Foot & ankle international
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Pressure in the tarsal tunnel has been shown to be elevated when the ankle is pronated. We hypothesized that this also would be true for the medial plantar and lateral plantar tunnels because they also are potential sites of nerve compression. Additionally, we hypothesized that decompression surgery, including a release of the superficial and deep fascia of the abductor hallucis muscle and excision of the septum between the medial and lateral plantar tunnels, would decrease the pressure in all three tunnels. ⋯ Symptoms related to chronic compression of the tibial nerve and its branches at the ankle may be relieved by an operative strategy that targets release of multiple anatomic regions of tightness in the medial ankle rather than focusing on the tarsal tunnel alone.
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Gymnastics is a competitive and popular sport that is started at an early age, and elite female gymnasts reach their prime in mid-teenage years. The level of intensity of practice and competition, the number of events, and the degree of difficulty of the maneuvers make gymnastics one of the most injury-producing sports. ⋯ Elite female gymnasts can sustain significant injury to the foot and ankle region. In our study, Lisfranc injuries were most likely career-ending.
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Randomized Controlled Trial
The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study.
Plantar fasciitis frequently responds to a broad range of conservative therapies, and there is no single universally accepted way of treating this condition. Modalities commonly used include rest, ice massage, stretching of the Achilles tendon and plantar fascia, nonsteroidal anti-inflammatory medications (NSAIDs), corticosteroid injections, foot padding, taping, shoe modifications (steel shank and anterior rocker bottom), arch supports, heel cups, custom foot orthoses, night splints, ultrasound, and casting. To our knowledge, no prospective, randomized, placebo controlled double-blind study has evaluated the efficacy of oral NSAIDs in the treatment of plantar fasciitis. ⋯ These results provide some evidence that the use of an NSAID may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen.
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Chronic lateral ankle instability has been associated with varus deformity of the hindfoot, hyperactivity of the peroneus longus muscle, and insufficiency of the lateral ligaments. Many operative procedures have been described to correct this problem, but instability can recur if all contributing components are not treated. The purpose of this study was to offer an approach in the diagnosis and treatment of recurrent lateral ankle instability. ⋯ Recurrent chronic lateral ankle instability often is associated with chronic hindfoot malalignment and leads to functional impairment and patient discomfort. Clinical examination should determine the causes of instability. Varus malalignment of the hindfoot, hyperactivity of the peroneus longus muscle, and insufficiency of the lateral ligaments should be assessed and treated in a combined operative procedure to correct structured, static and dynamic components of the instability. The preliminary results of this particular approach are encouraging.
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Complex regional pain syndrome (CRPS) is a clinical entity that develops after a precipitating injury. It involves dysfunction of the sensory, autonomic, and motor systems and frequently is missed on initial presentation. The purpose of this report was to describe a simple clinical sign that can aid in its diagnosis. ⋯ Patients with CRPS have variable clinical presentations. The awareness of this simple observation in the right clinical setting should raise the index of suspicion of CRPS in the differential diagnosis. Early treatment of this syndrome is associated with better outcome.