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Introduction All branches of the U.S. Military have a running component of their physical readiness testing battery. Running-related musculoskeletal injuries affect 20 to 40% of DoD Service Members each year. Running form has not historically been addressed with military running-related injuries. To assess the utility of a structured gait retaining protocol designed to treat the onset of running-related pain and/or injury by correcting identified biomechanical risk factors for injury and improve clinical outcomes. Study Design Case series. Materials and Methods A total of 160 Active Duty Service Members (ADSMs) with running-related lower-body musculoskeletal injuries were referred by a physical therapist for a multisession gait retraining program termed "Run with CLASS" (C adence, L ean, A lignment, S oft-landing, S trike). Run with CLASS utilized various drills to emphasize impact progression, proximal strengthening, and proprioception and spatial awareness. Results Results revealed that the implemented gait retraining protocol significantly improved running parameters following lower-body injury as evidenced by increased cadence, improved functional assessment scores, and a marked transition from predominantly heel strike to forefoot strike patterns during running. Conclusions A 3-week supervised gait retraining program focused on the gait retraining program termed "Run with CLASS" (C adence, L ean, A lignment, S oft-landing, S trike) was successful in altering biomechanics of self-selected running gait by increasing cadence and transitioning ADSMs to a forefoot foot strike. Additionally, ADSMs reported significant improvements on the self-reported functional scores on the University of Wisconsin Running Injury and Recovery Index and Single Assessment Numerical Evaluation. Level of Evidence 4 [ABSTRACT FROM AUTHOR]

This research presents a comprehensive study focused on the design, implementation, and analysis of an innovative fiber Bragg grating (FBG) based foot pressure assessment system. FBG sensors strategically placed on the great toe, metatarsal 1, metatarsal 2, and heel provided distinct peak resonant wavelengths, strains, and pressures during experimental cycles. Participant 1 exhibited peak resonant wavelength of 1537.745 nm for great toe, 1537.792 nm for metatarsal 1, 1537.812 nm for metatarsal 2, and 1537.824 nm for heel. Participant 2 showcased distinct graphical representations with peak resonant wavelengths ranging from 1537.903 to 1537.917 nm. In a fracture patient condition, the FBG‐based system monitored weight‐bearing capacity, integrated with real‐time X‐ray imaging for dynamic insights of rehabilitation as distinct approach. The strains and pressures at each position exhibited notable variations along with the sensitivity of 1.31με obtained across all positions, underscoring the FBG‐based system's reliability in capturing subtle foot pressure. [ABSTRACT FROM AUTHOR]

Introduction: Plantar fasciitis is the most common cause of heel and foot pain, leading individuals to use compensatory techniques to alleviate their pain, resulting in an antalgic gait. These compensations alter the feeling of joint position and muscle activation, making it challenging to maintain an upright posture within the base of support. According to Mulligan's concept, rigid tape allows painful or restricted movements with quick pain relief and increased range of motion while correcting positional faults and reducing tensile tension on the fascia, thereby decreasing inflammation and microscopic tears. Currently, there is a scarcity of data studying the effect of Mulligan’s calcaneal taping on dynamic balance. Aim: To evaluate the effect of Mulligan’s calcaneal taping on dynamic balance and functional performance in subjects with plantar fasciitis. Materials and Methods: The study was a prospective cohort study conducted at D.Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India. It began in March 2023 and concluded in March 2024, spanning one year. Thirty-six subjects were randomly divided into group A (n=18) and group B (n=18). Subjects experiencing pain for more than six weeks, aged between 18-60 years, with a positive Windlass test, plantar medial heel pain, and abnormal foot posture index (between +6 to +9) were included in the study. The experimental group received Mulligan’s calcaneal taping along with conventional physiotherapy exercises, while the control group received only conventional physiotherapy exercises. Pre-post assessments were conducted using the star excursion balance test for dynamic balance assessment and the Foot Function Index (FFI) for functional performance. Results: Statistically significant differences were found among the medial (p-value=0.0212), posteromedial (p-value=0.0199), and posterior (p-value=0.0091) directions of the star excursion balance test. Both groups did not show statistically significant differences in the FFI score. However, with effect size, there was good clinical significance for the FFI score and all directions of the star excursion balance test except the posterolateral direction. Conclusion: Mulligan calcaneal taping has been shown to be more effective in improving dynamic balance in subjects with plantar fasciitis.

Background/Objectives: This study aimed to investigate the relationship between posterior tibial artery blood flow velocity and plantar heel pain (PHP). Methods: The PHP group comprised patients diagnosed with plantar fasciitis with plantar heel pain during gait, and the control group comprised healthy participants without plantar heel pain. The peak systolic velocity of the posterior tibial artery was measured using ultrasonography; it was measured three times on each side, and the mean value was calculated. Receiver operating characteristic curve analysis was performed to calculate the peak systolic velocity cutoff value for plantar heel pain. Results: 23 patients (age 58.0 ± 16.5 years; 13 males and 10 females) and 23 healthy participants (age 51.3 ± 17.3 years; 10 males and 13 females) formed the PHP and control groups, respectively. Peak systolic velocity on the affected side was significantly greater in the PHP group (44.1 ± 13.1 cm/s) than in the control group (32.7 ± 5.9 cm/s). No significant difference was observed between the left and right sides in the PHP (7.1 ± 9.8 cm/s) and control (3.7 ± 3.0 cm/s) groups. A cutoff value of 38.2 cm/s was observed on the affected side. Conclusions: We quantified the increase in posterior tibial artery blood flow velocity in patients with plantar heel pain. Peak systolic velocity measurements can aid in quantitatively evaluating these patients. This study was registered as a clinical trial (UMIN000046875) on 1 October 2021. [ABSTRACT FROM AUTHOR]

this study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries. the study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5. significant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (−7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (−0.3 AU) with MPF. The findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies. • Significant difference in the microclimate variables were observed when the groups and the timepoint of measurement were compared. • Multilayer polyurethane foam with silicone seems to be more effective in controlling temperature and moisture in heels. • The findings should be better investigated in other studies. [ABSTRACT FROM AUTHOR]

Abstract Introduction Due to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants. Methods A double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants’ faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0. Results Eighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30–3.80(, and (1.15 ± 0.84, 95%: 0.95–1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30–5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p

Background: Sever's disease, or calcaneal apophysitis, stands as the most prevalent cause of heel pain in children, often linked to sports like soccer, Australian football, and basketball. While various therapies are documented in the scientific literature, the standard choice is conservative treatment. Thus, the objective of this research was to assess the effectiveness of diverse conservative methods and techniques in alleviating Sever's disease symptoms. Methods: Systematic searches were conducted in October 2023 in PubMed, Web of Science, Scopus, SportDiscus, and PEDro, using terms like Osteochondritis, Osteochondrosis, Apophysitis, Sever's disease, Calcaneus, Adolescent, Child, and Childhood. The PEDro scale gauged methodological quality, and the Cochrane Risk of Bias tool evaluated the risk of bias. Results: Eight randomized controlled studies were included, featuring commonly used treatments such as insoles, therapeutic exercises, Kinesio taping, and foot orthoses. The methodological quality was generally good, with an average PEDro score of 6.75 points. Regarding bias, four articles had low risk, three had high risk, and one had some concern. Conclusions: Conservative treatment emerges as an effective option for alleviating symptoms associated with Sever's disease. [ABSTRACT FROM AUTHOR]

Introduction: Due to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants. Methods: A double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants' faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0. Results: Eighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30–3.80(, and (1.15 ± 0.84, 95%: 0.95–1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30–5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05–91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35–96.85), (91.5 ± 1.24, 95% CI:91.12–91.87), and (93.60 ± 1.27, 95% CI:93.85–94.50). Conclusion: This study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants. [ABSTRACT FROM AUTHOR]

Plantar foot pressure provides an insightful data in the ankle and foot complex which may aid in the detection of underlying pathology. Since individuals with unilateral plantar heel pain (PHP) tend to develop compensatory loading strategies, this study aimed to observe the foot loading pattern compared to the asymptomatic side and its relationship with the morphological variations in individuals with unilateral PHP. It was a prospective cross-sectional study done on 17 participants with unilateral PHP. The calcaneal inclination and calcaneal first metatarsal angles were measured using lateral weight-bearing radiographs for both symptomatic and asymptomatic feet. Static and dynamic plantar foot pressures for both sides were obtained using a "Portable baropodometry platform 0, 5 m Entry Level footscan®. On the symptomatic side, the pressure in the lateral heel was reduced by 65% in static and 67% in dynamic measurements, while in the medial heel, it was reduced by 16 % in static and 47 % in dynamic measurements compared to that of the asymptomatic side. There was a transfer of pressure from the hind foot to the forefoot by 44 % in static and 46 % in dynamic measurements resulting in anterior load shift. It was also observed that the prevalence of PHP was higher in the normal arched foot (59%). Based on the observations, compared to the asymptomatic side, patients with unilateral plantar heel pain exhibited an anteromedial load shift (AMLS) in their plantar pressures. PHP was reported higher in the foot with normal morphology. Level 4. [ABSTRACT FROM AUTHOR]

Background: A distally based sural flap is a workhorse flap used to reconstruct the distal lower leg and foot. It developed a bad reputation due to venous congestion, leading to flap failure. Herein, we present a new modification in the form of proximal catheterization and distal ligation of the short saphenous vein to relieve flap congestion. Methods: Twenty patients underwent reconstruction with distally based sural artery flaps for defects around the ankle, distal leg, and foot from June 2019 to March 2021. Distal ligation with proximal catheterization of the short saphenous vein was performed to reduce the risk of venous congestion. Results: Early flap congestion was observed in five flaps (25%). The venous congestion was relieved by draining congested blood through the catheter. The total amount of blood removed was around 80–100 mL in the first 2 days postoperatively. The flaps healed uneventfully as two flaps with distal 2-cm necrosis healed with dressing. Conclusions: Distal ligation of the short saphenous vein may prevent venous overloading from the foot and reduce sural flap venous congestion. Proximal catheterization of the vein to relieve flap congestion is an effective flap safety tool. Level of evidence: Level V, Risk/Prognostic. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To determine whether high-resolution ultrasound (US) can identify the course and relations of the medial calcaneal nerve (MCN). Methods: This investigation was initially undertaken in eight cadaveric specimens and followed by a high-resolution US study in 20 healthy adult volunteers (40 nerves) by two musculoskeletal radiologists in consensus. The location and course of the MCN as well as its relationship to adjacent anatomical structures were evaluated. Results: The MCN was consistently identified by US along its entire course. The mean cross-sectional area of the nerve was 1 mm2 (range 0.5–2). The level at which the MCN branched from the tibial nerve was variable, located a mean of 7 mm (range − 7–60) proximal to the tip of the medial malleolus. At the level of the medial retromalleolar fossa, the MCN was located inside the proximal tarsal tunnel a mean of 8 mm (range 0–16) posterior to the medial malleolus. More distally, the nerve was depicted in the subcutaneous tissue at the surface of the abductor hallucis fascia with a mean direct distance to the fascia of 1.5 mm (range 0.4–2.8). Conclusions: High-resolution US can identify the MCN at the level of the medial retromalleolar fossa, as well as more distally in the subcutaneous tissue at the surface of the abductor hallucis fascia. In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of nerve compression or neuroma, and perform selective US-guided treatments. Clinical relevance statement: In the setting of heel pain, sonography is an attractive tool for diagnosing compression neuropathy or neuroma of the medial calcaneal nerve, and enables the radiologist to perform selective image-guided treatments such as diagnostic blocks and injections. Key Points: • The MCN is a small cutaneous nerve which rises from the tibial nerve in the medial retromalleolar fossa to the medial side of the heel. • The MCN can be depicted by high-resolution ultrasound along its entire course. • In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of neuroma or nerve entrapment, and perform selective ultrasound-guided treatments such as steroid injection or tarsal tunnel release. [ABSTRACT FROM AUTHOR]

Currently, many instructors of organ playing are teaching that all toe pedaling without the use of the heel is the only possible method for pedaling in the organ works of J. S. Bach. While that may be the current thinking, it is necessary to examine all of the sources available, and also to use rational thinking when deciding whether or not to use toes, heels, or a combination of them. This article will examine the issue, and when it may be preferable to use a heel depending on what the music itself is doing, and a variety of other factors. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to investigate the relationship between posterior tibial artery blood flow velocity and plantar heel pain (PHP). Methods: The PHP group comprised patients diagnosed with plantar fasciitis with plantar heel pain during gait, and the control group comprised healthy participants without plantar heel pain. The peak systolic velocity of the posterior tibial artery was measured using ultrasonography; it was measured three times on each side, and the mean value was calculated. Receiver operating characteristic curve analysis was performed to calculate the peak systolic velocity cutoff value for plantar heel pain. Results: 23 patients (age 58.0 ± 16.5 years; 13 males and 10 females) and 23 healthy participants (age 51.3 ± 17.3 years; 10 males and 13 females) formed the PHP and control groups, respectively. Peak systolic velocity on the affected side was significantly greater in the PHP group (44.1 ± 13.1 cm/s) than in the control group (32.7 ± 5.9 cm/s). No significant difference was observed between the left and right sides in the PHP (7.1 ± 9.8 cm/s) and control (3.7 ± 3.0 cm/s) groups. A cutoff value of 38.2 cm/s was observed on the affected side. Conclusions: We quantified the increase in posterior tibial artery blood flow velocity in patients with plantar heel pain. Peak systolic velocity measurements can aid in quantitatively evaluating these patients. This study was registered as a clinical trial (UMIN000046875) on 1 October 2021.

Introduction: Resurfacing the sole is still one of the great challenges of reconstructive plastic surgery. The tissues on the sole of the foot have unique characteristics essential for maintaining the limbs functionality. The heel has the most significant weight support and is subjected to the entire soles greatest impact. The medial plantar artery flap is one of the reconstructive options, as it represents similar tissue and maintains sensitivity to the recipient area. Methods: A retrospective study was performed by collecting data from medical records of patients who underwent reconstructions of the heel with a medial plantar artery flap from July 2013 to September 2019. The study was approved by the Ethics Committee for Analysis of Research Projects of HCFMUSP (CAAE number: 56849422.0.0000.0068). Results: Heel reconstruction was performed in 7 patients after acral lentiginous melanoma excision. Surgical complications were observed in 3 patients, all of whom were aged over 50 years or have associated comorbidity. There were 57.1% of complications, 37.5% related to the flap, and 12.5% related to the donor area. There were three total flap necroses (42.9%) and one total graft loss in the donor area (14.3%). Conclusion: The medial plantar flap presents itself as a good alternative for performing oncological reconstructions of defects in the plantar region of the foot. However, the choice of the ideal patient should be considered and we must remember that the dissection of its vascular pedicle is not easily executed.

The medial plantar flap is frequently used in heel reconstruction and has been described since 1969. We took care of a 25-year-old patient with a bilateral ballistic trauma and open fractures to the distal third of both legs. Given the seriousness of the damage to the left lower limb, a trans-tibial amputation had to be performed. Concerning the right lower limb, we decided to cover the defect with a spare part's free medial plantar flap thanks to the amputated fragment. The extremity spare tissues principle is already known and described, more particularly concerning hands, in emergency traumatic surgery and in planned surgery, mainly concerning thumb reconstruction, for example for hypoplasia or after traumatic amputation. Apart from an article on the use of foot spare part in the coverage of amputation stumps, no article has reported the use of a foot spare part in reconstructive surgery, even more in traumatic surgery. We believe that the use of an extremity spare tissues should be considered in rare cases where this is possible, in order to reduce donor-site morbidity in the context of reconstructive surgery. [ABSTRACT FROM AUTHOR]

Acquired digital fibrokeratoma is a benign fibrous tumor usually located on the toes and fingers. A 63-year-old man with an acquired giant plantar fibrokeratoma is described. He presented with an asymptomatic exophytic nodule of ten years duration; there is no history of trauma to the site. It measured 15x10x5mm and was located on the plantar foot proximal to the third toe. Excisional biopsy established the diagnosis of fibrokeratoma. Giant acquired fibrokeratoma,has been described in 16 patients including ours: three women and 13 men. They are located on either the upper extremity (one man) or the lower extremity (15 individuals). Acquired plantar fibrokeratoma is rare. Including our patient, it has been reported in 11 patients: one woman and ten men. The woman was 13 years of age and the men ranged from 15 to 77-years-old. Plantar acquired fibrokeratomas are located on either the plantar aspect of the toes, the sole of the foot, or the heel. An excisional biopsy provided adequate treatment without subsequent recurrence of both giant and plantar fibrokeratomas.

Introduction: Musculoskeletal complaints are often caused by accidents and occupational diseases. High heels that are often used by women workers in various companies can cause abnormalities in the shape of the feet. The purpose of this study was to detect the effect of using high heels on the foot arch of female workers in Makassar. Methods: This is a quantitative research using a cross-sectional research design. The sample in this study was 30 female workers who use high heels in Makassar who were selected using a non-probability sampling method with purposive sampling type. The data are primary data obtained through the measurement of the medial longitudinal arch with grid paper measurement which was analyzed using the Meyer line and the wet footprint examination which was analyzed by the Clarke index. Furthermore, the measurement of musculoskeletal complaint was analyzed using Nordic body map. Results: From research conducted on 30 respondents, more than 50% of respondents have pes cavus. The results of data analysis also showed the effect of heel height on increasing the height of the medial longitudinal arch of the sample based on the correlation of heel height and Clarke index. Conclusion: It found that the measurement of the soles of the feet on grid paper with the Meyer line parameter was not directly related to musculoskeletal complaints, on the contrary the Clark index could be used as a specific parameter in detecting an increase in the median longitudinal arc in the form of pes cavus.

Background: Sever’s disease, or calcaneal apophysitis, stands as the most prevalent cause of heel pain in children, often linked to sports like soccer, Australian football, and basketball. While various therapies are documented in the scientific literature, the standard choice is conservative treatment. Thus, the objective of this research was to assess the effectiveness of diverse conservative methods and techniques in alleviating Sever’s disease symptoms. Methods: Systematic searches were conducted in October 2023 in PubMed, Web of Science, Scopus, SportDiscus, and PEDro, using terms like Osteochondritis, Osteochondrosis, Apophysitis, Sever’s disease, Calcaneus, Adolescent, Child, and Childhood. The PEDro scale gauged methodological quality, and the Cochrane Risk of Bias tool evaluated the risk of bias. Results: Eight randomized controlled studies were included, featuring commonly used treatments such as insoles, therapeutic exercises, Kinesio taping, and foot orthoses. The methodological quality was generally good, with an average PEDro score of 6.75 points. Regarding bias, four articles had low risk, three had high risk, and one had some concern. Conclusions: Conservative treatment emerges as an effective option for alleviating symptoms associated with Sever’s disease.

Copyright of Revista Pediatría de Atención Primaria is the property of LUA Ediciones 3.0 S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is a lack of data regarding the single heel-rise test (SHRT) among children. Hence, we aimed to establish reliability and reference norms of SHRT among children aged 8 to 12 years. About 500 healthy children were randomly selected from the recognized school and community settings. After demographic measurements, SHRT was conducted to evaluate the strength of each plantar flexors. SHRT repetitions were assessed by the same rater on 2 occasions for intrarater (on the same day) and test-retest reliability (on different days) and by 2 raters for inter-rater reliability. Relative reliability was described in terms of the intraclass correlation coefficient (ICC) and Pearson correlation coefficient (r). Absolute reliability was indicated by the standard error of measurement (SEm), minimal detectable change (MDC), and Bland-Altman graph. The mean of the number of repetitions of SHRT was calculated to derive the reference norm of SHRT. The anthropometric parameters were correlated with SHRT for multiple regression analysis. Intrarater, test-retest, and inter-rater reliability of SHRT were, ICC = 0.81, ICC = 0.70, and ICC = 0.57, respectively. The Bland-Altman graph confirmed limits of agreement for intrarater, test-retest, and inter-rater reliability. The reference norm of SHRT is documented to be 20.6 ± 4.8. SEm and MDC are found to be 2 and 3, respectively. Multiple regression analysis predicted a correlation of age, weight, and calf muscle girth with SHRT. SHRT is moderate to good reliable in assessing the strength of plantar flexors. The reference norms of SHRT have been derived for healthy children aged 8 to 12 years. [ABSTRACT FROM AUTHOR]

Background: Ankle fractures pose a unique challenge to the treating orthopedic surgeon. Intramedullary (IM) distal fibula fixation is a relatively newer entity offering a viable option to minimize wound complications while providing similar outcomes. Our study utilizes an IM nail featuring proximal fixation via IM talons ensuring maintenance of fracture reduction this is the largest case series utilizing this novel device assessing time to weight-bearing (WB) and fracture union in addition to the safety and reproducibility of percutaneous reduction. Methods: A retrospective case series was conducted on 51 ankle fractures treated with a single IM device for lateral malleolar fixation. Postoperative radiographs were assessed, qualifying reductions as good, fair, or poor based on a reduction classification. Patient charts were reviewed for fracture characteristics, reduction method, fracture union, time to WB, and complications. Results: Mean follow-up time was 32.2 weeks; 47 fracture reductions (92%) were classified as good, and 4 (8%) were fair. All but 1 fracture (98%) went onto union. Average time to union was 10.3 weeks. Average time to WB with and without a walking boot was 6.8 and 11.2 weeks, respectively. Two patients experienced painful hardware. One patient had a superficial wound infection; Conclusion: When evaluating this novel IM device, fracture union and time to union were found to be acceptable, with minimal wound or other complications. Percutaneous reduction permitted good fracture reduction quality. Consistent time to WB for a variety of fractures was reliably demonstrated following operative fixation with this device, including those in the elderly population. Levels of Evidence: Level IV: Clinical case series [ABSTRACT FROM AUTHOR]

Background: Complications after plate and screw fixation of ankle fractures are frequently reported in the literature, with a higher rate in patients with advanced age, comorbidities, and poor skin conditions. A reduced complication rate has been reported with intramedullary nailing (IMN) of the fibula; however, the indication has been based on the surgeon's preferences. We report the results after IMN in patients with compromised soft tissue exclusively. Methods: A total of 71 patients with 72 distal fibula fractures were included in this retrospective study. Information about medical history, the ankle injury, treatment, and complications were collected from the medical records. Additionally, the preinjury and 6-week follow-up radiographs were evaluated. Results: Postoperative information was available for a minimum of 4.3 years postoperatively or until death. In all, 10 patients had complications related to the nail and required secondary surgery. These included 6 symptomatic hardware issues, 2 construct failures, 1 deep infection, and 1 combined deep infection and construct failure. Conclusions: After IMN of the fibula, 14% of the patients required reoperation. Our results support the previous literature suggesting IMN as an acceptable surgical alternative where the risk of complications with plate and screw fixation is considered too high. Compromised soft tissue is one important indication. Level of Evidence: Level IV: Case series without control [ABSTRACT FROM AUTHOR]

Objective Plantar fasciitis is the most common cause of heel pain. The night splints are used to prevent nocturnal contractures happening in the calf muscles and plantar fascia. The objective of this study was to investigate the effects of using a tension night splint for calf and plantar fascia on the range of motion of foot and ankle complex, pain severity, and quality of life. Materials & Methods 30 people (27 female) with plantar fasciitis volunteered in a parallel-group clinical study. Participants were allocated to three study groups: a tension calf splint, a tension plantar fascia splint, and a control group (heel pad). The study outcomes were the range of motion of foot and ankle complex, pain severity, and quality of life measured with a goniometer, visual analog scale, and 36-Item Short Form Survey (SF-36) questionnaire, respectively. The post-session was four weeks after participants received their interventions. The analysis of covariance statistical test was used to analyze the within and between-group differences. Results The analysis of covariance test showed statistically significant differences for pain (F=9.35, P=0.001, η2=0.44) and extension of the first metatarsophalangeal (F=4.76, P=0.017, η2=0.27). There was no statistically significant difference in the quality of life and the ankle dorsiflexion range between groups (P>0.05). The Bonferroni post-hoc showed a significant reduction of the reported pain post-session in all study groups (P

Introduction: Haglund's deformity, an abnormality of the postero-superior corner of the calcaneum, is a common, critically debated cause of posterior heel pain. Several radiological indices such as Fowler-Philip angle, Ruch pitch, Chauveaux-Liet angle, calcaneal pitch angle, parallel pitch lines, and X–Y ratio have been described to measure this deformity. However, most of these lack specificity and have variable intra- and inter-observer reliability. Purpose: The study aims to describe a new radiological "angle of BRINK" (Botchu-Reilly-Iyengar-Nischal-Kakarala) to measure Haglund's deformity. Patient and methods: We performed a retrospective cohort analysis, assessing 20 weight-bearing lateral ankle radiographs of patients with Haglund's deformity (Haglund's cohort) and 100 radiographs without the deformity (normal cohort). Demographic details and angle of BRINK to measure Haglund's deformity were measured for each patient. Statistical analysis was performed using t-test and inter-observer reliability was calculated using kappa coefficient. Results: The mean angle of BRINK to measure Haglund's deformity in the normal cohort was 20.04° (SD 4.88), and in the Haglund's cohort was 25.1° (SD 3.3). This was statistically significant with a p-value of less than 0.0001. There was excellent intra- and inter-observer reliability with kappa value of 0.8. Conclusion: Our proposed radiological angle of BRINK to measure Haglund's deformity is simple and easy to calculate on standard weight-bearing radiographs. Contrary to the traditional measurements used to estimate the deformity, it has shown a good intra- and inter-observer reliability and can support surgical decision-making process for management of patients with symptomatic Haglund's deformity. [ABSTRACT FROM AUTHOR]

In patients with primary calcaneal malignancies, such as Ewing's sarcoma, radical treatment with amputation of the foot can result in serious functional impairment and chronic pain. Total calcanectomy followed by the reconstruction of the calcaneal defect offers an alternative treatment to amputation. Capanna et al. described a technique for successfully reconstructing long limb segmental bone defects using a free fibula flap placed within the intramedullary canal of an allograft. We present both a review of the literature on calcaneal reconstruction and describe how the principles of Capanna can be adapted to reconstruct the calcaneus. Total calcanectomy due to Ewing's sarcoma and the subsequent application of this novel reconstructive technique was performed in two young patients aged 5 and 16 years. The reconstruction was achieved by inserting a distally pedicled osteocutaneous fibula flap within the reamed canal of an allograft and placing the composite in the calcaneal defect. Reconstruction was successful with complete bone union between the allograft and the adjacent bone. There were no fractures or infections and both flaps survived. Functional outcome was assessed with a physiotherapist at a follow-up period of 2 years postoperatively, showing near-normal ambulance. This novel technique proved excellent as a limb salvage procedure, avoiding amputation, and offering a satisfactory oncological and functional outcome. [ABSTRACT FROM AUTHOR]

This article considers the technology of making high-quality steels in electric arc furnaces on fresh furnace charge with the oxygen lancing of metal. To improve the performance indicators, the input of oxygen was dispersed and made under the heel level. The temperature of hot spots on the melt surface was decreased by adding after meltdown some part of furnace charge to the region between electrodes. The specified measures reduced the steelmaking duration, waste of metal, and specific energy and oxygen consumption rates. [ABSTRACT FROM AUTHOR]

Background: Plantar defects are difficult to manage due to several reasons. The challenges of plantar reconstructions include lack of abundant local tissue, the requirement of the skin to be sensate, as well as the mechanical demand of the reconstruction to be able to withstand shearing forces and weight-bearing. Although rare, these defects are encountered following infections, trauma, and burns in addition to surgical oncological resections. Case presentation: This case report describes the management of a plantar defect, measuring 45 × 55 mm, after surgical resection of a melanoma on the weight-bearing heel. The defect was managed with negative pressure wound therapy (NPWT) for 4 weeks, until granulation tissue was flush with the surrounding skin. Conservative treatment with wound care was conducted for another 12 weeks, until the wound, at 16 weeks, was completely healed. The patient tolerated the lengthy time of healing well and experienced no problems with the scar, and the functional and aesthetic outcome of conservative treatment of the plantar defect was excellent. Conclusion: Healing by secondary intention is an excellent treatment option for the closure of large plantar defects, despite often being an overlooked reconstructive option.

Abstract 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 .

Objectives: Quantitative ultrasound (QUS) is a bone densitometry method that is less expensive and more portable than DXA. It is also noninvasive. QUS parameters include speed of sound (SOS), broad band ultrasound attenuation (BUA), and stiffness index (SI). This study defined normal values of QUS parameters in Iranian men and women. Methods: QUS of heels measured in 258 Iranian men and women, aged 20–76 y/o. They were participants of Iranian Multicenter Osteoporosis study (IMOS), selected by randomized sampling. QUS device was an Achilles+ (GE-Lunar) device. Results: Percentiles of SI (2.5%, 50%, and 97.5%) determined. We found a good agreement between the Iranian reference values and western reference (used by device) value in defining normal and osteoporotic people (κ = 0.875). Conclusion: Results from this study suggest that QUS of the heel may be a good method for diagnosis of low bone mass in different regions. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) impact on patient's quality of life and are costly for healthcare providers. Heels are a particular concern due to specific risk factors. Relative effectiveness of medical devices, e.g., dressings, off-loading devices, heel cushioning devices, to reduce PU development is unknown. Systematic review of the effectiveness of heel-specific medical devices for the prevention of heel PU (HPU)s. Database searches were performed from inception to June 2021 for RCTs. The primary outcome was incidence of new HPUs. Trials were assessed for risk of bias and data analysed with risk ratios, mean difference or hazard ratios as appropriate. Fifteen RCTs (4724 participants) were identified. Dressings, as constant low pressure (CLP) devices vs standard care: eight trials (very low quality) showed no-significant difference in effectiveness (RR 0.31, 95%CI 0.10 to 1.01). Off-loading devices vs standard care: three trials (low quality), showed significant reduction in development of Category≥1 HPUs (RR 0.20, 95%CI 0.05 to 0.80) two trials (medium quality), showed significant reduction in development of Category≥2 HPUs (RR 0.08, 95%CI 0.01 to 0.67). Comparisons between off-loading devices: two trials (low quality) showed no clear difference in HPU incidence. In a paediatric post-surgical population, one trial of off-loading device and one of a dressing (CLP device), both versus standard care, showed no clear difference in HPU incidence (RR 0.19 95%CI 0.02 to 1.55 and RR 0.89 95%CI 0.56 to 1.42 respectively). Off-loading devices may reduce HPU incidence, from low-quality evidence. There is insufficient evidence to suggest that dressings reduce HPU incidence. • Pressure ulcers (PU) develop & heal differently to the heel compared to other body sites. • This paper reviews the effectiveness of all heel specific devices for the prevention of heel PUs. • Off-loading devices may reduce HPU incidence, but low-quality evidence reduces certainty. • Insufficient evidence of effectiveness for dressings or devices that reduce pressure at the heel. • Further good quality research is required. [ABSTRACT FROM AUTHOR]

Calcaneal osteotomy is a commonly established method used to correct various foot malalignment surgery problems that produce varus and valgus hindfoot abnormality as well as Haglund's deformity, cavovarus foot reconstruction, flatfoot deformity, plantar fasciitis, posterior tibial tendon insufficiency and planovalgus foot. After decades, several procedures in orthopaedic foot surgery have been suggested for reducing the risk of wound and neurovascular complications. The goal of this Prisma statement guidelines compliant systematic review was to establish the effectiveness and safety of calcaneal osteotomy in foot surgery. We have performed a novel systematic review of the current published literature in order to evaluate the scientific evidence now available on this association, assigning predefined exclusion and inclusion criteria. Eight investigations were selected which had 191 cases. The adult flatfoot, tibialis posterior reconstruction and cavovarus foot deformity were treated with different procedures of calcaneal osteotomy techniques. The adequate level of effectiveness of calcaneal osteotomy is associated with the kind and location of the incision, with or without screw application, in each specific foot condition. There is a limited number of scientific investigations of the effectiveness and safety of the different kinds of calcaneal osteotomy in foot surgery, and there is the need to enhance outcome knowledge on this foot surgery technique. [ABSTRACT FROM AUTHOR]

Abstract Background Calcaneal apophysitis, or Sever's disease, is the most common cause of heel pain in childhood and adolescence. It is regarded as an overuse syndrome. Studies on the incidence of calcaneal apophysitis in young athletes and their associated return-to-play time are lacking in the current literature. The aim of our current study was to identify the incidence of calcaneal apophysitis in professional youth soccer, the associated time to return-to-play, predisposing factors and their impact on time to return-to-play. Methods Retrospective evaluation of injury data gathered from a German youth soccer academy in the years 2009–2018. In total, 4326 injury cases in 612 players were included in the study. The diagnosis and the follow-up visits were carried out in a weekly consultation hour at the youth academy. Results During the observation period of 10 years, 22 cases of calcaneal apophysitis were detected. The incidence of calcaneal apophysitis per 100 athletes per year was found to be 0.36. The mean age of the affected athletes at the time of diagnosis was 11.8 ± 2.1 years (MW ± SD). The complaints were unilateral in 20 and bilateral in two cases. Three of the 22 detected cases of calcaneal apophysitis (13.6%) were recurrent injuries. The mean time to return-to-play of the affected athletes was 60.7 ± 64.9 days (MW ± SD). Athletes with recurrent complaints showed longer recovery time and time to return-to-play when compared to players with primary diagnosed disease. Our results could show that neither age nor body mass index at the time of diagnosis had an impact on time to return-to-play. Conclusions This is the first study investigating the incidence of calcaneal apophysitis and the associated time to return-to-play in youth elite soccer. Calcaneal apophysitis results in substantial time loss for the athletes. Further prospective clinical studies are required to fully understand the etiology and risk factors for calcaneal apophysitis and therefore develop preventive strategies.

Background/Aim. Determining the value of Gissane’s angle (GA) plays a role in the diagnosis and prognosis of heel fractures, determining treatment methods, and assessing the outcome of surgical treatment. Normal values of the GA vary in relation to ethnicity, age, and gender of the examined group, which indicates its anthropometric significance. The aim of this study was to determine the range of normal GA values in the population of Central Serbia. Methods. GA was determined on lateral radiography of the foot of 145 subjects of both sexes (67 women and 78 men), with subjects divided into 6 age groups. The patients included in the study did not have a calcaneus fracture. The obtained results were processed in the Graph Pad program. Results. The average value of GA in Central Serbia was 110.8° ± 8.1°, ranging from 93° to 132.9°. The mean value of GA decreased with age, and no difference was observed between women and men, except in the youngest age group, where women had higher GA values than men. Conclusion. The results of the study showed a wide range of normal GA values, as well as the existence of a difference in subjects of different ages and sex.

Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.

The utilization of wind-assisted propulsion technology could reduce ship fuel consumption and emission of pollutants. In the study, the effect of steady heel angles on the aerodynamic characteristics of wing sails was investigated. Full-scale three-dimensional simulations with the ship's superstructure were conducted at heel angles of 0°–15° in all apparent wind directions. The correctness of the numerical computations is verified by comparing them with the wind tunnel experimental data. Overall, the heel is detrimental to the capture of wind energy by the wing sails. The aerodynamic forces of the sail system decrease with increasing heel angles. Specifically, the average thrust performance is attenuated by 4.7%, 13.5% and 20.5%, respectively, at heel angles of 5°, 10°, and 15° compared to the upright condition. Due to changes in the airflow distribution around the sails, the aerodynamic force of sails in heeled to windward and heeled to leeward decreases by the reduced area of the low-pressure zone on the suction side and the high-pressure zone on the pressure side, respectively. Finally, a prediction scheme for assessing the effect of rolling motion on sail performance is proposed by steady heel results. • The effect of the heel on the aerodynamic performance of wing sails is determined. • The aerodynamic forces of the sail system decrease with increasing heel angles. • Thrust performance reduction of the sail system up to 20.5% at a 15° heel angle. • Pressure distribution variations on both sides lead to sail performance reduction. [ABSTRACT FROM AUTHOR]

Gait disturbances in Parkinson's disease are commonly refractory to current treatment options and majorly impair patient's quality of life. Auditory cues facilitate gait and prevent motor blocks. We investigated how neural dynamics in the human subthalamic nucleus of Parkinsons's disease patients (14 male, 2 female) vary during stepping and whether rhythmic auditory cues enhance the observed modulation. Oscillations in the beta band were suppressed after ipsilateral heel strikes, when the contralateral foot had to be raised, and reappeared after contralateral heel strikes, when the contralateral foot rested on the floor. The timing of this 20-30 Hz beta modulation was clearly distinct between the left and right subthalamic nucleus, and was alternating within each stepping cycle. This modulation was similar, whether stepping movements were made while sitting, standing, or during gait, confirming the utility of the stepping in place paradigm. During stepping in place, beta modulation increased with auditory cues that assisted patients in timing their steps more regularly. Our results suggest a link between the degree of power modulation within high beta frequency bands and stepping performance. These findings raise the possibility that alternating deep brain stimulation patterns may be superior to constant stimulation for improving parkinsonian gait.SIGNIFICANCE STATEMENT Gait disturbances in Parkinson's disease majorly reduce patients' quality of life and are often refractory to current treatment options. We investigated how neural activity in the subthalamic nucleus of patients who received deep brain stimulation surgery covaries with the stepping cycle. 20-30 Hz beta activity was modulated relative to each step, alternating between the left and right STN. The stepping performance of patients improved when auditory cues were provided, which went along with enhanced beta modulation. This raises the possibility that alternating stimulation patterns may also enhance beta modulation and may be more beneficial for gait control than continuous stimulation, which needs to be tested in future studies.

Bo Feng,&ast; Guang-Ming Dai,&ast; Yong-Jun Wang, Lan Zhang, Ke-Cheng Niu Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bo Feng Tel +86 13347173738Email femgbo@aliyun.comObjective: To summarize the clinical application effects of three different types of flaps for repairing soft tissue defects of the heel, and to discuss the importance of tissue repair and heel reconstruction.Methods: A total of 46 cases with skin tissue defects of the heel with deep tissue exposure were treated. The reasons for the defect were trauma (n = 26), burns and electric shocks (n = 12), chronic ulcers (n = 2), postoperative infection of the calcaneus and Achilles tendon (n = 5), and tumor resection (n = 1). The scope of wound defect was 2.0× 2.5 to approximately 15.0× 20.0 cm. The flaps used were medial plantar island flaps (n = 9), distal pedicled sural neurovascular island flaps (n = 23), and free anterolateral thigh (perforator) flaps (n = 14). The flap cutting range was 3.0× 3.5 to approximately 16.0× 22.0 cm.Results: After surgery, all 46 flaps survived. In two cases, patients experienced partial epidermal necrosis at the distal end of the flap that healed after local dressing exchange, and after this treatment, the complete skin grafts survived. Follow-up was conducted in 40 cases, with an average follow-up duration of 8.2 months (3– 44 months) and the two-point discrimination of 5– 14 mm. The average American Orthopaedic Foot and Ankle Society scale was 89.2 points with good flap color and texture, satisfactory appearance, and normal gait.Conclusion: The repair method should be selected according to the“ 5-zone method”: The plantar medial island flap is suitable for small area (< 5 cm) of medial, posterior and plantar defects. The distal pedicled sural neurovascular flap is suitable for lateral, posterior, and medium-range (6– 10 cm) joint area defects. The free anterolateral thigh perforator flap is suitable for large-scale (> 10 cm) joint area defects.Keywords: surgical flap, heel, functional reconstruction

Cases: Two women presented with newly growing callosities beneath the first and second metatarsal heads, initially believed to reflect gastrocnemius tightness and plantar plate pathology. In another man, swelling at the posterolateral aspect of the heel was mistaken for a Haglund deformity. Subsequent imaging of each patient led to delayed diagnosis of extraskeletal osteochondroma (ESO). Surgical excision resolved symptoms in all 3 with no recurrence over 12 months later. Conclusions: Whenever bony prominences newly develop in soft tissues of the foot, ESO should be suspected and appropriate imaging obtained. We describe physical features to help differentiate ESO from other common causes of foot overload. [ABSTRACT FROM AUTHOR]

Plantar heel pain (PHP), or plantar fasciopathy, is a common condition in active and sedentary populations, contributing to short- and long-term reductions in quality of life. The condition's aetiology and pathophysiology are the subjects of a significant body of research. However, much of this research has been conducted with sedentary participants, and comparatively little research exists in a population of highly-trained athletes focused on performance outcomes. Models for PHP and proposed mechanisms, such as high body mass index or systemic disease, are mostly absent from an athletic population. Even less is known about the origins of pain in PHP. Pain is believed to be a complex multifactorial process and may be experienced differently by sedentary and highly active populations, particularly endurance athletes. Consequently, conservative through to surgical treatment for athletes is informed by literature for a different population, potentially hindering treatment outcomes. The aim of this review, therefore, is to summarise what is known about PHP in athletic populations and propose potential directions for future research. Embase, PubMed, and Scopus using MeSH search terms for PHP and competitive sport and common synonyms. Two explanatory models for PHP were found. These primarily propose mechanical factors for PHP. It remains unclear how gait, body composition, and psychological factors may differ in an athletic population with and without PHP. Therefore, research in these three areas is needed to inform clinical and training interventions for this population. [ABSTRACT FROM AUTHOR]

Hawley, VS, Gurchiek, RD, and van Werkhoven, H. Can foot anthropometry predict vertical jump performance? J Strength Cond Res 36(7): 1860–1865, 2022—Vertical jumping is an important element of many sporting activities, and whether anthropometric adaptations can predict jumping performance is of interest. Few studies have specifically considered anthropometric measures of the foot and its link to performance. Furthermore, previous studies have mainly focused on a male subject pool, and whether relationships are consistent across sexes is unclear. The purpose of this study was to investigate relationships between common anthropometric measures, as well as specific foot measures, and jump performance in men and women. Anthropometric measures of 21 men (age: 22.0 ± 1.5 years; stature: 181.4 ± 6.3 cm; body mass: 85.6 ± 9.4 kg) and 21 women (age: 21.2 ± 1.8 years; stature: 166.1 ± 7.5 cm; body mass: 61.4 ± 11.4 kg) were taken before performing 3 maximal countermovement jumps (CMJs). Correlational analysis was used to determine relationships between anthropometric measures and CMJ height (a priori significance set at p ≤ 0.05, effect size: small >0.1; medium >0.3; large >0.5). There was no significant correlation between anthropometric variables and CMJ height for men, whereas for women, mass (r = −0.585, p = 0.005, large effect), foot length (r = −0.533, p = 0.013, large effect), and toe length (r = −0.604, p = 0.004, large effect) showed significant negative correlations with CMJ height. The unexpected result that smaller feet and toes predicted higher jumps for women warrants further investigation. Furthermore, these results highlight the need to incorporate diverse subject pools, and a need for caution when generalizing across sexes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Type 2 diabetes mellitus is a chronic condition that affects approximately 422 million people worldwide. This disease causes important complications such as peripheral neuropathy, that is characterized by the progressive loss of nerve fibers that predisposes patients to burning sensations, paresthesia or numb limbs. Traumatic subcorneal hemorrhage or black heel is an uncommon dermatosis related to the deposit of blood within the stratum corneum secondary to trauma. It affects acral skin and is characterized by brown-black or blue-black spots, which form a patch of dark pigment on keratotic skin. It is an asymptomatic dermatosis of chronic course and selfresolving when the risk factor is suspended. The diagnosis is suspected by observing the pigment and the distribution pattern by dermoscopy; it is confirmed by scraping the lesion with complete resolution and excellent prognosis. Its main differential diagnosis is acral melanoma. CLINICAL CASE: A 62-year-old female patient with medical history of type 2 diabetes, who consulted for a black pigmented, keratotic plaque, with an ulcer in the lower third. She was clinically diagnosed with acral melanoma. Histopathology study reported traumatic subcorneal hemorrhage. CONCLUSIONS: Traumatic subcorneal hemorrhage might be confused with acral melanoma since this dermatosis can occur secondary to diabetic peripheral neuropathy and patients do not report previous trauma. [ABSTRACT FROM AUTHOR]