Search

OBJECTIVES: To assess the frequency of normal plantar fascia thickness in the population of Pakistan by ultrasonography. MATERIALS & METHODS: This was a retrospective cross-sectional study conducted in the ultrasound department of Dr. Ziauddin Hospital, Clifton campus, Karachi from 06-02-2022 to 06-08-2022 for a period of six months. A total of 177 healthy individuals presenting with heel pain (VAS >3) for the first time, 18 to 70 years of age of both genders, were included. Patients having chronic or acute heel pain, morning heel stiffness and a history of surgical intervention of foot or trauma were excluded. Using ahigh-frequency transducer of a Toshiba ultrasound machine, the thickness of the plantar fascia was measured at the point 0.5 cm distal to its origin from the calcaneal tuberosity, by placing the transducer over the plantar aspect of the heel just medial to midline presence or absence of normal plantar fascia thickness was noted. RESULTS: Total 177 of participants included. The age range in our study was from 18 to 70 years with a mean age of 42.33 - 8.58 years. The majority of the patients 113 (63.84%) were between 18 to 45 years of age. Out of 177 patients, 98 (55.37%) were male and 79 (44.63%) were females with male to female ratio of 1.3:1. In our study, frequency of normal plantar fascia thickness in the local population by ultrasonography was found in 160 (90.40%) patients. The mean plantar fascia thickness was 2.68 - 1.05 mm. CONCLUSION: This study concluded that the frequency of normal plantar fascia thickness in the population of Pakistan by ultrasonography was found in 90.40% of patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the role played by ultrasound in evaluating plantar fasciitis and associate the findings with Magnetic resonance imaging. Study Design: Case series. Place and Duration of Study: Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Nov 2020 to Apr 2021. Methodology: All the patients underwent ultrasonography and magnetic resonance imaging scanning. The study and control Groups consisted of 38 patients. Results: Out of 38 patients, plantar fascia thickness in symptomatic feet was measured with ultrasound for both the Study and Control Groups. The Control Group had slightly thinner plantar fasciitis (1.1-2.4 mm, 1.7 ± 0.06 mm; p =0.03) compared to the Study Group (2.9-6.9 mm; 4.9±1.4 mm). In addition, this study compared other plantar fasciitis diagnostic signs on sonography with the magnetic resonance imaging findings. The diagnostic accuracy of plantar fascia pathological focal echogenicity, plantar fascia oedema, perifascial oedema, and plantar fascia rupture was 15(80.6%), 12(60.7%), 15(77.1%), and 13(68.6%) respectively. The diagnostic accuracy of ultrasonography was lower while evaluating for calcaneal spurs. Conclusion: The present study concluded that ultrasonography could be the basic initial diagnostic imaging modality to conrm clinically suspected cases of plantar fasciitis. However, magnetic resonance imaging could be the preferred diagnostic modality for suspected complex pathology and lack of clinical presentation. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis (PF) is a common cause of chronic foot pain that leads to functional limitations in individuals. There has been recent research on plantar fasciitis, but no studies have compared the effects of the active release technique and post-isometric relaxation in patients to determine which manual therapy technique improves foot pain and function. Objective: This study aimed to compare the effectiveness of the active release technique and post-isometric relaxation on proximal foot pain and functional status and to assess muscular tightness among patients with traffic police wards and plantar fasciitis. Methods: A quasi-experimental study (pre-test, post-test) was conducted in the Physiotherapy Department of Police Hospital, Gujranwala, Pakistan, between October 2022 and April 2023. We included 30 consecutively aged 25- to 60-year-old symptomatic police wardens diagnosed with planter fasciitis, who complained of pain on walking and standing for more than 3 months and met the inclusion criteria. They were equally assorted into two groups (n = 15 in each group) using convenient sampling. Group A received an active release exercise technique, group B received a post-isometric relaxation technique, and the participants in both groups received a similar baseline treatment protocol that consisted of calf stretching and stretching of the plantar fascia (5 repetitions and holding for 15 s). In the outcome measures, we included the Foot Function Index to assess the function of the foot and the Visual Analog Scale to examine the pain intensity measured during rest. The participants in both groups performed the selective protocol 3 days per week for 3 weeks, and we calculated the results at baseline and on the third day of the third week. We analyzed the data using SPSS software version 24 (IBM Corp., Armonk, NY). We compared within-group differences in the VAS score and FFI using paired t tests and analyzed between-group differences in the VAS score and FFI before and after performing the ART and PIR using independent t tests. Results: The 8-week intervention therapy revealed a demographic age mean and standard deviation of 36.60 ± 6.11 for group A and 35.60 ± 4.85 for group B. Within-group analysis demonstrated a significant decrease in VAS (pain) score following ART intervention (1.80 ± 0.862, p < 0.01) compared to PIR (6.07 ± 0.884). Between-group analysis indicated a significant reduction in FFI (disability) scores for group A (30.33 ± 3.200, p < 0.03) compared to group B (56.93 ± 4.773). Moreover, ART intervention exhibited significant improvement in VAS scores (p < 0.05), with 95% CI [1.49, 2.11]. The mean difference in FFI scores was substantially greater in the ART group (86.00 to 30.33) compared to the PIR group (p > 0.05), suggesting non-significant differences. Conclusion: The active release exercise intervention is more effective than post-isometric relaxation in improving pain and foot function disability in patients with plantar fasciitis. The present study aimed to help physical therapists choose the most efficient manual therapy exercise intervention to improve functional limitations. [ABSTRACT FROM AUTHOR]

Vitamin D is crucial for normal body metabolism. Two important vitamin D sources are synthesis in the lower layers of the skin (90%) and diet (10%). This systematic review and meta-analysis attempted to determine the incidence of vitamin D deficiency in Pakistan by using the findings of numerous cross-sectional studies. For subgroup analysis, a population-based subgroup analysis and a geographical location-based subgroup analysis were done. Different search techniques were utilized on various databases using the terms "vitamin D deficiency," "Pakistan," and "prevalence." The article names and abstracts were scrutinized, and associated complete texts were evaluated. The articles that satisfied the inclusion requirements were chosen for the meta-analysis. The I 2 test was used to determine heterogeneity. They were combined with the random-effect method. Out of 429 articles, 37 studies, with a total sample size of 19,338, were selected for the final analysis. The highest and lowest reported percentages observed were 100% and 15%, respectively. The overall pooled prevalence reported was 78% (95% CI = 74.2–82%). In subgroup analysis, children/adolescents showed a higher pooled prevalence of 84% (95% CI = 76.1–93.6%), and among province-wise subgroup analysis, Punjab province has shown a higher pooled prevalence of 84% (95% CI: 74–94%). Meta-analysis of the data showed a higher proportion of the population with deficient states. Interventions in public health are essential to address the high incidence of vitamin D insufficiency. Vitamin D levels can be increased, and related health concerns can be minimized through dietary supplementation, recommended sun exposure, and awareness initiatives. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis, a common musculoskeletal disorder, is characterized by inflammation of the plantar fascia, a thick band of tissue that connects the heel bone to the toes. The plantar fascia plays a crucial role in supporting the arch of the foot and absorbing shock during movement. Factors such as excessive physical activity, improper footwear, and biomechanical abnormalities are recognized contributors to the development of plantar fasciitis. However, the prevalence and underlying causes may vary across different demographic groups, necessitating targeted investigations. Objective: This study aims to investigate the prevalence, causes and treatment of plantar fasciitis in young female students (18–30) of a medical college in Pakistan and explore potential associations with high-heel footwear. Methodology: In this study, a cross-sectional survey was carried out, engaging 100 young females from a medical college. Employing a structured questionnaire, we assessed a spectrum of parameters, including heel pain symptoms, footwear habits, and available treatment options. The diagnostic precision of the Windlass test, specific to plantar fasciitis, was incorporated. Rigorous data analysis, utilizing SPSS, centered on discerning associations between the nuances of high-heel wear (considering types and duration) and the reported symptoms. This methodological framework ensures a comprehensive and precise exploration of the prevalence, causes, and treatment of plantar fasciitis in our targeted demographic. Results: All the participants were female, and the total number was 100, of which 66% felt pain in the heel when they wore high heels. Out of this 66%, only 6% are diagnosed with plantar fasciitis. The rest of the 60% have pain in the heel due to different causes such as heel spurs, stress fractures, etc. 2% of people receive treatment with steroid injections, and 12% are treated with ice. Conclusion: We conclude that the prevalence of plantar fasciitis is high in females wearing high heels. This study reveals that an increase in the total duration of wearing high heels with hard soles increases the symptoms of plantar fasciitis. Plantar fasciitis can be prevented by education and applying ergonomics and could be treated by steroids and the ice method, according to medical practitioners. [ABSTRACT FROM AUTHOR]

Osteoporosis is a global health concern characterized by reduced bone density and compromised bone quality, resulting in an increased risk of fractures, particularly in postmenopausal women. The assessment of bone mineral density (BMD) plays a pivotal role in diagnosing osteoporosis, as it accounts for approximately 70% of overall bone strength. The World Health Organization (WHO) has endorsed BMD measurement as a reliable method for diagnosing this condition. In Pakistan, the incidence of bone fractures is on the rise, largely attributable to an aging population and a range of contributing factors. Understanding the global and local prevalence of osteoporosis, its impact on morbidity and mortality, and the contributing factors is vital for developing effective preventive and therapeutic strategies. The role of adipokines, including chemerin, vaspin, and omentin-1, in bone metabolism is an emerging area of investigation. These adipokines play diverse roles in physiology, ranging from inflammation and metabolic regulation to cardiovascular health. Understanding their potential impact on bone health is a topic of ongoing research. The intricate relationship between bone density, bone quality, and overall bone strength is central to understanding the diagnosis and management of osteoporosis. Current innovation in machine learning and predictive model can bring revolution in the field of bone health and osteoporosis. Early identification of people with osteoporosis or risk of fracture through machine learning can prevent disability and improve the quality of life. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of low bone mineral density and its probable association with age and gender in Pakistani populations in suburban areas of Lahore. Study Design: Cross-sectional study Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, from Feb to May 2018. Methodology: In this study, 249 subjects were selected through non-probability convenience sampling. Information was endorsed in a pre-designed questionnaire after taking a brief history from al patients. The OsteoSys bone densitometer was used to calculate bone mineral density. To assess bone mineral density and the risk of osteopenia and osteoporosis, T-scores were used. In addition, to maximise accuracy and decrease the chance of error, we calibrated the machine before its use. Results: Osteoporosis was found in 91(36.54%) and osteopenia in 146(58.63%) of participants. Only 12(4.81%) had normal bone mineral density. A significant association of decreased bone mineral density with increasing age was seen (p-value = 0.001). Conclusion: This study revealed a high frequency of low bone mineral density in both genders of the Pakistani suburban population. The frequency increased with advancing age and post-menopausal status. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of Negative Pressure Wound Therapy (NPWT) in patients with foot and/or ankle injury compared with conventional dressing techniques. Study Design: Randomized controlled trial (Trial No: NCT04569305). Place and Duration of Study: Department of Plastic Surgery, Dr Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Dec 2019 to Oct 2020. Methodology: All patients with foot and ankle injury resulting in soft tissue injury with or without bones and tendons exposed were included. Thirty-five patients were randomized into the NPTW-Group and 35 into the Conventional Treatment Group using the lottery method. NPTW was applied to an injured foot and ankle area after debridement and cleaning the necrosed tissue. The effect of the technique was assessed by measuring the wound surface area covered with healthy granulation tissue measured in a centimetre square on follow-up. Results: Mean wound grade at the start of treatment was estimated as 3.20±0.71 in the NPWT-Group and 3.14±0.73 in the Control-Group, and at the end of treatment as 1.20±0.53 in the NPWT-Group and 1.71±0.78 in the Control Group. The mean wound size at the start of treatment was estimated as 52.74±21.92 cm2 in the NPWT-Group and 54.08±23.28 cm2 in Controls. At the end of treatment, an average wound size was estimated as 21.61±13.46 in NPTW and 30.40±16.50 in controls. NPTW significantly reduced wound grade and size more effectively than the conventional technique (p<0.05). Conclusion: Negative pressure wound therapy was more effective for soft tissue injury of the foot and/or ankle injury than the conventional dressing technique. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis is the most common cause of heel pain requiring medical attention. The clear understanding of the long‑term impact routine footwear has on plantar fasciitis is essential as any slight changes in shoe selection could possibly prevent the wearer from substantial discomfort and disability. Thus this study was planned to investigate impact of routine footwear on foot health by highlighting different features of the shoes worn daily by the people having plantar fasciitis. Methods: A cross‑sectional study was conducted in the orthopedics’ outpatient department of a tertiary‑care hospital in Pakistan. Data was collected using non‑probability convenient sampling from 101 people diagnosed with plantar fasciitis. Their routine footwear was categorized as appropriate or inappropriate on basis of heel height, sole thickness, and insole type (hard/cushioned/arched). Data were collected using a self‑designed questionnaire and analysed by applying descriptive statistics and non‑parametric tests. Results: The majority (83.2%) of the people wear inappropriate shoes, whereas only 16.8% wear the recommended shoes, i.e., with heel height between 0.5‑4 cm, thick soles, and arched or cushioned insoles. About 82.2% of plantar fasciitis patients reported wearing shoes of minimal heel height and 55.5% wore shoes with hard, non‑cushioned insole without built‑in arch support. Participants who wear inappropriate shoes experience more severe heel pain (P 0.013) which limits their daily activities. Conclusions: Footwear plays an important role in causing plantar fasciitis as the majority of the diagnosed cases wear inappropriate shoes with minimal heel height, thin sole, and hard insole without any built‑in arch support. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the prevalence of flatfoot among children aged 5-10 years. METHODS: This population-based cross-sectional study was conducted from April to July 2021, involving 379 children (aged 5-10 years) in Jhelum and Gujrat districts of Pakistan. Data was collected through non-probability convenient sampling using a questionnaire. Demographic data, including residential type, gender, age, height, weight, rear foot angle, flatfoot, injury, or pain in the lower limb were collected. The presence of flatfoot was determined using a footprint test, where inked soles were imprinted on paper as children stood. RESULTS: Of 379 participants, 196 (51.7%) were females and 183 (49.3%) were males, with a mean age of 7.90±1.60 years. The majority (59.6%) resided in urban areas, and 53.6% had normal weight and only 12.4% were overweight. Flatfoot was prevalent in 63.9% of children, with males exhibiting a significantly higher medial arch than females. Notably, a slight positive association was observed between gender, residence, and BMI with the medial arch, although statistical significance was not reached. These findings underscore the gender-related distinctions in arch development among pediatric populations in this region. CONCLUSION: The study revealed a 63.9% prevalence of flatfoot in children aged 5-10 years, notably higher in males with elevated medial arches. Moreover, the prevalence of flatfoot was particularly high among normal-weight children. The findings emphasize gender-related distinctions in pediatric flatfoot development, warranting further research and targeted interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the association of ethnic variations with the bone mineral density on Dual Energy X-ray Absorptiometry (DEXA) scan by using a database literature search. METHODOLOGY: This study was done at the department of Anatomy, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Center (JPMC) Karachi. A systemic literature search was carried out for the publications printed in between 2000-2017, dealing with the comparison of BMD on DEXA scan among various ethnicities of Pakistan. A total of 3 cross sectional studies, having 1232 subjects (n=421 males and n=811 females) enrolled, were found in the literature search and met the inclusion criteria. The BMD was assessed on DEXA by using Hologic model focused at the lumbar spine and neck of femur. RESULTS: Results were displayed as T scores and were statistically significant. Among 1232 subjects, 690 were Punjabi (56%), Osteopenia was found in 41.2% and osteoporosis in 25.8% (P-value=0.001), 198 (16%) were Pathan, among them 31.8% were osteopenic and 39.9% were osteoporotic (P-value=0.001). Sindhi were 78 (6.33%), 16.7% had osteopenia and 47.4% had osteoporosis (P-value= 0.001). 54 (4.38%) subjects were Balochi, among them 16.7% had osteopenia and 50.0% had osteoporosis (P-value= 0.001). Others ethnicities were 212 (17.20%), 40.6% were found to be osteopenic and 34.8% had osteoporosis (P -value= 0.001). CONCLUSION: Significant variations exist in the BMD scores among various ethnicities of Pakistan. Further research is highly suggested on larger scale based upon the ethnic and regional localization, as it directly influences and indicates a predictive relationship between low bone mass and increase risk of fracture. [ABSTRACT FROM AUTHOR]

Introduction: Foot pain is one of the presenting musculoskeletal condition usually encounter by Physical therapists. It is also found that fashion trends led the choices of footwear especially among females and there's vast range of versatility in female footwear. Objective: This study was conducted to determine the frequency of foot pain and its association with foot wear in young female DPT students. Method: The cross-sectional survey design was used. A self-administered questionnaire was distributed among 333 female students aged 18 to 25 years. Data forms was divided and distributed between all five years of DPT in IPMR and Ojha campus of Dow University of Health Science. Results: More than half (56.6%) of the participants reported foot pain in past three months using NIS (numeric intensity scale). 53.7% of the participants thought that this pain was associated with footwear. Among footwear choices jogger's and canvases was the first choice followed by pumps & pointed toe box as second choice, 52.3% and 30.9% respectively. Statistically, there were found no association between foot pain and foot wear. Conclusion: The results of the study has shown that more than half of the participant experienced foot pain disregarding the fact of jogger's and canvases was the top most choice of participants. Therefore, there's needing to create awareness regarding footwear choices that accommodates the foot biomechanically and ergonomically in correct position. [ABSTRACT FROM AUTHOR]

Archaeologists have long considered the Gandharan Grave Culture to be an intrusive technocultural complex in northwestern South Asia and have often equated its presence at the nexus between Central, South, and West Asia with the arrival of Indo-Aryan populations south of the Hindu Kush. Such assertions are largely based upon material cultural parallels with assemblages recovered from sites located in northwestern Iran (i.e, Tepe Hissar) or southern Central Asia (i.e., Bactria-Margianan Archaeological Complex). Recent discoveries of Gandharan Grave Culture sites in Chitral District attest that this archaeological culture encompassed a larger geographic region than previously understood. The current study provides foundational skeletal descriptions for 18 individuals recovered from Gandharan Grave Culture funerary features at the site of Shah Mirandeh, located near Chitral town, Chitral District. These individuals were recovered from an array of burial contexts ranging from intact primary inhumations to highly disturbed secondary inhumations of the commingled remains of multiple individuals. The 18 individuals include five males, three females and 10 individuals of unknown sex. Ages at death range from infancy to mature adults. Pathological conditions were generally rare and most often affected then dentition, being manifested as caries and linear enamel hypoplasia. Both conditions likely reflect the consumption of a diet highly reliant upon such domesticated cultigens at wheat, barley, peas and lentils. Although few in number and in fragmentary condition these remains, along with those previously described from the site of Parwak, provide the first biological evidence of the human populations associated with the Gandharan Grave Culture occupying the highland region lying intermediate between the Vale of Peshawar on the one hand and southern Central Asia on the other. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study was to analyze the pattern of injuries, hospital care, and outcome of the victims of suicide bomb attacks in Pakistan. Methods: This prospective, cohort study was conducted at the Combined Military Hospital Rawalpindi during the last 3 years. Seriously injured patients in the 'immediate category' were resuscitated in the emergency operation theater adjacent to the emergency room and, after resuscitation, the patients were transferred to the main operation theaters, where consultant surgeons were available. Results: During the study period, 1,296 terrorist victims presented to the emergency department and (86.9%) were admitted, with a mean hospital stay of 8.2 ± 2.1 days. The majority of patients arrived by ambulance (91%) and only 38 (3%) were evacuated by air. Penetrating splinter injuries were the most prevalent (87%), and 29% patients also had associated injuries. Open bone fractures were found in 48% and 42% had injured hollow and solid viscous. Overall, 33% of patients had thoracic injuries and neuro-trauma was observed in 16% of the study population. Deafness was a feature in 33% patients, 121 had to undergo limb amputations, and mortality remained in 7% of patients. Conclusion: Most of the problems encountered were logistic in nature. Early evacuation of the victims remains pivotal in saving lives. The major causes of death in peripheral patients was hypovolemic shock, sepsis, and hypothermia. Mortality and morbidity can be enhanced by ample fluid resuscitation, tetanus prophylaxis, and proficient first aid at the site of injury. [ABSTRACT FROM AUTHOR]

Background: Protocetidae are middle Eocene (49-37 Ma) archaeocete predators ancestral to later whales. They are found in marine sedimentary rocks, but retain four legs and were not yet fully aquatic. Protocetids have been interpreted as amphibious, feeding in the sea but returning to land to rest. Methodology/Principal Findings: Two adult skeletons of a new 2.6 meter long protocetid, Maiacetus inuus, are described from the early middle Eocene Habib Rahi Formation of Pakistan. M. inuus differs from contemporary archaic whales in having a fused mandibular symphysis, distinctive astragalus bones in the ankle, and a less hind-limb dominated postcranial skeleton. One adult skeleton is female and bears the skull and partial skeleton of a single large near-term fetus. The fetal skeleton is positioned for head-first delivery, which typifies land mammals but not extant whales, evidence that birth took place on land. The fetal skeleton has permanent first molars well mineralized, which indicates precocial development at birth. Precocial development, with attendant size and mobility, were as critical for survival of a neonate at the land-sea interface in the Eocene as they are today. The second adult skeleton is the most complete known for a protocetid. The vertebral column, preserved in articulation, has 7 cervicals, 13 thoracics, 6 lumbars, 4 sacrals, and 21 caudals. All four limbs are preserved with hands and feet. This adult is 12% larger in linear dimensions than the female skeleton, on average, has canine teeth that are 20% larger, and is interpreted as male. Moderate sexual dimorphism indicates limited male-male competition during breeding, which in turn suggests little aggregation of food or shelter in the environment inhabited by protocetids. Conclusions/Significance: Discovery of a near-term fetus positioned for head-first delivery provides important evidence that early protocetid whales gave birth on land. This is consistent with skeletal morphology enabling Maiacetus to support its weight on land and corroborates previous ideas that protocetids were amphibious. Specimens this complete are virtual 'Rosetta stones' providing insight into functional capabilities and life history of extinct animals that cannot be gained any other way. [ABSTRACT FROM AUTHOR]