The Effect of Pes Cavus on Foot Pain and Plantar Pressure

Joshua Burnsa, Jack Crosbiea, Adrienne Hunta, Robert Ouvrierb
Received 19 October 2004; accepted 10 March 2005 published online 9 May 2005.
Abstract
Background. Clinical management of patients with painful pes cavus is challenging because the mechanism of foot pain is poorly understood. The purpose of this study was to explore the influence of various pes cavus aetiologies on foot pain and plantar pressure characteristics, and to identify the relationship between foot pain and plantar pressure.
Methods. Seventy subjects were recruited for this study. They included 30 subjects with pes cavus of unknown aetiology (idiopathic), 10 subjects with pes cavus of neurological aetiology (neurogenic) and 30 subjects with a normal foot type. The presence and location of foot pain was recorded and barefoot plantar pressures were measured using the EMED-SF platform for the whole foot, rearfoot, midfoot and forefoot regions.
Findings. Subjects with pes cavus of either idiopathic or neurogenic aetiology reported a higher proportion of foot pain (60%) compared to subjects with a normal foot type (23%) (P=0.009). Pressure–time integrals under the whole foot, rearfoot and forefoot regions in pes cavus, of both idiopathic and neurogenic origin, were higher than in the normal foot type (P<0.01). Pressure–time integrals in subjects reporting foot pain were higher than for pain free subjects (P<0.001). There was a significant correlation between pressure–time integral and foot pain (r=0.49, P<0.001).
Interpretation. Foot pain is a common finding among individuals with pes cavus. Regardless of aetiology, pes cavus is characterized by abnormally high pressure–time integrals which are significantly related to foot pain. An understanding of the relationship between pes cavus pressure patterns and foot pain will improve the clinical management of these patients.

Effects of Low-Intensity Pulsed Ultrasound on Tendon–Bone Healing in an Intra-articular Sheep Knee Model

Effects of Low-Intensity Pulsed Ultrasound on Tendon–Bone Healing in an Intra-articular Sheep Knee Model
William R. Walsh, Ph.D.a, Paul Stephens, M.D.a, Frank Vizesi, M.S.a, Warwick Bruce, M.D.a, James Huckle, Ph.D.b, Yan Yu, Ph.D.a
Purpose: This study reports the mechanical and histologic properties of intra-articular tendon–bone healing with the application of low-intensity pulsed ultrasound (LIPUS) in an ovine knee model.

Methods: A single digital extensor tendon autograft from the right hoof was used as the graft in 89 adult sheep. Femoral fixation was achieved with an EndoButton (Smith & Nephew Endoscopy, Andover, MA) and tibial fixation by tying over a bony post. LIPUS treatment was performed daily for 20 minutes over the femoral and tibial tunnels until sacrifice in all groups, apart from the 26-week group, which was treated only for the first 12 weeks. Histology was performed at 3, 6, 12, and 26 weeks. Mechanical testing was performed at 6, 12, and 26 weeks.

Results: The LIPUS-treated group showed increased cellular activity at the tendon–bone interface and general improvement in tendon–bone integration and vascularity. Stiffness and peak load were greater compared with the control group at 26 weeks after surgery (P < .05).

Conclusions: The application of LIPUS appears to improve healing at the tendon–bone interface for soft tissue grafts fixed with a suspensory fixation technique. Histology supports a benefit based on increased integration between tendon and bone and a biologically more active interface, which would account for the improved mechanical properties. Clinical Relevance: The indications of LIPUS may be expanded to include tendon–bone healing, for example, in anterior cruciate ligament reconstruction.

H-reflex latency and nerve root tension sign correlation in fluoroscopically guided, contrast-confirmed, translaminar lumbar epidural steroid-bupivaca

Michael F. Stretanski DO
^a Surgical Neurology of North Central Ohio, Mansfield, OH, USA
Arch Phys Med Rehabil 2004;85:1479-82.

Objectives

To examine the correlation between physical examination parameters, commonly referred to as “nerve root tension signs,” and H-reflex latency measurements both pre- and postepidural steroid-bupivacaine (Marcaine) injection, and to propose mechanisms of pain alleviation.

Design

Prospective observational, with H-reflex latency measurement and physical examination at baseline and at 10 minutes postinjection.

Setting

Physical medicine and rehabilitation practice, outpatient surgical center, and community setting.

Participants

Ten consecutively recruited patients (6 women, 4 men; age range, 40–71y) with clinical radiculopathy and compatible magnetic resonance imaging findings, who were unaware of the outcome measures.

Interventions

Patients received a fluoroscopically guided, contrast-confirmed, paramedian translaminar lumbar epidural injection of 120mg of methylprednisolone acetate (80mg/mL) and 2.0mL of .25% preservative-free Marcaine.

Main outcome measures

Seated slump testing (SST), straight-leg raising (SLR), and H-reflex latency were measured bilaterally both pre- and postinjection. Differences were measured by using the paired t test in an A-B design.

Results

All SST of the affected (injected) side improved from pre- to postinjection, with 3 patients reporting discordant hamstring pain and 7 reporting no pain. SLR ability increased by an average of 29°±12°, corresponding to an average relative increase of 54% on the affected side. A statistically significant difference was found (Student t test, P=.02) between pre and post H-reflex latency on the affected side but not when comparing changes between affected and unaffected sides (Student t test, P=0.6).

Conclusions

Significant improvements in SST and SLR result from low volume epidural injection of Marcaine, with questionable prolongation of the H-reflex to the gastrocnemius-soleus complex on the affected side.

A critical Appraisal of this paper can be found by clicking here, this was undertaken as part of the London Deanery SEM Spr training 21.3.07

Neurophysiologic Influences on Hamstring Flexibility: A Pilot Study.

Clinical Journal of Sport Medicine. 11(4):241-246, October 2001.
Krabak, Brian J. MD *+; Laskowski, Edward R. MD ++; Smith, Jay MD ++; Stuart, Michael J. MD [S]; Wong, Gilbert Y. MD [P]

Abstract:
Objective: To examine the potential contribution of neurologic influences on hamstring length during passive range of motion.

Design: Prospective study.

Settings: Academic sports medicine center.

Patients: 15 subjects undergoing arthroscopic surgery for unilateral knee injuries without previous injury to the contralateral knee.

Interventions: Subjects received: 1) spinal anesthesia with bupivacaine, 2) epidural anesthesia with lidocaine, 3) general anesthesia, or 4) femoral nerve block of injured leg only.

Main Outcome Measures: Noninjured leg popliteal angle preoperatively, intraoperatively under anesthesia, and postoperatively after recovery from anesthesia.

Results: The overall mean popliteal angle was 132.5 +/- 3.1[degrees] preoperatively, 134.31 +/- 11.6[degrees] intraoperatively, and 130.7 +/- 10.2[degrees] postoperatively. Overall, the intraoperative angle was significantly greater than the postoperative angle (p = 0.02). The mean change in popliteal angle was 8.1 +/- 2.2[degrees] (Group 1), -0.4 +/- 1.9[degrees] (Group 2), 0.9 +/- 1.4[degrees] (Group 3), and -2.4 +/- 3.8[degrees] (Group 4). There was no significant change in pre- to postoperative popliteal angle in relation to postoperative pain. Females had a greater mean popliteal angle (139.84[degrees]) compared with males (128.84[degrees]) (p = 0.04).

Clinical Relevance: Understanding the neuromuscular influences on muscle flexibility will assist in the development of new rehabilitative and injury preventative techniques.

Conclusion: The present pilot study implicates neural contributions to muscle flexibility. Further studies are needed to delineate the relative contributions of neural and muscular components and to facilitate new techniques in the rehabilitation and prevention of injury.