associated with this screening method.

  3. Knowledge of and attitudes toward heel prick screening for sickle cell disease in Saint Lucia

    Directory of Open Access Journals (Sweden)

    Sonia Alexander

    2017-06-01

    Full Text Available ABSTRACT Objectives In the Caribbean country of Saint Lucia, umbilical-cord-blood screening for sickle cell disease (SCD was the testing method that health care workers (HCWs on the maternity wards of the hospitals preferred until the new heel prick (HP testing method was introduced in the country in 2014. This SCD study sought to assess HCWs’ knowledge of and attitude toward HP screening and also determine new mothers’ favorability toward HP screening. Methods A total of 70 HCWs and 132 new mothers answered survey questionnaires in three hospitals. In addition, four focus group discussions were held, two with HCWs and two with the mothers. Results Among the HCWs interviewed, 85.7% of them had knowledge of the HP test. However, only 25.7% had attended training sessions on the procedure. Among the HCWs, 64.3% of them felt the HP test should be mandatory, 27.1% said it should not be mandatory, and 8.6% did not know if it should be mandatory. In their focus groups, the HCWs said they believed the mothers would accept the HP method. For their part, 22.0% of the mothers said they had heard about the HP test, and 63.6% reported knowing the reason why the baby would be tested. Further, 83.3% indicated that the test would be beneficial for the baby. In addition, 88.6% of the mothers said that more information on the HP test was needed. In their focus group discussions, the mothers said they were generally not concerned about the pain the heel prick method might cause the baby. Conclusions The HCWs’ knowledge of the HP screening method was high. The mothers trust HCWs, and the mothers would accept the HP procedure irrespective of their knowledge of the test and any discomfort associated with this screening method.

  4. Investigation on the load-deformation curves of a human healthy heel pad

    DEFF Research Database (Denmark)

    Fontanella, C. G.; Matteoli, Sara; Carniel, E.L.

    2012-01-01

    The aims of the present work were to build a 3D subject-specific heel pad model based on the anatomy revealed by MR imaging of a subject's heel pad, and to compare the load–displacement responses obtained from this model with those obtained from a compression device used on the subject's heel pad....... A 30 year-old European healthy female (mass=54kg, height=165cm) was enrolled in this study. Her left foot underwent both MRI and compression tests. A numerical model of the heel region was developed based on a 3D CAD solid model obtained by MR images. The calcaneal fat pad tissue was described...... with a visco-hyperelastic model, while a fiber-reinforced hyperelastic model was formulated for the skin. Numerical analyses were performed to interpret the mechanical response of heel tissues. Different loading conditions were assumed according to experimental tests. The heel tissues showed a non-linear visco...

  5. Necrotizing fasciitis secondary to enterocutaneous fistula: three case reports.

    Science.gov (United States)

    Gu, Guo-Li; Wang, Lin; Wei, Xue-Ming; Li, Ming; Zhang, Jie

    2014-06-28

    Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.

  6. Flesh-Eating Disease: A Note on Necrotizing Fasciitis

    Directory of Open Access Journals (Sweden)

    H Dele Davies

    2001-01-01

    Full Text Available There has been much media attention in the past few years to the condition dubbed 'flesh-eating disease', which refers, primarily, to a form of invasive group A beta hemolytic streptococcal (GABHS infection that leads to fascia and muscle necrosis. In 1999, the Canadian Paediatric Society issued a statement on the state of knowledge and management of children, and close contacts of persons with all-invasive GABHS disease (1. The present note is intended to deal specifically with necrotizing fasciitis (NF by providing an update on the limited current state of knowledge, diagnosis and management. Surveillance to establish actual national rates and epidemiology of NF through the Canadian Paediatric Society is proposed.

  7. Diagnosis and management of necrotising fasciitis: a multiparametric approach.

    Science.gov (United States)

    Morgan, M S

    2010-08-01

    Necrotising fasciitis (NF) is situated with myositis and myonecrosis at the severe end of a spectrum of skin and soft tissue infections but is far removed from erisepelas, impetigo and cellulitis. Inexperienced clinicians are easily misled by the protean manifestations of infection, especially exotoxin or superantigen mediated consequences from streptococcal NF. Early clinical suspicion and surgery are key to improving survival, and patients with NF need integrated multidisciplinary management, adjusted to the infecting organism(s), the site of infection, and the effects from any toxins produced. A multiparametric approach, incorporating various clinical and laboratory parameters, can aid aggressive management. This review describes the diagnosis and management of the major types of NF, emphasising important aetiological clues from the history and the appropriate usage of diagnostic investigations. The potential benefits of controversial therapeutic approaches, including hyperbaric oxygen and intravenous immunoglobulin, are discussed. Copyright 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  8. Ultrasound-guided injection for plantar fasciitis: A brief review

    Directory of Open Access Journals (Sweden)

    A S Nair

    2016-01-01

    Full Text Available Plantar fasciitis (PF is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation.

  9. [Fournier gangrene (necrotizing fasciitis) in a woman with diabetes mellitus].

    Science.gov (United States)

    Kamper, Lars; Piroth, W; Haage, P

    2009-08-01

    A 67-year-old woman with insuline-dependent diabetes mellitus and chronic alcohol abuse was admitted with impaired consciousness and fever. Physical examination showed a livid induration of the perineal and vaginal soft tissues with crepitations. Laboratory tests showed greatly elevated infection parameters. Abdominal computed tomography revealed perineal and vaginal subcutaneous gas accumulation extending into the ventral abdominal wall. The combination of an obscure infection and subcutaneous genital gas accumulation suggested the diagnosis of Fournier gangrene, a necrotizing fasciitis. In spite of administration of broad-spectrum antibiotics and repeated surgical removal of necrotic tissue the patient died of multiple organ failure. Successful treatment of Fournier gangrene critically depends on immediate treatment. Administration of broad-spectrum antibiotics and aggressive surgical resection of the necrotic tissue may prevent continuing spreading of the infection. Computed tomography provides an early diagnosis and guides the presurgical evaluation of the subcutaneous spread. Georg Thieme Verlag KG Stuttgart * New York.

  10. Current concepts in the management of necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Evangelos P. Misiakos

    2014-09-01

    Full Text Available Necrotizing fasciitis is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%. Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure and liver cirrhosis. Necrotizing fasciitis is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the LRINEC score or FGSI score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites.Management of the infection begins with broad spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.

  11. Some of the factors influencing the Heel Pad Compressibility Index (HPCI): a literature search

    DEFF Research Database (Denmark)

    Matteoli, Sara; Wilhjelm, Jens E.; Torp-Pedersen, Soren T.

    2009-01-01

    The human heel pad is a complex structure that features non-linear visco-elastic characteristics as the majority of the human soft tissues. The biomechanical aspects of the heel pad are still under investigation and the influence of subject factors such as age, weight, gender, height, race......, and body activity have been reported. The aim of this paper is to study the literature in order to identify the influence of subject factors and diseases on the heel pad compressibility index....

  12. Biomechanical evaluation of heel elevation on load transfer — experimental measurement and finite element analysis

    Science.gov (United States)

    Luximon, Yan; Luximon, Ameersing; Yu, Jia; Zhang, Ming

    2012-02-01

    In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both experimental measurement and finite element analysis were used to evaluate the biomechanical effects of heel height on foot load transfer. A controlled experiment was conducted using custom-designed platforms. Under different weight-bearing conditions, peak plantar pressure, contact area and center of pressure were analyzed. A three-dimensional finite element foot model was used to simulate the high-heel support and to predict the internal stress distributions and deformations for different heel heights. Results from both experiment and model indicated that heel elevations had significant effects on all variables. When heel elevation increased, the center of pressure shifted from the midfoot region to the forefoot region, the contact area was reduced by 26% from 0 to 10.2 cm heel and the internal stress of foot bones increased. Prediction results also showed that the strain and total tension force of plantar fascia was minimum at 5.1 cm heel condition. This study helps to better understand the biomechanical behavior of foot, and to provide better suggestions for design parameters of high heeled shoes.

  13. Heel ulcers - Pressure ulcers or symptoms of peripheral arterial disease? An exploratory matched case control study.

    Science.gov (United States)

    Twilley, Heidi; Jones, Sarahjane

    2016-05-01

    To investigate the relationship between pressure ulcers of the heel and peripheral arterial disease (PAD) and determine the feasibility of conducting a statistically powered matched case control study. Evidence indicates a relationship between chronic leg ulcers and vascular disease. The relationship between pressure ulcers of the heel and vascular disease is less well established. A matched case control study. Data were collected between March 2014 and January 2015. 15 patients identified as having a grade 2, 3 or 4 pressure ulcer of the heel were compared with 15 matched controls without pressure ulcers of the heel. The primary clinical outcome measure was the ankle brachial pressure index (ABPI), where an ABPI 1.3 was considered clinically indicative of PAD. The primary feasibility outcome measure was the rate of recruitment. Eighty seven patients were reported as having foot and heel ulcers; 36 of whom were identified as having pressure ulcers of the heel, 15 (42%) of whom were recruited to the study. Patients presenting with pressure ulcers of the heel were significantly more likely to simultaneously have previously undiagnosed PAD compared with age, gender and ethnicity matched controls without pressure ulcers of the heel (odds ratio: 11, 95% confidence interval 1.99-60.57). The formation of pressure ulcers of the heel could, in some patients, be related to the presence of PAD rather than a consequence of poor quality care. Healthcare professionals should assess the patient to exclude or confirm PAD. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  14. Maternal mood and concordant maternal and infant salivary cortisol during heel lance while in kangaroo care.

    Science.gov (United States)

    Castral, T C; Warnock, F; Dos Santos, C B; Daré, M F; Moreira, A C; Antonini, S R R; Scochi, C G S

    2015-03-01

    Maternal kangaroo care (MKC) is a naturalistic intervention that alleviates neonatal pain, and mothers are assumed to play a stress regulatory role in MKC. Yet, no MKC infant pain study has examined relationship between maternal and infant stress reactivity concurrently, or whether post-partum depression and/or anxiety (PPDA) alters maternal and neonatal stress response and the regulatory effects of MKC. To examine the concordance of salivary cortisol reactivity between 42 mothers and their stable preterm infants during routine infant heel lance (HL) while in MKC and to compare salivary cortisol between groups of mothers with and without PPDA and their infants. Maternal and infant salivary cortisol samples were collected pre-HL and 20 min post-HL with two additional maternal samples at night and in the morning. Mothers and infants were allocated to with PPDA versus without PPDA study groups on the basis of maternal post-natal mental health assessment scores. Higher mothers' cortisol pre-HL was weakly associated with higher infants' salivary cortisol in response to the HL procedure. Maternal depression and/or anxiety were not associated with infants' cortisol. During HL, both groups of mothers and infants showed no change in salivary cortisol. Concordance between mother and infant salivary cortisol supports the maternal stress regulatory role in MKC. MKC may have stress regulatory benefits for mothers and their preterm infants during HL independent of PPDA. Future MKC studies that target mothers with altered mood will help to build on these findings. © 2014 European Pain Federation - EFIC®

  15. Investigation of Concrete Floor Vibration Using Heel-Drop Test

    Science.gov (United States)

    Azaman, N. A. Mohd; Ghafar, N. H. Abd; Azhar, A. F.; Fauzi, A. A.; Ismail, H. A.; Syed Idrus, S. S.; Mokhjar, S. S.; Hamid, F. F. Abd

    2018-04-01

    In recent years, there is an increased in floor vibration problems of structures like residential and commercial building. Vibration is defined as a serviceability issue related to the comfort of the occupant or damage equipment. Human activities are the main source of vibration in the building and it could affect the human comfort and annoyance of residents in the building when the vibration exceed the recommend level. A new building, Madrasah Tahfiz located at Yong Peng have vibration problem when load subjected on the first floor of the building. However, the limitation of vibration occurs on building is unknown. Therefore, testing is needed to determine the vibration behaviour (frequency, damping ratio and mode shape) of the building. Heel-drop with pace 2Hz was used in field measurement to obtain the vibration response. Since, the heel-drop test results would vary in light of person performance, test are carried out three time to reduce uncertainty. Natural frequency from Frequency Response Function analysis (FRF) is 17.4Hz, 16.8, 17.4Hz respectively for each test.

  16. Kangaroo care and behavioral and physiologic pain responses in very-low-birth-weight twins: a case study.

    Science.gov (United States)

    Cong, Xiaomei; Cusson, Regina M; Hussain, Naveed; Zhang, Di; Kelly, Sharon P

    2012-09-01

    The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition. Infant B had an incident of apnea and tachycardia by the end of the heel stick and a bradycardia episode during recovery in the IC condition. The twins had lower LF/HF ratios (better autonomic nervous system balance) during recovery in both longer and shorter KC conditions compared with the IC condition. Infant B had difficulty returning to LF/HF ratio baseline level after the painful procedure in the IC condition. These data suggest that both longer and shorter KC before and throughout painful procedures can be helpful in reducing behavioral and physiologic pain responses in preterm infants. Copyright © 2012 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  17. Successful heel pressure ulcer prevention program in a long-term care setting.

    Science.gov (United States)

    Lyman, Vicky

    2009-01-01

    Heel pressure ulcers (PUs) are common in long-term healthcare settings. Early identification of risk and the use of preventive measures are central to reducing the morbidity, mortality, and high medical costs associated with heel PUs. A Quality Improvement Process was initated based on a tailored protocol, in-service education program, and a heel protective device was approved by the US Food and Drug Administration. The Braden Scale was used to evaluate PU risk in 550 patients in a long-term healthcare facility. Patients with a Braden Scale score of 18 or less and with 1 of 7 high-risk comorbidities were considered at high risk for PUs, and this prompted a more aggressive prevention program that included a protocol for reducing the risk of heel ulceration. The number of hospital-acquired heel PUs during the 6-month preintervention period was 39. Following the intervention, there were 2 occurrences, representing a 95% reduction in heel ulcers between the 2 periods. After the cost of 2 heel protectors for 550 at-risk patients was subtracted from the estimated cost of treating the 37 heel ulcers prevented, the estimated cost savings was calculated to be between $12,400 and $1,048,400.

  18. Effect of Gender on Mechanical Properties of the Plantar Fascia and Heel Fat Pad.

    Science.gov (United States)

    Taş, Serkan

    2017-10-01

    The purpose of the study was to investigate the plantar fascia and heel fat pad stiffness and thickness parameters in females and compare these values with those of males. This study was carried out in 60 healthy sedentary participants (30 female, 30 male) between the ages of 19 and 50 years. Shear wave velocity (SWV) and thickness of the plantar fascia and heel fat pad were measured with an ultrasonography device. Males had a higher plantar fascia ( P = .037) and heel fat pad ( P = .001) thickness compared with females, but SWV of the plantar fascia ( P = .673), heel fat pad microchamber layer ( P = .240), and heel fat pad macrochamber layer ( P = .636) were similar in both groups. Body mass had a strong correlation with the plantar fascia ( r = 0.64, P plantar fascia ( r = 0.44, P Plantar fascia and heel fat pad stiffness were similar in both genders; however, females had a lower plantar fascia and heel fat pad thickness compared with males. Correlation analysis results suggest that higher plantar fascia and heel fat pad thickness in males may be related to higher body mass and height. Level III, Retrospective comparative study.

  19. Creative prosthetic foot selection enables successful ambulation in stiletto high heels.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Lipe, Delbert H; Rábago, Christopher A

    2017-11-01

    Walking in high heels presents biomechanical challenges, yet they remain part of many women's attire. However, women with a lower limb amputation are limited in available footwear options. Case description and methods: This case study is in response to one patient's assertion that she walked better and more symmetrically in heels than flat shoes with her below-knee prosthesis. She underwent gait analysis in athletic shoes and 10-cm stiletto high heels worn with a pediatric running foot to determine if these claims could be substantiated through biomechanical measures. Global gait asymmetry indices were calculated. Findings and outcomes: Asymmetry indices were nearly identical between athletic shoes and heels but joint-level findings differed substantially. Ankle mechanics were more symmetrical in heels but hip mechanics were less. The maintenance of symmetry in stiletto high heels does not imply maintenance of gait quality, as high heels are known to adversely affect some components walking mechanics. Clinical relevance Returning to high-heel wear is achievable for prosthesis users. Accommodations can be made using creativity in prosthetic foot selection to enable successful ambulation; however, attention to gait mechanics may be important for patient safety.

  20. Walking on high heels changes muscle activity and the dynamics of human walking significantly

    DEFF Research Database (Denmark)

    Simonsen, Erik B; Svendsen, Morten Bo Søndergaard; Nørreslet, Andreas

    2012-01-01

    The aim of the study was to investigate the distribution of net joint moments in the lower extremities during walking on high-heeled shoes compared with barefooted walking at identical speed. Fourteen female subjects walked at 4 km/h across three force platforms while they were filmed by five...... digital video cameras operating at 50 frames/second. Both barefooted walking and walking on high-heeled shoes (heel height: 9 cm) were recorded. Net joint moments were calculated by 3D inverse dynamics. EMG was recorded from eight leg muscles. The knee extensor moment peak in the first half of the stance...... phase was doubled when walking on high heels. The knee joint angle showed that high-heeled walking caused the subjects to flex the knee joint significantly more in the first half of the stance phase. In the frontal plane a significant increase was observed in the knee joint abductor moment and the hip...

  1. Successful Treatment of Necrotizing Fasciitis and Streptococcal Toxic Shock Syndrome with the Addition of Linezolid

    Directory of Open Access Journals (Sweden)

    Hana Rac

    2017-01-01

    Full Text Available Necrotizing fasciitis is a deep-seated subcutaneous tissue infection that is commonly associated with streptococcal toxic shock syndrome (TSS. Surgical debridement plus penicillin and clindamycin are the current standard of care. We report a case of necrotizing fasciitis and streptococcal TSS where linezolid was added after a failure to improve with standard therapy. Briefly after isolation of Streptococcus pyogenes from tissue cultures, the patient underwent two surgical debridement procedures and was changed to standard of care therapy. While the patient was hemodynamically stable, the patient’s wounds, leukocytosis, and thrombocytopenia all progressively worsened. After initiation of linezolid, the patient slowly improved clinically. The present report is the first to highlight the role of linezolid in streptococcal necrotizing fasciitis and TSS not improving with standard therapy.

  2. A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Abdullateef Abdulkareem

    2017-01-01

    Full Text Available Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrobial therapy and emergent fasciotomy with extensive debridement, his hospital course was complicated by septic shock and he required an above-the-knee amputation. Physicians need to be aware of the possibility of necrotizing fasciitis in patients presenting with skin infections after rituximab therapy.

  3. A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature.

    Science.gov (United States)

    Abdulkareem, Abdullateef; D'Souza, Ryan S; Shogbesan, Oluwaseun; Donato, Anthony

    2017-01-01

    Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrobial therapy and emergent fasciotomy with extensive debridement, his hospital course was complicated by septic shock and he required an above-the-knee amputation. Physicians need to be aware of the possibility of necrotizing fasciitis in patients presenting with skin infections after rituximab therapy.

  4. Necrotizing fasciitis with toxic shock syndrome in 5 month old baby: A case report

    Directory of Open Access Journals (Sweden)

    Abbas Al-Ramzi

    2017-12-01

    Full Text Available Necrotizing fasciitis is considered to be a severe form of soft-tissue infection that is accompanied with rapidly progressive necrosis to the subcutaneous tissue layer and the superficial fascia. It is also characterized by early development of systemic toxicity. The invasive Streptococcus pyogenes is the most often encountered species as a cause of this disease. The delay in diagnosing is common as the differentiation of the evolving necrotizing fasciitis from cellulitis can be very difficult. Treatments include rapid radical debridement and administration of appropriate antibiotics. However, even with proper treatment, the mortality rate is considered to be high. We reported a 5-month-old girls with fatal necrotizing fasciitis associated with toxic shock–like syndrome due to Streptococcal infection.

  5. The influence of heel height on utilized coefficient of friction during walking.

    Science.gov (United States)

    Blanchette, Mark G; Brault, John R; Powers, Christopher M

    2011-05-01

    Wearing high heel shoes has been associated with an increased potential for slips and falls. The association between wearing high heels and the increased potential for slipping suggests that the friction demand while wearing high heels may be greater when compared to wearing low heel shoes. The purpose of this study was to determine if heel height affects utilized friction (uCOF) during walking. A secondary purpose of this study was to compare kinematics at the ankle, knee, and hip that may explain uCOF differences among shoes with varied heel heights. Fifteen healthy women (mean age 24.5±2.5yrs) participated. Subjects walked at self-selected velocity under 3 different shoe conditions that varied in heel height (low: 1.27cm, medium: 6.35cm, and high: 9.53cm). Ground reaction forces (GRFs) were recorded using a force platform (1560Hz). Kinematic data were obtained using an 8 camera motion analysis system (120Hz). Utilized friction was calculated as the ratio of resultant shear force to vertical force. One-way repeated measures ANOVAs were performed to test for differences in peak uCOF, GRFs at peak uCOF and lower extremity joint angles at peak uCOF. On average, peak uCOF was found to increase with heel height. The increased uCOF observed in high heel shoes was related to an increase in the resultant shear force and decrease in the vertical force. Our results signify the need for proper public education and increased footwear industry awareness of how high heel shoes affect slip risk. Copyright © 2011 Elsevier B.V. All rights reserved.

  6. Epidemiology of High-Heel Shoe Injuries in U.S. Women: 2002 to 2012.

    Science.gov (United States)

    Moore, Justin Xavier; Lambert, Brice; Jenkins, Gabrielle P; McGwin, Gerald

    2015-01-01

    The purpose of the present study was to investigate the epidemiology of high-heel-related injuries among a nationally representative population of women in the United States and to analyze the demographic differences within this group. The data used in the present study were collected from the Consumer Product Safety Commission's National Electronic Injury Surveillance System. A total of 3294 injuries, representing an estimated 123,355 high-heel-related injuries, were treated in emergency departments within the United States from 2002 to 2012. The overall rate of high-heel-related injuries for the study was 7.32 per 100,000 females (95% confidence interval 7.08 to 7.56). The injury rate was greatest for young adult females, with the greatest rates observed for those aged 20 to 29 years (18.38 per 100,000 females) and those aged 30 to 39 years (11.07 per 100,000 females). The results from the present study suggest that high-heel-related injuries have nearly doubled during the 11-year period from 2002 to 2012. Injuries from high heels are differential by body region, with most injuries occurring as sprains and strains to the foot and ankle. Although high heels might be stylish, from a health standpoint, it could be worthwhile for females and those interested in wearing high heels to understand the risks of wearing high-heeled shoes and the potential harm that precarious activities in high-heeled shoes can cause. The results of the present study can be used in the development of a prospective cohort study to investigate the risk of injury from high-heeled shoes, accounting for the exposure time and studying differences in demographics (e.g., age and race). Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. The validity and reliability of a dynamic neuromuscular stabilization-heel sliding test for core stability.

    Science.gov (United States)

    Cha, Young Joo; Lee, Jae Jin; Kim, Do Hyun; You, Joshua Sung H

    2017-10-23

    Core stabilization plays an important role in the regulation of postural stability. To overcome shortcomings associated with pain and severe core instability during conventional core stabilization tests, we recently developed the dynamic neuromuscular stabilization-based heel sliding (DNS-HS) test. The purpose of this study was to establish the criterion validity and test-retest reliability of the novel DNS-HS test. Twenty young adults with core instability completed both the bilateral straight leg lowering test (BSLLT) and DNS-HS test for the criterion validity study and repeated the DNS-HS test for the test-retest reliability study. Criterion validity was determined by comparing hip joint angle data that were obtained from BSLLT and DNS-HS measures. The test-retest reliability was determined by comparing hip joint angle data. Criterion validity was (ICC2,3) = 0.700 (preliability was (ICC3,3) = 0.953 (pvalidity data demonstrated a good relationship between the gold standard BSLLT and DNS-HS core stability measures. Test-retest reliability data suggests that DNS-HS core stability was a reliable test for core stability. Clinically, the DNS-HS test is useful to objectively quantify core instability and allow early detection and evaluation.

  8. Can an off-the-rack orthotic stiletto alter pressure and comfort scores in the forefoot, arch and heel?

    DEFF Research Database (Denmark)

    Penny, Jeannette Østergaard; Speedtsberg, Merete Brink; Kallemose, Thomas

    2018-01-01

    MTH2+3 pressure (p rack orthotic stilettos can notably reduce...... plantar pressures and improve forefoot and heel comfort during everyday use. Practitioner Summary: Off-the-rack orthotic stilettos with built-in metatarsal pad, arch support and heel caps can lower the pressure under the heel and forefoot in comparison with a standard stiletto and can improve comfort...

  9. Necrotizing fasciitis of the lower extremity: a case report and current concept of diagnosis and management.

    LENUS (Irish Health Repository)

    Naqvi, G A

    2012-02-01

    Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge.

  10. Necrotizing Fasciitis of the Chest in a Neonate in Southern Nigeria

    Directory of Open Access Journals (Sweden)

    Oluwafemi Olasupo Awe

    2014-01-01

    Full Text Available We discuss the successful saving of a male neonate with necrotizing fasciitis of the chest following a hot fomentation of the umbilicus with exposure of the ribs and the pleural space on the right side. He recovered 5 weeks after admission. We stressed the need to recognize necrotizing fasciitis extending from the upper anterior abdominal wall to the chest following hot fomentation of the umbilicus. The need for multidisciplinary cooperation for excellent outcome is very important, that is, neonatologist, medical microbiologist, and plastic and chest surgeons.

  11. Necrotizing fasciitis following venomous snakebites in a tertiary hospital of southwest Taiwan

    Directory of Open Access Journals (Sweden)

    Yao-Hung Tsai

    2017-10-01

    Conclusions: Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000 cells/mm3 and ≥80% of segmented leukocyte forms. Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.

  12. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola

    Directory of Open Access Journals (Sweden)

    Kim Si-Hyun

    2012-03-01

    Full Text Available Abstract Background Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known. Case presentation We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement. Conclusions R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.

  13. A rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Carmen E. Flores

    2017-11-01

    Conclusions: Necrotizing fasciitis of the head and neck demands a high index of suspicion involving a multidisciplinary team, rapid diagnostic measures and aggressive surgical and antibiotic management as the mainstay of treatment in reversing this potentially fulminant and lethal disease process. In this rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis, the infection spread across cervical fascial planes onto the anterior chest wall rather than dissecting as usual to the parapharyngeal, retropharyngeal spaces or mediastinum. Extensive and potentially disfiguring debridements may be necessary to obtain negative margins with frequent reoperations until the patient is ready for reconstruction.

  14. Radiation levels on empty cylinders containing heel material

    Energy Technology Data Exchange (ETDEWEB)

    Shockley, C.W. [Martin Marietta Energy Systems, Inc., Paducah, KY (United States)

    1991-12-31

    Empty UF{sub 6} cylinders containing heel material were found to emit radiation levels in excess of 200 mr/hr, the maximum amount stated in ORO-651. The radiation levels were as high as 335 mr/hr for thick wall (48X and 48Y) cylinders and 1050 mr/hr for thin wall (48G and 48H) cylinders. The high readings were found only on the bottom of the cylinders. These radiation levels exceeded the maximum levels established in DOT 49 CFR, Part 173.441 for shipment of cylinders. Holding periods of four weeks for thick-wall cylinders and ten weeks for thin-wall cylinders were established to allow the radiation levels to decay prior to shipment.

  15. [Hidradenocarcinoma of the heel associated with inguinal metastases].

    Science.gov (United States)

    Labbardi, W; Hali, F; Marnissi, F; Cribier, B; Chiheb, S

    Hidradenocarcinoma is a rare malignant tumour involving the sweat glands. It classically arises de novo, only rarely resulting from pre-existing hidradenoma. The literature contains few reports of lymph node metastasis in this tumour. We report a case of a patient with hidradenocarcinoma of the heel associated with inguinal node metastases. We report the case of a 64-year-old patient with a history of chronic smoking, who in the last two years developed a painless nodule in his right heel, with no prior injury, and which gradually increased in size to become an ulcerated tumour. Physical examination revealed a rounded tumour mass, ulcerated in the centre, and associated with multiple inguinal adenopathies. Histological and immunohistochemical examination was suggestive of hidradenocarcinoma. The patient had undergone extensive local excision with inguinal lymphadenectomy. Histological examination showed infiltration of lymph nodes by the tumour with capsular rupture. Radiotherapy was subsequently given. The outcome was good without recurrence after 34 months of follow-up. Hidradenocarcinoma is a rare malignant tumour. Diagnosis is based on histological and immunohistochemical examination. However, hidradenocarcinoma may on occasion be difficult to differentiate from hidradenoma, a benign tumour, hence the interest of complete surgical resection with safety margins even in the absence of cytological malignancy. Local recurrences are common. The occurrence of lymph node metastasis during hidradenocarcinoma has been described only rarely in the literature. Such metastases usually occur after tumour resection. The specific features of our case are the rarity of lymph node metastases in hidradenocarcinoma coupled with the fact that these metastases were discovered upon diagnosis of the primary tumour. Copyright © 2017. Published by Elsevier Masson SAS.

  16. Effects of skin-to-skin contact on autonomic pain responses in preterm infants.

    Science.gov (United States)

    Cong, Xiaomei; Cusson, Regina M; Walsh, Stephen; Hussain, Naveed; Ludington-Hoe, Susan M; Zhang, Di

    2012-07-01

    The purpose of this randomized crossover trial was to determine the effects on autonomic responses in preterm infants of longer Kangaroo Care (30 minutes, KC30) and shorter KC (15 minutes, KC15) before and throughout heel stick compared with incubator care (IC). Beat-to-beat heart rate (HR) and spectral power analysis of heart rate variability, low frequency power (LF), high frequency power (HF), and LF/HF ratio were measured in 26 infants. HR changes from Baseline to Heel Stick were significantly less in KC30 and KC15 than in IC, and more infants had HR decrease in IC than in 2 KC conditions. In IC, LF and HF significantly increased from Baseline to Heel Stick and dropped from Heel Stick to Recovery; in 2 KC conditions, no changes across study phases were found. During Heel Stick, LF and HF were significantly higher in IC than in KC30. In all 3 conditions, LF/HF ratio decreased from Baseline to Heel Stick and increased to Recovery; no differences were found between IC and two KC conditions. Both longer and shorter KC before and throughout heel stick can stabilize HR response in preterm infants, and longer KC significantly affected infants' sympathetic and parasympathetic responses during heel stick compared with incubator care. This study showed that KC has a significant effect on reducing autonomic pain responses in preterm infants. The findings support that KC is a safe and effective pain intervention in the neonatal intensive care unit. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

  17. [Comparison of efficacy of heel ulcer prevention between classic padded bandage and polyurethane heel in a medium-stay hospital: randomized controlled trial].

    Science.gov (United States)

    Ferrer Solà, Marta; Espaulella Panicot, Joan; Altimires Roset, Jacint; Ylla-Català Borè, Elisenda; Moreno Susi, María

    2013-01-01

    The aim of the study is to determine the incidence of heel pressure ulcers (UPPT) and to compare the two systems for UPPT prevention: classic padded bandage and polyurethane heel. Prospective intervention study in a medium-long hospital stay of all people admitted that had no UPPT but had a risk of UPPT according to the Braden Scale or clinical judgment. The patients were randomized to prevention with classic padded bandage or polyurethane heel. The outcome variable was the incidence of UPPT for each study group, which was recorded every 15 days or when there were clinical changes. Of the 940 patients evaluated, 409 with a mean age of 80.5 years and 59.1% women,were included in the study. Of these, 78% had Barthel score ≤30; 28.6% dementia; delirium 37.6%; 27.6% diabetes; and 19.6% other UPP. The overall incidence was 2.9% UPPT; 2.49% in the classic padded bandage and 3.37% in the polyurethane heel group (p=0.82). No statistically significant differences were observed between the group with the classical dressing and the group with the polyurethane heel dressing. The use of multiple measures to prevent UPPT achieved a low incidence of these. Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.

  18. Severe form of streptococcal necrotizing fasciitis of the upper limb - diagnostic and therapeutic challenge: A case report

    Directory of Open Access Journals (Sweden)

    Mikić Dragan

    2015-01-01

    Full Text Available Introduction. Since delay in recognition and effective treatment of necrotizing fasciitis (NF caused by invasive group A streptococcus increases the mortality and disability, the early diagnosis and management of this disease are essential for a better outcome. We presented a patient with a severe form of streptococcal NF of the left upper limb in whom amputation was performed as a life saving procedure. Case report. A 65-year-old man, previously healthy, suffered an injury to his left hand by sting on a fish bone. Two days after that the patient got fever, redness, swelling and pain in his left hand. Clinical examination of the patient after admission indicated NF that spread quickly to the entire left upper limb, left armpit, and the left side of the chest and abdomen. Despite the use of aggressive antibiotic and surgical therapy severe destruction of the skin and subcutaneous tissues developed with the development of gangrene of the left upper limb. In this situation, the team of specialists decided that the patient must be operated on submited to amputation of the left arm, at the shoulder. After amputation and aggressive debridement of soft tissue on the left side of the trunk, the patient completely recovered. β-hemolytic streptococcus group A was isolated from the skin and tissue obtained during the surgery. Conclusion. In the most severe forms of streptococcal NF of the extremities, adequate multidisciplinary treatment, including limb amputation, can save the life of a patient.

  19. Necrotizing Fasciitis versus Pyomyositis: Discrimination with Using MR Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Seok, Jee Hyun; Jee, Won Hee; Chun, Kyung Ah; Kim, Ji Young; Jung, Chan Kwon; Kim, Yang Ree; Kim, Yang Soo; Chung, Yang Guk [The Catholic University of Korea, Seoul (Korea, Republic of); Eo, Wan Kyu [KyungHee University, Seoul (Korea, Republic of)

    2009-04-15

    We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM). The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them. The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2- weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2- weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively. MR imaging is helpful for differentiating between NF and PM.

  20. Necrotizing Fasciitis versus Pyomyositis: Discrimination with Using MR Imaging

    International Nuclear Information System (INIS)

    Seok, Jee Hyun; Jee, Won Hee; Chun, Kyung Ah; Kim, Ji Young; Jung, Chan Kwon; Kim, Yang Ree; Kim, Yang Soo; Chung, Yang Guk; Eo, Wan Kyu

    2009-01-01

    We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM). The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them. The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2- weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2- weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively. MR imaging is helpful for differentiating between NF and PM

  1. Facial paralysis as a result of severe cervico-facial necrotizing fasciitis

    African Journals Online (AJOL)

    Necrotizing fasciitis (NF) is a progressive, rapidly spreading, inflammatory infection characterized by necrosis of the deep fascia, with secondary effect on the subcutaneous tissue and differing degrees of toxicity. It is a fairly rare entity in the cervico-facial region where it usually originates from odontogenic infection; gingivitis ...

  2. Necrotizing fasciitis in a plastic surgery unit: a report of ten patients ...

    African Journals Online (AJOL)

    Background: Diffuse necrotizing fasciitis is the most treacherous soft tissue infection particularly because it may masquerade as simple cellulitis, thereby delaying diagnosis and treatment. Necrotizing fascitis correspond to deeper burns and require resuscitation, early debridement and skin coverage. It runs a rapid clinical ...

  3. Penile abscess and necrotizing fasciitis secondary to neglected false penile fracture

    Directory of Open Access Journals (Sweden)

    Al-Reshaid Reshaid

    2010-01-01

    Full Text Available Penile infection and abscess formation have been described in association with priapism, cavernosography, intracavernosal injection therapy, trauma and penile prosthesis. We report a case of penile abscess and necrotizing fasciitis of penile skin in a 37-year-old male, presented 3 weeks after neglected false penile fracture.

  4. Life-threatening necrotizing fasciitis of the neck: an unusual consequence of a sore throat

    NARCIS (Netherlands)

    Persaud, R.; Krahé, D.; Georgalas, C.; Kaniyur, S.; Das, S.; Alusi, G.

    2004-01-01

    BACKGROUND: Necrotizing fasciitis is life-threatening bacterial infection which spreads with frightening speed along the fascial planes resulting in extensive tissue necrosis and often death. The infection is caused by either Group A streptococci or a combination of aerobic and anaerobic bacteria.

  5. Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens

    Directory of Open Access Journals (Sweden)

    Hsu Wei-Hsiu

    2011-01-01

    Full Text Available Abstract Background Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen. Methods Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1 and 35 patients with a gram-negative pathogen (Group 2. Results Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors. Conclusions Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.

  6. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis.

    Science.gov (United States)

    Fox, Thomas Peter; Oliver, Govind; Wek, Caesar; Hester, Thomas

    2013-08-16

    We report the case of a 72-year-old woman suffering with severe plantar fasciitis who received a therapeutic corticosteroid injection. Two-and-a-half years after the injection she developed a small calcified lump under the skin which subsequently caused ulceration and infection. She went on to develop a diabetic foot infection requiring an extended course of intravenous antibiotics.

  7. Long-term outcome of eosinophilic fasciitis : A cross-sectional evaluation of 35 patients

    NARCIS (Netherlands)

    Mertens, JS; Thurlings, Rogier M; Kievit, Wietske; Seyger, Marieke M B; Radstake, Timothy R D; de Jong, Elke M G J

    BACKGROUND: Eosinophilic fasciitis (EF) is a connective tissue disease with an unknown long-term course. OBJECTIVE: To evaluate presence and determinants of residual disease damage in patients with EF after long-term follow-up. METHODS: Patients with biopsy-proven EF were included for this

  8. Long-term outcome of eosinophilic fasciitis: A cross-sectional evaluation of 35 patients

    NARCIS (Netherlands)

    Mertens, J.S.; Thurlings, R.M.; Kievit, W.; Seyger, M.M.B.; Radstake, T.R.D.J.; Jong, E.M.G.J. de

    2017-01-01

    BACKGROUND: Eosinophilic fasciitis (EF) is a connective tissue disease with an unknown long-term course. OBJECTIVE: To evaluate presence and determinants of residual disease damage in patients with EF after long-term follow-up. METHODS: Patients with biopsy-proven EF were included for this

  9. Cervical nodular fasciitis in a 10-year-old girl: a case report of a rare ...

    African Journals Online (AJOL)

    Thus, as clinical and morphologic characteristics are similar to those of malignant tumours, this entity is often misdiagnosed, with a few cases described in the literature. We present a case of nodular fasciitis involving the retropharynx and hypopharynx of a 10-year-old girl and discuss the importance of considering this rare ...

  10. Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: A test-retest intra- and intertester study.

    Science.gov (United States)

    Johannsen, Finn; Jensen, Signe; Stallknecht, Sandra E; Olsen, Lars Otto; Magnusson, S Peter

    2016-10-01

    To determine intra- and interobserver reliability and precision of sonographic (US) scanning in measuring thickness of the Achilles tendon, plantar fascia, and heel fat pad in patients with heel pain. Seventeen consecutive patients referred with heel pain were included. Two evaluators blinded to the diagnosis performed independently US scanning of both feet without any dialogue with the patient. The examiner left the room, and the next examiner entered. All patients had two US scans performed by each examiner. Two months later, the US images were randomly presented to the evaluators for measurements. Reliability and agreement were assessed by calculation of intraclass correlation coefficient (ICC), 95% limits of agreement (LOA), and typical error (TE). LOA was calculated as a percentage of the mean thickness of each structure to obtain a unitless parameter. We found excellent intratester reliability (ICC 0.78-0.98) and good intertester reliability using one measurement (ICC 0.72-0.91) and excellent (ICC 0.85-0.95) when using average of two measurements. The intratester agreements were good with LOA: 9.5-23.4% and TE: 3.4-8.4%. The intertester agreements were acceptable using one measurement with LOA: 16.1-36.4%, and better using two measurements with LOA: 14.4-33.2%. US is a reliable technique of measurement in the daily clinic, and one single measurement is sufficient. In research, we recommend that the same observer performs the US measurements, if one single scanning is preferred; if more researchers are involved, the average measurement of two US scans is recommended. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:480-486, 2016. © 2016 Wiley Periodicals, Inc.

  11. Influence of a Viscoelastic Insole on Foot, Knee and Back Pain among Members of the United States Army Band

    Science.gov (United States)

    2010-07-13

    Attenuation of spinal transients at heel strike using viscoelastic heel insoles: an in vivo study. Preventive Medicine. 2004;39:351-354. 30...2009 – March 2010 A-4 35. Bender JA, Pierson JK, Kaplan HM, Johnson AJ. Factors affecting the occurrence of knee injuries . Journal of the...EPIDEMIOLOGICAL REPORT NO. 12-HF-97G010-09 INFLUENCE OF A VISCOELASTIC INSOLE ON FOOT, KNEE AND BACK PAIN AMONG MEMBERS

  12. The Rare Benign Lesion That Mimics a Malignant Tumor in Breast Parenchyma: Nodular Fasciitis of the Breast

    Directory of Open Access Journals (Sweden)

    Hilal Erinanc

    2018-01-01

    Full Text Available We herein report the clinical and pathological findings of a rare case of nodular fasciitis in the breast parenchyma of a 48-year-old female. Because of potentially malignant findings on ultrasonography and during clinical examination, the patient underwent an excisional biopsy. Histologically, the lesion was composed of spindle to round shaped cells arranged in short bundles in a storiform pattern. Immunohistochemically, the cells were positive for vimentin and SMA and negative for desmin, S100, and CD34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. We emphasize that nodular fasciitis of the breast may show clinical features and imaging findings similar to those of breast cancer. The histopathologic diagnosis of nodular fasciitis can also be challenging. The purpose of this case report is to highlight the characteristics and the differential diagnosis of this rare neoplasm.

  13. The effectiveness of combined prescription of ankle–foot orthosis and stretching program for the treatment of recalcitrant plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Rehab A.E. Sallam

    2016-01-01

    Combined prescription of night-stretch ankle–foot orthosis and stretching exercises for plantar flexors and fascia had greater therapeutic effects compared with each treatment alone. Stretching exercises alone are not beneficial in the treatment of recalcitrant plantar fasciitis.

  14. Development of inexpensive prosthetic feet for high-heeled shoes using simple shoe insole model.

    Science.gov (United States)

    Meier, Margrit R; Tucker, Kerice A; Hansen, Andrew H

    2014-01-01

    The large majority of prosthetic feet are aimed at low-heeled shoes, with a few models allowing a heel height of up to 5 cm. However, a survey by the American Podiatric Medical Association indicates that most women wear heels over 5 cm; thus, current prosthetic feet limit most female prosthesis users in their choice. Some prosthetic foot components are heel-height adjustable; however, their plantar surface shapes do not change to match the insole shapes of the shoes with different heel heights. The aims of the study were therefore (1) to develop a model that allows prediction of insole shape for various heel height shoes in combination with different shoe sizes and (2) to develop and field-test low-cost prototypes of prosthetic feet whose insole shapes were based on the new model. An equation was developed to calculate insole shapes independent of shoe size. Field testing of prototype prosthetic feet fabricated based on the equation was successful and demonstrated the utility of the equation.

  15. Shoe heel abrasion and its possible biomechanical cause: a transversal study with infantry recruits.

    Science.gov (United States)

    Baumfeld, Daniel; Raduan, Fernando C; Macedo, Benjamim; Silva, Thiago Alexandre Alves; Baumfeld, Tiago; Favato, Danilo Fabrino; de Andrade, Marco Antonio Percope; Nery, Caio

    2015-11-19

    Excessive shoe heel abrasion is of concern to patients and shoe manufacturers, but little scientific information is available about this feature and its possible causes. The purpose of this study was to relate this phenomenon with biomechanical factors that could predispose to shoe heel abrasion. Ninety-seven recruits (median age 25) were enrolled in this study. Shoe abrasion was assessed manually with a metric plastic tape on the posterior part of the heel that comes in contact with the ground. The number of sprains, foot alignment, and calf muscle shortening (Silfverskiold test) was also assessed in order to relate it with shoe heel abrasion. After using our exclusion criteria, 86 recruits and 172 were considered for this study. The most common abrasion site was the lateral portion of the heel surface (50 %). Forty-four percent of the participants had neutral hind-foot alignment and 39 % had valgus alignment. Twenty-six (30 %) patients have had previous ankle or foot sprains. Neutral foot was related with less calf muscle shortening. On the other hand, valgus hind-foot alignment was more associated with Achilles shortening (p study was able to correlate shoe heel abrasion with biomechanical causes (neutral alignment-uniform abrasion/varus alignment-central and lateral abrasion). More effort has to be done to continue evaluating outsole abrasion with its possible biomechanical cause in order to predict and treat possible associated injuries.

  16. Study on lumbar kinematics and the risk of low back disorder in female university students by using shoes of different heel heights.

    Science.gov (United States)

    Iqbal, Rauf; De, Amitabha; Mishra, Wricha; Maulik, Shreya; Chandra, A M

    2012-01-01

    The study was taken up to investigate the effects of heel heights on lumbar kinematics and the risk of Low Back Disorder (LBD) in females. Nineteen female university students (24.5 ± 3.36 yrs) volunteered in the study. Lumbar kinematics was measured by using Industrial Lumbar Motion Monitor (iLMM). The volunteers were asked to walk for a distance of 50 meters in 3 different given conditions i.e bare foot (Heel 0), with flat heels (Heel 1) and with high heels (Heel 2). Heights of Heel 1 and Heel 2 were 1.5 ± 0.84 cm and 5.5 ± 1.70 cm respectively. The Lumbar kinematic parameters studied were- Average Twisting Velocity (ATV), Maximum Sagital Flexion (MSF) and Maximum Lateral Velocity (MLV). It was observed that all the above mentioned Lumbar kinematics - ATV, MSF and MLV increases with increase of heel heights, which in turn increases the risk of LBD. As a result of increase in Lumbar kinematic values with increase in heel heights, LBD risk has also increased. Mean and SD of the LBD risk with Heel 0, Heel 1 and Heel 2 were 16.79 ± 6.04%, 19.00 ± 7.38% and 22.11 ± 6.98% respectively. Lower stature with high heels showed higher risk of LBD than the higher stature with high heels.

  17. Nodular fasciitis: correlation of MRI findings and histopathology

    International Nuclear Information System (INIS)

    Wang, X.L.; De Schepper, A.M.A.; Vanhoenacker, F.; Gielen, J.; De Raeve, H.; Aparisi, F.; Rausin, L.; Somville, J.

    2002-01-01

    Objective: To compare the histopathology of nodular fasciitis (NF) with the magnetic resonance imaging (MRI) findings in order to evaluate the basis of the MR signal characteristics. Design and patients: Ten patients with NF, nine females and 1 male, with an age ranging from 13 to 58 years (mean 26.8 years) were studied. MRI findings, available in all 10 patients, were compared with the histopathology in nine patients, and an area-to-area comparative study of the whole specimen section histopathology and MRI was performed in two patients. Results: On the basis of an excisional biopsy or resection specimen, the nine lesions were classified into myxoid (n=4), cellular (n=3) and fibrous (n=2) subtypes. Four myxoid lesions with a subcutaneous location showed a homogeneous SI comparable with muscle on T1-weighted images, high SI on T2-weighted images, and had homogeneous enhancement. One cellular lesion presented with homogeneous, slightly higher SI than muscle on T1-weighted images and inhomogeneous, high SI on T2-weighted images. Alcian blue stain of the whole specimen section revealed the lesion had two parts corresponding to different enhancement patterns on MRI. The blue-stained myxoid part showed markedly diffuse enhancement, while the non-stained cystic space had only peripheral enhancement. Two other cellular lesions had the same appearance on both T1- and T2-weighted images and showed inhomogeneous, diffuse enhancement. One fibrous subtype lesion presented with inhomogeneous, overall slightly higher SI than muscle on T1-weighted images, lower SI at the periphery and high SI in the center on STIR images and only peripheral enhancement. Microscopy and CD-31 staining of the lesion showed more extracellular matrix, with poor vascularity in the center and more collagenous matrix with higher vascularity at the periphery. Conclusion: Although similar findings were found in some lesions, the large histologic variability of NF hampers the definition of a prototype of NF

  18. Heel effect adaptive flat field correction of digital x-ray detectors

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Yongjian [X-ray Products, Varian Medical Systems Inc., Liverpool, New York 13088 (United States); Wang, Jue [Department of Mathematics, Union College, Schenectady, New York 12308 (United States)

    2013-08-15

    Purpose: Anode heel effect renders large-scale background nonuniformities in digital radiographs. Conventional offset/gain calibration is performed at mono source-to-image distance (SID), and disregards the SID-dependent characteristic of heel effect. It results in a residual nonuniform background in the corrected radiographs when the SID settings for calibration and correction differ. In this work, the authors develop a robust and efficient computational method for digital x-ray detector gain correction adapted to SID-variant heel effect, without resorting to physical filters, phantoms, complicated heel effect models, or multiple-SID calibration and interpolation.Methods: The authors present the Duo-SID projection correction method. In our approach, conventional offset/gain calibrations are performed only twice, at the minimum and maximum SIDs of the system in typical clinical use. A fast iterative separation algorithm is devised to extract the detector gain and basis heel patterns from the min/max SID calibrations. The resultant detector gain is independent of SID, while the basis heel patterns are parameterized by the min- and max-SID. The heel pattern at any SID is obtained from the min-SID basis heel pattern via projection imaging principles. The system gain desired at a specific acquisition SID is then constructed using the projected heel pattern and detector gain map.Results: The method was evaluated for flat field and anatomical phantom image corrections. It demonstrated promising improvements over interpolation and conventional gain calibration/correction methods, lowering their correction errors by approximately 70% and 80%, respectively. The separation algorithm was able to extract the detector gain and heel patterns with less than 2% error, and the Duo-SID corrected images showed perceptually appealing uniform background across the detector.Conclusions: The Duo-SID correction method has substantially improved on conventional offset/gain corrections for

  19. Heel effect adaptive flat field correction of digital x-ray detectors

    International Nuclear Information System (INIS)

    Yu, Yongjian; Wang, Jue

    2013-01-01

    Purpose: Anode heel effect renders large-scale background nonuniformities in digital radiographs. Conventional offset/gain calibration is performed at mono source-to-image distance (SID), and disregards the SID-dependent characteristic of heel effect. It results in a residual nonuniform background in the corrected radiographs when the SID settings for calibration and correction differ. In this work, the authors develop a robust and efficient computational method for digital x-ray detector gain correction adapted to SID-variant heel effect, without resorting to physical filters, phantoms, complicated heel effect models, or multiple-SID calibration and interpolation.Methods: The authors present the Duo-SID projection correction method. In our approach, conventional offset/gain calibrations are performed only twice, at the minimum and maximum SIDs of the system in typical clinical use. A fast iterative separation algorithm is devised to extract the detector gain and basis heel patterns from the min/max SID calibrations. The resultant detector gain is independent of SID, while the basis heel patterns are parameterized by the min- and max-SID. The heel pattern at any SID is obtained from the min-SID basis heel pattern via projection imaging principles. The system gain desired at a specific acquisition SID is then constructed using the projected heel pattern and detector gain map.Results: The method was evaluated for flat field and anatomical phantom image corrections. It demonstrated promising improvements over interpolation and conventional gain calibration/correction methods, lowering their correction errors by approximately 70% and 80%, respectively. The separation algorithm was able to extract the detector gain and heel patterns with less than 2% error, and the Duo-SID corrected images showed perceptually appealing uniform background across the detector.Conclusions: The Duo-SID correction method has substantially improved on conventional offset/gain corrections for

  20. Investigations on the visco-elastic behaviour of a human healthy heel pad: in vivo compression tests and numerical analysis

    DEFF Research Database (Denmark)

    Matteoli, Sara; Fontanella, Chiara G.; Carniel, Emanuele L.

    2013-01-01

    The aim of this study was to investigate the viscoelastic behaviour of the human heel pad by comparing the stress–relaxation curves obtained from a compression device used on an in vivo heel pad with those obtained from a threedimensional computer-based subject-specific heel pad model subjected...... numerical analyses were performed to interpret the mechanical response of heel tissues, with loading conditions and displacement rate in agreement with experimental tests. The heel tissues showed a non-linear, viscoelastic behaviour described by characteristic hysteretic curves, stress......–relaxation and viscous recovery phenomena. The reliability of the investigations was validated by the interpretation of the mechanical response of heel tissues under the application of three pistons with diameter of 15, 20 and 40 mm, at the same displacement rate of about 1.7 mm/s. The maximum and minimum relative...

  1. ENGINEERING DESIGN OPTIMIZATION OF HEEL TESTING EQUIPMENT IN THE EXPERIMENTAL VALIDATION OF SAFE WALKING

    Directory of Open Access Journals (Sweden)

    Cristiano Fragassa

    2017-06-01

    Full Text Available Experimental test methods for the evaluation of the resistance of heels of ladies' shoes in the case of impact loads are fully defined by International Organization for Standardization (ISO procedures that indicate all the conditions of experiment. A first Standard (ISO 19553 specifies the test method for determining the strength of the heels in the case of single impact. The result offers a valuation of the liability to fail under the sporadic heavy blows. A second Standard (ISO 19556 details a method for testing the capability of heels of women' shoes to survive to the repetition of small impacts provoked by normal walking. These Standards strictly define the features for two different testing devices (with specific materials, geometries, weights, etc. and all the experimental procedures to be followed during tests. On the contrary, this paper describes the technical solutions adopted to design one single experimental device able to perform impact testing of heels in both conditions. Joining the accuracy of mechanic movements with the speed of an electronic control system, a new and flexible equipment for the complete characterization of heels respect to (single or fatigue impacts was developed. Moreover a new level of performances in experimental validation of heel resistance was introduced by the versatility of the user-defined software control programs, able to encode every complex time-depending cycle of impact loads. Dynamic simulations permitted to investigate the impacts on heel in different conditions of testing, optimizing the machine design. The complexity of real stresses on shoes during an ordinary walk and in other common situations (as going up and downstairs was considered for a proper dimensioning.

  2. COVERS Neonatal Pain Scale: Development and Validation

    Directory of Open Access Journals (Sweden)

    Ivan L. Hand

    2010-01-01

    Full Text Available Newborns and infants are often exposed to painful procedures during hospitalization. Several different scales have been validated to assess pain in specific populations of pediatric patients, but no single scale can easily and accurately assess pain in all newborns and infants regardless of gestational age and disease state. A new pain scale was developed, the COVERS scale, which incorporates 6 physiological and behavioral measures for scoring. Newborns admitted to the Neonatal Intensive Care Unit or Well Baby Nursery were evaluated for pain/discomfort during two procedures, a heel prick and a diaper change. Pain was assessed using indicators from three previously established scales (CRIES, the Premature Infant Pain Profile, and the Neonatal Infant Pain Scale, as well as the COVERS Scale, depending upon gestational age. Premature infant testing resulted in similar pain assessments using the COVERS and PIPP scales with an r=0.84. For the full-term infants, the COVERS scale and NIPS scale resulted in similar pain assessments with an r=0.95. The COVERS scale is a valid pain scale that can be used in the clinical setting to assess pain in newborns and infants and is universally applicable to all neonates, regardless of their age or physiological state.

  3. Impact of plantar fasciitis on the quality of life of male and female patients according to the Foot Health Status Questionnaire

    Directory of Open Access Journals (Sweden)

    Palomo-López P

    2018-04-01

    Full Text Available Patricia Palomo-López,1 Ricardo Becerro-de-Bengoa-Vallejo,2 Marta Elena Losa-Iglesias,3 David Rodríguez-Sanz,4 César Calvo-Lobo,5 Daniel López-López6 1Department of Nursing, University Center of Plasencia, Universidad de Extremadura, Spain; 2School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain; 3Faculty of Health Sciences, Universidad Rey Juan Carlos, Spain; 4Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain; 5Nursing and Physical Therapy Department, Faculty of Health Sciences, University of León, Ponferrada, León, Spain; 6Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain Background and purpose: Plantar fasciitis (PF is a foot disorder in adults secondary to an inflammatory response caused by repetitive micro-trauma. We evaluated and compared the impact on quality of life (QoL related to foot health and general health between males and females with PF. Methods: In this cross-sectional descriptive study, patients with PF were recruited from a podiatry clinic. Physical examination, sociodemographic data, and the self-reported Foot Health Status Questionnaire (FHSQ were recorded. The FHSQ has three sections and provides two composite scores from 0 to 100. Higher scores (close to 100 reflect better QoL related to foot health and health in general; lower scores (close to 0 denote a worse QoL related to these health items. Results: One hundred patients (49 males [42.38 ± 14.065 years old] and 51 females [43.90 ± 14.305 years old] were recruited. Section one of the FHSQ evaluates four foot domains, and significant differences (P<0.05 were shown for foot pain and footwear, with males having higher scores than females, but not for foot function and general foot health (P>0.05. Section two assesses four domains of general wellbeing, and significant

  4. Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: A case report

    OpenAIRE

    Chauhan, Deepender; Arora, Ritu; Das, Sima; Shroff, Daraius; Narula, Ritesh

    2007-01-01

    Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be...

  5. Necrotizing Fasciitis Caused by Inconspicuous Infection of Aeromonas hydrophila in an Immunocompromised Host

    Directory of Open Access Journals (Sweden)

    Kuo-Chun Liao

    2010-09-01

    Full Text Available We present a case of serious necrotizing fasciitis due to Aeromonas hydrophila without a suggestive history of routes of pathogen invasion in a 60-year-old male. Despite prompt broad-spectrum antibiotic and extensive surgical therapies, the patient died within 72 hours following initial presentation. Our experience suggests clinicians be highly alert to the disease when an immunocompromised patient featured fulminant soft-tissue infection in the endemic area.

  6. Fungal necrotizing fasciitis, an emerging infectious disease caused by Apophysomyces (Mucorales).

    Science.gov (United States)

    Chander, Jagdish; Stchigel, Alberto Miguel; Alastruey-Izquierdo, Ana; Jayant, Mayank; Bala, Kiran; Rani, Hena; Handa, Uma; Punia, Rajpal Singh; Dalal, Usha; Attri, Ashok Kumar; Monzon, Araceli; Cano-Lira, José Francisco; Guarro, Josep

    2015-01-01

    The mucoralean fungi are emerging causative agents of primary cutaneous infections presenting in the form of necrotizing fasciitis. The aim of this study was to investigate a series of suspected necrotizing fasciitis cases by Apophysomyces species over one-year period in a northern Indian hospital. The clinical details of those patients suspected to suffer from fungal necrotizing fasciitis were recorded. Skin biopsies from local wounds were microscopically examined and fungal culturing was carried out on standard media. The histopathology was evaluated using conventional methods and special stains. Apophysomyces isolates were identified by their morphology and by molecular sequencing of the internal transcribed spacer (ITS) region of the ribosomal genes. Antifungal susceptibility testing was carried out following EUCAST guidelines and treatment progress was monitored. Seven patients were found to be suffering from necrotizing fasciitis caused by Apophysomyces spp. Six isolates were identified as Apophysomyces variabilis and one as Apophysomyces elegans. Five patients had previously received intramuscular injections in the affected area. Three patients recovered, two died and the other two left treatment against medical advice and are presumed to have died due to their terminal illnesses. Posaconazole and terbinafine were found to be the most active compounds against A. variabilis, while the isolate of A. elegans was resistant to all antifungals tested. Apophysomyces is confirmed as an aggressive fungus able to cause fatal infections. All clinicians, microbiologists and pathologists need to be aware of these emerging mycoses as well as of the risks involved in medical practices, which may provoke serious fungal infections such as those produced by Apophysomyces. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  7. Quantification of tritium ''heels'' and isotope exchange mechanisms in La-Ni-Al tritides

    International Nuclear Information System (INIS)

    Wermer, J.R.

    1992-01-01

    Formation of tritium heels in LANA (LaNi 5-x Al x ) 0.30 (x=0.30) and 0.75 tritides was quantified; size of the heel is dependent on storage and processing conditions. Absorption-desorption cycling of the tritide beds mitigates formation of the tritium heel and can reduce its size. The higher pressure material LANA 0.30 showed slower heel formation than LANA 0.75; this allows more tritium to be removed at the maximum processing temperature. In plant application, LANA 0.30 beds are used as compressors; except during compressor operation, their aging will be very slow. Tritium heel removal by D exchange was demonstrated. Absorption-desorption cycling during an exchange cycle does not improve the exchange efficiency. Residual tritium can be removed to very low levels. For a tritide bed scheduled for removal from the process, a final tritium level can be estimated based on the number of D exchange cycles. 13 refs, 8 figs, 6 tabs

  8. The influence of a yacht's heeling stability on optimum sail design

    Science.gov (United States)

    Sneyd, A. D.; Sugimoto, T.

    1997-01-01

    This paper presents fundamental results concerning the optimum design of yacht sails and masts. The aerodynamics of a high aspect ratio sail in uniform flow is analysed using lifting line theory to maximise thrust for a given sail area. The novel feature of this work is that thrust is optimised subject to the constraint that the aerodynamic heeling moment generated by the sail is balanced by the righting moment due to hull buoyancy (and the weight of the keel). Initially, the heel angle is therefore unknown, and determined as part of the solution process. Under the assumption of small heel angle, the problem reduces to minimising a quadratic form in the Fourier coefficients for the circulation distribution along the mast, and a simple analytic solution can be derived. It is found that if the mast is too high, the upper section is unused, and as a consequence there is a theoretically ideal mast height for a yacht of given heeling stability. Under the constraints of given sail area and heeling equilibrium it is found that no advantage is to be gained by allowing reverse circulation near the top of the mast. Various implications for yacht performance are discussed.

  9. The influence of valgus heel position on foot loading in a child's gait

    Directory of Open Access Journals (Sweden)

    Eliška Martinásková

    2012-12-01

    Full Text Available BACKGROUND: Flat foot is a typical clinical sign in childhood, expressed as valgus positioning of the heel during vertical foot loading. This may lead to medial deviation of the foot axis and cause overloading of some foot areas. OBJECTIVE: To determine the influence of valgus position of the heel (both bilateral and unilateral on foot loading during gait. METHODS: An experimental group consisting of children with bilateral heel valgus deformity (16 children, age 5.3 ± 1.3 years and children with unilateral heel valgus deformity (14 children, age 5.6 ± 1.6 years. The control group comprised of 14 children (age 4.5 ± 1.2 years. For measuring foot loading during gait, the Footscan (RSScan International, Olen, Belgium pressure plate was used. Each subject went through 8 trials of gait measurement. From each trial, 8 foot areas were evaluated. Data processing with mean values for each subject was performed by non-parametric tests (Mann-Whitney and Wilcoxon tests, Spearman correlation in the STATISTICA programme (StatSoft, Inc., Tulsa, USA. RESULTS: Pressure peak and pressure impulse in the first metatarsal was greater for the bilateral valgus group (p CONCLUSION: The results show that valgus positioning of the heel influences foot loading in children during gait. The findings of this study suggest the necessity of a complex solution to the problem of preventing further progression of pathological changes.

  10. Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy

    DEFF Research Database (Denmark)

    Willerslev-Olsen, Maria; Lorentzen, Jakob; Nielsen, Jens Bo

    2014-01-01

    and facilitate heel strike in children with CP? METHODS: Seventeen children with CP (4-14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied...... in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking. CONCLUSIONS: Daily intensive gait training may influence the elastic properties of ankle joint muscles...... and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP....

  11. Emphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the Leg

    Directory of Open Access Journals (Sweden)

    Yu-Xiong Ye

    2009-03-01

    Full Text Available We report a 50-year-old man with poorly controlled diabetes mellitus who presented with a painful, swollen right leg. He had also experienced right flank pain for 1 week prior to admission. Physical examination was notable for tenderness over the right flank. The right leg was diffusely swollen and exquisitely tender to touch, with palpable crepitance. Laboratory tests revealed leukocytosis and pyuria. Computed tomography showed a right ureteral stone with hydronephrosis and characteristic findings of emphysematous pyelonephritis. Furthermore, a right perirenal gas-forming abscess with extension to the right leg was noted. The patient was successfully treated with antibiotic therapy, aggressive control of blood sugar, percutaneous drainage of the hydronephrosis and perirenal abscess, and aggressive debridement of the leg.

  12. Initial studies on the variations of load-displacement curves of in vivo human healthy heel pads

    DEFF Research Database (Denmark)

    Matteoli, Sara; Wilhjelm, Jens E.; Virga, Antonio

    2011-01-01

    The aim of this study was to quantify on the measurement variation of in vivo load-displacement curves by using a group of human healthy heel pads. The recordings were done with a compression device measuring force and displacement. Twenty three heel pads, one from each of 23 subjects aged 20...

  13. A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

    Directory of Open Access Journals (Sweden)

    Kiralj Aleksandar I

    2015-01-01

    Full Text Available Background/Aim. Necrotizing fasciitis (NF is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia. Methods. The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to December 2012 were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment. Results. During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140 - 64.81% were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183 - 84.72%. The majority of our patients were male (164 - 75.92%. Among the 216 patients, the most common pre-existing single factor was drug abuse (39 - 18.05%, followed by obesity (38 - 17.59% and diabetes mellitus (31 - 14.35%. Trauma was most common etiological factor (22 - 10.8% in infected wounds, followed by abdominal (15 - 6.94% and orthopedic (11 - 5.09% surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18% patients and more than one etiological factor were diagnosed in 20 (9.25% patients. The majority of our patients had type I acute NF

  14. Rare nodular malignant melanoma of the heel in the Caribbean: A case report.

    Science.gov (United States)

    Warner, Wayne A; Sookdeo, Vandana Devika; Umakanthan, Srikanth; Sarran, Kevin; Pran, Lemuel; Fortuné, Maurice; Greaves, Wesley; Narinesingh, Sharda; Harnanan, Dave; Maharaj, Ravi

    2017-01-01

    Malignant melanoma of the heel is a rare melanoma subtype with incidence rates that reflect the complex relationship between sun exposure at certain geographic locations, individual melanin levels and overall melanoma risk. It is oftentimes characterized by poor prognosis because of delays in presentation resulting in longitudinal tumor invasion, lymph node involvement and metastasis. A 59-year-old woman was admitted to the Eric Williams Medical Sciences Complex, Trinidad and Tobago with a 5mm pruritic lesion on her left heel. At presentation, the lesion was asymmetric with border irregularities, color heterogeneity, with dynamics in elevation and overall size. She was subsequently diagnosed with malignant melanoma with left inguinal lymphadenopathy. A single stage wide local excision (WLE) of the left heel lesion with a split-thickness skin graft (STSG) and a left inguinal lymphadenectomy were performed. Dacarbazine (Bayer) was administered post operatively. Globally, the incidence of malignant melanoma is rapidly increasing, particularly, in countries like Trinidad and Tobago with a significant population of non-fair skinned individuals. There is need for strategic initiatives to increase patient adherence in these populations. The rarity of malignant heel melanomas heightens the need for increased patient awareness and greater clinical surveillance to ensure early diagnosis and treatment. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Mechanics of toe and heel landing in stepping down in ongoing gait

    NARCIS (Netherlands)

    van Dieen, J.H.; Spanjaard, M.; Konemann, R.; Bron, L.; Pijnappels, M.A.G.M.

    2008-01-01

    When stepping down from a height difference in ongoing gait, subjects are known to use a heel landing at small height differences and switch to toe landing for larger height differences. We hypothesized that in toe landing, the leading leg can perform more negative work, to control the momentum

  16. Mechanical analysis of the landing phase in heel-toe running

    NARCIS (Netherlands)

    Bobbert, Maarten F.; Yeadon, Maurice R.; Nigg, Benno M.

    1992-01-01

    Results of mechanical analyses of running may be helpful in the search for the etiology of running injuries. In this study a mechanical analysis was made of the landing phase of three trained heel-toe runners, running at their preferred speed and style. The body was modeled as a system of seven

  17. Laminitis and interdigital dermatitis and heel horn erosion. A European perspective.

    Science.gov (United States)

    Peterse, D J

    1985-03-01

    Laminitis is one of the most important claw disorders in dairy herds. Nutrition, calving, burdening of the lateral claw of the rear feet, and hereditary susceptibility are all contributing factors. Interdigital dermatitis in cattle may be a result of infection by Bacteroides nodosus and Fusobacterium necrophorum. If this infection becomes chronic, heel horn erosion is its consequence.

  18. Feasibility of Quantitative Ultrasound Measurement of the Heel Bone in People with Intellectual Disabilities

    Science.gov (United States)

    Mergler, S.; Lobker, B.; Evenhuis, H. M.; Penning, C.

    2010-01-01

    Low bone mineral density (BMD) and fractures are common in people with intellectual disabilities (ID). Reduced mobility in case of motor impairment and the use of anti-epileptic drugs contribute to the development of low BMD. Quantitative ultrasound (QUS) measurement of the heel bone is a non-invasive and radiation-free method for measuring bone…

  19. Analysis of medial deviation of center of pressure after initial heel contact in forefoot varus

    Directory of Open Access Journals (Sweden)

    Wei-Li Hsi

    2016-03-01

    Conclusion: The most medial CoP of the row and CoP% detected increased medial CoP deviation in FV ≥ 8°, and may be applied to other clinical conditions where rearfoot angle and CoP of the array after initial heel contact cannot detect significant differences.

  20. Tank Farm WM-182 and WM-183 Heel Slurry Samples PSD Results

    International Nuclear Information System (INIS)

    Batcheller, T.A.; Huestis, G.M.

    2000-01-01

    Particle size distribution (PSD) analysis of INTEC Tank Farm WM-182 and WM-183 heel slurry samples were performed using a modified Horiba LA-300 PSD analyzer at the RAL facility. There were two types of testing performed: typical PSD analysis, and setting rate testing. Although the heel slurry samples were obtained from two separate vessels, the particle size distribution results were quite similar. The slurry solids were from approximately a minimum particle size of 0.5 mm to a maximum of 230 mm with about 90% of the material between 2-to-133 mm, and the cumulative 50% value at approximately 20 mm. This testing also revealed that high frequency sonication with an ultrasonic element may break-up larger particles in the WM-182 and WM-183 tank from heel slurries. This finding represents useful information regarding ultimate tank heel waste processing. Settling rate testing results were also fairly consistent with material from both vessels in that it appears that most of the mass of solids settle to an agglomerated, yet easily redispersed layer at the bottom. A dispersed and suspended material remained in the ''clear'' layer above the settled layer after about one-half an hour of settling time. This material had a statistical mode of approximately 5 mm and a maximum particle size of 30 mm

  1. Implementation guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511

    International Nuclear Information System (INIS)

    McDaniel, L.B.

    1998-01-01

    This report is an Implementation Guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511 to provide a set of uniform instructions for managing the two contractors selected. The primary objective is to produce the necessary deliverables and services for the HTI project within schedule and budget

  2. TARDEC FIXED HEEL POINT (FHP): DRIVER CAD ACCOMMODATION MODEL VERIFICATION REPORT

    Science.gov (United States)

    2017-11-09

    Public Release Disclaimer: Reference herein to any specific commercial company, product , process, or service by trade name, trademark, manufacturer , or...not actively engaged HSI until MSB or the Engineering Manufacturing and Development (EMD) Phase, resulting in significant design and cost changes...and shall not be used for advertising or product endorsement purposes. TARDEC Fixed Heel Point (FHP): Driver CAD Accommodation Model Verification

  3. A prospective cohort study of prognostic factors for the healing of heel pressure ulcers.

    Science.gov (United States)

    McGinnis, Elizabeth; Greenwood, Darren C; Nelson, E Andrea; Nixon, Jane

    2014-03-01

    pressure ulcers, 25-30% of which are on the heels are a major burden to patients and healthcare systems. A better understanding of factors associated with healing is required to inform treatment and research priorities. to identify patient and pressure ulcer characteristics associated with the healing of heel pressure ulcers. patients with heel pressure ulcers were recruited to a prospective cohort study in a large teaching hospital in the UK, with a maximum 18-month follow-up. Cox proportional hazards model regression analysis was used to identify prognostic factors for healing. one hundred and forty of 148 patients recruited were analysed. They had 183 pressure ulcers: 77 ulcers healed, 5 were on limbs amputated prior to ulcer healing, 88 were on patients who died prior to healing, 11 were present at the end of the study and 2 were lost to follow-up. The median time to healing was 121 (range 8-440) days. Of 12 variables associated with healing (P ≤ 0.2), multi-variable analysis identified two factors which were independently predictive of healing including the presence of a severe (versus superficial) ulcer (hazard ratio = 0.48, P ulcer severity and the presence of peripheral arterial disease significantly reduced the probability of healing. Treatments for heel pressure ulcers should consider the severity of the ulcer and the presence of peripheral arterial disease.

  4. Moving characteristics of single file passengers considering the effect of ship trim and heeling

    Science.gov (United States)

    Sun, Jinlu; Lu, Shouxiang; Lo, Siuming; Ma, Jian; Xie, Qimiao

    2018-01-01

    Ship listing and motion affects the movement pattern of passengers on board, thus pedestrian traffic and evacuation dynamics would be significantly different from those on level ground. To quantify the influence of ship listing and motion on passenger evacuation, we designed a ship corridor simulator, with which we performed single-file pedestrian movement experiments considering the effect of trim and heeling. Results indicated that density is not the only factor that affects pedestrian speed under ship trim or heeling conditions, for that both individual walking speed and group walking speed would be greatly attenuated due to the influence of the trim angles. However, heeling angles show less impact on speed when compared with trim angles. In addition, the speed correlation coefficient between the adjacent experimental subjects would be higher with larger angles and lower speed. Moreover, both female and male experimental subjects need similar distance headway for walking in different trim or heeling conditions. Furthermore, experimental subjects with lower individual walking speed need longer time headway to keep enough distance headway. This work will provide fundamental guidance to the development of evacuation models and the design of evacuation facilities on board.

  5. Effect of medial arch-heel support in inserts on reducing ankle eversion: a biomechanics study

    Directory of Open Access Journals (Sweden)

    Yung Patrick SH

    2008-02-01

    Full Text Available Abstract Background Excessive pronation (or eversion at ankle joint in heel-toe running correlated with lower extremity overuse injuries. Orthotics and inserts are often prescribed to limit the pronation range to tackle the problem. Previous studies revealed that the effect is product-specific. This study investigated the effect of medial arch-heel support in inserts on reducing ankle eversion in standing, walking and running. Methods Thirteen pronators and 13 normal subjects participated in standing, walking and running trials in each of the following conditions: (1 barefoot, and shod condition with insert with (2 no, (3 low, (4 medium, and (5 high medial arch-heel support. Motions were captured and processed by an eight-camera motion capture system. Maximum ankle eversion was calculated by incorporating the raw coordinates of 15 anatomical positions to a self-compiled Matlab program with kinematics equations. Analysis of variance with repeated measures with post-hoc Tukey pairwise comparisons was performed on the data among the five walking conditions and the five running conditions separately. Results Results showed that the inserts with medial arch-heel support were effective in dynamics trials but not static trials. In walking, they successfully reduced the maximum eversion by 2.1 degrees in normal subjects and by 2.5–3.0 degrees in pronators. In running, the insert with low medial arch support significantly reduced maximum eversion angle by 3.6 and 3.1 degrees in normal subjects and pronators respectively. Conclusion Medial arch-heel support in inserts is effective in reducing ankle eversion in walking and running, but not in standing. In walking, there is a trend to bring the over-pronated feet of the pronators back to the normal eversion range. In running, it shows an effect to restore normal eversion range in 84% of the pronators.

  6. Eosinophilic fasciitis in a military recruit: MRI evaluation with clinical correlation

    International Nuclear Information System (INIS)

    Liou, Chang-Hsien; Juan, Chun-Jung; Chen, Cheng-Yu.; Huang, Guo-Shu; Taylor, John A.M.; Gao, Hong-Wei

    2003-01-01

    Eosinophilic fasciitis (EF) is an uncommon connective tissue disease. We report a patient with EF who presented with episodic swelling and stiffness of his legs and forearms in combination with peripheral eosinophilia. Imaging studies of the legs and forearms, including computed tomography (CT) and magnetic resonance imaging (MRI), clearly demonstrated the characteristic finding of fascial thickening. The complete clinical imaging and pathological findings are described in this report. Cross-sectional imaging is useful in diagnosing EF and in the appropriate clinical scenario may be helpful in differentiating EF from other connective tissue diseases. (orig.)

  7. Eosinophilic fasciitis associated with hypereosinophilia, abnormal bone-marrow karyotype and inversion of chromosome 5.

    Science.gov (United States)

    Ferguson, J S; Bosworth, J; Min, T; Mercieca, J; Holden, C A

    2014-03-01

    We report the case of a male patient presenting with eosinophilia, pulmonary oedema and eosinophilic fasciitis (EF). He had the classic clinical appearance and magnetic resonance imaging of EF. Cytogenetic analysis of the bone marrow revealed a previously undescribed pericentric inversion of chromosome 5. Overall, the presentation was consistent with a diagnosis of chronic eosinophilic leukaemia, not otherwise specified (CEL-NOS). Dermatologists should consult a haematologist in cases of EF, in order to rule out possible haematological malignancies. © 2013 British Association of Dermatologists.

  8. Nodular fasciitis of the face diagnosed by US-guided core needle biopsy: a case report

    International Nuclear Information System (INIS)

    Lee, Sang Kwon; Kwon, Sun Young

    2006-01-01

    We report here on a case of nodular fasciitis (NF) that was diagnosed by ultrasonography (US)-guided core needle biopsy in a 31-year-old man, and we include the US and computed tomographic (CT) findings and the histopathologic findings at US-guided core needle biopsy (CNB). We suggest that high-resolution US is useful for the detailed evaluation of NF in the superficial regions, such as the face, and US-guided CNB is useful for the definitive histologic diagnosis of NF without causing scarring

  9. Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report.

    Science.gov (United States)

    Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia

    We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  10. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  11. Neonatal pain and preventive strategies: an experience in a tertiary care unit

    International Nuclear Information System (INIS)

    Mahmud, S.

    2017-01-01

    Little is known about neonatal pain in Pakistan. So, to know about neonatal pain, its scoring and the effectiveness of oral dextrose in neonatal pain management we carried this study in neonatal intensive care unit (NICU) of military hospital (MH) Rawalpindi. Methods: This randomized control trial was carried out in NICU of MH, Rawalpindi from to Jan 2013 to Dec 2013. Total of 252 babies were enrolled in the study. We assessed neonatal pain by using Modified Behavioural Pain Scale (MBPS). Babies were given 10% dextrose and sterile water two minutes before a painful procedure and pain assessment was done after the procedure. The different painful procedures included, heel prick, nasogastric (NG) tube insertion, cannulation, catheterization and venepuncture for blood sampling. Results: A total of 252 babies were enrolled in the study. Of these 139(55%) were male and 113(45%) were female babies. Painful procedures included heel lancing 120(48%), I/V cannulations 60(24%), venepuncture 40 (16%), NG insertion 26 (10%) and Foley catheterization 6 (2%). Mean MBPS score with 10% dextrose and sterile water were 4.31 and 6.26 respectively and the difference between two was significant statically. Conclusion: Oral dextrose is a cheap and easily available solution and can be used in neonatal pain management during various painful procedures. (author)

  12. EM-31 Retrieval Knowledge Center Meeting Report: Mobilize And Dislodge Tank Waste Heels

    International Nuclear Information System (INIS)

    Fellinger, A.

    2010-01-01

    The Retrieval Knowledge Center sponsored a meeting in June 2009 to review challenges and gaps to retrieval of tank waste heels. The facilitated meeting was held at the Savannah River Research Campus with personnel broadly representing tank waste retrieval knowledge at Hanford, Savannah River, Idaho, and Oak Ridge. This document captures the results of this meeting. In summary, it was agreed that the challenges to retrieval of tank waste heels fell into two broad categories: (1) mechanical heel waste retrieval methodologies and equipment and (2) understanding and manipulating the heel waste (physical, radiological, and chemical characteristics) to support retrieval options and subsequent processing. Recent successes and lessons from deployments of the Sand and Salt Mantis vehicles as well as retrieval of C-Area tanks at Hanford were reviewed. Suggestions to address existing retrieval approaches that utilize a limited set of tools and techniques are included in this report. The meeting found that there had been very little effort to improve or integrate the multiple proven or new techniques and tools available into a menu of available methods for rapid insertion into baselines. It is recommended that focused developmental efforts continue in the two areas underway (low-level mixing evaluation and pumping slurries with large solid materials) and that projects to demonstrate new/improved tools be launched to outfit tank farm operators with the needed tools to complete tank heel retrievals effectively and efficiently. This document describes the results of a meeting held on June 3, 2009 at the Savannah River Site in South Carolina to identify technology gaps and potential technology solutions to retrieving high-level waste (HLW) heels from waste tanks within the complex of sites run by the U. S. Department of Energy (DOE). The meeting brought together personnel with extensive tank waste retrieval knowledge from DOE's four major waste sites - Hanford, Savannah River

  13. Monomicrobial necrotizing fasciitis in a single center: the emergence of Gram-negative bacteria as a common pathogen

    Directory of Open Access Journals (Sweden)

    D. Yahav

    2014-11-01

    Conclusions: In our center, 42% of monomicrobial necrotizing fasciitis cases were found to be caused by Gram-negative organisms, mostly E. coli. These infections usually appeared in immunocompromised or postoperative patients, often presented with normal CPK levels, and were associated with high mortality rates.

  14. Necrotizing Fasciitis in a Pediatric Patient Caused by Lancefield Group G Streptococcus: Case Report and Brief Review of the Literature

    Directory of Open Access Journals (Sweden)

    John Rausch

    2011-01-01

    Full Text Available We report a case of necrotizing fasciitis with an accompanying toxic shock syndrome caused by Group G Streptococcus in a pediatric patient with a lymphatic malformation. Pediatricians need to be aware of the possibility of such infections, especially in those with vascular/lymphatic malformations, as early treatment is critical for survival.

  15. Successful treatment of a necrotizing fasciitis patient caused by Mucor indicus with amphotericin B and skin grafting.

    Science.gov (United States)

    Luo, Yijin; Zeng, Fanqin; Huang, Xiaowen; Li, Qun; Tan, Guozhen; Xi, Liyan; Lu, Changming; Guo, Qing

    2014-04-01

    Cutaneous mucormycosis, an uncommon disease caused by Mucorales, predominantly occurs in immunocompromised host. The present case is a primary cutaneous mucormycosis due to Mucor indicus in an immunocompetent individual. It is with the features of necrotizing fasciitis over the right pretibial area. We are presenting this case owing to its rarity and the successful treatment with amphotericin B and skin grafting.

  16. Therapeutic touch is not therapeutic for procedural pain in very preterm neonates: a randomized trial.

    Science.gov (United States)

    Johnston, Celeste; Campbell-Yeo, Marsha; Rich, Bonnie; Whitley, Julie; Filion, Francoise; Cogan, Jennifer; Walker, Claire-Dominique

    2013-09-01

    Preterm neonates below 30 weeks' gestational age undergo numerous painful procedures. Many management approaches are not appropriate for this population. Therapeutic Touch, an alternative approach based on the theory of energy medicine, has been shown to promote physiological stability in preterm neonates and reduce pain in some adult studies. The objective was to determine whether Therapeutic Touch is efficacious in decreasing pain in preterm neonates. Infants Touch (n = 27) with infant behind curtains, leaving the curtained area for the heel lance, performed by another. In the sham condition (n = 28), the therapist stood by the incubator with hands by her side. The Premature Infant Pain Profile was used for pain response and time for heart rate to return to baseline for recovery. Heart rate variability and stress response were secondary outcomes. There were no group differences in any of the outcomes. Mean Premature Infant Pain Profile scores across 2 minutes of heel lance procedure in 30-second blocks ranged from 7.92 to 8.98 in the Therapeutic Touch group and 7.64 to 8.46 in the sham group. Therapeutic Touch given immediately before and after heel lance has no comforting effect in preterm neonates. Other effective strategies involving actual touch should be considered.

  17. Clinical parameters and challenges of managing cervicofacial necrotizing fasciitis in a Sub-Saharan tertiary hospital

    Directory of Open Access Journals (Sweden)

    Adeola A Olusanya

    2015-01-01

    Full Text Available Introduction: Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF in the University College Hospital, Ibadan. Materials and Methods: Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings. Results: Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844 cm. The mean hospital stay was 27.8 (±23.1 days, and scar formation was the most common complication encountered. Conclusion: Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.

  18. Fascitis necrosante bilateral: a propósito de un caso Bilateral necrotizing fasciitis: case report

    Directory of Open Access Journals (Sweden)

    F. Fernández Gómez

    2011-06-01

    Full Text Available La fascitis necrosante es una enfermedad de origen infeccioso que afecta a la fascia muscular y progresa rápidamente. Para el manejo de este tipo de pacientes es clave un diagnóstico precoz y un tratamiento adecuado que combine antibioticoterapia y cirugía. Presentamos el caso de una paciente de 77 años de edad con diagnóstico de fascitis necrosante de presentación atípica por la bilateralidad de las lesiones, la ausencia de factores predisponentes y la presencia de un único germen causal.Necrotizing fasciitis is an infectious disease that involves muscular fascia and has a quickly progress. Early diagnosis and proper treatment that consists on antibiotic therapy and surgery are the key of patient management. We report the case of a 77 years old oman with necrotizing fasciitis diagnosis with atypical presentation due to bilateral skin lesions, lack of risk factors and only one germ as causal pathogen.

  19. Idiopathic neonatal necrotising fasciitis caused by community-acquired MSSA encoding Panton Valentine Leukocidin genes.

    LENUS (Irish Health Repository)

    Dunlop, Rebecca L E

    2012-02-01

    Neonatal necrotising fasciitis is very rare in comparison to the adult presentation of the disease and a Plastic Surgeon may only encounter one such case during his or her career. Often this is initially misdiagnosed and managed as simple cellulitis. It generally affects previously healthy babies, the site is often the lower back area and a history of minor skin trauma may be elicited. The causative organism is usually Streptococcus or polymicrobial, as is the case in the adult population. We present the case of a previously healthy 11-day-old infant with idiopathic, rapidly progressive necrotising fasciitis of the back, cause by Methicillin sensitive Staphylococcus aureus (MSSA) infection. The strain was isolated and found to encode the Panton-Valentine Leukocidin genes, which have been associated with particularly severe necrotising infections in other sites, with high mortality. These strains are the subject of specific treatment and eradication guidance in the UK but awareness of this and the importance of obtaining detailed culture typing is likely to be low amongst Plastic Surgeons.

  20. Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

    Science.gov (United States)

    Lee, Su-Jin; Kang, Jung-Ho; Kim, Ja-Young; Kim, Jin-Hong; Jung, Kwang-Ik

    2013-01-01

    Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT. PMID:23869336

  1. Endoscopic plantar fascia release via a suprafascial approach is effective for intractable plantar fasciitis.

    Science.gov (United States)

    Miyamoto, Wataru; Yasui, Youichi; Miki, Shinya; Kawano, Hirotaka; Takao, Masato

    2017-10-14

    To evaluate the medium-term clinical results of endoscopic plantar fascia release (EPFR) using a suprafascial approach for recalcitrant plantar fasciitis. Twenty-four feet of twenty-three patients who underwent EPFR using a suprafascial approach were followed up for more than 2 years using the American Orthopedic Foot and Ankle Society (AOFAS) score. The AOFAS score at final follow-up was compared between patients who participated in athletic activity (group A) and those who were sedentary (group S) and between those with and those without calcaneal spur (group with CS and group without CS, respectively). The ability of patients to return to athletic activity, and if so, the time interval between surgery and return to athletic activity, were investigated in group A. Complications were recorded. The median follow-up duration was 48 months. The mean AOFAS score in all patients increased significantly between before surgery and final follow-up (P plantar nerve occurred in three feet. EPFR using a suprafascial approach was effective for recalcitrant plantar fasciitis. However, the prognosis of sedentary patients was inferior to that of patients engaged in athletic activity. IV.

  2. [Necrotising fasciitis caused by Saksenaea vasiformis in an immunocompetent patient after a car accident].

    Science.gov (United States)

    Mayayo, Emilio; Stchigel, Alberto M; Cano, José F; Bernal-Escoté, Xana; Guarro, Josep

    2013-01-03

    Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others. A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA. This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier España, S.L. All rights reserved.

  3. Necrotising fasciitis after hysterectomy and concomitant transvaginal mesh repair in a patient with pelvic organ prolapse.

    Science.gov (United States)

    Pushkar, Dmitry Y; Vasilchenko, Mikhail I; Kasyan, George R

    2013-10-01

    Necrotising fasciitis is a severe form of soft tissue infection. Herein, we present an unreported complication of the transvaginal repair of a pelvic organ prolapse (POP) with trocar-guided polypropylene mesh and a concomitant hysterectomy. A 61-year-old Caucasian female who had been using an intrauterine device (IUD) for 30 years presented with a stage 3 pelvic organ prolapse. A genital ultrasound examination confirmed the presence of an IUD, but found no endometrial abnormalities. The surgical management was limited to a transvaginal hysterectomy and simultaneous anterior vaginal wall repair augmented with trocar-guided mesh. A morphological examination of the removed uterus confirmed the presence of the intrauterine device and additionally found endometrial cancer (T1N0M0), which was not revealed during the preoperative ultrasound. Within 6 days of the surgery, she developed anaerobic bilateral necrotising fasciitis on both thighs. Non-clostridial streptococci were identified in the wound. After 18 days of intensive care, the patient died of fatal coagulopathy.

  4. [Reconstruction of the heel in a two-year-old boy after lawn mower injury].

    Science.gov (United States)

    Kraus, R; Albrecht, J; Schnettler, R; von Pichler, M

    2012-04-01

    Lawn mower injuries in children usually involve the lower extremities and can lead to serious amputation injuries. Treatment should look not only at the acute reconstruction, but also on maintaining the ability to grow. We report the case of a two-year-old boy with amputation of the heel. The boy was run over by a lawn mower. He suffered a complete loss of heel soft tissue, 30 % of the os calcis and the Achilles tendon. The one-stage reconstruction was performed by transplantation of an iliac crest graft, fascia lata to reconstruct the Achilles tendon and a microvascular latissimus dorsi flap. After one year, the functional and cosmetic result is excellent, the bone graft is healed completely and shows growth trends. The successful treatment of such a severe amputation injury requires the interdisciplinary cooperation between paediatric traumatologists, plastic surgeons, physical therapists and orthopaedic shoemaker. The result justifies the great effort. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Interdigital dermatitis, heel horn erosion, and digital dermatitis in 14 Norwegian dairy herds

    DEFF Research Database (Denmark)

    Knappe-Poindecker, M.; Gilhuus, M.; Jensen, Tim Kåre

    2013-01-01

    The aim of this study was to assess infectious foot diseases, including identification and characterization of Dichelobacter nodosus and Treponema spp., in herds having problems with interdigital dermatitis (ID) and heel horn erosion (E) and in control herds expected to have few problems. We also......, with a prevalence of 50.4% in problem herds compared with 26.8% in control herds. Heel horn erosion was recorded in 34.8% of the cows in problem herds compared with 22.1% in control herds. Dichelobacter nodosus was detected in 97.1% of the cows with ID, in 36.4% with E, in all cows with both ID and E, in all cows...

  6. Sciatic nerve block causing heel ulcer after total knee replacement in 36 patients.

    Science.gov (United States)

    Todkar, Manoj

    2005-12-01

    Femoral and sciatic nerve blocks are often used for postoperative analgesia following total knee replacement surgery. In this report, we focus on cases of heel ulcers which occurred following the implementation of peripheral nerve block in concert with knee replacement surgery. In some instances, heel ulcers have resulted in delayed rehabilitation and prolonged hospital stays in this group of patients, which makes this phenomenon a potential burden on the healthcare system. Pressure points in the foot should be protected after the implementation of nerve blocks to prevent pressure sores. An awareness of this unusual complication related to knee replacement surgery is necessary to prevent its occurrence and avoid delays in patient rehabilitation and recovery.

  7. LIPOMA OF THE HEEL: A COMMON BENIGN TUMOR OVER UNCOMMON SITE

    Directory of Open Access Journals (Sweden)

    Mirat

    2015-09-01

    Full Text Available Lipoma is a universal benign tumour which is uncommon in foot and especially in sole region. It should be considered in the differential diagnosis of foot lesions. A case of lipoma of heel of five years duration in a 48 year s old housewife is described in which FNAC was inconclusive. However findings of imaging studies suggested diagnosis of lipoma w hich was confirmed on histopathological examination of the excised mass. Literature has been reviewed emphasising rarity of site lesion.

  8. [Ulceration of the heel in a woman from Djibouti: squamous cell carcinoma with carcinomatous lymphangitis].

    Science.gov (United States)

    Bertani, A; Massoure, P L; Menguy, P; Lamblin, G; Eve, O; Morand, J J

    2011-02-01

    The purpose of this report is to describe a case in which a heel ulcer with atypical features, i.e., large size and rapid progression, led to diagnosis of squamous cell carcinoma. Patient management was based on specialist advice obtained by "tele-dermatology" based on pictures and comments transmitted over the Internet. However, due to the risk of spreading and impossibility of providing other medical treatment (radiotherapy-chemotherapy), the lower limb was amputated at the top of the thigh.

  9. How well do clinical pain assessment tools reflect pain in infants?

    Science.gov (United States)

    Slater, Rebeccah; Cantarella, Anne; Franck, Linda; Meek, Judith; Fitzgerald, Maria

    2008-06-24

    Pain in infancy is poorly understood, and medical staff often have difficulty assessing whether an infant is in pain. Current pain assessment tools rely on behavioural and physiological measures, such as change in facial expression, which may not accurately reflect pain experience. Our ability to measure cortical pain responses in young infants gives us the first opportunity to evaluate pain assessment tools with respect to the sensory input and establish whether the resultant pain scores reflect cortical pain processing. Cortical haemodynamic activity was measured in infants, aged 25-43 wk postmenstrual, using near-infrared spectroscopy following a clinically required heel lance and compared to the magnitude of the premature infant pain profile (PIPP) score in the same infant to the same stimulus (n = 12, 33 test occasions). Overall, there was good correlation between the PIPP score and the level of cortical activity (regression coefficient = 0.72, 95% confidence interval [CI] limits 0.32-1.11, p = 0.001; correlation coefficient = 0.57). Of the different PIPP components, facial expression correlated best with cortical activity (regression coefficient = 1.26, 95% CI limits 0.84-1.67, p free.

  10. Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes.

    Science.gov (United States)

    Bates-Jensen, Barbara M; McCreath, Heather E; Nakagami, Gojiro; Patlan, Anabel

    2018-04-01

    We examined subepidermal moisture (SEM) and visual skin assessment of heel pressure injury (PrI) among 417 nursing home residents in 19 facilities over 16 weeks. Participants were older (mean age 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, 21% Hispanic), and at risk for PrI (mean Braden Scale Risk score = 15.6). Blinded concurrent visual assessments and SEM measurements were obtained at heels weekly. Visual skin damage was categorised as normal, erythema, stage 1 PrI, deep tissue injury (DTI) or stage 2 or greater PrI. PrI incidence was 76%. Off-loading occurred with pillows (76% of residents) rather than heel boots (21%) and often for those with DTI (91%). Subepidermal moisture was measured with a device where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with normal skin values significantly different from values in the presence of skin damage. Subepidermal moisture was associated with concurrent damage and damage 1 week later in generalised multinomial logistic models adjusting for age, diabetes and function. Subepidermal moisture detected DTI and differentiated those that resolved, remained and deteriorated over 16 weeks. Subepidermal moisture may be an objective method for detecting PrI. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  11. Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy.

    Science.gov (United States)

    Willerslev-Olsen, Maria; Lorentzen, Jakob; Nielsen, Jens Bo

    2014-01-01

    Foot drop and toe walking are frequent concerns in children with cerebral palsy (CP). Increased stiffness of the ankle joint muscles may contribute to these problems. Does four weeks of daily home based treadmill training with incline reduce ankle joint stiffness and facilitate heel strike in children with CP? Seventeen children with CP (4-14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied stretches below and above reflex threshold. Gait kinematics were recorded by 3-D video-analysis during treadmill walking. Foot pressure was measured by force-sensitive foot soles during treadmill and over-ground walking. Children with increased passive stiffness showed a significant reduction in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking. Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP.

  12. Clinical Conformity Between Heel Ultrasound and Densitometry in Postmenopausal Women: A Systematic Review.

    Science.gov (United States)

    Tabor, Elżbieta; Pluskiewicz, Wojciech; Tabor, Kamil

    2018-02-01

    To assess the conformity between heel ultrasound and densitometry, and the clinical application of densitometry T-score "gold standard" in quantitative ultrasound as a method of osteoporosis diagnosis in postmenopausal women. The study is a systematic review of studies published in the last 17 years in PubMed, NLM Gateway, Medline, Embase, and Cochrane Library. Calcaneal quantitative ultrasound sensitivity and specificity were analyzed with regard to densitometry measurements in postmenopausal women. In addition, we summarized the values of ultrasound T-scores, for which their accuracy in osteoporosis diagnosis is the highest. The inclusion criteria met 15 research studies conducted on postmenopausal women. In 11 of them, the authors concluded that clinical conformity between heel ultrasound and densitometry is good. The recommended quantitative ultrasound T-score for osteoporosis diagnosis ranged between -1 and -3.65. Heel ultrasound should be considered to be as accurate as densitometry in diagnosing osteoporosis. Nevertheless, it needs to have separate T-score ranges determined, because those used in densitometry are not adequate. © 2017 by the American Institute of Ultrasound in Medicine.

  13. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

    Science.gov (United States)

    Ribeiro, Ana P.; Sacco, Isabel C. N.; Dinato, Roberto C.; João, Silvia M. A.

    2016-01-01

    BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot. PMID:26786073

  14. How well do clinical pain assessment tools reflect pain in infants?

    Directory of Open Access Journals (Sweden)

    Rebeccah Slater

    2008-06-01

    Full Text Available Pain in infancy is poorly understood, and medical staff often have difficulty assessing whether an infant is in pain. Current pain assessment tools rely on behavioural and physiological measures, such as change in facial expression, which may not accurately reflect pain experience. Our ability to measure cortical pain responses in young infants gives us the first opportunity to evaluate pain assessment tools with respect to the sensory input and establish whether the resultant pain scores reflect cortical pain processing.Cortical haemodynamic activity was measured in infants, aged 25-43 wk postmenstrual, using near-infrared spectroscopy following a clinically required heel lance and compared to the magnitude of the premature infant pain profile (PIPP score in the same infant to the same stimulus (n = 12, 33 test occasions. Overall, there was good correlation between the PIPP score and the level of cortical activity (regression coefficient = 0.72, 95% confidence interval [CI] limits 0.32-1.11, p = 0.001; correlation coefficient = 0.57. Of the different PIPP components, facial expression correlated best with cortical activity (regression coefficient = 1.26, 95% CI limits 0.84-1.67, p < 0.0001; correlation coefficient = 0.74 (n = 12, 33 test occasions. Cortical pain responses were still recorded in some infants who did not display a change in facial expression.While painful stimulation generally evokes parallel cortical and behavioural responses in infants, pain may be processed at the cortical level without producing detectable behavioural changes. As a result, an infant with a low pain score based on behavioural assessment tools alone may not be pain free.

  15. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia

    International Nuclear Information System (INIS)

    O'Regan, Kevin; Maher, Michael M.; O'Mahony, Edward; MacEneaney, Peter; Fitzgerald, Edward

    2009-01-01

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management. (orig.)

  16. Epinephrine auto-injection radically increases risk for clostridial infection and necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Kenneth Larson

    2017-04-01

    Full Text Available Clostridial perfringens is a bacteria commonly found on skin flora. Due to the optimal growth environment intramuscular epinephrine injections predispose patients to the rapid development of clostridial myonecrosis. There have been only four cases, including this one, reported in the last 60 years of pediatric Clostridium perfringens infections post-epinephrine injection. We detail the successful management of a 16 year old, immunocompetent female who developed gas gangrene and necrotizing fasciitis on her thigh secondary to clostridial infection after utilization of an Epinephrine Auto-Injector and review the pediatric literature of patients with Clostridial perfringens secondary to epinephrine injection. We define common clinical signs and symptoms of clostridial infection from the review of the literature. The relevance of our findings is to raise awareness among emergency physicians when patients present following an injection in order to reduce diagnostic delay that could result in amputation or death.

  17. CT imaging of necrosive fasciitis; CT-Bildgebung der nekrotisierenden Fasziitis

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, M.; Overkamp, D.; Joanoviciu, S.; Horger, M.

    2008-07-15

    NF is a rare but dramatic and often fatal infection of the fascii and adjoining soft tissues. Contrary to the Fournier's definition, it is most common in elderly people. Patients with immune problems have a higher risk (e.g. Diabetes mellitus, alcohol or drug abuse, AIDS, leukaemia, chemotherapy and immunosuppressive medication). Predisposition factors are diverticulitis, insect bites, or surgical interventions (Uppot RN, Levy HM, PLatel PH, Radiology 2003; 226; 115; Wysoki MG, Santora TA, Shah RM et al. Necrotizing fasciitis: CT characteristics, Radiology 1997; 203;859). Men are affected more frequently than women. In principle, NF may occur everywhere in the body but incidence in the region of the scrotum, perineum and lower extremities are the most common. (orig.)

  18. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia

    Energy Technology Data Exchange (ETDEWEB)

    O' Regan, Kevin; Maher, Michael M. [Mercy University Hospital, Department of Radiology, Cork (Ireland); Cork University Hospital, Department of Radiology, Cork (Ireland); O' Mahony, Edward; MacEneaney, Peter; Fitzgerald, Edward [Mercy University Hospital, Department of Radiology, Cork (Ireland)

    2009-10-15

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management. (orig.)

  19. Pyoderma Gangrenosum Masquerading as Necrotizing Fasciitis: Stepping Away from Cognitive Shortcuts

    Directory of Open Access Journals (Sweden)

    Rachael Hilton

    2017-09-01

    Full Text Available A patient with post-Cesarean wound complication was treated for necrotizing fasciitis (NF with sharp debridement and broad-spectrum antibiotics. Several operations and three weeks later, her abdominal skin, subcutaneous fat, right-sided rectus abdominus, and underlying fascia had been removed without any improvement in granulation tissue. Original pathology samples demonstrated sheets of necrosis consistent with NF, but were re-reviewed by a dermatopathologist who diagnosed the patient with pyoderma gangrenosum (PG. She was started on high-dose steroids and dapsone, and her wound quickly showed signs of improvement. Anchor bias delayed the initiation of steroids and diagnosis of PG as the surgical, medical, and consulting teams were hesitant to stray from the diagnosis of NF.

  20. Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: A case report

    Directory of Open Access Journals (Sweden)

    Chauhan Deepender

    2007-01-01

    Full Text Available Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

  1. Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: a case report.

    Science.gov (United States)

    Chauhan, Deepender; Arora, Ritu; Das, Sima; Shroff, Daraius; Narula, Ritesh

    2007-01-01

    Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

  2. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia.

    LENUS (Irish Health Repository)

    O'Regan, Kevin

    2009-10-01

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management.

  3. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia.

    LENUS (Irish Health Repository)

    O'Regan, Kevin

    2012-01-31

    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management.

  4. Methods for Heel Retrieval for Tanks C-101, C-102, and C-111 at the Hanford Site - 13064

    Energy Technology Data Exchange (ETDEWEB)

    Sams, T.L.; Kirch, N.W.; Reynolds, J.H. [Washington River protection Solutions, Richland, WA 99352 (United States)

    2013-07-01

    The purpose of this paper is to evaluate the prospects of using bulk waste characteristics to determine the most appropriate heel retrieval technology. If the properties of hard to remove heels can be determined before bulk retrieval, then a heel retrieval technology can be selected before bulk retrieval is complete. This would save substantially on sampling costs and would allow the deployment of the heel retrieval technology immediately after bulk retrieval. The latter would also accelerate the heel removal schedule. A number of C-farm retrievals have been fully or partially completed at the time of this writing. Thus, there is already substantial information on the success of different technologies and the composition of the heels. There is also substantial information on the waste types in each tank based on historical records. Therefore, this study will correlate the performance of technologies used so far and compare them to the known waste types in the tanks. This will be used to estimate the performance of future C Farm heel retrievals. An initial decision tree is developed and employed on tanks C-101, C-102, and C 111. An assumption of this study is that no additional characterization information would be available, before or after retrieval. Note that collecting additional information would substantially increase the probability of success. Deploying some in-situ testing technologies, such as a water lance or an in-situ Raman probe, might substantially increase the probability of successfully selecting the process conditions without having to take samples from the tanks for laboratory analysis. (authors)

  5. Methods for Heel Retrieval for Tanks C-101, C-102, and C-111 at the Hanford Site - 13064

    International Nuclear Information System (INIS)

    Sams, T.L.; Kirch, N.W.; Reynolds, J.H.

    2013-01-01

    The purpose of this paper is to evaluate the prospects of using bulk waste characteristics to determine the most appropriate heel retrieval technology. If the properties of hard to remove heels can be determined before bulk retrieval, then a heel retrieval technology can be selected before bulk retrieval is complete. This would save substantially on sampling costs and would allow the deployment of the heel retrieval technology immediately after bulk retrieval. The latter would also accelerate the heel removal schedule. A number of C-farm retrievals have been fully or partially completed at the time of this writing. Thus, there is already substantial information on the success of different technologies and the composition of the heels. There is also substantial information on the waste types in each tank based on historical records. Therefore, this study will correlate the performance of technologies used so far and compare them to the known waste types in the tanks. This will be used to estimate the performance of future C Farm heel retrievals. An initial decision tree is developed and employed on tanks C-101, C-102, and C 111. An assumption of this study is that no additional characterization information would be available, before or after retrieval. Note that collecting additional information would substantially increase the probability of success. Deploying some in-situ testing technologies, such as a water lance or an in-situ Raman probe, might substantially increase the probability of successfully selecting the process conditions without having to take samples from the tanks for laboratory analysis. (authors)

  6. Methods for heel retrieval for tanks C-101, C-102, and C-111 at the Hanford Site-13064

    International Nuclear Information System (INIS)

    Sams, Terry L.; Kirch, N. W.; Reynolds, Jacob G.

    2013-01-01

    The purpose of this paper is to evaluate the prospects of using bulk waste characteristics to determine the most appropriate heel retrieval technology. If the properties of hard to remove heels can be determined before bulk retrieval, then a heel retrieval technology can be selected before bulk retrieval is complete. This would save substantially on sampling costs and would allow the deployment of the heel retrieval technology immediately after bulk retrieval. The latter would also accelerate the heel removal schedule. A number of C-farm retrievals have been fully or partially completed at the time of this writing. Thus, there is already substantial information on the success of different technologies and the composition of the heels. There is also substantial information on the waste types in each tank based on historical records. Therefore, this study will correlate the performance of technologies used so far and compare them to the known waste types in the tanks. This will be used to estimate the performance of future C Farm heel retrievals. An initial decision tree is developed and employed on tanks C-101, C-102, and C 111. An assumption of this study is that no additional characterization information would be available, before or after retrieval. Note that collecting additional information would substantially increase the probability of success. Deploying some in-situ testing technologies, such as a water lance or an in-situ Raman probe, might substantially increase the probability of successfully selecting the process conditions without having to take samples from the tanks for laboratory analysis

  7. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

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

    Energy Technology Data Exchange (ETDEWEB)

    Yu, J.S. [Ohio State Univ., Columbus (United States). Dept. of Radiology

    2000-09-01

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

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

    International Nuclear Information System (INIS)

    Yu, J.S.

    2000-01-01

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

  10. Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal

    Directory of Open Access Journals (Sweden)

    Fahri Yetışır

    2015-01-01

    Full Text Available Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS (ConvaTec and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT. Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.

  11. The comparison of manual lymph drainage and ultrasound therapy on the leg swelling caused by wearing high heels.

    Science.gov (United States)

    Lee, Dong-Yeop; Han, Ji-Su; Jang, Eun-Ji; Seo, Dong-Kwon; Hong, Ji-Heon; Lee, Sang-Sook; Lee, Dong-Geol; Yu Lee, Jae-Ho

    2014-01-01

    One of the major symptoms when women are wearing high heels for a long time is leg swelling. The purpose of this study was to compare the effect of manual lymph drainage with ultrasound therapy. The forty-five healthy women of twenties were participated in this study and divided randomly into three groups; manual lymph drainage group (n=15), ultrasound therapy group (n=15) and control group (n=15). Swelling was measured before wearing the high heels (10 cm-height), after one-hour of wearing the high heels, wearing the high heels of one-hour after the intervention of 15 minutes. Also swelling was calculated by using a tape measure, volumeter and body composition analyzer. Statistical analysis of the comparison between the three groups was performed by one-way ANOVA. Also comparison to the mean value in swelling according to the time was performed by repeated measure ANOVA. As the result of this study, a significant changes have emerged within each of manual lymph drainage, ultrasound therapy and control group (p 0.05). But the mean value of manual lymph drainage group showed the tendency of fast recovering before causing swelling. Therefore, we consider that the clinical treatment of manual lymph drainage and ongoing studies will be made since manual lymph drainage is very effective in releasing the leg swelling caused by wearing high heels and standing for a long time at work.

  12. Designing and Constructing Blood Flow Monitoring System to Predict Pressure Ulcers on Heel

    Directory of Open Access Journals (Sweden)

    Akbari H.

    2014-06-01

    Full Text Available Background: A pressure ulcer is a complication related to the need for the care and treatment of primarily disabled and elderly people. With the decrease of the blood flow caused by the pressure loaded, ulcers are formed and the tissue will be wasted with the passage of time. Objective: The aim of this study was to construct blood flow monitoring system on the heel tissue which was under external pressure in order to evaluate the tissue treatment in the ulcer. Methods: To measure the blood flow changes, three infrared optical transmitters were used at the distances of 5, 10, and 15 mm to the receiver. Blood flow changes in heels were assessed in pressures 0, 30, and 60 mmHg. The time features were extracted for analysis from the recorded signal by MATLAB software. Changes of the time features under different pressures were evaluated at the three distances by ANOVA in SPSS software. The level of significance was considered at 0.05. Results: In this study, 15 subjects, including both male and female, with the mean age of 54±7 participated. The results showed that the signal amplitude, power and absolute signal decreased significantly when pressure on the tissue increased in different layers (p<0.05. Heart rate only decreased significantly in pressures more than 30 mmHg (p=0.02. In pressures more than 30 mmHg, in addition to a decrease in the time features, the pattern of blood flow signal changed and it wasn’t the same as noload signal. Conclusion: By detecting the time features, we can reach an early diagnosis to prognosticate the degeneration of the tissue under pressure and it can be recommended as a method to predict bedsores in the heel.

  13. Rearfoot Transcutaneous Oximetry is a Useful Tool to Highlight Ischemia of the Heel

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, Valentina, E-mail: valentina-izzo@virgilio.it; Meloni, Marco, E-mail: meloni.marco@libero.it [University of Tor Vergata, Department of Systems Medicine (Italy); Fabiano, Sebastiano, E-mail: sebas575@yahoo.it; Morosetti, Daniele, E-mail: danielemorosetti@hotmail.com [University of Tor Vergata, Department of Diagnostic Imaging and Interventional Radiology (Italy); Giurato, Laura, E-mail: lauragiurato@yahoo.it [University of Tor Vergata, Department of Systems Medicine (Italy); Chiaravalloti, Antonio, E-mail: antoniochiaravalloti@hotmail.it [University of Tor Vergata, Department of Diagnostic Imaging and Interventional Radiology (Italy); Ruotolo, Valeria, E-mail: valeriaruotolo@virgilio.it [University of Tor Vergata, Department of Systems Medicine (Italy); Gandini, Roberto, E-mail: roberto.gandini@fastwebnet.it [University of Tor Vergata, Department of Diagnostic Imaging and Interventional Radiology (Italy); Uccioli, Luigi, E-mail: luccioli@yahoo.com [University of Tor Vergata, Department of Systems Medicine (Italy)

    2017-01-15

    PurposeTo demonstrate the usefulness of rearfoot transcutaneous oximetry to assess the peripheral arterial disease in diabetic patients with heel ulcer.MethodsFrom our database of 550 critical limb ischemia diabetic patients followed after a percutaneous transluminal angioplasty, we have selected patients with below the knee arterial disease. Patients were grouped according to the dorsal transcutaneous oximetry value (Group A < 30 mmHg; Group B ≥ 30 mmHg). Patients of Group B had a second oximetry performed at the rearfoot, close to the lesion localized in all cases at the heel. Finally, the analysis of the arterial pattern disease has been done.ResultsWe selected 191 patients: Group A (151 patients), dorsal transcutaneous oximetry of 11.8 ± 0.7 mmHg; Group B (40 patients), dorsal transcutaneous oximetry of 44.2 ± 10.1 mmHg. In Group B, rearfoot oximetry was 20.5 ± 5 mmHg, significantly lower than dorsal oximetry (p = 0.0179). The anterior tibial artery was involved in all patients of Group A. In Group B, the anterior tibial artery was involved in 15 subjects and never alone; the posterior tibial artery was involved in 20 subjects and in 11 cases alone. The peroneal artery was affected in 20 subjects and in 14 patients alone.ConclusionWhen a heel lesion is present and the transcutaneous oximetry recorded on the dorsum of the foot does not confirm the presence of critical limb ischemia (not ≤30 mmHg), a second oximetry recorded on the rearfoot is useful to point out ischemia of the peroneal artery and/or of the posterior tibial artery.

  14. Sludge Heel Removal By Aluminum Dissolution At Savannah River Site 12390

    International Nuclear Information System (INIS)

    Keefer, M.

    2012-01-01

    High Level Waste (HLW) at the Savannah River Site (SRS) is currently stored in aging underground storage tanks. This waste is a complex mixture of insoluble solids, referred to as sludge, and soluble salts. Continued long-term storage of these radioactive wastes poses an environmental risk. Operations are underway to remove and disposition the waste, clean the tanks and fill with grout for permanent closure. Heel removal is the intermediate phase of the waste retrieval and tank cleaning process at SRS, which is intended to reduce the volume of waste prior to treatment with oxalic acid. The goal of heel removal is to reduce the residual amount of radioactive sludge wastes to less than 37,900 liters (10,000 gallons) of wet solids. Reducing the quantity of residual waste solids in the tank prior to acid cleaning reduces the amount of acid required and reduces the amount of excess acid that could impact ongoing waste management processes. Mechanical heel removal campaigns in Tank 12 have relied solely on the use of mixing pumps that have not been effective at reducing the volume of remaining solids. The remaining waste in Tank 12 is known to have a high aluminum concentration. Aluminum dissolution by caustic leaching was identified as a treatment step to reduce the volume of remaining solids and prepare the tank for acid cleaning. Dissolution was performed in Tank 12 over a two month period in July and August, 2011. Sample results indicated that 16,440 kg of aluminum oxide (boehmite) had been dissolved representing 60% of the starting inventory. The evolution resulted in reducing the sludge solids volume by 22,300 liters (5900 gallons), preparing the tank for chemical cleaning with oxalic acid.

  15. Rearfoot Transcutaneous Oximetry is a Useful Tool to Highlight Ischemia of the Heel

    International Nuclear Information System (INIS)

    Izzo, Valentina; Meloni, Marco; Fabiano, Sebastiano; Morosetti, Daniele; Giurato, Laura; Chiaravalloti, Antonio; Ruotolo, Valeria; Gandini, Roberto; Uccioli, Luigi

    2017-01-01

    PurposeTo demonstrate the usefulness of rearfoot transcutaneous oximetry to assess the peripheral arterial disease in diabetic patients with heel ulcer.MethodsFrom our database of 550 critical limb ischemia diabetic patients followed after a percutaneous transluminal angioplasty, we have selected patients with below the knee arterial disease. Patients were grouped according to the dorsal transcutaneous oximetry value (Group A < 30 mmHg; Group B ≥ 30 mmHg). Patients of Group B had a second oximetry performed at the rearfoot, close to the lesion localized in all cases at the heel. Finally, the analysis of the arterial pattern disease has been done.ResultsWe selected 191 patients: Group A (151 patients), dorsal transcutaneous oximetry of 11.8 ± 0.7 mmHg; Group B (40 patients), dorsal transcutaneous oximetry of 44.2 ± 10.1 mmHg. In Group B, rearfoot oximetry was 20.5 ± 5 mmHg, significantly lower than dorsal oximetry (p = 0.0179). The anterior tibial artery was involved in all patients of Group A. In Group B, the anterior tibial artery was involved in 15 subjects and never alone; the posterior tibial artery was involved in 20 subjects and in 11 cases alone. The peroneal artery was affected in 20 subjects and in 14 patients alone.ConclusionWhen a heel lesion is present and the transcutaneous oximetry recorded on the dorsum of the foot does not confirm the presence of critical limb ischemia (not ≤30 mmHg), a second oximetry recorded on the rearfoot is useful to point out ischemia of the peroneal artery and/or of the posterior tibial artery.

  16. SLUDGE HEEL REMOVAL BY ALUMINUM DISSOLUTION AT SAVANNAH RIVER SITE 12390

    Energy Technology Data Exchange (ETDEWEB)

    Keefer, M.

    2012-01-12

    High Level Waste (HLW) at the Savannah River Site (SRS) is currently stored in aging underground storage tanks. This waste is a complex mixture of insoluble solids, referred to as sludge, and soluble salts. Continued long-term storage of these radioactive wastes poses an environmental risk. Operations are underway to remove and disposition the waste, clean the tanks and fill with grout for permanent closure. Heel removal is the intermediate phase of the waste retrieval and tank cleaning process at SRS, which is intended to reduce the volume of waste prior to treatment with oxalic acid. The goal of heel removal is to reduce the residual amount of radioactive sludge wastes to less than 37,900 liters (10,000 gallons) of wet solids. Reducing the quantity of residual waste solids in the tank prior to acid cleaning reduces the amount of acid required and reduces the amount of excess acid that could impact ongoing waste management processes. Mechanical heel removal campaigns in Tank 12 have relied solely on the use of mixing pumps that have not been effective at reducing the volume of remaining solids. The remaining waste in Tank 12 is known to have a high aluminum concentration. Aluminum dissolution by caustic leaching was identified as a treatment step to reduce the volume of remaining solids and prepare the tank for acid cleaning. Dissolution was performed in Tank 12 over a two month period in July and August, 2011. Sample results indicated that 16,440 kg of aluminum oxide (boehmite) had been dissolved representing 60% of the starting inventory. The evolution resulted in reducing the sludge solids volume by 22,300 liters (5900 gallons), preparing the tank for chemical cleaning with oxalic acid.

  17. Novel Surgical Treatment for Refractory Heel Ulcers in Werner’s Syndrome

    Directory of Open Access Journals (Sweden)

    Keisuke Oe

    2013-01-01

    Full Text Available Patients with Werner’s syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical heel ulcers. Treatment of the ulcer is challenging, as flap options are limited over the lower third of the leg and skin grafting is not easy as there is a lack of healthy granulations. We successfully treated the ulcer with osteomyelitis by drilling the bone and applying an ultrathin split thickness skin graft with the thigh skin as the donor site.

  18. Heel quantitative ultrasound in HIV-infected patients: a cross-sectional study.

    Science.gov (United States)

    Pinzone, Marilia Rita; Castronuovo, Daniela; Di Gregorio, Adriana; Celesia, Benedetto Maurizio; Gussio, Maria; Borderi, Marco; Maggi, Paolo; Santoro, Carmen Rita; Madeddu, Giordano; Cacopardo, Bruno; Nunnari, Giuseppe

    2016-04-01

    HIV infection has been associated with increased risk of osteoporosis and fragility fractures. Dual-energy X-ray absorptiometry (DXA) is the reference standard to assess bone mineral density (BMD); however, it is not easily accessible in several settings. Heel Quantitative ultrasound (QUS) is a radiation-free, easy-to-perform technique, which may help reducing the need for DXA. In this cross-sectional study, we used heel QUS (Hologic Sahara(®)) to assess bone status in a cohort of HIV-infected patients. A QUS stiffness index (QUI) threshold >83 was used to identify patients with a low likelihood of osteoporosis. Moreover, we compared QUS results with those of 36 sex- and age-matched HIV-negative controls. 244 HIV-positive patients were enrolled. Median heel QUI value was 83 (73-96) vs. 93 (IQR 84-104) in the control group (p = 0.04). 110 patients (45 %) had a QUI value ≤83. Risk factors for low QUI values were age (OR 1.04 per year, 95 % CI 1.01-1.07, p = 0.004), current use of protease inhibitors (OR 1.85, CI 1.03-3.35, p = 0.039), current use of tenofovir (OR 2.28, CI 1.22-4.27, p = 0.009) and the number of risk factors for secondary osteoporosis (OR 1.46, CI 1.09-1.95, p = 0.01). Of note, QUI values were significantly correlated with FRAX score (r = -0.22, p = 0.004). According to EACS guidelines, 45 % of patients had risk factors for osteoporosis which make them eligible for DXA. By using QUS, we may avoid DXA in around half of them. As HIV-positive patients are living longer, the prevalence of osteoporosis is expected to increase over time. Appropriate screening, prevention and treatment are crucial to preserve bone health in this population. The use of screening techniques, such as heel QUS, may help reducing the need for DXA. Further studies are needed to define the diagnostic accuracy of this promising technique in the setting of HIV.

  19. Results of Characterization and Retrieval Testing on Tank 241-C-109 Heel Solids

    Energy Technology Data Exchange (ETDEWEB)

    Callaway, William S.

    2013-09-26

    Eight samples of heel solids from tank 241-C-109 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, one-half to two-thirds of the solids were off-white to tan solids that, visually, were fairly evenly graded in size from coarse silt (30-60 μm) to medium pebbles (8-16 mm). The remaining solids were mostly strongly cemented aggregates ranging from coarse pebbles (16-32 mm) to fine cobbles (6-15 cm) in size. Solid phase characterization and chemical analysis indicated that the air-dry heel solids contained ≈58 wt% gibbsite [Al(OH){sub 3}] and ≈37 wt% natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}·19H{sub 2}O]. The strongly cemented aggregates were mostly fine-grained gibbsite cemented with additional gibbsite. Dissolution testing was performed on two test samples. One set of tests was performed on large pieces of aggregate solids removed from the heel solids samples. The other set of dissolution tests was performed on a composite sample prepared from well-drained, air-dry heel solids that were crushed to pass a 1/4-in. sieve. The bulk density of the composite sample was 2.04 g/mL. The dissolution tests included water dissolution followed by caustic dissolution testing. In each step of the three-step water dissolution tests, a volume of water approximately equal to 3 times the initial volume of the test solids was added. In each step, the test samples were gently but thoroughly mixed for approximately 2 days at an average ambient temperature of 25 °C. The caustic dissolution tests began with the addition of sufficient 49.6 wt% NaOH to the water dissolution residues to provide ≈3.1 moles of OH for each mole of Al estimated to have been present in the starting composite sample and ≈2.6 moles of OH for each mole of Al potentially present in the starting aggregate sample. Metathesis of gibbsite to sodium aluminate was then allowed to proceed over 10 days of gentle mixing of the

  20. Results of Characterization and Retrieval Testing on Tank 241-C-110 Heel Solids

    Energy Technology Data Exchange (ETDEWEB)

    Callaway, William S.

    2013-09-30

    Nine samples of heel solids from tank 241-C-110 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, the sample solids were primarily white to light-brown with minor dark-colored inclusions. The maximum dimension of the majority of the solids was <2 mm; however, numerous pieces of aggregate, microcrystalline, and crystalline solids with maximum dimensions ranging from 5-70 mm were observed. In general, the larger pieces of aggregate solids were strongly cemented. Natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}°19H{sub 2}O] was the dominant solid phase identified in the heel solids. Results of chemical analyses suggested that 85-87 wt% of the heel solids were the fluoridephosphate double salt. The average bulk density measured for the heel solids was 1.689 g/mL; the reference density of natrophosphate is 1.71 g/mL. Dissolution tests on composite samples indicate that 94 to 97 wt% of the tank 241-C-110 heel solids can be retrieved by dissolution in water. Dissolution and recovery of the soluble components in 1 kg (0.59 L) of the heel solids required the addition of ≈9.5 kg (9.5 L) of water at 15 °C and ≈4.4 kg (4.45 L) of water at 45 °C. Calculations performed using the Environmental Simulation Program indicate that dissolution of the ≈0.86 kg of natrophosphate in each kilogram of the tank 241-C-110 heel solids would require ≈9.45 kg of water at 15 °C and ≈4.25 kg of water at 45 °C. The slightly larger quantities of water determined to be required to retrieve the soluble components in 1 kg of the heel solids are consistent with that required for the dissolution of solids composed mainly of natrophosphate with a major portion of the balance consisting of highly soluble sodium salts. At least 98% of the structural water, soluble phosphate, sodium, fluoride, nitrate, carbonate, nitrite, sulfate, oxalate, and chloride in the test composites was dissolved and recovered in the

  1. Plantar fasciitis (fasciosis) treatment outcome study: plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement.

    Science.gov (United States)

    Fabrikant, Jerry M; Park, Tae Soon

    2011-06-01

    Ultrasound, well recognized as an effective diagnostic tool, reveals a thickening of the plantar fascia in patients with plantar fasciitis/fasciosis disease. The authors hypothesized that ultrasound would also reveal a decrease in the plantar fascia thickness for patients undergoing treatment for the disease, a hypothesis that, heretofore, had been only tested on a limited number of subjects. They conducted a more statistically significant study that found that clinical treatment with injection and biomechanical correction does indeed diminish plantar fascia thickness as shown on ultrasound. The study also revealed that patients experience the most heightened plantar fascia tenderness toward the end of the day, and improvement in their symptomatic complaints were associated with a reduction in plantar fascia thickness. As a result, the authors conclude that office-based ultrasound can help diagnose and confirm plantar fasciitis/fasciosis through the measurement of the plantar fascia thickness. Because of the advantages of ultrasound--that it is non-invasive with greater patient acceptance, cost effective and radiation-free--the imaging tool should be considered and implemented early in the diagnosis and treatment of plantar fasciitis/fasciosis. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Eosinophilic Fasciitis

    Science.gov (United States)

    ... MD, Assistant Professor, Division of Rheumatology and Clinical Immunology , Robert Larner, MD, College of Medicine, The University ... pneumonia in immunocompromised people ). Drugs Mentioned In This Article Generic Name Select Brand Names azathioprine IMURAN cyclosporine ...

  3. Plantar Fasciitis

    Science.gov (United States)

    ... the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should ... Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care ...

  4. Research Paper: Effect of Custom-Molded Insole With New Technique on Pain and Function in Females With Flexible Flat Foot: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Fateme Bahramian

    2017-02-01

    Conclusion According to our findings, there was a significant difference in pain and function in patients with a flat foot through medial heel skive technique. Therefore, it seems that the insoles can be an effective prescription for subjects with a flat foot.

  5. Impaired heel to toe progression during gait is related to reduced ankle range of motion in people with Multiple Sclerosis.

    Science.gov (United States)

    Psarakis, Michael; Greene, David; Moresi, Mark; Baker, Michael; Stubbs, Peter; Brodie, Matthew; Lord, Stephen; Hoang, Phu

    2017-11-01

    Gait impairment in people with Multiple Sclerosis results from neurological impairment, muscle weakness and reduced range of motion. Restrictions in passive ankle range of motion can result in abnormal heel-to-toe progression (weight transfer) and inefficient gait patterns in people with Multiple Sclerosis. The purpose of this study was to determine the associations between gait impairment, heel-to-toe progression and ankle range of motion in people with Multiple Sclerosis. Twelve participants with Multiple Sclerosis and twelve healthy age-matched participants were assessed. Spatiotemporal parameters of gait and individual footprint data were used to investigate group differences. A pressure sensitive walkway was used to divide each footprint into three phases (contact, mid-stance, propulsive) and calculate the heel-to-toe progression during the stance phase of gait. Compared to healthy controls, people with Multiple Sclerosis spent relatively less time in contact phase (7.8% vs 25.1%) and more time in the mid stance phase of gait (57.3% vs 33.7%). Inter-limb differences were observed in people with Multiple Sclerosis between the affected and non-affected sides for contact (7.8% vs 15.3%) and mid stance (57.3% and 47.1%) phases. Differences in heel-to-toe progression remained significant after adjusting for walking speed and were correlated with walking distance and ankle range of motion. Impaired heel-to-toe progression was related to poor ankle range of motion in people with Multiple Sclerosis. Heel-to-toe progression provided a sensitive measure for assessing gait impairments that were not detectable using standard spatiotemporal gait parameters. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Altered stiffness of microchamber and macrochamber layers in the aged heel pad: Shear wave ultrasound elastography evaluation

    Directory of Open Access Journals (Sweden)

    Chueh-Hung Wu

    2018-05-01

    Full Text Available Background/Purpose: To compare shear modulus of heel pad microchamber and macrochamber layers between young and elderly people using shear wave ultrasound elastography (SWUE, with the intent to clarify age-related changes. Methods: This single-center prospective cross-sectional study was conducted between March, 2014 and March, 2016. Shear modulus of entire heel pad (Gentire, macrochamber layer (Gmac, and microchamber layer (Gmic were measured with SWUE. Results: Elderly participants (15 men, 15 women; age = 66.9 ± 6.2 years had significantly higher Gmic (103.8 ± 20.7 vs. 60.1 ± 9.8 kPa; p < 0.001 and Gentire (39.4 ± 10.5 vs. 34.1 ± 5.4 kPa; p = 0.005, but a significantly lower Gmac (21.7 ± 7.5 vs. 27.9 ± 4.9 kPa; p < 0.001 compared with those of young participants (15 men, 15 women; age = 26.4 ± 2.9 years. Positive correlations were observed between age and Gmic (r = 0.79, p < 0.001 and between age and Gentire (r = 0.28, p = 0.03, and negative correlation between age and Gmac (r = −0.46, p = 0.001. Conclusion: SWUE revealed that the heel pad macrochamber layer was slightly softer but the microchamber layer was exaggeratedly stiffer, making the entire heel pad stiffer in the elderly group than in the younger group, implying age-related compensation in heel pad layers to retain foot function. Keywords: Age, Elastography, Heel pad, Ultrasound

  7. 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.

  8. CHEMICAL SLUDGE HEEL REMOVAL AT THE SAVANNAH RIVER SITE F TANK FARM CLOSURE PROJECT 8183

    International Nuclear Information System (INIS)

    Thaxton, D; Timothy Baughman, T

    2008-01-01

    Chemical Sludge Removal (CSR) is the final waste removal activity planned for some of the oldest nuclear waste tanks located at the Savannah River Site (SRS) in Aiken, SC. In 2008, CSR will be used to empty two of these waste tanks in preparation for final closure. The two waste tanks chosen to undergo this process have previously leaked small amounts of nuclear waste from the primary tank into an underground secondary containment pan. CSR involves adding aqueous oxalic acid to the waste tank in order to dissolve the remaining sludge heel. The resultant acidic waste solution is then pumped to another waste tank where it will be neutralized and then stored awaiting further processing. The waste tanks to be cleaned have a storage capacity of 2.84E+06 liters (750,000 gallons) and a target sludge heel volume of 1.89E+04 liters (5,000 gallons) or less for the initiation of CSR. The purpose of this paper is to describe the CSR process and to discuss the most significant technical issues associated with the development of CSR

  9. Heel Effect: Dose Mapping And Profiling For Mobile C-Arm Fluoroscopy Unit Toshiba SXT-1000A

    International Nuclear Information System (INIS)

    Husaini Salleh; Mohd Khalid Matori; Muhammad Jamal Md Isa; Mohd Ramli Arshad; Shahrul Azlan Azizan; Mohd Firdaus Abdul Rahman; Md Khairusalih Md Zin

    2014-01-01

    Heel Effect is the well known phenomena in x-ray production. It contributes the effect to image formation and as well as scattered radiation. But there is paucity in the study related to heel effect. This study is for mapping and profiling the dose on the surface of water phantom by using mobile C-arm unit Toshiba SXT-1000A. Based on the result the dose profile is increasing up to about 57 % from anode to cathode bound of the irradiated area. This result and information can be used as a guide to manipulate these phenomena for better image quality and radiation safety for this specific and dedicated fluoroscopy unit. (author)

  10. Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Michael M. Neeki

    2017-05-01

    Full Text Available Introduction: Necrotizing fasciitis (NF is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. Methods: This was a 10-year retrospective chart-review study that included emergency department (ED patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0–13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8, moderate risk (LRINEC score 6–7, and low risk (LRINEC score ≤5. All cases missing laboratory values were due to the absence of a C-reactive protein (CRP value. Since the score for a negative or positive CRP value for the LRINEC score was 0 or 4 respectively, a LRINEC score of 0 or 1 without a CRP value would have placed the patient in the “low risk” group and a LRINEC score of 8 or greater without CRP value would have placed the patient in the “high risk” group. These patients missing CRP values were added to these respective groups. Results: Among the 948 ED patients with cellulitis, more than one-tenth (10.7%, n=102 of 948 were moderate or high risk for NF based on LRINEC score. Of the 135 ED patients with a diagnosis of NF, 22 patients had valid CRP laboratory values and LRINEC scores were calculated. Among the other 113 patients without CRP values, six patients had a LRINEC score ≥ 8, and 19 patients had a LRINEC score ≤ 1. Thus, a total of 47 patients were further classified based on LRINEC score without a CRP value

  11. Sexual pain.

    Science.gov (United States)

    Boardman, Lori A; Stockdale, Colleen K

    2009-12-01

    Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs. This article provides a review of the terminology and definition of the condition, theories on the pathophysiology, diagnostic considerations, and recommendations on the management of female sexual pain.

  12. Developmental Changes in the Responses of Preterm Infants to a Painful Stressor

    OpenAIRE

    Lucas-Thompson, Rachel; Townsend, Elise L.; Gunnar, Megan R.; Georgieff, Michael K.; Guiang, Sixto F.; Ciffuentes, Raul F.; Lussky, Richard C.; Davis, Elysia Poggi

    2008-01-01

    The purpose of this investigation was to examine longitudinally gestational age and developmental differences in preterm infants' self-regulatory abilities in response to a painful stressor, as well as associations between behavioral and cardiovascular responses. Participants included 49 healthy premature infants. Behavioral and cardiovascular responses to a heel stick blood draw were compared between infants of 28–31 and 32–34 weeks gestational age at birth. Both gestational age groups displ...

  13. Control of the motion of the body's center of mass in relation to the center of pressure during high-heeled gait.

    Science.gov (United States)

    Chien, Hui-Lien; Lu, Tung-Wu; Liu, Ming-Wei

    2013-07-01

    High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. Knowledge of the motion of the body's center of mass (COM) with respect to the center of pressure (COP) during high-heeled gait may offer insights into the balance control strategies and provide a basis for approaches that minimize the risk of falling and associated adverse effects. The study aimed to investigate the influence of the base and height of the heels on the COM motion in terms of COM-COP inclination angles (IA) and the rate of change of IA (RCIA). Fifteen females who regularly wear high heels walked barefoot and with narrow-heeled shoes with three heel heights (3.9cm, 6.3cm and 7.3cm) while kinematic and ground reaction force data were measured and used to calculate the COM and COP, as well as the temporal-distance parameters. The reduced base of the heels was found to be the primary factor for the reduced normalized walking speed and the reduced frontal IA throughout the gait cycle. This was achieved mainly through the control of the RCIA during double-leg stance (DLS). The heel heights affected mainly the peak RCIA during DLS, which were not big enough to affect the IA. These results suggest young adults adopt a conservative strategy for balance control during narrow-heeled gait. The results will serve as baseline data for future evaluation of patients and/or older adults during narrow-heeled gait with the aim of reducing the risk of falling. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. Pelvic Pain

    Science.gov (United States)

    ... OLPP) Office of Science Policy, Reporting, and Program Analysis (OSPRA) Division of Extramural Research (DER) Extramural Scientific ... treat my pain? Can pelvic pain affect my emotional well-being? How can I cope with long- ...

  15. Neck pain

    Science.gov (United States)

    ... cause of neck pain is muscle strain or tension. Most often, everyday activities are to blame. Such ... of a heart attack , such as shortness of breath, sweating, nausea, vomiting, or arm or jaw pain. ...

  16. Patellofemoral Pain.

    Science.gov (United States)

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Bilateral Necrotizing Fasciitis of the Foot Associated with Group B Streptococcus

    Directory of Open Access Journals (Sweden)

    Keitaro Fukuda

    2016-09-01

    Full Text Available Necrotizing fasciitis (NF is a severe bacterial infection involving fascia and subcutaneous tissue. It generally affects upper or lower extremities unilaterally, and there are few reports of bilateral-extremity NF. Here, we report a case of a 43-year-old male with type 1 diabetes who had NF on the left foot and subsequently developed NF on the other foot 1 week later. The patient survived with antimicrobial therapy and bilateral below-knee amputation. As group B streptococcus (GBS was isolated by blood culture and culture of excised tissues of both feet, bilateral GBS NF of the foot was diagnosed. GBS is a rare causative pathogen in NF; however, there have been two case reports of bilateral GBS NF of an extremity in which NF appeared on the opposite extremity 1 week after the primary site infection, as in our case. GBS was isolated from cultures of blood and excised tissues of both extremities in both cases. Together, these observations suggest that GBS has a potential to cause secondary NF at remote sites by hematogenous dissemination with approximately 1 week delay and thereby lead to bilateral NF.

  18. Antibacterial Derivatives of Ciprofloxacin to Inhibit Growth of Necrotizing Fasciitis Associated Penicillin Resistant Escherichia coli

    Directory of Open Access Journals (Sweden)

    Ronald Bartzatt

    2013-01-01

    Full Text Available Escherichia coli (E. coli is associated with necrotizing fasciitis (type I and can induce enough damage to tissue causing hypoxia. Three ester derivatives of the broad-spectrum antibiotic ciprofloxacin were placed into bacteria culture simultaneously with the parent ciprofloxacin (drug 1 to ascertain the level of antibacterial activity. The n-propyl (drug 2, n-pentyl (drug 3, and n-octyl (drug 4 esters of ciprofloxacin were synthesized under mixed phase conditions and by microwave excitation. The formation of ester derivatives of ciprofloxacin modified important molecular properties such as Log P and polar surface area which improves tissue penetration, yet preserved strong antibacterial activity. The Log P values for drugs 1, 2, 3, and 4 became −0.701, 0.437, 1.50, and 3.02, respectively. The polar surface areas for drugs 1, 2, 3, and 4 were determined to be 74.6 Angstroms2, 63.6 Angstroms2, 63.6 Angstroms2, and 63.6 Angstroms2, respectively. These values of Log P and polar surface area improved tissue penetration, as indicated by the determination of dermal permeability coefficient (Kp and subsequently into the superficial fascial layer. All drugs induced greater than 60% bacterial cell death at concentrations less than 1.0 micrograms/milliliter. The ester derivatives of ciprofloxacin showed strong antibacterial activity toward penicillin resistant E. coli.

  19. Retroperitoneal Necrotizing Fasciitis from Fournier’s Gangrene in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Samuel B. Weimer

    2017-01-01

    Full Text Available Introduction. Necrotizing fasciitis (NF is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient’s immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV infection. Case Report. A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. Conclusion. NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.

  20. Necrotizing fasciitis after scrotum skin injury in an infant: A case report.

    Science.gov (United States)

    Ren, Z X; Liu, C L; Zhang, Q; Xu, F; Zheng, Y N; Li, X J; Yang, J

    2018-03-01

    Necrotizing fasciitis (NF) is a life-threatening situation that is rare in children, especially infants, and early diagnosis is challenging. Timely identification and broad-spectrum antibiotic and supportive treatment before surgical debridement are very important for survival and may reduce scar formation. A previously healthy 4-month-old infant was admitted to our pediatric intensive care unit (PICU) with a history of fever and cough for 5 days and extreme swelling of the scrotum for one day. Necrotic-like tissue without margins appeared on his scrotum and perineum in 24 hours. NF was suspected, and the patient soon developed shock. The patient underwent surgical debridement after his condition stabilized. Pathological analysis confirmed the diagnosis of NF. Broad-spectrum antibiotic, immediate fluid resuscitation, assistant ventilation, and vasoactive drugs were administered. Surgical debridement and autologous split-thickness skin grafting were performed. The wound recovered well after 2 months. Ultrasound revealed normal testicles, and no anorectal injury was found. Close clinical monitoring and timely treatment of skin injuries in sick children are very important. Sufficient antibiotic administration and supportive treatment before surgical debridement are crucial for survival from NF.

  1. 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...

  2. Knowledge of parents regarding newborn screening test, after accessing the website “Babies’ Portal” - Heel prick test

    Directory of Open Access Journals (Sweden)

    Caroline Antonelli Mendes

    Full Text Available ABSTRACT Purpose: to assess the knowledge of mothers about the heel prick test, develop contents on this test to make it available on the "Babies’ Portal" website, evaluate and validate the informative material developed. Methods: this study was conducted in three stages, that is, the first stage which is about a descriptive study involving 105 mothers of newborn children before performing the neonatal screening "Heel Prick Test", the second one consisting in the development of the website "Babies’ Portal", and the third stage, the evaluation and validation of this material carried out by 20 parents of children between zero and 36 months old, who underwent the neonatal screening Heel Prick Test by accessing the website “Babies’ Portal”. Results: although the interviewed mothers knew that their children had the right to be tested, they showed no knowledge of the diseases that can be prevented, time of diagnosis, nor the consequences arising from the lack of early diagnosis and treatment. The website creation and validation gathered basic information about the Heel Prick Test, and the participants regarded the content from satisfactory to excellent. Conclusion: it is necessary that families know not only about the procedures their children will undergo, but also the reason they are performed and the consequences of failing in doing so.

  3. Effects of Lateral Heel Wedges and Lateral Forefoot Wedge on the Knee Adduction Moment in Healthy Male Students

    Directory of Open Access Journals (Sweden)

    Fatemeh Shamsi

    2012-01-01

    Full Text Available Objective: Lateral wedged insoles have been designed to decrease the force applied on the medial knee compartment. The aim of this study was to assess the effects of laterally wedged insoles regarding to the placement of the wedge under the sole (under the heel or under the forefoot on the knee adduction moment and the ground reaction forces. Material & Methods: In this pretest-posttest study, three-dimensional gait analysis was performed on 20 healthy men between 18-30 years old. Knee adduction moment and ground reaction forces were compared among following three types of insoles: a flat insole, a 6˚ laterally inclined heel wedged insole and a 6˚ laterally- inclined forefoot wedged insole. Results: there was no difference between three conditions (flat insole (9.72±1.501, lateral heel wedge (9.866±2.141 and lateral forefoot wedge (9.952±1.986 in peak knee adduction moment (P>0.05. Ground reaction forces and spatiotemporal parameters of gait were not affected by any types of these insoles (P>0.05. Conclusion: Based on the current finding, placement of the lateral wedge under the sole, that is, under the heel or under the forefoot has no effect on the efficacy of these insoles on the adduction moment of the knee and ground reaction forces.

  4. Does shoe heel design influence ground reaction forces and knee moments during maximum lunges in elite and intermediate badminton players?

    Science.gov (United States)

    Lam, Wing-Kai; Ryue, Jaejin; Lee, Ki-Kwang; Park, Sang-Kyoon; Cheung, Jason Tak-Man; Ryu, Jiseon

    2017-01-01

    Lunge is one frequently executed movement in badminton and involves a unique sagittal footstrike angle of more than 40 degrees at initial ground contact compared with other manoeuvres. This study examined if the shoe heel curvature design of a badminton shoe would influence shoe-ground kinematics, ground reaction forces, and knee moments during lunge. Eleven elite and fifteen intermediate players performed five left-forward maximum lunge trials with Rounded Heel Shoe (RHS), Flattened Heel Shoe (FHS), and Standard Heel Shoes (SHS). Shoe-ground kinematics, ground reaction forces, and knee moments were measured by using synchronized force platform and motion analysis system. A 2 (Group) x 3 (Shoe) ANOVA with repeated measures was performed to determine the effects of different shoes and different playing levels, as well as the interaction of two factors on all variables. Shoe effect indicated that players demonstrated lower maximum vertical loading rate in RHS than the other two shoes (P badminton lunge. The differences in impact loads and knee moments between elite and intermediate players may be useful in optimizing footwear design and training strategy to minimize the potential risks for impact related injuries in badminton.

  5. Phantom Pain

    Science.gov (United States)

    ... Because this is yet another version of tangled sensory wires, the result can be pain. A number of other factors are believed to contribute to phantom pain, including damaged nerve endings, scar tissue at the site of the amputation and the physical memory of pre-amputation pain in the affected area. ...

  6. Spinal pain

    International Nuclear Information System (INIS)

    Izzo, R.; Popolizio, T.; D’Aprile, P.; Muto, M.

    2015-01-01

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  7. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  8. Does shoe heel design influence ground reaction forces and knee moments during maximum lunges in elite and intermediate badminton players?

    Directory of Open Access Journals (Sweden)

    Wing-Kai Lam

    Full Text Available Lunge is one frequently executed movement in badminton and involves a unique sagittal footstrike angle of more than 40 degrees at initial ground contact compared with other manoeuvres. This study examined if the shoe heel curvature design of a badminton shoe would influence shoe-ground kinematics, ground reaction forces, and knee moments during lunge.Eleven elite and fifteen intermediate players performed five left-forward maximum lunge trials with Rounded Heel Shoe (RHS, Flattened Heel Shoe (FHS, and Standard Heel Shoes (SHS. Shoe-ground kinematics, ground reaction forces, and knee moments were measured by using synchronized force platform and motion analysis system. A 2 (Group x 3 (Shoe ANOVA with repeated measures was performed to determine the effects of different shoes and different playing levels, as well as the interaction of two factors on all variables.Shoe effect indicated that players demonstrated lower maximum vertical loading rate in RHS than the other two shoes (P < 0.05. Group effect revealed that elite players exhibited larger footstrike angle, faster approaching speed, lower peak horizontal force and horizontal loading rates but higher vertical loading rates and larger peak knee flexion and extension moments (P < 0.05. Analysis of Interactions of Group x Shoe for maximum and mean vertical loading rates (P < 0.05 indicated that elite players exhibited lower left maximum and mean vertical loading rates in RHS compared to FHS (P < 0.01, while the intermediate group did not show any Shoe effect on vertical loading rates.These findings indicate that shoe heel curvature would play some role in altering ground reaction force impact during badminton lunge. The differences in impact loads and knee moments between elite and intermediate players may be useful in optimizing footwear design and training strategy to minimize the potential risks for impact related injuries in badminton.

  9. Spontaneous pain attacks: neuralgic pain

    NARCIS (Netherlands)

    de Bont, L.G.

    2006-01-01

    Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either

  10. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    International Nuclear Information System (INIS)

    Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

    2015-01-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment

  11. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    Energy Technology Data Exchange (ETDEWEB)

    Canyilmaz, Emine, E-mail: dremocan@ktu.edu.tr [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Canyilmaz, Fatih [Department of Orthopaedics and Traumatology, Yavuz Selim Bone Disease and Rehabilitation Hospital, Trabzon (Turkey); Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Uslu, Gonca Hanedan [Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon (Turkey); Aynaci, Osman [Department of Orthopaedics and Traumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Yoney, Adnan [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey)

    2015-07-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

  12. Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography

    Science.gov (United States)

    Leung, Wilson K.C.; Chu, KL

    2017-01-01

    Background Mechanical loading is crucial for muscle and tendon tissue remodeling. Eccentric heel drop exercise has been proven to be effective in the management of Achilles tendinopathy, yet its induced change in the mechanical property (i.e., stiffness) of the Achilles tendon (AT), medial and lateral gastrocnemius muscles (MG and LG) was unknown. Given that shear wave elastography has emerged as a powerful tool in assessing soft tissue stiffness with promising intra- and inter-operator reliability, the objective of this study was hence to characterize the stiffness of the AT, MG and LG in response to an acute bout of eccentric heel drop exercise. Methods Forty-five healthy young adults (36 males and nine females) performed 10 sets of 15-repetition heel drop exercise on their dominant leg with fully-extended knee, during which the AT and gastrocnemius muscles, but not soleus, were highly stretched. Before and immediately after the heel drop exercise, elastic moduli of the AT, MG and LG were measured by shear wave elastography. Results After the heel drop exercise, the stiffness of AT increased significantly by 41.8 + 33.5% (P eccentric heel drop exercise. The findings from this pilot study shed some light on how and to what extent the AT and gastrocnemius muscles mechanically responds to an isolated set of heel drop exercise. Taken together, appropriate eccentric load might potentially benefit mechanical adaptations of the AT and gastrocnemius muscles in the rehabilitation of patients with Achilles tendinopathy. PMID:28740756

  13. Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Joo; Kim, Ju Dong; Ryu, Hye In; Cho, Yeon Hee; Kong, Jun Ha; Ohe, Joo Young; Kwon, Yong Dae; Choi, Byung Joon; Kim, Gyu Tae [School of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)

    2011-12-15

    The advent and wide use of antibiotics have decreased the incidence of deep neck infection. When a deep neck infection does occur, however, it can be the cause of significant morbidity and death, resulting in airway obstruction, mediastinitis, pericarditis, epidural abscesses, and major vessel erosion. In our clinic, a patient with diffuse chronic osteomyelitis of mandible and fascial space abscess and necrotic fasciitis due to odontogenic infection at the time of first visit came. We successfully treated the patient by early diagnosis using contrast-enhanced CT and follow up dressing through the appropriate use of radiographic images.

  14. Pain Control Interventions in Preterm Neonates: A Randomized Controlled Trial.

    Science.gov (United States)

    Shukla, Vivek V; Bansal, Satvik; Nimbalkar, Archana; Chapla, Apurva; Phatak, Ajay; Patel, Dipen; Nimbalkar, Somashekhar

    2018-04-15

    To compare individual efficacy and additive effects of pain control interventions in preterm neonates. Randomized controlled trial. Level-3 University affiliated neonatal intensive care unit. 200 neonates (26-36 wk gestational age) requiring heel-prick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions. Neonates were randomly assigned to Kangaroo mother care with Music therapy, Music therapy, Kangaroo Mother care or Control (no additional intervention) groups. All groups received expressed breast milk with cup and spoon as a baseline pain control intervention. Assessment of pain using Premature Infant Pain Profile (PIPP) score on recorded videos. The mean (SD) birth weight and gestational age of the neonates was 1.9 (0.3) kg and 34 (2.3) wk, respectively. Analysis of variance showed significant difference in total PIPP score across groups (P<0.001). Post-hoc comparisons using Sheffe's test revealed that the mean (SD) total PIPP score was significantly lower in Kangaroo mother care group [7.7 (3.9) vs. 11.5 (3.4), 95% CI(-5.9, -1.7), P<0.001] as well as Kangaroo mother care with Music therapy group [8.5 (3.2) vs. 11.5 (3.4), 95%CI (-5.1, -0.9), P=0.001] as compared to Control group. PIPP score was not significantly different between Control group and Music therapy group. Kangaroo mother care with and without Music therapy (with expressed breast milk) significantly reduces pain on heel-prick as compared to expressed breast milk alone. Kangaroo mother care with expressed breast milk should be the first choice as a method for pain control in preterm neonates.

  15. The Relationship of Foot Shape and Sensitivity to Comfort of Shoe-Inserts

    Science.gov (United States)

    1998-07-30

    tension of the plantar fascia have been implicated by several authors as a cause of plan tar fasciitis which results in symptomatic heel pain and...Pressure distribution Relationship Between Foot Sensitivity and Plantar Pressure RESULTS AND DISCUSSION The shoe and insert factors Factor Sl...sensitivity of the plantar surface of the foot). For activities which are typical for army personal the choice of an appropriate shoe is essential

  16. Pain genes.

    Directory of Open Access Journals (Sweden)

    Tom Foulkes

    2008-07-01

    Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

  17. [Necrotizing fasciitis: results of a survey on management practices in French-speaking intensive care units].

    Science.gov (United States)

    de Prost, N; Bosc, R; Brun-Buisson, C; Chosidow, O; Decousser, J-W; Dhonneur, G; Lepeule, R; Rahmouni, A; Sbidian, E; Amathieu, R

    2014-12-01

    Necrotizing fasciitis (NF) are rare and severe soft tissue infections associated with a high mortality rate. In order to assess the management of NF in French-speaking intensive care units (ICUs), we conducted a survey endorsed by the French Society of Anesthesia and Intensive Care (SFAR). Online self-administered survey. A link to an online survey was sent by email to 4620 anesthesiologists and/or intensivists and was available online from January to February 2014. One hundred and seventy-five physicians (3.8%) who worked in 135 ICUs filled out the online survey. Among respondents, 42% reported having managed up to two patients with NF during the previous year; 59% and 72% of respondents reported not having a surgical and a medical specialist consultant, respectively. A delayed access to the operating room (OR) of more than 6hours was reported in 31% of cases and access to the OR was reported not to be routinely considered as a priority in 13% of cases. Only 17% of respondents reported that time to transfer to the OR was never a cause for delayed surgery. The main causes for delayed surgery were: delayed diagnosis (45%), delayed validation of surgical intervention (37%), and difficulty of access to the OR (8%). Finally, 83% of respondents estimated that creating dedicated multidisciplinary teams for managing NFs could lead to improving outcomes. This survey illustrates the heterogeneous management of NF in French-speaking ICUs and points out several logistical aspects that should be improved to reduce the time to the first surgical debridement. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  18. Functional genomic characterization of virulence factors from necrotizing fasciitis-causing strains of Aeromonas hydrophila.

    Science.gov (United States)

    Grim, Christopher J; Kozlova, Elena V; Ponnusamy, Duraisamy; Fitts, Eric C; Sha, Jian; Kirtley, Michelle L; van Lier, Christina J; Tiner, Bethany L; Erova, Tatiana E; Joseph, Sandeep J; Read, Timothy D; Shak, Joshua R; Joseph, Sam W; Singletary, Ed; Felland, Tracy; Baze, Wallace B; Horneman, Amy J; Chopra, Ashok K

    2014-07-01

    The genomes of 10 Aeromonas isolates identified and designated Aeromonas hydrophila WI, Riv3, and NF1 to NF4; A. dhakensis SSU; A. jandaei Riv2; and A. caviae NM22 and NM33 were sequenced and annotated. Isolates NF1 to NF4 were from a patient with necrotizing fasciitis (NF). Two environmental isolates (Riv2 and -3) were from the river water from which the NF patient acquired the infection. While isolates NF2 to NF4 were clonal, NF1 was genetically distinct. Outside the conserved core genomes of these 10 isolates, several unique genomic features were identified. The most virulent strains possessed one of the following four virulence factors or a combination of them: cytotoxic enterotoxin, exotoxin A, and type 3 and 6 secretion system effectors AexU and Hcp. In a septicemic-mouse model, SSU, NF1, and Riv2 were the most virulent, while NF2 was moderately virulent. These data correlated with high motility and biofilm formation by the former three isolates. Conversely, in a mouse model of intramuscular infection, NF2 was much more virulent than NF1. Isolates NF2, SSU, and Riv2 disseminated in high numbers from the muscular tissue to the visceral organs of mice, while NF1 reached the liver and spleen in relatively lower numbers on the basis of colony counting and tracking of bioluminescent strains in real time by in vivo imaging. Histopathologically, degeneration of myofibers with significant infiltration of polymorphonuclear cells due to the highly virulent strains was noted. Functional genomic analysis provided data that allowed us to correlate the highly infectious nature of Aeromonas pathotypes belonging to several different species with virulence signatures and their potential ability to cause NF. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  19. Bone pain

    DEFF Research Database (Denmark)

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

    2016-01-01

    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

  20. Whole-Genome Sequencing of a Human Clinical Isolate of emm28 Streptococcus pyogenes Causing Necrotizing Fasciitis Acquired Contemporaneously with Hurricane Harvey

    OpenAIRE

    Long, S. Wesley; Kachroo, Priyanka; Musser, James M.; Olsen, Randall J.

    2017-01-01

    ABSTRACT We discovered an emm28 Streptococcus pyogenes isolate causing necrotizing fasciitis in a patient exposed to the floodwaters of Hurricane Harvey in the Houston, TX, metropolitan area in August 2017. The Oxford Nanopore MinION instrument provided sufficient genome sequence data within 1 h of beginning sequencing to close the genome.

  1. Necrotising fasciitis as atypical presentation of infection with emerging Neisseria meningitidis serogroup W (MenW) clonal complex 11, the Netherlands, March 2017

    NARCIS (Netherlands)

    Russcher, Anne; Fanoy, Ewout; van Olden, Ger D. J.; Graafland, Antonie D.; van der Ende, Arie; Knol, Mirjam J.

    2017-01-01

    In March 2017, a patient with necrotising fasciitis caused by Neisseria meningitidis serogroup W (MenW) clonal complex 11 was diagnosed in the Netherlands. Unusual and severe presentations of MenW infections are common in the current European epidemic. In the Netherlands, the incidence of MenW

  2. Ankle and subtalar synovitis in a ball-and-socket ankle joint causing posterolateral painful coarse crepitus: a case report.

    Science.gov (United States)

    Fan, Ka Yuk; Lui, Tun Hing

    2014-01-01

    A 17-year-old girl with bilateral ball-and-socket ankles reported left medial heel pain. Her left heel had gone into a varus position on tiptoeing, and a painful clunk had occurred when returning to normal standing. The clunk persisted after physiotherapy and treatment with an orthosis. Subtalar arthroscopy and peroneal tendoscopy showed mild diffuse synovitis of the ankle joint, especially over the posterior capsule, and a patch of inflamed and fibrotic synovium at the posterolateral corner of the subtalar joint. The clunk subsided immediately after arthroscopic synovectomy and had not recurred during 5 years of follow-up. We found no other reported cases of ankle and subtalar synovitis occurring in patients with a ball-and-socket ankle joint. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Fascitis nodular cervical en paciente gestante: revisión de la literatura y presentación de un caso Cervical nodular fasciitis in a pregnant woman: Review of the literature and presentation of a new case

    Directory of Open Access Journals (Sweden)

    Manuel Acosta-Feria

    2010-09-01

    Full Text Available La fascitis nodular es una lesión benigna rara, de crecimiento rápido, cuya patogenia es aún desconocida. Si bien a nivel de cabeza y cuello aparece en un 20% de los casos, su aparición en pacientes gestantes es extremadamente rara. Presentamos el segundo caso descrito en la literatura en el cual está presente dicha asociación. Mujer de 25 años y gestante de 13 semanas, con una tumoración retroauricular derecha de 3 cm de diámetro, 3 meses de evolución y rápido crecimiento. No presentaba parálisis facial ni dolor en la exploración inicial. Tras la exéresis quirúrgica de la lesión, el diagnóstico anatomopatológico definitivo de ésta, fue de fascitis nodular. Tras 2 años desde la intervención quirúrgica no se ha evidenciado recidiva de la tumoración, llevándose el embarazo a término sin presentar complicaciones ni para la madre ni para el feto.The nodular fasciitis is a rare benign lesion of rapid growth, whose pathogenesis is still unknown. While at the head and neck appeared in 20% of cases, its occurrence in pregnant patients is extremely rare. We report the second case described in the literature in which this association is present. Woman of 25 years and 13 weeks pregnant, who had a right auricular tumour 3 cm in diameter, 3 months of development and rapid growth. No facial paralysis or pain in the initial exploration. After surgical resection of the lesion, the final pathological diagnosis of the same was nodular fasciitis. After two years since the surgery, there was no evidence of recurrence of the tumour, taking ad términun pregnancy without complications or the mother or the fetus.

  4. Saltwater nectotizing fasciitis following coral reef laceration possibly exacerbated by a long-haul flight: a case report.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2009-01-01

    INTRODUCTION: Necrotising fasciits is a rapidly progressive disease characterised by extensive necrosis of the fascia, skin, and subcutaneous tissue, with relative sparing of the underlying muscle. CASE PRESENTATION: We present the case of a 24-year old Irish male student who sustained a laceration to his right shin from contact with a coral reef while swimming in the Phuket region, off the west coast of Thailand. The following day, he returned to Ireland and presented with an aggressive and destructive variant of group A beta-hemolytic streptococcal necrotising fasciitis originating at the site of the coral reef injury, and exacerbated by the long-haul flight. He was successfully treated with aggressive surgical debridement, vacuum-assisted dressings, split skin grafting and broad spectrum antibiotics. CONCLUSION: Necrotising fasciitis can progress rapidly to systemic toxicity and even death without expedient diagnosis and aggressive treatment. Long-haul flights induce significant fluid accumulation in the lower extremity. These physiological fluid shifts may have contributed to the severity of our patient\\'s necrotizing condition following his flight from Thailand.

  5. Evaluation of the anode heel effect on the testes dose during pelvic radiography

    Directory of Open Access Journals (Sweden)

    Vahid Karami

    2017-05-01

    Full Text Available Background: Anode heel effect refers to reduction of radiation intensity in the anode side of X-ray tube. This variation in radiation intensity across the anode-cathode of X-ray tube can be benefited for decrease radiation exposure in some radiological examinations. The aim of this study was to evaluate the effect of anode heel orientation on the radiation dose received by the testes in male patients undergoing pelvic radiography. Methods: This is a cross-sectional study, conducted at one of the teaching hospitals of Ahvaz, Jundishapur University of Medical Science Ahvaz, Iran, from September 2015 to March 2016. In order to measure the profile of radiation intensity variation, 13 paired sets of high radiosensitive cylindrical lithium fluoride thermo-luminescent dosimeters (TLD aligned on the cathode-anode central axis upon the table and then irradiated using routine exposure parameters. The anode of X-ray tube was positioned toward the feet for 40 patients and toward the head for 39 patients undergoing pelvic radiography. For measure the entrance skin dose (ESD, 8 TLD chips were located on the central point of the radiation field and 5 TLDs were located on the testes position to measure the dose received. Results: Radiation intensity profile showed that radiation intensity decrease from the cathode to the anode side. Discrepancy of radiation intensity on central axis of cathode-anode was calculated about 35%. The radiation dose received by the testes was 26.74% lower for patients the anode directed toward the feet, compared to the patients in which the anode directed toward the head (FTC: 1.260±0.296 mGy, FTA: 0.923±0.167 mGy, P<0.05. There was no meaningful difference for the measured ESD of pelvis between two groups of patients (FTC: 1.256±0.315 mGy, FTA: 1.195±0.205 mGy, P=0.788. Conclusion: In pelvic radiography, positioning of testes directed to the anode of X-ray tube can decrease the receive dose.

  6. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy.

    Science.gov (United States)

    Liang, Huey-Wen; Wang, Tyng-Guey; Chen, Wen-Shiang; Hou, Sheng-Mou

    2007-07-01

    Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.

  7. Mixing of process heels, process solutions, and recycle streams: Results of the small-scale radioactive tests

    International Nuclear Information System (INIS)

    Lumetta, G.J.; Bramson, J.P.; Farmer III, O.T.; Greenwood, L.R.; Hoopes, F.V.; Mann, M.A.; Steele, M.J.; Steele, R.T.; Swoboda, R.G.; Urie, M.W.

    2000-01-01

    Various recycle streams will be combined with the low-activity waste (LAW) or the high-level waste (HLW) feed solutions during the processing of the Hanford tank wastes by BNFL, Inc. In addition, the LAW and HLW feed solutions will also be mixed with heels present in the processing equipment. This report describes the results of a test conducted by Battelle to assess the effects of mixing specific process streams. Observations were made regarding adverse reactions (mainly precipitation) and effects on the Tc oxidation state (as indicated by K d measurements with SuperLigreg s ign 639). The work was conducted according to test plan BNFL-TP-29953-023, Rev. 0, Small Scale Mixing of Process Heels, Solutions, and Recycle Streams. The test went according to plan, with only minor deviations from the test plan. The deviations from the test plan are discussed in the experimental section

  8. Ejaculatory pain

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Møhl, Bo; Kehlet, Henrik

    2007-01-01

    . The psychosexual interview revealed no major psychosexual disturbances and concluded that the pain was of somatic origin. All patients with ejaculatory pain had experienced major negative life changes and deterioration in their overall quality of life and sexual function as a result of the hernia operation...

  9. Breast Pain

    Science.gov (United States)

    ... result in the development of breast cysts. Breast trauma, prior breast surgery or other factors localized to the breast can lead to breast pain. Breast pain may also start outside the breast — in the chest wall, muscles, joints or heart, for example — and ...

  10. Neuropathic pain

    Directory of Open Access Journals (Sweden)

    Giuseppe Re

    2009-02-01

    Full Text Available Neuropathic pain is the expression of a dysfunction or primary lesion of a nerve in the peripheral or central nervous system, or both, rather than the biological signal transmitted by the nerve following peripheral nociceptor activation. It represents about 20% of all painful syndromes, with an estimated prevalence of 1.5%, however is actual incidence is hard to pinpoint due to the difficulties encountered in distinguishing it from chronic pain, of which it represents a significant percentage, on account of the not infrequent concurrence of conditions. It is crucial to recognise the variety of symptoms with which it can present: these can be negative and positive and, in turn, motor, sensitive and autonomic. In public health terms, it is important to emphasise that the diagnosis of neuropathic pain does not in most cases require sophisticated procedures and does not therefore weigh on health expenditure. In clinical practice, a validated scale (the LANSS is mentioned is useful for identifying patients presenting neuropathic pain symptoms. Therapy is based on three categories of medication: tricyclic antidepressants, anti-epileptics and opioids at high doses: neuropathic pain has a bad reputation for often resisting common therapeutic approaches and responding less well that nociceptor pain to monotherapy. Therapeutic strategies are all the more adequate the more they are based on symptoms and therefore on the pain generation mechanisms, although the recommendations are dictated more by expert opinions that double-blind randomised trials.

  11. Painful shoulder

    Directory of Open Access Journals (Sweden)

    Benno Ejnismann

    2008-03-01

    Full Text Available Many factors can be involved in the painful shoulder. Beyond articularcauses other pathologies such as artrosis, periarticular diseases as rotadorcuff tears, long head of the biceps tendinitis, adhesive capsulitis, calcifyingtendinitis, degenerative arthritis of the acromioclavicular joint, cervicalradiculopathy and nervous injuries can cause pain in the shoulder.

  12. Orofacial Pain

    Science.gov (United States)

    ... aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. Pain also can be caused by clenching or grinding teeth, trauma to the head and neck or poor ergonomics. ; Some people may experience pain in the ears, ...

  13. Neck Pain

    Science.gov (United States)

    ... Vomiting Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath ... worse or doesn’t get better. Start OverDiagnosisYour pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  14. Influence of patellofemoral pain syndrome on plantar pressure in the foot rollover process during gait

    Directory of Open Access Journals (Sweden)

    Sandra Aliberti

    2011-01-01

    Full Text Available BACKGROUND: Patellofemoral Pain Syndrome is one of the most common knee disorders among physically active young women. Despite its high incidence, the multifactorial etiology of this disorder is not fully understood. OBJECTIVES: To investigate the influence of Patellofemoral Pain Syndrome on plantar pressure distribution during the foot rollover process (i.e., the initial heel contact, midstance and propulsion phases of the gait. MATERIALS AND METHODS: Fifty-seven young adults, including 22 subjects with Patellofemoral Pain Syndrome (30 ± 7 years, 165 ± 9 cm, 63 ± 12 kg and 35 control subjects (29 ± 7 years, 164 ± 8 cm, 60 ± 11 kg, volunteered for the study. The contact area and peak pressure were evaluated using the Pedar-X system (Novel, Germany synchronized with ankle sagittal kinematics. RESULTS: Subjects with Patellofemoral Pain Syndrome showed a larger contact area over the medial (p = 0.004 and central (p = 0.002 rearfoot at the initial contact phase and a lower peak pressure over the medial forefoot (p = 0.033 during propulsion when compared with control subjects. CONCLUSIONS: Patellofemoral Pain Syndrome is related to a foot rollover pattern that is medially directed at the rearfoot during initial heel contact and laterally directed at the forefoot during propulsion. These detected alterations in the foot rollover process during gait may be used to develop clinical interventions using insoles, taping and therapeutic exercise to rehabilitate this dysfunction.

  15. Heel blood flow during loading and off-loading in bedridden older adults with low and normal ankle-brachial pressure index: a quasi-experimental study.

    Science.gov (United States)

    Masaki, Nami; Sugama, Junko; Okuwa, Mayumi; Inagaki, Misako; Matsuo, Junko; Nakatani, Tosio; Sanada, Hiromi

    2013-07-01

    The purpose of this study was to evaluate the differences in heel blood flow during loading and off-loading in bedridden adults older than 65 years. The patients were divided into three groups based on ankle-brachial pressure index (ABI) and transcutaneous oxygen tension (tcPO₂): (1) patients with an ABI ≥ 0.8 (Group A); (2) patients with an ABI < 0.8 and heel tcPO₂ ≥ 10 mmHg (Group B); and (3) patients with an ABI < 0.8 and heel tcPO₂ < 10 mmHg (Group C). Heel blood flow was monitored using tcPO₂ sensors. Data were collected with the heel (1) suspended above the bed surface (preload), (2) on the bed surface for 30 min (loading), and (3) again suspended above the bed surface for 60 min (off-loading). Heel blood flow during off-loading was assessed using three parameters: oxygen recovery index (ORI), total tcPO₂ for the first 10 min, and change in tcPO₂ after 60 min of off-loading. ORI in Group C (n = 8) was significantly shorter than in Groups A (n = 22) and B (n = 15). Total tcPO₂ for the first 10 min of off-loading in Group C was significantly less than that in Groups A and B. Change in tcPO₂ after 60 min of off-loading in Group C was less than in Group A. Based on these findings, additional preventive care against heel blood flow decrease in older adults with an ABI < 0.8 and heel tcPO₂ < 10 mmHg might be necessary after loading.

  16. Comparative study of the results of heel ultrasound screening and DXA findings (lumbar spine and left hip of postmenopausal women

    Directory of Open Access Journals (Sweden)

    Amila Jaganjac

    2012-04-01

    Full Text Available Introduction: Osteoporosis is a silent and invisible disease of bone, great presence and is considered to suffer from osteoporosis at least 200 million women worldwide. The goal of this paper is to show average ageof postmenopausal respondents, values of anthropometric parameters (weight, height, BMI, anamnestic data on clinical symptoms, fractures of women in menopause, analysis of heel ultrasound screening results,analysis of lumbar spine DXA results, analysis of left hip DXA results.Methods: In retrospective study 61 respondents were involved, 33 to 79 years old, treated in u Center for Physical Medicine and Acupuncture “AD” in Sarajevo during the period from 01.01.2008 till 31.12.2009. Alldate are shown numerically and percentage account with calculation of mean value, expressed in the form of tables and charts.Results: Finding of heel ultrosound screening compared to T values of postmenopausal respondents indicates on osteoporosis in case of 17 (27,87%, in case of 44 (72,13% respondents osteopenia, while normalvalues were not found. T value with lumbar spine DXA method in postmenopausal female respondents correspond to 43 (70,5% respondents, in 15 respondents (24,6% finding corresponded to osteopenia, while 3 respondents (4,9% had physiological finding. Left hip DXA finding shows 36 (59% respondents corresponded osteoporosis, 19 (31,2% respondents corresponded osteopenia, while physiological finding was found in 6 respondents (9,8%. T value of lumbar spine DXA finding was - 2,71 ± 1,16; DXA finding of left hip -2,35 ±1,36; heel ultrasound screening -2,19 ± 0,54.Conclusion: Research results indicate that DXA finding in relation to the heel ultrasound screening confirms gold standard in diagnosing osteoporosis.

  17. Co-bedding between preterm twins attenuates stress response after heel lance: results of a randomized trial.

    Science.gov (United States)

    Campbell-Yeo, Marsha L; Johnston, C Celeste; Joseph, K S; Feeley, Nancy; Chambers, Christine T; Barrington, Keith J; Walker, Claire-Dominique

    2014-07-01

    To examine the effect of co-bedding between preterm twins on stress response after heel lance. Using a multisite randomized controlled trial design, stable preterm twins (67 sets, N=134 infants) between 28 and 36 completed weeks' gestational age, stratified by gestational age (≤ and >32 weeks) and site, were randomly assigned to a co-bedding group, cared for continuously in the same incubator or crib or a standard care group, cared for in a separate incubator or crib, and underwent a medically indicated heel lance after at least 24 hours and no greater than 10 days of group allocation. The reported outcome was cortisol from saliva samples from 89 twins (n=49 co-bedding, n=40 standard care) collected immediately before the heel lance (baseline levels) and 113 twins (n=58 co-bedding, n=55 standard care) collected 20 minutes after heel lance (stress levels) as an index of stress response. No group differences were noted in baseline salivary cortisol levels: 0.36 μg/dL (SD 0.25) in the co-bedding group and 0.43 μg/dL (SD 0.50) in the standard care group. Twenty minutes after lance, levels were significantly lower in the co-bedding group, 0.28 μg/dL (SD 0.25) versus 0.50 μg/dL (SD 0.73) in the standard group (P=0.04). Similarly, the mean of paired changes in salivary cortisol from baseline was lower in the co-bedding group (-0.06 μg/dL) compared with the standard care group (0.14 μg/dL, Plance. clinicaltrials.gov Identifier: NCT009176.

  18. The oscillatory behavior of the CoM facilitates mechanical energy balance between push-off and heel strike.

    Science.gov (United States)

    Kim, Seyoung; Park, Sukyung

    2012-01-10

    Humans use equal push-off and heel strike work during the double support phase to minimize the mechanical work done on the center of mass (CoM) during the gait. Recently, a step-to-step transition was reported to occur over a period of time greater than that of the double support phase, which brings into question whether the energetic optimality is sensitive to the definition of the step-to-step transition. To answer this question, the ground reaction forces (GRFs) of seven normal human subjects walking at four different speeds (1.1-2.4 m/s) were measured, and the push-off and heel strike work for three differently defined step-to-step transitions were computed based on the force, work, and velocity. To examine the optimality of the work and the impulse data, a hybrid theoretical-empirical analysis is presented using a dynamic walking model that allows finite time for step-to-step transitions and incorporates the effects of gravity within this period. The changes in the work and impulse were examined parametrically across a range of speeds. The results showed that the push-off work on the CoM was well balanced by the heel strike work for all three definitions of the step-to-step transition. The impulse data were well matched by the optimal impulse predictions (R(2)>0.7) that minimized the mechanical work done on the CoM during the gait. The results suggest that the balance of push-off and heel strike energy is a consistent property arising from the overall gait dynamics, which implies an inherited oscillatory behavior of the CoM, possibly by spring-like leg mechanics. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Evaluation of Extended Wall OSB Sheathing Connection under Combined Uplift and Shear Loading for 24-inch Heel Trusses

    Science.gov (United States)

    Vladimir Kochkin; Andrew DeRenzis; Xiping Wang

    2014-01-01

    This study was designed to evaluate the performance of the extended wall structural panel connection in resisting combined uplift and shear forces at the roof-to-wall interface with a focus on a truss heel height of 24 in. to address the expected increases in the depth of attic insulation used in Climate Zones 5 and higher. Five full-size roof-wall assemblies were...

  20. Effect of medial and lateral heel wedge changes On mechanical parameters of diabetic foot ulcers during gait

    Directory of Open Access Journals (Sweden)

    Ebrahim Abdi

    2017-12-01

    Conclusions: These findings indicate that heel wedges change effect was significantly different between the peak pressure and peak pressure time integral on the metatarsal head regions. A median slope of 6 degrees can also be suitable for reducing the peak pressure in the three, four, and five metatarsal head, as well as a 6 degree can also be suitable for reducing the peak pressure in the metatarsal head.

  1. The use of hemoglobin saturation ratio as a means of measuring tissue perfusion in the development of heel pressure sores.

    Science.gov (United States)

    Aliano, Kristen A; Stavrides, Steve; Davenport, Thomas

    2013-09-01

    The heel is a common site of pressure ulcers. The amount of pressure and time needed to develop these wounds is dependent on various factors including pressure surface, the patient's anatomy, and co-morbidities. We studied the use of the hemoglobin saturation ratio as a means of assessing heel perfusion in various pressure settings. The mixed perfusion ratio in the heels of 5 volunteers was assessed on 3 pressure surfaces and at the time of off-load. The surfaces studied included: stretcher pad, plastic backboard without padding, and pressure reduction gel. Each surface was measured for 5 minutes with a real-time reading. On the stretcher, the average StO2% decrease for each pressure surface was 26.2 ± 10 (range 18-43). The average StO2% decrease on the backboard was 22.8 ± 12.3 (range 8-37), and 24.0 ± 4.8 (range 19-30) on the gel pad. The StO2% drop plateaued with the stretcher and gel pad, but with the backboard there was a continued slow drop at 5 minutes. This study demonstrates that hemoglobin oxygenation ratio may be effective in assessing a tissue's direct perfusion in the setting of tissue pressure and may also be beneficial to better assess the effects of pressure-reduction surfaces. Further studies will be needed to determine time to skin breakdown as it pertains to pressure and tissue oxygenation.

  2. The influence of heel height on vertical ground reaction force during landing tasks in recreationally active and athletic collegiate females.

    Science.gov (United States)

    Lindenberg, Kelly M; Carcia, Christopher R

    2013-02-01

    To determine if heel height alters vertical ground reaction forces (vGRF) when landing from a forward hop or drop landing. Increased vGRF during landing are theorized to increase ACL injury risk in female athletes. Fifty collegiate females performed two single-limb landing tasks while wearing heel lifts of three different sizes (0, 12 & 24 mm) attached to the bottom of a athletic shoe. Using a force plate, peak vGRF at landing was examined. Repeated measures ANOVAs were used to determine the influence of heel height on the dependent measures. Forward hop task- Peak vGRF (normalized for body mass) with 0 mm, 12 mm, and 24 mm lifts were 2.613±0.498, 2.616±0.497 and 2.495±0.518% BW, respectively. Significant differences were noted between 0 and 24 mm lift (psneaker significantly alters peak vGRF upon landing from a unilateral forward hop but not from a jumping maneuver.

  3. The influence of heel height on sagittal plane knee kinematics during landing tasks in recreationally active and athletic collegiate females.

    Science.gov (United States)

    Lindenberg, Kelly M; Carcia, Christopher R; Phelps, Amy L; Martin, Robroy L; Burrows, Anne M

    2011-09-01

    To determine if heel height alters sagittal plane knee kinematics when landing from a forward hop or drop landing. Knee angles close to extension during landing are theorized to increase ACL injury risk in female athletes. Fifty collegiate females performed two single-limb landing tasks while wearing heel lifts of three different sizes (0, 12 & 24 mm) attached to the bottom of a sneaker. Using an electrogoniometer, sagittal plane kinematics (initial contact [KA(IC)], peak flexion [KA(Peak)], and rate of excursion [RE]) were examined. Repeated measures ANOVAs were used to determine the influence of heel height on the dependent measures. Forward hop task- KA(IC) with 0 mm, 12 mm, and 24 mm lifts were 8.88±6.5, 9.38±5.8 and 11.28±7.0, respectively. Significant differences were noted between 0 and 24 mm lift (psneaker significantly alters sagittal plane knee kinematics upon landing from a unilateral forward hop but not from a drop jump.

  4. Impact reduction through long-term intervention in recreational runners: midfoot strike pattern versus low-drop/low-heel height footwear.

    Science.gov (United States)

    Giandolini, Marlène; Horvais, Nicolas; Farges, Yohann; Samozino, Pierre; Morin, Jean-Benoît

    2013-08-01

    Impact reduction has become a factor of interest in the prevention of running-related injuries such as stress fractures. Currently, the midfoot strike pattern (MFS) is thought as a potential way to decrease impact. The purpose was to test the effects of two long-term interventions aiming to reduce impact during running via a transition to an MFS: a foot strike retraining versus a low-drop/low-heel height footwear. Thirty rearfoot strikers were randomly assigned to two experimental groups (SHOES and TRAIN). SHOES progressively wore low-drop/low-heel height shoes and TRAIN progressively adopted an MFS, over a 3-month period with three 30-min running sessions per week. Measurement sessions (pre-training, 1, 2 and 3 months) were performed during which subjects were equipped with three accelerometers on the shin, heel and metatarsals, and ran for 15 min on an instrumented treadmill. Synchronized acceleration and vertical ground reaction force signals were recorded. Peak heel acceleration was significantly lower as compared to pre-training for SHOES (-33.5 ± 12.8 % at 2 months and -25.3 ± 18.8 % at 3 months, p heel height footwear seemed to be more effective than foot strike retraining to attenuate heel impact in the long term.

  5. The Achilles' heel of left ventricular assist device therapy: right ventricle.

    Science.gov (United States)

    Ranganath, Neel K; Smith, Deane E; Moazami, Nader

    2018-06-01

    Many patients suffer from either persistent right ventricular failure (RVF) at the time of left ventricular assist device (LVAD) or have ongoing symptoms consistent with RVF during chronic mechanical circulatory support. The lack of long-term right ventricular assist devices (RVADs) has limited the impact that mechanical circulatory support can provide to patients with biventricular failure. We aim to review the entire spectrum of RVF in patients receiving LVADs and reflect on why this entity remains the Achilles' heel of LVAD therapy. In the early postoperative period, LVAD implantation reduces right ventricle (RV) afterload, but RV dysfunction may be exacerbated secondary to increased venous return. With prolonged therapy, the decreased RV afterload leads to improved RV contractile function. Bayesian statistical models outperform previously published preoperative risk scores by considering inter-relationships and conditional probabilities amongst independent variables. Various echocardiographic parameters and the pulmonary artery pulsatility index have shown promise in predicting post-LVAD RVF. Recent publications have delineated the emergence of 'delayed' RVF. Several devices are currently being investigated for use as RVADs. Post-LVAD RVF depends on the RV's ability to adapt to acute hemodynamic changes imposed by the LVAD. Management options are limited due to the lack of an easily implantable, chronic-use RVAD.

  6. A Case of Heel Reconstruction with a Reverse Sural Artery Flap in a Hemophilia B Patient

    Directory of Open Access Journals (Sweden)

    Byung Kwon Lee

    2012-03-01

    Full Text Available Hemophilia B is a rare blood coagulation disorder. Complications such as bleeding and hematoma can cause necrosis of flaps, wound disruption, and the disturbance of wound healing. In particular, guidelines for flap operations in hemophilia B patients have still not been defined, and case reports are rare. We reconstructed the heel of a 41-year-old male hemophilia B patient using a reverse sural artery flap operation. The patient presented with mild hemophilia, having 27% of the normal value of coagulation factor IX. Coagulation and the changing value of the coagulation factor were regularly measured, and 70% of the normal value of coagulation factor IX was maintained through the injection of recombinant coagulation factors and antihemorrhagics. Hematoma developed twice (postoperative day [POD] 5 and POD 7 and in each case the hematoma was removed. Injections of recombinant coagulation factors and antihemorrhagics were continuously administered until postoperative week 2. When the coagulation factors were within normal ranges. In this article, a hemophilia B patient underwent reverse sural artery flap surgery and the healing progress was analyzed. We conclude that higher than baseline levels of coagulation factors are needed for successful healing in reverse sural artery flap surgery.

  7. EM-31 Alternative And Enhanced Chemical Cleaning Program For Sludge Heel Removal - 11220

    International Nuclear Information System (INIS)

    King, W.; Hay, M.; Wiersma, B.; Pennebaker, F.

    2010-01-01

    Mixtures of oxalic acid with nitric acid have been shown to be superior to oxalic acid alone for the dissolution of iron-rich High Level Waste sludge heels. Optimized conditions resulting in minimal oxalate usage and stoichiometric iron dissolution (based on added oxalate ion) have been determined for hematite (a primary sludge iron phase) in oxalic/nitric acid mixtures. The acid mixtures performed better than expected based on the solubility of hematite in the individual acids through a synergistic effect in which the preferred 1:1 Fe:oxalate complex is formed. This allows for the minimization of oxalate additions to the waste stream. Carbon steel corrosion rates were measured in oxalic/nitric acid mixtures to evaluate the impacts of chemical cleaning with these solutions on waste tank integrity. Manageable corrosion rates were observed in the concentration ranges of interest for an acid contact timescale of 1 month. Kinetics tests involving hematite and gibbsite (a primary sludge aluminum phase) have confirmed that (ge)90% solids dissolution occurs within 3 weeks. Based on these results, the chemical cleaning conditions recommended to promote minimal oxalate usage and manageable corrosion include: 0.5 wt. % oxalic acid/0.175 M nitric acid mixture, 50 C, 2-3 week contact time with agitation.

  8. Dendritic cells as Achilles' heel and Trojan horse during varicella zoster virus infection

    Directory of Open Access Journals (Sweden)

    Günther eSchönrich

    2015-05-01

    Full Text Available Varicella zoster virus (VZV, a human alphaherpesvirus, causes varicella and subsequently estab-lishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems’ Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article.

  9. Narcissistic rage: The Achilles’ heel of the patient with chronic physical illness

    Science.gov (United States)

    Hyphantis, Thomas; Almyroudi, Augustina; Paika, Vassiliki; Goulia, Panagiota; Arvanitakis, Konstantinos

    2009-01-01

    Based on the psychoanalytic reading of Homer’s Iliad whose principal theme is “Achilles’ rage” (the semi-mortal hero invulnerable in all of his body except for his heel, hence “Achilles’ heel” has come to mean a person’s principal weakness), we aimed to assess whether “narcissistic rage” has an impact on several psychosocial variables in patients with severe physical illness across time. In 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease, and glaucoma, we assessed psychological distress (SCL-90 and GHQ-28), quality of life (WHOQOL-BREF), interpersonal difficulties (IIP-40), hostility (HDHQ), and defense styles (DSQ). Narcissistic rage comprised DSQ “omnipotence” and HDHQ “extraverted hostility”. Hierarchical multiple regressions analyses were performed. We showed that, in patients with disease duration less than one year, narcissistic rage had a minor impact on psychosocial variables studied, indicating that the rage was rather part of a “normal” mourning process. On the contrary, in patients with longer disease duration, increased rates of narcissistic rage had a great impact on all outcome variables, and the opposite was true for patients with low rates of narcissistic rage, indicating that narcissistic rage constitutes actually an “Achilles’ Heel” for patients with long-term physical illness. These findings may have important clinical implications. PMID:19936167

  10. EM-21 Alternative Enhanced Chemical Cleaning Program For Sludge Heel Removal

    International Nuclear Information System (INIS)

    Hay, M.; King, W.; Martino, C.

    2009-01-01

    Preliminary studies in the EM-21 Alternative Chemical Cleaning Program have focused on understanding the dissolution of Hematite (a primary sludge heel phase) in oxalic acid, with a focus on minimizing oxalic acid usage. Literature reviews, thermodynamic modeling, and experimental results have all confirmed that pH control, preferably using a supplemental proton source, is critical to oxalate minimization. With pH control, iron concentrations as high as 0.103 M have been obtained in 0.11 M oxalic acid. This is consistent with the formation of a 1:1 (iron:oxalate) complex. The solubility of Hematite in oxalic acid has been confirmed to increase by a factor of 3 when the final solution pH decreases from 5 to below 1. This is consistent with literature predictions of a shift in speciation from a 1:3 to 1:1 as the pH is lowered. Above a solution pH of 6, little Hematite dissolves. These results emphasize the importance of pH control in optimizing Hematite dissolution in oxalic acid.

  11. A COMPARITIVE STUDY ON EFFECTIVENESS OF TAPING WITH IONTOPHORESIS AND TAPING ALONE IN CHRONIC PLANTAR FASCITIS

    Directory of Open Access Journals (Sweden)

    Biju Chetri

    2016-04-01

    Full Text Available Background: Plantar fasciitis is a painful condition caused by microtrauma to plantar fascia due to overuse. It is a most common cause of heel pain in runners. Various studies proved taping and Iontophoresis as effective in the treating plantar fasciitis. But there are no studies comparing the combined effect of iontophoresis with taping and taping alone in the treatment of plantar fasciitis. Methods: 50 patients suffering from plantar fasciitis who met the inclusion criteria were selected. The subjects were randomly divided into two groups i.e. Group A and Group B. Group A received taping, iontophoresis with plantar fascia stretching. Group B received taping and plantar fascia stretching. A total of 6 treatment sessions were given on alternate days over a period of two weeks for both the groups. Results: VAS and FFI scores across baseline and post intervention showed a significant improvement statistically in their mean scores between Groups A and B (P<0.05. Between group comparison of VAS and FFI scores, it showed that subject treated with Iontophoresis in combination with taping and plantar fascia stretch (Group A had significant improvement in VAS and functional ability when compared to subjects treated with taping and plantar fascia stretching alone (Group B. Conclusion: Iontophoresis along with Taping and plantar fascia stretching gave an additional benefit when compared with Taping and plantar fascia stretching alone in reducing pain and improving function in plantar fasciitis.

  12. Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

    Directory of Open Access Journals (Sweden)

    Orestis Ioannidis

    2017-07-01

    Full Text Available BackgroundFournier’s gangrene (FG is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease.MethodsThe current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis.ResultsIn our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4% and 4 females (16.6%. In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%. All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and

  13. Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study.

    Science.gov (United States)

    Oud, Lavi; Watkins, Phillip

    2014-12-01

    Necrotizing fasciitis (NF) is a rare complication in pregnant women. There have been no population-level data reported to date on its epidemiology, clinical features, resource utilization, and outcomes. This was a retrospective, population-based cohort study, using the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations for the years 2001-2010. Hospitalizations with a diagnosis of NF were then identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 728.86. Denominator data for incidence estimates were derived from the Texas Center for Health Statistics reports of live births, abortions and fetal deaths, and previously reported population-based, age-specific linkage data on miscarriage, and were used to estimate the annual total number of pregnancies (TEP). The incidence of pregnancy-associated NF (PANF), hospitalization type, clinical features, resource utilization and outcomes were examined. There were 4,060,201 pregnancy-associated hospitalizations and 148 PANF hospitalizations during study period. Postpartum hospitalizations accounted for 82.4% of all PANF events, and intensive care unit care was required in 61.5%. The key trends noted between 2001-2002 and 2009-2010 included rising incidence of PANF from 1.1 vs. 3.8 per 100,000 TEP-years (P = 0.0001), chronic comorbidities 0% vs. 31.7% (P = 0.0777), and development of organ failure in 9.1% vs. 31.7% (P = 0.0302). There was no significant change in total hospital charges or hospital length of stay. Three patients (2%) died in the hospital and 55% of survivors had routine home discharge. The present cohort of PANF is the largest reported to date. The incidence of PANF rose nearly 3.5-fold over the past decade, with most events developing following delivery hospitalization. Chronic illness has been increasingly present, along with rising severity of illness. The majority of patients required ICU care. Hospital mortality was

  14. Determinants of Home Discharge Among Survivors of Necrotizing Fasciitis: A Population-Level Analysis.

    Science.gov (United States)

    Oud, Lavi

    2016-07-01

    The majority of patients with necrotizing fasciitis (NF) in the United Sates survive their illness, and there is increasing interest in addressing the ability of survivors to return to their community following hospitalization. However, there are no data on the factors affecting home discharge among survivors of NF. We used the Texas Inpatient Public Use Data File to conduct a retrospective population-based examination of hospitalizations with NF aged 15 years or older between 2001 and 2010. Multivariate logistic regression modeling was used to explore predictors of home discharge among hospital survivors. There were 10,724 NF hospitalizations surviving to discharge during study period, of which 62.5% were discharged home. The following key predictors have adversely affected odds of home discharge (odds ratio and 95% confidence intervals): age ≥ 75 years (0.349 (0.292 - 0.417)), Medicare insurance (0.582 (0.510 - 0.663)), congestive heart failure (0.836 (0.719 - 0.972)), chronic liver disease (0.684 (0.522 - 0.895)), respiratory failure (0.464 (0.386 - 0.558)), neurological failure (0.573 (0.418 - 0.787)), and need for mechanical ventilation (0.339 (0.199 - 0.578)). Increased odds of home discharge were found among males (1.116 (1.058 - 1.285)), Hispanics (1.193 (1.056 - 1.349)), those lacking health insurance (2.161 (1.183 - 2.521)) or managed at a teaching hospital (1.264 (1.127 - 1.418)). In this first population-level examination of the determinants of home discharge among survivors of NF, older age, Medicare insurance, selected comorbidities, and development of organ failure decreased patients' odds of home discharge. Unexpectedly, male gender, Hispanic ethnicity, lack of health insurance, and being managed at a teaching hospital were associated with favorable impact on patients' discharge disposition. Further studies are warranted in other populations and healthcare environments to corroborate the present findings and to refine our understanding of the

  15. Skin hydration of the heel with fissure in patients with diabetes: a cross-sectional observational study

    Directory of Open Access Journals (Sweden)

    Oe M

    2018-06-01

    Full Text Available Makoto Oe,1 Kimie Takehara,2 Hiroshi Noguchi,3 Yumiko Ohashi,4 Mayu Fukuda,1 Takashi Kadowaki,5 Hiromi Sanada1,6 1Global Nursing Research Center, 2Department of Advanced Nursing Technology, 3Department of Life Support Technology (Molten, Graduate School of Medicine, The University of Tokyo, 4Department of Nursing, The University of Tokyo Hospital, 5Department of Diabetes and Metabolic Diseases, 6Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Purpose: Foot fissure should be prevented in patients with diabetes due to the likelihood of subsequent diabetic ulcer. The purpose of this study was to investigate a cutoff point for skin hydration with fissure and the factors associated with low skin hydration in patients with diabetes. Subjects and methods: Subjects were patients with diabetes who visited the diabetic foot clinic and were evaluated for skin hydration on the heel between April 2008 and March 2015. Information about fissure, skin hydration, age, sex, autonomic neuropathy, angiopathy, and tinea pedis were collected from the medical charts. Skin hydration on the heel was measured using a moisture checker. Skin hydration was compared between heels with and without fissure, and a cutoff for skin hydration with fissure was determined using receiver operating characteristic analysis. Based on the determined cutoff, factors associated with lower skin hydration were analyzed using logistic regression analysis. Results: Participants comprised 693 patients. Mean±SD age was 66.8±10.8 years, and 57.0% of subjects were male. The frequency of fissures on the heels was 10.4%. Area under the receiver operating characteristic curve for skin hydration in the presence of fissure was 0.717. Twenty percent was selected as the cutoff point, offering sensitivity of 0.478 and specificity of 0.819. Logistic regression analysis showed correlations between three factors (male sex, tinea

  16. Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain.

    Science.gov (United States)

    Kortlever, Joost T P; Janssen, Stein J; Molleman, Jeroen; Hageman, Michiel G J S; Ring, David

    2016-06-01

    Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific arm pain to eventual identification of discrete pathophysiology that corresponds with symptoms? 2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms? We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same pain. There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms. Nonspecific diagnoses are not harmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology.

  17. Cervical necrotizing fasciitis due to bacterial tonsillitis Fasceite necrotizante cervical secundária a amigdalite bacteriana

    Directory of Open Access Journals (Sweden)

    Bruno Zilberstein

    2005-04-01

    Full Text Available Necrotizing fasciitis is a severe and potentially fatal soft tissue infection, but involvement of the head and neck is rare. We report on 4 cases of cervical necrotizing fasciitis arising from tonsillitis. One patient was diabetic and one had received steroids before disease development. One patient developed acute respiratory failure and died of septic shock. Three patients recovered, helped by early recognition, aggressive surgical intervention, appropriate broad-spectrum antibiotics, and supportive therapy. The common bacteria found in all abscess samples were Streptococcus sp., but mixed flora with anaerobic organisms was seen in all but 1 case. Tonsillitis and peritonsillar abscess must be suspected as a cause of cervical necrotizing fasciitis and a successful result can be achieved with immediate aggressive treatment.A fasceite necrotizante cervical é uma infecção grave de partes moles do pescoço. Trata-se de entidade rara, porém quando presente tem como principal origem um foco infeccioso odontogênico. São descritos 4 casos de fasceite necrotizante cervical a partir de tonsilites e abscesso peritonsilar, os quais, foram admitidos e tratados na unidade de terapia intensiva. Um dos pacientes era portador de Diabetes Melittus não insulino- dependente e outro paciente havia recebido corticoterapia antes do desenvolvimento da infecção. Em um dos casos ocorreu mediastinite, insuficiência respiratória e o paciente evolui para o óbito em decorrência de choque séptico. Durante o tratamento, 3 pacientes evoluíram satisfatoriamente devido ao diagnostico precoce, tratamento cirúrgico agressivo e utilização de antibiótico terapia de largo espectro. A bactéria mais comumente encontrada foi o Streptococcus sp, mas flora mista com germes anaeróbios foi encontrada em 3 dos casos descritos. CONCLUSÕES: Deve-se suspeitar de tonsilite e abscesso peritonsilar como causa de fasceite necrotizante cervical para que tratamento agressivo e

  18. How Is Pain Managed?

    Science.gov (United States)

    ... Detection- Goggins Lab Sol Goldman Center Discussion Board Pain Management Pain is a very common symptom in patients ... of pain. Pain Assessment The first step in pain management is a thorough assessment. Your healthcare provider will ...

  19. The conundrum of calcaneal spurs: do they matter?

    LENUS (Irish Health Repository)

    Moroney, Paul J

    2013-12-30

    Background: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. Methods: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). Results: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. Conclusion: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. Clinical relevance: We have demonstrated the relevance of a radiographic finding once considered irrelevant.

  20. Pain Management

    Science.gov (United States)

    ... Funding Funding Opportunities (NIH Guide) Forms and Deadlines Electronic Research Admin (eRA) Grants Policy OER News About ... remains the most commonly used pain reliever. The French physician, Dr. Albert Schweitzer, proclaimed in 1931 that, “ ...