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This study investigated the thickness and stiffness of the heel fat pad among male university athletes involved in sports with different performance characteristics: with shoes, barefoot, and in water. Participants included 34 male athletes—12 judo players (barefoot competition), 10 American football players (shoe competition), and 12 swimmers (water-based)—as well as 12 male non-athlete controls. Using ultrasonography, we measured the thickness of the shallow and deep layers of the heel fat pad under 0%, 50%, and 100% loading conditions, along with their respective rates of change. Stiffness (elasticity) of both layers was also assessed. At 0% load, both the shallow and deep layers were thickest in swimmers and thinner in judo and American football athletes. In the shallow layer, swimmers showed the greatest rate of change in thickness with loading. In the deep layer, significant changes were found in the judo and swimmer groups compared to the American football group, and in swimmers compared to controls. Elasticity in the shallow layer was lower in American football players than in the judo and swimmer groups. In the deep layer, judo athletes had the lowest elasticity, whereas swimmers had the highest. These findings indicate that the heel fat pad’s morphology and mechanical properties differ across sports disciplines, likely reflecting adaptations to sport-specific loading patterns.

Background This study employed a retrospective analysis to compare the short-term efficacy of the medial and lateral dual incision approach versus the medial dual incision approach for endoscopic spur resection combined with plantar fascia release in the treatment of heel pain syndrome, aiming to provide orthopedic surgeons with a reference for surgical treatment of heel pain syndrome. Methods From December 2022 to December 2023, a total of 44 patients were included in the study, with 22 cases in the medial and lateral dual incision group and 22 cases in the medial dual incision group. Postoperative follow-up lasted for 12 months, during which the following information was recorded: operative time and postoperative hospital stay. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, and the Maryland Foot Score. Changes in calcaneal spur were assessed using lateral X-rays of the calcaneus. Results There was no significant difference in postoperative VAS, AOFAS, or Maryland scores between the two surgical approaches ( P  > 0.05), and both showed significant improvement compared to preoperative scores ( P  < 0.05). However, the operative time in the medial dual incision group was significantly shorter than that in the medial and lateral dual incision group ( P  < 0.05). Conclusion Compared to the medial and lateral dual incision approach, the medial dual incision approach for endoscopic spur resection combined with plantar fascia release achieves similar short-term clinical outcomes and safety in the treatment of heel pain syndrome. However, considering the shorter operative time, the medial dual incision approach may be a better choice.

Objective This study aimed to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) and high-intensity laser therapy (HILT) in managing calcaneal spur-related symptoms. These non-invasive modalities were compared in terms of their ability to reduce pain and improve functional outcomes. Methods In this randomized clinical trial, patients diagnosed with calcaneal spur based on clinical and radiographic findings were randomly assigned to receive ESWT or HILT. Participants were randomized into two groups to receive either ESWT or HILT, complemented by standardized exercise regimens. Pain intensity was measured using the Visual Analog Scale (VAS), and functional outcomes were assessed with the Foot Function Index (FFI) at baseline, post-treatment, and three months post-treatment. Results Both groups showed significant improvements in pain and functional outcomes. In the ESWT group, VAS scores for initial step pain decreased from 7.8 ± 1.0 to 4.0 ± 1.0 post-treatment and further to 3.4 ± 1.0 at three months ( p  = 0.002). The HILT group demonstrated a similar trend, with scores reducing from 7.5 ± 1.2 to 4.2 ± 1.1 post-treatment and 3.5 ± 0.9 at follow-up ( p  = 0.001). Total FFI scores improved significantly in both groups, with the ESWT group showing a larger reduction (58.8 to 19.7; p  = 0.033) compared to the HILT group (57.4 to 35.4; p  = 0.046). No significant adverse events were reported in either group. Conclusion ESWT and HILT are effective non-invasive options for treating calcaneal spur with ESWT providing slightly greater functional benefits. Clinical trial registration Not applicable

Background The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs. Methods Ultimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC ( N  = 42) or MISTA ( N  = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded. Results The average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group ( p  < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p  < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group ( p  < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group ( p  < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures ( p  < 0.05). Conclusion The clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own advantages in improving the calcaneal width, providing a more clear visualization and accurate reduction of the articular surface, especially for Sanders Type-III DIACFs. Trial registration ChiCTRIOR16008512 . 21 May 2016.

Objective Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. Design A prospective, randomized, single-blind study. Setting Single-center pain clinic. Subjects Forty-nine patients who met the inclusion criteria were randomized into two groups. Methods Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study’s primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. Results NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. Conclusions US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. Clinical Trial Number NCT06240507.

Background While numerous clinical studies have compared the surgical and non-surgical treatment of acute Achilles tendon rupture (ATR), there are no studies that have performed a non-inferiority analysis between treatments. Methods Data from patients who were included in five randomised controlled trials from two different centres in Sweden were used. Outcomes at 1 year after ATR consisted of the patient-reported Achilles tendon Total Rupture Score (ATRS) and the functional heel-rise tests reported as the limb symmetry index (LSI). The non-inferiority statistical 10% margin was calculated as a reflection of a clinically acceptable disadvantage in ATRS and heel-rise outcome when comparing treatments. Results A total of 422 patients (350 males and 72 females) aged between 18 and 71 years, with a mean age of 40.6 (standard deviation 8.6), were included. A total of 363 (86%) patients were treated surgically. The ATRS (difference (Δ) = − 0.253 [95% confidence interval (CI); − 5.673;5.785] p  = 0.36) and LSI of heel-rise height (difference = 1.43 [95% CI; − 2.43;5.59] p  = 0.81), total work (difference = 0.686 [95% CI; − 4.520;6.253] p  = 0.67), concentric power (difference = 2.93 [95% CI; − 6.38;11.90] p  = 0.063) and repetitions (difference = − 1.30 [95% CI; − 6.32;4.13] p  = 0.24) resulted in non-inferiority within a Δ − 10% margin for patients treated non-surgically. Conclusion The non-surgical treatment of Achilles tendon ruptures is not inferior compared with that of surgery in terms of 1-year patient-reported and functional outcomes.

Objective To investigate the imaging characteristics and clinically assess heel enthesitis in spondyloarthritis (SpA) by applying in a post hoc analysis the Heel Enthesitis Magnetic Resonance Imaging Scoring system (HEMRIS) in blinded and centrally-read MRI data from the ACHILLES trial (NCT02771210). Methods ACHILLES included patients (≥18 years) with active psoriatic arthritis or axial SpA with clinical and MRI-positive heel enthesitis refractory to standard treatment. Patients were randomized to receive subcutaneous secukinumab 150/300 mg or placebo. At week 24, patients on placebo were switched to secukinumab treatment. MRI-positive heel enthesitis was confirmed in all patients by local investigators. MRIs were performed at 3 timepoints: screening and weeks 24 and 52. In the present analysis, all MRIs were re-evaluated by 2 blinded central readers in a consensus read fashion for a priori defined MRI parameters based on HEMRIS. Results At screening, 171/204 (83.8%) of patients presented with entheseal inflammation and/or structural damage, considering both the Achilles tendon and plantar fascia. Pathologies were more evident in the Achilles tendon area compared to the plantar aponeurosis. The most frequent pathologies were intra-tendon hypersignal and retrocalcaneal bursitis. The mean total entheseal inflammation score at screening in the Achilles tendon area was 2.99 ( N =204) and the mean change (standard deviation [SD]) from screening to weeks 24 and 52 was − 0.91 (1.99) and − 0.83 (2.12) in the secukinumab group vs − 0.48 (1.86) and − 0.80 (1.98) in the placebo-secukinumab group, respectively. The mean total structural damage score at screening was 1.36 ( N =204) and the mean change (SD) from screening to weeks 24 and 52 was 0.00 (0.65) and − 0.06 (0.56) in the secukinumab group vs 0.08 (0.48) and 0.04 (0.75) in the placebo-secukinumab group, respectively. Conclusions Based on the newly developed HEMRIS, entheseal inflammation and/or structural damage was confirmed in 83.3% of ACHILLES patients. Pathologies were more evident in the Achilles tendon area compared to plantar fascia, with the inflammatory parameters being more responsive with secukinumab treatment compared to placebo. The present analysis, with detailed information on individual MRI parameters, contributes to the scientific debate on heel enthesitis. Trial registration ClinicalTrials.gov NCT02771210 .

Various non-pharmacologic methods are used to alleviate pain in preterm infants who spend their first days in neonatal intensive care units (NICU) because they are exposed to numerous painful interventions. To determine the effects of Yakson and Gentle Human Touch (GHT) methods on pain and physiologic parameters during heel lancing procedures in preterm infants. This was a randomised controlled trial. The study was conducted in a NICU between June 2018 and June 2019. A total of 90 preterm infants were divided into three groups: 30 infants in the Yakson group, 30 infants in the GHT group, and 30 infants in the control group. All preterm infants were randomly divided into groups. Pain responses were evaluated using the Neonatal Infant Pain Scale. It was found that pain scores and heart rates were significantly lower during and after heel lancing in preterm infants in the Yakson and GHT groups than in the control group, the difference was statistically significant (p < .001). Yakson and GHT applied to preterm infants during heel lancing has positive effects on pain and physiologic parameters.

Since screening programs identify only a small proportion of the population as eligible for an intervention, genomic prediction of heritable risk factors could decrease the number needing to be screened by removing individuals at low genetic risk. We therefore tested whether a polygenic risk score for heel quantitative ultrasound speed of sound (SOS)-a heritable risk factor for osteoporotic fracture-can identify low-risk individuals who can safely be excluded from a fracture risk screening program. A polygenic risk score for SOS was trained and selected in 2 separate subsets of UK Biobank (comprising 341,449 and 5,335 individuals). The top-performing prediction model was termed \"gSOS\", and its utility in fracture risk screening was tested in 5 validation cohorts using the National Osteoporosis Guideline Group clinical guidelines (N = 10,522 eligible participants). All individuals were genome-wide genotyped and had measured fracture risk factors. Across the 5 cohorts, the average age ranged from 57 to 75 years, and 54% of studied individuals were women. The main outcomes were the sensitivity and specificity to correctly identify individuals requiring treatment with and without genetic prescreening. The reference standard was a bone mineral density (BMD)-based Fracture Risk Assessment Tool (FRAX) score. The secondary outcomes were the proportions of the screened population requiring clinical-risk-factor-based FRAX (CRF-FRAX) screening and BMD-based FRAX (BMD-FRAX) screening. gSOS was strongly correlated with measured SOS (r2 = 23.2%, 95% CI 22.7% to 23.7%). Without genetic prescreening, guideline recommendations achieved a sensitivity and specificity for correct treatment assignment of 99.6% and 97.1%, respectively, in the validation cohorts. However, 81% of the population required CRF-FRAX tests, and 37% required BMD-FRAX tests to achieve this accuracy. Using gSOS in prescreening and limiting further assessment to those with a low gSOS resulted in small changes to the sensitivity and specificity (93.4% and 98.5%, respectively), but the proportions of individuals requiring CRF-FRAX tests and BMD-FRAX tests were reduced by 37% and 41%, respectively. Study limitations include a reliance on cohorts of predominantly European ethnicity and use of a proxy of fracture risk. Our results suggest that the use of a polygenic risk score in fracture risk screening could decrease the number of individuals requiring screening tests, including BMD measurement, while maintaining a high sensitivity and specificity to identify individuals who should be recommended an intervention.

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 < .01) and patients with bilateral pain (P < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups (P < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. 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 given an injection (P = .66). Conclusion: The risk of having PF in this study was 45.6% at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time 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 to determine the efficacy of different treatment strategies.